Each year, four million Americans travel abroad as participants in short-term missions (STMs), the religious branch of the billion-dollar volunteer-tourism industry. Rooted in 13 months of multi-sited ethnographic research, this dissertation examines evangelical STMs in the Dominican Republic as vehicles for evangelization and voluntarism in the contexts of postcolonial tourism and the production of sugar for the global market. In doing so, it also examines STMs as important sites of religious socialization for American participants, particularly, socialization of moral ideologies. These moral ideologies, expressed and performed through the discursive practices, religious rituals, and routinized cross-cultural interactions that are characteristic of STMs, (re)create and justify unequal power relations between Americans and Dominicans. STMs expose American volunteers to striking socioeconomic and racial inequalities, which could powerfully (re)shape their worldviews by raising their awareness, for example, of the exploitative working and living conditions behind a ubiquitous commodity, sugar. However, STM leaders and volunteers conceptualize these inequalities in ways that are inconsistent or contradictory, disconnected from their understandings of inequality back home, and decontextualized from broader processes and systems, including colonialism and contemporary global capitalism. The personal narratives and the religious and economic discourses that are (re)produced during STMs shape American participants’ understandings of inequalities and cultivate a moral subjectivity in which they are divinely charged with the responsibility of ameliorating others’ poverty, lack of social welfare, and poor living conditions. STM discourses and practices thus legitimize forms of charitable giving that may actually contribute to poverty and inequality by concealing Americans’ pre-existing socioeconomic relations with Dominicans. Amid heightened efforts to dismantle social welfare in the US, it is increasingly important to deconstruct ideologies and practices of giving in order to understand why evangelical Christians prefer charity, which provides only partial and temporary relief at best, over other methods that could provide more sustainable and transformative solutions to poverty and inequality. The research presented in this dissertation reveals that, despite what participants believe to be their moral intentions and good works, STMs work in various ways to perpetuate inequalities between sending and receiving countries. / Anthropology

The work presented aims to show the complexity, causes, and challenges of being stateless in the Dominican Republic through the medium of documentaries. This thesis will also uncoverpossibilities of resistance and coalitional engagement. To do so, I align myself with a decolonial feminist approach, which is a way of searching for alternative ways of being, doing, sensing, knowing, and loving for resistance, change, and a different future. This approach opens the possibility to understand statelessness within the triad of modernity/coloniality/decoloniality and to move beyond the Eurocentric inventions of human rights, the concept of citizenship, and the figure of the 'citizen'. Decolonial feminism also grapples with the problem of victimization and gives us a possibility to see stateless Dominicans of Haitian descent both as an oppressed and resistant community. In a phenomenological sense, the documentaries Stateless by Michèle Stephenson (2020) and Our Lives in Transit by Sofia Olins (2015), are used in this thesis to explain and explore the lived conditions of being stateless Dominicans of Haitian descent in the Dominican Republic. I am conscious that film studies and particularly documentary filmmaking are colonized spaces and tools of modernity to spread the white / Anglo male gaze through the films' very impact on our senses and perception. For this reason, the work presented delinks from traditional methodologies which are often taken for granted in social sciences and migration studies. I aim to achieve this goal by practicing decolonial feminism as a theory and methodological guide for this thesis. Consequently, this thesis is a bridge-making process and an exploration of methodologies to grasp the complex reality in the Dominican Republic by practicing this work as a researcher, an audience, and a resister. Through the inspiring work of black feminists, decolonial and Caribbean scholars, but most importantly the lived experiences and voices of stateless Dominicans of Haitian descent, I intend to argue statelessness as amodern form of genocide to explain its root causes and persistence. Then, I will support this argument by bridging the links between statelessness and the coloniality of gender. Lastly, the different "world"-traveling experiences of directors Michèle Stephenson and Sofia Olins will deepen the discussion around possibilities of resistance to ongoing modes of subjugation through decolonial feminism.

In the past, many measures have been taken in the Dominican Republic to address the functional outcomes of a school-aged child with a disability. However, none of these measures have explored or addressed function within context. Under the current paradigm used in the Dominican Republic, similar to the medical model, provision of therapy services in the Dominican Republic would be designed to remain outside of the educational context. The Centro de Atencion Integral Para la Discapacidad (CAID), a government initiative set by the first lady of the Dominican Republic and the Dominican Association of Rehabilitation (ADR), a pioneer non-profit organization, are the first organizations to offer comprehensive rehabilitative services and treatment for children with disabilities. The services delivery model used in the ADR removes the child from their natural school environment (M. Paniaguas, personal communication, July 17, 2014). This is further impacted by a lack of professional training to enable practitioners to treat children in context (M. Paniaguas, personal communication, July 17, 2014), making occupational therapy service provision (or any other related service) in schools virtually non-existent (M. Paniaguas, personal communication, July 17, 2014). Educational inclusion is presented as a goal. The availability of continuing professional education is presented as a solution to the problem. Many factors affecting the implementation of inclusion in developing countries are explored. The recommendation is given for a training/certificate program focused on the inclusion framework. The design is developed and catered to aid in enabling occupational therapists in the DR with skillsets in three major areas: standardized evaluations, service delivery, and ongoing staff development and training. Recommendations are to deliver the program through three one-week courses. The theory is that post-professional training closes gaps in the pediatric care of the Dominican Republic and shifts how occupational therapy services are delivered by Dominican occupational therapists in the Dominican Republic.

