+1(978)310-4246 credencewriters@gmail.com


Jay and Sue Kim, ages 29 and 26 years and married for 2 years, immigrated from South Korea and settled in Los Angeles. They have lived in a small one-bedroom apartment since their arrival. Both graduated from the same Korean university with baccalaureate degrees in English literature. They have one child, Joseph, age 1 year. When they arrived in the United States, Jay was unable to find a job because of his poor proficiency in English, despite his major in English literature. He eventually obtained a job with a moving company through a church friend. Sue is not working because of their son. Although the Kim’s did not attend a church before immigration, they are now regularly attending a Korean Protestant church in their neighborhood.

Sue is pregnant again, determined by a home pregnancy kit, with their second child and concerned about the medical costs. They did not use any contraceptives because she was breastfeeding. Because of financial limitations, Sue did not initially have prenatal care with her first pregnancy. However, she did keep up with the Korean traditional prenatal practice, tae-kyo. Eventually, she received help from her church and delivered a healthy son. She is not sure whether she can get financial help from her church again but is confident that her second child will be healthy if she follows the Korean traditional prenatal practices.

Jay is concerned about job security because he recently heard from colleagues that the moving company might soon go bankrupt. Although Jay has not been satisfied with his current job (he thinks that he is overqualified), this news is still a cause for concern. Moreover, Sue’s recent pregnancy has made Jay more stressed, and he has started drinking alcohol. Joseph cannot stand up by himself and still wants to be breastfed. Although Sue has tried to give foods such as oranges, apples, steamed rice, and milk (because she is now pregnant), Joseph refuses to eat them and cries for breastfeeding. Joseph’s weight is low-normal for same-age babies.

Describe the Korean cultural practice tae-kyo. Is this practice congruent with allopathic recommendations for prenatal care?

How do food choices among Koreans differ with pregnancy and postpartum?

Describe cultural attitudes toward drinking among Koreans.

Identify two or three culturally congruent strategies a healthcare provider might use to address Jay’s drinking.

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Chapter 15
People of Haitian Heritage
Jessie M. Colin and Ghislaine Paperwalla
*The authors would like to thank Ingrid Parenteau and Sheran Kegerise, graduate students at Barry University, for their
assistance in the literature review and preparation of the manuscript.
Overview, Inhabited Localities,
and Topography
Haiti, located on the island of Hispaniola between
Cuba and Puerto Rico in the Caribbean, shares the island with the Dominican Republic. With a population
of 9.7 million inhabitants, Haiti covers an area of
27,750 square kilometers (10,714 square miles), about
the size of the state of Maryland (CIA World Factbook, 2011).
In 1492, Christopher Columbus landed on the
island and named it Hispaniola, which means “Little
Spain.” Haiti, or Ayti, meaning “land of mountain,”
was given its name by the first inhabitants, the Arawak
and the Caribe Indians. Before 1492, there were five
well-organized kingdoms: the Magua, the Marien, the
Xaragua, the Managua, and the Higuey (Dorestant,
1998). Two-thirds of Haiti contains mountains, great
valleys, and extensive plateaus; small plains mark the
rest of the country.
The capital and largest city, Port-au-Prince, has a
population of over 800,000. Widespread unemployment and underemployment exist; more than twothirds of the labor force do not have formal jobs
owing to the marked decrease in assembly sector jobs.
In addition, Haiti’s economy suffered a severe setback
when a magnitude 7.1 earthquake devastated its capital city, Port-au-Prince, in January 2010. About
80 percent of the population had already lived under the
poverty line, with 57.4 percent living in abject poverty
(CIA World Factbook, 2011). After the earthquake, the
GDP per capita was $1200 (CIA World Factbook, 2011).
Prior to the earthquake, two-thirds of Haitians depended on the agricultural sector, mainly small-scale
subsistence farming, and are still vulnerable to damage
from frequent natural disasters, exacerbated by the
country’s widespread deforestation. U.S. economic engagement under the Haitian Hemispheric Opportunity
through Partnership Encouragement (HOPE) Act,
passed in 2006, has boosted apparel exports investment
by providing tariff-free access to the United States (CIA
World Factbook, 2011).
The infant mortality rate is high, with 54.02 deaths
per 1000 live births; the average life expectancy is
62.17 years (CIA World Factbook, 2011); and in 2008,
only 70 percent of the urban population (50 percent
in rural areas) had access to improved drinking water
sources (WHO, 2010). The World Health Organization (WHO) estimated that prior to the disaster in
2010, diarrheal diseases accounted for 16 percent of
deaths among children less than 3 years of age. In
October 2010, an outbreak of cholera added to the
devastation of the earthquake, killing an additional
3000 people and infecting approximately 130,000
more (BBC News, 2011).
The Haitian population in the United States is not
well documented; this may be because of the U.S.
Census Bureau’s inability to track the large numbers
of undocumented immigrants. According to the 2010
census, over 830,000 Haitians, or 0.3 percent of the
population, live in the United States (U.S. Census
Bureau, 2009). Most of them live in Florida,
New York, Massachusetts, New Jersey, and Connecticut. However, some Haitian leaders and activists
believe that close to 1.5 million Haitians live in the
United States. An additional 122,000 live in Canada,
of which 90 percent live in Quebec (Statistics Canada,
2006). Haitians, like other ethnic groups, are very
diverse. They come from urban and rural Haiti and
represent all socioeconomic classes. Factors affecting
Haitians’ acculturation and assimilation include
variant cultural characteristics (see Chapter 1).
Heritage and Residence
Before the time of Columbus, the various indigenous
tribal groups intermarried. With the arrival of
Europeans, and then Africans, the people of Haiti
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became more diverse. Today, Haitians range from
light- to dark-skinned, and social identity is shaped
by sharp class stratification and color consciousness.
In 1697, Haiti came under French rule. By the end
of the 18th century, the slave population numbered
500,000. In 1791, a slave insurrection broke the chain
of slavery, and on January 1, 1804, Haiti gained its
independence from France. The French plantation
owners were removed and replaced by the generals of
the indigenous Haitian Army, which ruled mercilessly
(Louis-Juste, 1995). Agricultural workers and peasants were trapped in a semifeudal system: They were
exploited by landowners, terrorized by the section
chiefs of police, and forced to obey laws explicitly. The
coffee fields of the peasants served as the primary
source of revenue for the government coffers, thereby
guaranteeing all government debt payments between
1826 and 1932 (Louis-Juste, 1995). These harsh conditions did not prevent the peasants from rising up
against injustice and exploitation, as evidenced by the
Goman uprising in 1820, the Acaau in 1880, and the
peasant movement of Jean Rabel (Louis-Juste, 1995).
Haitian immigrants have a sense of national pride,
including a high level of self-esteem regarding their
blackness, although in both public and private discourse, they may focus on color and class division—
two painful wedges within Haitian society.
Haiti’s independence from France in 1804 did not
resolve the division among the descendants of French
colonists, the African slaves, and the core of the population, who were largely of African descent and culture. Many members of the upper class used the
markers of mulatto (color), the French culture, and
the French language to differentiate themselves from
the lower class, who were mostly black and Creole and
spoke a predominantly African language.
Ti Manno, a Haitian singer who migrated to
New York, used satire and irony to expose and deride
the type of thinking that divides Haitians in Haiti and
abroad. The following lyrics depict the turmoil and
struggle that promote the division within the Haitian
society (Jean-Baptiste, 1985):
The Black Man
Neg Kwens dil pa Kanmarad neg Brooklyn.
Neg Potopwens dil pa anafe ak neg pwovens.
Mon Che se-m nan fe yon ti pitit.
M’rayi ti pitit la
A fos li led.
Li nwa tankou bombon siwo.
Nen-l pa pwenti.
Ti neg mwe ala nou pa gen chans o.
La vi nou toujou red o.
Nou deyo, pi red.
Se neg nwe cont milat o.
Nou deyo nap soufri.
Nou lakay se pi red.
Haitians in Queens feel superior to those who live in
Haitians in Port-au-Prince despise those who live in
the provinces.
My dear, my sister had a little baby.
I hate this little kid.
This baby is ugly.
He is as dark as sugarcane syrup cake.
His nose is not pointy.
We Haitians, we are so unlucky.
Life is always hard for us.
Away from home we suffer more.
It’s black against mulatto.
Abroad we suffer.
At home it is even worse.
Despite independence, colonial prejudices about
skin color have persisted. Internal social rivalries and
the scale of Haitian mobility are tied to a European
color, race, and class model. This model relates to skin
pigmentation, hair texture, the shape of the nose, and
the thickness of the lips. Whereas the structure of
Haitian society continues to be built on a neocolonial
model, relationships based on color are extremely
complex. For example, dark skin color tends to be associated with underprivileged status. Although more
black-skinned people have entered the circle of the
privileged, most blacks are poor, underprivileged, and
Haiti defines itself as a black nation. Therefore, all
Haitians are members of the black race. In Haiti, the
concept of color differs from the concept of race. The
Haitian system has been described as one in which
there are no tight racial categories but in which skin
color and other phenotypic demarcations are significant variables.
In the 1940s, a black middle class emerged in Haiti
and claimed to represent the majority. The development of this class and its rhetoric served as a springboard for Francois Duvalier, a rural physician who
was elected president for a 4-year term in 1957. In
1964, he became president-for-life, using the issue of
black empowerment and a promise to eliminate the
color and class privileges of the mulattos. By the late
1970s, a group of dark-skinned, primarily Americaneducated and English-speaking technocrats had attained positions of prominence and influence in the
government. However, the mulatto retained social
prominence, and color continued to play a major role
in the perception of class in Haiti.
Reasons for Migration and Associated
Economic Factors
Haitian immigration and travel to the United States
have continued for many years. Most, but not all, of
those who emigrated were members of the upper class.
