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1 FY YO: REFLECTIONS OF EXPERIENCES OF HEALTH AND HEALTHCARE WITH HAITIANS IN EAST FLATBUSH By AREN ISADORA DEL VECCHIO A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS UNIVERSITY OF FLORIDA 2009
2 2009 Aren Isadora Del Vecchio
3 To my daughter Alithia
4 ACKNOWLEDGMENTS This study was m ade possible through a grant fr om the University of Florida Center for Latin American Studies. I would like to give my thanks to the Caribbean Womens Health Association and their employees. Without their assistan ce and trust I would not have been able to make as many successful contacts in Central Brooklyn. I would also li ke to thank Dr. Marco Mason of the Caribbean Womens Health A ssociation for supporting me throughout my research. I would like to thank Dr. Anita Spri ng, Dr. Faye Harrison, and Dr. Florence Babb who provided patience, intellect, and encouragement. I would like to thank my mother, Julienne Obadia, and Chris Berry who all read chapters of my thesis and made many helpful suggestions. I would also like to thank Kiran Jayaram who not only read my enti re thesis, but helped me with planning and intellectualizing thro ugh out the entire process. Fi nally, thank you to the universe for giving me the strength and resolve to complete a project such as this.
5 TABLE OF CONTENTS page ACKNOWLEDGMENTS ............................................................................................................... 4 LIST OF TABLES ...........................................................................................................................7 LIST OF FIGURES .........................................................................................................................8 ABSTRACT ...................................................................................................................... ...............9 CHAP TER 1 INTRODUCTION .................................................................................................................. 11 Introduction .................................................................................................................. ...........11 The Field Site Area .................................................................................................................14 The Making of a Medical Anthropology ................................................................................15 Four Approaches to Illness Studies ........................................................................................ 16 Folk Illness as Inquiry ....................................................................................................... .....18 Transnationality and the Nation-State: The Quest for Identity ..............................................21 Race and Ethnicity for Caribbean Transnationalists .............................................................. 24 Haitian Transm igrants ......................................................................................................... ...26 Stigma as Discourse ........................................................................................................... .....27 Blackness and Disease ............................................................................................................28 HIV/AIDS and Vodou .............................................................................................................29 Summary ....................................................................................................................... ..........30 2 HISTORY AND BACKGROUND ........................................................................................ 32 Introduction .................................................................................................................. ...........32 Haiti: The First Independent Black Republic ......................................................................... 33 1915 through 1934 ...........................................................................................................34 1990 Through 1994 .........................................................................................................36 Haiti: The Poorest Country in the Western Hemisphere ........................................................38 Haitian Migration to the USA ................................................................................................. 39 Haitians in New York .......................................................................................................... ...43 Reproductive Health in Central Br ooklyn, United States, and Haiti ...................................... 45 Healing Role of Vodou ...........................................................................................................46 Summary ....................................................................................................................... ..........47 3 METHODS ....................................................................................................................... ......48 Introduction .................................................................................................................. ...........48 East Flatbush ...........................................................................................................................48
6 Methods and Sampling Design ...............................................................................................49 Sampling Issues ......................................................................................................................50 The Research Sites ..................................................................................................................51 Events and Participant Observation ........................................................................................ 54 Data Collection .......................................................................................................................55 Summary ....................................................................................................................... ..........56 4 SURVEY DATA ....................................................................................................................58 Introduction .................................................................................................................. ...........58 Illness Concepts Provided by Haitian Informants .................................................................. 59 Folk Illnesses ..........................................................................................................................62 Pdisyon and Ti Moun Mare nan Vant ...................................................................................63 Healthcare Workers ............................................................................................................ ....68 Biomedical and Folk Health as Reported by Health Workers ................................................69 Folk Illnesses and Stigma .......................................................................................................71 Summary ....................................................................................................................... ..........72 5 CASE EXAMPLES ................................................................................................................74 Introduction .................................................................................................................. ...........74 AIDS, Vodou and Blackness .................................................................................................. 75 LIFT: Folk Models to Explain HIV/AIDS .................................................................... 75 NANSI: Vodou and Discrimi nation .................................................................................79 Reflections on Folk Illnesses ................................................................................................. .82 LAMSI: Using both Haitian and US Biomedical Health System s ............................... 83 WOZ: Childlessness and Illness ...................................................................................... 85 Summary ....................................................................................................................... ..........88 6 CONCLUSION ................................................................................................................... ....89 Introduction .................................................................................................................. ...........89 Findings ...................................................................................................................... ............89 Making the Connections: The Findings Relationship to the Literature .................................. 91 Future Research ......................................................................................................................92 Conclusion .................................................................................................................... ..........93 REFERENCES .................................................................................................................... ..........94 BIOGRAPHICAL SKETCH .......................................................................................................108
7 LIST OF TABLES Table page 3-1 Distribution of the sample ................................................................................................ ..564-1 Illness concepts of ten Haitian subjects ............................................................................. 73
8 LIST OF FIGURES Figure page 3-1 Map of field site locations................................................................................................ ..57
9 Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts FY YO: REFLECTIONS OF EXPERIENCES OF HEALTH AND HEALTHCARE OF HAITIANS IN EAST FLATBUSH By A. Isadora Del Vecchio August 2009 Chair: Anita Spring Major: Anthropology Haitian migration to East Flatbush, Brooklyn bega n in the 1960s. However, racist and paternalistic attitudes toward Haiti and Haitians by the United States had been occurring since the 1800s. This relationship led to anti-Vodou ca mpaigns in the early 19 00s, racist attitudes and segregation during the US occupation of Hait i, and, in the 1980s, the Centers for Disease Control labeled Haitians as vectors for AIDS. Haitians were not passive they reacted to this relationship through protest and, often, were em powered when their protests were heard. This thesis focuses on the experiences of Haitian identity and related health concepts which are negatively associated with AIDS, Vodou, and Blackness. These negative associations have affected the ways in which people adhere to or avoid folk models for health and explanations of health. An ex ample of how these associations manifest is through the use and avoidance of folk explanations for reproductive issues and infertility. Women who use folk health categories hope to avoid the stigma associated with bareness. This thesis examines three main behaviors surrounding the ways in which folk models interact with AIDS, Vodou, and Blackness. First, health care providers consider folk illnesses and the women who use these theories negatively. Second, the historical and so cial context of Haitians in the United States impacts Haitian folk health and biomedical h ealth models, and, third, women with reproductive
10 health issues use folk models to explain bareness due to the stig ma associated with infertility rather then using US biomedical models. Haitians in Brooklyn did not discuss folk illnesses with healthcare workers. These same workers felt that women who believe d in theories of folk health were uneducated. Historical and social constructions of folk and biomedical m odels for Haitian healthcar e are highlighted by the ways in which people apply folk models of health to themselves and to individuals. One way this manifests is that some women use folk illne sses as an explanation for infertility to avoid the stigma associated with bareness.
11 CHAPTER 1 INTRODUCTION Fy, O! Sove lavi m wen nan miz mwen ye, O! Pitit mwen malad Mwen kouri kay gangan Leaves! Save my life. Im in misery, O! My child is sick I run to the house of the Vodou priest --Haitian folk song Introduction This song, fy yo (the leaves), found in the title of this thesis, and here in the beginning of chapter one, is prominent because of the importa nce of this song to a proud history of folk medicine in Haiti. This traditional song has b een remade in both Haiti and the United States because of its popularity which addr esses the political nature of pe oples healthcare choices. The songs lyrics do not state that when your child is sick you go to the hospital it states that you go to a Vodou healer. This song recognizes, and th rough its popularity, (r e)recognizes both historically and pres ently, the role of Vodou in everyday healing practices. This is relevant because the Haitian experience with health a nd healthcare is what this thesis is about. Haiti and the United States have a long political militaristic, and medical relationship that has impacted Haitian culture. This relationship has been, in many ways paternalistic, with the United States acting as father and deeming Haiti the child. This relationship has affected medical institutions by favoring bi omedical methods and theories over folk medical methods and theories. Negative associations with AIDS, Vodou and Blackness flood United States policy implementation in Haiti and in the United St ates. Through this process, these negative associations have impacted the ways in which Haitians experience health and healthcare in the
12 United States, including their interactions with fo lk illnesses. This is important because it shows how Haitian immigrants living in the United States have constructed Haitian folk illnesses in a new country. Research Statement This thesis is about the experiences of Haitia n identity and related health concepts which are negatively associated with AIDS, Vodou, and Blackness. These negative associations have affected the ways in which people adhere to or av oid folk models for health and explanations of health. Haitian identity and related health c oncepts are negatively associated with AIDS, Vodou, and Blackness by both Haitian and United States fo rmal medical institutio ns. Experiences of health and healthcare in Brooklyn reflect these negative associati ons. This study researches how folk theories of health, in particular, move san (bad blood), lt gat (spoiled milk), and ti moun mare nan vant (the tied baby) and folk models for the spread of AIDS are associated with stigma. My study has three statements, the first one stemming from the Brooklyn health advocacys communitys concerns with culture and healthcare. The last tw o statements are from my own prior experiences, beginning in June of 2000, with Haitians in Haiti and Miami. The hypotheses used in this thesis are: 1. The historical and social context of United St ates and Haitian relationships impacts folk health and biomedical health models concerning Haitians. 2. Health care providers consid er folk illnesses and the wo men who use these theories negatively. 3. Women with reproductive health issues use fo lk models to explai n bareness due to the stigma associated with infertility. In order to give context to why the res earch statement has relevance I provide a background on how anthropology approaches illne ss, transnationalism, and race, and will
13 provide demographic information about Haitians in Haiti and New York. Next, I discuss the methodology of the research and th en present and analyze the surv ey data and the interviews. Then, I conclude with research find ings and ideas for future research. In this chapter I will address the field site area and how African Americans, and, eventually, Caribbean migrants, arrived in East Flatbush. Next, I address how medical anthropology formed and Ruth Benedicts role in putting medical definitions under scrutiny. This leads into the different, but connected ways of theorizing about illness studies, including studies concerning folk illnesses. Anthropological inquiry into this topic has shown that biomedicine is but one of many types of medical systems in the world. For instance, AfroCaribbean folk medicine is based within an oral tradition and contains se veral different types of healers and categorizes illness acco rding to the hot/cold dichotomy. Third, this chapter addresses transnational ity. This includes people who are politically socially, culturally, and economica lly invested in more then one nation-stateone in which they migrated to and the other where they migrated fro m. Social aspects such as race and ethnicity are important to transmigrants because when they migrate to a new country they are faced with understanding the ways in which race and ethnicit y are configured in th eir new home. Haitians in general, and Haitians in East Flatbush, are tr ansmigrants because they maintain connections to family and friends in Haiti. Theorists use cente r periphery and political economic theories to understand Haitian transmigrants. Finally, the ways in which Haitians are stigma tized is addressed. Stigma as discourse includes social rejection, blame, shame, and discrimination. This can be seen when Black bodies are targeted as diseased. Th roughout United States history, and, more recently, Haitian bodies have been blamed for disease spread. An example of this is when the Centers for Disease
14 Control (CDC) labeled Haitians as vectors for AIDS. After the CDCs announcements the media incorrectly connected the spread of AIDS among Haitians to Vodou. The Field Site Area East Flatbush, a neighborhood in Central Brookl yn, was populated by Italians and Jews in the late 1800s. This area saw large scale developm ent in the 1920s, and by the 1960s was largely populated by people from the Caribbean (New York City Department of Parks and Recreation 2006 ) This area of Brooklyn, similar to many areas of New York City, was, and is subject to, residential se gregation which is a long standing pr ocess which separates racial groups from each other (Grady 2006 and Kaplan and Holloway 1998). This affects Haitian migrants because before Caribbean migration was happening in large numbers institutional racism such as steering (showing housing to African Ameri cans in predominantly African American neighborhoods) and red lining (banks refusal to lend money to people buying in non-white neighborhoods) focused on African Americans wa s happening in New York City. African Americans were steered toward Harlem, the South Bronx, and Bedford-Stuyvesant and because of these practices African Americans of all cla ss backgrounds were forced to live in the same neighborhoods. When Caribbean mi gration began in the 1960s these Black immigrants affected residential segregation in an expansion of Black neighborhoods in Central Brooklyn that now included Flatbush (Grady 2006). Central Brooklyn contains some of the poores t neighborhoods in New York City with one of every three people living in pove rty. Health indicators such as cancer rates, death rates, and infant mortality rates are higher in Central Brooklyn neighborhoods when compared to other Brooklyn neighborhoods while life span is reported ly lower in the poores t neighborhoods with Black New Yorkers specifically when compared with White New Yorkers (Department of
15 Mental Health and Hygiene 2004). These dispariti es make the study of Haitian migrants health to New York City matter to anthropology. The Making of a Medical Anthropology Early anthropologists questioning about the no rm al and abnormal in regards to illness categories framed the making of medical anthr opology. Anthropology has a history of being linked to, and being purveyors of, colonialism or colonial mentalities (Good 1994). A good example of this in medical anthropology is the early focus on beliefs and practices which has continued into present anthropological works (Good 1994). In the 1940s, observations made by physicians and historians concer ning non-Western health systems considered these systems of health to be primitive and to be a proto form of biomedicine (Ackernecht 1946). The study of medicine and medical anthropology is based in the empiricist tradition where reliance upon observation and experiment are im portant aspects of the resear ch. However, within this tradition, even as early as the 1930s, it was noted (Good 1994) that the use of biomedical disease categories, when applied to non-Western peoples, wa s problematic. This is because this type of application does not, and did not; address the social aspects of the construction of illness knowledge. Thus, out of the Boasian tradition, an an thropology of physiology was born (Opler 1960 and Good 1994). Ruth Benedict (1934) put medical definitions und er scrutiny. She wrote that it is important to note that biomedical definitions of medical categories such as normal and abnormal are culturally specific and differ cross-culturally. In essence these are not homogenous definitions that define all societies in the same ways. Wh at is normal for one society may be considered abnormal in another. Benedict pointed out that these definitions were re lative to their cultural context. Critics of her theories of relativity as applied to mental health suggest the extreme relativity discounts the possibility of any mental illness. Benedicts mapping of normal and
16 abnormal, her writings on the importance of soci al response when dealing with pathology, and her ideas that abnormality and pathology are cult urally interpreted, are a part of medical anthropological inquiry (Opler 1960; Modell 1989; and Good 1994). Four Approaches to Illness Studies Four approaches to illn ess studies are addressed in this section empiricism, cognitive anthropology, interpreti ve anthropology, and critical medical anthropology. While there are several different models and approaches that coul d be applied to illness studies, these approaches differ in some aspects, and they suggest a continuum of thought. The empiricist paradigm shares much of its view with biomedicine. Its writings focus on belief and behavior models, where biomedical knowledge is the norm. In medical anthropology, a critique of empiricism occu rs, but empiricism persists in anthropological theorizing and practice on health and medical systems (Smith Doody 1992). The persistence of empiricism is seen when medical anthropology is viewed as the study of medical beliefs and practices. According to Good (1994) empiricism for medical anthropology covers three things: the analysis of illness representations as health be liefs, a view of culture as adaptation, and an analytic primacy of the rational, value-maximizing individual (Good 1994: 39). The problem with the idea of belief is that it is juxtaposed against scientif ic knowledge as if the latter is somehow more correct. Belief is consid ered a misunderstanding whereas knowledge of something is considered understanding. The pr esentation of belief in this context occurs throughout anthropological l iterature and be seen in Lepowsky ( 1990). This idea of belief verses knowledge is closely linked to th e empiricist notion of medical systems as adaptive strategies. This idea suggests that people adapt to their enviro nment and that medical systems are a result of such adaptation.
