Disaster, death, and destruction instantly spring to mind when we hear mention of Haiti in light of recent events. But what of the people, the culture? Especially now, a knowledge of the culture of this “Mountainous Country,” the third largest country of the Caribbean, is so important and intriguing.
Haitian culture is considered so because of the shared knowledge, beliefs, values, language, attitudes, and experiences that exist among the population group there. The people of Haiti associate meaning with learned and shared patterns of communication and information (Hofstede, 1997). They are a national culture in the sense that they identify with Haiti, the nation, and their values and practices, etc. are associated with the country of Haiti as a whole and common among the people who live there as compared to those of other countries. Haitian ethnic culture exists through shared ancestry, history, kinship, religion, language, shared territory, nationality, and often physical appearance.
Here are some facts about Haiti culture…
-When a guest comes over they do not leave empty-handed or without drinking coffee because it is considered rude.
-Haitians find greetings very important. Men will shake hands when they meet and when they leave, men and women kiss each other on the cheek, and women from rural areas will kiss each other on the lips to show friendship.
-Alcohol is not used in excess with men or women. Women drink on festive occasions, and men drink at cockfights, funerals, and festivities. Men smoke tobacco more than women do.
-Both men and women hold hands with friends of the same gender, but don’t show affection in public with those of opposite genders.
-Haggling is very common with loud arguments that are animated and loud. People who are a higher class treat those under them with disrespect. Violence is not common in these encounters but if it is started, then it can quickly become serious. (Schwartz)
Children, starting at the age of 7 or 8, are expected to start working for the family. They perform household chores, such as cleaning, cooking, getting water, and helping with the livestock and garden. Much is expected of these children and they are disciplined harshly. They must show respect to those older then them. There is a difference between these children and those of the elite families, however. Children from the elite family are spoiled and raised to hold this over those less fortunate.
Education is tied to those who have money and is looked at with importance. Haitian who live in rural areas send their children to primary school and if the child excels and the family has enough money then the child’s education is continued and that child doesn’t have to work around the house and their work is split up among the other children. (Schwartz)
Carnival is one of the most celebrated holidays of Haiti. It starts a few days before Ash Wednesday and last three days, ending the Tuesday before Ash Wednesday. Music, parade floats, dancing, and singing are all part of the celebration. Each weekend after this, for all of lent, Rara celebrations happen, also called “Peasant Carnivals” or “Rural Carnivals.” They are shows of Voodoo society filled with music and dancing through the streets. They represent strength, health, vitality, and wealth. (Earth)
The following are holidays celebrated by the Haitian people.
-3 Major Feasts
Carnival, Good Friday and Easter
January 6 Epiphany (Catholic)
January 25 Annunciation (Catholic)
April 30 Feeding the Dead (Voodoo)
Feeding the Deities May 12 (Voodoo)
Notre Dame de Lourdes August 15 (Catholic)
All Saints Day –All Souls Day November 1-2 (Catholic)
Immaculate Conception Dec. 6 (Catholic)
Feeding the Sea Dec 12-14 (Voodoo)
Christmas Day (December 25).
-Secular holidays include Independence Day (January 1), Ancestors Day
(January 2), Agriculture and Labor Day (May 1), Flag Day (May 18)
anniversary of the death of Jean-Jacques Dessalines (October 17,), United
Nations Day (October 24), and Battle of Vertieres Day (November 18).
Following the death of a person there is ritual wailing by family, friends, and neighbors. Funerals last for several days and are an important social event, with feasting and drinking rum. Family travels from far away to stay at the house during this time. The women cook, while the men play dominoes. After the funeral there is the priè, which last for nine nights. This time is full of socializing and rituals. All of this is very expensive and so is the actual burial. Haitians want to be buried “above ground in a kav, an elaborate multi chambered tomb that may cost more than the house in which the individual lived while alive” (Schwartz).