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People of Haitian Heritage
Before 1920, Haitians traveled to North America and
Europe only for educational purposes. In 1920, the
United States occupied Haiti, and the first wave of
Haitian migration to North America soon followed.
Over the next decade, more than 40,000 Haitian peasants were forced to go to Cuba and the Dominican
Republic to cut sugarcane in the bateys (plantations).
Haitian land was taken and used for apple and banana
plantations, and many acres of land throughout Haiti
were controlled by the United States (Haiti: Early
History to Independence, 2007).
The late 1950s showed signs of weakness in Haitian
agriculture. The peasants started leaving the provinces
in search of work and a better life. Migrating to the
capital, Port-au-Prince, they established Lasalin, the
first slum of Port-au-Prince (Aristide, 1995). Today,
over 2 million people live in and around the capital,
many in large slums (CIA World Factbook, 2011).
A significant turning point in Haitian migration
occurred in 1964 when Duvalier declared himself president-for-life. As a result of his government, many
Haitians began fleeing the island. These immigrants
were primarily relatives of politicians who opposed
the political philosophy of Duvalier. When Duvalier
died in 1971, his son, Jean Claude (a.k.a. “Bébé
Doc”), age 19, was appointed president-for-life. In addition, during this era, Haiti was suffering from economic deprivation, which motivated a major exodus
of urbanites and peasants. Because many Haitians
were unable to pay for their transportation, passports,
and visas, some covertly emigrated to the United States
in small sailboats.
From 1980 until recently, Haitian immigrants have
been divided into two groups: those who have arrived
in the United States legally and those who have entered through the underground. An explosion of immigration took place in 1980, in part because of a
short-lived (April to October) change in U.S. immigration policy during the period of the Mariel boat
lift from Cuba. The influx of Cuban refugees required
that a special status be created by the State Department called “Cuban-Haitian entrant: status pending.”
According to Health and Rehabilitation Services,
Haitian refugees were included in this status to prevent the policy from being discriminatory. This group
of immigrants were referred to as boat people, a term
associated with extreme poverty. Today, this term
does not evoke as much negativism, although it
continues as a reminder of a painful emigration period
in Haitian history.
From the 1990s to 2010, political unrest, coups,
and protests occurred. The tides of history were
changing, and Jean-Bertrand Aristide was elected in
the first democratically held election in many years.
The democratic process did not last; in that same
year, a coup d’état on Aristide and a hemisphere-wide
embargo was imposed on Haiti. In 2001, Aristide was
reelected in a flawed election. In February 2004, an
armed rebellion led to the departure of President
Jean-Betrand Aristide; an interim government took
office to organize new elections under the auspices of
the United Nations Stabilization Mission in Haiti
(MINUSTAH). Continued violence and technical
delays prompted repeated postponements, but Haiti
finally did inaugurate a democratically elected president, Réné Preval, and parliament in May of 2006.
Haitian migration took on a new face when the earthquake of January 2010 occurred. Today, more than
1 million people still remain displaced—380,000
being children (Simon, Kleschnitzki, & Shusterman,
2011). Although thousands of Haitians remain in an
immigration holding pattern since before the earthquake, 55,000 Haitians have gained family visas
but continue on waiting lists because of immigrations
quotas (Zissis, 2010). The Dominican Republic
has accepted as many as 50,000 people since the
earthquake (Paravisini, 2010). Since the earthquake,
2500 Haitians have been granted temporary resident
visas or permits allowing them to go to Canada. In
addition 3700 students and temporary workers from
Haiti have been permitted to stay in that country
(Power, 2010). France is home to approximately
80,000 Haitians and allowed for a temporary residence by undocumented Haitians soon after the
disaster in Haiti (McKenzie, 2010).
Prior to the earthquake, more than two-thirds of
the population was living on less than US$2 daily
(PAHO, 2011). Approximately 250,000 people lost
their lives in this catastrophic event, marked as one of
the worst in world history. Roughly 2.8 million people
were affected, and nearly 1.5 million became homeless.
After one year, many countries and organizations, including the Pan American Health Organization
(PAHO) and the World Health Organization (WHO)
launched initiatives to assist Haiti in restructuring and
rebuilding their infrastructure. A Post Disaster Needs
Assessment (PNDA) was initiated on February 18,
2010, by the United Nations, the World Bank (2010),
the European Commission, and the inter-American
Development Bank, at the request of the prime minister of Haiti. This group led other groups in assessing
restructuring needs (PAHO, 2011). Disease, structural
instability, hunger, and an inability to reach all those
outside of the city have been some of the many obstacles after the earthquake (Simon, Kleschnitzki, &
Shusterman, 2011).
A special focus was placed on the 1.5 million people
in IDP (internally displaced person) camps (PAHO,
2011). In late October 2010, there was an outbreak of
cholera that required specific reporting and handling
(PAHO, 2011). Many hospitals were totally destroyed,
and many others were seriously damaged. The disposal of medical waste continues to pose an environmental risk to everyone in Haiti. Haiti has suffered a
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catastrophic tragedy that will take continued support
from many to rebuild.
Educational Status and Occupations
Following Haiti’s independence in 1804, the new rulers
of Haiti began advocating French cultural patterns
and replicating the French value system. A French
model of education was informally adopted and codified in 1860, in accord with the Roman Catholic
Church. This resulted in two major changes: The
Catholic Church became the official church of Haiti,
and Catholic missionaries became responsible for education. The accepted language for communication
was now French. During this era, Creole, the language
of the uneducated, was perceived as inferior. Social
mobility was possible only for French-speaking
Haitians. While the educated elite became acculturated into the European value system, the illiterate
masses tended to perpetuate the traditional values and
customs of their African heritage.
Even though Haitians value education, few are
privileged enough to attain a formal education. The
Haitian school system is based on the French model
and offers free primary and secondary education.
Public schools include those operated and controlled
by religious orders as well as those under the direct
jurisdiction of the Minister of Education. Children
from families with financial means attend private
schools. The educational model emphasizes liberal
arts and humanities rather than technical and vocational studies.
The Haitian educational system continues to emphasize 19th-century values, which promote good
manners, the classics, literature, philosophy, Latin, and
Greek. It deemphasizes the physical and social
sciences. The Haitian educational system is based on
a two-level curriculum. In the first level, the student
receives a certificate of primary education. To receive
this certificate, the student must sit for a rigorous test,
which includes spelling, reading comprehension, composition, Haitian history and geography, general
knowledge, arithmetic, and biology. At this level, the
student can speak, read, and write French at the basic
The next level consists of two parts: The first is
reached after 6 years of secondary education. To receive this diploma, the student must pass examinations in French, English, and Spanish; Haitian
literature and history; mathematics; and sciences such
as physics, chemistry, biology, and botany. Students in
the classical track also take Latin and Greek examinations. A student who has received the first-level certificate should be able to enter the first year of college
in American schools. The second-level baccalaureate
is likened to the first year of college in North America;
the emphasis is on the liberal arts. Again, the student
must pass an examination in all the areas covered in
the first level, plus philosophy. The results of these
national examinations are announced on the radio
over a 2-day period or posted on a board in front of
the school.
Although Haiti has several universities, they are
mainly located in Port-au-Prince. Most of them are
state universities. With proper credentials, anyone can
enter the university system. However, since the early
1980s, only those in positions of influence have been
able to benefit from the state universities. Haitian professionals mirror those of American society; they are
lawyers, physicians, nurses, engineers, educators, electricians, plumbers, and construction workers.
The literacy rate, which means that those age 15
and over can read and write, is 52.9 percent (CIA
World Factbook, 2011). The level of illiteracy continues to be a major concern in Haiti. Since 1940, the
government has conducted several literacy programs.
In 1948, Haiti had its first experience with community
education. This public educational system was based
on the growth model of development, a UNESCO education project, which duplicated experiences in Latin
America (Jean-Bernard, 1983).
Among Haitian immigrants, women work in hotels,
hospitals, and other service industries in domestic and
nursing assistant roles. Men work as laborers and factory helpers. Many more Haitians are in the workforce
today than there were in the early 1980s, although
data for the years 1974 and 1994 from the U.S. Immigration and Naturalization Service (2006) revealed
that a disproportionate number of legal Haitians were
not employed. In addition, when comparing data by
specific groups, a dramatic increase in the number of
Haitians in all work environments is found. Data
about the work structure of undocumented people
are not available because these people technically are
“underground” and do not exist.
In Haiti, most major industries are owned and operated by the government. Unemployment is 66 percent
(CIA World Factbook, 2011). Those who are employed
often work under such poor conditions that they have
become unmotivated and take little pride in their work,
which results in low productivity. In general, Haitians
are entrepreneurial, operating their own shops, marketplaces, or schools. Among these entrepreneurs, the motivation, spirit, and pride in their work are readily
Dominant Language and Dialects
The two official languages in Haiti are French and
Creole. Creole, a rich, expressive language, is spoken
by 100 percent of the population, whereas French is
spoken by 15 percent of the population. Since 1957,
Creole has been the unofficially accepted language in
the internal affairs of the Haitian government, but in
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People of Haitian Heritage
1987, during the Aristide presidency, it was designated
in the Haitian Constitution as one of the official languages. Because Creole is the official language, it is
used for internal communication within the island.
In contemporary society, the Haitian dilemma can
best be understood through this dual-language system.
Language is one of the vehicles used to depersonalize
those of the lower classes. French is the dominant language of the educated and the elite, whereas Creole is
the language of those who are suppressed, the lower
classes. The emphasis on French served as a barrier to
the early social dynamism that permitted Creole to develop and serve as a unifying force among the African
slaves, who came from many different tribes and spoke
different languages. In spite of its suppression in formal education, Creole has inspired a very rich and interesting oral literature comprising songs, proverbs,
and tales. This oral literature is the most significant
aspect of Haitian folklore.
