Operating Room Nurses Deploy to Haiti 
February 01, 2010 - eUpdate

Medical help on hold as groups await transportation to Haiti
CNN News 01/21/10

Haiti RN Volunteer Update...  
January 17, 2010

RNs Volunteer to go to Haiti - HELP Send A Nurse Today!  
January 16, 2010

URGENT NEED for RN Volunteers - Haiti Ravaged by Earthquake  
January 13, 2010

Basic Information for Nurses

Required Vaccinations:

• Hepatitis A
• Hepatitis B
• Typhoid
• Tetanus
• Malaria Prophylaxis

List of travel clinics where vaccines are offered

Other Requirements:

• Valid Passport
• Current License (free from restrictions)
• Available for a minimum of 10-14 days

Sample List of What to Bring (Abbreviated List):

• Personal Hygiene and toiletry articles
• Medications
• Comfortable shoes
• Change of clothing/scrub
• Hats, light clothing etc.
• Sun tan lotion
• Mosquito repellant/netting [info]
• Personal first aid kit
• Rain Gear
• DO NOT BRING JEWELRY OR OTHER VALUABLE ITEMS

Anticipated Weather:

• January Averages - High 84.6 °F, Low 67.3 °F, Precip 2.50 in
• February Averages - High 84.6 °F, Low 67.5 °F, Precip 2.20 in
• March Averages - High 85.3 °F, Low 68.4 °F, Precip 2.10 in

Desired Languages:

• French
• Creole

Please Call and Demand Support for RN Mission to Haiti:

• Obama Administration
• Various Airlines

Links:

1. Comprehensive Guidance for Relief Workers and Others Traveling to Haiti for Earthquake Response from the CDC
   
   
2. CDC Health Recommendations for Relief Workers Responding to Disasters
   
   
3. Public Health Issues and Priorities for the Haiti Earthquake
   
   
4. Emergency Wound Management for Healthcare Professionals
   
   
5. After an Earthquake: Management of Crush Injuries & Crush Syndrome

Country Profiles: Haiti & Dominican Republic

Country Description:

Haiti is the poorest country in the Western Hemisphere. Located in the Caribbean, Haiti lies east of Cuba and Jamaica and west of the Dominican Republic and Puerto Rico it has been plagued by political violence for most of its history.  80% of the population lives under the poverty line and 54% in abject poverty.

Population:

Slightly smaller than the state of Maryland, Haiti’s population is 9,035,536, with a median age of about 18 years.

note: Estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality, higher death rates, lower population growth rates. People living with HIV/AIDS - 120,000 (2007 est.).

Weather:

November-March, day temperatures are in the 70s-80s F/23-32 C and nights are in the 60s-70s. During February through May, the weather is very wet.

Major Infectious Diseases:

• Degree of risk: HIGH
• Food or Waterborne Diseases: Bacterial and Protozoal Diarrhea, Hepatitis A and B, and Typhoid Fever
• Vectorborne Diseases: Dengue Fever and Malaria
• Water Contact Disease: Leptospirosis (2009)

Ethnic Groups:

Black 95%, Mixed-race and White 5%

Religions:

Roman Catholic 80%, Protestant 16% (Baptist 10%, Pentecostal 4%, Adventist 1%, other 1%), none 1%, other 3%

note: roughly half of the population practices voodoo

Languages:

French (official), Creole (official)

Literacy: (defined as age 15 and over can read and write)

• Total Population: 52.9%
• Male: 54.8%
• Female: 51.2% (2003 est.)

Political Pressure Groups and Leaders:

Autonomous Organizations of Haitian Workers or CATH [Fignole ST-CYR]; Confederation of Haitian Workers or CTH; Federation of Workers Trade Unions or FOS; General Organization of Independent Haitian Workers [Patrick NUMAS]; Grand-Anse Resistance Committee, or KOREGA; National Popular Assembly or APN; Papaye Peasants Movement or MPP [Chavannes JEAN-BAPTISTE]; Popular Organizations Gathering Power or PROP; Protestant Federation of Haiti; Roman Catholic Church

Airports:

Total: 14 (2009)

Airports with Paved Runways:

Total: 4

Disputes - International:

Since 2004, about 8,000 peacekeepers from the UN Stabilization Mission in Haiti (MINUSTAH) maintain civil order in Haiti; despite efforts to control illegal migration, Haitians cross into the Dominican Republic and sail to neighboring countries.

