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Mexican & Mexican-Americans: Health Beliefs & Practices culture hh

Charles Kemp, FNP, FAAN - last update 3/2005

 


Note on printing Hispanic Health: To print, I suggest you paste this material into Word or other word processing program. I don't know why, but some people have difficulty printing from IE.

A very personal note: My first real contact with Latinos was long ago in the Marine Corps. There are things from then that cannot be told, except that I want to say this: I learned a lot about what it means to be a man of honor from Cruz. There is death in that learning. Like the song says, "I've got more important things to do than surviving." So here's to you, Cruz.

This section grew out of our work in the East Dallas barrio. Working door-to-door and en la clinica, I began to see, little by little, the lives and essence of people from Mexico. There is something compelling about La Raza. Some things are obvious: Strength and dignity; beautiful women, handsome men. Honor. There are other, not so appealing parts, too - violence, especially (though that gets mixed in with the other, sometimes). Check out Vatos by Galvez & Urrea, available from Cinco Puntos Press. All the vatos, now in a poem.

Introduction

This site is intended to help health care professionals and students to better understand Hispanic patients, families, and communities. While it is impossible to make global characterizations of a culture and people with any degree of accuracy, there are commonalties and unique characteristics in every culture. For the purposes of this discussion, we will use the following definition of culture:

"Culture . . . is a system of symbols that is shared, learned and passed on through generations of a social group. Culture mediates between human beings and chaos; it influences what people perceive and guides people's interactions with each other. It is a process rather than a static entity and it changes over time" (Lipson, 1996).

Not everything written here applies to Hispanics; but much of this information does apply to some degree to this population. As Lipson notes above, this information and the way it is lived out is best perceived as dynamic and changing.

The racial breakdown of people living in Mexico, and presumably Mexican-Americans, is 60% Mestizo (Amerindian and Spanish), 30% primarily Amerindian, 9% Anglo, and 1% other (Central Intelligence Agency [CIA], 1998). There are approximately 6 million undocumented Mexicans living in the United States and about 1/6 of these are under age 18 years (Pew Hispanic Center, 2005)

There are, of course, differences among individuals in any population and differences among populations within cultures. Differences may be due to personal differences and differences in socio-economic status, migration status/pattern, subculture, age, gender, life experiences, and myriad other factors. For the most part and unless otherwise noted, this paper focuses on Mexicans and Mexican Americans (hereafter termed "Hispanics" or "Latinas/Latinos") who hold traditional beliefs, such as first generation, new immigrants, and older persons. Much of the information applies also to persons of lower socio-economic status, even though they may be second or third generation. Photo above: 4/9/2006 - ¡Si Se Puede!

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History of Immigration

People migrate from Mexico (and other Latin American countries) to the United States for a number of reasons, including:

  • Many Mexicans are poor and there is little likelihood of improving their economic status in Mexico. There are an estimated 98,000,000 people living in Mexico and of these, about 66% live in poverty. While the Mexican economy has grown in recent years, buying power has shrunk 80% since 1976 and inflation continues to increase at a faster rate than wages (CIA, 1998; Rangel, 1999).
  • Economic and educational opportunity in the U.S. is far greater than in Mexico. The "American dream" is a reality for people the world over; and in some cases, the dream comes true.

To more fully understand the Hispanic population in a given area in the U.S., it is helpful to determine is there is a specific area of Mexico or other countries from which the people originate, as there may be health beliefs, practices, or problems specific to that area. In certain industrial areas of Mexico, for example, up to 92% of children have unsafe serum lead levels (Preston, 1999).

There are several basic patterns of legal and illegal migration to and settlement in the U.S., all of which were impacted by 9/11.