Understanding the language dilemma and the literacy issues assists health-care providers in developing
creative tools for educating Haitians. Some of these
tools may include video programs, audiocassettes, and
radio programs in Creole. Because of the masses of
people who are unable to read, printed literature in
Creole is not a helpful educational tool.
Cultural Communication Patterns
Haiti has an oral culture with a long tradition of
proverbs, jokes, and stories reflecting philosophical
systems. These are used to pass on knowledge, convey
messages, and communicate emotions. For example,
the Creole phrase Pale franse pa di lespri pou sa translates to “To speak French does not mean you are
smart.” Crayon Bon Die pa gin gum (“God’s pencil has
no eraser”) conveys the concept of fatalism. Another
proverb frequently used is Sonje lapli ki leve mayi ou
(“Remember the rain that made your corn grow”),
which means that one must show gratitude to those
who have helped them or done good for them.
Haitians are very expressive with their emotions. By
observing them, one can tell whether they are happy,
sad, or angry. Haitians’ communication patterns include loud, animated speech and touching in the form
of handshakes and taps on the shoulder to define or
reconfirm social and emotional relationships. Pain
and sorrow are very obvious in facial expressions.
Most Haitians are very affectionate, polite, and shy.
Uneducated Haitians generally hide their lack of
knowledge to non-Haitians by keeping to themselves,
avoiding conflict, and, sometimes, projecting a timid
air or attitude. They smile frequently and often respond in this manner when interacting with Americans
or when they do not understand what is being said.
Many may pretend to understand by nodding; this
sign of approval is given to hide their limitations.
Therefore, health-care providers must use simple and
clear instructions. Because Haitians are very private,
especially in health matters, it is inappropriate to share
information through friends. Many may prefer to use
professional interpreters who will give an accurate
interpretation of their concerns. Most importantly,
the interpreter should be someone with whom they
have no relationship and will likely never see again.
Voice intonations convey emotions. Haitians speak
loudly even in casual conversation among friends and
family; the pitch is moderated in formal encounters.
When the conversation is really animated, the conversants speak in close proximity and ignore territorial
space, especially when emphasizing a point or an issue.
Sometimes, the conversation is at such a high pitch
and speed that, to an outsider, the conversation may
appear disorganized or angry. Haitians love political
discussions. In these instances, the conversation may
appear stressful and hostile; however, to the participants, the conversation is enjoyable, motivating, and
Traditional Haitians generally do not maintain eye
contact when speaking with those in a position of authority. In the past, maintaining direct eye contact was
considered rude and insolent, especially when speaking with superiors (e.g., children speaking with parents, students with teachers, or employees with
supervisors). However, the influence of American education seems to be changing this trend. Most adults
maintain eye contact, which means “We are on equal
terms, no matter who you are. I respect you and you
respect me as an equal human being.” For children,
however, the custom of not maintaining eye contact
with superiors remains deferential. Thus, health-care
providers may need to assist children in dealing with
conflicting messages.
Haitians touch frequently when speaking with
friends. They may touch you to make you aware that
they are speaking to you. Whereas Haitian women
occasionally walk hand-in-hand as an expression of
their friendship, this trend is disappearing both in
Haiti and in Haitian communities in North America.
This behavior may be changing because of the concept of homosexuality, which is taboo within the
Haitian culture.
Haitians greet one another by kissing and embracing in informal situations. In formal encounters, they
shake hands and appear composed and stern. Men
usually do not kiss women unless they are old friends
or relatives. Children greet everyone by kissing them
on the cheek. Children refer to adult friends as Uncle
or Auntie out of respect, not necessarily because they
are related by blood.
Temporal Relationships
The temporal orientation of Haitians is a balance
among the past, the present, and the future. The past
is important because it lays the historical foundation
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from which one must learn. The present is cherished
and savored. The future is predetermined, and God is
the only Supreme Being who can redirect it. One often
hears Bondye bon (“God is good”), meaning if you
conduct yourself conservatively and the right way,
God will be there for you. The future is left up to God,
who is trusted to do the right thing. In a study by
Prudent, Johnson, Carroll, and Culpepper (2005), several of the informants voiced their belief in God’s will
when talking about whether or not they would survive
being HIV positive and/or having AIDS.
Haitians have a fatalistic but serene view of life.
Some believe that destiny or spiritual forces are in control of life events such as health and death, so they say,
Si Bondye vle (“If God wants”). Given the belief in a
predetermined path of life, one can understand this
view. Haitians believe that they are the passive recipients of God’s decisions. Health-care providers must
be clear, honest, and open when assessing Haitian
individuals’ perceptions and how they perceive the
forces that have an influence over life, health, and
illness. Acceptance of these beliefs is an important
factor in building trust and ensuring adherence.
Most Haitians do not respect clock time; flexibility
with time is the norm, and punctuality is not valued.
They hold to a relativistic view of time, and although
they try, some find it difficult to respond to predetermined appointments. Arriving late for appointments,
even medical appointments, is not considered impolite. In North America, Haitians may be more readily
compliant with business appointments, but socially,
the margin around expected time is very wide—
anything or anyone can wait. It is not unusual to see
an invitation to a social function listed with an invitation time an hour earlier than the actual time of the
function. For example, a wedding invitation may say
6:00 p.m. when the ceremony is actually scheduled for
7:00 p.m. to ensure that all invitees are there on time.
Health-care providers should be mindful of this time
orientation by making reminder calls for appointments
and encouraging the patient in a respectful and caring
manner about the importance of timeliness. A thorough assessment of time and temporal view helps
health-care providers to plan appointments so that
clinic or office backlogs and disruptions are minimized.
Format for Names
Haitians generally have a first, middle, and last name—
for example, Marie Maude Guinard. Sometimes the
first two names are hyphenated as in Marie-Maude.
The family name, or nom de famille, is very important
in middle- and upper-class society; it helps to promote
and communicate tradition and prestige. However,
friends call individuals by their first names. Families
usually have an affectionate name or nickname for individuals. The father, mother, grandparent, or any close
family member gives this affectionate name at birth.
When a woman marries, she takes on her husband’s
full name. For example, if Marie-Carmel Guillaume
marries Charles Guy Lespinasse, she is always called
Mrs. Lespinasse. In an informal setting, she might
even be called Mrs. Charles. She loses her name except
on paper. Her name and identity are subsumed by her
husband’s name. This is a reflection of Haitian society
in which women are considered subservient to men.
Haitian names are primarily of French origin, although many Arabic names are now heard since
the migration of Arabs and Jews to Haiti in the 1920s.
Haitians are formal and respectful and, as such,
should be addressed by their title: Mr., Mrs., Miss,
Ms., or Dr.
Family Roles and Organization
Head of Household and Gender Roles
Traditionally, the head of the household was the man,
but in reality, most families today are matriarchal.
Haitian men prefer and choose to believe that they
make the decisions, but most major decisions are
made by the wife and/or mother, with the man remaining a distant figure with a great deal of authority.
Today, joint decisions are common. The man is generally considered the primary income provider for the
family, and governance, rules, and daily decision making are considered his province. Sociopolitical and
economic life centers around men. Men are expected
to be sexual initiators, and the concept of machismo
prevails in Haitian life. Women are expected to be
faithful, honest, and respectable. Men are usually
permitted freedom of social interaction, a freedom
not afforded to women. The opportunities offered in
North America for women to become income
providers, together with their observations of different
male-female interactional styles, have encouraged
many Haitian women to reject their native, subservient role. This change in the marital interaction
has created much stress on marital relationships and
an increase in domestic violence, although domestic
violence remains one of those closeted issues that are
not publicly discussed.
Prescriptive, Restrictive, and Taboo Practices
for Children and Adolescents
Children are valued among Haitians because they are
key to the family’s progeny, cultural beliefs, and values.
Children are expected to be high achievers because Sa
ki lan men ou se li ki pa ou (“What’s in your hand is
what you have”). In other words, education can never
be taken away from you. Children are expected to be
obedient and respectful to parents and elders, which
is their key to a successful future. They are not allowed
to express anger to elders. Madichon is a term used
when children are disrespectful; it means that their future will be marred by misfortune. Another proverb
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used to scare and compel children to behave is Ti
moun fwonte grandi devan baron (“An impudent or insolent child will grow under the Baron’s eye [Baron
Samedi is the guardian of the cemetery in the voodoo
religion] and therefore won’t have a long life”).
Physical punishment, which is often used as a way
of disciplining children, is sometimes considered child
abuse by American standards. Fear of having their
children taken away from them because of their methods of discipline can cause parents to withdraw or not
follow through on health-care appointments if such
abuse is evident (e.g., bruises or belt marks). Haitians
need to be educated about American methods of discipline and laws so that they can learn new ways of
disciplining their children without compromising their
beliefs or violating American laws.
Many parents feel confused about how to raise
their children in the United States. Their authoritarian
behavior is challenged in American society, which they
perceive as being too permissive. They feel powerless
in understanding how to raise their children in America
while still retaining Haitian traditions. The liberal
American approach to child rearing poses a great
dilemma for Haitian children. They find themselves
living in two worlds: the American world, which
allows and supports self-actualization and oneness,
and the Haitian world, which promotes silence,
respect, and obedience.
In the summer, Haitian parents engage their children in certain health-promotion activities such as giving them lok (a laxative), a mixture of bitter tea leaves,
juice, sugarcane syrup, and oil. In addition, children
are also given lavman (enemas) to ensure cleanliness.
This is supposed to rid the bowel of impurities and refresh it, prevent acne, and rejuvenate the body.
