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Based on ethnographic and survey data from a rural area in Haiti, Coreil (1983) described the professional (formal) and folk (informal) spheres of health care in Haiti. Dispensaries (religious health care facilities) and herbalists were by far the most common choice for treatment (80% of all consultations), they were less expensive and more easily available, practitioners often visiting patients in their homes. Hospital clinics and other types of healers were physically less accessible and their treatments more expensive. Patients therefore resorted to them less frequently (only 6% and 5% of consultations, respectively) to treat more uncommon and severe illnesses.

Brodwin (1997) studied biomedical health services in a small village in southern Haiti, where a public clinic provided primary health care, through a “Rural Health Care Delivery System” that emphasized “the equitable distribution of resources and the cost- effective provision of preventive care” (p. 75). He describes the interactions between staff and patients: “most people do not come prepared with a story of their illness to tell the dispensary staff but instead expect staff to take the initiative and give them a physical exam and prescription for medication” (77). He goes on to describe the teasing and chastising of patients by nurses, arguing that this behavior is indicative of codes of deference that are enforced by institutions throughout the village.

Treatment Expectations

Haitians expect healthcare professionals to be engaging and active in resolving issues. In general, Haitians do not like to expose their intimate or domestic problems to strangers or professionals. Many are shocked by the ways that some Euro-Americans discuss their private difficulties in public or with complete strangers. For some Haitians, mental health problems are considered taboo, shameful, and should be hidden from people outside of the family. Any initial psychological assessment should explain the goals and process of treatment and focus on establishing trust. Empathic listening and culturally consonant explanations will help show that the helper is credible, trustworthy and potentially effective.

Most Haitians do not use Western psychological language to explain their symptoms and feelings. Writing for U.S. practitioners, Desrosiers and Fleurose (2002) note that Haitians tend to tell their story in minute detail in order to provide the circumstances surrounding an event. They point out the importance for the clinician to remember some of the details and refer to them during the session as a sign of interest and caring. Haitian patients may expect a concrete plan of action at the end of any encounter. Neutrality and lack of feedback may be seen as a waste of their time. Concrete action could include assisting with practical needs for food and clothing (Desrosiers & Fleurose, 2002; Gopaul- McNicol, Benjamin-Dartigue, & Francois, 1998). Once trust is established, Haitians may expect the mental health professional to be a respected authority figure and expert who can solve problems quickly.

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