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The Dominican Republic (DR) and Haiti are two Caribbean countries that share the same island, Hispaniola, and a tumultuous history. Both countries' historical relationship is ridden with geopolitical conflict stemming from the DR creating an unwelcoming environment for Haitian immigrants. This dissertation is a interdisciplinary study that investigates how Dominican thinkers play a significant role in creating the intellectual impetus that encourages anti-Haitian sentiment throughout Dominican society in the aftermath of the 2010 earthquake. In this dissertation I examine how Dominican anti-Haitian ideals, as delineated by Dominican nationalist intellectuals, that I refer to as Defensive Dominican Nationalists (DDN), continue to resonate amongst "everyday" Dominicans and within the recently amended 2010 Dominican constitution that denies citizenship to Dominicans of Haitian descent in the aftermath of the earthquake. I conclude that although the new constitution reinforces the anti-Haitian ideals espoused by conservative Dominican elite thinkers, "everyday" Dominicans, in the post 2010 earthquake timeframe, rejected some of the DDN's beliefs concerning the true definition of Dominican-ness and how the Dominican government had recently amended its constitution. My methodology, consists of literary analysis, a survey, and focus group interviews conducted on both Dominicans and Haitians residing in the DR. Unexpectedly, I found that documented Haitians and second generation Dominicans of Haitian descent actually oppose the new influx of Haitian immigrants adopting some of the anti-Haitian attitudes of the DDN. In essence, this dissertation diagnoses a racial problem emanating from geopolitical conflict and the tumultuous history between Dominican and Haitian society. / African American Studies

Osteopathic Manipulative Treatment (OMT) has been used for more than 100 years to enhance the physiologic process of labor and delivery by normalizing pelvic structures and providing adequate blood supply to the uterus. Since maternal morbidity and mortality is a major health concern for developing countries, it was desirable to explore the benefits of OMT. After IRB approval by the Virginia College of Osteopathic Medicine and Virginia Tech, the research was conducted in Santo Domingo, Dominican Republic at Hospital Maternidad Nuestra Señora de la Altagracia to determine the relationship of OMT during labor and delivery on rates of cesarean section and perineal lacerations/ episiotomies. Qualifying candidates received the next sequentially numbered envelope with a randomized number assigning her to either the treatment or control group. Staff physicians at the hospital provided care to women in the control group according to their standard protocol. Four Osteopathic Physicians and one pre-doctoral OMM fellow performed OMT on women during the first and second stages of labor and performed their deliveries. There were 33 parturients in the OMT Treatment group and 32 in the control, for a total of 65 in the trial. The results of a logistic regression analysis using Wald criterion, with a statistical significance of alpha = 0.05, indicated treatment group reduction of rates of episiotomies in the primiparous (P = .04) and marginal significance in the combined primiparous and multiparous population (P = .05). The percentage of episiotomies in the primiparous treatment group was 35.29% and 75% in the control group. The percentage of episiotomies in the combined primiparous and multiparous groups were 15.15% in the treatment group and 37.5% in the control group. The cesarean rate for the treatment group was 9.09% and 18.75% for the control group (P = 0.098). The percentages of grade I & II perineal lacerations were 15.15% for the treatment group and 12.5% for the control group (P = 0.55) due to the extensive use of episiotomies in the control group. There were composite calculations made of the total number of parturients who had either a cesarean section, an episiotomy, or a perineal laceration so that overall maternal morbidity in each group could be compared. In the combined groups, there were fourteen total parturients (42.42%) who had undergone one of the three outcomes measures in the treatment group and twenty-one (65.63%) in the control group. This brings an odds ratio of 0.200 and a significant P value of 0.0235. Though cross-cultural issues made it difficult to perform the research as originally intended, there is evidence that Osteopathic Obstetrics provides benefit to parturients. A multi-institutional randomized controlled trial is proposed as the next step for the evaluation of OMT during labor and delivery. / Ph. D.