Because Haitian life is centered on males, particularly firstborns, the education of boys is different from
that of girls. The family is more indulgent of the behavioral deviations of boys. Boys are given more freedom and are even expected to receive outside initiation
in social and sexual life. However, girls are educated
toward marriage and respectability. Their relationships
are closely watched. Even when they are 16 or 17 years
of age, they cannot go out alone because any mishap
can be a threat to the future of the girl and bring
shame to her family. These beliefs increase Haitians’
frustrations and challenges of rearing their children,
especially girls, in America.
Health-care providers need to be aware of these
various challenges and be prepared to assist children
and family members to work through these cultural
differences, while still conveying respect for family and
cultural beliefs. Health-care providers can play a significant role by helping children and their parents to
better understand American practices.
Approximately 300,000 restavec children are in
Haiti. Restavec is translated to mean “to live with.” It
was started as an economically motivated action to relieve some parents of the hardship of feeding, clothing, and paying for the education of their children by
loaning them out to relatives (Saint-Domingue, 2011).
Unfortunately, this has not proven to be true and has
not met its original intent. Restavec children work
long hours and rarely go to school. They are regularly
abused. They usually eat scraps of food and sleep on
the floor (Schaaf, 2009). Although they are not
chained or locked up, they stay to avoid severe abuse
and beatings (Schaaf, 2009). Sixty-five percent of
the population of children are girls between 6 and
14 years old. After the earthquake, the incidence of
restavec rose dramatically because many lost their parents or were abandoned (Schaaf, 2009). Organizations
like International Organization for Migration (IOM)
have started an initiative to end the restavec system
(Saint-Domingue, 2011). Because of the homelessness
and desperation after the quake, there has been a
surge in the practice. In 2009, CNN aired a program
describing the practice and posted it into a blog so
people around the world would become aware of the
situation (Schaaf, 2009). IOM is working to stop it,
along with an organization headed by a man who was
a restavec as a child: the Jean Robert Cadet Foundation
(Saint-Domingue, 2011).
Family Goals and Priorities
The family is a strong component of the Haitian culture. The expression “Blood is thicker than water” reflects family connectedness. An important unit for
decision making is the conseil de famille, the family
council. This council is generally composed of influential members of the family, including grandparents.
The family structure is authoritarian and includes linear roles and responsibilities. Any action taken by one
family member has repercussions for the entire family;
consequently, all members share prestige and shame.
The family system among Haitians is the center of
life and includes the nuclear, consanguine, and affinal
relatives, some or all of whom may live under the same
roof. Families deal with all aspects of their members’
lives, including counseling, education, crises, and marriage. Each family has its own traditions, which form
the basis for a family’s reputation and are generalized
to all members of the family. The prestige of a family
is very important and is based on attributes such as
honesty, pride, trust, social class, and history. Even
families who experience economic difficulties are well
respected if they are from a grande famille. Wealthy
families who have no historical background or tradition are referred to as nouveaux riche and find it difficult to marry into the more well-established grandes
familles, even though they have money.
The family is an all-encompassing concept in the
Haitian culture. By including family members in the
care of loved ones, health-care providers can achieve
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more trusting relationships, which foster greater
adherence to treatment regimens. Haitians believe that
when family members are ill, there is an obligation to
be there for them. If a family member is in the hospital, all family members try to visit. Many visitors may
cause concern to health-care providers who are not
accustomed to accommodating large numbers of
visitors. Health-care providers need to be patient with
them and facilitate their visits.
When grandparents are no longer able to function
independently, they move in with their children. The
house is always open to relatives. Elders are highly respected and are often addressed by an affectionate title
such as “Aunt,” “Uncle,” “Grandma,” or “Grandpa,”
even if they are not related. Their children are expected to care for and provide for them when self-care
becomes a concern. The elderly are family advisers,
babysitters, historians, and consultants. Migration to
America poses a tremendous challenge in caring for
elderly Haitians. The nursing home concept does not
exist in the Haitian culture; therefore, Haitians are
generally very reluctant to place their elderly family
members in nursing homes.
Alternative Lifestyles
Homosexuality is taboo in the Haitian culture, so gay
and lesbian individuals usually remain closeted. If a
family member discloses that he or she is gay, everyone
keeps it quiet; there is total denial. Gay and lesbian
relationships are not talked about; they remain buried.
There are no gay bars in Haiti, and overt homosexual
conduct is not publicly displayed, although this trend
seems to be changing.
Although divorce is common among Haitians, before
it becomes final, family members, friends, the church,
and elders try to counsel the couple. Health-care
providers must approach this issue carefully and establish a trusting relationship before discussing divorce.
Single parenting, widespread in Haiti, is well accepted and closely tied to the issue of concubinage. In
Haitian society, a well-accepted practice is for men to
have both a wife and a mistress, with the latter relationship referred to as placage. Both women bear children.
The mistress raises her children alone and with minimal
support from the father. These children are often
known by the man’s family but are not known to the
wife. Haitian women in general know that their husbands are involved in extramarital relationships but
pretend not to know. Health education, birth control,
and safe sex are issues that should be approached with
sensitivity and acceptance within cultural boundaries.
Workforce Issues
Culture in the Workplace
Haitians living in America have demonstrated a
very strong motivation for work and a continued
commitment to the entrepreneurial spirit. They can be
found in every sector of the American workforce.
They are hard workers, and many work two jobs to
provide for their American family while sending
money to Haiti for those left behind. In the first year
of migration, they are generally forced to take lowerstatus and low-paying jobs. These jobs are used as
stepping-stones to better jobs until they are able to
communicate in English and legalize their immigrant
status. According to the U.S. Census Bureau (2010),
in 2009, 71 percent of Haitians over the age of
16 years were in the civilian workforce, compared with
65 percent of the total workforce. At the same time,
median earnings for Haitian males were $33,000 for
men and $29,000 for Haitian women, compared with
$45,000 for men and $36,000 for women in the total
workforce. In addition, 20 percent of Haitians were
living below the poverty line compared with the total
population of 14 percent. Work is a necessity, and they
conform to the rules and regulations of the workplace.
Haitian immigrants have taken menial, low-paying
jobs that many Americans would not accept even
when unemployed. Haitians appreciate comfort, and
they work to be able to afford the necessities of life.
The economic survival of Haiti is closely tied to the
financial support provided to family members in Haiti
by Haitians who have migrated to the United States
and Canada.
Issues Related to Autonomy
In America, educated Haitians seek job opportunities
in their fields. Those who have a trade try to find employment in that area. Uneducated, undocumented,
and illiterate individuals experience much more difficulty in entering the job market, where employment
opportunities are restricted to working in places in
which there is overcrowding, poor ventilation, and
high pollution, all of which place them at high risk for
occupational diseases.
Immigrants from various Haitian villages and cities
tend to settle in clusters with their relatives or neighbors from their areas of origin. This pattern of settlement by area of origin helps immigrants adapt to the
demands of their new environment and ensure that
they have someone living nearby whom they can call
on in times of illness or other crises. However, when
people live and work primarily in an ethnic enclave,
the native culture becomes a barrier to assimilation
and acculturation into the dominant society.
The educational level of health-care providers in
Haiti is different from that in America. For example,
medical education is not research-based, and nursing
programs for the most part are at the diploma level
with an apprenticeship. The only nursing baccalaureate program is the Faculté des Sciences Infirmières de
L’ Université Episcopale D’Haiti (Faculty of Nursing
Science of the Episcopal University of Haiti), in
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Leogane on the southern coast of the island. Establishing this school and adopting this name were major
accomplishments. Nursing is finally accepted on
par with the medical community, as well as with the
other professional schools. All other professional
schools start with the words “Faculté des Sciences”
and end with whatever the science is (e.g., medicine,
law, engineering).
Haitian health-care providers who migrate to the
United States have experienced a great deal of difficulty in obtaining licensure to practice. Those who
learned their profession in Haiti were taught in French
and the test-taking approach is different; multiplechoice examinations are a new and difficult concept
for Haitians.
Haitian nurses are very skilled clinically; however,
sometimes they may experience difficulty in applying
theoretical knowledge to practice. This may be due in
part to language barriers, socialization, and their
diploma education, which focuses on tasks and skills
development. Haitian professionals struggle with professional cohesiveness and collegiality. Many groups
have established professional societies whose goals
are to support one another, to promote professional
development, and to promote collegial relationships.
Some examples of these professional groups are the
Haitian Nurses Association, the Haitian-American
Medical Association, the Haitian Educator Association,
the Haitian-American Engineers, and the HaitianAmerican Lawyers.
Sometimes Haitians in the workplace greet one another in their native tongue because it is easier to articulate ideas and feelings and to express support in their
native language. This may be irritating to non-Haitians,
who consider it rude.
Biocultural Ecology
from inadequate potable water sources in their homeland. Actual tuberculosis rates for Haitians are misleading because, until a few years ago, Haitians living in
Haiti were routinely vaccinated with Bacille bilié de
Calmette-Guérin, thus making all subsequent skin tests
positive, even though they may not actually have had
the disease. Unfortunately, upon immigration, many
Haitians continue to live in overcrowded areas, are malnourished, and live in very poor sanitary conditions, factors that increase their risk for infectious diseases.
Haitians are prone to diabetes and hypertension—
a reflection of genetics and their diet, which is high in
fat, cholesterol, and salt. Data on the prevalence of
diabetes and hypertension among Haitian Americans
are difficult to assess because they are categorized as
black. In addition to type 1 and type 2 diabetes, there
is a type 3 malnutrition-related diabetes, also known
as tropical diabetes. The prevalence ranges from 2 to
8 percent, accounting for different parts of the island
(Pan American Health Organization, 2001). In addition, Haitians experience a high incidence of heart disease. Cerebrovascular diseases are the third leading
cause of death; other cardiopathies are in 5th place,
and arterial hypertension is in 11th place. More deaths
are registered among females than males. In addition
to cardiovascular diseases, there is a high incidence
of cancer. The National Cancer Institute statistics
showed that the most frequent type of cancer treated
was cervical cancer, representing 40 percent of cases.
