“The Strange Case of the Caribbean Headache”
Intersection of Culture and Medicine
It was 1993. As an experienced physician and obstetrician-gynecologist, I was at the peak of a busy practice in Lafayette, Louisiana. At the heart of Creole and Cajun country, known as Acadiana, Lafayette is historically the cultural “gumbo pot” of America’s Deep South that for centuries had attracted island immigrants from the tropical Caribbean. I am a Haitian, and after my specialization at New York Medical College, I had been drawn to Lafayette and emigrated there to establish my medical career.
One afternoon, in the cafeteria of the University Medical Center at Lafayette, I was lunching with two colleagues, both eminent neurologists. They had recently thoroughly examined and tested a Haitian immigrant named “Ti Pierre” whose chief complaints were severe intermittent headaches and continuous insomnia. Everything seemed normal, but they felt they were missing something. It became a personal challenge for them to find an explanation and a cure. So that day at lunch, they challenged me, too. “Although this is not your line of work,” they said, “would you like to talk to him?” I accepted.
Soon after, I contacted Ti Pierre and offered to visit and learn about his malady. He was living in a small house with other Haitian refugees whom the government had settled in the rural village of Maurice, about fifteen miles southwest of Lafayette. Incorporated in 1911 and only two square miles in area, Maurice is an African-American farming community with a population of about two thousand. I discovered that many residents spoke Louisianan Creole and danced to Zydeco, an Acadiana black folk rhythm whose baseline and drumbeat reminded me of Haitian “Compas Direct” music.
Ti Pierre was a black man, thirty-something or maybe older, tall, slender, handsome, but anxious, and apprehensive. He was relieved to see that I was Haitian and spoke Haitian Creole, his native tongue. He quickly embarked on an emotional rant about the unfairness of his situation. “Doc,” he said, “these white docs don’t get it. Let me tell you my story. I swear over my mother’s head who is still living in Haiti that I will be honest and truthful with you.”
He continued, “About a year ago, I had a noisy altercation with my next-door neighbor “Ti Mouché” after he beheaded one of my goats that jumped the candela [ a variety of cactus] fence between our properties and ate three of his corn stalks. Despite my loss, I had to acknowledge that my neighbor was in the right. After Ti Mouché killed my goat, as custom dictates in the Haitian countryside, he kept for himself its head and three legs cut just over the knees, hung the rest of the body on a branch of a big mango tree outside of my yard and gashed the tree with the three parallel machete marks stained with the goat’s blood. Nonetheless, I was beside myself. I cursed him and his mother and told him he will soon ‘see his grandmother’s bones,’ meaning that he will soon die. As strange as it may seem,” he continued, “Ti Mouché died a week later and his family was obstinately convinced that I killed him through magical means.”
Ti Pierre looked me in the eyes and said, “Doc, may the thunders burn me if I lie to you, I swear that I had nothing to do with Ti Mouché’s death! Nevertheless, I was afraid for my life. Therefore, I went to Celvius, the hougan [voodoo priest] of our village, looking for some power to protect me. As I had little money to pay him, he performed a low-cost ceremony, put a small scapular [ribboned necklace] around my neck with the effigy of Saint James the Major [one of the twelve apostles of Jesus] and advised me to go into hiding to evade any mystical or physical revenge from the family of Ti Mouché “.
Then he paused. I thought, “A scapular with the effigy of Saint James Major?” I recalled my history of Haiti before its independence from France more than two hundred years ago. The slaves preserved their African beliefs and concurrently assimilated and adapted Catholicism, the religion imposed by the colonial system, to this mixture of ancestral and religious beliefs. Consequently, through this religious syncretism was born the Haitian voodoo. For example, in voodoo, there are spirits named loa represented by Catholic icons and saints in statues, paintings and ornaments such as scapulars. Saint James Major is a representation of Ogou, a warrior spirit that bestows upon the wearer strength and power of survival. It was Ogou was who led the slaves in their fight for independence. Nevertheless, the legend said that Ogou who feared water, during a trip at sea, found himself in difficulty. Without the intercession of Agwe, the spirit of the sea would have drowned. Based on this syncretism, Agwe is represented by the Catholic saint Ulrich of Augsburg or by the archangel Raphael, both holding fish.
