Undetermined relationship between five modalities of mind-body medicine, and non-mind body complementary medicine practices among a subset of an indigenous culture in Miami-Dade County, Florida: An exploratory integrative medicine view in the COVID-19 Era

Abstract The concepts of Mind-body medicine (MBM), and non-mind body complementary medicine practices among Haitians in Little Haiti, Florida are unexplored. This article investigated five non-habituated MBM modalities and practices within the Haitian culture. An additional objective of this article was to determine whether a relationship could exist among the mbm and non-mbm modalities in the indigenous culture in Miami-Dade County, Florida, looking at the cultural and traditional medicine practices. A literature survey shows adherence through cultural health beliefs and spiritual conduits of the indigenous culture. The result shows that MBM modalities are salient within this group, and awareness or exposure to MBM and non-MBM modalities can be essential in cultural health beliefs formation, and practices. In a COVOD-19 era these modalities can help alleviate the ill-consequences. Knowledge and embrace of the modalities are paramount while maintaining traditional medicine and cultural traditions. Further research is needed.

ABOUT THE AUTHOR Clarence St. Hilaire is pursuing a Ph.D. in mindbody medicine at Saybrook University. He earned a MD degree from American International Medical University after completing his clinical rotations in Maryland, and Washington, D.C. He is a House Physician in Florida. He has a post-graduate certificate in conflict analysis and resolution from Nova Southeastern University (NSU), and a Master of Public Administration (MPA) from Florida International University with a concentration in grant writing. His research interests consist of health disparities, mind-body medicine, gastroenterology, gynecology, social and ethnic medicine. He taught introduction to alternative dispute resolution as a teacher assistant during his postgraduate years in 2006 at NSU Graduate School of Humanities and Social Sciences. He is also a published poet, manuscript reviewer, has written two books reviews for the Journal of Ethnic and Racial Studies, several peer-reviewed articles, currently working on a memoir, a new poetry book, and a program evaluation about cervical cancer narrative stories.

PUBLIC INTEREST STATEMENT
Mind-body medicine (MBM), and alternative sources of health offer a viable platform for individuals espousing the whole person concept of healthy living. For certain ethnic minorities, and Haitians in Miami-Dade County, Florida, limited access to healthcare associated with lower economic status, and greatly affected by the COVID-19 pandemic in terms of comorbidities, higher hospitalization rates, and mortality, there is a solution that a mind-body medicine approach presents, utilizing powerful modalities in the indigenous culture such as meditation, herbal medicine, songs and dance, spirituality, symbolism and guided imagery to cope with many associated health consequences. Through community-based initiatives adhering to MBM, it is possible that unexplored existing MBM modalities within this group can yield positive health outcomes and decrease mistrust leading to COVID-19 vaccine hesitancy.

