Cultural Diversity

1. Cultural Diversity ELDER Project Fairfield University School of Nursing Haitian Culture Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

2. Haitian Culture Objectives: Upon completion of this session, the participants will be able to …. • Discuss the role of religion, traditional health care beliefs, social values, and family structure of Haitian Culture and the impact these factors have on health care. • Identify specific culturally sensitive practices that can be incorporated into your work with Haitian patients and Haitian American patients. • Identify similarities and differences between the Haitian and Jamaican cultures. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

3. Haitian Culture Introduction: • The Haitian community in the United States is diverse and their differences in social class and regional variations make it difficult to generalize about this population. • This group is comprised of 95% Black and 5% Mulatto. • Most Haitians indicate Black or African American as their racial category, but do not identify with that culture. • Currently, there is no category for them on surveys. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

4. Haitian Culture Introduction: • Haiti’s history has been plagued with political violence for most of its existence: • In 1492 Columbus landed on the island of Hispaniola (Spanish Island) which was originally inhabited by Taino and Arawak Indians. • Almost immediately the Spanish set up agricultural settlements using the natives on the island as labor. • Early 1500’s – The Spaniard began to bring over slaves from West Africa • Early 1600’s – France became interested in the island • 1697 - The Spanish cede the western third of the island to France via the Treaty of Ryswick. • Formed a French colony called Saint-Dominque and became one of the richest colonies of the time period. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

5. Haitian Culture Introduction: • 1789 - The French Revolution started • 1804 - After 3 decades of slave revolts, Haiti declared independence from France and became the first black republic in the world. • The leader at the time chose an Arawak name meaning “country of mountains”. • 1844 - Dominican Republic declares its independence from Haiti • 1915 - The Unites States invaded Haiti as a strategic move during World War I, and occupies the nation for almost 25 years. • Although the U.S. did improve the conditions of the cities, poverty and illiteracy still predominated. The Americans left in 1934, leaving behind a well-trained military. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

6. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

7. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

8. Haitian Culture Communication: • Two official languages-Haitian Creole (known as Kreyol) and French Kreyol (mixture of French and African languages that Haitian slaves spoke). • Creole is spoken by the majority of Haitians. • Identifying as French is an indicator of social class. • Oral forms of communication are preferred over written forms of communication. • Word of mouth is used to disseminate information. • It is common for Haitians to use a lot of hand gestures while talking. • Speech may be loud, but it is not an indication of anger. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

9. Haitian Culture Communication: • Direct eye contact is appropriate to use with friends, along with an active tone of voice. • Eye contact is avoided with those of higher socioeconomic status or someone of authority. • Touch is accepted in informal situations; however, embracing those of the opposite sex is not typical. • A stern handshake is an acceptable greeting in formal situations. • Often smile and nod head, but this does not indicate understanding. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

10. Haitian Culture Family and Social Structure: • Family is very important and often those Haitians living in the US have financial responsibility to those who are still in Haiti. • Haitians in the U.S. do not identify themselves solely as residents of America or Haiti, but instead live life that bridges both countries • Home is geared towards the needs and strengths of the extended family. • Households often consist of multiple generations • Traditionally a patriarchal society: • Men are the bread winners and do not get involved in child care at home. • The man has ultimate control. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

11. Haitian Culture Family and Social Structure: • Children are viewed as a gift from God. • Elderly parents live with children. • It is considered an honor when a parent has chosen the child’s home to live. • Mother, father or elder family member makes the healthcare decisions. • Elders are viewed as knowledgeable and their counsel is sought. • Education is important; it can improve social status. • Gender roles are strictly defined: • In healthcare, nurses are women and physician are men and expected to be an authority and trusted to do what needs to be done. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

12. Haitian Culture View of Illness: • Illness is thought to have either a natural or supernatural cause. • Natural illness occurs due to an imbalance with nature, thus a short duration. • If hot and cold equilibrium is disturbed, it results in a natural illness. • Illness can also be caused by sympathetic magic, such as voodoo dolls and magicoreligious beliefs • Supernatural illness is caused by God or the spirits and usually appears suddenly, without warning. • Sick person becomes passive and allows others to help. • Family typically comes to their assistance. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

13. Haitian Culture View of Illness: • Illnesses specific to this group: • Fright (seizisman): • Result of extreme fright, surprise or shock. • Believe blood is moved from the head into the body and causes headache, visual disturbance and temporary mental problems. • Oppression: • Describes asthma or a state of hyperventilation and anxiety. • Evil eye (maldyok): • Result of a person’s envious glance and could be accidental. • It can cause gastrointestinal problems (diarrhea) in children. • It is treated by an herbalist or a voodoo practitioner. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

14. Haitian Culture Folk Medicine: • Believe they are sick if the illness interferes with their ability to work. • Home remedies are used first and include herbal preparations, massage, and over-the-counter medications. • These remedies are often passed on by the family and Haitian Americans will even have ingredients sent from Haiti. • Often biomedical care will be simultaneously used with magico-religious care. • Strong belief that the quality of a person’s blood signifies the health of the person. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

