Week 8

Post your week 8 discussion questions here.

People of Haitian Heritage

People of Iranian Heritage

Read chapter 15 and 32 of the class textbook and review the attached PowerPoint presentations.  Read content chapter 32 Davis Plus Online Website.  Once done present a 800 words essay discussing the Haitian and Iranian Heritages.  The essay must contained the following;

-Geographical localization and topography

-Politic and economy

-Health care beliefs and the relationship with their religious beliefs

-How they view the health, illness and death concepts

You must used at least two evidence-based references (excluding) the class textbook. 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Iranian
Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage
Over 400,000 in the United States with about ½ living in California
Currently about 76 million in Iran with 75% under the age of 30
Much diversity in Iran (Persia) among its inhabitants and also much diversity among Iranians in the United States

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued
The reform institutions of current Iran are colored by religious traditions and ideology of Islam.
Current industrialization of Iran has been from the outside, not from the inside and is due to the oil production industry.
Political instability continues with clashes between conservatives and liberals.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued
First wave of immigration between 1950 and 1970 were mostly students and professionals from the social elite and many stayed in the United States.
Second wave between 1970 and 1978 were varied in their background, but most were still affluent and urban and came for education and to be with family.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued
Not a major influence in the United States because they did not live in ethnic enclaves and assimilated into the United States culture easily
The third wave of immigration began in 1979 at the time of the Islamic revolution and included voluntary and involuntary political exiles and others who come for economic and personal security

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued
The hostage crisis between 1979 and 1981 increased ethnic tension of Iranians in the United States
Many are unable to find work in the United States that is compatible with their education in Iran
Most highly educated immigrant group in the United States

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications
Farsi (Persian) is the national language of Iran but half speak another language with the educated group speaking three or more languages, including English
Invasions by numerous other nations have caused a mistrust and suspicion of foreigners resulting in not sharing one’s feeling with strangers

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Tell stories rather than being blunt and to the point in conversations leading to politeness and sometimes disguised as modesty
Hierarchical relationships dictate politeness and social communication resulting in a public self and a personal self

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Family affairs remain within the family
Self-control is valued and therefore do not show anger or emotions
Men can show affection for men and women for women in public, but not men and women
Stand close in conversations, regardless of social status between conversants

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Maintain intense eye contact between intimates, but avoid eye contact with superiors and elders
Expressive gesturing
Balance in temporality
Clock time is meaningless, even with appointments unless well acculturated

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Formality in addressing each other unless close friends
More traditional men do not mention their wives’ names in public
Man should wait for woman to extend her hand for a greeting

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Name Format
Order of the name is the same as the Western method with the given name followed by the surname.
Traditional women do not take their husband’s last name although some in the United States and elsewhere may upon immigration.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles
Society is patriarchal and hierarchical
Oldest son takes over if father is not present or unable to carry out decision-making
Male children are more desirable than female children—true in other cultures as well

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Men deal with finance and matters outside the home.
Women care for the home and children.
Before 1960s social reform, women were legally expected to be obedient and submissive to their husbands.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Marry early and have children. New law says women cannot marry until age 14—was 12 and marriages may still be arranged, but less so in the United States
Respect elders and never speak rudely to them
Children rarely left with babysitters

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Traditional do not allow dating; women are expected to remain virgins until married, but not men
Strong intergenerational ties and family life together or nearby
May dress conservatively outside the home but less so while at home

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Divorce uncommon in Iran and carries a stigma—if divorce, it is the woman’s fault, never the man’s—varies in the United States
Pregnancy before marriage can have devastating outcomes and is not talked about, it does not happen—it is just taken care of
Gay and lesbianism highly stigmatized and is a capital crime punishable by death in Iran

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology
Wide variations in skin color, hair color, and eye color and depends on heritage from previous domination by other countries and cultures
Common illnesses in Iran include malaria, hypertension, meningitis, hookworms, and parasitosis