17 Cognitive anthropology is another way to view illness representations. It shows that each culture orders all life events, ideas, and materiality within its own specific domain. Those who focus on medical anthropology focus on taxonomy of disease, folk theories of health and healing, and the ways in which illness narratives are structured (Conklin 1969; Colby 1996). Other early studies by cognitive medical anthropologists focuse d explicitly on disease classification (Frake 1961; Fabrega 1970; Fabrega and Silver 1973). These studies of disease clas sification helped to document the everyday use of medicine in a cros s-cultural context focusing on taxonomy. In response to cognitive anthropology, anthropologi sts created a more interpretative approach. Interpretive medical anthropologists focus on th e relationship between culture and illness where disease itself is an explanatory mode l (Good 1994). This meaning-centered approach addresses three categories of illn ess study. First, it addresses th e relations between biology and culture, and the phenomenology and trajectory of illness (Csordas 1983; 1988; Finkler 1983; Roseman 1988). Second, it addresses the symbolic structures and processes that occur with illness and illness therapy (Lock 1980; Nich ter 1989). Third, interpretive medical anthropologists address embodiment or the idea th at a persons lived experiences contribute to illness which can present as illness in the body (Csordas 1990; Gordon 1990; Pandolfi 1990). The criticisms waged against this approach are that it is too th eoretical and not practical for applied anthropologists, and it is too closely aligned with the bi omedical paradigm (Good 1994). Critical medical anthropology addresses how global, local, political, and economic issues affect health and medical systems (Richters 1988). Anthropologists draw upon theories of political economy, Marxism, and Gramscis hegemony as a way to understand health and medical systems. Hegemony is used in the Marxist context to show how the industry of medicine can be dominant culturally, socially, and economically. As Good (1994) writes, A
18 critical medical anthropology forcefully poses the question of when illness representations are actually misrepresentations which serve the interest s of those in power, be they colonial powers, elites within a society, dominant economic arra ngements, the medical profession, or empowered men (Good 194:57). These anthropologists look at how power relationships occur in health care systems (Waitzkin 1991) and how political issues such as poverty are transferred into illness categories because of hegemony (Sheper-Hughes and Lock 1987; Taussig 1980). Other critical medical anthropologies examine the ways resist ance is acted out in illness representations through things such as somati zation (Ong 1987). A critique of critical medical anthropology waged by Good (1994) is that local concepts of health, and the people wh o practice them, can get lost in the theorizing about the effects of hegemony on the population being discussed. However, since then Merrill Sing er suggests an applied critical medical anthropology where medical anthropologists can go beyond academics and into health clinics, federal and international health organizat ions, and community health or ganizations (Singer 1995). Folk Illness as Inquiry Early m edical anthropologies of folk illne ss in America focused on criticizing and critiquing biomedicine for the lack of understand ing of the cultural asp ects of illness and how people respond in culturally specific ways to illness (Clark 1959; Rubel 1960, 1964; Snow 1974). Subsequently anthropologist s studied health internationally (Foster 1976; Kleinman et al. 1976; Leslie 1976). These studies contributed to a large body of work that shows that biomedicine is but one of many systems of medici ne in the world. Studies by Fabrega and Silver (1973) and Fabrega (1975) have shown how biomed icine is different from folk medical belief, practice, and response. These early cross-cultural studies of health and health systems critique medicine in North America and Europe in gene ral, and, more specifically, show a world-wide
19 trend toward bureaucratic profe ssionalization in medical practic es (Fabrega and Silver 1973; Fabrega 1975). Afro-Caribbean folk medical knowledge comes from many experiences of health, disease, and healing and this knowledge has been shaped by ecology and history. Afro-Caribbean folk medicine occurs in response to several variable s: the physical environmen t, specific diseases and how they are experienced, illness knowledge and cure, exposure to biomedicine, education level, and social class (Laguerre 1987) According to Laguerre (198 7), there are three types of patients: those who only use folk medicine, those who use folk me dicine as a last resort, and those who use folk medicine for minor problems and biomedicine for major problems. Folk medical traditions are, according to Lague rre the totality of health knowledge and medical practices of the Afro-Caribbean populat ion which fall outside the mainstream medical system and are transmitted mainly by way of or al tradition from one generation to the next (Ibid: 35). This knowledge can be transferred oral ly, through dreams, proverbs, or songs. In the Caribbean, folk healers are differentiated by religious affiliation, specialty, or both. Beckwith (1969) differentiates between Jamaican h ealers pointing out th at there are Obeah1 and revivalist healers2, both use herbs and ritual in their healing, they have different faith, and thus, different healing practices. In Martinique Horowitz (1967) found that folk healers are called curers and are differentiated by the types of herbal remedies they utilize, wh ile in Guadalupe there are four categories of healer: curer, masseur, midwife, and magical healer (La guerre 1987). Caribbean 1 Obeah is similar to the Vodou practiced in Haiti. Obeah priest and pr iestess were prominent community leaders and teachers of African culture since slavery. Obeah priest and prieste sses are know for their power when interacting in the supernatural realm. As well, they we re the healer of choice for ma ny people of African descent instead of a physician (Slave Resistance: A Caribbean Study. 2008 ) 2 Revivalist healers are spiritually based practitioners. They use stones, herbs, blood, and water as common elements in their healing repertoire (Payne-Jackson and Mervyne C Alleyne 2004).
20 healers attend to patients in their homes (Beckw ith 1969), patients are serviced at the temple for supernatural illnesses (Mtraux 1972), or patien ts may go to a healers home (Madam Tizo 2005). There are two defining characteristics of Ca ribbean folk health knowledge. One is the categorization of illnesses and the other is the hot/cold dichotomy. In the Caribbean, there are personalistic and naturalistic categories to illness (Foster 1976; Cori el 1983; Laguerre 1987; McCarthy-Brown 2001). Foster (1976), argues that the personalistic il lness category includes that magic, religion, and illnesses are inseparable and the naturalistic category includes the idea that disease has nothing to do with magic or religion. Disease is seen as belonging to natural, human, or spiritual origins. If it is a natural illn ess home remedies or a biom edical or folk healer will be used, and, if it is a supernatural illness a ritual or spiritual healer will be used (Foster 1976; Coriel 1983; Laguerre 1987; McCarthy-Brown 2001). As well, cures take the form of hot or cold where a cold illness must be cured w ith hot cures and vice versa (Foster 1976; Coriel 1983; Laguerre 1987; Brodwin 1996; McCarthy-Brown 2001). The Haitian folk medical system has many of the characteristics of the Caribbean folk health system and is considered to mimic more closely its African roots in respect to folk medical traditions (Dutroit 2001). Thus, the ho t/cold dichotomy, natura listic, and personalistic illnesses are characteristic of folk health in Haiti (Coreil 1983; Laguerre 1984; Brodwin 1996; Dutroit 2001; McCarthy-Brown 2001). There are five kinds of healer: le af doctor, midwife, bone setter, blood letter, and Vodou priest or priestess (Murra y 1976; Coreil 1983; Laguerre 1987; Farmer 1988; Brodwin 1996; McCarthy-Brown 2001). Midwives and herbal healers are the most commonly used practitioners (Coreil 1983). Scholars writing on Haitian folk health use several different theoretical models of which to frame their research. These approaches are empiricism, interpretive an thropology, and critical medical anthropology.
21 Based within the empiricist tradition, wher e biomedicine is considered the norm, folk illnesses are questioned by Murray (1973; 1976; 1991) and considered psychological manifestations of the ways that people (mos tly women) deal with biomedical dilemmas seemingly incurable with folk health methods, such as infertility and subfucundity. Other empiricists (Coreil et al. 1994) use epidemiology to identify at-risk people for folk illnesses in order to address those issues with Western scie nce. These scholars contend, similar to Murray (1973; 1976; 1991), that a distinctly biomedical categorization for these illnesses can occur. Other scholars using an interpreti ve approach consider illness to be an explanatory model where the lived experiences of Haitian women are seen in the ways that folk illnesses manifest in their bodies. These folk illnesses have an etiology in stress, anger, and interpersonal strife that is experienced in the day-to-day life of these women (Farmer 1988). Singer et al. (1988), use a critical medical anthropological view to address folk health in Haiti. They contend that rural to urban movement raises accessibility to biomedicine which alters the ways that folk health is expressed. This process is considered by them to be a product of biomedical hegemony couched in the belief that these are illnesses shaped by historical, political, a nd economic factors. Transnationality and the Nation-State: The Quest for Identity This section presents the concepts of transnat ionalism as applied to Haitians living in the United States and the importance of identity to these peoples. Transnationalism is the set of social fields constructed by migr ants within two or more countri es. These social fields cross geographic, cultural, and political borders (Basch, Glick Schiller and Szanton Blanc 1994; Glick Schiller and Fouron 2001). Transmigrants devel op relationshipseconomic, political, familial, social, and religiousacross national borders. Transnational movements are fluid, constantly shifting, and heterogeneous, making transnationa lity a complex topic (Chow 2003; Ifekwunigwe 2003; Lowe 2003; Duany 2004; and Sags and Molina 2004).
22 Important to the idea of transnationalism and to the ways that Haitians are racialized is a discussion of the nation and the nation-state. These thingstransmigration, the nation, and the nation-state are connected because the transm igrant is constructed by and through economic and political reasons, and as we ll, through their identification w ith the nation-state. Current theories address the idea that the state transcends its borders and reaches out to a constituency of people whose ancestral homeland is within that state, yet, dwe ll within another state. A good example of the elasticity of st ate boundaries is in Haiti. In 1991, President Aristide was inaugurated and called the diaspora the tenth department (the Haitian government has nine departments). He asked for their help, power, ec onomic and political intere st, and interaction to continue supporting Haiti from abroad. Haiti, at this time, was an example of a deterritorialized nation-state. A deterritorialized nation-state exists when the state no long er recognizes constituents in its territory as the only constituency of th e nation. The state extends its constituency to include those beyond its borde rs. Basch, Glick-Schill er, and Szanton Blanc (1994) suggest that the nation-state includes citi zens whose geographic location is within other states, but these people politically, socially, culturally, a nd economically belong to their ancestors nation-state (Basch, GlickSchiller, and Szanton Blanc 1994). Identity is important to transmigrants because they struggle with dual associations. Who are these people? Do they identify as transnat ional peoples? Basch, Glic k-Schiller, and Szanton Blanc (1994) write that most peopl e have not formed transnational identities. And, in fact, there are rarely transnational states, communities, or in dividuals who identify as transnational (Basch, Glick-Schiller, and Szanton Bl anc 1994). Transnational subj ects have double or triple associations which are consta ntly undergoing negotiation. Economics, family and community relationships, and political and economic practices are the interstitial space that they must
23 negotiate in order to live between the nations of which they identify (Khan 1994; Ong 1999; Radhakrishnan 2003). In order to understand ho w identities are construc ted in transnational contexts an explanation of Appadurais imagination and ethnoscapes frame how transnational peoples construct who they are. For Appadurai (2003), the imagination is an orga nized field of social practices, a form of work (both in the sense of labor and of cultura lly organized practice) and a form of negotiation between sites of agency (individuals) and glob ally defined fields of possibility (Appadurai 2003: 30). Based upon Andersons (1991) use of imagination, Appadurai (2003) moves imagination out of the realm of the nation, the community, and geographic place and puts the imagination into a global context of imagined wo rlds (Kearney 1995). Imagined worlds are the historically situated imaginations of persons or groups spread around the globe (Appadurai 2003:31). Imagined worlds are important to tran snational studies because they show the multidimensional global spaces people occupy (Ong 1999). The building blocks to these imagined worl ds are Appadurais (2003) landscapes. The landscapes, often called scapes by other scholars, cons titute the global m ovements of people, technologies, media, finances, and ideas (Gli ck Schiller, Basch, and Szanton Blanc 1995; Kearney 1995; Glick Schiller a nd Fouron 2001; Stoller 2002). Th ese scapes are the core of Appadurais (2003) model of global cultural flow. They are a t entative formulation about the conditions under which current global flows occur: they occur in and through the growing disjunctures between ethnoscapes, technoscapes, finacesc apes, mediascapes, and ideoscapes (Appadurai 2003:35) This implies a reality that exits in the interstitial areas of peoples daily lives. It is at these interstices or narrow spaces between realities (which are constructed through interpretations gained from lived experiences) that a constant negotiation of what global reality is
24 occurs. Diasporic groups are within the inters tices of global cultural flow because of an essentialized concept-bound border th at places diasporic groups in between two societies. These borders are essentialized by the people who live within their geographic borders, and as well, they benefit from this essentia lization of other outside groups. Appadurai (2003) writes of fissures and fragmentations between the movement of peoples, technologies, and financial flows which is linked to the idea of in terstitial realities (Appa durai 2003). It is w ithin the disjunctures between the scapes, as well as within the movement of the scapes themselv es, that global cultural flow occurs. Appadurais (1996; 2003) work puts forth a cha llenge to how we do our work and how we should think about culture, cultural flow, and gl obalization. Appadurai ( 1996; 2003) helps us see disjuncture between what appears to be and the reality of what is to be when applied to the formation of identity. Finally, Appadurais ( 1996; 2003) works show how globalization, rather then homogenize, is a complicated process that allows for dive rsity and in fact introduces diversity. However, Appaduari (2003) ignores th e reality that nations and states are still bound together and his analysis of global cultural flow does not address issues of class, race, or gender giving the idea that all people have equal oppor tunities to mobility and to the different landscapes (Ong 1999). Relocation alters the ways that people live, view, and construct their lives which is seen in the importance of identities to transnational studies. Race and Ethnicity for Caribbean Transnationalists In this sec tion, I reason th at race and ethnicity beco me important factors to transnationalism because when people migrate they deal with a new set of ideas and practices surrounding these culturally-construc ted categories (Basch, Glick Schiller, and Szanton Blanc 1994; Foner 2001; Vickerman 2001). Embedded in na tionalism are ideas of race and ethnicity that construct the ways that transmigrants view themselves and are perceived in the host and
25 home country (Fuglerud 1999; Glick Schiller and Georges Fouron 2001; Vickerman 2001). Race is important to Caribbean migrants to the United States because of the commonality across the Caribbean of African roots which make many migrants B lack in the eyes of their new country. Ethnicity is important to Caribbean migr ants because it is used as a way to distinguish groups of people. For instance, some Black migran ts use their ethnic dist inctions to separate themselves from African Americans. This occurs because African Americans are perceived to be at the bottom in Black American society in regards to cultural status (Harrison 1994). Therefore, it is better to be viewed as a foreign-born Black then a native-born Black person because of White oppression. In this way, ethnic distinctions are used by migrants in order to gain status in the United States. The social and cultural meanings that human s have applied to phenotypic variations are cultural constructions however, in the United States race is considered to be a biological fact. Although this is not accurate, race is a part of the dominant lived reality of many Americans and race as a cultural construction has real conse quences faced by many. Race as defined by the American Anthropological Associati on is based within the idea that, most physical variation, about 94%, lies within so-called racial groups. Conventional geographic "racial" groupings differ from one a nother only in about 6% of their genes. This means that there is greater variation within "racial" groups than between them. (www.aaanet.org 2008) Glick Schiller and Fouron (1990) wr ite that in the United States ra ce cannot be considered lightly because, race has emerged as a category criti cal to the maintenance of hegemony of the capitalist class and as such it takes on a pr ofound reality(Glick Schiller and Fouron 1990:332). Race, and its emergence as a critical category in the United States, is important to this thesis because racism affects the ways in which people have access to health care. There is a racial order and health issues are affected by r acial discourses. The Ne w York City Department
26 of Health and Mental Hygiene st ates in a letter to New Yorkers at the beginning of a health disparities bulletin that, while great gains have occurred in improving overall health and reducing health disparities, the persistence of raci al, ethnic, economic, or ot her social inequalities in health is unacceptable (Depar tment of Mental Health and H ygiene 2004). The paragraph to New Yorkers finishes up by stating the ways the city can work towards eliminating these injustices and improve overall health care. Haitian Transmigrants Haitian s are transmigrants because many develop and maintain relationships that occur across national boundaries. Current theories of transnationalism have focused on Haiti and Haitians (Glick Schiller and Four on 1990; Glick Schilller et al. 1992; Basch, Glick-Schiller, and Szanton Blanc 1994; Laguerre 1997; Glick Schiller and Fouron 2001). For Laguerre (1997), the Haitian diaspora is displaced and reattached in a new place. This re-rooted life takes place in another state, but ties are kept with the homel and making them transnatio nal citizens (Laguerrre 1997). Thus the Haitian diasporic subject has a double allegiance to ancestral home and new home and lives within the tensions that interstitial life brings (Laguerre 1997; Duany 2004). This interstitial space can be an aren a of resistance. Within the so cial space of the dominant sector diasporic subjects are found or made to occ upy a minoritized space the locus of everyday resisting practices (Laguerre 1997:31). Haitians send remitt ances (kept more regularly by women), keep up kin ties, and own business that operate in Haiti and the US (Laguerre 1997; 1984). Laguerres theoretical model depends upon center-periphery theory as its basis for how transmigrations occur. In this model the cente r includes geographic area s of Europe and North America and the periphery includes the countries where migrants come from, usually in the developing world (Laguerre 1997; Thomas-Hope 2003) In a similar vein to Laguerre (1997), Glick Schiller and Fouron (1990), Basch, Glic k-Schiller, and Szanton Blanc (1994), Glick