Sense of self
About 95% of Haitians are of African descent leaving the other 5% white or half white. Haitians gained independence in 1804 from the French. Many of those fighting for independence were former slaves. This independence is extremely important, it was “an event that made Haiti the first independently black-ruled nation in the world, and only the second country in the Western Hemisphere to achieve independence from imperial Europe” (Schwartz). Haitians continue to have a strong sense of nationalism. Two important national symbols include their “flag, Henri Christophe’s citadel and the statue of the “unknown maroon” (Maroon inconnu ), a bare-chested revolutionary trumpeting a conch shell in a call to arms” (Schwartz).
Sense of Space
Eye contact and personal touch does not invade Haitian’s sense of space. They use touch as a form of friendship when having a conversation. They also gain attention and respect from a person by their use of eye contact. (Giger)
Marriage varies between the elite and non-elite classes, “less than forty percent of the non-elite population marries” while most of the elite marry (Schwartz). Formal marriage is not needed for a union. The union is made complete when a man builds a house for the women and a child has been born. When marriage does happen it is usually later in life, when their children are becoming adults. About 10 percent of men have more then one wife. This is not legal but is allowed by the community. Sometimes the wives will live in separate houses, each given by the husband. The other times, for the wealthy and urban class and usually with less fortunate women, separate housing is not provided for the wives. (Schwartz)
In non rural areas, men are expected to work outside of the house, while women are expected to do house work. Men in Haiti hold most of the jobs including jewelers, doctors, teachers, and pastors. Women have been able to work as professionals in the medical field, however. Men are also responsible for taking care of livestock. Women mostly do the cooking and cleaning. In the rural areas women also help with water, firewood, and harvesting and can be so involved with the harvest that they are in charge of it along with marketing it. This leads to them controlling the house earnings. (Schwartz)
Men sing vodou chants as they work: http://www.youtube.com/watch?v=Ozeys_EMwxE
In Haiti the official religion is Roman Catholic, but voodoo is a major religion there as well. Many people in Haiti beleive in a combination of these two religions. The last major religion is Protestant. Protestants do not mix their religion with voodoo.
Voodoo is seen as a religion where they serve spirits called loua. Certain spirits protect the children. In return for the protection families must feed their spirits through offerings to the spirits. These offerings are performed at certain times, usually on the family’s land. One service is held once a year and the other is held about once a generation. If a family is poor, they may not perform these services until they feel they need to repair a relationship with their spirits.
Protestant churches provided needed services to the lower class before Roman Catholics did, and they were in small villages. Many Haitians converted to Protestant as either a way to reject thier spirits who hadn’t protected them or as extra protection against misfortune. Since the 1950 Protestantism has been focuesd on the middle and upper class with about 20% of the populations following this religion (Richard).
The two main languages of Haiti are Creole and French. French has been considered the official language of Haiti but mostly used by the higher class and the government. Only about 5-10% of people speak French (Schwartz). Creole, even though it is spoken by most of the population, has had trouble becoming an official language. It has been seen as a non-language by many Haitians because it seems to have a lack of rules. This made Creole not as valuable and it built an illusion of wonder around French, though most Haitians did not feel comfortable speaking it. It was not in text until 1925, and in 1987 Creole finally became an official language (Richard). It is now used in the upper class and on radio and television. English is becoming a common language with the emigration of Haitian to the United States and with the ability to watch cable television from the United States (Schwartz). Also, the increase in trade with the United States has made English important to know and more easily accessible. Spanish is being used more as people migrate to the Dominican Republic (Pike).
The communication styles of Haiti are ones much like the United States. People of authority keep a formal distance. Eye contact and gestures make conversation friendly, along with humor. It is inappropriate to point. (Centre) Shaking hands is an appropriate greeting for men and strangers. Different from the U.S. is that when women and youth meet elders and friends with a kiss on the cheek and even if a man is a friend of a woman it is not appropriate to hug. Also, children use the term “Auntie” and “Uncle” for adult friends. (Colin)
The Haitian culture sees time as a flexible thing. It isn’t impolite for people to arrive over an hour late to a festivity or appointment, however, if the appointment time is stressed like for a medical appointment then the person does show up on time.