Introduction
Mind body medicine (MBM), and non-mind body complementary practices occupy a significant role in the healing process and illness continuum. In the United States, the widespread use of MBM, fluctuating from about 35 percent to over 50 percent Americans attempting to combat illness, as a complementary health alternative to conventional medicine, places a particular emphasis on holistic health approaches to diseases, patient care, healthcare, and traditional medicine (Briggs, 2015;Gordon & Moss, 2003;Moss, 2002). Holistic health entails the whole human being, body and mind concept relying on the body's inner capacity to heal or enhance essential changes (McGrady & Moss, 2018).
The National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH) defines mind and body practices as a diverse group of therapies such as acupuncture, meditation, Tai chi, and yoga (National Center for Complementary and Integrative Health [NCCIH], 2017). Mind body medicine and therapies encompass a connection between the brain, mind and behavior, as essential to the health and diseases, and also consider hypnosis, meditation, biofeedback, massage, art, dance therapy, prayer, music, imagery, and mental healing (McGrady & Moss, 2018;Wahbeh et al., 2008). The body of knowledge exploring the mind's capacity to influence the body, is aligned with the integrative medicine (IM) model that considers the combination of MBM therapies with complementary and alternative medicine (CAM), and conventional medicine as capable of generating high-quality scientific evidence (Karren et al., 2014). It is an effort to combine evidence-based therapies relying on outcomes with typical healthcare. Barrett (2004) sees in this process an integrated healthcare system. Non-mind body complementary practices refer to non-based practitioner complementary alternative therapies that include self-relaxation, the use of traditional herbal medicine, megavitamins, sacred oils, rites with medicinal plants, protective baths, hot teas, and candle lighting, other folk medicine systems such as espiritismo (spiritism), shamanism, Santeria, vodou, massagers (sobadores), community healers (bone setters or Doktè Zo; Agu et al., 2019;Coupet et al., 2013;Davis et al., 2011;Dennis, 2012a;Graham et al., 2005;Krueger & Torres, 2018). The predictors use of the cited therapies for both MBM, and non-based practitioners' complementary alternative therapies will warrant further considerations, which can be considered in further research.
Consistent with the MBM and non-based practitioners complementary alternative medicine practices, it is also paramount to explore how their utilization among ethnic minority communities can help assess self-evaluation and further research explain their modalities. Arcury et al. (2006), in a study using the 2002 National Health Interview Survey (NHIS), reported significant odds of CAM use among three ethnic groups: Black, Hispanic, and White adults aged > or = 65 years old. Asian adults showed greater odds of CAM use, mind-body medicine, biologically centered therapies, and lower odds of using body-based and manipulative therapies than Whites. Hispanics exhibited greater odds than Whites using any type of CAM, and biologically associated therapies. Black adults significantly differed from Whites to a lesser extent of body-based and manipulative methods. Sanchez et al. (2014) opined that a consensus statement is needed to access traditionally underserved racial and ethnic communities. The same view is shared by various scholars arguing for a better understanding of MBM, CAM use among ethnic minorities, the promotion of an integrative medicine culture prioritizing values of diversity, health equity minimizing the social determinants of health (SDH: unfair classification of differences in health status), and cultural perceptions of health and healing (Chao & Adler, 2018;Graham et al., 2005;McKinney & Geller, 2018). Thus, to look at mind body medicine, and non-mind body complementary medicine practices among a subset of the indigenous culture in Miami-Dade County, Florida: Haitians in Little Haiti, five specific modalities are considered: (1) herbal medicine (Phytotherapy) (2) symbolisms and guided imagery (3) songs and dance (4) spirituality and prayer (5) meditation It is noteworthy to add that this subset of Haitians living in Little Haiti has been well Researched. Pierre-Noel (1959) in his book Les Plantes D'Haiti qui guérissent (Haiti's Plants that heal) wrote that the use of herbal medicine has helped Haitians suffering from sleep deprivation. In the same vein, some Haitian women use herbal leaves for their feminine hygiene or douching as cleaning and tightening agents (Barbee et al., 2010;Hebblethwaite & Bartley, 2011;Kobetz, Menard, Barton et al.,2009, as cited in Kish, 2012. However, there are no studies addressing mind body medicine therapies for Haitians in Florida. Haitians in Miami use herbal teas for sleep deprivation, among them are the balm (mélisse) and the soursop (corossol) leaves (Gamaldo et al., 2016;Pierre-Noel, 1959). Both plants help with sleep deprivation, and other problems related to anxiety. It would be interesting to look at further research questions asking how do aged Haitians in Miami-Dade County, Florida, cope with sleep deprivation, and how can MBM therapies may present symptom reliefs?
The objectives of this article are twofold: (1) to briefly investigate how MBM interpolations and non-mind-body complementary medicine practices among Haitians in Little Haiti may influence health.
(2) to determine if a relational pattern exists between MBM and non-mind-body complementary medicine practices utilization. A limited assessment of the modalities can help guide further research interests.
Haitian population is widely segregated all over the State of Florida. Haitian communities are in 51 cities, towns, villages, or localities in Florida (Epodunk map, n.d.): The North Miami population has 33% of Haitian ancestry.
The village of El Portal totaled 23% of Haitian ancestry.
North Miami Beach has 19% of Haitian ancestry.
The village of Miami Shores 8.3% of Haitian ancestry.
Golden Glades with 33.5% of Haitian ancestry.

What need or problem does the approach or practice address?
While mind body medicine (MBM) associated with complementary alternative medicine is gaining ground within many sectors of the country, and in various parts of the world (Briggs, 2015 Wahbeh et al., 2008), and integrative medicine (IM) fosters patient's total wellness needs to optimal health status (L.D. Fortune & Kurtz, 2017), Black minorities continue to face health disparities within a healthcare system with deep tentacles of racial and economic discriminations impairing the patient-provider relationship (Kinser et al., 2016). The solution of a multilevel health channel with interprofessional collaboration proposed by Kinser et al. (2016) may not be sufficient enough, due to the complex systems of MBM, and IM integration I argue, and the inability to create delivery models to satisfy the changes and reduce inequalities (Kobetz et al., 2012).
Little Haiti, a subset with low economic status (LES) showing strong patterns of Haitian life resiliency, lacks available resources to foster MBM interventions or therapies because of healthcare inaccessibility (Val, 2015).
The idea to meet the individual patient at his location appears to be ground for addressing the underserved needs (Vonarx, 2011). It will be prudent for any researcher to have an emic perspective, defined as a culture's internal view (Avruch, 2002; NORC at the University of Chicago, 2020; Stepick et al., 2006b;Val, 2015;Vonarx, 2011) from the minority cluster of Little Haiti to better understand how complementary/integrative health be accepted and implemented. Furthermore, there are various modalities from the MBM interventional realm that some Haitians in Miami-Dade County have already incorporated within their culture, and religious practices attesting healing as an intervention outcome or treatment. Some examples are religious or spiritual art, guided imagery, dance, meditation, various body movements which can be behavioral, spiritual, psychosocial, and associated with treatment interventions, Karren et al. (2014) asserted. The benefits of guided imagery create a meditative sphere where calmness, performance improvement, and positive sensory messages through visualization are articulated (Fortune,