27 Schilller et al.(1992), and Glic k Schiller and Fouron (2001) a ddress Haitian transnationalism and transnationalism in general and focus on a political economy approach. Political economy, in its most general form, refers to the inters ection of people and societies in relationship to markets and the state. Political economy can reference health, migration, or any number of commodified aspects of society. For many transnational theorists th is means that history, space, and identity politics must be analyzed to show their relationships to th e global (re)structuring of capital (Szanton Blanc, Basc h, and Glick Schiller 1995). Stigma as Discourse This section discusses stigm a as a discourse because stigma causes life problems for the Haitian community. Discourse is the different ways in which we hu mans integrate language with non-language stuff, such as different ways of thinking, acting, intera cting, valuing, feeling, believing, and using symbols, tools, and objects in the right places and at the right times so as to enact and recognize different identities and activities, give the mate rial world certain meanings, distribute social goods in a certain way, make certain sort s of meaningful connections in our experience, and privilege certain symbols and ways of knowing over others.(Gee 1996: 13) Discourse creates, recreates, focuses, modifies and transmits language (Sherzer 1987: 295) and the subjective experiences of the Self. The Se lf is created through exchanges where the position of others is internalized and becomes how we view ourselves (Fife and Wright 2000). Stigma is discourse because it is charac terized by social rejection, blame, internalized shame, and discrimination, which results from a judgment ma de about a person or a group being identified with a particular concern. Stigma is created, recreated, and modified by the ways that humans interact with language and non-la nguage stuff. People participat e in stigma producing behaviors and beliefs, write Phelan et.al (1997), [because ] those at the bottom of the economic heap are viewed as having arrived there b ecause of their own shortcomings, responsibility is shifted from structural components of the st ratification system to the individual, and the status qou is
28 legitimized (Phelan et al. 1997: 325). This has to do with the use and role of power in the relationships between those creati ng stigma and those living it. Blackness and Disease Blackness becom es stigmatizing when it is used as a tool of discrimination. The subtleties of this type of discrimination are the driving force behind negativ e associations, in the case of Haitians, being linked negatively to AIDS and Vodou. Harrison (1998: 610) suggests, racism assumes more subtle and elusive forms in th e contemporary world, it is being reconfigured without race as a classificatory device for demarcating difference. An example of this is the negative associations made toward Haitians concerning AIDS and Vodou. Haitians are not the first people of African heritage to be considered vectors for diseas e in the United States. There is a long history in the United States of racism occu rring in the form of targ eting black bodies as unhealthy and blaming them for disease sprea d. In the early twen tieth century, African Americans were targeted as carri ers of hookworm, which was considered a disease of laziness in the South. Physicians thought Africans brought it from Africa and spread it throughout the United States (Wailoo 2006). African Americans in Baltimore were targeted when syphilis became known as a black disease because African Americans were considered to be unable to control their sexual instincts. Historically th e United States has linked disease and Blackness, and, much like the Haitian AIDS situation, are exam ples of Goffmans (1963) ideas of the stigma of race being linked to stigmatized disease. Goffman also addresses how categories of normal and abnormal reflect ideas about health and illness and are used to create difference between people who are normal and people who are abnormal. In 1932, a southern physician suggests that Black bodies are culturally abnormal because, safeguarding of the health of the Negro [was not a] fight against disease, but against physical, mental, and moral inferiority, against ignorance and superstition, against pov erty and filth. (Waliloo 2006:531 quoting Miller
29 CJ. Special Problems of the Colored Woman. South Med J 1932, 25: 734). Racism in healthcare ideology and practice created the so cial and cultural responses to illness in Black peoples in the United States. HIV/AIDS and Vodou In the 1980s Haitians were labeled as carri ers of the AIDS virus by the Centers for Disease Control (CDC). In November 1981, medi cal authorities stated that newly arrived Haitians in Florida and New York showed characteristics of the yet unnamed disease. By July 1982, the CDC released information stating that 34 Haitians in the United States had characteristics of this new disease yet Haitians diagnosed with the disease denied using drugs or having homosexual sex (at the time, the only kno wn risk factors for AIDS) (Farmer 2006). Haitian cases of AIDS confused the medical community because Haitians told health practitioners that they were not gay or IV drug users. This lead to an incorrect assumption that Haitians were a vector for AIDS and, subsequen tly, the medical establishment linked contraction of AIDS by Haitians to Vodou. Farmer (2006) writes that this occurred because of preexisting folk models that Americans had regarding Hai tians. The Haitians, write s Farmer (2006), fit the already established scrip t: the incidence of AIDS in Haitians served to reinforce the stigma experienced by those with AIDS. For this to be so, there must have been strong, preexisting folk models of Haitians (Farmer 2006: 221). Information that supports his statement was plentiful during this time in the media. Images of filth, squalor, Vodou, and disease in Haiti flooded the papers. Further denigrating Vodou and its role in health, Dr. Jeffery Viera expressed to the New York Daily News that Vodou theoretically is related to AIDS. He stated, references to voodoo were made in the context of a discu ssion of theoretical means of transmission of putative infectious agent among susceptible indi viduals (Farmer 2006: 221). Viera also wrote that magical rituals sometimes transfer blood and secretions from pe rson to person. Women
30 have been known to add menstrual blood to the f ood and drink of partners to prevent them from straying (Farmer 2006: 221). This sort of type-casting of Vodou as a religion of blood and ritual is a gross misrepresent ation of the many types of ritu al that are performed during ceremonies. This is an example of how a preexisting model of Vodou was invoked during this time. Summary Chapter 1 addressed how medical an thropology has progressed and changed methodologically and theoretically since its incep tion. Ruth Benedicts work in anthropology helped frame medical anthropological inquiry wh en she began to question medical definitions scrutinizing the biomedical system. Folk medical inquiry in anthropology has lead to a larger understanding of the different ways of knowing and the co rrelating systems of medicine to that knowing that exist in the world. The Haitians of this research are transmigrants who bring their folk medical methods and theo ries with them to the United States. Their status as transnationalists, and the identities they construct because of this, is directly linked to the ways they utilize and experience medicine and health. Chapter 2 on the background and history describes a political history of Haiti and how United States interventions and policies affect Haiti and Haitians. Demographic information about Haitians in Haiti followed by a brief overv iew of Haitian migration contextualizes the Haitian experience in New York. Demographic information about Haitians in New York City in general, and Central Brooklyn more specifically a llows for a comparison of the general standard of living faced by migrants when th ey arrive in the United States. Chapter 3 presents survey data from Haitian subjects and health care workers. All surveys occurred in public places throughout the East Fl atbush community. A basi c history about East
31 Flatbush, methods and sampling design, sampling issu es and a description of the research sites occurs. Chapter 4 presents a range of twelve illness concepts and categories used by Haitians in Brooklyn. Categories were chosen because they were addressed by the public health advocacy community or because they were folk illnesses th at are used to explain pathologies related to reproductive health issues. In this section it beco mes clear that women use folk health categories to avoid inter-group stigma, but are faced with stigma from health practitioners in regards to their belief in folk concepts of health. Chapter 5 presents and analyzes the data from the interviews in the form of case examples. There are four narratives divided into two sets because two of the narratives address the issues of AIDS, Vodou, and Blackness while the other two narratives addre ss peoples experiences and reflections on folk health illnesses. Chapter 6, the conclusion and findings, shows how race and religion, and peoples experiences with health and h ealthcare reflect one another and shows how women use folk illness categories to lessen the stigma associated with barrenness and related reproductive health issues.
32 CHAPTER 2 HISTORY AND BACKGROUND Introduction This chapter contextu alizes the Haitian experience through a brief political history of Haiti, basic demographic information about Haitians in Haiti, and peak periods of Haitian migration that coincide with periods of political instability. The United States government and military were involved through an occupation from 1915-1934, by backing Duvalier for president in 1957, and by not supporting Jean Betrand Ariside, a democratically electe d president. These years, 1915-1934, 1957-1971, and 1972-1994, were not only plagued by political instability in Haiti, but were important political times for Haitia ns in the United States. Haitians were labeled as AIDS vectors, and the FDA banned Haitians from donating blood, which led to protests in Miami and New York. These protests helped to end the ban against Haitians donating blood. Haitians in New York have not managed to escape politics or poverty. They live in overcrowded households and have higher-then-average health indicators such as death rate and instances of HIV and AIDS. Statistics on repr oductive health in Brooklyn an Central Brooklyn do not fare better. In Brooklyn, health indicators such as infant mortality rate and maternal mortality rate are higher then for New York City as a whole. An important aspect to Haitian health and healthcare is Vodou This complex relationship means that Haitians have multiple ways of understanding and particip ating in healthcare interactions. Therefore, Vodou and folk medical practices ar e connected through belief and practice. There are specific folk illnesses that only a Vodou priest can heal. These illnesses are believed to be created by the Haitian lwa or spirits that are worshipped in Vodou.
33 Haiti: The First Independent Black Republic Haiti was declared indep endent by Jean-Jacque s Dessalines who took over the Black army after Toussaint, then leader of the Black army, was taken captive. This marked the end of the only successful slave revolt in the history of the world and the first Black nation to win independence. The victory was bitt er-sweet as it resulted in Hait i struggling internally and being ostracized from the global political society. This was a time of isolation for the country. Further neglect from outside sources occurred when Dessaline was named Emperor and liquidated the French who still resided on the island. Battles with the French and Spanish army splintered Haiti. Outside of Haiti, the United States, Fr ance, and Britain took notice of the internal struggles occurring in Haiti. A lthough the Congress of Vienna abol ished the African slave trade, the world was not yet ready to recognize a natio n whose insurrection was led by a slave revolt. The United Sates position with Haiti was splitNort hern merchants wanted to trade with Haiti, but Southern slave owners did not (Heinl and Heinl 1996). United States support of Haiti began as early as 1803, when arms were shipped to aid Dessaline even though President Jefferson, at the behest of Napoleon, had placed an embargo against Haiti from 1806 to 1809. When the Americans decided to occupy Ha iti in 1915, the country had gone through its eighth brutal overthrow of government in less then seven years (H einl and Heinl 1996). In fact, of the twenty-two leaders be tween 1843 through 1915, only one ha d served out his term of office. Four had died in office. One had been blown up in his palace. One had been overthrown and executed. One had been torn to pieces by his subjects. Thirteen had been ousted by coup or revolution (Heinl and Heinl 1996: 385). Thus, the occupation began. Jean Dominique, an outspoken radical Haitian journalist, references hi s memories of this time in Haitian history when political decisions on behalf of Haiti began to be decided by, or were hi ghly influenced by, the United States marines and government.
34 I was 4, 4 years old when the Marine left Haiti, the US marine left Haiti, I was a kid, and every time a Marine battalion passed in front of the house my father took my hand and said, dont look at them...dont look at them. And every May 18th which is the Flag Day, defiantly, he put the Haitian flag in front of the house and I said, father what is that, what does that mean for you? He said, that mean that you are Haitian. That mean that my great grandfather fought adversity never forget that. You are Haitian. You are from this land. You are not French. You are not Britis h. You are not American. You are Haitian. (Wyclef Jean 2004) This political decision-making plagued by patern alistic attitudes from the United States has continued to the present day through the most recent electi ons. This quote speaks to the frustration that was felt by many Haitians during this occupation of their country. The line where Dominiques father reminds him that he is not French, British, or American speaks to all of the different colonial influen ces that have at one time or anot her intervened in the politics, economy, and society in Haiti. Dominiques father did not want him to get lost in those other identities, but wanted him to continue to identify as proud to be Haitian especially in the midst of an American occupation. 1915 through 1934 From 1915 to 1934, the United States Marines occ upied Haiti in respons e to the instability that plagued the state. The United States identified three tasks in Haiti: to create political stability, to control Haiti in regard to United St ates interests in the Caribbean, and to integrate Haiti into the global capitalist economy (Renda 2001) When the United States Captains arrived in Haiti, they addressed those in power and expl ained that they would c hoose the next leaders, and, would institute pseudo-elections to hide this fact. Before the election, the United States informed Haitian congress that th ey would take control over cu stoms and financial affairs in Haiti as they deemed necessary. The political age nda of the United States in Haiti was large in scope and included a decision by the marines to di ctate culture as well as state function. The United States marines instituted a law which prohibited the practice of Vodou (Renda 2001).
35 The marines burned drums and other Vodou related articles and cerem onies were prohibited. This behavior paved the way for the early 1940 antisuperstition campaigns where the Haitian clergy, local missionaries, and Presid ent Lescot destroyed and burned Vodou temples, drums, and other artifacts. Other oppres sive and paternalistic acts the United States committed while in Haitiinvestments in fruit, sugar, transportation, and banking which used forced labor gangs of Haitians to promote this modernization. The forced labor system was brutal and many marines acted with racist tendencies. A main aspect of the militarism at this time was its racist paternalism which was a part of United Stat es foreign policy (Renda 2001). The marines considered Haiti and Haitians to be wards of the United States Renda 2001 writes, Indeed, over the course of the occupation paternalist discourse constructed Haiti as a nation orphaned by parental neglect, sometimes figuring France as th e father who abandoned Haiti and Africa as the single mother incapable of rais ing her illegitimate child alone (Renda 2001: 16). Because of racist attitudes, forced labor, and other comple x interactions frustration with the occupation began to build (Renda 2001; Arthur 2004). In 1934 the United States left Haiti. 1957 through 1986 After years of independence from the Unite d States, in 1957 electi ons occurred in Haiti with the United States supported Franois D uvalier (Heinl and Heinl 1996; Arthur 2004). Duvalier won the election. This election was considered to be corrupt and was contested by many (Heinl and Heinl 1996). The early 1960s, was the most oppressive and terror-filled time of the Duvalier family rule. In 1971, Papa Doc D uvalier died and his son, Jean-Claude Duvalier or Baby Doc, took over as president for life. Baby Doc was just a figure-head for the first few years because of his age, but during his time he had built up Haiti as a place for tourism. In 1982, when the Centers for Disease Control (CDC ) linked Haitians to AIDS, tourism in Haiti declined (CDC 1982a and 1982b). By 1983, newly immigrated Haitians to the United States
36 became labeled by the CDC as a high risk grou p for AIDS (CDC 1982b). The effect was catastrophic in both Haiti and the US. By 1983, the tourist industry in Haiti floundered and failed (Heinl and Heinl 1996). During the su mmer of 1983, Haitians were taken off the New York Citys Public Health Departments list of a high risk group for AIDS because of the high levels of discrimination toward Haitians in the city. In April 1985, the CDC removed Haitians from their high risk group list (Farmer 2006). Ho wever, tourism never recovered and Americans never forgot this distinction. In 1986, a popular uprising that began in the Northern city of Gonaives, overthrew Baby Doc in what Haitians called Dechoukaj (to uproot) (Heinl and Heinl 1996 and Freeman 2004). 1990 Through 1994 In 1990, two things happened. The United Stat es m ade changes in their health policies toward Haitians and Haiti elected a new president. Haitians in the United States had long struggled with racist policies by the Centers for Disease Cont rol (CDC) which declared their health status as AIDS vectors, and, policie s by the Food and Drug Administration (FDA) which disallowed Haitians who migrated to the US after 1977, from donating blood (CDC 1982b and Farmer 2006). This policy changed on Februa ry 5, 1990, when the FDA banned all Haitians from donating blood. The FDA defended their decisi on stating that with Haitians HIV/AIDS is transported mainly through heterosexual sex, and, because of this, they had no good screening methods of which to locate Haitians who were at high risk for HIV/AIDS (Farmer 2006). Haitians renamed the FDA to the Federal Discrimination Agency which was seen on placards that were held by some protestors about 5,000, in Miami that March (Farmer 2006). This movement by Haitians in cities across the US began to grow rather then subside and on April 20, 1990, fifty thousand protestors supported by Mayor Dinkins and the Reverend Jesse Jackson marched across the Brooklyn Bridge closi ng the bridge to traffic for the day (Farmer
37 2006). The Haitian press commented that numbers this large of a sea of black faces had not been seen in New York since Martin Luther King s funeral in 1968. The FDA responded to this protest by forming an advisory panel, which calle d for an end to blood donor bans based within nationality and geography (Farmer 2006) which in December of 1990, was enacted and the ban against Haitian blood removed. Alongside the politic al struggles that Haitians were having in the United States Haitians in Haiti were affecting political and national growth. Jean Betrand Aristide, a catholic priest deeply connected to the Haitian people, ran for president. In 1990, Jean-Betrand Aristide became the firs t democratically elected president of Haiti by a 67% majority. Aristide brought hope to the people who began to come together and tried to better their communities through community servi ce. Aristide, they thought, would bring positive change to Haiti. However, Aristide was not supported by the United States government (Heinl and Heinl 1996; Arthur 2004 ) or Haitian elites, and so in 1991, the Haitian army ruled by General Cdras, took over the country in a coup d etat. The Cdras government ruled under a reign of terror surpassing the violence and political oppression of Duvalier in the early 1960s (Heinl and Heinl 1996). Arthur wr ites, For three years, summary executions, arbitrary searches and arrests, disappearances, bea tings, torture, and extortion were systematic and commonplace (Arthur 2004:25). This regime was supported by the Front for Haitian Advancement and Progress (FRAPH) and by the CIA, although this f unding was unofficial (Bell 2001). Bell writes of some of the atrocities experienced by Haitians during this time. She writes, A common tactic of FRAPH members themselves largely recruited from slums and villageswas to slice off the faces of their victims before depositing them in open-field garbage dumps in Cit Soleil (Bell 2001:13).