Once a boy and girl start dating, he will build a house for her after her first born. Marriage occurs later in the relationship after their family has a solid foundation and the children have matured. The house is usually built on the Males parent’s property. Sometimes men have multiple wives, despite breaking the law, but it is not very common. Although the women are the decision makers of the property and are in control financially, the man is the owner and must do yard work and manage the cattle. (Culture of Haiti).
When a women gives birth to a child she may not start breastfeeding until a day or two after because of a tradition linked back to western nurses. After about two weeks liquid nutrients are introduced to the baby and they are weaned off breastfeeding. On the 30th day, food is usually set up to establish a normal pattern in the babies life. Although these practices in Haiti vary, breastfeeding is almost always discontinued by the babies 18th week of life (Culture of Haiti).
Live stock is very important in Haiti and is managed by the father or the male of the household. Children are also responsible for this type of work at about age seven or eight. They are to collect firewood and do household chores as well (Culture of Haiti). Many of the income come from selling food and harvest to tourists and other locals in the capital. During this time, clothing and other handmade items are sold (Food in Haiti).
In Haiti learning and education is highly valued. Ninety percent of primary schools are private education sectors and require fees for textbooks, uniforms, supplies and other miscellaneous items. However, only about thirty five percent of the students will complete this level of education. Secondary school is very expensive and many Haitians cannot afford it. In Haiti, there is a private and a local state university, which includes a medical school but they only consist of a few thousand people. Usually only the elite attend college, which is less than 30% of the Haitian population. (Bureau of Western Hemisphere Affairs, 2009).
Haitian food differs from other Caribbean flavors because of the addition of pepper and the influence of French and Creole cooking techniques. Another way the Haitians add flavor to their meals is by frying them in pig fat. Locally grown foods are eaten in large amounts such as “rice, corn, beans, millet and yams” (Culture of Haiti). A famous Haitian dish that is usually served for lunch on Sunday afternoons is called “Soup jomou” which is a type of pumpkin soup. Meat and sweet desserts are only popular within the elite crowd of Haiti. “Riz et Pois” is the nation’s most famous dish, consists of rice and beans and is commonly eaten. Exotic fruit juices are homemade using fresh fruit, such as mangos and coconuts that are grown due to the amazing tropical climate. Another way the Haitians celebrate their culture is by attending a harvest festival in November that lasts 2 days. “Manger-Yam” celebrates the importance of yam in the Haitian diet by singing, dancing, drinking and feasting. (Food in Haiti)
Literature focuses little on current dress, but Haitians appear to favor American clothing styles in many areas. Women most often are seen in dresses and skirts as opposed to pants, and while their attire is appropriate for the climate, they tend to dress more on the conservative side in length. The pictures below illustrate the attire one might see in Haitian culture.
Haitians in the United States
Terrazas states that of Haitians abroad, the largest concentration in one country is that here in the United States (2010). The 2008 American Community Survey reports that in 2008, the United States was home to about 535,000 foreign born Haitians, a number which equals about one in twenty of the total population census of Haitians. According to Terrazas (2010), that number has increased since then, and is predicted to continue to do so at an accelerated rate in light of the devastating earthquake of January 2010. Over 79% of these resided in New York or Florida, and over 75% in five metropolitan areas, including New York City and Miami. More than one-fourth of the Haitian immigrants living in the US arrived here between now and the year 2000. In 2008, there was a larger women to men ratio, almost half were proficient in English, albeit limited, and almost half were college educated to some degree (Terrazas, 2010). Immigrants from Haiti were less likely than other immigrant groups to live in poverty and more likely to be naturalized and more Haitian women to participate in the civilian labor force than other immigrant women. Of the Haitian men employed in the US, almost half work in services, construction, extraction, and transportation, and over a quarter of the US workforce of Haitian women are employed in healthcare support. In 2008, the census of legal Haitian residents in the United States was 230,000, and the 2000 Census estimated about 76,000 illegal immigrants (Terrazas, 2010).
|Table 1. Total and Haitian Foreign-Born Populations, 1960 to 2008|
Table 2. Occupations of Employed Workers in the Civilian Labor Force Age 16 and Older by Gender and Origin, 2008
Source: 2008 American Community Survey.
