Haitian Community Research Articles

Cancer Screening and Haitian Immigrants: The Primary Care Provider Factor

Haitian immigrants, among the fastest growing immigrant communities in the United States, have low cancer screening rates. Several patient barriers have been identified and associated with low screening rates but little is known on provider barriers for cancer screening. To address this gap, we assessed the cancer screening practices, attitudes, and beliefs of primary care providers serving the Haitian community. We surveyed a random sample of physicians serving first generation Haitian immigrants in New York City, identified through their zip codes of practice. Participants completed a questionnaire to assess their beliefs, attitudes and practices surrounding cancer screening, and their perceptions of patient barriers to screening. 50 of 87 physicians (58%) consented to participate in the study. Cancer site-specific and overall cancer screening scores were created for breast, cervical, and colorectal cancer screening. 75% of providers followed breast cancer screening guidelines, 16% for cervical cancer, and 30% for colorectal cancer. None of the providers in the sample were following guidelines for all three cancer sites. Additionally, 97% reported recommending digital rectal exam and PSA annually to patients 50 years or older with no family history, and 100% to patients over 50 years old with family history. The reported practices of providers serving the Haitian immigrant community in New York City are not fully consistent with practice guidelines. Efforts should be made to reinforce screening guideline knowledge in physicians serving the Haitian immigrant community, to increase the utilization of systems that increase cancer screening, and to implement strategies to overcome patient barriers.

Sucking salt: Caribbean women writers, migration, and survival

It is a persistent image in Caribbean literature. But for Caribbean women especially, - particularly the image of - has long signified how they have endured hardship and found ways to transcend it. In this study of Caribbean women writers, Meredith Gadsby examines the fiction and poetry of both emigrant and island women to explore strategies they have developed for overcoming the oppression of racism, sexism, and economic deprivation in their lives and work. She first reviews the cultural and historical significance of in the Caribbean, then delineates creative resistance to oppression as expressed in the literature of Caribbean women writing about their migration to the United States, Great Britain, and Canada. From British poet Dorothea Smartt to Edwidge Danticat of New York's Haitian community - and with a special emphasis on the creative artistry of Paule Marshall - Gadsby shows how through migration these writers' protagonists move into and through metropolitan spaces to create new realities for themselves, their families, and their communities. Her work draws on critical and ethnographic studies as well as creative works to take in a range of topics, not only considering the salty sexuality of calypso songs and offering new insights into Jamaican slackness culture but also plumbing her own family history to weave travels of her mother and aunts from Barbados into her studies of migrating writers. Through these close readings, Gadsby shows that Caribbean women express complex identities born out of migration and develop practical approaches to hardship that enable them to negotiate themselves out of difficulty. Her innovative study reveals that sucking salt is an articulation of a New World voice connoting adaptation, improvisation, and creativity - and lending itself to new understandings of diaspora, literature, and feminism.

Entre convergences et divergences : la communauté haïtienne de Montréal

In Canada, multiculturalism which was officially adopted in 1971 has been debated for several years, mainly as regards the consequences of excessive pluralism and the free expression of ethnic differences on the national cohesion and on the coherence of citizenship. Is ethnic divergence compatible with social convergence? Could this association lead to a more productive definition of a multicultural Canada and unveil a new conception of Americanness? Beyond a traditional geographic or monocultural meaning, the notion of Americanness could be regarded today, in a pluralistic context, as an identity duality, as a compromise between distinction and borrowing. The perceptions of the Haitian community of Montreal as regards its adoptive country (Canada, Quebec and Montreal) were useful to specify this new definition. As regards the elements of discourse gathered during individual interviews conducted with the members of the first generation of Haitian immigrants, an identity pattern can be observed, matching two different and yet complementary systems of functioning: detachment and symbolic recognition

Haitians in New York City: Transnationalism and Hometown Associations (review)