38 In 1994, 20,000 United States troops arrived in Haiti and Aristide was restored to presidency by the United States government under President Clinton to finish his five-year term. Ren Prval acted as president in 1996, as a part of Aristides Lavalas Cleansing rain party. In 2000, Aristide was elected again (USA Today 2006), but was removed, in 2004. The United States marines took Aristide and his family to a plane and forced him to leave the country (BBC 2004a and 2004b). Until present day, the United States contends that Aristid e requested to leave, but Aristide insists he was kidnapped (BBC 2004a and 2004b). Gera rd Latourtue, the new US appointed Prime Minister began his very s hort term. CARICOM (C aribbean Community Secretariat) and 22 members of the Congression al Black Caucus all refused to recognize Latourtue (Edwards 2004). Haiti: The Poorest Country in the Western Hemisphere Haiti is the poorest cou ntry in the Western Hemisphere (Loescher and Scanlan 1984; Stepick and Portes 1986; Lennox 1993; CIA World Factbook 2006). This is one of the most commonly written references about Haiti as if the complexities that have created Haitis economic, political, and cultural position can be su mmed up in this one statement. Haiti is a little smaller then the state of Maryland and located on the Western 1/3 of the island of Hispaniola which it shares with the Dominican Re public. Due to major soil erosion, only 28% of land is arable (CIA World Fact book 2006). Deforestation is a majo r issue as trees are used for fuel and cleared for agriculture and most of th e country does not have access to potable water (Lennox 1993; Arthur 2004; and CI A World Factbook 2006) which all, along with historical and political occurrences, contri bute to Haitis poverty. Haitis population is about 8, 308,504 (CIA Worl d Fackbook 2006), with the median age at 18.2 years. Ninety-five percent of the population descends from Africa while 5 % is biracial, Caucasian, and of other descent. The average life expectancy is 53 years and the HIV/AIDS
39 prevalence rate among adults is 5.6 %. There are 36.4 births per 1,000 women and an infant mortality rate of 71.7 deaths per 1,000 live bi rths (CIA World Factbook 2006). Inadequate nutrition and sanitation leaves Haitians in poor h ealth. Thirteen percent of Haitian children die before the age of five and one-fourth of Haitians die before the age of forty (Arthur 2004). Roughly half of Haitis children do not attend sc hool due to lack of access to affordable schools. There are few free statefunded schools (less then 100 in th e entire country) as most are run by mission groups and are private. The typical cost of tuition is $US40 per year which is 16 % of the average annual income of $US250 (Arthur 2004). Haitia n education is based upon the French system and includes seven years of primary education and seven years of secondary education (Building with Books 2004). When st udents finish primary school, they receive a primary education certificate and may then take exams to enter a lyce (public school) or a collge (private school) (SAGART De sign 2006). Secondary education has a lower-level cycle that lasts three years and a higher level cycle that lasts four years. After completion of the first three years, a student is awarded a baccalaurat. In the higher-level cycle, receiving a classe de philosophie, which is a part of the baccalaurat, allows potential candidates to be able to attend college (SAGART Design 2006) Forty-eight percent of the populat ion is illiterate (CIA World Factbook 2006). More then 60% of urban male s in Haiti are unemployed, while women are afforded more job opportunities1. Given the political and economic adversity faced by many it is not surprising that Haitians who are given the opportunity to l eave Haiti migrate. Haitian Migration to the USA The objectiv e of this section is to show mi grations patterns of Haitians to the United States. There are three peak times that Haitian migration to the United St ates occurred. These 1 This is because of a gendered division of labor imposed by outside companies who perceive woman to be better at piecework and by internal divisions of labor where woman are c onsidered to be better at commerce.
40 were during the 1915-1934 occupation of Haiti by the US, 1957-1971 when Duvalier was in power, and 1972-1994 during Baby Docs term and the post Duvalier po litical aftermath (Lennox 1993; Laguerre 1997). Labor migrations fr om the Caribbean have taken place for the last 500 years; however, Haiti has not followed this pattern (Stepick and Portes 1986). Haitian migrants first began to arrive in the USA between 1791 and 1809 (Lennox 1993; Laguerre 1997) during the French and Haitian re volutions in low numbers. In attempts to stifle Haitian migration to the United States during this ti me fugitive slave legislation was implemented (Lennox 1993). This applied to Haitians because, although most Haitians were free by Haitian law, they did not have proof of this freedom (Lennox 1993). United States involvement in Haiti has contri buted to Haitis current political, economic, and cultural situation. Historic ally, the United States dominated Haitian affairs while seeking hegemony over the Caribbean region (Lennox 1993). This was achieved through governance over Haitian import markets, investment in railwa ys, and in 1910, the US gained control over the Haitian banking system (Renda 2001). In 1915, the United States staged an election which installed the first client-pre sident who was hand picked by the United States (Lennox 1993). From 1915 to 1929, over half a million Haitians left Haiti, some as labor migrants to the cane industries in Cuba and the Do minican Republic (Arthur and Dash 1999). When the United States occupied Haiti, they were also occupying the Dominican Republic from 1916-1925 and American owned sugar companies used Haitian labor in both countries (Arthur and Dash 1999). During the United States occupation of Haiti, the United States implemented segregation policies between White Americans and Black Haitians and encouraged United States businesses to exploit the few resources available in Haiti (Lennox 1993). The United States was partially successful in creating infrastructu re such as roads, hospitals, and schools, but when the United
41 States left in 1934 the nation was economica lly crippled (Lennox 1993), However, Laguerre (1997), notes that as soon as the United States Marines left Haiti, the infrastructure they had built began to crumble. The second peak era of Haitian migra tion was from 1957 through 1971, when Duvalier was president. Duvalier was elected with Haitian military backing in 1957 and by the early 1960s large numbers of Haitian migrants began arriving in the United States (Loescher and Scanlan 1984; Laguerre 1984; 1997; Lennox 1993; Arthur 2004) From 1956 to 1986, one million US visas were given to Haitians with half of these people over-staying their visas. The Duvalier era was characterized by migration, creating a middle-class in Haiti that survived on remittances from Haitians in the United States (Laguerre 1997), which were roughly 25 % of the GDP in 2005 (CIA World Fact Book 2005). T hose who migrated were mostly government officials, politicians, and pr ofessionals who had limited or no economic opportunities under Duvalier. Duvalier formed the Tonton Macoutes2 a secret police or private militia. This police force helped Duvalier to impose indiscriminate violence against all real and imagined opposition to his regime (Arthur 2004). Roughly 30,000 opponents of Duvalier were killed and the United States continued to support th e regime. Duvalier was favored by many US presidents, including Eisenhower and Johnson. Duvalie rs violent oppression was ignored and aid flowed freely to this corrupt government, with the United Stat es supplying about 20 million in aid from 1946 through 1972 (Loescher and Scanla n 1984). Duvalier was able to hold favor of the US through political tactics such as his denunciation of communism, which, linked his government to the US rather then to Cuba. 2 Tonton Macoute literally means Uncle Sack. Uncle Sack is a person who comes around at night and puts bad children into his sack and st eals away into the night.
42 After Papa Doc Duvaliers death in 1971 a s econd wave of Haitian migration occurred (Lennox 1993 and Laguerre 1997). Lennox ( 1993) writes that, Between 1972 and 1980, approximately 50,000 Haitians attempted to gain asylum in the United States; as few as 25 succeeded (Lennox 1993: 700). The United States was able to refuse large numbers of people through interdiction at sea, depor tation, and detention. Accelerate d deportation occurred by the INS asking immigrant judges to see, rather than the normal one case per day, up to 50 cases per day (Lennox 1993). Interdiction at sea occurred formally during the Reagan administration. Reagan claimed that too many refugees posed a th reat to United States interests and gave aid packages to Baby Doc in exchange for his suppo rt of the interdiction program. The United States rationalized their restrictions on Haitian immigration by stating that Haitians are economic rather than political refugees. During this time in Haitian history, an exodus from Haiti began that came to be known as the Haitian Boat People. In 1972, the Haitian Boat People began to arrive on the shores of Florida, some dead and some alive. They arrived in small to medium-si zed vessels that were over-loaded with people. Life on the boat was extremely difficult and many did not make it. On some boat trips the people ran out of water and food well before they arrived in the United States, and many died at this stage (Stepick 1982). Sometimes the boats capsized and people drowne d before the trip was over. The people in these boats could not afford ex it visas or plane tickets, but sold all of their land and belongings to board the rickety ship s (Arthur and Dash 1999). Throughout the 1970s, about 50,000-80,000 people arrived in Florida this way. Until 1981, when interdiction began, the boat people were detained in Florida and depo rted as quickly as possible. Since 1981, they have been returned directly to Haiti without oppo rtunity to request asylum (Mitchell 1994). This policy is challenged by many who believe it is inhumane and is based on discrimination.
43 However, the United States has the legal ability to uphold their interdiction policy of Haitians (Mitchell 1994). Although the boa t people were arriving in desper ation on US shores, monetary support to the Haitian go vernment continued. There are several economic reasons why the Un ited States should not have given monetary and political support to the D uvalier government. Loescher a nd Scanlan (1984) note that, In 1978, the Congressional Research Service estimated that 50% of Haitis income was in unbudgeted accounts that were presumed to end up in private hands (1984: 317). A 1979 World Bank report stated that in 1977, 40% of all Haitian govern ment costs and income were channeled through special accounts with the Nationa l Bank so that it was difficult to know where the monies came from or where they went (Loescher and Scanlan 1984). In 1986, a mass of people rose up to dechouka j the Duvalier family from their place of power. Haitians in New York Haitian s rank 18th for those living in the United States who are foreign born. There are 419,317 Haitians in the United States and Haitia ns account for 95,580 of New Yorkers (Burden 2000). These figures do not take into account ill egal migrants. Laguerre (1984) writes that Haitians regard each borough through the eyes of economic class. For instance, middle-class Haitians reside in Manhattan, upper-class Haitians reside in Queens, and lower-class Haitians reside in Brooklyn (Laguerre 1984 ). The top three neighbor hoods in Brooklyn where Haitians reside are: Central Flatbush of which 15.5 % are Haitian, Flatlands-Carnarsie of which 12.1 % are Haitian, and Crown Heights of which 8 % are Haitian (Burden 2000). Socio-demographic characteristics such as age distribution, family type, average size of household, English language proficiency and ed ucation, and household income give a more complete idea of the lives of Haitians in New York. In general, immigrants to New York are 18-
44 65 years of age. Haitians fit this statisti c with 48.8 % between the ages of 18-44, 31.5 % are between the ages of 45-64, and 12.6 % of Haitian migrants are 65 and over (Burden 2000). A family household, as defined by the census, is any group of people living together in a home or apartment, who are related (Burden 2000). Out of 40,694 Haitian households, the average number of people per household is 3.5 which is higher than the city -wide average of 2.6. However, it is common for foreign-born households to be larger then native-born households. Out of these households, 30.2 % are owner occupied, and 26.4 % are overcrowded. Overcrowding is defined by federal standards as occurring when there is more then one person per room (Burden 2000). Seventy-one percent of the Haiti an population in New York above the age of five is not proficient in English. Thirtyone percent of Haitians have ha d less then a high school education, while 25.8 % are high school graduates, and 16 % have had some college or more (Burden 2000). Haitians who migrate to the United Stat es have higher educati on levels than most Haitians in Haiti, but lower education levels th an people who were born in the United States (Lennox 1993). The median household income of Haitians in New York is $36,000. Out of 96,032 Haitians, 19.1 % of Haitians are in poverty 3 and out of 40,694 Haitian households, 5.9 % are on public assis tance (Burden 200 0). Statistics for Haitian hea lth in Central Brooklyn reflects the general poverty conditions as desc ribed above that people endure. The overall death rate in Ce ntral Brooklyn is 20% higher th en all of Brooklyn and 30% higher then New York City. People living with HIV and AIDS is about 35% in Central Brooklyn while in the last year resi dents are more likely then New Yo rk City as a while to get an HIV/AIDS test they are less lik ely to use a condom (New York City Department of Mental 3 The poverty level is a federal standard. This refers to households of four with an income of $16,665 per year or below (Burden 2000).
45 Health and Hygiene 2008). Twenty-nine percen t of residents do not have a primary care physician while 21% of residents are uninsured and 66% of residents have been insured for at least one year. Twelve percent of adults in Central Brooklyn have diabetes compared to 9 % in New York City as a whole. Reproductive Health in Central Brooklyn, Un ited States, and Haiti Women are more likely to be screened for cervical cancer and less likely to have a mammogram in Central Brooklyn then in all of New York City while people are less likely to be screened for colon cancer (New York City Depa rtment of Mental Health and Hygiene 2008). Thirty-five percent of wo men in Central Brooklyn are more likely to receive late or no prenatal care while in New York City in general 28% of women receive late or no pre-natal care. Maternal and child health in Central Brooklyn rates in the bottom 10 New York City neighborhoods out of 41 neighborhoods being comp ared (Department of Mental Health and Hygiene 2003). The fertility rate in Br ooklyn is 68 per 1000 with a population of 2,465,326 compared with NYC as awhile which is 66 per 1000 with a population of 8,008,278. Infant mortality rate (IMR) in Brooklyn is 6.6 while it is 6.1 for all of New York City with only the Bronx having a higher IMR at 7.1 (New York City Department of Mental Health and Hygiene 2004). The maternal mortality rate for Brooklyn in 2006 was 34.7 per one-thousand births compared to all of New York Citys rates of 29.3 (Personal Communi cation, Richard Genovese, NYC Department of Health 2009). In the United States in general the infant mortality rate is 6.3 per one-thousand with 14.18 live births per one-hundred thousan d with a total fertility of 2.1 children born to each woman and the maternal mortality is 14 per one-hundred thousand (CIA World Factbook 2008). While in Haiti there are thirty-five live births per one-thousa nd with the infant mortality rate at sixty two per one-thousand and a total fertility rate of a bout 5 children born to each woman (2008 World
46 Fact Book). The maternal mortality rate in Haiti is six-hundred eighty per one-hundred thousand (World Health Organization 2006). Healing Role of Vodou Vodou, health, and healing for m a complex relationship which is important to understanding folk illness concepts and practices in Haiti, and with Haitians in the United States. Ekspedisyon (sent sickness) is an etiological category that can be applied to a range of illnesses both biomedical and Haitian folk-based illnesses. A sent sickness is sent through ritual created by an oungan or mambo ( Vodou priest or priestess). Magical illn ess or spirit-based illnesses are magical at their point of causation and are sent by the lwa. This means only the lwa can cause this type of illness and it is magic because the lwa and God are supernatural beings. Farmer (1990) found that when informants discusse d magical illnesses some linked this to Vodou while others (both Protestant and Cat holic) did not make this distinction (Farmer 1990). He suggests that the links to Vodou concerning sent and magical illness are unclear. However, in the canon on Vodou, there is discussion of Vodou as a part of the healing sy stem in Haiti (Laguerre 1984). Folk illnesses are known, in some cases, to be caused by supernatural entities (Murray 1991; McCarthy-Brown 2001). In Vodou, there is God or Lord (Bondye or Granmt) Bondye created the spirits ( lwa) that exist in Vodou (Murray 1991 and Desmangles1992). The lwa may correspond to Catholic Saints and often draw upon West African prototypes. Murray (1991) gives an excellent example of how bondye and the lwa are regarded within Vodou cosmology. Only he can create rain, for example. Once the rain clouds are there the loua can mischievously move the clouds around to help or punish someone; and they can tie up the rain to prevent it from falling. But they are powerless to create rain. Only Bondye has that power Most importantly for this discussion, only Bondye can create life in the womb of a woman. (Murray 1991:9)
47 There are types of lwa such as family lwa that are adopted by each family. The lwa can be used for positive and negative purposes. A lwa can mount a person through spirit possession or a person can purchase a lwa making it do whatever is asked (Herskovits 1937). The priests and priestesses in Vodou are called Oungan and Ma mbo respectively (Mu rray 1991; Desmangles 1992; Desrosiers and St. Fleurose 2002). These ritual practitioners oversee ceremonies and perform spiritual healing rights. There is also a third ritual practiti oner called a bk. A bk is a sorcerer or priest who deals in malevol ent magic (Herskovits 1937; Desmangles 1992; Desrosiers and St. Fleurose 2002). Some folk illnesses are known to be caused by Vodou alone while other folk and biomedically based illnesses can have various etiolo gies that include Vodou. Summary This chapter describes Haitian and U nited States political history. Demographic information about Haitians in Haiti and their mi gration to the United St ates is overviewed and demographic information about Haiti and in Ne w York and central Brooklyn is addressed in order for a more complete picture of Haitian migrants in the New York to emerge.
