Structural Violence as Social Practice: Haitian Agricultural Workers, Anti-Haitianism, and Health in the Dominican Republic
Simmons, David, Human Organization
Understanding the structural obstacles people face with regard to health has become an important area of intellectual and practical concern, particularly with vulnerable populations in low-income countries. This article documents some of the experiences of a little-documented, vulnerable population-Haitian agricultural workers, or braceros, on the bateyes (primarily Haitian communities) of the Cibao region of the Dominican Republic. The qualitative data presented here draw from a sample of Haitian agricultural workers (N=370) living in six different batey communities. Geographic segregation, access to transportation, occupational and environmental health challenges, and negative treatment by doctors and other health professionals-all expressions of structural violence-emerged as salient impediments to health and well-being. Structural violence, especially through the mechanism of anti-Haitianism, works to both create environments that undermine the well-being of Haitian agricultural workers and, when seeking treatment, can limit opportunities for access to care.
Key words: structural violence, Haitians, bateyes, Dominican Republic, health
By the time Doña Maria finally visited a clinic for the chronic pain in her left breast, her diagnosis was essentially a death sentence: stage-three breast cancer. Her efforts to receive a diagnosis and care were compromised by a number of factors. Though born in the Dominican Republic, this poor, middle-aged Haitian woman had never been issued a birth certificate. Without this document, she could not register for school as a child, nor could she claim Dominican citizenship. An essentially stateless woman - because she had no Haitian passport either - and undocumented worker, she lived under the constant threat of forcible deportation, imprisonment, or worse. More insidiously, without a birth certificate and passport, she could not visit appropriate health care facilities in Santiago, the next largest city, because of a chequeo (police checkpoint) between her community and the city.1 To risk attending the clinic to diagnose and treat her cancer meant risking her freedom. Unfortunately, Doña Maria's case is more the rule than the exception for Haitians in the Dominican Republic.
There are an estimated 800,000 Haitians living and working in the Dominican Republic. While many have historically migrated from Haiti for purposes of working in the Dominican Republic's sugar cane fields, many now also work in other agricultural and non-agricultural sectors such as coffee, rice, tobacco, construction, and tourism. Wherever they work, however, Haitians are often subject to labor and legal conditions that not only make them more vulnerable to economic and social exploitation (Camejo et al 1990 and 1992;Fontus 1989; Baud 1992; Calder 1981, 1982; Ferguson 1992; Lemoine 1985; NCHR 1995; Plant 1987), but undermine their health as well.
Although there is a vast literature detailing structural obstacles to health and well-being in high-income countries, particularly around issues of equity and health care access (Fiscella et al 2000; Goddard and Smith 2001; Oliver and Mossialos 2004; Smedley, Stith, and Nelson 2003), little of this literaturture sheds light on the experience of populations in low-income countries (cf. Whitehead, Dahlgren, and Evans 2001). Likewise, there is an ample literature documenting discrimination against Haitians living and working in the Dominican Republic (Baud 1992; Hoetink 1982; Martinez 1995; Murphy 1991; Sagas 2000; Vega 1988; Williams 1984), but a comprehensive literature review found little literature covering how discrimination - particularly as an expression of structural violence - shapes health and well-being for this marginalized population. Discrimination against Haitians - locally referred to as antihaitianismo (anti-Hatianism) - is "the manifestation of the long-term evolution of racial prejudices, the selective interpretation of historical facts and the creation of a nationalist Dominican 'false consciousness'" (Sagas 2000:2 1 ). …