Teleradiology has far-reaching implications for the health of remote and underserved populations. With coordination of radiographic evaluation and diagnosis from a distance, teleradiology has the potential to raise the standard of patient care throughout the world. Perhaps the safest and most cost-effective mode of teleradiology today is telesonography. The current research determined that telesonography improves the standard of care at a rural, government-run primary clinic within the Dominican Republic. The work reported herein is intended to compare the use of telesonography to the current standard of sonographic examination which is referral to government hospital 60km from the clinic. the following research questions were addressed: When compared to the standard of care, (1) To what extent does the use of asynchronous telesonography increase the percentage of received sonographic reports based on the total number of ultrasound referrals (sonographic reports / total number of referrals)? (2) To what extent does the use of asynchronous telesonography increase the rate of successful follow-up visits based on the total number of ultrasound referrals? (3) To what extent does the elapsed time between ultrasound referral and sonographic report delivery decrease with the use of asynchronous telesonography? (4) To what extent does the elapsed time between ultrasound referral and patient follow-up decrease with the use of asynchronous telesonography? Research methodology included randomly assigning 100 patients with clinical indications for sonographic examination into experimental and control groups during a 9-week implementation period. Findings from this study indicate that the implemented telesonography system, along with patient awareness of such a system, while not having an appreciable effect on the time to patient follow-up, provided a 4-fold increase in the proportion of patient follow-ups and a 6-fold increase in the proportion of returned radiological reports, and delivered those reports to the referring physician 6-times faster than in the control group. This study demonstrates the feasibility of utilizing a store-and forward telesonography system within this setting. Additional research focusing on the impact of telesonography on patient outcomes within this setting is recommended. / Ph. D.

Background: Selected factors place Dominican female adolescent and adults at risk for sexually transmitted infections (STIs) such as Chlamydia, causative organism Chlamydia trachomatis, and Gonorrhea, causative organism Neisseria gonorrhoeae. The purpose of this study was to determine the prevalence of Chlamydia and Gonorrhea among adolescent and adult females that utilize the clinic in Veron, Dominican Republic. Clinical standards of care for these STIs and educational programs for prevention were developed from the data gathered from this study. Significance at 0.05 ά of the relationship of educational level, management of risk factors and other selected independent variables on prevalence rate of Chlamydia and Gonorrhea in the clinic population of Veron, Dominican Republic were determined. The objectives of the study were to 1) determine the prevalence of adolescent and young adult females diagnosed with Gonorrhea and Chlamydia who visit the clinic for prenatal visits, annual pap smear exams and gynecological complaints; 2) determine the extent to which educational level is a predictor of positive diagnosis or risk for infection of Chlamydia and Gonorrhea and; 3) determine which selected demographic and risk factors are associated with positive test results for Gonorrhea and Chlamydia. Methods: All adolescent and adult females ages 15 years and older visiting the clinic in Veron for prenatal exams, pap smear exams and gynecological complaints between January 28, 2008 – March 3, 2008 were invited to participate in this prevalence study. Of the 90 invited, the accepting sample was 90 who signed an informed consent form. Prior to STI testing each patient completed a verbal interview and questionnaire on sociodemographic characteristics as well as knowledge, attitudes, and beliefs related to Chlamydia and gonorrhea, sexual experiences and behaviors and illicit drugs use. Specimens collected from the endocervical canal of each female were tested and results provided within two hours, followed by immediate treatment by a licensed Dominican physician and follow-up care based on the guidelines and standards of care. The data were analyzed using descriptive statistics, chi square, t-test and logistic regression. Results: A total of ninety women participated in the study. Chlamydia was detected in 6.7% of the patient population and Gonorrhea was detected in 22.2% of the patient population. Co-infection of both Chlamydia and Gonorrhea was present in 2 cases. Among the positive Chlamydia tests results, 50% had less than a six-year education and 50% had more then six years of education. In addition, 83.3% of the patients with positive Chlamydia results answered "yes", they could read and 16.6% stated they could not read, while 83.3% of the patients with positive Chlamydia results stated they could write and 16.6% stated they could not write (P>0.05). Among the patients that tested positive for Gonorrhea, 55% stated they had less than six years of formal education and 45% had more than six years of formal education (P>0.05). There were 75% of the patients that tested positive for Gonorrhea that stated they could read and 25% who stated they could not read (P>0.05); while 85% of the patients with positive Gonorrhea results stated they could write and 15% stated they could not write (P> 0.05). Conclusion: Educational level and other selected demographic characteristics and risk factors in this study are not a significant predictor of positive diagnosis or risk of infection for Chlamydia or Gonorrhea. We cannot conclude that specific risk factors are associated with positive test results for Gonorrhea and Chlamydia. For the physicians involved in the clinical decision-making regarding the female patients at the Veron clinic, more data are needed to determine appropriate populations for screening of Gonorrhea and Chlamydia as well as appropriate educational tools on sexually transmitted infections. / Ph. D.