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued
Great numbers with genetic disorders brought on by close sanguinity marriages resulting in blindness, epilepsy, anemias, hemophilias
Glucose-6-phosphate dehydrogenase deficiency —fava bean allergies can cause hemolytic crisis

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition
Food is a symbol of hospitality; serve the best food for guests who are expected to eat several servings.
Polite to refuse snacks and beverages when first offered—accept it on the third offering
Rarely eat fast food; fresh food is greatly preferred, and many hours are spent preparing meals

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued
Strict Muslims avoid pork and alcohol and meat must be prepared with ritual slaughter called halal.
Food should be eaten with the right hand (clean hand) and food should be passed with the right hand or both hands.
Traditional prefer family to bring food from home if hospitalized.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued
Balance food between garm (hot) and sard (cold) —if balance does not occur, one may become “chilled” or “overheated.”
Women are more susceptible to these conditions than are men.
Newer immigrants may have protein and vitamin deficiencies.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family
Menstruating women are not allowed to touch holy objects, have intercourse, exercise, or shower.
Iran is changing from openly discouraging birth control to now cautiously and secretly encouraging birth control because of the population explosion.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued
Cravings must be satisfied because the fetus needs the craved food
Avoid fried foods or foods that cause gas
Eat lots of fruits and vegetables
Balance garm and sard foods
Pregnant woman should not work after the sixth month

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued
The father should not be present at birth in the traditional family
30- to 40-day postpartum period where other women are to care for the new mother
Ritual bath after this period so religious obligations can continue
Eat different foods if a boy baby versus girl baby
Eat an herbal extract (taranjebin) to have a boy

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals
Okay to begin life support, but usually not okay to end life support
Multiple family members come to bedside of the dying person and recite/read prayers
Bed should be turned to face Mecca
More traditional want to return to Iran to die

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued
Even though death is seen as a beginning, not an end, mourning and grief are displayed openly and even dramatically to encourage letting go
After death, relatives and friends gather on days 3, 7, and 40 to pray and grieve with family and friends

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued
All wear black for mourning and women should not wear makeup
On the anniversary of the death, family and friends again gather to express grief and pay respect to their loved one

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued
Ritual body washing by another Muslim after death and dressed in a white shroud; body orifices stuffed with cotton and ritual prayers said during the cleansing
If non-Muslim, touch the body only with gloves
No embalming in Iran nor is cremation practiced

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality
Specific Muslim practices include praying 5 times each day and need privacy and ritual washing before prayer
During Ramadan, fasting from sunup to sundown unless pregnant or ill
Family relationships and friendships are primary sources of strength

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality Continued
Sadness is valued and a sad person is considered to be deep, thoughtful, and sensitive
God’s Will and power over one’s fate fosters passivity and dependence

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
A 76 year old Iranian, Muslim male is in the process of dying after a long debilitating illness. The nurse would
Have his Imam visit.
Make sure no one touches him with bare hands.
Turn him to face Mecca.
Place him in a supine position.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: C
At the time of death, the dying person should be positioned to face Mecca. This can be accomplished by moving the bed or at a minimum of turning the patient’s face towards Mecca.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices
Combination of humoral medicine, Islam, and biomedical practices
Humoral medicine—illness is caused from an imbalance in wet and dry and hot and cold forces
Sacred men are able to heal
Evil eye is alive and well

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Good health is a daily way of life
Seek care immediately and shop around for the right treatment
Use traditional herbs and over-the-counter medicine to relieve symptoms and seek care provider to determine the cure
Able to purchase a wide variety of drugs over-the-counter in Iran and bring them to the United States

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Narahati—general term to express unpleasant emotional or physical illnesses and somatization is common and accepted and can be treated religiously or medically, depending on what the cause might be
Ghalbam gerefteh—distress of the heart—is an expression of emotional turmoil or homesickness

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Various remedies for the evil eye and dependent on the age and family of the person afflicted
Language can be a barrier to care for some
Descriptions of conditions may be different from the US description
Many do not have health insurance

