A Closer Look into the Culture of Haitian Health and Diagnoses

Abstract

This piece is an overview exploring the culture of Haitians in southern Florida and how their culture relates to their view on their personal well being and health care. It also assesses the overall community health risks and diagnoses the community’s overall scope of health.

Haitian Community in Southern Florida

During times of political unrest, refugees from Haiti flocked to the shores of the United States seeking refuge from the persecution from their own government and turmoil that their country was undergoing at the time. While the initial influx of immigrants from Haiti to the states was the upper class residents of Haitians, over time the severity of the situation forced lower classes of Haitians to seek refuge in America as well (Stepick, 1992). Currently, the largest population of Haitian immigrants in the United States resides in southern Florida, with almost 80% of all the Haitian born immigrants currently residing in the United States, living in the southern region of the state (Nicolas et al., 2006). A relatively peaceful culture, there are some indicators that the community displays regarding health risks. Data collected regarding Haitian culture, particularly in Florida, reports a diagnosis of the southern Florida Haitian community’s health and the indicators they display for health risks. These risks can be linked to a number of factors including poverty and a mistrust of traditional Western medicine. While Western medicine may be quick to label some behaviors that the Haitian culture displays as risky or fatalistic, the Haitians feel that by abiding by the tenants of their religion and culture, they are correctly following the most effective and efficient model of healing process (Ross, 2010).

Review of Haitian Immigrant Health Care Views

As in many healthcare models outside of the United States, Haitian’s concept of health is a profoundly spiritual one. While they believe that daily maintenance of physical health can be maintained through a balance of staying out of cold weather, proper eating habits, good hygiene practices, and being on decent terms with familial members, another very large part of their overall scope of their health model is prayer. Haitians believe that God is the ultimate authority in health decisions. While most Haitians identify as Catholic, they most accurately adhere to the faith of Voudou. Whether openly admitting to the practicing of Voudou or not, Haitian culture does believe that faith based in supernatural forces and health are intertwined (Viera et al., 1983). Supernatural causation for illness such as spiritual unrest is commonplace belief among Haitians who practice Voudou. Typical treatment for such is normally herbal home remedies. Some Haitians believe that if herbal home remedies are not sufficient in curing the illness, seeking Western medicine will only exacerbate the ailment (Ross, 2010). Additionally, the Haitian immigrant community is typically more collectivist than typical United States cultures. Decision making is much more of a familial and community process than an individual process.

Haitians may not be receiving the medical treatment they require as a community. In addition to cultural differences, issues that contribute to this include literacy problems, transportation issues, lack of cultural competence in the healthcare system, and inadequate financial resources. Compared to other immigrants, Haitians have some of the lowest health insurance coverage with nearly half being uninsured. There is also a general mistrust of the American government by some Haitians. In the 1980’s, Haitians were largely blamed for carrying the HIV virus into the United States (Stepick & Swartz, 1998). This claim was proven to be false with no basis of fact but still remains in perception. This mistrust also fuels a different kind of fear in this case of seeking medical treatment for fear of deportation. This also oftentimes prevents Haitians from utilizing federally funded resources for fear of family members from in the future ever being able to immigrate into the United States.

Haitian immigrants choosing to practice Voudou and not seek Westernized medical attention, whether due to financial or moral reasons, are at high risk for certain chronic diseases. These may remain untreated and become progressively worse or even fatal depending upon the circumstances surrounding the illness. Haitian immigrants are at risk for such illnesses as cardiovascular disease, type II diabetes, and sickle cell anemia. An estimated over 70,000 people in the United States have sickle cell anemia, and the average life span for an individual diagnosed with the illness that goes untreated is no more than 50 years old (Ross, 2010). Haiti also has the highest rate of HIV/AIDS within communities outside of Africa, and according to research, up to twelve percent of the population is infected with the virus.

Applying the community epidemiology concepts of distribution, determinants, health-related states, and population can help understand the health care problems of Haitian immigrants in South Florida. The population is studied according to exposure to certain diseases, symptomology, and the rate of development of the disease based on longitudinal case studies. With this population specifically, a high number of Haitian immigrants suffer from cardiovascular diseases, diabetes, and sickle cell anemia. These diseases are a combination of genetic factors, lifestyle, and lack of medical treatment for the reasons detailed above. By studying general cultural perceptions and behaviors regarding illness and treatment, it is possible to have a fuller understanding of the epidemiology and provide more helpful treatment options for the community at large.

Genogram and Assessment

The following figure (see Figure 1) is a compiled genogram that presents a composite of the discussed data regarding the risks that Haitians in southern Florida undertake by not seeking Westernized medical treatment. The chart represents two separate families. The family entity on the left has a father with heart disease and a mother afflicted by metabolic syndrome. Their child is born with diabetes. In the right genogram, the father, deceased, was afflicted with morbid obesity which is typically not seen as an issue in the Haitian community. The mother is HIVpositive, and the child died from the same virus, most likely during childbirth from lack of medication. As the diseases represented are some of the most common ones afflicting this community, the genogram can be applied to many different family units.

(Figure 1 omitted for preview. Available via download)

(Figure 2 omitted for preview. Available via download)

The families in this discussion are connected to their collectivist community which is part of the larger South Florida community, Western medicine practices, cultural and religious healing components, and the community’s economy. Western medicine, which is unfortunately under-utilized by this community, is often over shadowed by the religious and spiritual healing principles of the immigrant population. The community’s economy also plays a role in this genogram because the low income of many Haitian immigrants is a further deterrent to paying for and receiving medical care for diabetes, HIV, heart disease, and other illnesses.

Community Diagnosis

The Haitian immigrant community is one that struggles with its overall health. Many community members are at risk for deterioration of health due to cultural differences between the community and the surrounding communities. People who are sick may not seek treatment because they do not agree with the general Westernized medical community in South Florida. In order to help this culture, it is important for nurses to have a great amount of cultural competency. Nurses must understand cultural stigmas regarding illness and treatment, the importance of religion in this community, and the relation of spirituality to wellness. Without a solid understanding of this, it will be very difficult to gain the trust of the Haitian immigrant population. Once trust and rapport are obtained, nurses are advised to educate Haitian immigrants on various Western treatments and the importance of health as it relates to general well-being. Education on general prevention will also help this population. Also, the general erroneous opinion of Western medicine is that holistic treatments are not effective. It is advised that the cultural beliefs of health care be integrated to a treatment plan so as not to exclude potentially helpful and useful treatment modalities.

References

Nicolas, G., DeSilva, A. M., Grey, K. S., & Gonzalez-Eastep, D. (2006). Using a multicultural lens to understand illnesses among Haitians living in America. Professional Psychology: Research and Practice, 37(6), 702.

Ross, C. (2010). Background on haiti & haitian health culture. Cook Ross. Retrieved from http://www.cookross.com/docs/haiti.pdf

Stepick, A. (1992). The refugees nobody wants: Haitians in Miami. Miami Now, 57-82.

Stepick, A., & Swartz, D. F. (1998). Pride against prejudice: Haitians in the United States. Boston, MA: Allyn and Bacon.

Vieira, J., Frank, E., Spira, T. J., & Landesman, S. H. (1983). Acquired immune deficiency in Haitians: Opportunistic infections in previously healthy Haitian immigrants. New England Journal of Medicine, 308(3), 125-129.