Francois Pierre-Louis Jr., Haitians in New York City: Transnationalism and Hometown Associations. Gainesville: University Press of Florida, March, 2006,160 pp. Haitians in New York City is an admirable effort to reveal dimensions of the Haitian immigrant experience in the United States that have yet to receive full scholarly attention. Building upon the pioneering work of Basch, Click Schiller, and Blanc (1994), Chierici (1991), Laguerre (1984), Miller (1984), Glick Schiller and Fouron (2001), Stepick (1998), and Stepick and Portes (1994)-works on the immigrant experience that highlight the challenges Haitians have faced to find political and economic security, and recognition as rights bearing subjects deserving of asylum in the U.S.-Pierre-Louis reveals the way that segments of a more established Haitian community have achieved a transnational lifestyle and identity that transcends the so-called boundaries of the state. The Haitian communities in the U.S., and in particular in New York, are gaining ground as viable political forces whose influence is growing both at home in Haiti, and at home (4) in the United States. Integral to Pierre-Louis's analysis are questions about the state itself as a political entity and the challenge that individuals' transnationalism poses to the power of either the sending or receiving state. It is crucial to note that Pierre-Louis is writing from the discipline of political science rather than anthropology. He also writes from his own experience as a Haitian immigrant to the United States who has successfully forged the path of transnational citizenship. Although his study does employ both qualitative and quantitative methods, it is not for the most part ethnography in the traditional sense that would employ life histories or extended exposes of individuals, or that would provide extended processual analyses of historic events (with the exception of the concluding chapter). Nor is it exactly a history. While the entity of study through which Pierre-Louis discusses these issues is the hometown association, what is presented is a meditation on Haitian history, politics, and the transformation of its diasporic citizenry from the late twentieth to early twenty-first centuries. Pierre-Louis's history of activism with the Haitian refugee population in the U.S. and his insider position as a member of former President Jean-Bertrand Aristide's first cabinet certainly provide much of the source material for the book's statements about the Haitian experience and the political and economic upheavals that Haiti continues to experience. Chapter one gives a short overview of how Mexican, Dominican, and Haitian immigrant associations flourish to different degrees according to the politics of their reception by the United States, as well as the extent to which immigrants are focused upon integration with their host country or to politics in the sending state. Indeed, sending states also vary in their capacity to support or partner with hometown associations. According to Pierre-Louis this difference correlates with the level of democracy and effective bureaucratization the sending state has achieved. He makes the crucial point in this chapter that not only do hometown associations act as political forces in the sending state, strengthening links between nongovernmental associations in Haiti and in the U.S., they are also crucial tools for maintaining and reinforcing the distinctiveness of the ethnic group. In the Haitian case asserting linguistic and cultural difference from other groups of African descent is a strategy to shield the community from the racial oppression historically targeted towards African Americans, a point to which Pierre-Louis returns throughout the book. They have increased from ten associations in the 1970s to forty plus organizations in the year 2000, an increase that may indicate as much about the Haitian community's need for support in New York City as it does about the increased possibility to act transnational in Haiti. …

Community health workers as a cornerstone for integrating HIV and primary healthcare

Haiti is the poorest and most heavily HIV–burdened country in the Western hemisphere, with even less health infrastructure than many countries of sub-Saharan Africa. Since the early 1980s the HIV epidemic has affected the poorest communities in Haiti, who lack access to even basic healthcare. Large-scale HIV treatment requires that basic healthcare services be built and scaled up simultaneously with HIV-prevention and -care programmes. Such improvement in access to general healthcare will require substantial investments in health infrastructure, service delivery and human development. This study describes the contribution of the non-governmental organization, Zanmi Lasante (ZL) to the HIV prevention and treatment scale-up and to the ongoing efforts to improve primary healthcare (PHC) services in the public health system in Haiti. The model depends on community health workers (CHWs) who supervise antiretroviral therapy (ART) and provide community outreach, including active case finding and outreach to marginalized populations. Zanmi Lasante has recruited, trained and financed a large cadre of CHWs to provide such linkages between communities and health centres in rural Haiti. The study analysed key components of their work—their self-perception, their role in enhancing community uptake of services and their role in targeting vulnerable groups. We found that most patients at risk were properly identified at a community level. The CHWs are facilitating the uptake of PHC services, including by the most vulnerable households. The general training of CHWs has created a positive self-definition in these cadres of their medical, patient support and health service roles; although with some variability across different groups. The results of this study will be used to emphasize, standardized and strengthen the biosocial training of CHWs.