Creole Words & Phrases

Learn the common Creole words and phrases
Learn Creole medical phrases
Download a Creole translator for your iPhone or iPod

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 pregnancy due to perceived risk of hemorrhage). Diarrhea is thought to be a hot illness, requiring cold foods to correct the imbalance. Foods that Haitians prefer during illness include soups, meats, dumplings, plantains, yams, pumpkin soup, porridge, oatmeal and cornmeal mush made with milk, sugar, cinnamon, and vanilla. “Heavy” foods are generally eaten in the day time, and “light” foods at night due to greater ease of digestion. Heavy foods include cornmeal mush, potatoes, and broiled plantains, and light foods include soup, hot cocoa, and bread. The largest meal is usually eaten midday, with bread and coffee in the morning and hot cereal or soup at night. 
   
The rate of chronic illness is high among Haitians due to religious beliefs and noncompliance with modern medical treatments. This may be secondary to language barriers, mistrust of healthcare providers, and socioeconomic factors. It is common for Haitians to self medicate with black market medicines or those loaned to them by friends who have been prescribed medication for similar symptoms.
Pregnancy is not seen as an illness and is a happy time for the Haitian family. The fatalistic attitude that health-related conditions are determined by God contributes to the high fertility rate of 4.3 children per woman (PAHO, 2001). Breastfeeding is the traditional means of feeding infants, but is often made impossible by the instance of Haitian mothers working outside the home. Haitian mothers often add starches to formula to promote weight gain and docility in the infant. Enemas and purgatives are often given to children and to pregnant women and infants, with the purpose of cleansing the body of impurities.

More than 50% of all Haitian preschoolers are malnourished, and more than 35% of all Haitian women are anemic and have experienced major health problems, often due to pregnancy (PAHO, 2001). Haitian women tend to be very modest, so physical examination, as well as teaching about health maintenance techniques such as breast self exam can be very difficult. The healthcare provider should take care to only expose those areas of the body which are being examined and spent minimal time on those parts considered private.

Health problems that are common for Haitians include diabetes, heart disease, hypertension, malnutrition, anemia, tropical infectious diseases such as dengue fever, malaria, and typhoid, tuberculosis, parasitic diseases, sexually-transmitted diseases (STD’s), and cancer of the reproductive and gastrointestinal systems.
In Haitians, STD’s are common due largely to the acceptance of polygamous lifestyles of men, and their refusal to use contraceptives. Also, due to their fatalistic belief systems, many do not associate illnesses with sexual intercourse. Cardiovascular disease and diabetes are likely due to obesity and the use of tobacco products, as well as lack of exercise. These factors all contribute to the young life expectancy of about 49 years (World Health Organization, 2001).

When caring for a client of Haitian descent, it is important to be mindful of language and education level, religious and cultural beliefs, and traditional health maintenance practices that may be incompatible with modern medicine. The healthcare provider should respect these cultural differences and be accommodating whenever possible to promote the spiritual and physical well-being of the client.

References

Ackerman, L.J. (1997). Health problems of refugees. Journal of the
     American Board for Family Practice. 10,337-48.

Minarik, P.A. (1996). Culture & nursing care: A pocket guide.
     San Francisco: UCSF Nursing Press.

Pan American Health Organization (1999). Haiti: Country health profile.
     Accessed 6/28/04.

Spector, R.E. (2003). Cultural diversity in health and illness (6th ed).
     Upper Saddle River: Prentice Hall.

World Health Organization (2001). Healthy life expectancy rankings.
     Accessed 6/28/04.

Map of Hispaniola

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