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Meet Manuel Gonzales: ‘It’s Better to Prevent than to Treat’

Helping is in Dr. Manuel Gonzales’ nature. It’s not just what he does; it’s who he is.

“My vocation is to help people and help my country,” said Gonzales, who became the national manager of the Dominican Republic’s successful Lymphatic Filariasis Elimination Program in April 2001.

Raised in a family of helpers — his father and four of his six brothers became doctors — Gonzales’ character was formed early. His position as the youngest child gave him a guaranteed role.

“I was the little one,” he said. “Even as an adult, whenever my mother needed help with something, she would call me.”

He could have gone into private medicine and made a very comfortable living, but Gonzales chose to go into public health instead. During his medical training at a public hospital, he had noticed that most illnesses he was seeing were affecting many people.

“If you saw one person with a sickness, the next day you might see 20 people with the same thing because they were all being infected from the same source,” he said. “I switched to public health because it’s better to prevent than to treat 20 cases. I made a decision to focus on prevention and elimination. To me, it makes more sense.”

Gonzales devoted decades to public health and became an expert in prevention of lymphatic filariasis, a disease in which tiny worms infect the body’s lymphatic system, triggering “elephantiasis,” an irreversible, extreme, disabling swelling of the extremities.

  • Ani Esther Rapsant, a medicator known to everyone as Lula, discusses drug administration for lymphatic filariasis at a “batey,” or farmworker village, with Dr. Manuel Gonzales of the Dominican Republic’s federal ministry of health. (Photo: The Carter Center)

Together the Dominican Republic and its neighbor on the island of Hispaniola, Haiti, account for approximately 90 percent of the lymphatic filariasis burden in the Americas. In 2008, The Carter Center began supporting a binational effort between the two countries to eliminate lymphatic filariasis and malaria, both mosquito-borne diseases, throughout Hispaniola.

The two countries have a complicated relationship and historically have not cooperated on much of anything. They speak different languages, maintain different cultures, and have sharp economic differences. That’s one reason the Hispaniola Initiative is special: It required an acknowledgement by both countries that the only way either one could hope to eliminate the two diseases was to work together.

The ministries of health in both countries have made significant progress against lymphatic filariasis. While the Dominican Republic is on the brink of eliminating the disease, pockets of transmission remain in Haiti. Thus the incentive to cooperate remains.

“Progress for Haiti is progress for us,” Gonzales said. “I feel a solidarity with them. If they reduce prevalence of lymphatic filariasis, we will reduce prevalence. So we will do what we have to do. If we don’t eliminate lymphatic filariasis across the whole island, we could lose what we’ve gained within three to five years.”

In the Dominican Republic, lymphatic filariasis mainly occurs in rural farming areas, home to generations of migrant workers from Haiti — the poorest, most neglected, and least powerful people there, people whose faith in government benevolence has been sorely tested over decades. Elimination depends on mass drug administration, annual blanketing of communities with a combination of medicines that kill the worms that cause the disease. Working with community leaders to ensure support for elimination efforts, Dominican health agents have to go door to door, explain what they are doing, educate people about the disease, and persuade them to take medicines they may never have heard of before.

“Trust is the most important thing to making anything happen at the community level,” Gonzales said. “If you don’t have the trust of the community, it’s very near to impossible to do anything. They have to believe in the process; if they don’t believe, they won’t participate, or the participation will be poor.”

Gonzales has worked hard to earn that trust. He has built a team of health agents who are sympathetic to these disenfranchised populations living in the vast sugar cane fields, and at times he has even committed his own personal resources to the effort. He doesn’t act like a remote bureaucrat or a phony politician.

“I value the ability to talk with the community, and I always speak the truth,” he said. “If I promise something to someone, no matter who, I try to accomplish my promise.”