Anti-Haitianism, Historical Memory, and the Potential for Genocidal Violence in the Dominican Republic

Following the 2005 murder of a Dominican woman near the border between the Dominican Republic and Haiti, Haitian communities were deported en masse and their homes violently ransacked by Dominican civilians seeking revenge. These violent expulsions were not only human-rights violations but part of a historic pattern of anti-Haitianism in the Dominican Republic that originated in the nineteenth century. This article calls attention to the possibility of genocidal violence in the Dominican Republic by examining the violent 2005 attacks on the Haitian community there. It suggests that an anti-Haitian legacy that includes the 1937 Haitian Massacre and the contemporary and systematic denial of Dominican citizenship to Dominicans of Haitian descent are important but understudied indicators that raise the potential for an escalation of mass violence against the largest ethnic and racial minority in the Dominican Republic.

Birth Defects as an Indicator of the Health Status of Haitian Women and Their Children

This study focuses on the incidence of birth defects among children born to Haitian women in Florida. Analysis of comparative data collected by the Florida Birth Defects Registry indicates a disproportionate rate of birth defects among babies born to Haitian women. Sociocultural and economic characteristics of the Haitian community and their relationship to birth defects are explored. The implications of the findings for public policies that address prenatal care and childbirth- related problems are discussed.

Anti-Haitianism, Historical Memory, and the Potential for Genocidal Violence in the Dominican Republic

Following the 2005 murder of a Dominican woman near the border between the Dominican Republic and Haiti, Haitian communities were deported en masse and their homes violently ransacked by Dominican civilians seeking revenge. These violent expulsions were not only human-rights violations but part of a historic pattern of anti-Haitianism in the Dominican Republic that originated in the nineteenth century. This article calls attention to the possibility of genocidal violence in the Dominican Republic by examining the violent 2005 attacks on the Haitian community there. It suggests that an anti-Haitian legacy that includes the 1937 Haitian Massacre and the contemporary and systematic denial of Dominican citizenship to Dominicans of Haitian descent are important but understudied indicators that raise the potential for an escalation of mass violence against the largest ethnic and racial minority in the Dominican Republic.

A FAMILY STUDY OF LYMPHEDEMA OF THE LEG IN A LYMPHATIC FILARIASIS–ENDEMIC AREA

The risk of filarial lymphedema may not be equivalent for all members of filaria-exposed populations. While evidence for a genetic factor that influences acquisition of infection has been growing, very little work has addressed whether there is a genetic basis to the development of disease due to lymphatic filariasis. We designed a family study of lymphedema in a rural community in Haiti to assess disease aggregation. Three hundred sixty-eight female patients sixteen years of age or older were enrolled at a lymphedema treatment clinic between June 1995 and December 1999. After applying additional eligibility criteria, 172 probands were enrolled into the family study for detailed pedigree collection between September 1998 and December 1999. Fifty-three lymphedema cases were identified among the probands' parents, full-siblings, children, half-siblings, and mating partners of the parents. Twelve of the 53 cases were among males. The proportion of cases occurring in a biologic parent of the proband was higher than in unrelated individuals married into the proband's family (P = 0.0010). This is the first large family study based on pedigrees to assess the familial aggregation of lymphedema due to filariasis. This family study will be useful to investigate the role of genes and environment in the development of filarial-related lymphedema.

