Participatory health assessment in Haiti: practical tools for community empowerment.

BACKGROUND: Recent changes in development practices have recognized the importance of community involvement in assessing needs and resources. Community based participatory research, including Participatory Rural Appraisal (PRA), provides a process that empowers communities to identify their own needs and build on their strengths. OBJECTIVES: This paper describes a participatory health assessment in Haiti using a methodology that can be replicated in other settings. In contrast with traditional, needs-based assessment, this assessment was designed to train participants to discover their own needs and assets, in preparation for a potential community health program. METHODS: A training team was invited by a faith community to facilitate an appraisal in three villages in northwestern Haiti. Facilitators trained local participants to implement PRA tools such as mapping, scoring, focus groups, and root cause analysis to discover perceptions of socioeconomic and health contexts of the community. The local team members conducted the activities with other community participants, analyzed the results together, and presented the findings to each community. RESULTS: Key findings across the activities included loss of productive land, minimal irrigation or sanitation resources, priorities of maternal health, malnutrition, diarrhea, and a general distrust of organizations, but the existence of some effective local groups. CONCLUSIONS: The PRA process empowered participants to define and prioritize their problems, identify potential resources, and offered insights into the practical implementation of research tools. The authors describe the methodology and implications of choosing a participatory health assessment, including the advantages, challenges, and potential for replication in other settings.

An interdisciplinary view of medical pluralism among Mexican-Americans.

This article highlights the relationship between traditional, complementary, and alternative medicine (TCAM) and biomedicine, and the challenges this relationship poses to patients. Medical professionals tend to represent these systems dualistically - as mutually exclusive and in competition with one another. Patients, on the other hand, tend to make truly pluralistic health care decisions - moving freely between TCAM and biomedicine based on what they can access, what they can relate to, and what they believe works. Using their experience with Mexican immigrant and Mexican-American populations in Southwestern United States, the authors discuss strengths and weaknesses in both healthcare systems, and how medical dualism can be a significant barrier to effective healthcare. Recent literature on medical pluralism is discussed from the public health (i.e., community) and medical (i.e., provider) perspectives. These two disciplines are brought together in an attempt to deconstruct the notion that TCAM and biomedicine are diametrically opposed healthcare systems. Biomedically trained health care providers must understand, appreciate, and integrate into their practice how their patients make use of other healing practices and beliefs. Such integration is particularly essential when serving immigrant or minority populations as these groups are more likely to use a pluralistic approach in meeting their health needs.