Cultural Competency and Haitian Immigrants

 

Health Care Practices ... page 3

Purnell's Model

Overview/Heritage:
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Communication
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Family roles & organization
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Workforce issues

Biocultural ecology

High-risk behaviors

Nutrition
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Pregnancy

Death rituals

Spirituality
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Health care practices
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Health care practitioners

References

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  • Barriers to Healthcare: Barriers to Healthcare for Haitian immigrants are numerous.

    • Language barrier: Unfortunately, unlike Spanish, Haitian Creole is not taught in U.S. schools, therefore interpreters are harder to find. (See communication).

    • Prejudice: Due to the false label of "High Risk for HIV" given to Haitians in the early 1980s, many health care professionals have tainted attitudes towards this ethnic group.4, 21

    • Legal issues: Some Haitians who are in the country illegally may be reluctant to seek care due to the fear they will be deported.17, 65

    • Poverty: If they have to pay for health care, it may not be a priority.52 

    • Rural vs. Urban Origin: The place of origin of Haitians may determine how they use our biomedical health care system. Since there are fewer biomedical health care sites available in rural Haiti, immigrants from rural areas may not be accustomed to seeking healthcare in those settings. Immigrants from urban areas may be more familiar with the clinics and hospitals that are available in the city, and may make the transformation to American healthcare a bit easier.31, 32 

    • Pain: Haitians tend to be very vocal about pain; moaning and complaining are not uncommon. They are described as having a low pain threshold, but are very vague about where the pain is coming from. They believe that the pain affects the whole body system; therefore the origination of the pain source is not important. They prefer injections for pain relief, then liquids, tablets, and lastly capsules.29, 30, 31, 32, 61 

    • Mental illness: Mental illness is not well accepted in the Haitian culture29 and they don’t often utilize the mental health system.66 Due to more prominent physical illnesses, unless mental illness causes a major social disruption it goes unnoticed.61  Mental illness is believed to have supernatural causes such as a hex.29, 30, 32, 61 A person who is suffering from depression may not admit to it, since it carries such a stigma in Haitian culture.29 A Haitian who seeks care from a biomedical practitioner such as a psychiatrist may not think he was treated unless there was evidence that a physical exam was done.

    • Surgery: Abdominal surgery is particularly frightening to Haitians. After the surgery, the patient would prefer to rest until fully recovered. It is necessary to explain the benefits of postoperative mobility and encourage movement.31

    • Reason for Visit: Since Haitians often use vague terms, it may be hard for practitioners to understand the reason for the visit. If the practitioner asks “what do you or your family think you have,” it may help to get to the problem.31

    • Deformities: Physical deformities are thought to be the result of a spell brought on by an angry spirit that may have been conjured by an enemy.29, 32

    • Care of Chronically Ill: Haitians with chronic illnesses are usually cared for at home by family and friends; nursing homes are not usually used. If the person is able to return to his/her roles, they will pay the spirits by having a ritual of thanksgiving.31, 32 The use of a wheelchair to a Haitian means they are very sick, so if it is considered policy for patients to use a wheelchair, the procedure needs to be explained to avoid misunderstanding.31, 32

    • Sick Role: The sick person becomes passive and allows others to help. The family usually comes to the aid of the sick person and will do all they can to be of assistance.29, 30 

    • Organ Donation: Organ donation is neither discussed nor encouraged.29, 30

    Health Care Practices:

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