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knowledge, attitudes and practices
Cholera control and anti-Haitian stigma in the Dominican Republic: from migration policy to lived experience
Hunter M. Keys | Bonnie N. Kaiser | Jenny W. Foster | Matthew C. Freeman | Rob Stephenson | Andrea J. Lund | Brandon A. Kohrt
Date of Publication:
May 4, 2019
Anthropology & Medicine
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 disease 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 including lack of safe water and sanitation, difficulty accessing healthcare and lack of documentation. By rendering 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 undermine vulnerable groups.
What is cholera? A preliminary study on caretakers’ knowledge in Bangladesh
Charlotte C. Tamason | Suhella M. Tulsiani | A. K. Siddique | Bilqis A. Hoque | Peter K. Mackie Jensen
Date of Publication:
Journal of Health, Population and Nutrition
Cholera has afflicted the Indian sub-continent for centuries, predominantly in West Bengal and modern-day Bangladesh. This preliminary study aims to understand the current level of knowledge of cholera in female Bangladeshi caretakers, which is important in the outcome of the disease and its spread. A pilot study was conducted among 85 women in Bangladesh using qualitative questionnaires to explore the ability of female caretakers in identifying cholera and its transmission.
The survey revealed that though all the female caretakers were aware of the term “cholera,” nearly a third of the respondents did not associate diarrhea with cholera or mentioned symptoms that could not be caused by cholera (29 %). Approximately half of the respondents associated water with the cause of cholera (56 %) and only 8 % associated cholera with sanitation or hygiene. Shame and stigma (54 %) were more commonly described than death (47 %) as negative effects of cholera.
The results from this study are suggestive of a need for reformulation of cholera and diarrhea communication. Messaging should be based on signs of dehydration, foregoing the use of medical terminology.