48 CHAPTER 3 METHODS Introduction This chapter describes the research area and field site locations as well as m ethods and sampling design. East Flatbush is located in Ce ntral Brooklyn one of the five boroughs in New York City. Methods used were typical for anthropological inquiry a nd included participant observation, open-ended interviews, and surveys. The sample size included 27 structured interviews with Haitian informants, 27 surveys with health care worker s in the community, and four in-depth interviews with Haitian informants. Some sampling issue were my r acial and outsider status, however after daily visits people began to trust me. The research sites were vari ed and included local health care facilities and non-profits, a local Caribbean market, and a health fair. Data were collected from these sites after one month of observation and time sp ent learning about the community and making contacts within the community. East Flatbush The community of East Flatbush is located in Central Brooklyn bounded to the East by Utica Avenue, the North by the Eastern Parkway, to the South by Flatbush Avenue, and the W est by Ocean Avenue which runs along Prospect Park (Boundaries of the Brooklyn Community Districts 2004). These are rough boundaries. Fo r instance different New York City government agencies site slightly different areas for th is neighborhood and the people who live there also have different boundaries for their community then the city. When exiting at the Church street subway stop the street is lin ed with Haitian, Jamaican, Trinidadian, Guyanese, and fast food restaurants. The smells of baking chicken and sw eets fill the air. Walking West toward Flatbush Avenue, there are at least three money transfer businesses that advert ise in Creole and are
49 adorned with the Jamaican flag. There are Hait ian women who sell peanuts, perfume, and spices along the street and older men who hang out drin king sodas, socializing. The foot and motor vehicle traffic on these main street s is heavy with lighter traffic on the residential cross streets. Apartment complexes in this neighborhood stand anywhere from 4 to 15 stories with a few ranch style houses sprinkled in among the urban ar chitecture. One apartment I visited in this neighborhood was a clear indicator of the poverty level. The hallway had large chunks of tile missing, and while I was visiting, the apartment and hallway flooded with more then an inch of water and we lost electricity for about 2 hours due to the flooding. Ev eryone was calm; we continued to play cards (alt hough we took it outside) while an other member of the building temporarily stopped the flooding and re turned the electricity. The resi dential areas, at least in the summer, are teaming with people, children r unning around and eating ice cream, people playing dominoes or cards at tables, and women having casual conversations in corner stores. Methods and Sampling Design The relevance of the previous section concerni ng the background of East Flatbush is that a general description of the nei ghborhood and housing available create a structure of which to construct and further analyze the research area. My m ethods included participant observation, open-ended interviews, and surveys. I collected pa mphlets and flyers that were handed out in the neighborhood and at health events and clinics an d took photographs in order to contextualize the community of East Flatbush and the Haitian ev ents that took place outside of this neighborhood. The original field plan called for work with obstetric nurses and doctors who served the Haitian community and Haitian women of different ag es. I soon realized that my field plan and research had to be altered. First, access to obstetric doctors and nurses was difficult because I did not have any connections to this community. Second, it seemed necessary to speak with both men and women about the illnesses in question. The revised research plan considered two
50 distinct groups and the variables were more general. Health workers who served the Haitian community and Haitian subjects, both men and women, were included in the new research. All interviews took place in a public place. The sa me structured interview was used for men and women, but questions about the menstrual cycle we re omitted for male interviewees. I had the advantage of speaking Haitian Creole and Englis htwo of the three languages, Haitian Creole, English, and French, spoken in the Haitian commun ity in the United States. Most interviews and surveys occurred in Haitian Creole except when an informant requested English to be used. The final sample size was twenty-seven structured interviews from Haitian subjects1, twenty-seven questionnaires from health workers, and five structured interviews. However, the final data I drew upon includes ten Haitian subj ects, twenty-six health workers, and four structured interviews. I chose to leave out 17 of the questionnaires with Haitian subjects because I asked baseline data and asked about use of t eas, but omitted questions concerning folk health illnesses. The following questionnaires were omitted: eleven collected from Kreylfest, 3 collected from the Caton Flatbush market, 1 co llected from the Linden Medical clinic, and 2 from CWHA These questions were omitted as they were not giving me the type of information I wanted, nor did they lead into conversations about the health c oncepts I wanted to address. Table 3.1 shows the distribution of the samp le collected across seven locations. Sampling Issues The first issue was m y racial and outsider status in the eyes of the community. This became clear when an informant Lamsi told anothe r woman Mikerlin that, s he is not a racist. You can talk with her. Although this comment was made, I still found it difficult to gain the trust of the women in the market. However, after daily visits, by th e time I was finished with my 1 When I use the term Haitian subjects this refers to th e men and women who were not health workers, but were patients at the Linden Medical Clinic and marketers at the Caton Flatbush market.
51 research; people in the market had become more comfortable with me. Second, was my lack of familiarity with the informants. Farmer (1988) and Chen and Murray (1976) write that familiarity with Haitians in par ticular is an important factor to collecting dependable information when compared with other groups with whom they had conducted research. This is true for the studies they had conducted with at that time a nd may not be true for all groups of Haitians and all studies with Haitians. I found this to be an issue in my research even after 3 months of daily visits and one year of occasional visits. In my later visits during the initial summer research people became more comfortable with me and became a bit more open in their discussions. After one year when I returned to do more interviews informants we re much more comfortable with me and I found that they were more will ing to share information. The Research Sites My second day in New York I headed to Brookl yn to m ake appointments with some of the Haitian non-profits I had previously researched. I intended to create an affiliation with a nonprofit so that I could access the Haitian community in this way. Although I did not create an affiliation with my first nor second choice, my first choice was in the process of moving, and my second choice never contacted me, however, the th ird non-profit proved to be my way into the community. At the Caribbean Womens Health A ssociation (CWHA) I spoke with the executive director and was awarded an intern position which began the following Monday. Figure 3.1 is a map of the general research area and each individual research site is shown by a yellow thumbtack on the map. Table 3.1 shows the dist ribution of the sample broken down by number of questionnaires completed. The Caribbean Womens Health Associati on (CWHA), located on Linden Boulevard in East Flatbush, services the Caribbean community by offering a range of health services that
52 include, but are not limited to, adolescent health, pe rinatal and prenatal health outreach, HIV/AIDS outreach, and Asthma ou treach. I was one of two people at the office who were not of Caribbean descent. However, people were welcoming and interested in my research. Through colleagues at CWHA, I was able to make contacts with Haitian subjects in the general community. CWHA seemed typical of many non-prof its in this community. There were always clients flooding the hallways, waiting for a meeti ng. They sat on metal chairs and were cooled by the one large fan provided for the entire area. Offices were small a nd everything from Rapid HIV/AIDS tests to the filling out of immigration papers occurred w ithin their walls. Needless to say the diversity of New York City was very much alive inside CWHA as lively discussions in at least four languages, Creole, Fr ench, English, and Spanish occurre d between clients and between staff and clients in the hallways. Through my af filiation at CWHA I was able to gain access to other non-profits and health clinics in the area. The Caribbean American Center is a sister nonprofit to CWHA, Luth eran Families, and Partners in Health. It is one of many clinics that serve the Ha itian community. Clinics in this neighborhood tended to be very busy, had small o ffices, and patients sat in a stuffy waiting room on metal chairs. An interesting aspect of this c linic was that all the labels on the doors were in both English and Haitian Creole. I was invited to attend a health fair where I signed up clients for the different tests they would receive that day and gave people instructions on where to go. Although I took no official count I would say th at the people seeking care were roughly 60% Haitian, and spoke only Haitian Creole. Attendees of th e health fair were grateful to be receiving free services which included rapid HIV/AIDS test s, prostrate cancer screens, mammograms, and asthma monitoring.
53 I was recruited through CWHA to work as a promoter for Maimonedes Medical Center and Hospitals upcoming health fair. During the fa ir I served as a walking advertisement for the upcoming Maimonedes health fair. I was asked to participate because I spoke both Creole and English and gave out promotional information and ma terials. Kreylfest is a concert that lasts several hours with high profile Haitian musicians. The energy at the concert was high. There were many people in attendance and a food vendi ng area filled with Haitian food venders. I received permission to conduct interviews with Haitian subjects at the concert and finished 11 surveys. A colleague at CWHA suggested that I visit the Caton Flatbush market which is nestled between clothing stores, restaurants, and shoe stores on Flatbush Av enue, a main street that runs throughout Brooklyn. The market is a welcome sight among all the urban clut ter as it has a large empty area for produce sales at the front. This ma rket is owned by the City of New York. The stalls cost $ 15.00 per day or $420.00 per month (NYC Business Solutions 2006). Informants reported that capital gains were roughly one hundred dollars per w eek. This market serves the West Indian, African, and African American co mmunity in this area of Brooklyn. At this market, there are ten Haitian-run stalls: rented by eight women, one man, and one to a married couple. Most stalls sell Ca ribbean country flag clothing, dr ied goods, spices and herbs, and Haitian food stuffs. There is one stall that sells Vodou flags, shakers, and herbal sexual remedies as well as art from Haiti and Ghana. The Flatbush Haitian Center is located one fl oor below CWHA and offered social work services to families with drug addicted members. In contrast to CWHA the Flatbush Haitian Center was very quite as all client meetings o ccurred off-site. People he re were very supportive
54 and welcoming. I attended a luncheon at a local elderly center with coll eagues from the Flatbush Haitian Center. I found the Linden medical clinic while wa lking from CWHA to the Caton Flatbush market. This medical clinic provides general me dicine and provides servi ces to people age fifty or older, although some younger people use this f acility. The clinic staffed one doctor, one nurse, and an office assistant who were of Haitian descent and spoke Haitian Creole in the office. The staff introduced me as a researcher and asked people in the waiting room to participate. All subjects addressed agreed to an interview. The pa tients here were excited to talk as it seemed to be a good way to pass the time. They also asked me lots of questions and which made it easier for me to conduct the questionnai re. Often times when eliciting responses form one informant other people would chime in, sometimes they were related to the informant sometimes they were not. It was in these moments that interesting conversations began. Dr. Marco Mason asked me to assist him in preparing a cultural tr aining seminar for a group of midwives at SUNY Downstate Medical Center. I helped him in preparing all documentation and gave a short presentation on the social aspects of illness. There were 5 midwives in attendance and we all sat in a circle and were able to share are many experiences. We discussed issues of class, race, gender, and the impact poverty has on the health of people. This was a very successful seminar. Events and Participant Observation During m y first week at CWHA I was sent to Health Advocacy Day along with 3 other female representatives from CWHA Health Advocacy Day occurred at City Hall in Downtown Manhattan. Council members were appointed to hear a ll issues on the floor above the allotted discussion space for the advocacy conference. Howe ver, each time we rode the elevator to visit them and ask questions few were actually availa ble. A 30 woman 2 man crew of advocates for
55 the different in-need communities in Brooklyn attended the conference. The conference consisted of each group speaking about different c oncerns in their community such as access to interpreters, the need for medication waivers fo r illegal immigrants, th e need for funds for general health education and the incidences of the di fferent health issues that plague their communities such as asthma, HIV/AIDS, low birth weight, and cancer. At the end of the formal presentations a press conference was held on the front steps. At first there were not many journalists, but lucky for our cause the Reverend Jesse Jackson and several members of the press appeared from within the building and spoke about the health discrepancies in Brooklyn. I was able to tape the entire speech while sta nding less then a foot from the Reverend. I attended another health event sponsored by CWHA and Maimonides medical center and hospital about health disparitie s in the Central Brooklyn Commun ity. I was appointed as note taker for this event called Community Strategies to Reduce Health Disp arities: Connecting the Dots. The speakers were from local non-profits and several physicians from local hospitals who were concerned with the health care disparitie s that was occurring in the community. Race, economic position, migrant status, gender, and lack of funding for the poor were all main issues addressed. Data Collection The content for the m edical questionnai re came from one month of observations, discussions, and attendance at health advocacy meetings in Brooklyn. The questionnaires administered to the health workers were written in English with limited Creole expressions that were translated or explained. Each included general questions concerning Haitian Patients, illnesses that occur in the community, Haitian fo lk illness knowledge, and socio-demographic information about each practitioner.
56 The content for the questionnaire with Haitia n subjects was developed from observations made in the field as well as research from pr evious studies of Haitian folk illness (Murray 1976, Farmer 1988, and Coreil et al. 1996). Thes e questionnaires included socio-demographic information, health-seeking choices, illness concepts, and knowledge of Haitian folk illnesses. Informants were asked about their sex, age, income level, and place of birth. Informants had difficulties with hypothetical questi ons so these types of questions were excluded. The content for the open-ended interviews was selected to address issues of stig ma with Vodou-related illnesses, AIDS, and race. Summary Data f rom the survey were collected from te n Haitian subjects and twenty six healthcare workers and the information for the case studies wa s taken from four interviews. All interviews took place in public e.g., the Caton Flatbush market, CWHA, the Caribbean-American Center, Kreylfest, the Linden Medical Clinic, the Flatbus h Haitian Center, and ot her private clinics and workshops. Table 3-1. Distribution of the sample Location of Data Collected Number of Questionnaires Conducted With Health Practitioners Number of Questionnaires Conducted with Haitian Subjects Caribbean Womens Health Association 7 (6 Women 1 Man) Caribbean-American Center 6 (3 Women and 3 Men) Caton Flatbush Market 5 ( 3Women and 2 Men) Flatbush Haitian Center 1 Woman Linden Medical Clinic 6 (5 Women and 1 Man) 5 (4 Women and 1 Man) SUNY Downstate 6 (6 Women) Private Clinic 1 Woman Totals 27 10
57 Figure 3-1. Map of field site locations [Created in google maps, www.google.com. 2005]
58 CHAPTER 4 SURVEY DATA Ti Moun se Richs Pv Malr Children are the wealth of the poor Tout Maladi Se Pa Maladi Dokt All illness is not illn ess a doctor can treat --Haitian proverbs Introduction The two proverbs above highlight Haitian beliefs and experiences in regards to theories of folk health. Ti Moun se richs pv m alr, addresses the importance of children to the Haitian people. Tout maladi se pa maladi dokt implies two things. First, that the Haitian medical system is medically plural and addresses a supe rnatural realm that causes sickness and cure. Second, people get sick and must live with it, ta ke some herbs, and move on. This chapter presents results from data collected from ten surveys with Haitian subjects, and twenty-six surveys with health care workers that servic e the Haitian community. Illness concepts and categories are important to this research because the different responses people gave show the stigma inherent in some illness categories versus others. Twelve illness categories were addressed which ranged from AIDS to common cold to various folk illnesses. Pdisyon (miscarriage) and ti moun mare nan vant ( the tied baby) are two reproductive pathologies that form a continuum from biomedically understood i ssues such as miscarriage, to a folk illness the tied baby. Ti moun mare nan vant is a way for women to explain infertility or temporary infertility issues in order to avoid stigma with in the Haitian community. Health care workers in East Flatbush noted that diabetes and high blood pressure are common issues faced by Haitian patients. In regard s to folk health issues health workers, in general, had not discussed these with patients and felt that patients believed in folk health
59 because they were uneducated. I found that wome n utilized folk illnesses as a way to protect themselves form the stigma associated with bareness and other reproductive health issues. However, while utilizing these indigenous theori es of health women are faced with negative views from biomedical practitioners when discussing these problems. Illness Concepts Provided by Haitian Informants To investiga te the range of illness concepts and categories utilized by Haitians in Brooklyn, the current research inqui red about twelve illness categories. The categories were chosen for two reasons. First, some categories such as AIDS, cancer, and diabetes were both widely researched and addressed by the public health advocacy community in Brooklyn. Second, I wanted to have a range of illnesses so that the differentiati on between biomedically based theories of illnesses, theories of non-illness, and folk theories of illnesses could be identified. Illness categories that help to frame biom edical theories of illness are AIDS, cancer, diabetes, cold/flu, mucus, and sprain. Menstrua l cycle, pregnancy, and miscarriage helped to frame theories of non-illness while the tied baby bad blood, and spoiled milk helped to frame theories of folk illness. Table 4.1 demonstrates the ways that Haitian subj ects consider illness. The illnesses listed range from HIV/AIDS, cancer, and di abetes to folk illnesses. Informants were asked to explain each selection and whether it was or was not an illness. These questions were asked of ten Haitian subjects. The Caribbean health advoc acy and non-profit communities focus on testing and education concerning HIV/AIDS, cancer, and di abetes. Their focus on testing and education in these topics is because of re search findings from the Departme nt of Public Health. Central Brooklyn is labeled as below average, it is in the bottom ten neighborhoods out of 41 researched, in New York City for the following health issues: general health, maternal and child health,
60 infectious diseases, and chronic diseases such as diabetes (New York City Department of Health and Mental Hygiene 2008). Death from AIDS and diabetes in central Brookl yn occurs two times more then for the rest of New York City while death from cancer o ccurs 25% more (2003 New York Department of Mental Health and Hygiene). In the East Flatbush and Flatbush neighborhoods of Central Brooklyn there is a 32% prevalen ce rate of HIV in the Caribbean foreign born population (New York City Department of Health and Mental H ygiene 2008.). This is the highest percent of HIV of all United Hospital Fund (UHF)1 neighborhoods in Brooklyn. Th erefore, its not uncommon to see free testing centers for HIV/AIDS, prostate cancer, and ma mmograms on the street or to be given condom kits with information about how to get a test for HI V/AIDS. AIDS, cancer, and diabetes analyzed together in this section because informants consid ered all three to be terminal diseases. As seen in table 4.1, 90% of informants believe that AIDS ( SIDA ) and cancer are diseases, and, all informants believe that diabetes is a di sease. AIDS was considered a disease by one informant because, it transports to others and another informant because it is a virus and an epidemic. One female informant said that cancer was a disease because, it kills people and there is no treatment, while another female inform ant said that AIDS and Cancer were diseases and that people can be cured but the power structure stops them from getting what they need. For both AIDS and cancer, several informants said they were diseases because they affect your health and because they kill you. Both AIDS and cancer were spoken of and described as 1 UHF is a nonprofit that funds resear ch and philanthropy in New York City. They focus on having a positive impact on New Yorkers health. They work with hospitals, clinics, and other care center s and also work with civic leaders and others to impact change.