LET’S TALK ABOUT HEALTH CARE
Discrimination – An Issue?
Discrimination is going to be a problem in any health care scenario where a person tends to be different from the rest of society because of an illness, disease, or deformity. Not only is this discrimination going to affect one’s self esteem and activities of daily living, but it is also going to affect one’s financial life, decreasing the likelihood that they will receive a job. “In Haiti, if you’re an amputee you don’t exist; you’re a burden to society and to your family–people do not have time for you” (Padgett 2010). Especially since the traumatic earthquake that hit this country in 2010, the rate of amputees increased dramatically due to the damage of the falling city. One of the reactions from the amputee victims after the earthquake once realizing he was going to be an amputee in society was “people are going to think I’m a freak!” (Padgett 2010). His life will unfortunately be changed forever as he becomes an outcast from the place he calls home.
Not only is discrimination a problem with a physical deformity, but it is also a problem with illness and disease; mainly TB and AIDS, the two most common diseases present in the Haitian culture. “Some Haitians view illness as punishment or an assault on the body” (Mangan 2009, 7). In people with AIDS, discrimination varies from just an illness to condemnation from the spirits. Many view people with AIDS as “souls of infected individuals have been stolen and replaced with those of the dead” (Mangan 13) while others view these individuals as virus carriers and may “experience discrimination related to housing or employment, physical isolation by others, or being provided with separate eating utensils, blankets, and clothing” (Mangan 13). In general, “Haiti was one of the first countries recognized with AIDS and named as a high risk group, and they are blamed for the spread of HIV/AIDS” (Dancy & Santana 2000, 162). This is definitely one of the greatest acts of discrimination towards the Haitian culture.
Tuberculosis, or TB, is another disease that also causes discrimination by the surrounding society because it is such a communicable disease. “TB patients are required to stay in a separate house and not permitted to eat with others…family and community members may not speak to a person diagnosed with TB…this isolation or shunning is considered humiliating” (Mangan 9). Not only does society discriminate against these individuals diagnosed with TB, but family is also part of the practice of shunning. It appears to be very humiliating for the family that one of their members have become so ill. However, “if the person’s TB disease is thought to have a supernatural cause, the patient may be given sympathy and experience less discrimination” (Mangan 9).
Haiti vs United States – What’s the Difference?
The health care environment greatly depends on the availability to resources; both medical and not. Resources other then medical, including education, money, and sanitation, are what is going to make a better quality health care practice that is going to benefit the Haitian culture more effectively. However, with extreme poverty, lack of resources, and unsanitary conditions, the Haitian culture seems to lack many things necessary in order to treat, diagnose, and advocate for their people. In comparison to the United States’ culture, this Haitians are being overtaken by illness, disease, and infection causing more suffering on their behalf. Without the supplies and resources, they will continue to struggle to support themselves and their health will continually decline.
In the United States’ culture, one of the things greatly valued would have to be sanitation. Not only are all the facilities very sanitary, but there are plenty of clean water and supplies for every patient that requires health care treatment. According to the American standards, the Haitians provide health care in “shacks comprised of nothing more than a concrete shell with a tin roof, open windows with no screens, and doorways that have nothing more than an old curtain for privacy” (Beaton 2007, 445). One from America would say that their hospital looked like “one from the 1900’s” (Beaton 445). Water retrieved for sanitary purposes is polluted increasing the risk for infection and disease causing their culture to be infected with diseases that are not commonly seen in the United States. Not only are the health care facilities unsanitary, they also seem to be very scarce across this country.
