Kansky DeLisma, MD, MPH

Kansky DeLisma, MD, MPH

2005-2006

Attending Physician, Miami VA Medical Center & Jackson Memorial Hospital, Miami, FL

Dr. DeLisma is a board-certified internal medicine attending physician at both the VA Medical Center and Jackson Memorial Hospital in Miami, FL. He previously served as an attending physician at Yale-New Haven Hospital and the Veterans Affairs Health Care System in New England. Dr. DeLisma has been consistently committed to the needs of underserved populations. His interest for public service led to his creation of a literacy school for Haitian migrant workers in South Florida and the establishment of Initiatives for Health Promotion, Inc., a non-profit organization for minority health education and access to careers in health care. During his medical residency training at Yale, he developed and organized the First Annual Primary Care Community Health Fair. He has been recognized for his work through several awards, including the Project Upstart Award for Outstanding Tutorial Help to Homeless Children, National Medical Fellowship Award, and the Humanism in Medicine Award from the Yale University School of Medicine, and the Harvard University Presidential Scholarship Award.

Born in Haiti, Dr. DeLisma is fluent in English, French, Haitian Creole, and Spanish. He completed his formal training in psychology, sociology, and political science in France. He received his medical degree from Howard University in 2001, and completed his internal medicine residency at the Yale-New Haven Hospital in 2004. He completed the CFHU Fellowship along with an M.P.H. degree in 2006.

Identifying and Addressing Barriers to HIV Care for Haitians in the Greater Boston Area

Background:

Although Haitians represent only approximately 1% of the state population, when compared with other migrant populations in Massachusetts, they suffer the highest prevalence of HIV/AIDS (6%). Our literature review also reveals that Haitians also present at the time of diagnosis with more advanced disease, and consequently suffer disproportionately higher mortality rates.

Methods:

Working with two (2) community-based organizations, the Center for Community Health Education and Research (CCHER) and the Prevention and Access to Care and Treatment (PACT) agency, we developed a provider survey and conducted individual interviews and a focus group with Haitian patients living with HIV.  Survey design was based on literature review and preliminary interviews with community gatekeepers, including CCHER and PACT affiliated providers, HIV peer educators and health promoters.

The patient questionnaire and provider survey were piloted using a convenience sample of patients and providers affiliated with the two sponsoring organizations.  Providers were selected based on serving 5 or more Haitian patients with HIV. Mailed surveys inquired about provider demographics. A 5- point Likert scale was constructed to assess provider’s impression of Haitian’s utilization of health services.

Patient participants were selected by convenience sampling in the CCHER office. After obtaining informed consent, participants were interviewed on an individual basis or in focus group. The questionnaire was administered in Haitian Kreyol and English when appropriate. Qualitative methods were used to analyze the results and develop emerging themes.   

Results:

Of 25 mailed surveys, providers returned 10 at the time of this abstract. Responding providers included 5 community health education providers and 5 physicians. Eight of the providers were Haitian and the average time in practice was greater than 5 years for the group. The volume range of patients with HIV served by these providers was 5-150.  There were 21 total patient encounters. Twelve patients were interviewed individually, 9 in a focus group. Sixteen were female; the average age was 42 and level of education ranged from basic literacy to college level.

Barriers to HIV care identified from analysis of interviews, focus group and survey can be classified in 3 overlapping categories: ethnocultural, socio-economic, and systemic. The ethnocultural barriers were predominant and include stigma, cultural health beliefs, trust/denial, gender inequality (male dominance), pre-migratory factors, and language/communication. The socio-economic barriers include poverty, low level of education and isolation. Systemic barriers include immigration status, provider’s lack of cultural competency, adequate medical staffing dilemma for the Haitian population, and mistrust in the system.

Recommendations in accordance with different categories of barriers focus mainly on a community level. For the ethnocultural barriers, we recommend developing cultural efficacy models in the community recruiting healthy Haitian Living with HIV to promote diagnosis and developing strategies to lessen stigma related to HIV. For the socio-economic barriers, recommendations include upgrading current social benefits package for people living with HIVand conducting massive educational and health literacy campaign. For the systemic barriers, recommendations include promoting cultural competency for providers, lessening fear of immigration by ensuring that medical information will not be divulged to immigration authorities, and developing the Haitian Center for Excellence in Health Care, Research and Community Empowerment.

Conclusion:

Addressing these barriers, which are mainly structural, requires a multidisciplinary approach with long-term commitment. Policy recommendations at a community level must aim at developing policies to address the barriers holistically by focusing on ethnocultural, socio-economic, and systemic policies.

Faculty Preceptors:

Eric Schneider, MD, Assistant Professor, Dept. of Health Policy and Management. Harvard School of Public Health
Heidi Behforouz, MD, Medical and Executive Director of the Prevention  Access to Care and Treatment (PACT) Project, Brigham and Women’s Hospital