Breast cancer ranked second with 30 percent. Nasopharyngeal cancer ranked in third position with 10 to
15 percent of the cases (Pan American Health Organization, 2001). Both cancer and heart disease are related to a high-fat diet. Today, Haitians in Haiti and
in the United States are very conscious of the need
to limit the fat content in their diets; as a result, the
Haitian diet is not as fatty as it once was.
Skin Color and Other Biological Variations
Different assessment techniques are required when
assessing dark-skinned people for anemia and jaundice. One must examine the sclera, oral mucosa, conjunctiva, lips, nailbeds, palms of the hands, and soles
of the feet when assessing for cyanosis and low blood
hemoglobin levels. To assess for jaundice, one must
examine the conjunctiva and oral mucosa for patches
of bilirubin pigment because dark skin has natural
underlying tones of red and yellow.
Diseases and Health Conditions
Because Haiti is a tropical island, prevalent diseases include cholera, parasitosis, and malaria. Haiti has no
mosquito control, so newer immigrants should be assessed for signs of malaria such as chills, fever, fatigue,
and an enlarged spleen. Other diseases of increased
incidence among Haitian immigrants are hepatitis, tuberculosis, HIV/AIDS, venereal diseases, and parasitosis
Marie-Sandra is a 36-year-old Haitian woman. She was para 2
gravida 2, is 18 months postpartum, and has been breastfeeding her child. She noticed a change in the color of the breast
milk from the right breast. She previously had a lesion in her
right breast that was initially diagnosed as an abscess and appeared to have been there for 3 months. She returned to her
physician after seeing the change in the color of her breast
milk. The examination revealed a mass measuring 8 × 10 cm in
the superior aspect of the breast.
A biopsy confirmed carcinoma infiltrate of the right breast.
Marie had a sister who died of breast cancer at age 31. Her
mother died at age 51 from “some interabdominal cancer.”
The oncologist believed that it was suggestive of breast and
ovarian syndrome of a mutation gene.
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Marie-Sandra had chemotherapy in Haiti that made her
very ill, so she went to Cuba for continuation to complete
four cycles of chemotherapy. Because definitive care was not
available in Haiti, a university medical center in the United
States enrolled her in a pro bono program. She came for the
first time to the United States alone and that afternoon saw
the surgeon, had a mammogram, and had preoperative diagnostic studies. A French translator was used.
The next day, Marie-Sandra had bilateral mastectomies.The
left mastectomy was prophylactic because of her family history
and no ability for mammography monitoring in Haiti. She remained in the United States without any family for 1 year while
undergoing treatment and additional surgery. She received a
1-year course of chemotherapy, radiation therapy to the chest
wall, genetic testing, Herceptin therapy, and prophylactic bilateral
oophorectomies. Genetic BRCA 1 and BRCA 2 results were
Marie-Sandra did well, and after 1 year, she returned to
Haiti and started working again.
1. Given what you know about Marie-Sandra’s history, how
could she be helped to understand to change this major
health event?
2. What suggestions might be provided for Marie-Sandra
regarding her nutrition?
3. How might the health-care team assist with MarieSandra’s acculturation in the United States?
4. How do traditional Haitians deal with family separation?
5. How might she be helped with being separated from her
Attention-deficit/hyperactivity disorder (ADHD) is
a commonly diagnosed chronic mental condition in
Haitian children (Prudent, Johnson, Carroll, &
Culpepper, 2005). This disease has a large genetic
component (McCann, Scheele, Ward, & Roy-Byrne,
2006). In the Haitian culture, there is no conceptual
term for ADHD, nor is there a Creole term to describe
it. Unfortunately, in the Haitian culture, the behavior
displayed with this diagnosis may be interpreted as an
ill-behaved or a “poorly raised” child or a psychically
victimized child suffering from an “unnatural” condition. Parents may believe that this behavior can be
controlled by parental discipline, or they may seek an
alternative health consult such a Hougan or voodoo
priest. Although medications are the preferred treatment for ADHD, which may be combined with psychological intervention, Haitians are fearful of
psychoactive drugs because they see them as the cause
of substance abuse and even possibly mental illness
(Prudent et al., 2005). Therefore, assessing the parents’
perceptions of the cause of the ADHD behavior and
assisting them in holistic treatment are important.
Variations in Drug Metabolism
The literature reveals no studies on drug metabolism
specific to Haitians or Haitian Americans. When
Haitians are included in drug studies, it is assumed
that they are included under the category of African
American. Therefore, health-care providers may need
to start with the literature for this broad category of
ethnicity to posit and test theories of ethnic drug metabolism among Haitian Americans.
High-Risk Behaviors
Haitian refugees are one of the most at-risk populations
living in the United States. Therefore, it is important for
health-care providers to consider a number of factors in
providing health-care services. An in-depth assessment
of the person’s environmental, occupational, socioeconomic, demographic, educational, and linguistic status
enables the development of strategies that are culturally
appropriate, adequate, and effective. As a new group of
immigrants, Haitians bring to the health-care system a
different set of beliefs and values about health and illness. These differences challenge health-care providers
who must try to explain treatments while acknowledging, but not changing, their patients’ cultural convictions. Attempts to change firmly held beliefs are
counterproductive to establishing trusting health-care
provider–patient relationships.
Behaviors that may be considered high risk in
American society are generally viewed as recreational
or unimportant among Haitians. Alcohol, for example, plays an important part in Haitian society. Drinking alcohol is culturally approved for men and is used
socially when friends gather, especially on weekends.
Women drink socially and in moderation. Cigarette
smoking is another high-risk behavior practiced by
Haitian men, whereas Haitian women have a very low
rate of tobacco use. The trend toward decreasing cigarette use in America has not influenced Haitian
society. Drug abuse among Haitians used to be low,
but drug abuse in the adolescent population is increasing. In 1982, Haiti became the first developing country
to be incorrectly blamed for the beginning of the
AIDS epidemic. As a result, Haitians have had to endure the stigma associated with the belief that
Haitians are “AIDS carriers.” Unfortunately, HIV/
AIDS has continued to spread in the Haitian community both in Haiti and the United States. Heterosexual
transmission is the primary mode of HIV transmission in the Haitian community and is rapidly becoming an infection of women and children (Santana &
Dancy, 2000). Health-care providers need to recognize
the impact the stigma has had on male–female relationships, as well as familial relationships, in the Haitian
community. Health providers must broaden their scope
and approaches to HIV prevention by incorporating
societal, contextual, and economic factors designed to
modify traditional gender roles germane to influencing
beginning negotiations of safer sex practices.
High-risk behavior in the Haitian culture includes
the nonuse of seat belts and helmets when driving or
riding a motorcycle or bicycle. Most cars in Haiti do
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not have seat belts, and there are no laws regarding the
use of seat belts and helmets. Haitian cities are extremely overpopulated and traffic laws are very loose,
resulting in hazardous driving conditions. Everyone
tries to gain the upper hand. Haitian Americans must
be educated about traffic laws, seat belt use, car seats
for youngsters, and the need for helmets. Health-care
providers may have to use graphic videos or skits when
instructing patients about these safety practices.
Health-care providers may also use Haitian radio
stations for educational programs when they are available. Other strategies that may be used to help promote behavioral changes are through church and
community group activities. Through these avenues,
health-care providers can have a significant impact on
health promotion and health risk prevention among
Haitian Americans.
Health-Care Practices
To Haitians, good health is seen as the ability to
achieve internal equilibrium between cho (hot) and
fret (cold) (see also Nutrition and Health-Care Practices). To become balanced, one must eat well, give attention to personal hygiene, pray, and have good
spiritual habits. To promote good health, one must be
strong, have good color, be plump, and be free of pain.
To maintain this state, one must eat right, sleep right,
keep warm, exercise, and keep clean.
Haitians who believe in voodoo (see Dominant Religion and Use of Prayer) and other forms of folk
medicine may use several types of folk healers. These
healers include a voodoo practitioner, a docte fey (leaf
doctor), a fam saj (lay midwife), a docte zo (bonesetter), and a pikirist (injectionist). Depending on
whether the individual believes that the illness is natural or unnatural, she or he may seek help other than
Western medicine from one of these healers.
Meaning of Food
For many Haitians in lower socioeconomic groups,
food means survival. However, food is relished as a
cultural treasure, and Haitians generally retain their
food habits and practices after emigrating. Food practices vary little from generation to generation. Most
Haitians are not culinary explorers. They prefer eating
at home, take pride in promoting their food for their
children, and discourage fast food. When hospitalized,
many would rather fast than eat non-Haitian food.
Haitians do not eat yogurt, cottage cheese, or “runny”
egg yolk. Haitians drink a lot of water, homemade
fruit juices, and cold, fruity sodas.
Common Foods and Food Rituals
The typical Haitian breakfast consists of bread, butter, bananas, and coffee. Children are allowed to drink
coffee, which is not as strong as that consumed by
adults. Generally, the largest meal for Haitians is eaten
at lunch. At lunchtime, a basic Haitian meal might include rice and beans, boiled plantains, a salad made
of watercress and tomatoes, and stewed vegetables
and beef or cornmeal cooked as polenta. Table 15-1
lists popular foods in the Haitian community.