Current evidence
The five pillars of MBM therapies and non-mind body complementary medicine practices enunciated earlier can offer a critical and important outlook "to promote healing and wellbeing by qualified practitioners" (L.D. Fortune & Kurtz, 2017). However, such approach is not exhaustive when other ethnic minorities use their own notion or worldview of healing and wellbeing are studied. The key assertion is what kind of mind-body practices among Haitian ethnic minorities in Little Haiti may promote or enhance wellness in a community not familiar with MBM therapies?

Herbal medicine (phytotherapy)
A vast majority of Haitians in Little Haiti in Miami-Dade County use herbal medicine for various conditions such as blood pressure, diabetes, stress (Beauvoir, 2006), as forms of self-care under the mind body practice (MBP) to manage their illness, sustain health, and manage the cost of conventional medicine treatments (Ménard, 2010). For example, Haitian women in Little Haiti use a douching practice called twalèt déba to ensure cleanliness and tightness of vaginal mucosa to please their partners (Ménard, 2010;St.Hilaire et al., 2017).Twalèt déba uses ingredients such as boric acid (borasol, boron) liquefied powder in water, lemon juice, castor oil, pigeon pea (pwa Congo), aloe vera, potassium permanganate (Ménard, 2010;Rhodes, 2001, p. 3) to clean and tighten the vagina. Researchers at the University of Miami concluded that the practice is linked to HPV 16 and 18, causing cervical inflammation, vaginal and cervical lesions. High cervical inflammation has been linked to HPV 16, and 18 (Barbee et al., 2010;Carrasquillo et al., 2014;Kish, 2012;Kobetz et al., 2012;Ménard, 2010).
McBride (2019) also cautioned about the risks of natural supplements use, and alternative medicine that are real, due to the lack of regulatory guidelines. Herbal medicine fits within the therapeutic modalities of naturopathic medicine that encompasses prevention, self-healing through natural therapies (Karren et al., 2014). There is an emphasis alluded by Bastyr University (2016) that herbal and naturopathic practice help create a patient-focus mentality.
Herbal medicine is also associated with healing from a spiritual standpoint among vodou practitioners, and certain plants and herbs are believed to be associated with spiritual powers (Dennis, 2012b). I have observed many Haitian herbalists in Little Haiti at various Haitian markets displaying the benefits of herbs. Although the patient outcome measures are not yet assessed, it would not be prudent to make tabula rasa of a person's perception of health and disease using herbal medicine (Agu et al., 2019). Older Haitian adults with discrepancies in sleep patterns associated with age, dementia, depression, anxiety, stages of pain and physical distress (Breakspear, 2015), have also gained from herbal teas for sleep deprivation, the balm (mélisse), and the soursop (corossol) leaves (Arcury et al., 2006;Missildine et al., 2010;Pierre-Noel, 1959). Both plants show efficacy for sleep deprivation, and other problems related to anxiety. McKinney and Geller (2018, p. 118) offered a list of low-cost alternative treatments for conventional health conditions and presented certain conditions such as: gastrointestinal disorders showing treatment of Swedish bitters, chamomile, peppermint, and for gynecology, to prevent urinary tract infection, and bacterial vaginosis, highlighted boric acid as treatment.

