Some NYC residents have taken to putting signs out of their windows, coping with the shelter in place instituted in the state

By Santra Denis, MPH, Nancy Metayer, MHS, Ludmilla Paul, MPH, and Gilbert Saint Jean, PhD

By Santra Denis, MPH, Nancy Metayer, MHS, Ludmilla Paul, MPH, and Gilbert Saint Jean, PhD

The COVID-19 pandemic, is causing distress around the world, including in Haiti. The nation lacks the health infrastructure of many developed countries, yet Haiti is taking precautions to contain the disease. 

The Haitian government has publicly stated that it will support factories that produce medical garments, impose quarantines for those who have possible exposures, and is generally only allowing for charter flights for foreign nationals who wish to leave the country.

 Although Haiti only has 21 confirmed COVID-19 cases, as of April 5th, there are broader implications for the Haitian diaspora in the United States. Hundreds of Haitians who live in the east coast-  such as MA, NY, NJ, FL-  have been stricken with many dying.

These states all have a large number of Haitian residents, and although the data is not publicly available by ethnicity or national origin, these states also have a combined number of over 146,483 confirmed COVID-19 cases and 4,593 related deaths. And the numbers are still rising. It should concern us how this disease is impacting our community. The spread of this pathogen poses health, economic, and social risks for the Haitian-American community throughout the diaspora.

Navigating the United States’ fragmented health system is especially frustrating during a pandemic. Unlike chronic disease, infectious diseases are transmissible from person to person and require inclusive surveillance in order to contain and prevent transmission. Identifying cases is a vital component of managing an outbreak. Increased testing can help public health agencies monitor cases, but there are several barriers to achieving this, particularly for the Haitian community. Very few testing sites are in communities with large Haitian populations. Community spread is ongoing. Without broad surveillance, the Haitian community is mostly excluded and very few might qualify for testing, even though there are many people testing positive who do not meet some of the above mentioned requirements.  Unfortunately, with limited testing available, communities that should be tested will likely be overlooked. 

Additionally, the common health belief in Haitian culture that one is not really sick unless you’re symptomatic also poses a barrier. Home remedies are typically used first before seeking medical services. Haitians tend to only seek care from a healthcare provider when it becomes abundantly clear that it’s needed. This poses concern since it is possible to have COVID-19 while being asymptomatic.

Social distancing has been recommended by the US Centers for Disease Control and Prevention (US CDC) and other public health experts as a way to combat the pathogen. Self-isolation and quarantine are also proven effective measures. However, this poses unique challenges to vulnerable communities like members of the Haitian community as their cultural practices often conflict with the public health directives. Relationships are very important in Haitian culture. Haitians greet new and formal acquaintances with a handshake in order to express that they are fond of someone. Kisses on one or both cheeks are also customary when greeting our family, friends and colleagues. They use touch as a form of friendship when having a conversation. It is absolutely necessary to ensure that all communication about social distancing is not only interpreted, but also culturally competent with directives on how to cope that are safe and sensitive to cultural practices. 

Social distancing in cases of funeral rituals during the COVID-19 pandemic, poses cultural and spiritual anxiety. It presents an inability to properly bury the deceased, which includes gathering family members to share stories of the deceased at a wake, grieving and praying during church and burial services, and finally a reception. Haitians who practice Vodou have different rituals that adhere to their beliefs of a life after death. Priest or priestess will perform a ritual to release the soul from the body. It is obvious that this pandemic disrupts several cultural norms. It’s also clear that this pandemic has made many of the customs mentioned unaligned with best practices to contain the infectious pathogen that is COVID-19 and will have emotional and mental health implications.

According to the Migration Information Institute, 40% of the Haitian diaspora in the United States are employed in service occupations—with a concentration of 36% in health care and education-related jobs. Many are doctors, nurses, and other healthcare workers whose jobs put them potentially in direct contact with people infected with COVID-19.  Many also work as domestic workers, dishwashers, busboys, jobs that also may put them in direct contact with people who have come into contact with COVID-19. Haitian migrants and farm workers are also at great risk. With Florida’s peak growing season underway, if the virus spreads among these workers, many of whom sleep in run down trailers, and overcrowded quarters. This could spread the illness among the laborers and negatively impact growers’ ability to harvest agricultural fields and stock grocery stores. 

Since 70% of Haiti’s skilled workers reside outside of the island, the diaspora often serves as an economic lifeline to their families back home. According to the World Bank’s latest briefing note, remittances from the diaspora to Haiti in 2017 reached a record level of $ 2.4 billion, about $1.4 billion of that coming from the diaspora in the United States. This was about 29% of Haiti’s Gross Domestic Product (GDP) and more than 25% of the state budget. Haitian workers are experiencing layoffs and facing difficulties applying for unemployment benefits and thus unable to meet their monthly expenses. The pandemic will have a negative impact on the Haitian diaspora’s ability to support Haiti.

Finally, with the closure of school systems, Haitian Parents are adjusting to online learning and homeschooling their children, a task that is difficult for many to facilitate given it’s in a  language that is not their own and with technology that they may not be comfortable with. 

There needs to be a coordinated effort with several interventions to contain COVID-19 and shield communities. Initiatives to control the spread of this pathogen should be tailored to fit various populations while leveraging positive cultural traditions and existing communication networks. Existing health and social disparities are being exacerbated. Vital resources to address the pathogen include appropriate risk assessments, access to testing, and safety net programs. It is imperative that we be vigilant in advocating for ourselves and communities. 

Call to Action:

  • Haitians in the Diaspora: If given the opportunity to receive a test, get tested. Since so few tests are being allocated, it is imperative that we know our status in order to protect the most vulnerable in our community. Also, we encourage individuals to stay home and only leave their home if they absolutely need to.
  • State, County, and Municipal Governments: Press conferences should have a translator for Haitian Creole speakers to receive timely information. There should also be a telephone hotline to call for updates and information on unemployment, small business assistance, SNAP benefits, testing sites, and the CARE Act in multiple languages including Haitian Creole.
  • Public Health Agencies and Health Systems: Drive through testing and masks should be made available in neighborhoods with large Haitian populations.
  • Haitian media and radio outlets: Vetted information should be shared in real time so that people can have relevant updates for their small businesses, SNAP recipients, unemployment, and rent assistance.

Santra Denis, MPH, is President and founder of Avanse Ansanm. 

Ludmilla Paul, MPH, is a health policy and research specialist. 

Nancy Metayer, MHS, is an environmental scientist. 

Gilbert Saint Jean, PhD. is a biological scientist and evolutionary genetics researcher.

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