Dietary Practices for Health Promotion
Hot and cold, acid and nonacid, and heavy and light
are the major categories of contrast when discussing
food. Illness is caused when the body is exposed to an
imbalance of cold (fret) and hot (cho) factors. For example, soursop, a large, green prickly fruit with a white
pulp that is used in juice and ice cream, is considered
a cold food and is avoided when a woman is menstruating. Eating white beans after childbirth is believed
to induce hemorrhage. Foods that are considered
heavy, such as plantain, cornmeal mush, rice, and
❙❙◗ Table 15-1 Popular Foods in the Haitian
Soup made with beef broth mixed
with various green vegetables
(e.g., spinach, cabbage, watercress,
string beans, carrots), meat or
poultry, plantain, sweet potato, and
Malaga, a sweet aromatic wine
Codfish or smoked herring, unsalted,
shredded finely, mixed with onions,
shallots, finely chopped hot pepper,
vinegar, and lime
Marinade: flour, water, eggs, parsley,
onions, garlic, salt and pepper,
chicken, hot pepper, and a pinch of
baking soda, mixed together to pancake consistency and deep-fried
Acra: chopped parsley, eggs, garlic,
and onion mixed with Malaga; finely
shredded codfish or smoked herring
and hot pepper may be added
Beignet: sweet ripe banana, sugar, and
eggs, mixed with cinnamon, milk,
margarine, flour, nutmeg, and vanilla
Green plantain
Boiled or fried, usually eaten with
Marinated pork cut up in small pieces
and fried
Conch meat softened and prepared
in a sauce
Vegetables such as chayote and eggplant cooked with meat
Pastry dough filled with choice meat,
chicken, or smoked herring
Pumpkin squash soup Meat or poultry mixed with vegetables and pureed cooked squash and
Similar to dumplings, cooked and
made into round balls and eaten with
beef stew and okra
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meat, are to be eaten during the day because they provide energy. Light foods, such as hot chocolate milk,
bread, and soup, are eaten for dinner because they are
more easily digested. Table 15-2 presents a classification of hot and cold foods.
To treat a person by the hot-and-cold system, a
potent drink or herbal medicine of the class opposite
to the disease is administered. Cough medicines, for
example, are considered to be in the hot category,
whereas laxatives are in the cold category. Certain
food prohibitions are related to particular diseases
and stages of the life cycle. Teenagers, for example, are
advised to avoid drinking citrus fruit juices such as
lemonade to prevent the development of acne. After
performing strenuous activities or any activity that
causes the body to become hot, one should not eat
cold food because that will create an imbalance, causing a condition called chofret. A woman who has just
straightened her hair by using a hot comb and then
opens a refrigerator may become a victim of chofret.
This means she may catch a cold and/or possibly develop pneumonia.
When they are sick, Haitians like to eat pumpkin
soup, bouillon, and a special soup made with green
vegetables, meat, plantains, dumplings, and yams. The
Haitian diet is high in carbohydrates and fat. Eating
“right” entails eating sufficient food to feel full and
maintain a constant body weight, which is often
higher than weight standards medically recommended
in the United States. Men like to see “plump” women.
Furthermore, weight loss is seen as one of the most
important signs of illness. Additional components of
what Haitians consider a healthy diet are tonics to
stimulate the appetite and the use of high-calorie supplements such as Akasan, which is either prepared
plain or made as a special drink with cream of cornmeal, evaporated milk, cinnamon, vanilla extract,
sugar, and a pinch of salt.
A thorough nutritional assessment is very important to effectively promote nutritional health. Understanding food rituals assists health-care providers
in designing individualized dietary plans, which can
be incorporated into the diet to facilitate compliance with dietary regimens that promote a healthier
Nutritional Deficiencies and Food Limitations
Many Haitian women and children who come from
rural areas have significant protein deficiencies owing
to Haiti’s economic deprivation. A cultural factor contributing to this problem is the uneven distribution of
protein among family members. However, the problem
is not one of net protein deficiency in the community
but, rather, the unwise distribution of the available
protein among family members. Whenever meat is
served, the major portion goes to the men, under the
assumption that they must be well fed to provide for
the household. This same pattern exists today among
Haitian immigrants. Being aware of this cultural
factor enables health-care providers to prepare nutritional plans that meet patients’ dietary needs.
Another major concern in this area is that of food insecurity and short intervals between births, chronic malnutrition, and anemia, which are widespread among
Haitian women of childbearing age. These health inequalities result in a high prevalence of low birth weight,
estimated at 15 percent; anemia, ranging from 35 to
50 percent; a body mass index under 18.5 kg/m2, estimated at 18 percent; and a high maternal mortality rate,
estimated at 456 per 100,000 live births (Pan American
Health Organization, 2001).
Pregnancy and Childbearing
Fertility Practices and Views Toward Pregnancy
Pregnancy and fertility practices are not readily discussed among Haitians. Most Haitians are Catholic
and are unwilling to overtly engage in conversation
about birth control or abortion. This does not mean
that these two practices do not occur, but rather that
they are just not openly discussed. Abortion is viewed
as a woman’s issue and is left to her and her significant
other to decide. Accurate assessments and teaching related to these sensitive areas require tact and understanding. Initially, health-care providers should be
cautious in assessing and gathering information related
to fertility control. Pregnancy is not considered a health
problem but rather a time of joy for the entire family.
Pregnancy does not relieve a woman from her work.
Because pregnancy is not a disease, many Haitian
❙❙◗ Table 15-2 Haitian Hot and Cold Food Classification
Very Cold (–3)
Cashew nuts
Quite Cold (–2)
Source: Adapted from M.S. Laguerre (1981, pp. 194–196).
Cool (–1)
Cane syrup
Neutral (0)
Brown rice
Warm (+)
Very Hot (+2)
Cornmeal mush
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People of Haitian Heritage
women do not seek prenatal care. Pregnant women are
restricted from eating spices that may irritate the fetus.
However, they are permitted to eat vegetables and red
fruits because these are believed to improve the fetus’s
blood. They are encouraged to eat large quantities of
food because they are eating for two. Pregnant women
who experience increased salivation may rid themselves
of the excess at places that may seem inappropriate.
They may even carry a “spit” cup in order to rid themselves of the excess saliva. They are not embarrassed by
this behavior because they feel it is perfectly normal.
Fifty percent of women living in Port-au-Prince give
birth in a hospital, compared with 31 percent of births
in other urban areas, and only 9 percent of births in
rural areas. The leading causes of maternal deaths are
obstructed labor (8.3 percent), toxemia (16.7 percent),
and hemorrhage (8.3 percent). The high maternal mortality rate is mainly the result of inadequate prenatal
care (Pan American Health Organization, 2001).
The most popular methods of contraception are
the birth control pill, female sterilization, injections,
and condoms (3 percent each). Among sexually active
women, 13 percent use a modern method of contraception and 4 percent rely on traditional methods.
Among sexually active men, 17 percent use a modern
method (6 percent use condoms) and 16 percent
rely on traditional methods (Pan American Health
Organization, 2001).
Prescriptive, Restrictive, and Taboo Practices
in the Childbearing Family
During labor, the woman may walk, squat, pace, sit,
or rub her belly. Generally, Haitian women practice
natural childbirth and do not ask for analgesia. Some
may scream or cry and become hysterical, whereas
others are stoic, only moaning and grunting. What
they need is support and reassurance; for example, applying a cold compress on the woman’s forehead
demonstrates caring and sensitivity on the part of the
health-care provider. Since migrating, some Haitian
women have adopted American childbearing practices
and request analgesics. Cesarean birth is feared because it is abdominal surgery. Women in higher social
strata are more amenable to having cesarean deliveries. Fathers do not generally participate in the labor
and delivery, believing that this is a private event best
handled by women. The woman is not coached; female members of the family give assistance as needed.
The crucial period for the childbearing woman is
postpartum, a time for prescription and proscription.
The woman takes an active role in her own care. She
dresses warmly after birth as a way to become healthy
and clean. Haitians believe that the bones are “open”
after birth and that a woman should stay in bed during the first 2 to 3 days postpartum to allow the bones
to close. Wearing an abdominal binder is another way
to facilitate closing the bones.
The postpartum woman also engages in a practice
called the three baths. For the first 3 days, the mother
bathes in hot water boiled with special leaves that are
either bought or picked from the field. She also drinks
tea boiled from these leaves. For the next 3 days, the
mother bathes in water prepared with leaves that are
warmed by the sun. At this point, the mother takes
only water or tea warmed by the sun. Another important practice is for the mother to take a vapor bath
with boiled orange leaves, a practice believed to enhance cleanliness and tighten the internal muscles. At
the end of the 3rd to 4th week, the new mother takes
the third bath, which is cold. A cathartic may be administered to cleanse her intestinal tract. When the
process is completed, she may drink cold water again
and resume her normal activities.
In the postpartum period, Haitian women avoid
white foods such as lima beans, as well as other foods,
including okra, mushrooms, and tomatoes. These
foods are restricted because they are believed to increase vaginal discharge. Other foods are eaten to give
the new mother strength and vitality. Foods associated
with this prescriptive practice are porridge, rice and
red beans, plantains boiled or grated with the skins
and prepared as porridge (the skin is high in iron,
which is good for building the blood), carrot juice, and
carrot juice mixed with red beet juice.
Breastfeeding is encouraged for up to 9 months
postpartum. Breast milk can become detrimental to
both mother and child if it becomes too thick or too
thin. If it is too thin, it is believed that the milk has
“turned,” and it may cause diarrhea and headaches in
the child and, possibly, postpartum depression in the
mother. If milk is too “thick,” it is believed to cause
impetigo (bouton). Breastfeeding and bottle-feeding
are accepted practices. If the child develops diarrhea,
breastfeeding is immediately discontinued. Practices
that do not put the mother or the child at risk should
be supported and encouraged. Respecting the patients’ cultural beliefs and practices helps to establish
trust between the patient and the health-care provider
and demonstrates caring. By being familiar with these
health practices and beliefs, health-care providers can
assist women in making culturally safe decisions related to pregnancy and plans for delivery.