Symbolisms and guided imagery
Not all Haitians in Miami practice vodou. The vodou practitioners use water as a connection to a powerful transcendent deity, and it is essential to religion. Vodou religion is embedded in the Haitian family, culture, community, history, identity, and found in all aspects of everyday life (Dennis, 2012b;Laguerre, 1979Laguerre, , 1987. In the vodou religion, water is seen as a communicating channel to the ancestral spirits or "lwa," purification, healing, and its aquatic symbolism is equated with pain resulting from the enslavement of the ancestors, and memory (Rey & Stepic, 2010).
Through this symbolism, and guided imagery vodou practitioners see visual imagery as capable of alleviating the pains or other issues, and meaning in symbolism. Imagery is also vivid in Haitian art, painting, and can either reflect vodou themes or daily human experiences, countryside, and natural elements having meaning to their lives (Rey & Stepic, 2010). In cardiac patient, guided imagery shows significant decreased in pain, stress, d anxiety, and helps evoke specific images with psychological links and emotional states, using an individual's imagination (Mellenthin, 2021;Veena & Alvi, 2016).
The symbol of the Legba deity, or the Legba vèvè (voudou sign) is included below. It is called vèvè or vodou sign (Jeanty, 1993), drawn by the priest or priestess to invite a spirit during a vodou ceremony. Within the Haitian vodou, vèvè expresses channels or portals to the spirits or lwas. It appears that during a vodou ceremony, the vèvè creates for the participants a form of meditation, symbolizes respect, a transcendent pathway to the spirit or lwas, and something closes to their daily pleas or struggles. The meaning of the vèvè is ground for further research studies. Vonarx (Hebblethwaite & Bartley, 2011;Vonarx, 2011) stated that vodou is a locus for spotting the suffering, confronting the daily burdens of the living, finding treatment and opportunities to deal with health and illness. He postulated vodou as a healthcare system.

Songs and dance
The interconnectedness of guided imagery, herbal medicine, songs and dance indicates Haitians in Miami share a common material and spiritual bond which is manifested through ritual practices or spaces and leads to identity via ritual practices formation and health (Rey & Stepic, 2010;Vonarx, 2011). For vodou practitioners, dancing allows body movements to reach a higher transcendental space and allows the spirit to take possession of an individual. Non-vodou practitioners use dance as stress relievers and part of their cultural folkways (Vodou le (Artist), 2020). The energy generated is both physical and spiritual. In Little Haiti, there is a panoply of dance groups associated with Haitian folkways and vodou practices called "Sosyete" (society; Dennis, 2012b).
In this article, the lyrics of a musical song associated with guided imagery (Vodou le (Artist), 2020) is presented to ascertain the viability of meditation through songs and dance. The song is used for vodou ceremony, and states "vodou Legba, Papa Legba, money brakes stones", and legba is presented as a godfather. It also reflects Papa Legba (Father Legba), the lwa or deity who rules all crossroads and paths, the divine messenger carrying pleas of sacrifices to other spirits (Dennis, 2012b;Kobetz et al., 2012; Vodou le (Artist), 2020). The song, dance and imagery imply a form of portal. When I return, I will thank the lwa. Abobo!"

Spirituality and prayer
Haitians are deeply rooted in the religious experiences of Christianity and the Vodou religion (Beauvoir, 2006;Dennis, 2012b;Laguerre, 1979Laguerre, , 1987Vonarx, 2011). Some Haitians who are considered as Catholics or Protestants share a type of religious syncretism of Christianity and Vodou (Beauvoir, 2006; Vodou le (Artist), 2020). It is not surprising to find Christians practicing vodou in secret, adhering to spirits and serving them, in search of power, deliverance, to find favor for all their endeavors, using vodou's traditional healing system as spirituality and accepted cultural derivatives (Laguerre, 1979(Laguerre, , 1987. Centers such as "Botanicas" where Haitians go to purchase ritual elements for vodou practices, or articles for physical (biological) healing, play a vital role within Little Haiti, and are considered as both spiritual and material pharmacy (Dennis, 2012b;Krueger & Torres, 2018). Within this context, it is plausible to accept that spirituality and prayers are important portals that can support MBM interventions within this ethnic group.

Meditation
As part of the spirituality and transformation continuum presented as "new medicine" by Gordon & Moss (2003), meditation plays a key role in Haitian culture. It is captured through various channels during religious services and vodou ceremonies. In Little Haiti, there is a proliferation of protestant churches, and vodou societies. An example presented by Dennis (2012b) is the Halouba community located at the convergence of 101 N.E 54 th Street, a place of vodou worship, a Hounfò (Temple), considered as part of the "Sosyeté Saint Jacques Majeur"(St. James the Major Society) with an approximate membership of 150 persons (Dennis, 2012b, p. 76).
The meditative components are translated into forms of prayers to a transcendent being to achieve peace, and calmness through meditative voices, and chanting. Fortune (2019), in the same vein explained that meditation dwells into a traditional framework, creates emotional calmness, and lucidity of the mind. Another powerful platform for the spiritual transformation is presented by Manbo Ingrid (n. d.) at the Vodou Holistic Center in Miramar, Florida. The center offers services such as vodou color for depression therapy, drum sound for anxiety, rituals and danse workshops, vodou arts and vèvè displays, and healing herbs. The center claims to offer expertise and clarity in spiritual affairs.

