Dominica

Dominica is a small country located in the Windward Islands of the Caribbean, between the islands of Guadeloupe and Martinique. Its virtually unspoiled beauty has won it the nickname of “the nature island of the Caribbean.” The island is 289.5 square miles (754 square kilometers) and has eight active volcanoes; 65 percent of the country is covered with rainforest. Dominica is home to the world's second largest “boiling [Page 552]lake,” a fumarole, or opening, in the Earth's crust that allows volcanic gases to heat lake water to almost 200 degrees F. The site was declared a World Heritage Site in 1997.

Dominica's population is 68,900, with a growth rate of minus 0.08 percent annually. The migration rate is minus 9.3 per 1,000, as natives leave in search of work and opportunity. The economy is based on agriculture, particularly the cultivation of bananas. The industry has been in decline since the 1990s, leading to high rates of unemployment. The country's geographical location in the “hurricane belt” leaves it vulnerable to heavy rainfall, flash flooding, and landslides. Volcanic activity and earthquakes are common.

Life expectancy is high, at 72 years for males and 78 years for females. Child mortality is quite low, at 13 deaths per 1,000 for infants under age 1, and 15 deaths per 1,000 for children aged 1–5. Maternal mortality is reported at 67 deaths per 100,000 live births. All births in Dominica are attended by trained personnel, and 100 percent of women receive prenatal care.

Immunization rates for children are high, and all schoolchildren are tested for hearing and vision problems, as well as growth and development issues. Adolescents accounted for 53 percent of attempted suicides reported between 1996 and 1999.

Dengue fever is the most common vector borne disease present in Dominica. Malaria was eradicated in 1962, although there are some sporadic “imported” cases. Gastrointestinal diseases such as E. coli, giardia, and typhoid are frequently reported. There was a single case of leprosy diagnosed in 1998. Mortality is driven by accidents and violence, cardiovascular disease, and cancers. Diabetes is becoming more of a health problem for Dominicans. It is the second leading cause of hospital and clinic visits and the fourth leading cause of death in adults. In 2000, there were an estimated 3,000 cases of diabetes on the island. Dominica is almost free of HIV/AIDS, with only 69 cases confirmed in 2002. There are no known tuber-culosis/HIV co-infections.

The Dominica healthcare system is small, with 38 doctors and 317 nurses reported in 1997. Per capita government expenditures on health are $151 annually, although citizens generally pay 100 percent of medical expenses out of pocket. The Ministry of Health monitors seven health districts, including general hospitals and community-based clinics. The government has been active in developing programs for specific populations in need, particularly children and the elderly.