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Concept of insurance may not be known to some
Usually very expressive with pain and discomfort
Mental illness is highly stigmatized and may hinder other family members from marriage
Prefer drugs, the stronger the better, and prefer IV over IM, and IM over pills
The more invasive, the better

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practitioners
Organ donations and transplantations may be seen as a business transaction
Folk or religious practitioner used for narahatis
Most respected biomedical practitioner is a middle-aged male with a title and white hair
Firm believers in high technology

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practitioners Continued
Nurses are usually afforded little respect—partially because of training
Physicians are on top—all other healthcare providers take a lesser position
If self-care is encouraged, it may be seen as non-caring

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
Mrs. Said is brought to the nurse practitioner by her daughter because she has naharati. The nurse recognizes this condition as
Equivalent to congestive heart failure.
Generalized distress.
Generalized weakness of aging.
Abdominal pain.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: B
Naharati is generalized distress that can be brought on by stress, anxiety, homesickness, or other things that can cause emotional turmoil.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Transcultural Health Care
Haitian Americans
Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview
Haiti shares the Island of Hispaniola with the Dominican Republic.
Dominican Republic and Haiti have little in common culturally.
Haiti is the poorest country in the Western hemisphere with a per capita income of less than $450.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview Continued
Over 500,000 Haitians live in the United States, with more arriving after the Haitian earthquake in 2010. Their numbers may exceed 1.5 million.
Most live in NYC, FL, Boston, Chicago, and CA
Most come here for better economic opportunities and political freedom

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview Continued
Haitians are a mix of Arawak Indian, Spanish, French, and African Black resulting in sharp class stratification and color consciousness
1791 ended slavery in Haiti

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications
Languages are primarily Creole (for the poor) and French (wealthier) and English although many speak all three languages
Black, mulatto, or white and colors in-between
Most Blacks are poor and underprivileged

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview
Early immigration to the United States was the wealthier groups for education, followed by general immigration after 1920 and the United States occupation of Haiti
After 1964, Duvalier became president for life, mass exodus because of oppression politically and economically

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview Continued
1980 immigration with the Mariel Boat Lift from Cuba brought first legal and then the Boat People from Haiti.
Many had left Haiti to Cuba in previous generations and this group joined in coming to the United States.
Resulted in Cuban-Haitian entrant: status pending

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview Continued
French model of education with liberal arts, philosophy, classics, and languages—Latin and Greek and de-emphasizes technical and vocational training and the social and physical sciences
Educated Haitians are multilingual
Only 15% to 20% receive an education—high illiteracy rates

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications
French and Creole official languages
15% speak French, 100% speak Creole
Oral communication patterns to pass on culture through proverbs and storytelling
Smile timidly to hide lack of education and understanding
Nod of the head does not mean “I understand”

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Most are private individuals who do not want friends or family to interpret for them
Traditional Haitians do not usually maintain eye contact
Touching is common
Women may hold hands while walking in public

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
Most are present oriented out of necessity, the past is cherished and the future is predetermined —many remain rather fatalistic
Punctuality is not valued—flexible time is the norm

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued
First and middle name are usually hyphenated
Woman takes her husband’s name upon marriage
Last names are usually French or Arabic in origin
Formality in name is the norm

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles
Matriarchal or shared decision-making is the norm—although there are variations
Male is the primary breadwinner
Concept of machismo prevails
Not uncommon to have more than one mistress or for women male partners

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Children are valued and expected to be well behaved—otherwise physical punishment may be used
Most feel US society is too permissive
Boys are given more freedom and permissive behavior
Girls cannot go out alone until age 17+

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Nuclear, consanguine, and affinal relatives are the norm
Family lineage is what denotes respect, not money
Children expected to care for parents when self-care is a concern

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued
Single parenting is well accepted
Homosexuality is taboo—if known, total denial from both sides
Mistress supports her children with little to no financial help

