Tragedy in Haiti: Suicidality, PTSD, and Depression Associated with Intimate Partner Violence Among Haitian Women After the 2010 Earthquake.

Across the world, suicidal behaviors are responsible for more than one million deaths each year. In Haiti, suicidal behaviors were found to be related to intimate partner violence (IPV) against women. This study was conducted after the 2010 earthquake in Haiti and women were asked about IPV before and after that event. A sample of women between 18 and 44 years of age responded to a questionnaire about physical, psychological, or sexual abuse by an intimate or non-intimate partner. The women were divided into two groups: (a) women who were abused by partners (n = 133) and (b) women who were not abused (n = 75). Those who were abused had 2.2 times higher odds for suicidal thoughts and 1.9 times higher odds for suicidal attempts and were significantly more likely to suffer from depression and PTSD. For each 1-unit increase in a measured PTSD score, the odds of being abused increased by 105.7%. For each 1-unit increase in the measured depression score, the odds of being abused increased by 14.9%.

Hypertension among adults living in Haiti: An integrative review.

AIMS AND OBJECTIVES: To determine what is known about hypertension among adults living in Haiti. BACKGROUND: Hypertension is the leading cause of morbidity, the identified cause of heart failure in 45% of patients and is associated with more than 70% of cardiovascular disease-related hospital admissions in Haiti. DESIGN: An integrative review of the literature. METHODS: Searching four databases from 2007 to 2018, Whittemore and Knafl's method was used to review the literature. Three nurse researchers independently reviewed and appraised each publication applying the Johns Hopkins Evidence-based Practice Appraisal tool. RESULTS: Eight publications were identified and appraised for level and quality of evidence. The synthesis of the literature yielded common themes of (i) high prevalence of hypertension among adults living in rural areas, (ii) public health challenges, (iii) lack of knowledge and awareness of hypertension and (iv) barriers to effective treatment. CONCLUSION: Hypertension is a highly prevalent disease in Haiti that is understudied and warrants attention. To better serve this vulnerable population, culturally tailored prevention strategies and disease management programmes are recommended. RELEVANCE TO CLINICAL PRACTICE: There is a lack of quality evidence to guide nurses in the management of hypertension for this vulnerable population. Identification of barriers to effective treatment among this underserved population will assist nurses and other healthcare professionals in identifying best possible practices for patient care in clinical settings across Haiti.

Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster.

AIM: To describe the physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake and related risk factors, health concerns and cultural norms. BACKGROUND: Thousands of adolescents were displaced following the earthquake, leaving them vulnerable to abuse and violence. Displaced survivors are disproportionately vulnerable to violence after natural and man-made disasters. DESIGN: A descriptive-correlational design was used to: (1) describe the extent of violence, health risks and concerns in the displaced adolescent girls; and (2) identify correlations in the strength and magnitude of relationships between selected variables including demographics, risk factors and cultural tolerance of violence. METHODS: Data were collected from participants using computer-assisted self-interviews between 2011-2013 including demographics, pre- and post-earthquake violence, perpetrators, risk factors and health consequences. Analysis included frequency, logistic regression and multiple regression. RESULTS/FINDINGS: A majority reported physical, psychological, or sexual abuse both pre- (59%) and post- (64.1%) earthquake. Pre-earthquake, abused adolescents reported the perpetrator as a boyfriend (50%) or family member (30%). Post-earthquake, 20.5% of physical abuse perpetrators were family members. Pre- and post-earthquake physical and sexual abuse did not change. The risk of being sexually abused post-earthquake increased after controlling for age and education. CONCLUSION: Displaced adolescent girls reported similar rates of physical and sexual abuse pre- and post-earthquake. These findings show the importance of preventive policies for adolescent girls in disaster situations in countries with low resources. Social and cultural change is critically needed since abuse was at an unacceptably high rate prior to the earthquake.

Violence and abuse of internally displaced women survivors of the 2010 Haiti earthquake.

OBJECTIVES: Limited research following disasters suggests that internally displaced women are disproportionately vulnerable to violence and abuse. An interdisciplinary collaborative of researchers and practitioners in Haiti, the US Virgin Islands, and the US Mainland investigated gender-based violence (GBV) pre- and post-earthquake and health outcomes among Haitian women living in tent cities/camps following the 2010 earthquake. METHODS: A comparative descriptive correlational design using culturally sensitive and language appropriate computer-assisted interviews of 208 internally displaced women 2011-2013. RESULTS: Found high rates of violence and abuse both before (71.2 %) and after (75 %) p = 0.266, the earthquake primarily perpetrated by boy friends or husbands. Significantly more mental and physical health problems were reported by abused than non-abused women. The majority (60-78 %) of abused women did not report personal or community tolerance for violence and abuse, but acknowledged a community context of limited involvement. CONCLUSIONS: Coordinated planning and implementation of needed interventions are essential to provide a balanced approach to the care of displaced women after natural disasters with sensitivity to the abusive experiences of many women both before and after the disasters.

"The women, they maltreat them therefore, we cannot assure that the future society will be good": Male perspectives on gender-based violence: A focus group study with young men in Haiti.

The purpose of this study was to explore the perceptions of violence against women (VAW) held by Haitian men to gain a better understanding of why VAW occurs. Women in Haiti have experienced significant violence, both before and following the 2010 earthquake. Fifteen men aged 26 to 47 participated in a focus group. The data revealed three themes: men's beliefs about VAW and its context, factors influencing VAW, and recommended interventions. When approaching VAW, men must be part of the collective effort. Their insights are valuable when planning and implementing interventions to decrease VAW in Haiti and worldwide.