“Health care facilities tend to be in more urban areas” (Beaton 446), however, for the population that does not tend to live near the urban areas, it becomes quite difficult for them to reach the health care treatment that they are needing. While health care facilities tend to be in the urban areas in the United States’ culture as well, there are many more of them available to the population and transportation to these facilities is more advanced in our culture. Because of the inability to access health care facilities, Haitians can go undiagnosed and untreated for long periods at a time contributing to their tendencies to have poor health. “For Americans, taking ibuprofen for pain seems so simple, however, for Haitians, they get sent home without relief only to suffer even more” (Beaton 446). Lacking supplies is a huge factor involved in denying this culture health care. Without the resources and funding, it is near impossible to support clinics for all the people that are seeking help. They are unable to support the large population with weakened health. ” Within Haiti, health centers are seriously understaffed and lack needed supplies. These
centers have received criticism for not treating patients with respect and dignity, as well
as non-treatment of patients” (Mangan 2009, 8).
In Haiti, if one is able to finally reach a health care facility before their illness has progressed, they still may not be able to obtain the help that they are need. Usually when one arrives at a health care facility, there are “long waiting times that can last up to six hours” (Beaton 447). In the United States’ culture, if one is in need of health care, there is always the hospital or doctor’s office that we can go to by making an appointment. “Punctuality is not an important value in Haiti, and Haitian patients may not keep
appointments” (Mangan 15). However, if one of those is not available, there is always the emergency room that will provide care to everyone based off the intensity of the illness or emergency. In the United States, there also tends to be plenty of doctors or medical staff that can assist them in some way. In Haitian health care, “the doctor is only there about once a month and no one really ever now when he’s going to be there” (Beaton 447). If this is the case, one is never guaranteed to get the treatment they need and is not going to benefit and improve the health of this culture. Unless a patient has a positive experience at a health center, they will most likely seek care from traditional healers instead of returning to health centers” (Mangan 8).
Risky Business – Health Risks in Haiti
As in any other culture, the Haitians live their lifestyles in ways that may propose risk to their health. “Social drinking is common in the Haitian culture” (Cook Ross Inc. 2010, 35) which can increase the risk for liver failure, obesity, and hypertension if one practices social drinking fairly common. Smoking is also another common practice that occurs in the Haitian culture. “Serum cotinine levels are higher in African Americans causing them to have a 50% more likelihood of developing lung cancer” (Cook Ross Inc. 35). Exercise is necessary in order to prevent many health related diseases from occurring. However, “exercise as disease prevention and health promotion is not a usual part of Haitian life” (Cook Ross Inc. 35). While they may be involved in physical activities including some sports and dancing, these activities “are not encouraged until it is part of a prescribed treatment regimen” (Cook Ross 35). It has been said that too much exercise may actually cause illness causing the likelihood of participation in exercise will be much lower than it actually needs to be. ” What is considered normal body weight by Haitians may seem to be overweight by other standards and that a moderate amount of body fat is considered healthy” (Cook Ross Inc. 36). It is believed that fat is beautiful and wealthy, while thin people are considered to be sickly and malnourished. Because of the way that this culture chooses to live, an increased risk for metabolic syndrome has become widely spread and encompasses all their lifestyle factors, putting them at greater risk for this disease. These men and women are then “placed at a higher risk for heart disease, stroke, and diabetes” (Cook Ross 36).
Some of the beliefs by the Haitian culture also compromise their health due to lack of knowledge of maintaining a healthy lifestyle. “Many diseases go undiagnosed or untreated because of their mistrust of health care providers” (Cook Ross 37). They fail to comply by denying health screenings which ultimately will help diagnose, treat, or even prevent diseases from occurring. “They feel that because screening has not been specifically recommended by the doctor or because they do not present any signs or symptoms that it is unnecessary to undergo any sort of screening” (Cook Ross 37) ultimately putting their lives at risk for further complications and death. The traditional Haitian concept of health is based on the balance of equilibrium of several factors: “proper diet, cleanliness, exercise, adequate rest, staying warm, prayer, being in harmony with friends and relatives, and good rapport with the spiritual world” and that illness occurs because of the “wrong doing, excessive anger, fear, and sadness, or curses by angry people” (Cook Ross 37). It is very apparent that they have many spiritual and emotional beliefs that are going to contribute to health and that they can prevent health issues if they maintain these beliefs.