ASSESSMENT OF FAMILIES FOR EXCESS RISK OF LYMPHEDEMA OF THE LEG IN A LYMPHATIC FILARIASIS-ENDEMIC AREA

The influence of host genes on the distribution of lymphedema due to lymphatic filariasis is unknown. To assess this, pedigree and disease information were collected from lymphedema patients in a lymphatic filariasis-endemic area. These patients were female, with an average age of approximately 40 years, who were enrolled between June 1995 and July 1999 in a lymphedema treatment clinic, and from the rural Haitian community served by the clinic. Interviews were conducted between September 1998 and December 1999. Families with multiple lymphedema cases were of similar size, with an average of 15 members, as those families with only a single lymphedema case. We determined whether families observed to have multiple lymphedema cases had a higher prevalence of lymphedema than expected when stratified population estimates and family size were considered. Lymphedema of the leg was excessive in 15 of 43 families with multiple lymphedema cases. The number of families demonstrating excess disease was significantly different than was expected based on population estimates of lymphedema prevalence (P = 0.026). Families with multiple cases of lymphedema were not significantly larger in family size than families with a single lymphedema cases. Twelve of the 15 families had a male with lymphedema, which influenced the interpretation of the results. The significance of these results is discussed.

Immigrant households and hardships after welfare reform: a case study of the Miami‐Dade Haitian community

Compared with other nations such as Canada and Australia, the US experiment with welfare reform has yielded steeper and more immediate caseload declines. These declines have been especially pronounced for immigrants who have been subject to a new set of service restrictions implemented under the 1996 Welfare Reform Act. This article examines service access for Haitian immigrants in Miami, Florida since the onset of these reforms. The data presented here are derived from a series of qualitative interviews with Haitian service professionals and a quantitative survey of Haitian immigrant households. The survey data indicate that many Haitians who are living in poverty and qualified to access services are not enrolled for government services. Confusion over eligibility guidelines explains some of the variation of these low enrolments for specific services (such as child health insurance and childcare) but not for services most commonly used by immigrant adults such as food stamps and Medicaid. The survey also demonstrates that qualified immigrants living in households with unqualified persons are less likely to access services than are other qualified immigrants and are more likely to experience hardships that impede their ability to find stable employment. The concluding discussion highlights the significance of using a household unit of measure in assessing immigrant enrolments and hardships.

Epidemiology of Cyclospora cayetanensis and other intestinal parasites in a community in Haiti.

We conducted an exploratory investigation in a community in Haiti to determine the prevalence of Cyclospora cayetanensis infection and to identify potential risk factors for C. cayetanensis infection. In 2001, two cross-sectional stool surveys and a nested case-control study were conducted. In 2002, a follow-up cross-sectional stool survey was conducted among children < or =10 years of age. Stool specimens from study participants and water samples from their wells were examined for Cyclospora and other intestinal parasites. In stools, the prevalence of infection with Cyclospora in persons of all ages decreased from 12% (20 of 167 persons) in February 2001 to 1.1% (4 of 352 persons) in April 2001, a 90.8% decrease. For children < or =10 years of age, the prevalence rates were 22.5% (16 of 71 children) in February 2001, 3.0% (4 of 135 children) in April 2001, and 2.5% (2 of 81 children) in January 2002. Use of the water from the artesian well in the northern region of the community versus the one in the south was the only risk factor associated with Cyclospora infection in multivariate analyses (odds ratio, 18.5; 95% confidence interval, 2.4 to 143.1). The water sample from one of the nine wells or water sources tested (one sample per source) in January 2001, shortly before the investigation began, was positive for Cyclospora by UV fluorescence microscopy and PCR. None of the water samples from the 46 wells or water sources tested during the investigation (one sample per source per testing period, including the artesian wells) were positive for Cyclospora. Further studies are needed to assess the role of water as a possible risk factor for Cyclospora infection in Haiti and other developing countries.

Powerful Partnerships

ABSTRACT Using a multi-cultural, inter-generation partnership model, undergraduate students participated in a service learning collaborative project with immigrant and refugee youths. Recognizing the multiple issues facing newcomers to this country, the collaborative attempted to teach community problem solving and cross cultural leadership skills while promoting civic participation. The youths from Cape Verdian, Haitian, and Somalian community agencies identified a problem area: the public education system, specifically, accessing services and knowing one's rights. Both groups of students worked as partners conducting needs assessments, researching information and creating a booklet for use by parents and students. In addition to meeting specifically identified needs, the project heightened ethnic pride and inter-generational understanding for all participants.