Another prescriptive postpartum practice among
Haitian women is to feed their infant a lok similar to
the one administered to the older children in the summer. The laxative is administered with the initial feeding and is intended to hasten the expulsion of
meconium. Because Haitians are fearful of diarrhea
in children, health-care providers should stress the
risks associated with lok and any other type of bowelcleansing cocktails in infants and children. It is important to stress the impact of laxative use on the body
system and educate the woman about the need to
prevent dehydration.
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Death Rituals
Death Rituals and Expectations
Generally, Haitians prefer to die at home rather than
in the hospital. Since migrating to America, many
have accepted death in a health-care facility to alleviate the heavy burden on the family during the last
stage of the loved one’s life. When death is imminent,
the family may pray and cry uncontrollably, sometimes even hysterically. They try to meet the person’s
Manou is a 59-year-old Haitian American woman who lives in
the Midwest United States. About 6 years ago, Manou lost her
only son, age 20, who died tragically after dropping out of college and joining the military. Two years after her son’s death,
Manou fell ill and was diagnosed with cancer of the gallbladder.
Her husband, a Lutheran pastor, had moved to Florida to build
a church and to serve the Haitian American population living
in the area. Manou stayed in the Midwest to care for her
youngest daughter, who was then finishing high school. Manou
was able to function for a number of years without ever mentioning her illness to her husband or daughter. She isolated
herself from her family, including her parents.
Recently, Manou fell gravely ill while she was alone in the
house. Her husband, who was still in Florida at the time, had
to call a family member to check on her condition. She was
taken to the nearest hospital emergency room and then transferred to a nursing home. She suffered with pain on her left
abdominal quadrant and had difficulty eating. Her family members rushed to care for her, although they were unaware of
her condition. They made leaf teas (parsley, garlic) in the hope
of alleviating her pain and epigastric discomfort.
Manou was transferred from the nursing home to another
hospital for further testing. There, it was revealed to her family
that she was terminally ill and needed to be admitted to a
hospice care facility. The family refused and wanted to take her
home to care for her.
You happen to be a nurse and a member of the family.
Manou’s family was in disbelief; her husband and daughter
looked to you for answers and to assist them in coping with
this news. They need to be prepared for her imminent death.
1. What do you need to know about the health practices
that Manou had engaged in at home? Why would this be
2. How can you help the family come to terms with this
major event that Manou kept from them?
3. Do you think Manou kept her illness a secret because of
lack of trust, or was she trying to protect her family? Is this
behavior typical in the Haitian community, or is this out of
the ordinary?
4. How can you assist this family in their grief?
5. What can you do to assist Manou in coming to terms
spirituality/religiously with her imminent death?
spiritual needs by bringing religious medallions, pictures of saints, or fetishes. When the person dies, all
family members try, if possible, to be at the bedside
and have a prayer service. If possible, and if it is not
too disturbing to other patients, health-care providers
should encourage this practice and involve a family
member in the postmortem care.
Responses to Death and Grief
Death in the Haitian community mobilizes the entire
family, including the matrilineal and patrilineal extensions and affines. Death arrangements in America are
similar to those in Haiti. Generally, a male relative of
the deceased makes the arrangements. This person
may also be more fluent in English and more accustomed to dealing with the bureaucracy. This person is
also responsible for notifying all family members
wherever they might be in the world, an important activity because family members’ travel plans influence
funeral arrangements. In addition, he is responsible
for ordering the coffin, making arrangements for
prayer services before the funeral, and coordinating
plans for the funeral service.
The preburial activity is called veye, a gathering of
family and friends who come to the house of the deceased to cry, tell stories about the deceased’s life, and
laugh. Food, tea, coffee, and rum are in abundant supply. The intent is to show support and to join the family in sharing this painful loss. Another religious ritual
is called the dernie priye, a special prayer service consisting of 7 consecutive days of prayer. Its purpose is
to facilitate the passage of the soul from this world to
the next. It usually takes place in the home. On the
7th day, a mass called prise de deuil officially begins the
mourning process. After each of these prayers, a reception/celebration in memory of the deceased is held.
Haitians have a very strong belief in resurrection and
paradise; thus, cremation is not an acceptable option
(Fr. Darbouze Gerard, personal communication, 2001).
Haitians are very cautious about autopsies. If foul play
is suspected, they may request an autopsy to ensure that
the patient is really dead. This alleviates their fear that
their loved one is being zombified. According to this belief, this can occur when the person appears to have died
of natural causes but is still alive. About 18 hours after
the burial, the person is stolen from his or her coffin; the
lack of oxygen causes some of the brain cells to die, so
the mental facilities cease to exist while the body remains
alive. The zombie then responds to commands, having
no free will, and is domesticated as a slave.
Dominant Religion and Use of Prayer
Patients’ cultural beliefs and religion can have a great
impact on their acceptance of and adherence to health
care and, therefore, on the outcomes of treatment.
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People of Haitian Heritage
Lélé, a young Haitian man, survived the earthquake in Haiti on
January 12, 2010. Prior to the earthquake, he was active, full of
life, and pursing his studies. He lived in one of the small towns
in Haiti and was going to school at the same time. Soon after
the earthquake, Lélé developed some signs and symptoms
that baffled many of the health-care providers who were giving assistance to the earthquake survivors. Lélé started losing
weight, his skin color changed, and he became discolored. As
his condition became worse, he had difficulty swallowing. Suspecting scleroderma, Lélé was brought along with his mother
to the United States for treatment.
After 6 weeks, Lélé’s mother returned home because there
was nothing that Western/conventional medicine could do for
him. She stated that she did not want to witness Lélé’s death
and would rather remember him alive. After 3 months of a languishing illness, Lélé died alone and far away from his young
wife, his mother, and the rest of his family. Lélé’s wish was to be
buried in his homeland. Given the high cost of sending the body
home for burial, his wife contemplated cremation and sending
his ashes home. However, Lélé had converted to the Mormon
faith, which prohibits cremation. When Lélé’s wife was informed
of this, she sought out a spiritual leader from the Mormon faith
to assist her in making such an important decision.
1. Should Lélé’s mother be brought into the decision-making
process regarding cremation?
2. How important is family in the Haitian culture?
3. What resources might be made available to have Lélé’s
body returned to Haiti?
4. If the decision was made for cremation, which is contrary
to Haitian culture, how might a nurse assist his wife with
the grieving process?
Catholicism is the primary religion of Haiti. Since the
early 1970s, however, Protestantism has gained in popularity throughout the island and has seriously challenged the Catholic Church, especially among the
lower socioeconomic classes. Even though Haitians
are deeply religious, their religious beliefs are combined with voudou (voodooism), a complex religion
with its roots in Africa (Fig. 15-1). Voudou, in the
most simplistic sense, involves communication by
trance between the believer and ancestors, saints, or
animistic deities. Voudou is not considered paganism
among those who practice it, even though many of the
rituals resemble paganism. Participants gather to worship the loa or mystere, deities or spirits who are believed to have received their powers from God and are
capable of expressing themselves through possession
of a chosen believer. With their great powers, the loa
or mystere can provide favors such as protection,
wealth, and health to those who worship and believe
in them.
Figure 15-1 Santeria evolved from two main cultural
antecedents: the worship of orisha among the Yoruba tribe
of Nigeria and the cult of saints from the Roman Catholicism
of Spain.
Meaning of Life and Individual Sources
of Strength
The family system among Haitians is the center of life
and includes the nuclear, consanguine, and affinal relatives. They may all live under the same roof. The family
deals with all aspects of a person’s life, including counseling, education, crises, marriage, and death.
The best way to understand and assess the spiritual
beliefs and needs of Haitian American patients is to
understand their culture. This is especially important
because Haitian patients may express their concerns
in ways that are unique to their cultural and religious
beliefs. To ensure accurate assessments of these patients, it is essential to ask questions carefully and to
completely understand the answers in order to gain an
understanding of patients’ perceptions of health and
illness as dictated by their culture and religious beliefs.
By recognizing and accepting patients’ beliefs, healthcare providers may alleviate barriers, and patients may
feel more at ease to discuss their beliefs and needs.
Spiritual Beliefs and Health-Care Practices
Voudou believers may often attribute their ailments or
medical problems to the doings of evil spirits. In such
cases, they prefer to confirm their suspicions through
the loa before accepting natural causes as the problem,
which would lead to seeking Western medical care.
For Haitian patients, the belief in the power of the supernatural can have a great influence on the psychological and medical concerns of the patients.
Health-Care Practices
Health-Seeking Beliefs and Behaviors
For Haitians, illness is perceived as punishment, considered an assault on the body, and may have two
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different etiologies: natural illnesses, known as maladi Bondye (“disease of the Lord”), and supernatural
illnesses. Natural illnesses may occur frequently, are
of short duration, and are caused by environmental
factors such as food, air, cold, heat, and gas. Other
causes of natural illness are movement of blood
within the body, disequilibrium between hot and
cold, and bone displacement. Supernatural illnesses
are believed to be caused by angry spirits. To placate
these spirits, patients must offer feasts called manger
morts. If individuals do not partake in these rituals,
misfortunes are likely to befall them. Illnesses of
supernatural origin are fundamentally a breach in
rapport between the individual and her or his protector. The breach in rapport is a response from the
spirit and a way of showing disapproval of the
protégé’s behavior. In this instance, health can be
recovered if the patient takes the first step in determining the nature of the illness. This can be accomplished by eliciting the help of a voudou priest and
following the advice given by the spirit itself. To accurately prescribe treatment options, health-care
providers must be able to differentiate between these
belief systems.