Potential growth areas and limitations
The considerations about MBM interventions, and non-mind body complementary medicine practices within the Haitian indigenous culture of Little Haiti in Miami-Dade County, Florida, are powerful to create avenues for MBM practices or implementation. It is important to address the five modalities of: herbal medicine (phytotherapy), symbolism and guided imagery, songs and dance, spirituality and prayer, and meditation among both Haitians who are Christians and vodou practitioners, to ascertain how mind and body health fits within the cultural and spiritual dualism of faith and spiritual practices. The limitations of this article relate: (1) to its new perspective (2) to further establish a reasonable relationship between MBM interventions, and non-mind body complementary medicine practices requires a methodology and design. A new pathway is needed.
(3) this article may be limited to the mind and body medicine perspective with deep social and ethnic medicine tentacles.

COVID-19 reality
Without a doubt, the above modalities presented (herbal medicine, symbolisms and guided imagery, songs and dance, spirituality and prayer, and mediation) can help this community, and others bypassing the stress conduits that COVOD-19 has imposed on many groups. The COVID Impact Survey: Week 3, Florida findings (NORC at the University of Chicago, 2020; Wozniak et al., 2020) show that a total of 334 individuals, during interviews conducted from May 30 to June 8, 2020, from a sample size of 446 resident adults in Florida (N = 446), in the past 7 days, have suffered from nervousness, anxiety, felt depressed, lonely, and hopeless about the future. Mindfulness training, and the promotion of Haitian culture's symbolism and guided imagery, herbal medicine, songs and dance, spirituality, and prayer (regardless of faith), and seconded by meditation, are powerful avenues that can help decrease stress, anxiety, and other ill effects of COVID-19.
Additionally, it would be paramount, considering MBM, and non-MBM therapies to address the burden of high mortality rates imposed by COVID-19 on Haitians or Haitian-Born Black in South Florida with diabetes as a specific comorbidity. More ethnic-racial analyses of social determinants of health would be required (Pinheiro et al., 2021). The web of informative platforms available through the internet, mobile devices, social media, and the use of virtual town halls [Zoom, Webex] (participatory sensing) for promoting the indigenous MBM practices, can be another option to foster vaccination campaigns for COVID-19, thus reducing mistrust about the vaccines, and existing fears among Haitians in Miami-Dade County, Florida (Jacobs et al., 2017;Wagner et al., 2021).
It is significant that further research studies tap into the wellbeing of the citizens of Miami-Dade County, Florida to capture behavioral changes generated due to COVID-19 restrictions, such as social distancing, quarantine, masking that impact daily lives. The COVID Impact Survey (Wozniak et al., 2020) designed to assess a comprehensive scale of wellbeing processes with elevated occurrence is also a great tool to use, in any effort to integrate MBM, and non-mind body complementary medicine practices.

Conclusion
There are research opportunities about mind-body medicine within this subset of the Haitian culture in Little Haiti, in Miami-Dade County, Florida. Several researchers and authors in various fields (Chaitain et al., 2009;Dupuy,1997;Jacobs et al., 2017;Jeanty, 1993;Laguerre, 1979;Mooney, 2005;Pamphile, 2001;Rahill, 2008) have captured the experience of Haitians in Miami-Dade Florida and the US. Some of the considerations deal with social, political, immigration issues, ethnicity, and identity issues in relation to belonging (Chao & Adler, 2018;Gamaldo et al., 2016;Kobetz et al., 2012;Rahill, 2008;Rhodes, 2001;United States Census Bureau, 2000). Although some of the social, economic, political, and psychological aspects of Haitians have been documented in the literature, few studies have attempted to explore the underlying needs to maintain a mind-body medicine focus. Within this culture, the investigated modalities of mind-body medicine, and non-mind body complementary medicine practices represent a deeply rooted, and silent reality that many need to be exposed to. There are cultural tentacles of mind-body health in this indigenous culture that encompass its resiliency, powerful spiritual self-efficacy, and present a viable platform to minimize anxiety, fear, and health challenges in this COVID-19 era. There is only one research by the Department of Pediatrics, University of Miami School of Medicine that addressed the concept of resiliency dealing with the effects of the pandemic on diverse caregivers, with the emphasis on stress and caregiver-stated child psychosocial concerns, caregivers' psychological health symptoms, and self-efficacy (Davidson et al., 2020). Further research is needed.