Haitian Culture: Impact on Nursing Care

Haitian Culture: Impact on Nursing Care

The Republic of Haiti is in the western part of the island of Hispaniola in the West Indies. It is densely populated and has the lowest per capita income in the western hemisphere (Kemp, 2001). The population of more than seven million is made up of mostly descendents of African slaves brought to the West Indies by French colonists. The horrible conditions in Haiti, such as crushing poverty, unemployment and illiteracy, and high rates of acute and chronic illnesses and child and infant mortality, result in the illegal immigration of many Haitians to the United States, France, and other countries in Western Europe. Most immigrants are adults and teens who leave Haiti in tiny boats, despite the risk of drowning and other hazards. According to Pan American Health Organization (PAHO) 2001 statistics, the number of refugees has declined to several thousand per year since the early 1990's.

Nearly all Haitian immigrants entering the U.S. are poorly educated, illiterate, and speak only Creole, which is seldom seen in written form. Creole is a "pidgin" language, meaning it is a simplified form of a base language with parts of other languages added. These types of languages were frequently used by sailors, pirates, and other trade people to accommodate the span of communication needs they faced. Haitian Creole is thought to have been derived by combining various native African dialects with the French language of their owners. Very few Haitians (10%) can actually speak French, and one's ability to do so is seen as an indicator of social class. Because of Haitian views that Creole is the language used by the poor and uneducated, many will claim to be able to speak French and become insulted if it is suggested that they speak Creole. This can pose a problem for the healthcare worker trying to find a way to communicate. Often the only interpreters available to a family are their children who have learned English in schools here. This can create conflict within the family therefore a facility provided interpreter usually produces a better outcome. Written materials are often of no use to the Haitian immigrant.

Socioeconomic status plays a huge part in how Haitians identify themselves, and influences their actions greatly. Many Haitians will nod, smile, and indicate agreement with a person of higher socioeconomic status (such as a healthcare provider) rather than risk conflict or show disrespect or ignorance. When amongst friends, however, they are very expressive and animated, use direct eye contact, and frequently use touch to communicate. Most interactions are very close due to smaller personal space requirements. For these reasons, touch by trusted caregivers is often appreciated.

Religion is very important in the life of a Haitian, especially during illness, death, or other crises. The majority of Haitians (80%) are Catholic, but many of these also believe in Voodou (Kemp, 2001). Similar to Catholicism, Voodou revolves around belief in one central God, called Bon Dieu or Bondye. Religion is often seen as a magical process, and Voodou beliefs include the existence of a spirit world made up of saints, mysteres, or loas. These spirits are mostly the sould of family members and are incorporated into the lives of Haitians. If neglected, malicious ancestors, and the living dead or zombies may appear to the living to bring about illness, death, or other misfortune. Rituals are practices to ensure the relationships with these spirits are protective, or at least not damaging. Loas are thought to be controlled through the magic of Voodou practitioners such as Diviners or Fortune Readers, Shaman, including Rriestess (mambo), and Priest (houngan), Leaf Doctors or herbalists (docte fe), Bonesetters (docte zo), Midwives (matron or fam saj), and Injectionists (pikirist). Practitioners of black magic are called bokors. Most practitioners are paid for their services, and their duties include healing, calming the spirits, foretelling the future and dream reading, creating protections and casting spells, potion making, and presiding over ceremonies in which sacrifices are usually offered. In addition to these spiritual figures, Catholic saints may also be incorporated into religious practices, though they are often called by different names and have different meanings. Because of this intermixing of beliefs, religious symbols may appear to be Catholic, but are actually Voodou.

For Haitians, to have extended family is the ideal, but where immigration is concerned, this is not always possible, as many family members may be left behind. The family dynamic is mostly matriarchal, but the man holds the ultimate power of decision-making in matters outside of the family and is typically the primary wage-earner. Common-law marriage is widely seen, and the woman usually takes the name of her husband and loses her own. There are often inconsistencies in the traditional ways of Haitian childrearing and accepted practices in American culture. Discipline is swift and physical and may be seen as abuse by American standards. Children are seen as a gift from God, and are cherished by the whole community. Family and community are very important to the Haitian people and those who emigrate are often still financially responsible for those left behind. To make up for the loss of family, many Haitians live as groups in the community to serve as a support system for one another, as well as for new immigrants, even if they are not biologically tied to the family.

Health maintenance practices and beliefs vary with education level among Haitians, with those having higher levels of education or experience having also a greater understanding of the basis of illness and modern treatments for such. Those lacking in education are more likely to attribute altered health to external forces (Colin, 1996). For example, illness is often seen as a punishment from God or spirits. Healthcare providers should be respectful of these beliefs and the likely use of traditional healers and remedies along with modern medicine.

Diet plays an important role in the perceived health of a Haitian. Being plump, rather than being thin, is seen as a sign of health and prosperity. Also of great concern is the balance between "hot" and "cold" forces thought to be present in foods. Foods are classified as hot or cold and heavy or light. There are thought to be certain times when you should not eat hot foods (such as after performing rigorous activity) and times when you should not eat cold foods (such as after