15. Haitian Culture Folk Medicine: • Health care practitioners include: • Voodoo practitioners – • They help with supernatural illnesses. • They are well respected in the community. • They diagnosis using cards, shells or trances. • They treat with dancing, incantations, herbal preparations, prayer and the calling on of spirits. • They utilize a holistic perspective. • It is not uncommon for American Haitians to seek help of these practitioners even if it means going back to Haiti. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

16. Haitian Culture Folk Medicine: • Health care practitioners continued: • Herbalists- • Are the most common traditional healers • Lay trained; have no formal training. • Are sought out for common illnesses such as colds, fever, and diarrhea. • They treat evil eye (maldyok) as well. • They utilize a holistic perspective. • Midwives- • They deliver babies and provide prenatal care. • Lay trained; have no formal training. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

17. Haitian Culture Folk Medicine: • Health care practioners continued: • Bone setters- • They treat musculoskeletal problems. • Their treatment includes casts, massage, manipulation, poultices (soft, herbal treated, warm covering) and prayer. • Injectionists- • They travel from area to area giving injections of whatever is needed. • They use medication and herbal preparations. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

18. Haitian Culture Time Orientation: • Present orientation. • Sense of time management does not emphasize punctuality as this is not seen as an issue. • Do not consider being late for appointments rude. Dietary Habits: • Haitian cuisine has both French and African influences. • Grains are a staple of the Haitian diet. • Rice is eaten at almost every meal and is often cooked with beans and served with sauce. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

19. Haitian Culture Dietary Habits: • Typically the largest meal is eaten in the middle of the day. • Heavy foods are eaten during this time and include: • potatoes, cornmeal mush, and broiled plantains • These foods provide energy for work. • A good amount of spices are used in cooking. • A common Haitian dish is griot: • fried pork cubes marinated in sour orange juice and garlic. • Food is often used to establish relationships and networks with new friends. • Foods have a light or heavy characteristic. • Light foods are eaten at night because they are easily digested. • They include bread and soup. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

20. Haitian Culture Dietary Habits: • Haitians believe there are certain times when a person should not eat hot foods and certain times when a person should not eat cold foods. • For example, if a person was hot from exercise, cold foods will not be eaten. • The belief is that this can throw off a person’s equilibrium. • Some may be reluctant to try new foods. • They believe a healthy baby is a fat baby. • This perspective carries over into adulthood. • Weight is associated with health. • Good nutrition means eating a lot. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

21. Haitian Culture Religious Beliefs: • Religious beliefs affect almost every aspect of Haitian society. • 80% are Catholic • Catholicism is very ritualistic and has adapted itself to local ritual. • 16% Protestant • This culture is most famous for Voodoo and exists side by side with the Christian faiths. • Roughly half of the population practices Voodoo Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

22. Haitian Culture Religious Beliefs: • Voodoo is a fatalistic religion; it is believed that your destiny is controlled by spirits and only by contacting them can you control your destiny. • Voodoo is a mixture of African and Haitian beliefs. • It is made of a large number of spirits who have great influence on people and must be respected. • Daily life is conducted according to what would make these spirits happy. • Voodoo is the national religion of Haiti. • No organized hierarchy or specific theology exists. • To some degree, most Haitians practice or are affected by Voodoo in some way. • Its most important tenant is healing people from sickness. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

23. Haitian Culture Religious Beliefs: • Ministers of Voodoo include priests or houngan and priestess or the mambo. • Their major duties include: • healing • presiding over rituals • foretelling the future • dream reading • spell casting • creating protections • making potions • animal sacrifice Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

24. Haitian Culture Religious Beliefs: • There are two types of Voodoo: • White magic (Rada) – which deals with peaceful worship of happy spirits. • Black magic (Petro) – which deals with angry spirits, death curses and orgies. • This practice only represents 5% of all Voodoo practiced. • Black magic is related to Voodoo like Satanism is related to Christianity. • Many are sensitive to being seen as voodoo worshipers, yet it continues in the U.S. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

25. Haitian Culture Conclusion: • Trust is a key issue with the Haitian culture. • One way to establish trust is to sympathize with the patient and their family and acknowledge specific stressors, which can help calm fears. • Just listening without saying anything can bring positive benefits. • Sensitivity must be given to the specifics of Haitian identity. • Health care providers must recognize Haitians as distinct from other Caribbean people and African Americans. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

26. Reference • Cultural Competency and Haitian Immigrants. Retrieved January 23, 2011 from http://www.salisbury.edu/nursing/haitiancultcomp. • Haiti: A Historical Time Line. Retrieved on March 23rd, 2010 from http://www.theroot.com/views/haiti-historical-timeline?page=0,0 • Jacobson, E. (2003). An Introduction to Haitian Culture for Rehabilitation Services Providers. Retieved January 11, 2011 from http://cirrie.buffalo.edu/monographs/haiti.php. • The World Factbook: Haiti. Retrieved on March 23rd, 2010 from https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858

27. Power Point Presentation Created by: Joyce Cunneen, MSN, RN Fairfield University School of Nursing ELDER Project Education Coordinator Monica Starr, BSN, RN Fairfield University School of Nursing ELDER Project Program Coordinator Supported by DHHS/HRSA/BHPR/Division of Nursing Grant#D62HP06858