of People Haitian Heritage
Overview, Inhabited Localities, Topography
Macro Aspects of Model
Global society
Poverty Political, social violence Death squads Voodoo
Macro Aspects of Model
Community Family Person Health
Overview
Encountered by Columbus, 1492 First independent Caribbean nation 1/3 island of Hispaniola, 2nd largest island in Caribbean, 9 departments, size of Maryland New government in 2006, all new municipal officials, new deputies, senator, presidency ~ 9 million Life expectancy 55 years
Overview
Largest population in capital of Port-auPrince, (2 million, 21%). 64% rural, 15% other urban areas 40% under age 15, 5% over 65 In-migration to urban areas, outmigration to Dominican Republic & other countries 2/3 s formal jobs Rugged mountains c small coastal plains, river valleys, eastern elevated
Overview
Many is US undocumented, 1.5 million, esp NYC, Boston, Chicago, California, Florida Very diverse, urban, rural, varied SES
Heritage and Residence
Arawak & Caribe Indians c much intermarriage Europeans, dominantly French, 1697 Africans as slaves, 500,000 in 1791 Sharp class stratifications, color consciousness, lighter the better > European features
Heritage and Residence
Slave revolt in 1791 independence from France in 1804 Deposed French land owners, ruled by military generals, frequent unsuccessful peasant rebellions Proud of black heritage & government Mullato upper class, creole mostly black Growing middle class
Migration and Economics
Emigration more common among upper class Education Occupied by US in 1920m many migrated to Harlem 1950s poor agriculture urban, slums Political asylum Undocumented, boat people
Migration and Economics
Most businesses government owned Informal economy prosperous
Educational Status and Occupations
Modeled on French system In accord with Roman Catholic Church Shifted education to Catholic missionaries Emphasized French language Elite European vs impoverished African Value but only 15% get formal ed
Educational Status and Occupations
Free primary, secondary, emphasizes arts & humanities & not technical/ vocational If $, go to private schools Get certificate after rigorous test, diploma after more testing Announces on radio Need influence to get into universities Lieracy 52.8%
Educational Status and Occupations
In Us, women work in hospitals, hotes, service industries, nursing assistants, Men work as laborers, factory helpers
Communication
Dominant Language & Dialects
Two official languages: French, educated, elite (15%), Creole (100%) Creole c oral tradition
Cultural Communication Patterns
Oral tradition Expressive c emotions Loud animated speech, much touch Affectionate, polite, shy Hide lack of knowledge c smiling, nodding Use professional translators Close personal space among intimates
Cultural Communication Patterns
Traditional & children avoid eye contact c authorities Modern maintain eye contact Informal kiss/embrace; Formal handshake Children greet by kissing on cheek Auntie or uncle used for adult friends out of respect not kinship
Temporal Relationships
Past lays historical frame Present to be cherished Future Gods direction, fatalistic, serene Si Bondye Vle Flexibility c time, non-punctual In US, better c bsn appts, send reminders or calls of appts
Format for Names
First, middle, last Affectionate names given @ birth Changes c marriage Formal, use titles
Family Roles and Organization
Head of Household and Gender Roles
Traditionally, father as head, distant c authority, income provider Practically, mother functions as head, joint decision making, Father, income producers, governance, rules, machismo, sexual initiators women faithful, hones, respectable In US , women less subservient possible domestic violence
Prescriptive, Restrictive & Taboo Behaviors for Children & Adolescents
Value children, expect high achievement Respectful to parents, adults, no anger expressed Physical punishment may be considered child abuse in US, not seek healthcare if bruises evident, educate on US customs and laws Children conflicted by US vs Haitain styles
Prescriptive, Restrictive & Taboo Behaviors for Children & Adolescents
