Thousands of mothers die each year from preventable pregnancy-related causes in the Dominican Republic. The country's maternal mortality rate of 110 per 100,000 live births is among the highest in the Western Hemisphere.

Of equal concern to health officials are the high numbers of children who die needlessly from treatable illnesses during their first year of life. Estimates provided by the Latin American Demographic Center and the Economic Commission for Latin America and the Caribbean project a rate of 33.6 infant deaths per 1,000 lives births for the period of 1995-2000. While public health authorities concede that this number represents a significant reduction from the previous five-year period (47 per 1,000), it nonetheless falls short of the hoped-for target of 25 per 1,000 set for the end of the year 2000.

Improving the chances for survival of mothers and their children has been the number-one priority of the Dominican Health Secretariat since 1997. It was then that health officials launched the "National Mobi-lization to Reduce Infant and Maternal Mortality" initiative, with the goal of increasing access to health care and im-proving the quality of health services for this group. At the same time, the Secre-tariat called on the active participation of community organizations throughout the nation to help address this health issue.

One of the first steps came from the Dominican Scout Association, which now includes health training to reinforce the organization's goal of instilling the development of leadership skills, a sense of individual responsibility, and teamwork in its 6,000 members between the ages of 7 and 21. Juventud por la Vida (Youth for Life) was officially launched in January 1998 under the technical supervision of the Dominican Health Secretariat and the Country Office of the Pan American Health Organization (PAHO) in Santo Domingo.

Under the project, Scouts receive training in basic health promotion and protection techniques, then fan out into poor neighborhoods across the country where maternal and child mortality rates traditionally have been high. Their job is to build working partnerships with community groups, who in turn propose volunteers for the project. Those selected are trained to be Padrinos y Madrinas de Salud, or health sponsors, and are assigned to work one-on-one with mothers whose infants the local health service has deemed may be at high risk of becoming sick or dying due to health conditions present at their birth.

The sponsors, working with the Scouts, visit the mother at least once monthly. During this time, they check on the baby's weight and overall health, provide advice on breast-feeding and maternal nutrition, ensure that the child's vaccination record is up-to-date, instruct the mother in the use of oral rehydration therapy, and educate her about common signs indicating illness, how to care for the child, and when medical intervention is required. Just as importantly, the sponsors provide moral support, listen to the mother's concerns, and offer advice about community services that can assist her.

Scouts and sponsors complete their official tour of duty on the child's first birthday, at which time they organize a community celebration called "Comme-moration of Life." The mother, child, sponsors, Scouts, and other participants receive special recognition for their efforts and are encouraged to share their experiences with others.

"When my daughter was born I was only 15 years old," says Juana Polanco. "I didn't know anything and was afraid I wouldn't be able to take care of her. The Madrina gave me support and taught me confidence and many other things. Today my daughter is a healthy 1-year-old. I wish all young mothers could have this opportunity. Now I want to become a Madrina for another neighborhood child who needs this kind of support."

Dr. Rafael Schiffino, the country's Assistant Secretary of Health and National Health Director, says that "Juventud por la Vida has made a major contribution to our national mobilization efforts," and "clearly demonstrates how community commitment and caring can increase the possibilities of survival for high-risk children."

Dr. José M. Puello, a member of the National Council of Scouts and Juventud coordinator, adds: "This project gives young people a hands-on opportunity to respond to one of our country's most pressing problems today, and the fact that no high-risk newborn enrolled in the proj-ect has died before its first birthday is for us the best reward of all."

More than 1,000 health sponsors have been trained since the project began, and the cities of Baní and San Pedro de Macorís-the latter best known for the number of major league baseball players it has produced-recently joined Juventud's growing ranks.

Much of the project's success and popularity is due to the spirit and enthusiasm of its participants, who, like Germania Martínez, see firsthand the fruits of their labor. "This project has shown me how to be of greatest use to the neighbors who most need my help," she says. "Even though the child I sponsored already has turned 1, I will keep on visiting her, but I've also asked the Scouts to assign me another baby from the neighborhood, so that I can begin working with a new mother, as well." José Nuñez, a Scout who is studying medicine, feels a new dimension has been added to his future plans: "This project has been a great opportunity for me to work closely with communities," he says. "I have discovered so much about the nobility that lies in poor homes and families and see the impact we can have on other people's lives. I think this experience ultimately will help me become a better physician once I finish at the university."

The fact that the Scouts are promoting the same basic message that PAHO has fostered for years-that people can greatly improve their health with simple, low-cost, and highly effective measures-brings great satisfaction to Dr. Socorro Gross, who heads the PAHO Office in Santo Domingo. "We've supported this project from the start," she notes, adding that PAHO's Director, Dr. George A.O. Alleyne, has been especially enthusiastic in his support. "Opportunities like these enable us to show that health promotion and community participation really work, and that simple interventions full of enthusiasm and love can go a long way toward improving everybody's health."

"The Scouts have done a great job," she says, and many others doubtlessly would agree. Yet perhaps their finest achievement lies in having sown the seeds for pride and self-esteem among the country's large youth population and service organizations everywhere.