Cholera and humiliation in the Dominican Republic: A qualitative study of stigma and psychosocial stress among Haitian migrants Public

Abstract

Cholera is not only a crippling enteric infection that can lead to death, but it can stigmatize those it most afflicts-namely, the poor and socially marginalized. The island of Hispaniola, which Haiti and the Dominican Republic share, is still experiencing an outbreak of epidemic cholera that started in late 2010. Haitian migrants, long a subordinate and stigmatized class in Dominican society, play an important role in the epidemic because their circular migration links poor communities in both countries. To date, little is known about cholera-related stigma or its effects on psychosocial health of Haitian migrants. This qualitative study used focus group data collected among Haitian migrant and Dominican community members in urban and rural areas of Duarte Province, Dominican Republic in summer 2012. A total of eight focus groups, stratified by nationality, sex, and urban-rural setting, were held with a total of 47 participants (23 Haitians, 24 Dominicans). Theoretical frameworks of stigma's moral experience and the psychosocial stress model informed thematic analysis of focus group transcripts. Both Haitians and Dominicans expressed fear of cholera and used a rich dichotomy of cleanliness and dirtiness to characterize it. However, accounts diverged when Dominicans blamed the "lower culture" of their Haitian neighbors for the epidemic's spread. In contrast, Haitian migrants cited structural hardships and feelings of unimportance, vulnerability, and powerlessness in the face of the epidemic. Haitian migrants, already cast as morally inferior by an anti-Haitian ideology, became labeled as cholera-carriers. By examining local, subjective points of view held by both the stigmatized and the dominant population, this study uncovered how cholera-related stigma impinges directly on psychosocial health of Haitian migrants and threatens what matters most to them. Public health interventions to address stigma are outlined.

Table of Contents

Literature Review.................1

Manuscript..........................8

Public Health Implications.....42

References........................49

Figures.............................55

Tables..............................58

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Anthropology, Cultural Health Sciences, Public Health Sociology, Ethnic and Racial Studies
Mot-clé	migrants psychosocial stress stigma Cholera Haiti Dominican Republic
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Committee Members	Tolbert, Paige, Emory University Foster, Jenny, Emory University Stephenson, Robert, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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