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Appendix A.

Table 1. Health care as a function of cultural systems (Adapted from: Sterlin, 2010)

Ways of Being (Worldview)

Concepts of the Person

Health

Cosmocentric Culture of Haiti Human beings are only a particular form of condensed energy drawn from the great cosmic and all-encompassing cosmic Being, whose primary concern is to achieve and maintain harmonious synergy with the universal energy. The person has four dimensions:

  • Kò kadav (‘body’);

  • Lonbraj (‘shade’);

  • Gwo bon-anj (‘big good angel’);

  • Nam/ti bon-anj (‘little good angel’).

Health is the state of “well-being in connectedness” to the environment which includes:

  • the non-human environment (land, plants, animals, air, forces of nature, etc.);

  • the human environment (nuclear and extended family, network of close allies, collectivity, others);

  • ancestors and spirits (the invisible).

Anthropocentric Culture Humans are the centre of an imperfect universe that they must understand, explore, master, transform, exploit, etc.

The person has two dimensions: body and mind.

Health is the state of well-being that results from the optimal functioning of organs and systems defined by physiological and biochemical parameters. The influence of the environment is mainly physical (e.g. quality of air, food, etc.). There is modest recognition of the importance of the social environment.

Illness

Origins of Illness

Classification of Illness

The indicator of health and wellbeing is the experience of harmonious integration in the environment (“ontonomy”). The state of “being-ill-with” results from a loss of harmony between the components of the person and/or between the person and one or more elements of the environment.

  • Non-observance of the rules that govern the human relationship with the physical environment;

  • Non-observance of rules of hygiene

  • Non-observance of ethical rules

  • Malign influence of others (poisoning, sorcery)

  • Non-respect of the rites or prescriptions regarding the ancestors and/or spirits

  • Maladi Bondyè: domain of visible or “ordinary” physical illnesses; can be healed with the aid of Western medicine or a contè- fèy (traditional healer);

  • Maladi fè-moun mal (or maladi diab):domain of the invisible, secret or magic; can be healed by intervention of a bòkò or a

The indicator of health and well-being is individual autonomy and performance.

The state if ill-being results from a perturbation of functions of an organ or system.

  • Manifestations of hereditary or genetic problem;

  • Non-observance of rules of hygiene (nutrition, toxins, microbes, etc.)

  • Pathogenic interpersonal factors (poor emotional care, loss, trauma, etc.)

  • Psychosocial stress

  • Physical illness

  • Mental illness

  • Psychosomatic illness

All require the aid of a biomedical physician and may not improve

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