Haitian parents cleanse childrens bowels in summer c laxatives, enemas, & mixtures of tea leaves, juice, sugarcane syrup, oil More indulgent of boys, more freedom, outside initiatiation Girls- marriage, respectability, always escorted, hard in US
Family Goals and Priorities
Family connectedness, use family councils c extended family Nuclear, consanguine, affinal members Family reputation impt. HCPs need to include family, systems for accomodating visitors Elderly live c family (nursing homes not in Haiti), serve roles of advisers, babysitters, historians, consultants, use titles of affection even if not
Alternative Lifestyles
*Taboo closeted, denied, no gay bars *Divorce common *Single parenting well-accepted, concubinage, sex ed critical
Workforce Issues
Culture in the Workplace
In Us, strong motivation to work, entrepeneurism Start in lower echelon & then move up once learn English Send $ to Haiti
Autonomy
If uneducated, work in high-risk environments Educated in chosen professions Settle in small ethnic enclaves RNs - diploma programs c apprenticeship, one BSN program US licensure hard due to English format, multiple choice format, Talk to colleagues in French or Creole
Biocultural Ecology
Skin Color & Biological Variations
Range of skin colors Assess for jaundice, cyanosis different in dark skin
Diseases & Health Conditions
Tropical diseases
Cholera Parasitosis Malaria
Tuberculosis Hypertension-diet , high in fat, cholesterol, salt HIV/AIDS
Diseases & Health Conditions
Diabetes Type I, Type II, Type III malnutrition related (Tropical diabetes) CVD CA- cervical (40%), breast (30%), nasopharyngeal 10-15%) ADHA genetics, concept doesnt translate well, Tx c discipline, voodoo, leery of ADHD meds as leading to substance abuse
Variations in Drug Metabolism
In studies classified as African American so no specific data known.
High-Risk Behaviors
High-Risk Behaviors
- Most at-risk refugees in US - HCPs must explain Tx while acknowledging but not changing cultural beliefs - View US high risk behaviors as trivial - ETOH culturally o.k. for men, social drinking - Smoking o.k. for men, very low in women
High-Risk Behaviors
- AIDS, first known as 4H disease, i.e. Haitian, heroin user, homosexual, hemophiliac - Stigma of AIDS in Haiti, contact heterosexual - Non-use of seat belts, helmets
Health Care Practices
Balance of hot and cold
Eat well Personal hygiene Prayer Spiritual habits
Health Promotion
Be strong, have good color, be plump, be free of pain
Health Care Practices
Folk medicine & Folk healers
Voodoo practitioner Lay midwife Bonesetter Injectionist
Nutrition
Meaning of Food
Survival Little eating out or fast food In hospital, may prefer to fast rather than eat non-Haitian food Avoid yogurt, cottage cheese, runny egg yolk
Common Foods and Food Rituals
Breakfast bread, butter, bananas, coffee Lunch largest meal, rice & beans, plantains, salad, vegetables, beef., polenta
Dietary Practices for Health Promotion
Hot/cold, acid/nonacid, heavy/light Balance Avoid some re: health Heavy at lunch Light at dinner Health conditions classified as hot or cold, Tx c opposite Use tonics, high-calorie supplements
Nutritional Deficiencies and Food Limitations
Protein deprivation in rural areas in women & children, more meat to men Food insecurities Short birth intervals Chronic malnutrition Anemia ( 35-50%) low birth weight (10-15%) Low BMI (18%), > maternal mortality
Pregnancy & Childbearing Practices
Fertility & Pregnancy Views
Catholic reticence to discuss birth control, abortion Abortion womens issue, couples decision Contraception- (3%) each
Birth control pills Female sterilization Injections Condoms
Fertility & Pregnancy Views
Pregnancy not health problem prenatal care, time of joy Avoid spices Eat for two, use spit cup High maternal death rate due to:
Lack of prenatal care Obstructed labor Toxemia Hemorrhage
little
Predominantly home births
Prescriptive, Restrictive, & Taboo Practices
Active during labor, walks, squats Natural childbirth s analgesia Caring activities, fathers not involved Fear C-sections Dresses warmly in post-partum, bed rest for 3 days to allow bones to close, abd. Binder to close bones
Prescriptive, Restrictive, & Taboo Practices
3 baths, hot water c special leaves x 3 days, sun warmed leaves x 3 days, vapor bath c orange leaves, at 3 weeks, cold bath c cathartic Avoid white foods, okra, mushrooms, tomatoes Special foods to rebuild the blood
