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
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Transcultural Health Care
Haitian Americans
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
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.
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
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
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
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
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
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
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”
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
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
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
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
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+
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 selfcare is a concern
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
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
a. Ask her to repeat the instructions.
b. Give her written instruction to ensure.
c. Have her demonstrate an injection.
d. Give the instructions to a family member.
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.
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
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
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
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
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
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”
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
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
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.
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.
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
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
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
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
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
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
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
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
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
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
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Iranian
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
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
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.
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.
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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.
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.
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.
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
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
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
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
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
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
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
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
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
a. Have his Imam visit.
b. Make sure no one touches him with bare hands.
c. Turn him to face Mecca.
d. Place him in a supine position.
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.
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
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-thecounter in Iran and bring them to the United States
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
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
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
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
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
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
a. Equivalent to congestive heart failure.
b. Generalized distress.
c. Generalized weakness of aging.
d. Abdominal pain.
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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