Drug and Alcohol Use Among Boston's Haitian Community: A Hidden Problem Unveiled by CCHER's Enhanced Innovative Case Management Program

SUMMARY This article discusses the Enhanced Innovative Case Management Program of CCHER, Inc., a community-based agency serving Boston's immigrant Haitian population living with HIV/AIDS. A psychosocial educational counseling program of 25 topics was created to address psychosocial needs of Haitian HIV consumers. Counseling sessions are one-to-one, in Haitian Creole. A pre-post evaluation design assesses the effectiveness of the curriculum in relation to the objectives of the project. The project has allowed CCHER to identify complex substance abuse issues and as a result has enabled the agency to address substance abuse among Haitians and plan culturally appropriate educational, outreach, and counseling strategies for Haitian substance abusers and community members.

Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy).

In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.

Impacts of Welfare Reform on Families with Haitian Backgrounds

During 1997 and 1998 I did field work on the influences of social networks on the school experiences of children of Haitian immigrants in the Tampa Bay Area. I had many opportunities to interact regularly with children and their caregivers. Rather than living in one neighborhood, the Haitian community was dispersed in the Tampa Bay area. Welfare reform was not my research topic per se, but still I had opportunities to hear about welfare and gathered some data on the issue. Observation, participant-observation, and ethnographic interviews, mainly through visits and socializing, were strategies used to collect data. The study used social network analysis as tool for research. While I was studying participants' social networks, I met many people and made friends, even fictive kin. Perhaps especially because I am an African woman, the Haitians received me as a sister, a cousin, a daughter, an aunt, and a friend.

Between privilege and opprobrium: The Arabs and Jews in Haiti

The historic experience of Arabs and Jews in Haiti has been characterized by mutual ambivalence between host and immigrant. While racism and slavery benefited Semitic‐speaking peoples as whites, mercantilism in the colonial period and nationalism thereafter placed limitations on their full participation in the Haitian community. The traditional social marginality of Arabs and Jews as traders, coupled with the comparative privilege they enjoyed, makes a revealing study of the nuances of race and class in a Caribbean society.

Introduction of partner referral and treatment for control of sexually transmitted diseases in a poor Haitian community.

Focus group discussions were held with women attending slum-based antenatal clinics and with male partners of pregnant women separately to evaluate knowledge and attitudes regarding sexually transmitted diseases (STDs) and acceptability of a proposed antenatal STD screening and treatment programme, including partner management. Subsequently, antenatal women found to have a STD were asked to refer their partner(s) for STD treatment. The institution's routine procedure of internal referral to the curative center was evaluated for loss to follow-up. Focus group participants described common STD syndromes, knew that a pregnant woman could transmit a STD to her child, and knew that all sex partners needed to be treated for STDs. Discussion participants disagreed on the possibility of asymptomatic STDs and mentioned other ways of contracting STDs beside sexual transmission. The response to the proposed programme was positive. Of 331 male partners named by antenatal women who were found to have at least one STD, 101 (30%) presented at the clinic through index referral, and an additional 38 (11.5%) presented because of health worker referral. Of the 59 men sent to the curative center for care, only 26 (44%) received treatment. The study demonstrated that in Haiti, partners of antenatal STD patients can be treated without apparent adverse effects. However, internal referrals to separate treatment centres should be avoided. Following this study, education efforts have emphasized the curable nature of STDs, the threat of vertical transmission, and frequent asymptomatic presentation of STDs to promote prevention and treat more partners of STD patients.