Physical illnesses are thought to be on a continuum beginning with “Kom pa bon” (“I do not feel
well”). In this phase, the affected person is not confined to bed; illness is transitory, and the person
should be able to return to his or her normal activities. The next phase is Moin malad (“I am sick”), in
which the individuals stay at home and avoid activity.
The third phase is Moin malad anpil (“I am very
sick”). This means that the person is very ill and may
be confined to bed. The final phase is Moin pap refe
(“I am dying”).
Haitians believe that gas (gaz) may provoke pain
and anemia. Gas can occur in the head, where it enters through the ears; in the stomach, where it enters
through the mouth; and in the shoulders, back, legs,
or appendix, where it travels from the stomach.
When gas is in the stomach, the patient is said to suffer kolik, meaning stomach pain. Gas in the head is
called van nan tet or van nan zorey, which translates
to “gas in one’s ears,” and is believed to be a cause
of headaches. Gas moving from one part of the
body to another produces pain. Thus, the movement
of gas from the stomach to the legs produces
rheumatism, to the back causes back pain, and to
the shoulder causes shoulder pain. Foods that help
dispel gas include tea made from garlic, cloves,
and mint; plantains; and corn. To deter the entry of
gas into the body, one must be careful about eating
“leftovers,” especially beans. Since migrating to
the United States, Haitians have begun eating
leftovers, which is believed to cause many of their
ailments. After childbirth, women are particularly
susceptible to gas, and to prevent entry of gas into
the body, they tighten their waist with a belt or a
piece of linen.
Responsibility for Health Care
Haitians engage in self-treatment and see these activities as a way of preventing disease or promoting
health. Haitians try home remedies as a first resort for
treating illness. They are self-diagnosticians and may
use home remedies for a particular ailment, or if they
know someone who had a particular illness, they
may take the prescribed medicine from that person.
They keep numerous topical and oral medicines on
hand, which they use to treat various symptoms. For
example, an individual who suspects a venereal disease
may buy penicillin injections and have someone
administer them without consulting a physician. In
Haiti, many medications can be purchased without a
prescription, a potentially dangerous practice. However, health-care providers must be very discrete in assessing, teaching, and guiding the patient toward safer
health practices. Admonishing patients may cause
them to withdraw and not adhere to instructions.
Haitians may also lead health-care providers to believe
that they are interested, when in fact they have already
discredited the health-care provider. When taking the
patient’s history, the health-care provider should inquire if the patient has been taking medication that
was prescribed for someone else. Moreover, when prescribing a potentially dangerous drug, the health-care
provider should be sure to caution the patient not to
give the medication to ailing friends or relatives. Even
though the health-care provider may not be completely successful at stopping the practice of exchanging medications, with continued reminders, she or he
may be successful later.
Folk and Traditional Practices
Haitians may use others’ experiences with a particular illness as a barometer against which to measure
their symptoms and institute treatment. If necessary, a person living in the United States may ask
friends or relatives to send medications from Haiti.
Such medications may consist of roots, leaves, and
European-manufactured products that are more
familiar to them. Therefore, it is very important to
ascertain what the patient is taking at home to avoid
serious complications.
Constipation, referred to as konstipasyon, is treated
with laxatives or herbal teas. Sometimes, Haitians use
enemas (lavman). Diarrhea is not a major concern in
adults; however, it is considered very dangerous in
children and sometimes interpreted as a hex on the
child. Parents may try herbal medicine, may seek help
from a voudou priest or hougan, or if all else fails, may
consult a physician. It is very important to assess the
child carefully because he or she may have been ill for
quite some time.
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A primary respiratory ailment is oppression, a term
used to describe asthma. However, the term really describes a state of anxiety and hyperventilation rather
than the condition. Oppression is considered a cold
state, as are many respiratory conditions. A home
remedy for oppression is to take a dry coconut and cut
it open, fill it with half sugarcane syrup and half
honey, grate one full nutmeg and add it to the syrup
mix, reseal the coconut, and then bury it in the ground
for a month. The coconut is reopened, the contents
are stirred and mixed together, and 1 tablespoon is administered twice a day until all of the contents have
been consumed. By the end of this treatment, the child
is supposed to be cured of the respiratory problem.
Barriers to Health Care
Because orthodox medicine is often bypassed or perceived as a second choice among Haitians, the potential delay of medical care can pose an increased risk
to patients. The view that physicians of conventional
medicine do not understand voudou and, therefore,
cannot cure magical illness or that an illness worsens
if the bewitched person seeks a physician is enough to
persuade these individuals to seek unconventional
modes of therapy with which they are more comfortable. The health-care team should understand some
of the basic principles and practices of folk medicine,
particularly root medicine, because this can play a significant role in determining the progress of the client’s
health status.
Many Haitians are in low-paying jobs that do not
provide health insurance, and they cannot afford to
purchase it themselves. Thus, economics acts as a barrier to health promotion. In addition, for those who
Marie was raised by her grandmother since typhoid took
the lives of her parents. Marie said that when her brother,
Jean-Claude, contracted the disease, her grandmother used a
paste-like mixture of sour oranges, the leaves of a sour orange
tree, and papaya leaves and placed it on his forehead to
reduce the fever. This was used for 3 days, at which time her
grandmother realized that the treatment was ineffective. At
that point, Marie and her grandmother took Jean-Claude via a
donkey-pulled cart to the nearest clinic. The trip took 8 hours.
Even though the staff immediately started intravenous fluids
and medication, Jean-Claude died the next day.
1. What were some of the major obstacles to treating
2. What are some of the variant cultural characteristics from
the Purnell Model in this vignette?
3. What other traditional remedies do Haitians use?
4. What are traditional Haitian burial practices?
do not speak English well, it is difficult for them to access the health-care system, fully explain their needs,
or understand prescriptions and treatments.
Cultural Responses to Health and Illness
The root-work system is a folk medicine that provides
a framework for identifying and curing folk illnesses.
When illness occurs, or when a person is not feeling
well or is “disturbed,” root medicine distinguishes
whether the symptoms and illness are of natural or
unnatural origin. An imbalance in harmony between
the physical and the spiritual worlds, such as dietary
or lifestyle excesses, can cause a natural illness. For example, diabetes is considered a natural illness, but
most Haitians do not seek immediate medical assistance when they detect the symptoms of polyuria, excessive thirst, and weight loss. Instead, they attempt
symptom management by making dietary changes on
their own by drinking potions or herbal remedies.
When the person finally seeks medical attention, she
or he may be very sick. At this point, the health-care
provider should be cautious in explaining the condition and use a culturally specific approach when explaining the medical regimen, diet, and medications.
Pain is commonly referred to as doule. Many
Haitians have a very low pain threshold. Their demeanor changes, they are verbal about the cause of
their pain, and they sometimes moan. They are vague
about the location of the pain because they believe
that it is not important; they believe that the whole
body is affected because disease travels. This belief
makes it very difficult to accurately assess pain. Injections are the preferred method for medication administration, followed by elixirs, tablets, and capsules.
Chest pain is referred to as doule nan ke mwen, abdominal pain is doule nan vent, and stomach pain is
doule nan ke mwen or doule nan lestomak mwen. Oxygen should be offered only when absolutely necessary
because the use of oxygen is perceived as an indicator
of the seriousness of the illness.
Nausea is expressed as lestomak/mwen ap roule,
M santi m anwi vomi, lestomak/mwen chaje, or ke mwen
tounin. Those who are more educated may express their
discomfort as nausea. Because of modesty, they may
discard vomitus immediately so as not to upset others.
Specific instructions should be given regarding keeping
the specimen until the practitioner has had a chance
to see it.
Fatigue, physical weakness known as febles, is
interpreted as a sign of anemia or insufficient blood.
Symptoms are generally attributed to poor diet.
Patients may suggest to the health-care provider that
they need special care—that is, to eat well, take vitamin injections, and rest. To counteract the febles,
the diet includes liver, pigeon meat, watercress,
bouillon made of green leafy vegetables, cow’s feet,
and red meat.
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Aggregate Data for Cultural-Specific Groups
Another condition is fright or sezisman. Various external and internal environmental factors are believed
to cause sezisman, thereby disrupting the normal
blood flow. Sezisman may occur when someone
receives bad news, is involved in a frightful situation,
or suffers from indignation after being treated unjustly. When this condition occurs, blood is said to
move to the head, causing partial loss of vision,
headache, increased blood pressure, or a stroke. To
counteract this problem, the patient may sit quietly,
put a cold compress on the forehead, drink bitter
herbal tea, take sips of water, or drink rum mixed with
black, unsweetened coffee.
Haitian Americans may strongly resist acculturation,
taking pride in preserving traditional spiritual, religious,
and family values. This strong hold on cultural views
sometimes creates stress leading to depression. The
stigma attached to mental illness is strong, and most
Haitians do not readily admit to being depressed. A
major factor to remember is the strong prevalence of
voudou, which attributes depression to possession by
malevolent spirits or punishment for not honoring
good, protective spirits. In addition, depression can be
viewed as a hex placed by a jealous or envious individual. Factors that may trigger depression are memories
of family in the homeland, thoughts about spirits in
Haiti, dreams about dead family members, or guilt
and regrets about abandoning one’s family in Haiti
for the abundance in America. Health-care providers
need to be sensitive to the underlying causes of problems
and ascertain the need for comfort within specific
religious beliefs.
In the case of an unnatural illness, the person’s poor
health is attributed to magical causes such as a hex, a
curse, or a spell that has been cast by someone as a result of family or interpersonal disagreement. The
curse takes place when the intended victim eats food
containing ingredients such as snake, frog, or spider
egg powder, which cause symptoms of burning skin,
rashes, pruritus, nausea, vomiting, and headaches
(Fishman, Bobo, Kosub, & Womeodu, 1993). These
symptoms often coincide with psychological problems manifes…
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