The No-No’s: Cure to “Foot-in-Mouth Syndrome”
The predominant religion in Haiti is Roman Catholicism. Of the countries population, 80%-85% of the population is Catholic. Therefore, it would be very unwise to talk down or bad about the Catholic religion, because most likely you will be talking to a Roman Catholic Haitian. In the country, there is also a lot of government corruption and political division. As a visitor to Haiti, talking about politics would be an area to steer away from in conversation. Their country is not as developed as out country is, Haiti is still a third world country, so being safe and being conscious of who you are in conversation with would be very wise on your part.
5 Things to Know About Providing Healthcare to a Haitian
1. While working with individuals from who identify themselves as being part of the Haitian culture, Health care workers should know that Fathers play a very important role in the young lives of children from Haitian villages. The Haitian Health Foundation (HHF) set up a study in 23 different Haitian villages, to determine whether establishing Fathers’ clubs would help improve the health of children in Haiti or not. A Fathers’ clubs focuses on the health education in families and especially with children. The results of the study found by HHF was reported as, “After adjusting for socioeconomic status and the quality of the village health agent, we found that being born in a village with a fathers’ club had statistically significant positive effects on vaccination status at 1 and 2 years of age, vitamin A supplementation at 1 year of age, and growth monitoring at 1 and 2 years of age (Table 1). Two year- olds born in villages with fathers’ clubs were 2.6 times more likely to be fully vaccinated than were 2-year-olds born in villages without fathers’ club…”(Soland & Gebrian, 2010). This study done by the HHF, shows that having Fathers’ clubs and that role of protection of health for children in Haiti, significantly increases the children’s health and mortality.
2. Another important fact for nurses or health care worker’s working with patients from the culture of Haiti, is that maternal syphilis is prevalent in rural Haiti. This has been found to be true because late prenatal care. A study was done with 5 rural Haitian villages. The data was collected from Haitian Health Foundation’s public health records. The results that were founded were reported as that there is a high rate of maternal syphilis that usually resulted in a bad pregnancy. There were also high outcomes of congenital syphilis which led to active teaching to Haitian mothers about seeking prenatal care. So as a nurse, emphasizing the importance of seeking prenatal care while pregnant.
As a health care worker or nurse working with people who are from the Haitian culture, it is important to recognize that sexual health practices is a topic that needs to be taught widely. Teens in Haiti have been found to be quite sexually active so it is important to be proactive about teaching about safe sex practices, about sexual violence, and about sexually transmitted AIDS (Gómez, Speizer, & Beauvais, 2009).
Health care workers should also be aware of the high possibility of a mother transferring HIV/AIDS to her child in the Haitian cultures. There are studies and researches being conducted on ways of preventing the transmission of HIV from mothers to babies since there is such a high rate of this occurring in Haiti. The main methods of effectiveness in preventing this from occurring is education, prevention, early HIV testing, and by providing these types of services to all parts of Haiti, not just the main city areas such as Port-au-Prince (Deschamps, et al., 2009). As a nurse working with patients of a Haitian culture, it would be important to know the education and testing for HIV would be a priority or services to provide to your patient.
With the earth quake in mind that just recently hit Haiti, a lot of the population is now facing severe stress disorders. The natural disaster that has befallen them all has created a major life change that none of us can imagine. When an individual is faced with such stress, it would be hard to believe that they aren’t faced with great problems of stress. As health care workers, this factor would be important to keep in mind. Many of the Haitian residents could now be facing severe post traumatic stress disorder. Documenting their symptoms and characteristics of this disorder can help with the treatment that we could provide to these individuals.
Healthcare Response in Haiti: http://www.youtube.com/watch?v=VIHIjWiWu5U
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