Ti Pierre resumed his story. “About that time, I learned that a local boatman was organizing a secret voyage on a sailboat to Miami. Therefore, it was an opportunity to escape because, as they say in Haiti, “Wanga pa janbe dlo.” [“Magic do not cross the ocean.”]. “Unfortunately, our overcrowded boat capsized and wrecked near Cuba, offshore of the Guantanamo Naval Base. The American Coast Guard discovered, scooped us up from the sea and took us to the naval base. Later, I learned that thirty-four had drowned from the sinking and I was one of only six who survived. After many interviews, I was granted asylum in the United States based on my story and fear of persecution back home. I was fortunate. Remember at that time, many Haitians were fleeing after a military coup. Little I knew then that the American courts had just ruled that refugee status was only for those who reached American soil. Nevertheless, they resettled me and others legally to Maurice, here in Louisiana. It’s lucky without being lucky because, when the boat capsized, I lost my protective scapular. Since then, I have been suffering from terrible migraines and insomnia. ”
Hearing this, I murmured to myself, “I see, says the Blind Man.” Then to Ti Pierre, I said, “As a doctor, I serve with both hands. The right-hand treats disease, whether of a natural, sacred or divine cause. With the left hand, I treat the magical, mystical and supernatural affectations. Come to my house at the stroke of midnight on Saturday. In the meantime, Thursday bring me the usual ingredients for the ceremony,” without purposely specifying the ingredients. As expected, Ti Pierre, now my patient, brought me white rum, salt, two bitter oranges, perfume, palm-Christi oil and a stick of beeswax. Then, with a distressed look, he whispered in my ear that he could not locate a white enameled plate. “I’ll take care of it,” I reassured him. ” However, don’t forget to bring the twelve pennies for the guinen [African spirits]. For my part, I borrowed a skull from the pathology department and three pairs of white overalls from the cleaning and hygiene department of the university hospital.
In preparation for the big moment, I had replicated in my garage a small arbor-like hounfor or voodoo temple under which a prayer ceremony would unfold. Ti Pierre arrived at the stroke of midnight. Entering the garage, he became completely disoriented because I had turned off all the lights. It was black as ink. Suddenly, I struck a match and lit the beeswax candle that I had carefully erected on the top of the skull. The flickering flame intermittently projected on the wall, the outlines of a vèvè, symbolic drawing associated with the loa. At the heart of the peristyle, place of passage of spirits, in this case my little arbor, was placed the central pillar called poteau-mitan. In the dim light, our own undulating shadows, sometimes subdued, sometimes bright, produced a lugubrious, mysterious and enigmatic effect.
By my side were two Haitians that I had hired for the roles of hounsi kanzo, religious assistants. The three of us wore the white overalls I had borrowed from the hospital. I began the ceremony by commanding Ti Pierre to recount to the skull the story of his adversity in a hushed voice. He obeyed, turned towards the skull and for a good fifteen minutes stammered his story with intensity. I then put a large scapular bearing the effigy of Saint-Jacques Major around his neck. Solemnly, I announced that he was now mystically protected. I warned that, especially for the next week, he should not speak to anyone about this ceremony, not even to me. And to make sure he had a good night’s sleep, I made him swallow a sweetened potion, courtesy of the house, containing a small swig of white rum and 2.5 milligrams of diazepam. As he left, near the door, I heard his distressed and tearful voice saying, “Oh, I forgot my engagement to bless the liturgy with the twelve pennies!” I said, “Just throw them on the ground, keep your head straight, and especially do not look back!” He did so and left.
A week later, Ti Pierre told me that he was now sleeping like a baby and that his headaches were gone. He was nevertheless puzzled and intrigued by the white overalls from the secret ceremony. Laconically, I explained, “In White Country, I use white trappings.” It was a sly answer. Ti Pierre seemed satisfied but not quite convinced.
I shared my experience with my fellow neurologists. The following week, they presented the case of Ti Pierre during at the Grand Round, a medical training session where patients’ problems and treatments are presented to attending physicians, residents, interns and medical students. The message was clear: When evaluating and treating patients in a multicultural setting, discovering and understanding their culture in term of spirituality, religion, and social experiences are fundamental. As a matter of fact, in the late 1930s, the eminent Haitian ethnologist and psychiatrist, Doctor Louis Mars, known as the “Father of Ethnopsychiatry” or Transcultural Psychiatry, had described this pathology. His extensive research in Haiti has demonstrated an overlap of clinical psychology and cultural anthropology in the understanding, diagnosis and treatment of these interrelated psychic disorders. Today, many medical schools are introducing and incorporating cultural awareness and competence in their training curricula.
Two years passed, and I had completely forgotten my mystical treatment when I received an emergency phone call from Florida.
-”Doc, it’s Ti Pierre. My headaches and my insomnias…! I lost my scapular…! Now I have money… I can pay for a big prayer and the biggest scapular!”
- Don’t worry Ti Pierre! Big prayer at my house tonight at midnight… I will be sent to you biggest scapular by Federal Express first thing tomorrow morning. “
Two weeks later, I received a note by post from Florida: “Thank you Doc, scapula well received… No more headaches… Sleeping like a newborn baby… God will bless you. Ti Pierre.”
Aldy Castor, M.D., email@example.com
President, Haitian Resource Development Foundation (HRDF)
Director, Emergency Medical Services for Haiti Medical Relief Mission, Association of Haitian Physicians Abroad.
Member, United Front Haitian Diaspora
Stuart Leiderman, firstname.lastname@example.org Environmental Response, USA
Weston, Florida, US