Florida’s Haitians nix notion of ethnic staff
Finding contradicts long-held assumption
In TB control, it’s a familiar mantra: "Hire culturally compatible staff to deal effectively with foreign-born populations." The trouble is, not all foreign-born groups agree, or so TB experts in Florida have found. When focus groups culled from the state’s large Haitian community were asked whether they liked having Haitians working in public-health clinics, the answer was an emphatic "no."
"Haitians say they don’t want other Haitians knowing their business, and that applies especially to public health staff who are Haitian," says Michael Lauzardo, MD, a senior physician at the Florida TB Control and Refugee Health Department in Tallahassee.
Convened to help TB controllers get to the bottom of high TB and HIV rates in the Haitian community, the focus groups turned up barriers to access as well. That includes a short list of the usual gripes, Lauzardo says — the staff are distant and impersonal, the waits are long, the hours inconvenient. But even those findings turn out to be surprising, because, according to Lauzardo, the clinic where the focus group members were recruited is one of the very best in the state, with dedicated and caring staff who go out of their way to reach out to the Haitian community.
In a sense, the disconnect validates Lauzardo’s longstanding impression that the state’s Haitian community suffers from extreme isolation and alienation compared to other foreign-born groups. "It could help explain some of our epidemiological findings," says Lauzardo, such as why the average number of TB contacts named by Haitian cases is only about four, half the statewide average of eight.
On the other hand, Haitian docs are good
On the plus side, the focus groups are also suggesting some answers. For one thing, Haitians say they’d prefer to be seen by private physicians, not public health doctors. What’s more, the Haitians say they’d be especially reassured if those private doctors were — did you guess? — Haitian. "They say they feel as if they could tell these doctors anything, and that’s who they’d really like to talk to," says Lauzardo.
So it might work to use incentives to lure community members to church-based screenings, he says, and then route those who need treatment to a pool of "proactive" private Haitian physicians who, he hopes, can be persuaded to partner with the public sector. Thanks to the focus groups, Lauzardo says he also has a better sense of what those screening programs need to include. For example, there’s little interest in screenings targeted specifically to just HIV or TB. "People say they want health fairs that will meet all their other health care needs as well, and help them tie into other resources, such as jobs," he says.
When it comes to HIV testing, the Haitians are especially wary. "They tend not to believe a positive [HIV] test unless they’re actually feeling sick," Lauzardo says. "They say they aren’t sure they would get adequate treatment. And they say as long as they’re not feeling sick, they’d rather not even know."
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