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Cultural Ambassador Workshop: Haitian Americans Monday, December 8th, 2014 1 p.m. to 4 p.m. Two River Conference Center RMC Meridian Health Cultural Diversity Department Ann May Center for Nursing Cultural Ambassador Workshop Agenda • • • • • • • Check-In Welcome Video #1 Presentation on Haitian Culture Video #2 Panel Discussion Wrap-up - Next Meeting Dates A few things… • • • • Please turn off your cell phones Bathrooms Breaks Folder: – HRSA demographic form – Evaluation – Other interesting items • Enjoy the program! HRSA statement • This project is supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under D62HPO5069 Comprehensive Geriatric Education Program $471,625. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any official endorsement be inferred by the DN, BHPr, HRSA, DHHS, or the US Government. Disclosure statement • All speakers have indicated that they have no financial relationship with any pharmaceutical or medical device company that they may mention today in their lecture presentation. • Speaker and planners have agreed that this activity is free of bias. • There is no commercial or non-commercial support for this activity. Objectives 1. Understand cultural background of Haitians in the United States. 2. Discuss and describe cultural norms and possible cultural barriers experienced by Haitian Americans when accessing healthcare in the U.S. 3. Group dialogue with local healthcare providers of Haitian descent to further understanding of how to care for Haitian patients. Meridian’s Rationale for This Overview • Significant Haitian population in the Monmouth and Ocean County area • Haitian Creole is Meridian patients’ third most preferred language after English and Spanish 7 Haitian Language Demand Increasing at Meridian Haitian Creole Face to Face Interpreting demand saw a significant increase across Meridian this year! • 2012 • 2013 • 2014 (thru Nov. 30) 8 10 hours 14 hours 307 hours! Demographics and Socio-Economics about the area’s Haitian population • Demographics: – Approximately15,000 Haitian residents reside in the Monmouth/Ocean County area. – Median age: 30 – Asbury Park was 29 out of the top 30 US communities with the highest percentage of people claiming Haitian ancestry • Socio-Economics: – Median household income (2006-2008) • • • • Haitian (NJ): African-American (Monmouth): Latino (Monmouth): White (Monmouth): $54K $48K $50K $85K Sources: 2000 US Census data; 2006-2008 American Community Survey 3-Year Estimates Ancestry Map of Haitian Communities". Epodunk.com. http://www.epodunk.com/ancestry/Haitian.html. 9 Introductory Video Haitian Americans Documentary Published Jan 20, 2013 23 minutes long http://youtu.be/fUwGrZ1dYYQ 10 Barriers to Healthcare for Haitians • Language barrier: – Unfortunately, unlike Spanish, Haitian Creole is not taught in U.S. schools, therefore interpreters are harder to find. • Cultural differences: – Due to cultural belief systems, preventive care is not always sought. However, preventive injections and vaccines are considered acceptable. – However, care usually sought for babies and children under 5 years old. • Immigration status: – Some Haitians who are undocumented may be reluctant to seek care due to the fear they will be deported. • Poverty: – If they have to pay for health care, it may not be a priority. – At the same time, in Haiti, patients are used to paying for their own medical supplies, which may be confusing for some patients in the U.S. where that is not the case. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 11 Barriers to Healthcare for Haitians • Level of Education – The educational level of Haitians may determine how they use our American health care system, if they have the means to do so. – Educational level can be a sore point for some. • Important cultural value: Pride in Appearance – Important for people to advance and better themselves. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 12 Barriers to Healthcare for Haitians • Mental illness: – Mental illness is not well accepted in the Haitian culture – Often may be labeled as “stress”, “being tired”, generally “feeling bad”, “needing rest. – May equate mental illness as something shameful and embarrassing. – Often assumed as being “crazy” or “requiring being institutionalized”. – Not always perceived as something chronic; usually considered more of a transient condition. – Could be associated with having a “bad spirit”. – Stigmas can lead to social withdrawal and hiding from treatment. • Fear of Surgery: – Abdominal surgery is particularly frightening to Haitians. – More afraid of the after effects and use of anesthesia. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 13 Barriers to Healthcare for Haitians • Fear of Cancer – Many assume a cancer diagnosis to be always terminal – Can lead to social isolation for the patient – Patients may not want to be seen by others as sick. • Reason for Visit: – Older Haitians may use vague terms to describe their illness or symptoms (“gas”) , making it 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. • Organ Donation/Transplant: – Organ donation & transplants are typically neither discussed nor encouraged in Haitian culture, although receiving an organ may be considered for a child as a lifesaving measure. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 14 Common Health Disparities • Poor access to primary care can make newly arrived Haitian immigrants at higher risk for the following include: – – – – – – – – – • • • Hypertension Diabetes Sexually Transmitted Diseases Cancer (most prevalent are colon, prostate, cervical, hepatic, gastrointestinal, and Kaposi's sarcoma) Tuberculosis Vector borne diseases like malaria, dengue, and lymphatic filariasis Diarrheal diseases Parasites Typhoid Many conditions may be mitigated by the patient’s social status. U.S. screening upon arrival for legal immigrants may catch many conditions. Disparities can exist between those who are documented versus those who are not. Source: http://www.salisbury.edu/nursing/haitiancultcomp/biocultural_ecology.htm 15 Common Health Behaviors & Practices • Sexually transmitted diseases (STDs) are a common health problem in Haiti. – Many Haitians do not associate STDs with sexual intercourse. • Exercise should be encouraged for its benefits. – “Sexy” = “Fit” – Being healthy helps avoid diabetes and needles Source: http://www.salisbury.edu/nursing/haitiancultcomp/high_risk_health_behav.htm 16 Common High-Risk Health Behaviors • Traditionally, Haitians tend to seek clinical care only when all other options are exhausted. – One’s ability to afford care factors into this as well. – Home remedies often sought first. – Many weigh “Not feeling good” versus an illness that requires a hospitalization. – Illness is associated with not being able to work. Source: http://www.salisbury.edu/nursing/haitiancultcomp/high_risk_health_behav.htm 17 Haitian Spiritual Overview The most prevalent religion found in Haitian culture is Christianity. Christianity • Catholicism was the first Christian religion to be introduced to the Haitians and it is now the religion of the majority of the population in Haiti. • Protestantism was introduced more recently and is growing in popularity. • Haitians in the U.S. are very active in their churches and for most Haitians, religion helps to maintain their cultural identity. Source: http://www.salisbury.edu/nursing/haitiancultcomp/spirituality1.htm 18 Haitian Spiritual Overview There are two religions that Haitians may practice and that can be practiced simultaneously-Christianity & Voodoo. Voodoo (also spelled Voudou, Vodoun, or Vodon) • The word Voodoo comes from an African word meaning spirit. The Voodoo religion was thought to have been brought with the slaves to Haiti, and over time, it developed into a religion specific to Haiti. • Voodoo is often considered the national religion of Haiti as many Haitians may practice it to some degree or are affected by it in some way. • Voodoo does not have an organized hierarchy or a specific theology. Source: http://www.salisbury.edu/nursing/haitiancultcomp/spirituality1.htm 19 Haitian Spiritual Overview Voodoo (also spelled Voudou, Vodoun, or Vodon) - continued • Misconceptions about voodoo have given Haiti a reputation for sorcery and zombies. • Popular images of voodoo have ignored the religion's basis as a domestic cult of family spirits. http://blogs.reuters.com/photographersblog/2013/04/05/voodoo-alive-and-well/ • Adherents of voodoo may not perceive themselves as members of a separate religion; most consider themselves Roman Catholics or Christians. Source: http://countrystudies.us/haiti/33.htm 20 , U.S. Library of Congress Nutritional Preferences • Haitian cuisine has both French and African influences, and also uses spices commonly found in the Caribbean. • Food is often used to establish reciprocal relationships and networks with new immigrants or new friends. Source: http://www.salisbury.edu/nursing/haitiancultcomp/nutrition.htm 21 Nutritional Preferences • Many Haitians may be reluctant to try new foods and would rather not eat than eat unfamiliar foods. – • For older Haitians, the way a meal is prepared may present problems for them. Haitian foods can be very spicy and fattening. – Traditionally, high in sodium and very starchy. • • Common beverages include water, homemade fruit juices, coffee in the morning, and cold fruity soda. Herbal teas are also popular. – Source: http://www.salisbury.edu/nursing/haitiancultcomp/nutrition.htm 22 Example: “maggi” – bouillon cube a common recipe component Tea is only used when sick. Characteristics and values important to Haitian families and communities Education: “Education is like religion.” • Haitians attach a great value to education, although affordable access to education can be very limited in Haiti. • French was traditionally the language of instruction in Haiti, but the majority of Haitians do not speak French at home. • In the late 1970s this changed, and now Creole is used as the language of instruction in the first four grades. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/overview_cont5.htm •Local Haitian community feedback, Meridian Health, 2010. 23 http://atlantablackstar.com/2013/06/08/delta-sigma-thetasorority-opens-school-in-haiti/ Characteristics and values important to Haitian families and communities Education: continued • The literacy rate in Haiti in 2001 was estimated at 48.6%. In the U.S., however, literacy rates for Haitian immigrants mirrors American literacy rates. • In the U.S., some Haitian parents may choose to send their children to Catholic school, because of the emphasis on discipline and perceived success as well as their belief that it a mark of social status. • Many Haitians in the U.S. seek to quickly complete their high school education and will get their high school equivalency before they would normally graduate from high school. • For Haitians both in Haiti and in the U. S., a college degree is valued and a sign of status. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/overview_cont5.htm •Local Haitian community feedback, Meridian Health, 2010. 24 Characteristics and values important to Haitian families and communities Education: continued • For Haitians both in Haiti and in the U. S., a college degree is valued and a sign of status. Ralph Alexis, who arrived as an orphan from Haiti, hugs mentor Michael Kelly after graduating from Haverford College. His brother, Ruben, graduated as well. (MICHAEL BRYANT / Staff Photographer) http://articles.philly.com/2013-0521/news/39395722_1_philadelphia-futuresmichael-kelly-joan-mazzotti Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/overview_cont5.htm •Local Haitian community feedback, Meridian Health, 2010. 25 Characteristics and values important to Haitian families and communities Family Roles and Organization: Traditional Roles • Haitian society is a matriarchal society, yet the man has the ultimate control. However, typically when Haitians come to the U.S., the relationship may become more egalitarian. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ.htm •Local community feedback, Meridian Health, 2010 •http://galleryhip.com/haitian-family.html 26 Characteristics and values important to Haitian families and communities Family Roles and Organization: Traditional Roles • The person that makes the health care decisions may vary between mother, father or elder family member. – Older patients may defer to younger children. – Families may gravitate to the family member who is most knowledgeable. – Church leaders may also be consulted. • Gay and lesbian relationships in Haitian culture may not be recognized. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ.htm •Local community feedback, Meridian Health, 2010 •http://galleryhip.com/haitian-family.html 27 Characteristics and values important to Haitian families and communities Family Roles and Organization: Obligations to family members on the island • Family is very important to Haitians, and emigration does not mean that their obligation to the family in Haiti has lessened. • It is not uncommon for individuals to have extended families, one in Haiti and one in the U.S. – Family members that have emigrated are still financially responsible to those in Haiti. – They also may help to finance others' immigration to the U.S. – When new immigrants arrive, they often live with a friend or relative. – Haitians are expected to be generous and often will take in new refugees, even if there are no ties to these individuals. Source: http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ.htm 28 Characteristics and values important to Haitian families and communities Family Roles and Priorities: Children • Children are viewed as a gift from God and they must be well cared for to fulfill God's blessing. • There may be a general expectation that children are an investment in providing for the parents’ future needs. • The lack of extended family and kin support has been noted to be one of the most difficult aspects of raising children in the United States. Source: http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ2.htm 29 Characteristics and values important to Haitian families and communities Family Roles and Priorities: Children continued • In Haitian culture, discipline of children can be swift and physical which may be considered abusive by American standards. • Haitian children are encouraged to be independent and self-reliant from an earlier age than American children. • Haitian children are socialized to know they must be obedient, quiet, and subordinate to their parents. – Lack of discipline and lack of respect for authority are taboo. Source: http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ2.htm https://www.microlinks.org/learning-marketplace/notes/note-haiti-microcredit-education 30 Characteristics and values important to Haitian families and communities Family Roles and Priorities: The Elderly • Elderly parents often live with their children and a child usually considers it an honor that a parent has chosen their home to live in. • Elders are viewed as knowledgeable and their counsel is often sought. Fred R. Conrad/The New York Times “I don’t know if it makes me lucky or unlucky to still be here. It’s like part of me is gone.” — Junie Sufrad, a 110-year-old survivor of the Haiti earthquake. Source: http://www.salisbury.edu/nursing/haitiancultcomp/family_roles_and_organ2.htm http://www.nytimes.com/2010/03/12/world/americas/12elderly.html?_r=0 31 Gender Roles and Authority Expectations in Healthcare • Gender roles in the workplace are not as strictly defined as in the past. – For example, in healthcare, nurses are women. • The physician in Haiti is expected to be an authority, and is trusted to do what needs to be done. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/workforce_issues.htm •Local community feedback, Meridian Health, 2010 32 Gender Roles and Authority Expectations in Healthcare • Challenges with Informed Consent forms – A Haitian physician in the U. S. may have difficulty with understanding the rationale behind informed consent. – International and Haitian patients also may not understand the need for informed consent forms. – Insistence on signing consent forms may raise concerns about a physician’s motives behind the form. – Many want to know if they can change their mind once the form is signed. Sources: •http://www.salisbury.edu/nursing/haitiancultcomp/workforce_issues.htm •Local community feedback, Meridian Health, 2010 33 Health Beliefs • Pain: – Some Haitians can be very vocal about pain; moaning and complaining are not uncommon. – Some Haitians may have a low pain threshold, but can be very vague about where the pain is coming from. – Alternatively, some Haitians are not very expressive about their pain or discomfort. – It is often believed that the pain affects the whole body system; therefore the origination of the pain source is not important. – Haitians tend to prefer injections for pain relief, then liquids, tablets, and lastly capsules. Injections are thought to lead to a faster result. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 34 Health Beliefs: Pregnancy and Childbearing Practices • In Haiti, contraceptive use is not common and Haitian men are generally not willing to use contraceptives. – • The fertility rate in Haiti, as of 2002, is 4.3 infants per woman. In Haiti, pregnancy does not relieve a woman from work nor does it require medical visits, thus prenatal care is not traditionally sought. – However in one study subjects revealed that they thought prenatal care was important. • In the U.S., Haitian women are at risk for accessing prenatal care later than other cultural groups. • Fathers are usually not involved as labor is considered woman's work, and best handled by female friends and family members. Source: http://www.salisbury.edu/nursing/haitiancultcomp/preg_and_childbear_prac.htm 35 Health Beliefs: Pregnancy and Childbearing Practices • Breastfeeding is the norm in Haiti and in the U.S. • However, health care practitioners have been alarmed at the lower rates of breast feeding practiced by Haitians in America. – The increase in formula feeding has been related to socioeconomic factors including mother's need to work outside the household. – In America, there may be a lesser priority to continue breastfeeding among Haitian women. Source: http://www.salisbury.edu/nursing/haitiancultcomp/preg_and_childbear_prac.htm 36 Death Rituals • When death is impending, the entire family will gather, pray, cry, and use religious medallions or other spiritual artifacts, dependent on the family’s religious practice. • Organ donation is not viewed as an option. • Haitians prefer to die at home, although the hospital is acceptable. • Autopsy is allowed in certain circumstances. – If it is thought that the death was a result of malfeasance, an autopsy may be requested. Source: http://www.salisbury.edu/nursing/haitiancultcomp/death_rituals.htm 37 Death Rituals • When death is close, family members may make a more fervent effort to take care of the patient. – – – – Hair brushing Teeth brushing Changing bed linens Bathing the patient • Family members may want to take on “nursing” duties. • Nurses should ask the family about their role in taking care of the patient. Source: Local community feedback, Meridian Health 2010. http://graphics8.nytimes.com/images/2010/03/31/us/31family-span-337-395/31family_CA0-articleLarge.jpg 38 Haitian Language/Dialects Identifying the correct language is essential for proper communication • The official languages of Haiti are French and Creole. • French has always been the language of business, and Creole, the language of the people. • Creole was only accepted as an official language in 1987. • The origin of Haitian Creole is not certain. One theory asserts that Creole was created by slaves combining their African dialects with the French spoken by their white owners. Others site its influences as Spanish, African, English, and Portuguese. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm http://270c81.medialib.glogster.com/devonconstant/media/d3/d368d1330bc45ab556c25e1f36a31d43b607387c/creole.jpg http://images.betterworldbooks.com/073/The-Haitian-Creole-Language-Berotte-Carole-9780739112366.jpg 39 Haitian Language/Dialects • Creole is spoken by the majority of Haitians, while only about 10% of the population can communicate in French. However, many are not fluent in French. • French is still valued by all Haitians and is an indicator of social class and higher education. • Creole is seldom written. – Not until 1979 was there a Creole spelling system recognized by the government. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm 40 In this Jan. 24, 2013 photo, Carline cameau Fils-Aime teaches Creole at the Louverture Cleary School, which also teaches French, English and Spanish, in Croix-des-Bouquets, Haiti. Haitian Creole, which grew out of a mix of 18th-century French and West African languages, is the nation’s lingua franca, but it wasn’t until 1961 that it joined French as one of the country’s two official tongues. (AP Photo/Dieu Nalio Chery) (The Associated Press) Haitian Language/Dialects • According to 2002 statistics, in Haiti, the literacy rate of Haitians is 45%. – This low rate is a result of poor access to schools as well as the late acceptance of Creole as a written language. • In the U.S., 85% or more of Haitian residents are literate. – Many older Haitians may not be able to read or write in French and/or Creole. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm http://d1d7ektpm2nljo.cloudfront.net/QoGaVIvK9xd6JMEpzRHHCg/thumb-Haitian-Creole-Translation.jpg 41 Haitian Language/Dialects • Because Creole is viewed as the language of the poor, many Haitians will claim to be able to speak French. • Newly arrived immigrants may initiate conversations in French with persons unfamiliar to them. • To suggest that someone only speaks Creole, even if they do only speak Creole, can be construed as an insult. • However, there is cultural pride in the generation of younger Haitians in their ability to speak Creole. • Providers may initiate a conversation in French. • Many in the U.S. think that only French is spoken in Haiti. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm http://cache.boston.com/bonzai-fba/Third_Party_Photo/2011/07/22/thepowerofcreole__1311364025_8668.jpg 42 Language/Dialects To access any Meridian language assistance services, please consult the Meridian’s Language Assistance Policy and Procedures which are available online via Meridian’s Intranet. 43 Haitian Communication Style • When speaking with friends, Haitians will use direct eye contact, and an active tone of voice. – However, eye contact is usually avoided with people of a higher socioeconomic status or position of authority. • Tone reflects emotion. – Speech may get loud, but this does not necessarily mean there is anger or that a patient is combative. • Haitians may smile and nod their heads rather than reveal their lack of understanding. – Uneducated Haitians may be unwilling to expose their lack of knowledge to Americans, so many will keep to themselves and may seem timid. – Speech is usually accompanied by hand gestures. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm http://vegueroviajero.blogspot.com/2013/04/gloria-rolando-in-miami.html 44 Haitian Communication Style • When in informal situations, touch is accepted, like embracing, kissing, or hugging. • In formal situations, a firm handshake is the accepted greeting. – • However, woman may give a limp hand shake as a sign of good etiquette and femininity. Haitians require much less personal space than Americans, so they may position themselves close to another in communication. Source: http://www.salisbury.edu/nursing/haitiancultcomp/communication.htm http://findingpaola.files.wordpress.com/2012/09/dsc_1914.jpg 45 Haitian Time Orientation & Naming Conventions • • Many Haitians tend to be oriented in the present. It is not considered rude to be late to appointments. • For example, a wedding invitation will show a starting time of 6 pm, when the actual starting time is in fact 7 or 7:30. – However, most Haitians will make the effort to be on time if punctuality is stressed or if being on time is a priority for them. Name formats are similar to that of traditional U.S. name formats. – – Women are given a first, middle and last name. When she marries, she loses the last name of her father and is always called by her husband's last name. Sourcehttp://www.salisbury.edu/nursing/haitiancultcomp/communication.htm 46 Culture-Specific Customer Service Recommendations: Health Care Practices • Home remedies may be used first before seeking help, and may include herbal preparations, massage, or over the counter medications. • The use of herbal medicine is passed on by the family and sometimes Haitians in the U.S. will even have ingredients sent from Haiti to make herbal preparations. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 47 Culture-Specific Customer Service Recommendations: Health Care Practices Medicinal Spices • Haitian spices are grown for medicinal purposes as well. Those who live there and treat people with herbs and Haitian spices are known as leaf healers. The following are just a few of the plants grown for medicinal purposes: – – – – – – – – – – – Aloe Vera: Use the leaves of the plant to treat cuts, burns and sunburn. Catnip or catmint: Make a tea from the leaves of the plant, which has several uses including treating arthritis, digestive upsets and colic. Cinnamon: Use the ground up bark to treat diarrhea and vomiting. Eucalyptus: Make an extract from the leaves to treat coughs, the flu and joint pain. Peppermint, spearmint, lemonmint and horsemint: Healers use these herbs to calm a queasy stomach and to aid in digestion. Quassia or bitterroot: Use the bark of this tree to create a tonic that has several health properties, being an antifungal and anti-bacterial agent. Red sage: Use this herb to thin the blood and also increase menstrual flow. Sarsaparilla: Use the tea made from the sarsaparilla root to treat several skin ailments and arthritis. Senna: Make a tea of the plant and to use as a laxative. Thyme: Use this Haitian spice is in a tea to treat skin disorders or as a diuretic. Verbena: Use this herb as a pain killer during child birth. Source: http://herbs.lovetoknow.com/Hatian_Spices 48 Culture-Specific Customer Service Recommendations: Health Care Practices • When a Haitian decides the illness warrants a doctor's visit, the doctor is usually someone he/she knows or has heard about from a friend, someone that is considered trustworthy. – Trust is extended more to the individual physician than to an entity or organization like Meridian. – Haitian patients may be more interested in the cultural and personal connection they have with their nurse, doctor, or clinician. • Haitians are very private and modest. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 49 Culture-Specific Customer Service Recommendations: Health Care Practices • Although in Haiti, there is health insurance available, many Haitians are used to paying out of pocket for their health care. • According to interviews with Haitian immigrants, in Haiti the concept of no money = no health care has predominated, even in emergency situations. Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm 50 Culture-Specific Customer Service Recommendations: Health Care Practices • When consulting a physician, a Haitian expects a quick diagnosis, politeness, the use of the stethoscope (evidence of a physical exam), and a prescription. • Compliance with a physician's course of treatment depends on the perceived severity of the illness. ... a doctor assigned from the Haitian Ministry of health to work for his first year out of medical school. He's displaying his new stethoscope, ... Source http://www.salisbury.edu/nursing/haitiancultcomp/health_care_practpg1.htm http://healingartmissions.org/images/Apr2014Mission/IMG_4833427x640.jpg 51 Summary • Strong family values Source: http://www.medicalmobilizers.org/The_OliviersFamilyValery__Micka_008.jpg • Be mindful of possible cultural barriers that may influence Haitians approach to the U.S. healthcare system • High concern and regard for children and elders • Importance of strong community relationships with trusted leaders and using word-of-mouth as key approaches for informing and educating Haitian community members. 52 Video #2 Kay Lasante: Quality Health Care Services For Haitians By Haitians Published Aug 26, 2013 12 minutes long http://youtu.be/OKSJaKZz6vw 53 Bibliography • 2003. Cultural Competency, Haitian Immigrants, and Rural Sussex County, Delaware, Lisl Doscher Phelps, RN, BSN, MSN, Salisbury University, Department of Nursing, Salisbury, Maryland, http://www.salisbury.edu/nursing/haitiancultcomp/default.htm • U.S Census • U.S. Library of Congress 54 Break 55 Panel Discussion Panelists: Rose St. Fleur, MD, FAAP, IBCLC Clinical Assistant Professor Rutgers Robert Wood Johnson Medical School Pediatric Hospitalist Medical Director, Center for Breastfeeding Jersey Shore University Medical Center Florence Germain, RN Registered Nurse 3 South Complex Care Riverview Medical Center 56 Final Questions? Please complete evaluation and demographic form 57 Thank you for your participation! See you in the New Year and have a happy and safe holiday! 58