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
The nurse is providing insulin injection instructions to Mrs. Paul, a 44-year-old Haitian. When the nurse asks her if she understands the instructions, she nods. To assure understanding, the nurse should
Ask her to repeat the instructions.
Give her written instruction to ensure.
Have her demonstrate an injection.
Give the instructions to a family member.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: C
The best way to assure understanding is for the patient to demonstrate the injection.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health Conditions
Cholera, parasitosis, and malaria without malaria control measures
Hepatitis, tuberculosis, venereal disease have high rates
Most test positive for TBC because of Bacille bilie de Calmette-Guerin vaccinations
High rates of diabetes and hypertension

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition
For many, food means survival
Prefer eating at home and dislike fast food
When hospitalized, many prefer to fast rather than eat hospital food
Dislike yogurt, runny eggs, and cottage cheese
Staples are rice and beans, plantains, salad

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued
Lists of foods are in the Haitian–American chapter
Foods are classified as cold (fret) and hot (cho), acid and non-acid, and heavy and light
Must balance fret and cho foods or illness occurs

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued
Cough medicines are hot, laxatives are cold
Avoid citrus, causes acne
After ironing do not open refrigerator door
Do not shower when you are hot
Do not put warm feet directly on the cold floor

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued
Diet high in carbohydrates and fat
Being overweight is seen as positive
Major portion of meat protein is given to men

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy
Pregnancy is not an illness so why seek prenatal care
Spicy foods will cause the fetus to be irritable
Vegetables and red fruits build blood for the fetus
Increased salivation—“use a spit cup”

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy Continued
Prefer natural childbirth, although changing somewhat in the United States
Men usually not present during labor—female family members are preferred
Dress warmly and stay in bed 2 to 3 days after birth and use an abdominal binder to close the bones so cold air does not enter and cause illness

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Postpartum
Three baths postpartum, more difficult in the United States
Avoid food believed to increase vaginal discharge—lima beans, okra, mushrooms
Other foods are strength foods
Breastfeeding is encouraged
All infants receive lok to help meconium pass

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
Most Haitians practice the hot and cold dichotomy of foods. This is know in Haitian Creole as
a. Yin and yang.
b. Calor y frio.
c. Fret and cho.
d. Am and duong.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: C
Fret and cho are the Haitian Creole words for hot and cold.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals
Prefer to die at home
Death watch by family who brings religious pictures and have bedside prayer
Male kinsman responsible for funeral arrangements, notifying all family members, and coordinating the service
Preburial veye to celebrate deceased’s life

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued
Seven consecutive days of prayer in the home to help the passage of the soul into the next life
Believe in resurrection so no cremation
Autopsy may relieve fear of deceased becoming a zombie

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality
Family is the center of life
Catholicism is the primary religion of Haiti
Religious practices combined with voodooism
Loa, the gods or spirits, believed to receive powers from God can provide protection and wealth

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices
Good health is balance between hot and cold, eat well, be plump, pray, be free of pain, eat and sleep right, and exercise
Illness is seen as punishment and comes of two types—natural and supernatural
Natural illnesses of two types—short duration caused by environmental factors

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Natural longer term illness due to disequilibria between hot and cold and bone displacement
Supernatural illnesses are caused by angry spirits, which are placated by ceremonial feasts
Gas is a major cause of illness and can be in any part of the body

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Certain foods can dispel gas
Postpartum more susceptible to gas
Traditional Haitians have a low pain (doule) threshold and is difficult to assess because of vague terms used to describe pain
Injections are preferred to oral medications

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Condition is deemed very serious if oxygen is needed
Special diet for physical weakness—vitamins, liver, pigeon meat, leafy green vegetables, and cow’s feet
Sezisman, similar to susto or magical fright, is caused by unexpected bad news and fright

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued
Strong stigma with mental illness
Self-treat and self-medicate or take friends medicine
May bring medicines from Haiti
Cultural bound illness—oppression

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Barriers
Delay seeking care because of self-care
No health insurance
View that Western medicine does not understand voodooism
Language difficulties
Very reluctant to receive blood transfusions or engage in organ donation

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practitioners
Use traditional and Western practices simultaneously
Respectful of Western healthcare providers
May have limited understanding of Western healthcare providers and their functions and capabilities

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