Guitele J. Rahill

SHELTER RECOVERY IN URBAN HAITI AFTER THE EARTHQUAKE: The Dual Role of Social Capital

This paper documents the culture-specific understanding of social capital among Haitians and examines its benefits and downsides in post-disaster shelter recovery following the 12 January 2010 earthquake. The case study of shelter recovery processes in three socioeconomically diverse communities (Pétion-Ville, Delmas and Canapé Vert) in Port-au-Prince suggests that social capital plays dual roles in post-disaster shelter recovery of the displaced population in Haiti. On the one hand, it provides enhanced access to shelter-related resources for those with connections. On the other hand, it accentuates pre-existing inequalities or creates new inequalities among displaced Haitians. In some cases, such inequalities lead to tensions between the haves and have-nots and instigate violence among the displaced.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake

BACKGROUND This study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. METHOD We used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC) RESULTS: Among our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (β=.366, p<.001) and Depression symptoms (β=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors.

Expecting the unexpected: field research in post-disaster settings

The purpose of this article was to examine field research after disasters by focusing on fieldwork challenges in post-disaster research settings. We describe and evaluate post-disaster fieldwork based on three separate research projects: A study of land use change adaptation strategies following the 2011 Great East Japan Earthquake and Tsunami; a study of long-term housing recovery following the 2001 Gujarat Earthquake in India; and a study of the role of social capital in shelter recovery following the 2010 Haiti Earthquake. The main findings of this study deal with some of the unique set of challenges that accompanies fieldwork in post-disaster settings. Our findings indicate six aspects that researchers might consider prior to undertaking fieldwork in a disaster setting: the critical role of language, logistics of transport and living accommodation, methodological matters, the researcher’s position in the field (i.e., gender, ethnicity), fieldwork blues and ethical concerns. Potential solutions to these challenges include understanding the target community prior to embarking on fieldwork, having flexibility in the field to deal with unexpected issues and problems, planning ahead for institutional review board approvals, forming research collaborations and having strategies in place to manage stress in the field.

Haitian Picuristes/Injectionists as Alternatives to Conventional Health Care Providers in South Florida

Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian “lay injectionists” in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed.

Language of Sexual Violence in Haiti: Perceptions of Victims, Community-level Workers, and Health Care Providers

Non-partner sexual violence (NPSV), an important risk factor for HIV, is of global public health significance and understudied. The 2010 earthquake interacted syndemically with structural factors to increase sexual violence and HIV risk for women in Cité Soleil, Haiti. We used an exploratory sequential qualitative design and Grounded Theory to investigate language/terminology for NPSV, victims and perpetrators, and health effects of NPSV on victims, in four focus groups: Health care providers (HCPs) (n=3; n=8), community advocates (n=8), and victims (n=8). Crucial differences exist among stakeholders: HCPs prefer French and possess different explanatory models of illness from victims, who provided more extensive and explicit descriptions (e.g., “strangled like a chicken,” “tuyo”/“faucet”/“flooding” for gang rapes). Victims also reported purposeful injury to their external and internal genitalia, signaling STI/HIV risk. Reconciling within-culture differences between victims and HCPs can inform screening, diagnosis, treatment, follow-up and delivery of relevant interventions.

Insights and Practical Strategies for Health Research Among Haitian Immigrants: Lessons Learned From the Miami-Dade Picuriste Study

Useful health research is foundational to disease prevention and treatment, especially when conducted among understudied populations for whom hidden cultural health beliefs and norms may result in disease. Lessons learned from field experiences during an exploratory mixed-method study of Haitian picuristes (injectionists) in Florida reveal the usefulness of knowledge and application of formal and informal protocols that demonstrate awareness and respect of Haitian norms, and the importance of fostering relationships of trust as complements to clear and relevant research objectives. These facilitate entrée, engagement, rapport, management of discursiveness and environmental interruptions, and modification of research instruments. Health researchers in U.S. Haitian enclaves should be process-oriented, flexible, and transparent from recruitment to dissemination phases of research.

