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speak about it openly with strangers, clinicians, or others outside the tradition. Although individual knowledge and attitudes vary with education and religious affiliation, Vodou is part of the cultural background for most Haitians, regardless of their identity.

Vodou is not only a religion but constitutes a health care system, which includes healing practices, health promotion and prevention of illness and promotion of personal well- being (Augustin, 1999). Vodou provides information on how to promote, prevent and treat health problems, with theories of illness, treatment interventions, and prescriptions for behavior that are congruent with widely held explanatory models (Vornarx, 2008, p. 182). A first level of interpretation of illness in Vodou is based on the need to establish a harmonious relationship with the spirit world of the ancestors. A second level deals with the role of magic or sorcery attacks in which the afflicted person is the victim of a spell. According to the causal explanations of Vodou the health and illness of a particular person depends on his or her connection to tradition and place in the social and moral order and in a wider universe of being that includes the ancestors and the gods.

In Haiti, the African gods or deities are called lwa-s (loas) and represent the spirit of African ancestors, deceased family members and biblical figures. The lwa-s are seen as guardian angels. They can protect the devotee against the curse of an enemy and can be called upon for help in times of distress to provide guidance or to transform a situation (Desrosiers & Fleurose, 2002). To express themselves the lwa-s can inhabit the body of a person and this is called possession. Women are more likely than men to be possessed (Desrosiers & Fleurose, 2002; Miller, 2000). When possessed, the person may initially appear to lose consciousness and fall to the ground writhing and moaning. Once the person regains consciousness, the lwa can use her as a medium to communicate with other persons present. While the lwa-s can be a buffer to stress they can also be a cause of stress. If an individual fails to satisfy the lwa-s, they may retaliate by causing misfortune, poor physical health and mental illness (Desrosiers & Fleurose, 2002).

In Vodou, the oungan (Vodou priest) and the manbo (Vodou priestess) possess the knowledge of the tradition. They are endowed with power and are well respected in the community. The bòkò is considered to be a professional magician who can buy spirits to send curses, transmit malevolent spells and help someone achieve personal aims. Farmer (1990) found that Protestant, Catholic, and Vodouisant informants all acknowledged the possibility that sickness and misfortune can be “sent.” Because one’s enemy can use the supernatural to cause harm, Vodou may contribute to a sense of mistrust of others, though it is also experienced as a supportive system for many Haitians living without formal health care (Desrosiers & Fleurose, 2002; Gopaul-McNicol, Benjamin-Dartigue, & Francois, 1998).

According to Brown (1989; 1991), Vodou is based on a vision of life in which individuals are given identity, strength and safety in a dangerous world through the thick fabric linking them together with other human beings, as well as spirits and ancestors. For

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