61 biomedically based and understood di seases. However, this has not always been the case in the Haitian understanding of AIDS. When Farmer (1990) began studying AIDS in rural Haiti in the early eighties, it was considered a sickness of the city that dirtie d weak blood, or that people with bad blood ( move san) could more easily contract AIDS (Farmer 1990). However, by the late 1980s, these views changed and people in rural Haiti began to link AI DS to tuberculosis. AIDS was considered to be a sent sickness2 or to have been caught from a microbe3 (Farmer 1990). By this time there was also an understanding that AIDS could be caught through blood transfusions and sexual intercourse. Therefore, a strong belief in AIDS as a disease w ith informants is not surprising given the long history of both western biomedical and indigenous Haitian understandings of this disease. All informants believed that diabetes ( maladi sik literally the sugar illness) was a disease, because it has grave affects on h ealth and could kill you. The World Health Organization (WHO) lists that th ere are 161,000 documented cases of diabetes in Haiti out of a total population of 8,326,000 (.01%) and a total public and private he alth expenditure of $INT 83.004 in 2002 (WHO 2006). Haiti had the lowest h ealth expenditure of any other area in the WHO region of the Americas. Th e total number of diabetes ca ses is much higher than the documented cases as it is clear that much of the population cannot afford, does not have access to, or chooses not to seek out, healthcare that offers such documentation. For comparison, the United States health expenditure was at $INT 5,274.00 in 2002 (WHO 2002). 2 Sent sickness is when one person sends an illness to another person by paying a oungan or bk to perform a ritual. 3 A microbe is a microscopic organism or germ. 4 This $83.00 is configured by the international dollars formula (INT). The international dollar accesses differences in the purchasing power of different currencies. Internatio nal dollars are calculated using purchasing power parities (PPP), which account for differences in price level betwee n countries (WHO).
62 In table 4.1 the next category of inquiry was cold or flu ( grip ) and mucus. Eighty percent believe that cold or flu is an illness. Sixty percent believe that the presence of mucus ( larim ) is an illness while two out of four informants thought both mucus and cold and flu are not illnesses, but they are ailments. Informants who thought cold, flu, and mucus are illnesses, thought that medication is required, but that these are not serious illnesses. Most informants, 60%, believe sprain to be an uncomfortable ailment becau se, you must go to a doctor for medicine and because there is pain. Two of four informants believed sprain to be accident, which, for them precluded its possibility of being an ailment or an illness, it is an accident so it is not the same as being sick. Next, in the table the menstrual cycle, pregna ncy, and miscarriage we re considered to be non-illnesses and were grouped together because of this distinction. Ninety percent of informants did not think that menstrual cycle was an illness and all informants said that pregnancy is not an illness. Informants said that menstrual cycle was not an illness because, you are supposed to get rid of blood each month, this is natural. Informants also said that it caused people to have cramps or a headache, but that the menstrual cycle itself was not an illness, but caused women suffering. Informants sa id that pregnancy was natural. Sixty percent of informants did not consider miscarriage ( pdisyon) to be an illness. Informants said it was not an illness because, it is an emergenc y or that it was an accident. Folk Illnesses Afro-Caribbean folk m edicine is based within an experiential framework. This means that it is based within a history of use by a group of people. Laguerre (1987:6) writes that, folk medical discoveries are an alogs of conventional scientific experiments using repeated observations not in vitro but in vivo Through experimentatio n, new techniques and new remedies which have been compared th rough trial and error are added to the materia medica of the people.
63 Folk medicine has a marginal status because of its relationship to biomedicine and is rejected knowledge by mainstream society because it is not strictly scientif ically based. Although Laguerre does not focus on medical pluralism later writing on these topics addresses syncretism. Syncretism is relevant to this thesis because it shows that all societies have a mixture of medical systems and paradigms that they utilize even if some of the practices are taboo and carry stigma. Obermyrer states that syncretism occurs in Moroccan birthing practices. Often in a home birth, the woman in labor will lie in a bed instead of squatting on the floor as is the traditional practice, and some traditional birth attendants give vitamin p ills or injections or administer pain relievers in the form of suppositories in addition to using herbal remedies (Makhlouf Obermyer 2000:190). In rural Haiti, Farmer (1988) found sync retism in the ways that people understand the etiology of an illness. Illness can be sent through magic, or can be the product of a microbe, germ, bacteria, or organism (Farmer 1990). Are folk illnesses considered illnesses or diseases in the Haitian health cosmological viewpoint? This is a complex que stion because not all Haitian info rmants agreed as to whether a folk illness was a health problem at all, an ailment, an illness, or a serious illness. For instance, Paul Farmer notes that, both pdisyon and TMMV [ Ti Moun Mare Nan Vant ] seem to me [to be an] association with a larg e variety of pathologies and experiences-from miscarriage (the most common) to infertility to dysmenorrhea to so cial problems around childbearing (Personal Communication, Paul Farmer, 9/10/2008). This range of pathology and e xperience extend to all the folk illnesses discussed in this thesis. Pdisyon and Ti Moun Mare nan Vant Although for the purposes of this thesis pdisyon is being con sidered the word for miscarriage, this is not the case in all of the literature on this t opic. Through my research I found that pdisyon could mean a young loose woman or miscarriage. However, in the
64 anthropological literature, pdisyon is the term used to describe what my informants called in my research as ti moun mare nan vant (the tied baby). When I asked Haitian subjects, have you ever heard of pdisyon they would say yes. When I as ked them what it was, they always responded, miscarriage. At first this confounded me as the anthropological literatu re that I had read stated that the word for the child tied in the womb was pdisyon. After this I began to describe the tied baby (wha t the literature called pdisyon ) to informants and then asked them for the name for it and they always said, ti moun mare nan vant Murray (1991) writes that it is impossible for pdisyon to be a miscarriage. Freeman s (2004) Haitian English dictionary states that pdisyon is miscarriage (non-apparent), as we ll as an extended pregnancy (Freeman 2004). Thus, p disyon has several definitions in the litera ture or the definitions have changed over time. Murray (1976) tran slates it as perdition while Coreil et al. (1996) calls pdisyon arrested fetal development syndr ome. Murray (1976) translates pdisyon from the French or English word perdition which is a state of spir itual ruin or utter damnation (Merriam Webster 2006). Singer, Davison, and Gerdes (1988) found that their informants described pdisyon as a loss of blood (Singer, Davi son, and Gerdes 1988). In the structured interviews I asked four informants if pdisyon and ti moun mare nan vant were the same thing in order to clear up my ow n confusion about the ways the two terms were being used differently. I found that all my informants considered pdisyon to be a miscarriage and ti moun mare nan vant to be the tied baby. During the interviews, informants were asked to explain in more depth the difference between ti moun mare nan vant and pdisyon Out of the four people who responded, a ll of them said that pdisyon and ti moun mare nan vant were different, but Nansi clarified the differences by saying, they are the same in that they both affect your pregnancy, but they are different because a wo man can deliver a child tied in the womb and
65 with a miscarriage she loses the baby. Singer et al. believe that TMMV is a part of a folk illness complex that is part of a larger complex of interrelated reproductive illnesses experienced by Haitian women (1988: 375). This is a similar vi ew to Murray (1976) and Coreil et al. (1996), who call TMMV a culture-bound illness that reflect s a way of dealing with infertility or temporary infertility. Ti moun mare nan vant ( the tied baby), is a folk illne ss where, according to Murray (1976 and 1991) and reflected by some of my informants, occurs when the Haitian lwa (spirits) create this illness. With TMMV a woman is unable to give birth within the biomedically constructed notion of gestation. People beli eve that pregnancy can take up to five years when in this condition because the child is tied-up within the womb. Char acterized by bleeding in the third month of pregnancy, TMMV becomes a problem because, in Haitian folk theories of health, menstrual blood is thought to nourish the fetus (M urray 1976; Singer et al 1988; Coreil et al. 1996). If the menstrual blood resumes, the child is no longer being nouris hed and the fetus will shrink into a small spot that stays attached to the womb for several months or years (Murray 1976 and Singer et al. 1988). The continuum of thought regarding the ra nge of reproductive pat hologies differed among informants. Of the five informants who believed TMMV was an illness caused by the lwa, two were not sure how, if at all, TMMV was rela ted to pdisyon while three informants thought it was related to pdisyon in that TMMV and p disyon are both reproductive health issues which often have different outcomes, sy mptoms, and etiologies. Informan ts who did not think this was an illness (two) or did not know a bout it (three) did not gi ve any insights about why they felt that way. TMMV is not the only folk illness that a range of pathology and experience can be applied to. All of the folk illnesses addressed in this research resemble each other in that people
66 attributed a range of pathology, belief, and experience when discussing them. M ove san (bad blood), which occurs due to anger, shock, or grief related to interpersonal issues emphasizes this range. Move san is a common illness in Haiti and the Un ited States (Farmer 1988; Brodwin 1996; Wiedman 1978). Farmer (1988) found that 36 mothers (77 %) of informants had experienced move san. Farmer (1988), believes that move san is an illness caused by malignant emotions anger born of interpersonal strife, shock, grief, chr onic worry. It is thus not possible to relegate move san to such categories as psy chological or somatic (F armer 1988:63). Farmer (1988) argues that somatization is an over-simplification of the complexities at work in Haitian illness cosmology. These illnesses and their etiologies va ry and include the realm of the supernatural. Farmers (1988) informants were reluctant to speak in detail about th e exact incident or incidences that caused the anger, shock, or surpri se. It is possible that magical poisoning could be a cause for anger, shock, or surprise that could cause move san. Farmer (1988) speculates that informants were reluctant to tell him details because of the possibility of magical etiology. Once the anger, shock, or surprise occurs, there are a series of possible symptoms. Table 4.1 shows that Move san not only affects the blood, but it can affect th e entire body including, "the head, limbs, eyes, skin, and uterus (Farmer 1988:62). Symptoms of move san include anger, hives, sleepine ss, lack of concentration, and back pain (Farmer 1988). The symptoms of move san that Farmer (1988) found were reflecte d in, and added to, in my research. Informants reported symptoms such as red eyes scratchy voice, high blo od pressure, diarrhea, crying, hives, stomachache, stroke, and death. Six informants considered move san an illness. Three of these informants considered it to be a mild illness while three informants consider ed it to be a disease-causing illness. These
67 informants felt that move san was an illness because it impede s daily functioning, and could, in the worst cases, cause stroke, high blood pressure, or even death. The four people who did not consider move san to be an illness thought that it was temper, an accident5, or that it was not an illness itself, but that it could cau se illnesses (such as stroke, hi gh blood pressure, or death) to occur. Farmer (1988) found that move san can be part of a complex that he calls the move san/lt gate (bad blood/spoiled milk) complex. Although Farmer (1988), and my research, found that both men and women could get move san women were more likely to have move san especially those who are pregnant or lactating (F armer 1988). New mothers that develop move san almost always develop lt gate. Spoiled milk occurs when bad bl ood mixes with breast milk causing it to spoil. This can cause the nursing mother great harm and often results in the early weaning of a child (Murray and Alvarez 1981 a nd Farmer 1988). Although spoiled milk is affected by bad blood (Farmer 1988) my informants did not find consensus concerning the range of pathology for spoiled milk or its links to bad blood. One informant who believed bad blood to be an illness was unsure if spoiled milk was an illness or if it was just a symptom of bad blood while another informant who did not believe bad blood to be an illness was unsure if spoiled milk was an illness. The five informants that thought bad bl ood was an illness also considered spoiled milk to be an illness. Spoiled milk is considered to be an illness of the emotions which can cause serious mental problems or death if not treated with herbs or w ith allopathic medicine. Three informants who did not believe that bad blood was an illness considered it to be an accident. These informants thought spoiled milk to be a symptom of bad blood. 5 The use of the idea of an accident in relationship to health is complex and is something that I did not explore in this research. It could mean just a simple accident, or it could mean that another person hired a bk (Vodou sorcerer) to place a curse on ones health (Freeman 1998).
68 Healthcare Workers I was able to adm inister, in some cases in person and others through drop off, 26 questionnaires with several different types of health workers. These health workers were recruited from CWHA, the Caribbean American Center, the Flatbush Haitian Family Center, a health clinic on Linden Boulevar d, SUNY Downstate, and a private clinic on Norstrand Avenue. The health workers at these sites ranged in posi tion from social workers to community health workers to medical assistants, medical doctors, and several midwifes. Creole and English were the top two languages spoken in the offices of hea lth workers. Informants reported that twenty to 50% of their clients ethnicity was Haitian. Th irty eight percent of health workers were born in the United States followed by 27% who were born in Haiti. A good portion of the health workers were women (21) with fi ve male respondents. Most health workers, twelve of the twenty-six, had a post graduate education with el even of the health workers having some college or a Bachelors degree. Annual income for te n health workers was fifty thousand or over annually followed by nine informants who refused to answer this question. The purpose of including health care workers in this study was to find their perspective concerning folk health issues in respect to th eir Haitian patients as this is important to understanding the experiences behind Haitians hea lth and healthcare choices. Hypothesis one is supported by the data collected from healthcare work ers. Hypothesis one states, that health care providers consider folk illnesse s and the women who use these theories negatively. Healthcare workers in this study did not, in ge neral, have patients discuss folk health issues with them. As well, they believed that patients who used theories of folk health were uneducated. In Haiti, Maternowska 2006, found Haitian doctors to have negative views and practices of their, usually poor, patients theories and practices concer ning health and healthcare in Haiti.
69 Maternowska tells a story about Yvonne, a 24 ye ar old mother of four, who was receiving birth control from a family planning center in Cit Soleil, Port Au Prince. Yvonne needed another pack of birth control pills, but because she had not gotten her period the doctor became angered with her and accused her of not taking her pills and coming too late to refresh her prescription. Yvonne defended herself by explai ning to the doctor that he had given her 2 months worth of pills. He became enraged, threw her chart at her, and accused her of lying. Yvonne said nothing, but stood there until the doctors tirade was finished and left without her packet of birth control pills. Once the patient left the docto r continued by saying, Shes so stupid thatshe says she took two packets of pi lls, but she didnt. Oh Its all the same! Theyre still stupid, they still lie and theyr e still slaves! (Mater nowska 2006:77). When Maternowska checked the patients record the doctor had indeed prescribed her two packets of pills. Although the health workers in my study were not as vocal about their negative views toward their patients, Maternowskas analysis of these types of interactions situation is reflected in this Brooklyn in that the doctor-client relationship is a domain where ideologydoctrine of a distinctive perspectiveis reproduced. The asymmetrical relationship, including the infallible doctor and the initially challenging client who, in the end has no choice but to agree with the accusations made against her, reflects and re plicates the dominating structures that reverberate throughout Haitian society. In this way as Waitzkin contends, Medical encounters become micropolitical situations that reflect and s upport broader social relations, including social class and political-e conomic power. (1991:9 in Maternowska 2006:78) Biomedical and Folk Health as Reported by Health Workers When health workers were asked about comm on m edical problems found in clients high blood pressure and diabetes (88 %) were the two most commonly found health issues followed by the common cold, asthma, HIV and Stroke (46%), and finally anemia, and eclampsia and etopic pregnancy. The percent of patients with diabet es or HIV/AIDS reflects the public advocacy
70 focus on diabetes and HIV/AIDS as main health concerns in Central Brooklyn. Although use of folk illnesses is a way for women to explain bare ness and reproductive health issues there is a lack of understanding of this among healthcare workers, and thusly, on how the healthcare community can advocate for women experiencing these issues. The questionnaire for health workers defined each of the three folk illnesses, bad blood, spoiled milk, and the tied baby, and asked them a series of questions concerning patients complaints in regards to these common problems. In regards to bad blood, eighteen health workers had never had a patient complain of this problem while seven health workers had patients who had complained of this problem. When health workers were asked if patients complained about spoiled milk eight een of them said that patients never complained of this issue while seven health workers have had patients wi th spoiled milk. When health workers were asked if patients said they had a tied baby ninete en said they had never had this complaint while five health workers had dealt with this issue. What does this mean? The low number of health workers who had not had patients complain about these folk concerns suggests that patients do not want to share this type of information with doctors for f ear of chastisement or judgment. Although I was unable to follow patients into office visits this I believea doctrine of distinctive perspective is at work because of two reasons. First, the health workers who encountered patients who complained of folk health issues were either midwives (two ) or community health wo rkers (five) and second, the health workers who had not encountered these issues had a common narrative about their patients. These health workers, eleven of them reported that patients believed this way because they were uneducated and because of their poverty lacked access to proper health care. Although this is not the same chastising voice of the Haitian doctors Catherine Maternowska writes about
71 it is still a negative judgment concerning the soci al and economic standing of their patients, and thus, an example of the negative associations th at health workers place upon Haitians who claim folk health illnesses. In opposition to these negative attitudes we re the positive statements made by health workers who had encountered clients with folk health issues. These women believed that it was important for medical doctors to respect clients health beliefs in order to provide them with needed services in order to avoid women using u nhealthy cures to solve folk health illnesses. Folk Illnesses and Stigma The im portance of folk illnesses in Haiti and the United States is their larger relationship to stigma in the context of folk ve rsus biomedical illnesses where Haitian folk illnesses are laden with negative associations concerning AIDS, Vodou, and Blackness. Haitian women who are struggling to come to terms with their lack of ability to bear children empower themselves and are able to cope emotionally and physically with ba reness and reproductive health issues by using socially accepted folk illnesses in order to hold onto their sense of womanhood. However, once they, or if they, decide to use a folk illness to explain a set of sympto ms to a doctor they are faced with negative attitudes because of their beliefs. Women who claim Move San Lt Gat and Ti Moun Mare Nan Vant for different reasons, but all of these folk illnesses are ways to cope with stigma in relation to a lack of reproductive health. Bad Blood, spoiled milk, and the tied baby affect women of child bearing ages disproportionably to others in the population. Th is set of folk illnesses affect pregnant and nursing women (bad blood and spoiled milk) or a ffect women who have primary and secondary infertility issues (the tied baby). In Haiti, social and economic pressure to mate after puberty...is high, as evidenced by the rates of fertility of young girls and women: by seventeen years, 19% of all woman already have a baby or are pregnant. The prop ortion increases to 31%
72 by the time Haitian girls are nineteen years old (Emmus III 2000 in Maternowska 2006 ). The importance placed on fertility occurs because children pave the way for people to live a meaningful life. It is not only a rite of passage to adulthood, but children work, carry water, sell in the market, and cook food, just to name a few task s. Also, with children is the possibility that the family will get out of Haiti through the childs progress. Because of these reasons childlessness is considered a negative state of being (Leventhal 1987 in Maternowska 2006). The persistence of the importance of child bearing continues in th e United States for many of the same reasons except, now that they are out of Ha iti it is for their children to become educated and create success for the family. For these re asons not being able to bear children is a damaging social stigma among Haitians (Maternowska 2006:90). Summary A range of illness concepts and categories, both biom edical and folk in origin, were addressed in this chapter to de monstrate what people believe and how they experience health. A background and description of how biomedical a nd folk illnesses are contextualized for this research is given and the data collected form the survey from Haitian informants is presented. The data collected from the surveys with health pr actitioners and an analysis of the links between folk illnesses and stigma highlight the main issues researched.
