Cholera control and anti-Haitian stigma in the Dominican Republic: from migration policy to lived experience

ABSTRACT

As cholera spread from Haiti to the Dominican Republic, Haitian migrants, a largely undocumented and stigmatized population in Dominican society, became a focus of public health concern. Concurrent to the epidemic, the Dominican legislature enacted new documentation requirements. This paper presents findings from an ethnographic study of anti-Haitian stigma in the Dominican Republic from June to August 2012. Eight focus group discussions (FGDs) were held with Haitian and Dominican community members. Five in-depth interviews were held with key informants in the migration policy sector. Theoretical frameworks of stigma's moral experience guided the analysis of how cholera was perceived, ways in which blame was assigned and felt and the relationship between documentation and healthcare access. In FGDs, both Haitians and Dominicans expressed fear of cholera and underscored the importance of public health messages to prevent the epidemic's spread. However, health messages also figured into experiences of stigma and rationales for blame. For Dominicans, failure to follow public health advice justified the blame of Haitians and seemed to confirm anti-Haitian sentiments. Haitians communicated a sense of powerlessness to follow public health messages given structural constraints like lack of safe water and sanitation, difficulty accessing healthcare and lack of documentation. In effect, by making documentation more difficult to obtain, the migration policy undermined cholera programs and contributed to ongoing processes of moral disqualification. Efforts to eliminate cholera from the island should consider how policy and stigma can undermine public health campaigns and further jeopardize the everyday ‘being-in-the-world’ of vulnerable groups.

KEYWORDS:

• Cholera
• stigma
• migration
• moral experience
• Dominican Republic

Ethical approval

A longstanding research partnership between Emory University, the regional campus of Universidad Autónoma de Santo Domingo, and the regional public hospital had fostered strong relationships among various key figures in the area, including Haitian and Dominican research assistants (RAs), professional contacts at the regional public health office and hospital, and community gatekeepers in surrounding communities. The ethics committees of each institution approved the study.

Acknowledgments

The authors thank Ms Rosa Ypania Burgos, Mr Rafael Alvarez Castillo, Dr Luis Adolfo Dominguez, and Dr Ambrosio Rosario for the institutional support they provided on behalf of the Universidad Autónoma de Santo Domingo, the Ministerio de Salud Publica, and the Hospital Regional San Vicente de Paúl. We thank Liza Vertinsky, Emory School of Law, for her input and guidance on legal analysis. Sarah Willen and Sam Martínez provided helpful comments on earlier versions of this manuscript. We thank the research assistants who collected data for this study, including Dhaysi Batista Berroa, Jhefri Augustin Reyes Reinoso, Mere Dieuliphene, Anniset Jean Charles, Benson Cherichel, Yanahaira Rivera, Asela Tejada, and Lidia Joaquin. The Emory Global Health Institute and the American Association of Occupational Health Nurses provided funding to support this project. The study was approved by the institutional and ethical review boards of Emory University and the Hospital Regional San Vicente de Paúl, San Francisco de Macorís. The lead author is supported by the Netherlands Organization for Scientific Research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Global Health Multidisciplinary Team Award, Emory University Global Health Institute; Medique Research Award, American Association for Occupational Health Nurses.