The Yoruba Orisha Tradition Comes to New York City

The work of Katherine Dunham, Zora Neale Hurston, and Pearl Primus - building on the research of Melville Herskovits and W. E. B. Du Bois - introduced an intellectual perspective of the African Diaspora into the arts. These artists worked studiously to incorporate an international racial and cultural legacy into an African-based aesthetic which could serve as a unifying link for Africans in the Diaspora. Dunham, for example, insisted that the members of her dance company understand the cultural traditions of creative expression in their respective countries, and her school at 43rd and Broadway nurtured developing and accomplished artists who embraced the African Diaspora in their creative expression. "Our school," writes Dunham in an unpublished autobiography, became the popular meeting place of Caribbean, Central and South American diplomats, painters, musicians, poets and the like. At our monthly "Boule Blanches" we usually presented new and untried Cuban orchestras such as Perez Prado, Tito Puente, Mongo Santamaria and Bobby Capo. Cuban Julio Iglesias toured with us for a couple of seasons. Celia Cruz came to these affairs both as a guest and entertainer. Among our regular participants and followers were Helen Hayes and her daughter, Lena Home, Xavier Cougat and many others. (2) Dunham's work with the Maroons of Jamaica and with traditional African communities in Haiti, along with research in Cuba, Martinique, and Senegal - among other locations - filled the productions she staged for international audiences with images, symbols, music, dance, instruments, and ritual practice of the African Diaspora. But Cuba held a special attraction for her. On Dunham's first trip there, in 1938, she met the families of the drummers Julio and LaRosa, and performed rituals that they had been unable to accomplish in New York City. And to maintain an African Diaspora focus in her dance company, she incorporated the expertise of researchers like Fernando Ortiz and Lydia Cabrera; the writing of Afro-Cuban poet Nicolas Guillen; and the music of the composer Lecona in her productions. "Cuban music and ritual," she writes, "were inextricably interwoven into my life - both personal and professional."(1) When Dunham could not find drummers for her company in 1952, she returned to Cuba and recruited Julito Collazo and Francisco Aguabella, renowned percussionists in the Latino, jazz, and popular music communities who had been trained in the Orisha tradition.(2) Julito Collazo would become one of the pioneer members of a small group of Yoruba traditional practitioners who were instrumental in establishing Orisha worship in New York City. He settled in New York in 1955 when Dunham's touring company ran out of engagements,(3) and along with Francisco Aguabella, he performed the songs, dances, and music of Afro-Cuban traditions and spread these traditions to international audiences. In 1955, there were approximately twenty-five people in New York City who were believers in the Orisha tradition (Collazo interview). The founding member of the Orisha tradition in New York City was Babalawo Pancho Mora (Yoruba name, Ifa Morote), who arrived in New York in 1946 and, soon after, established the "first ile, or house of the orishas" there (Murphy 50). Mora had been initiated as a high priest of Ifa in Cuba on January 27, 1944, by Babalawo Quintin Lecon, a renowned Cuban Ifa priest, and was the first babalawo in New York to practice Ifa divination (Murphy 49-50). Mora's belief in this ancient tradition and his desire to maintain his belief system motivated him to found the first Orisha community in the city. From his pioneering work, the tradition has grown to include thousands of initiates from all walks of life and ethnic groups. He has initiated several thousand godchildren from varied professions and international backgrounds, and has traveled extensively to Latin America and nationally to perform rituals and spread the practice of Santeria (Mora interview). …

Heterogeneity in Filarial-Specific Immune Responsiveness among Patients with Lymphatic Obstruction

The relationship between chronic obstructive disease and antifilarial immune responsiveness was studied in the Haitian community of Leogane, where Wuchereria bancrofti is endemic. Differences in sex ratios and in the prevalence of microfilaremia were observed between patients with hydrocele and those with lymphedema or elephantiasis of the lower limb. Only 2 of 84 patients with limb involvement (74 women, 10 men) were microfilaremic compared with 25 of 42 men with hydrocele. Microfilaria-positive men with hydrocele had significantly lower IgG2 and proliferative responses to filarial antigen than did amicrofilaremic men with hydrocele or individuals with lymphedema or elephantiasis. Parasite-specific cellular responses of amicrofilaremic individuals with obstructive disease were greater, although not significantly so, than those of amicrofilaremic asymptomatic members of the community. These results are compatible with the hypothesis that development of obstructive disease of the lymphatics has an immune component in amicrofilaremic persons.