73 Table 4-1. Illness concepts of ten Haitian subjects Does Not Know If It Is An Illness Considered An Illness Not Considered An Illness AIDS 1 9 0 Cancer 1 9 0 Diabetes 0 10 0 Cold/Flu 0 8 2 Mucus 0 6 4 Sprain 0 6 4 Menstrual Cycle 1 0 9 Pregnancy 0 0 10 Miscarriage 1 3 6 Bad Blood 0 6 4 Spoiled Milk 2 6 2 The Tied Baby 3 5 2
74 CHAPTER 5 CASE EXAMPLES Tout moun se moun All people are people --Haitian Proverb Introduction Tout moun se moun, a popular Haitian proverb, rem inds us that we are all the same at our core. This suggests that acceptance is an importa nt aspect of Haitian philosophy especially since this proverb is used so often. However, the di fficulty of maintaining this philosophy both within and outside of Haitian culture has been made appare nt throughout this thesis and is clarified in this chapter through in ter and intra group discrimination a nd through stigma women endure due to reproductive health issues a nd infertility. This chapter focu ses on four case examples that reflect peoples range of expe riences in regards to AIDS, Vodou, and Blackness and how these negative associations have been experienced by informants. All f our narratives are connected to the larger themes of AIDS, Vodou, Blackness, and as well, either partially or fully support the hypotheses of this thesis. The first two narratives are categorized under AIDS, Vodou, and Blackness because each narrative addresses how discrimina tion concerning one of more of these three themes is felt by informants. The first narrative, about Lift, c oncerns folk models to explain HIV/AIDS while the second narrative, about Nansi, concerns V odou. The next two narra tives are categorized under reflections on folk illness. In these narrativ es, folk illnesses, and how they are used and avoided, are made apparent through peoples experiences. In the fi rst narrative, Lamsi reflects on both traditional and biomedical health care experiences in Haiti and the United States. As well, Lamsis narrative begins to address how infertility is stigmatizing through a story about
75 her daughter. Wozs narrative incl udes opinions and stories about childlessness and illness from Woz and three other people who part icipated in the interview. AIDS, Vodou and Blackness The following case examples share a common thr ead of experience in regards to AIDS, Vodou, and Blackness. These two narratives, through th eir different stories and life experiences, address how negative associations concerning these th ree themes affect their lives. In this first set of narratives Lifts story highlights the relations hips between discrimination, AIDS, Blackness, and the use of folk models. Nans is narrative highlights the relationship between discrimination, Vodou, and Blackness. The data from these two narratives fully support hypothesis two: the historical a nd social context of United Stat es and Haitian relationships impacts folk health and biomedical health models concerning Haitians. LIFT: Folk Models to Explain HIV/AIDS A background of folk models as pertaining to AI DS is im portant to contextualizing Lifts narrative because he uses folk models for e xplaining how people get AIDS. Some Haitians believe that the United States, with the support of the Duvalier government, used Haitian blood to test and create the AIDS virus. Luckner Cambronne, a Duvalierist, sold Haitian blood to the United States government earning him the name Vam pire of the Caribbean. Some believe that from this blood the United States made the AIDS virus to target Haitia ns and stem migration (Farmer 2006). This may seem like an outrageous cl aim, but the United Stat es has used AIDS to stem Haitian migration through the screening-in process1. When the sale of Haitian blood became known in Haiti people felt that they had b een wronged. Some Haitians believed that the 1 The screening in process is a term created by the Immigr ation and Naturalization Service to signify whether or not refugees have a credible fear of persecution if returned home when picked up during interdiction at sea. If they have credible fear they are required to be brought to the United States to apply for refugee status (Lennox 1993). However, in the case of Haitians, they were re-screened af ter first being screened in and tested for HIV/AIDS. Those with HIV/AIDS status were denied legal counsel and returned back to Haiti (Lennox 1993).
76 Duvaliers created sida (AIDS), while others believed that th ey sold-out to the United States and allowed Haitians to be used as test subject s for AIDS (Farmer 1990). Over time, Haitians believed that Vodou priests were being contracted by North American firms to build sidateargas grenades filled with the virus th at could be released to spread AIDS (Farmer 1990). These ideas about the origins of AIDS created a climate wher e Haitians felt that Americans blamed them for all grave illnesses (Farmer 1990). Real exampl es of this blame came from the CDC which throughout the 1980s and 1990s either labeled Haitians as AIDS vectors or as a group of people who could not give blood in the United States. When AIDS discrimination began, Haitians in the diaspora looked to Haiti for their strength and power to help them in their newf ound need for support. An example of this crossborder support surrounded the death of Ti Ma nno, a Haitian Compa musician. When people found out that Ti Manno was ill, money poured in from New York and all around Haiti to ensure that he receive the medical care he needed. Ti Manno is important to this discussion because his lyrics, especially from his 1985 record titled Sida, denounced oppression and discrimination from the Duvaliers, the United Stat es, or both. Glick Schiller a nd Fouron (1990: 329-330) write, Through his music, Ti Manno, more powerfully than any of the self-identified Haitian leaders, had attacked the stigmatization of Haitians as carriers of AIDS. This stigmatization was for him one aspect of the general rejection of Haitians by American society and the world, a rejection that he count ered with assertions of Haitian pride and a strong positive Haitian identity. During the 1980s and 1990s, at the height of AI DS discrimination, Haitians in the US were dealing with the double association of bei ng Haitian and Black (Radhakrishnan 2003; Khan 1994; and Ong 1999). Drawing upon Appadurais (2003) idea of global cultural flow, for Haitians, this association with AIDS created a new reality within two nationswhether Haitian American, or newly arrived Haitians, to the Ameri cans they were AIDS vectors. In Haiti, they
77 were received as United States citizens who gave economic, polit ical, and social power to the Haitian nation-state. Through blame, an element of stigma, Lift displays a typical response from the resulting feelings of stigma because of the social reject ion and isolation that he felt when Haitians were designated as vectors for AIDS. This case mode l is important as Lifts experiences in the United States address the themes AIDS and Bl ackness and his narrative fully supports hypothesis two of this thesis. In his narrative, Lift explains that race discrimination was the motivating factor for the United States medical communities designation of Haitians as AIDS vectors. Lift uses folk models and powerful metaphors to explain the spread of AI DS. He believes that condoms laced with AIDS are given to certain populations of people and blames the United States for the spread of AIDS as a device for ethnic cleansing. These folk models are based within, as hypothesis two states, the historical and social contex t of the United States and Haiti which has impacted the models Haitians apply to folk and biomedical health. Lift was born in the south of Haiti in 1960. Currently he is a painter who owns his own gallery and is the singer for a popular rasin music group. He travels around the United States, including frequent trips to Miami, North Central Florida, and Chicago. Wh en I asked him if he was born in the hospital he said, My grandmothe r was the hospital. In 1986, he came over to the US for political reasons. In Port Au Prince we did a performance of the Bwa Kayiman2 ceremony to symbolize the need for us to break the chains of the government and to become free of years of oppression. This performance took place in Duvalierville. During the performance Macoutes with guns came and shot at us. We all ran and I kept running. After this, Lift went back to the countryside an d was in hiding for two weeks. His grandmother sent someone with the news that the Tonton Ma coute had come to her house looking for him and 2 Literally, this means Alligator Woods. This was a historic Vodou ceremony that led to the Haitian Revolution.
78 that he should not return to the city. Later, his mother told h im he had to leave Haiti and go to the United States. In the late 1980s, Lift was an organizer in Miami who gathered people to speak out against the United States designations of Haitians as AIDS carriers. During this time, Lift felt that there was some discrimination against Haiti ans although he himself never experienced this, but that, they took us off the list of people w ith AIDS and everything is now fine. Lift believes that the biggest discrimination that Haitians face is race discrimination. Lift believes that race discrimination was the motivation for th e United States designation of Haitians as AIDS vectors. He, like Ti Manno, associates the United States with Babylon. Lift believes the United States wants to eliminate particular ethnic populati ons with the AIDS virus. Lift feels that he faces discrimination because he is Black everyday. For instance if there is me, a dark-skinned Haitian, and a light-skinned Haitian who are up for the same job with the same qualifications, the light-skinned Haitian will get the job every time. In the United States, people discriminate because of skin color. I asked Lift why he t hought the United States labeled Haitians as AIDS carriers. He said that the reason for that is known by everyone, the Unit ed States did this for political purposes they knew it was not true. They put this information out there like a bomb that spreads its poison over the people. AIDS is a w eapon of mass destruction created to get rid of certain people like Africans or Haitians. The people in charge did this so that they could have control over certain people and keep themselves in power. Lift believes that people in power created AIDS. This is the same thing that they have done with condoms. Condoms can give you AIDS or other problems. They have two types of condoms some that they produce are normal and cause no harm and others have the AIDS virus in them. They do this so that there are more sick people so that they can make more money from selling medicine. AIDS is an industry.
79 Lift uses these folk models surrounding AIDS as a metaphor for how institutionalized power is plagued with discriminatory policies, which aff ect the ways people experi ence life. Lift has chosen to use his knowledge of th ese issues to protect future ge neration by crea ting a non-profit for children where he teaches them to embr ace Haitian art, music, drumming, dance, and Vodou. NANSI: Vodou and Discrimination Similar to Lift, Nansi feels that she expe riences race discrimination daily, but, as a Vodou practitioner must defend herself from both inter-group and intra-gr oup stigma, but chooses to be empowered by her way of life. Schmidt sums-up stigma linked to Vodou by writing, The relationship between Haiti and the USA is a long and painful story. Haiti is a main target of US imperialism in the Caribbean, but Haitians are not well received within the USA. From the day it gained its independe nce in 1804, Haiti was portrayed as the land of black magic, cannibalism, and the like. (2003: 222) When discussing with non-Haitian New Yorkers my work with Haitians, on several occasions I was warned about Vodou in the park. I was told by at least two different people (both nonHaitian) to stay away from the Haitians in the park. I was told that so-called black magic happened there and I could be harmed. Nansis na rrative is relevant to this thesis because she addresses discrimination felt because she is both a Black Haitian and a Vodou practitioner. Her narrative addresses two of the three themes of this thesis. Na nsis narrative is data for hypothesis two, but reflects the negative use of folk models di fferently then Lifts experiences. For Nansi, instead of creating folk models to view others, others (usually Haitians according to Nansi, but also non-Haitians in my experiences as suggested above) have created negative folk models concerning her in relationship to her religious be liefs. People believe that she will cause harm, usually through poisoning or other illnesses, to them or their families. This way of thinking bout Vodou is based within beliefs created through, as hypot hesis two states, the historical and social context of the United States and Haiti which has impacted the models Haitians apply to folk and
80 biomedical health. Nansi s view of herself and her Vodou practice are in direct opposition to these folk models people hold concerning Vodou practitioners. Nansi is a Vodou practitioner who serves the sp irits in Prospect Park and looks to Vodou to prescribe how she lives life. She sells herbs, Haitian metal art, and Vodou ritual items in her booth at the Caton Flatbush mark et. Her hair, dress, and items in her booth all stand out and indicate that she is a Vo dou practitioner who is involve d with the Haitian rasin 3 movement. To m any Haitians and non-Haitians, she represents a threat. Nansi she experiences discrimination because she is Haitian, woman, and a Vodou practitioner. Nansi feels that non-Haitians judge her because she is Haitian and a Vodou practitioner and Haitians judge her because she is a Vodou practitioner. Nansi, born in Port Au Prince Haiti in 1956 moved to the United States in 1980. Nansi attended high school in Haiti. In New York, Nansi worked in the non-profit sector with local youth and decided to begin selling in the market full-time because she believes that is her true call ing. Nansi lives with her mother and one of her younger children. She lives within walking distance of the market she works at and enjoys her life of travel and caring for herself and her family. Nansi is a known Vodou practitioner. This can be seen in the African-styled clothing she wears, the dreadlocks in her hair, and the items fo r sale in her booth at th e market. When Nansi first came to the market there were many problems. All of the other women and men who sell at the market are protestant and they held a grudge against Nansi because she, as far as they were concerned, served evil. The Haitian women in the market shunned her and treated her poorly. People felt this way toward Nansi be cause of the common fear that a Vodou practitioner would 3 The Haitian rasin (roots) movement is a musical corollary to a socio-political grassroots movement for structural change in Haiti, which does use revitalization and inte rpretation in their practices and interactions with Vodou Roots people attend Vodou ceremonies in the countryside and draw upon like-minded movements and music such as Rastafarianism and reggae.
81 become angry or jealous and send a sickness, death, or other health related misfortune to them. By not associating with her they could avoid these calamities. After time passed peoples attitudes changed, they saw me bring many intelligent people to the market whether they were White, Black, or Asian. These people purchased fr om me and this began to change their minds about who I was and what I represented. Altho ugh people came to respect Nansi for her skills as a sales woman they still create political difficulties for her at the market because of her religious beliefs. While I was visiting Nansi one day, a local Vodou priest, Brickner, who manages the lakou4 that Nansi belongs to, stopped by. We began to talk about Vodou. He explained that Vodou was a balance of good and bad, negative and positive things must happen in the world to keep that balance intact, including peoples hea lth. I asked Brickner about sent sicknesses and TMMV. Brickner explained that sent sickness is a part of the balance of positive and negative that occurs in the world. Sent sickness is cons idered to be a negative aspect of the role of Vodou in peoples health. This causes negative health. However, he e xplained, there are positive things that can be done for protection or healing that is a part of the necessary bala nce to life and healing. Brickner said that knowing when to send a sickness is about wisdom and how to use the knowledge you have about Vodou and when to use it for positive or negative. Nansi agreed with him and explained the role of Vodou in her life in more depth. Vodou is not bad. It represents the earth, the sky, the water. The food we eat and the trees around us are all a part of Vodou. Vodou is in the way you live and the way you eat, dress, and function 4 In Haiti A lakou or courtyard is the family compound that connects several Haitian houses together. In the US lakou has become a metaphor for a Vodou priest and his practitioners who practice in the same Vodou family. Lakou here represents the familial ties through religion this group has without the physical connection to a courtyard or genetic connection of the family.
