Clorox and Canal Water: Characterizing Cholera Risk Factors for Haitian Migrants Living in the Dominican Republic Open Access

Abstract

Background: In January of 2010, an earthquake shook the Haitian capital of Port-au- Prince, initiating far-reaching consequences including the migration of large numbers of Haitians into the Dominican Republic. The first case of cholera in Haiti was confirmed on October 21, 2010. The first case of cholera in the Dominican Republic was reported less than two weeks later on October 31, 2010. Since October 2010, there have been over 17,784 cases of cholera in the Dominican Republic, many of which were confirmed in Haitian communities. There is a need for research characterizing factors that influence Haitian migrants' risk for cholera.

Research Question: How does the context of poverty, lack of healthcare access and discrimination contribute to increased risk of cholera (compared with Dominican nationals) amongst Haitian migrants in the Dominican Republic?

Methods: From June to August 2012, eight focus group discussions were held with study participants who had been stratified based on gender, nationality, and place of residence (urban or rural cities). All qualitative data were transcribed, de-identified, and translated into English. Transcripts were coded, and codes used in the formation of a theory grounded in the data.

Results: Many migrants did not have the resources to purchase treated bottled water, or the items needed to treat their water from other sources. Healthcare access was not related to the risk of contracting cholera; however, the lack of access to quality care could potentially influence cholera severity, diagnosis and treatment in all nationalities and geographical locations. Anti-Haitian prejudices increased as Dominicans blamed Haitians for cholera in the Dominican Republic, and discrimination including physical and structural violence had the greatest impact on cholera risk for migrants.

Discussion: This study highlighted the experiences and opinions of Dominican nationals and Haitian migrants with regards to knowledge of cholera, and disease severity. Based on study findings, there is a need for further research on factors impacting Dominicans and Haitians' perception of cholera risk, and the development of culturally appropriate interventions designed to increase Haitian migrants' knowledge of cholera prevention, transmission, and severity.

Table of Contents

TABLE OF CONTENTS

Chapter One: Introduction ........................................................................................................... 1

Introduction ................................................................................................................................. 1 Definitions.................................................................................................................................. 10 Study Purpose............................................................................................................................. 11 Research Question...................................................................................................................... 11 Conclusion ................................................................................................................................. 12

Chapter Two: Literature Review............................................................................................... 13

Introduction................................................................................................................................ 13

Characterizing Cholera Risk ....................................................................................................... 13

Migrants' Economic Disadvantage ............................................................................................. 16

Lack of Access to Health Care ................................................................................................... 19

Anti-Haitian Discrimination ....................................................................................................... 21

Conclusion ................................................................................................................................. 23

Chapter Three: Methods............................................................................................................. 25

Research Context........................................................................................................................ 25 Study Population......................................................................................................................... 27 Data Collection Methods ............................................................................................................ 27 Data Collection Process ............................................................................................................. 31 Data Analysis ............................................................................................................................. 33 Limitations ................................................................................................................................. 35 Chapter Four: Results............................................................................................................. 37 Introduction................................................................................................................................ 37

Rural Migrant Haitians' Cholera Risk.......................................................................................... 37

Healthcare and Cholera Risk....................................................................................................... 41

Haitian Discrimination and Cholera Risk.................................................................................... 45

Cholera Risk Perception.............................................................................................................. 50 Conclusion.................................................................................................................................. 55

Chapter Five: Discussion............................................................................................................. 56

Introduction................................................................................................................................ 56

Rural Migrant Haitians' Cholera Risk.......................................................................................... 56

Healthcare Access and Cholera Risk........................................................................................... 58

Haitian Discrimination and Cholera Risk.................................................................................... 60

Cholera Risk Perception.............................................................................................................. 61 Conclusion.................................................................................................................................. 63 References................................................................................................................................. 65 Appendices.......................................................................................................................................

Appendix A. Focus Group Discussion Guide............................................................................. 70

Tables............................................................................................................................................

Table 1. Characteristics of Focus Group Discussion Participants................................................ 29

Figures.............................................................................................................................................. Figure 1. Map of Hispaniola......................................................................................................... 3

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Qualitative Research Public Health Cholera Global Health
Committee Chair / Thesis Advisor	Evans, Dabney, Emory University
Committee Members	Hennink, Monique, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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