Prescriptive, Restrictive, & Taboo Practices
Breast feeding > 9 months, too thin, too thick Laxative to newborn to expel meconium
Death Rituals
Rituals & Expectations
Prefer to die at home In hosp., visitors may pray, cry, be hysterical
Medallions, saints, fetishes
Prayer service of family @ bedside of deceased Involve family in postmortem care
Entire family involvement Male kinsman c English makes arrangements & notifies relatives worldwide Veye gathering of family & friends @ home preburial 7 days of prayers ending in special mass
Responses to Death & Grief
No cremation Cautious re: autopsies Zombies
Responses to Death & Grief
Spirituality
Dominant Religion & Use of Prayer
*Catholicism *Protestantism *Voodooism communication by trance with ancestors, saints, animistic deities
Meaning of Life & Individual Sources of Strength
*Family is central system
Spiritual Beliefs and HealthCare Practices
Voodoo attributes to evil spirits, confirm c loa
Health-Care Practices
Health-Seeking Beliefs and Behaviors
*Illness viewed as punishment, assault on body, either natural or supernatural causes *4 stages to illness Gas pain, anemia; dispel gas c garlic, clove, mint tea, plantain, corn; avoid leftovers, abd binder to keep gas out
Responsibility for Health Care
Self-Tx, home remedies 1st Meds available s Rx, use meds prescribed for someone else
Folk & Traditional Practices
*Compare their sx to others when deciding how & if to treat *Send meds from Haiti to US
Barriers
*Delay in seeking care *If believe they have magical illness, not seek Western healthcare *HCPs need to understand basic elements of root medicine *No health insurance *Language barriers
Cultural Responses to Health and Illness
*Root-work system *Dx natural vs magical *Imbalance in harmony between spiritual & physical worlds *Fright bad news, scare disrupts blood flow HAs, loss of vision, > BP, stroke
Tx by cold compresses, bitter tea, coffee c rum
Cultural Responses to Health and Illness
*Depression unnatural illness, stigma of mental illness *Hex, curse, spell *HCPs must understand unnatural illnesses so as not to misdx as mental illness
Blood Transfusions, Organ Donation
Fear blood-need situations, concern re: HIV *Body to remain intact after death, therefore no organ donation *Dont want to receive organ since donors personality may invade their body
Activities of Daily Living
Modesty - both genders very, offer
pajamas to men or bring from home, Male MDs, female RNs, will accept care from male RNS
Skin Care daily a.m. shower, peri-care in
p.m. c soap & water, >SES use lotion
Hair Care women shampoo weekly, nightly
rollers, oil-based pomades, men shampoo daily
Nail Care short, unpolished, if >SES,
manicures & pedicures
Toileting prefer BR, if family present,
bedpans & urinals, pericare after BMs, provide pitcher in BR
Special clothing or amulets Catholics c
religious medallions, rosaries, icons, saints same in voodoo, usually in room for protection, do not remove s permission
Self-care family helps, afraid to move post
op, need encourage to cough, turn, deepbreathe
Symptom Management
Symptom Management
Pain doule, < pain threshold, demeanor
changes, verbal, moan, vague on location, prefers injections, then elixir, tablets, capsules, alternative med o.k.
Dyspnea oppression, asthma, anxiety
c hyperventilation, cold state, O2 means serious disease
Symptom Management
NV dispose of immediately C/D laxative, herbal teas, enemas, very
dangerous in children, may be seen as hex, wary of strangers offering food to child
Symptom Management
Fatigue febles, anemia, insufficient
blood, poor diet, Tx c iron rich foods
Depression stigma re mental illness
not reporting sx, possession by malevolent spirit, punishment for not honoring protective spirits, hex by jealous, get priest, will use meds
Symptom Management
Self-care Self-dx & tell HCP what they have rather than tell sx, use home remedies first
Health-Care Practitioners
Sx management Self-care Spiritual & western med used simultaneously
Traditional vs. Biomedical Practitioners
Status of Health-Care Providers
*Respectful of MDs, RNs *Refer to RNs as Miss *HCPs need to expend effort to educate re: US system