82 everyday. Vodou is all about love...one love5. As far as the discrimination she faces because she is a Vodou practitioner, she says it mainly has to do with ignorance. People do not like that I serve the lwa especially some Haitians. They feel negatively because people in their families may have had a bad experience with Vodou and now they think it is bad. Or the people in their families have not had a bad experience and they still say it is bad. People are i gnorant they do not know what they say and they do not give good people a chance. Because of her way of life, Nansi feels that sh e experiences discrimination on a daily basis. Nansi said, Every single day I experience discrimination because I am a Haitian woman and because I am linked to Vodou. People come to the market that I work in and sometimes they know I am Haitian right away because of the thi ngs I sell and the way I dress. Often these people will not make purc hases from me. Nansi said in one conversation, discrimination occurs to people because of the ignorance that other people have agai nst them. For you, perhaps this happens because you are a woman, for me this happens because I am black and Haitian and a woman. Reflections on Folk Illnesses This set of case exam ples share a common thr ead of experiences that, first, people do not go to, or should not speak to, medical doctors concerning folk illnesses, and second, felt stigma in regards to TMMV. Women mu st defend themselves to other Haitians when dealing with bareness and reproductive health issues by using folk theories of health to reinvent these illnesses as temporary health concerns, rather then a perm anent inability to produce children. As well, if women choose to divulge this information to health care practitioners they face a negative response i.e. the judgment that they are uneducated, or worse, and so choose to not include health care professionals when deali ng with these issues. Lamsi s case example fully supports 5 One Love is a common reference given by young Vodou practitioners in reference to Bob Marley who has touched the hearts and minds of so many globally.
83 hypothesis threewomen with reproductive health is sues use folk models to explain bareness due to the stigma associated with infertility. Wozs narrative partially supports hypothesis three as Woz herself does not use folk models to e xplain infertility, but Anayiz knows people who use folk models in regards to infertility. LAMSI: Using both Haitian and US Biomedical Health Systems Lam si reflects on folk illnesses and how sh e experienced them in both Haiti and the United States. I interacted with Lamsi 5 days a week for 3 months. Throughout this time we conducted a survey and two interviews where, gr adually, Lamsi became comfortable with me and began to share her experiences with folk illnesses. Lamesis narrative is relevant to this thesis because her stories of herself and her da ughter reflect both the three themes of AIDS, Vodou, and Blackness, and the third hypothesis, that women with re productive health issues use folk models to explain bareness because of the stigma associated with infertility. Lamsis stories are indicative of the ways in which Haiti an identity and related health concepts are negatively associated with AIDS, Vodou, and Blackness. Lamsi associates certain Haitian health issues and folk models with Vodou, a practice she considers to be unacceptable. She has internalized the three nega tive associations of AIDS, Vodou, and Blackness and tries to distance associations with Vodou through a religious conversion from Vodou to Christianity. Due to this conversion Lamsi and her family must find other ways of dealing with infertility issues when addressing the Haitian community. Lamsi tells a story of her daught ers issues with infertility, but clearly states that she is ca reful when discussing her, and he r familys use of folk health remedies or beliefs. Lamsi feels that these ideas are linked to Vodou and, therefore, she would be linked to Vodou. For Lamsi this is unacceptable because she depends upon the support of her church community and an affiliation with Vodou may risk the loss of th is support network.
84 Lamsi was born in Haiti in 1940. Born to a madanm sara (international wholesaler), Lamsi was only able to attend school through the first grade. In New York, similar to her mother, Lamsi sells goods at the Caton Flatbush market where she earns $500 each month. She migrated to the United States in 1991 because of po litical conflict in Hait i. Currently she lives by herself as her son (one of her three children who reside in the United States) recently moved away, but a friend comes to stay with her at night in her apartment. Lamsi, a Protestant, attends a Haitian Fundamental Christian church. With the birth of her first child in Haiti, Lamsi experienced both move san and lt gat Although she had delivered he r child in a hospital sh e went to the leaf doc tor to help her with these folk illnesses because, as she stated severa l times throughout the interview, doctors do not want to help us with these types of issues. It seems, much like the experiences of Maternowskas clients in Haiti, Lamsi knew sh e would be taunted by a medical doctor if she divulged her folk theoretical con cerns. She was able to cure move san and lt gat by drinking herbal teas and orange juice and bathing in herbs to cleanse her body and spirit as directed by her leaf doctor ( dokt fy) and with knowledge about herbs that her mother had passed down to her through oral tradition. A few years later Lamsi experienced an ekspedisyon (sent sickness). As is common with ekspedisyon she was sent a sickness by a je alous lover of her new husband. I was married to a man who had a mistress. That woman was angry with me for getting married to him and soon after I became ve ry ill. The woman admitted to causing this sickness and my husband had nothing to do with her anymore. I became a protestant to serve God and pray to him [God] and took some herbs and I never got sick like that again. God helped me. The woman used a Vodou priest to send this sic kness to me. Because of this I repented to make my life better. I have accepted Jesus and no one can harm me. Lamsi avoided biomedical practitioners when trying to cure folk health issues because of the negative attitudes concerning folk heath in the biomedical realm. When Lamsi and her family migrated to the United States they did not abandon their ways of addressing folk health issues.
85 They still used the folk medical system for folk illnesses and teas for prevention of allopathic diseases, but now, had increased access to health care with a biomedical doctor. After her religious conversion and migrati on to the United States, Lamsi expressed that she was not comfortable sharing her or her familys use of herbal remedies with other Haitians (only her immediate friends or family) or her doctors. Sh e became especially guarded when telling a story about TMMV because she wanted her daughter to be able to get married. However, in the second interview, she finally discussed her daughters encounter with TMMV. She said, My child thought she was pregnant, th ere was no menstrual cycle, but she was never able to give birth. In Haiti they would give her a massage and a bottle of medi cine to make the baby strong. When I asked her how they helped her daughter she would only say that she did not go to a doctor because doctors could not help her daughter. An interesting aspect of her need to keep this bought with TMMV quiet was a connection she made with good fortune that came through her c hurch. She confided she was glad they had kept her daughters issues with TMMV private because recently her son applied for, and received with the help of their church, a state-pa id position in Chicago. It seems that Lamsi was worried that her daughters barene ss could affect the churchs de cision to help out her family members. WOZ: Childlessness and Illness Woz owns a restaurant and, at th e time of the interv iew, there were several other people in the restaurant, and is Haitian custom, everyone became involved in our conversation. The folks involved were Anayiz, Wozs assistant, and Fr ank and Py two of Wozs customers. This narrative is relevant as several different storie s are told in regards to childlessness and folk illnesses. In Wozs case, she, contrary to hypothesi s three, does not use folk theories to explain her childlessness. When asked about TMMV and miscarriage she claims to have never heard of
86 these types of issues. As she is clearly uncomfort able with these topics she invites her assistant and restaurant patrons to partake in the interview. Anayizs story of TMMV fully supports hypothesis three in that her narrat ive suggests that if women use fo lk health theories to explain bareness and other reproductive he alth issues they can find a cure for infertility. Wozs restaurant is in East Fl atbush where she boasts a dedica ted, but small, clientele that she has built up over the past four years. The restaurant has about four tables and boasts a successful take-out business. Woz went to c ooking school in New York City and lives with several family members whom she supports. She wo rks at her restaurant seven days a week for twelve to fourteen hours each day. Woz was frie ndly when she heard I wanted to interview her and in exchange I would work at the restaurant that day. I worked at the restaurant serving patrons and cleaning up for several hours. After we had prepared all the meals for the evening rush we sat down to begin the interview process. Woz who is a childless and an unmarried woman of forty-three is singu lar to my research in this respect. Every other woman I interviewe d had children and, at some point in their lives, had been married. In fact, at one point when talking with some women in the market the importance of bearing children was made clear to me. They asked me if I had any children. When I responded, no, they asked me why I hated children so much. When Woz said that she did not have any children she became uncomfort able and I did not ask anymore questions regarding these topics after reflecting on my own experience with my admitted childlessness. Not surprisingly, when I asked Woz about TMMV and pdisyon she claimed ignorance and turned to Anayiz and her clientele and asked them if they had ever heard of such a thing. Woz was unable to bare children and this is why she became flustered when I asked her about TMMV and pdisyon
87 At this point, as is usual when people have disagreement concerning a topic, the conversation became quite lively. Several people were often talking at once and, on occasion, talking over one another. Sounds of exasperation and head-sha king (back and forth signaling no) ensued along with other forms of body language that expressed disagreement and frustration. Everyone else in the restaurant had heard of one, or both, of these issues. The first customer, Frank, said that he had heard of pdisyon and TMMV. He said that they were two different problems that women faced. Pdisyon said Frank is when you lose a child. You must go to the hospital and have doctors or nurses he lp you with this. With TMMV a woman does not have blood nourishing the child and the baby does not develop. He continued to say that in order to make your blood strong and save the baby people may drink the blood of a tortoise mixed with bulls heart. When Frank said this Woz became flustered and upset. When I asked her if she disagreed she said th at these types of behaviors were disgusting and that she doubted people behaved like that. Anayiz, Wozs assistan t agreed with Frank and began to tell her personal experiences with each of these problems. Anayiz described a miscarriage she had experienced in depth. When asked about TMMV she said, TMMV is another prob lem all together. Anayiz he rself has never had TMMV, but a friend of hers has had this problem so she began to describe it. If you go to the doctor, they cannot help you b ecause they will say they cannot cure this type of problem. If you go to where they will give you herbs, your child will be healed and will become good and strong. TMMV is not easy for people to deal with because people want as many children as possible. You can also go to the bk who can tie or untie a child. The bk can cause miscarriage too. After the bk unties the baby for you it can still take longer, like 10 or 11 months for you to have a baby and sometimes even longer. When Anayiz had finished speaking, Woz, and th e second male customer, Py, disagreed with her. They became upset and said that what she has said is not possible. Py speaks up loudly and begins to disagree. He makes noises in disagreement and tells Anayiz that she is wrong and
88 that she is speaking nonsense. Woz and Py felt that TMMV, and the herbal ability to cure it was impossible. Py told me that TMMV was not re al that women used this as an excuse to keep their husbands. Summary In summ ary, these four narratives support hypot heses two and three, and, are examples of how the main themes of AIDS, Vodou, and Black ness are negative associations that affect Haitian identity. Lift and Nansis narrative fully support hypothesis two while Lamesis narrative fully supports hypothesis three. Wozs narrative, because it includes more then one person partially supports hypothesis three because Woz does not use folk models for infertility although Anayiz does use folk illnesses to situate infertility.
89 CHAPTER 6 CONCLUSION Introduction In this chapter, the findings are related to the research hypothesis. Also discussed are the various theories that add ress the topic. Exampl es of narratives are given to show how the data and hypothesis are linked to folk models and the ways in which folk models impact peoples everyday lived experiences with health and heal thcare. These experien ces show how Haitians and their healthcare workers create, interpret, and internalize what is considered normal and abnormal in society. Haitian identity and related health concepts are negatively associated with AIDS, Vodou, and Blackness by both Haitian and United States fo rmal medical institutio ns. Experiences of health and healthcare of the Ha itian community in Brooklyn reflec t these negative associations. This study found that folk theories of health, in particular, move san (bad blood), lt gat (spoiled milk), and ti moun mare nan vant (the tied baby), and folk models for the spread of AIDS are associated with stigma. The hypotheses concern the following: 1. The historical and social context of United St ates and Haitian relationships impacts folk health and biomedical health models concerning Haitians. 2. Health care providers consid er folk illnesses and the wo men who use these theories negatively. 3. Women with reproductive health issues use fo lk models to explai n bareness due to the stigma associated with infertility. Findings Hypothesis one is supported th rough the historical backgr ound and context of US and Haitian relations. Considering the first hypothe sis, informants experiences highlight issues of discrimination in relationship to AIDS and Blackness and Vodou and Blackness respectively and
90 how they interact with folk models of health. The narratives of Lift and Nansi, for example show how race discrimination and religious discrimi nation affect individuals. Lift feels that race discrimination was the driving force behi nd the CDCs designation of Haitians as AIDS vectors and. Lift uses folk models and powerfu l metaphors to explain the spread of AIDS. He believes that condoms laced with AIDS are given to certain populations of people and blames the United States for the spread of AIDS as a de vice for ethnic cleansing. Nansis narrative is a reflection of the ways that the historical and social context of the Un ited States and Haitian relationships impact folk health models because of the ways that other people construct Vodou. Nansis status as Vodou practitioner opened her up for bot h Haitians and non-Haitians to develop folk based ideas concerni ng whether or not she can cause i llness and destru ction in their lives. Hypothesis two is supported as healthcare worker s do consider theories of folk health and the woman who use them negatively. In the data here, most healthcare workers did not have a patient discuss folk illnesses with them and stated that women who used folk theories for health were uneducated. Concerning hypothesis three, women with reproductive health issues use folk models to explain bareness due to the stigma associated with infertility, is supported. Lamsis and Wozs narratives are examples of women avoiding stigma when defending themselves to other Haitians concerning bareness and reproductive health issues. They use folk theories of health that reinvent these illnesses as temporary health co ncerns. In Lamsis narrative, even though she and her family risk losing the suppor t of their church, they continue to use folk theories of health. However, they are careful when discussing folk theories with people outside of their family.
91 Woz does not use theories of folk health to desc ribe her childlessness, but Anayiz, her assistant, tells a story that affirms the use of ti moun mare nan vant to explain infertility. Making the Connections: The Findings Relationship to th e Literature The data collected support the hypotheses that re late to the literature on transnationalism, stigma, and ideas of normal and abnormal, by the us e of folk and biomedical systems of health. Transnationalism is reflected in the ways in which Haitians in the United States construct their social interactions and form identity because they participate in two nation-states. This means that Haitian migrants must integrate nationalist social categories from bo th nations into their construction of identity. Negativ e associations by the current country of residence identify Haitians with AIDS, Vodou, and Blackness. These are a part of these nationalist constructions of self. For example, both Nansi and Lifts na rratives exemplify how this interstitial space becomes an arena of resisting practices. By empowering herself through exertion of her Blackness and participation in Vodou, Nansi is resisting the predom inating negative associations of being Haitian and a Vodou practitioner. Lift shows re sistance by educating himself and others about discrimination, and the uses of folk models as a resisting practice. Issues of racism affect the ways in which Ha itians experience health and healthcare in the United States because of the history of Black bodi es being linked to disease and, specifically for Haitians, Haitian bodies being linked to AIDS. Li fts narrative about the political motivations of the CDCs choice to label Haitians as vec tors for AIDS is an example of how Haitians experience this type of discrimination. Lift feels the impact of the social rejection and isolation associated with the stigma of being designate d as a carrier of stigmatized disease. Social rejection, isolation, and the stigma based on disease is also a part of the ways in which difference in regards to what is normal or abnormal is constructed. Ruth Benedict (1934), and Irving Goffman (1963), considered these themes of how ideas of normality and
92 abnormality affected peoples lives. Goffman ela borated upon the ways in which individuals and groups internalized, and reacted to, attributes of difference. For Haitians, their use and application of folk health theories is whether to avoid or react to stigma. For example, the distinction between normal and abnormal theori es of health was manifested by healthcare workers in Brooklyn who reported that patients did not discuss folk health issues with them and that if people subscribed to fo lk theories of health, it was because they were uneducated. By ascribing an abnormal status to folk illnesse s patients who utilize folk theories become stigmatized. However, Haitian women continue to claim folk illnesses such as TMMV because there is a chance that a woman can cure it, a nd conceive a baby, while they say bareness cannot be cured. Lamsi and Wozs narrative show how Haitian women use multiple systems of healthcare in Haiti and the United States. Laguerre di scusses the ways in which Afro-Caribbean populations use the healthcare systems available to them. In the case of Lamsi, and from what Anayiz (from Wozs narrative) expr essed concerning folk illnesses, they followed one aspect of Laguerres (1987), modelthey used folk remedies for minor issues or as a preventative and used biomedicine for major health issues. To add to this, both women suggested that when dealing with TMMV, it was necessa ry to seek folk health prac titioners because biomedical practitioners would not, and could not, cure bareness. Future Research Negative a ssociations of Haitians with AIDS, Vodou, and are experienced in daily life. In the United States qualitative and quantitative studies on stigma a nd the different ways that it affects peoples lives could de lve further into how AIDS, Vodou, and Blackness impact Haitians consciousness in regard to stigma. My questions surrounding stigma show some of the ways that stigma is internalized. An in-depth study coul d be designed and implem ented using participant
93 observation, cross cultural compar ison, interviews, survey, and free list and pile sorts to show how the extent of each of these factors (AIDS, Vodou, and Blackness) are related to each other in the consciousness of Haitian people. A larger sample size than used here would be required as well as multi-site ethnography in the United Stat es and Haiti for a more complete study. Conclusion This chapter discussed how folk models in re lationship to health and healthcare choices are complex interactions that include identity. S tigma based on constructi ons of AIDS, Vodou, and Blackness form a part of the folk models themse lves. The research findings provide evidence that support the hypotheses. Access to healthcare that incorporates loca l ideas of health and healing surrounded by a discourse of acceptance would help to de-politicize the healthcare system that could help to alleviat e stigmatized cultural experiences.
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108 BIOGRAPHICAL SKETCH Born and raised in Beaco n Falls, CT, A. Is adora Del Vecchio received her bachelors degree in cultural anthropology from the University of Kansas in 2003. Upon graduation, she began graduate school at the University of Florida focused on cultu ral anthropology. After several years of work in the field of edu cation she became a Teach for America 2009 corps member. In the summer of 2009, she graduated with her M.A. from the University of Florida. In September 2009, she will be working as an ESL teacher in New York City where she resides. In fall 2009 she will begin her M.T. in TEOSL at Fordham University in New York City. She has one daughter: Alithia, age 8 months.