3. HEALTH IN HAITI
Major Causes of Mortality
According to PAHO/WHO (2003), the main causes of infant death in Haiti include acute diarrheal disease, intestinal infectious diseases, infections of the perinatal period, malnutrition and acute respiratory infections. In schoolchildren common causes of death include infectious and parasitic diseases. Among adolescents, the main causes of death are HIV/AIDS, assault, homicide, tuberculosis, typhoid and maternal death. Female adolescents may have high rates of exposure to violence and sexual abuse. In adults, common causes of death include AIDS, intestinal infections and maternal causes (e.g. arterial hypertension, eclampsia, complications of labor). Among the elderly, causes of death include non-communicable diseases, diseases of the circulatory system, malignant neoplasms of the digestive organs, tuberculosis and HIV/AIDS. Because Haitian patients often expect health professionals to ask about the presence of a series of symptoms (in order to pose a diagnosis), knowing about these prevalent diseases may help in the exploration of symptoms.
Explanatory Models of Illness and Idioms of Distress
Haitian culture provides a range of explanations for illness drawing on commonly held cultural, religious and social beliefs. Explanatory models can determine help-seeking behaviour and service utilization. In Haiti, illness explanations and help-seeking behaviors vary greatly depending on factors such as location, religion and social class. Individuals use resources pragmatically, and often hold multiple or hybrid models of health and illness. As a result, the same person may seek help from multiple sources, when available.
Haitians divide illnesses into several broad categories, including: maladi Bondyè (God’s disease, or those of “natural” origin), maladi peyi (“country”, or common, short-term ailments), maladi moun fè mal (magic spells sent because of human greed), and those of supernatural origin, maladi bon lwa (‘disease of God’) and maladi Satan (Satan’s or “sent” sicknesses) (Sterlin, 2006; See Appendix A).
Many Haitians also use a humoral theory of health and illness. Imbalance of hot and cold within the body are believed to be causes of natural illness. These imbalances can stem from environmental elements such as rain, wind, sun, and dew or emotional reactions to the physical environment (e.g., witnessing lightning strike) or to the actions of others. Health may be restored through the use of herbal teas, regulated diet, compresses, baths, and massages. The treatment must be in the opposite direction of the imbalance in order to restore equilibrium. Foods have hot and cold, heavy and light properties, such that