Assessing the Development of Cultural Proficiency Among Upper-Level Social Work Students

ABSTRACT Graduate social work pedagogy is challenging to diverse faculty and students who work with diverse clients, often in international practice. We discuss the development, outcomes, and assessment of an assignment designed to stimulate students’ research on proverbs as cultural resources for practice and to promote attainment of six competencies related to diversity and social justice of the Council on Social Work Education’s Educational Policy and Accreditation Standards. We used procedures from grounded theory and Atlas.ti to analyze 40 student papers. More than 70% of papers reflected students’ mastery of three competencies, suggesting the assignment was insufficient to ensure attainment of all six competencies and signaling errors in the structure of the assignment and in the rubric. Ensuring students’ achievement of the competencies requires careful design and assessment of assignments and deliberate, structured assessment of the assignment outcomes.

In their Own Words: Resilience among Haitian Survivors of the 2010 Earthquake.

Abstract:Social sciences literature highlights the importance of resilience in relation to risk and trauma. The 2010 Haitian earthquake compounded trauma for a nation that has endured slavery/despotic leadership, structural violence and poverty. Since 2010, various sources broadly describe Haitian survivors as resilient. We reviewed definitions of resilience published between 1990 and 2013, comparing them with perspectives of earthquake survivors from economically diverse communities in Haiti who, participated in semi-structured interviews (n=38) and in six focus groups (n=63) between 2010–2011. Haitian resilience accords with some definitions from the literature. It also comprises independent, discrete, and isolated contextual resignation and intentional choice to survive and function—when there is no alternative course of action. Understanding Haitian resilience, can inform health/mental health and policy interventions, if these are taken as cultural resources. Intervention efforts should incorporate survivors’ input as key informants on what constitute resilience and reconstruction goals for them.

Adapting an evidence-based intervention for HIV to avail access to testing and risk-reduction counseling for female victims of sexual violence in post-earthquake Haiti

ABSTRACT Haiti has the highest prevalence of HIV/AIDS in the Caribbean. Before the 2010 earthquake, Haitian women bore a disproportionate burden of HIV/AIDS, had lower HIV knowledge, less capacity to negotiate for safer sex, and limited access to HIV testing and risk-reduction (RR) counseling. Since 2010, there has been an increase in sexual violence against women, characterized by deliberate vaginal injuries by non-intimate partners, increasing victims’ risk of sexually transmitted infections including HIV/AIDS. Needed is an adaptation of evidence-based interventions for HIV that include HIV testing and counseling for this stigmatized population. We reviewed several features of Centers for Disease Control and Preventions 103 evidence-based interventions for HIV (e.g., measures used, participant risk characteristics, theoretical framework, outcome variables, and evidence tier) in an attempt to seek a feasibly adaptable evidence-based intervention for HIV that could be used for victims of sexual violence (VOSV). RESPECT, one of the reviewed evidence-based HIV interventions, comprises of one-on-one, client-focused HIV prevention/RR counseling, and RAPID HIV testing. Adapting RESPECT can enhance access to testing for Haitian VOSV and can influence their perceptions of HIV risk, and establishment of RR goals for future consensual intimate relations. Adapting and implementing RESPECT can increase uptake of evidence-based HIV interventions among Haitians and positively affect a region with high HIV prevalence and increased rates of sexual violence.

Type and Frequency of Substances Injected in a Sample of Haitian Immigrant Picuristes (Informal Injectionists) and Clients

In view of health inequities disfavoring Haitians, substances given by Florida Haitian picuristes/informal injectionists were investigated. Semi-structured interviews of 10 picuristes and 25 clients were obtained, transcribed, and analyzed using ATLAS.ti and SPSS. The most commonly injected substances were antibiotics (reported by eight of 10 picuristes, who sometimes compose substances when conventional pharmaceuticals are inaccessible). Haitian picuristes give injections based on clients’ reported symptoms, and no clear or consistent protocol appears to exist for diagnosis, insuring injection safety, determining amount, or frequency of substances injected. Findings indicate frequent use and misuse of antibiotics. While not limited to this sample of Haitian immigrants, frequent and unmonitored use of antibiotics may add to health disparities by increasing antibiotic resistance among them and among others with similar health practices. A harm reduction approach for mitigating effects of antibiotic overuse is suggested.