Barriers and Facilitators to Engaging Communities in Gender-Based Violence Prevention following a Natural Disaster.

Humanitarian workers in disaster settings report a dramatic increase in gender-based violence (GBV). This was true after the 2010 Haiti earthquake when women and girls lost the relative security of their homes and families. Researchers from the United States Virgin Islands and the United States mainland responded by collaborating with Haitian colleagues to develop GBV-focused strategies. To start, the research team performed a situational analysis to insure that the project was culturally, ethically, and logistically appropriate. The aim of this paper is to describe how the situational analysis framework helped the researchers effectively approach this community. Using post-earthquake Haiti as an exemplar, we identify key steps, barriers, and facilitators to undertaking a situational analysis. Barriers included logistics, infrastructure, language and community factors. Facilitators included established experts, organizations and agencies. Researchers in such circumstances need to be respectful of community members as experts and patient with local environmental and cultural conditions.

Experiences of nurse volunteers in Haiti after the 2010 earthquake.

PURPOSE: The purpose of this study was to explore the experiences of volunteer nurses after the Haiti earthquake, January 2010. DESIGN: A descriptive qualitative study design using in-depth interviews focuses on experiences of 12 American nurse volunteers who served in Haiti following the 2010 earthquake. METHODS: Semistructured interviews were conducted in person or by phone using an interview guide. The interviews were audio-taped, transcribed, and checked for accuracy. Data analysis was assisted using NVivo9. FINDINGS: Six themes emerged: initial shock, relentless work, substituting and making do, questioning, systems building, and transitioning back. CONCLUSIONS AND IMPLICATIONS: Nurses who are interested in volunteering after a disaster can expect the experience to be overwhelming and will require them to exercise great flexibility, creativity, and strength in their nursing practice. Nurse volunteers can expect a rewarding experience that will likely change their perspective on nursing work and personal life.

Nursing children after a disaster: a qualitative study of nurse volunteers and children after the Haiti earthquake.

PURPOSE: The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010. DESIGN AND METHODS: This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers. RESULTS: Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses. PRACTICE IMPLICATIONS: Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care.

Fathers' beliefs about parenting and fathers' clubs to promote child health in rural Haiti.

Health care providers are challenged to use culturally appropriate, low-technology approaches to improve child health in resource-poor countries. Village fathers' clubs is one approach used in rural Haiti since 1994. Fathers meet regularly for health education and community-building activities. Our aim was to investigate parenting practices and beliefs among Haitian fathers of young children and to explore their views on fathers' clubs. We conducted semistructured interviews with 18 fathers. Themes identified were fathers' involvement in routine care of their children, the close partnerships of fathers and mothers in child care, fathers' responsibilities to their communities, and fathers' clubs as an important supportive institution for the Haitian fathers and their families. Rural Haitian fathers reported taking a very active role in the lives of their families and children. Increased involvement of fathers should be explored as a strategy to improve child health and survival in other parts of Haiti and throughout the world.

Ambulatory medical care in rural Haiti.

INTRODUCTION: In 2005, a team of U.S. physicians, nurse practitioners, nurses, pharmacists, emergency medical technicians and lay support personnel provided health services in an isolated town in rural Haiti. METHODS: During one week, the team saw 788 patients. They recorded age, sex, vital signs, diagnoses, and treatments in an electronic database. A descriptive analysis is presented. RESULTS: Intestinal parasitosis was the third most common diagnosis overall, and the most common diagnosis for children. For adults aged 50 years or older, 52% of women and 37% of men had elevated blood pressures, significantly more than adults aged 15-49 years. DISCUSSION: This paper focuses on intestinal parasitosis and hypertension. Periodic anti-helminthic treatment and community sanitation are discussed as ways to reduce the burden of parasites and secondary malnutrition. Challenges to implementing a sustainable antihypertensive program are discussed, including patient education, medication availability and prioritization, and adequate follow-up in a very austere rural setting.

The impact of fathers' clubs on child health in rural Haiti.

In recognition of the important role that fathers play in the lives of young children in Haiti, a public health organization instituted fathers' clubs in 1994 as a strategy to improve the health outcomes of children. Fathers' clubs focus on child and family health education. To evaluate the effectiveness of fathers' clubs, we examined the health of children born in Haitian villages with and without active fathers' clubs and compared results for the two groups. The presence of a fathers' club in a child's birth village had a positive effect on vaccination status, growth monitoring, and vitamin A supplementation after we controlled for socioeconomic status, time, and the quality of the village health agent. Child weights and mortality were not affected by the fathers' clubs.

Fathers clubs to improve child health in rural Haiti.

OBJECTIVES: This paper describes an innovative public health nursing strategy, village-based fathers clubs, to improve child and family health in rural Haiti. It discusses related nursing implications in Haiti and other parts of the world. DESIGN: Relevant current literature was reviewed and evaluated with respect to child health in Haiti and the development of the fathers clubs. Program participants and organizers were consulted. SAMPLE: The fathers clubs in remote areas of Jeremie Haiti, participants and program directors, provided input for this description. RESULTS: Public health practitioners continually face grave challenges when addressing the health care needs in less developed countries. One such case is Haiti, where crushing poverty, poor infrastructure, a failing economy, natural disasters, and chaotic sociopolitical conditions compound these challenges. Public health practitioners, including nurses, must seek creative, culturally-appropriate, low technologic approaches to improve the health of the children and families in the remote villages of Haiti. The institution and support of village fathers clubs is one approach that has been ongoing since 1994. Fathers meet together on a regular basis for health education, support, and community building activities. The curriculum is health-based and facilitated by nurses, with participation by young and old men alike. CONCLUSIONS: Participants and organizers believe that family and child health is improved as a result of the groups.