  • Migrant workers may travel to the U.S. each year and follow agricultural patterns of sowing and reaping from one crop to another before returning home to Mexico. Migrant health is a highly specialized field and is not addressed here.
  • Others, especially men, come to the U.S. to work as day laborers for individuals and businesses while seeking steady employment. Most share apartments with several other men in similar circumstances and send money home to their families on a regular basis. Except to persons who use such labor, these individuals are virtually invisible to the Anglo community and are seldom, if ever, included in community assessments.
  • Other Mexican migrants, especially families, come to the U.S. and seek employment and housing in one locale, and thus establish themselves as part of a community. Those who came before the mid 1990s are eligible for permanent resident status and eventually U.S. citizenship.
  • Readers should remember that many Mexicans are college graduates who come to the U.S. for professional employment; and many have sophisticated world views and understanding of health.

In all the above patterns and variations on these patterns, it is common to travel back and forth from the U.S. to Mexico at least yearly, and sometimes monthly. It is not uncommon for people to obtain much of their primary health care in Mexico where the cost of care and medicine is significantly less than in the U.S. In other cases, especially among the very poor or those treated without success in Mexico, the U.S. is a primary source of health care. There are others who obtain care from both sources. Photo above: 4/9/2006 - ¡Si Se Puede!

Implications: Hispanics encountered in health care settings and elsewhere range from physicians with postgraduate degrees and born in the U.S. to uneducated, non-English speaking peasants who arrived in the U.S. last week. In many cases, those who live in barrios will have significant intrinsic and extrinsic barriers to health care.Top

Communication

Spanish is the primary language of many Hispanics. There are numerous dialects and variations, but little difficulty with understanding among those who have differences. Among the young, it is common to use a mix of Spanish and English. Newer immigrants, especially women who do not work outside the home, tend to speak less English.

About 90% of Mexicans are literate (CIA, 1998) and a higher percentage of Hispanics in the U.S. are literate. This does not mean, however, that reading and writing are common means of communication among those from lower socio-economic backgrounds. The most commonly encountered books in many Hispanic homes in the barrio are required schoolbooks, pictorial novelettes, and the Bible. Photo below: 4/9/2006 - ¡Si Se Puede!

Verbal and nonverbal communications from Hispanics usually are characterized by respeto (respect) and communications to Hispanics should also be respectful. There is an element of formality in Hispanic interactions, especially when older persons are involved. Over-familiarity, physical (touch by strangers) or verbal (casual use of first names), is not appreciated early in relationships (de Paula, Lagana, & Gonzalez-Ramirez, 1996). It is uncommon for Hispanics to be aggressive or assertive in health care interactions. Direct eye contact is less among Hispanics that among Anglos. Direct disagreement with a provider uncommon; the usual response to a decision with which the patient or family disagrees is silence and noncompliance. A brusque health care provider may (1) not learn of significant complaints or problems and (2) find the patient unlikely to return. Despite a lack of public complaint, Hispanics tend to have an acute sense of justice and often perceive failures in communication to be due to prejudice.

Communications and the relationship between patient and health care provider are key to providing quality care. Trust and interpersonal comfort is a critical component of the relationship between the person who is ill and the healer. In large part, it is this relational aspect of care that places folk healers in a place of importance among Hispanics living in the U.S. (Zapata & Shippee-Rice, 1999). Note that quality care as seen here is not just correct diagnosis and treatment, but also the way in which the treatment is provided. Photo below: 4/9/2006 - ¡Si Se Puede!

The use of interpreters is often necessary, and ideally these should be of the same gender. Family members or friends are sometimes pressed into service as translators, but this may result in problems (personal, sexual, etc.) not brought up. The use of family or friends to interpret also presents difficulty in communicating and assessing the accuracy of vital communications such as medication regimes, side effects the patient must understand, and informed consents. Using children to translate puts the parent and child in a difficult reversed power and authority position, hence using a child to translate for a parent should be a last resort. In general, it is best to have Spanish-speaking staff or volunteers to translate. When there are staff whose primary function is translating, care should be taken that the position does not become an opportunity to wield power or make an additional profit from non-English speaking persons. Check out Babel Fish for free assistance translating English to Spanish and vice versa: http://babelfish.altavista.com/translate.dyn

Communications about family planning are especially sensitive. Most Hispanics are Catholic, but increasing numbers of Latinas are using contraception without informing their husbands. Depo-provera seems to be the contraceptive of choice.

Implications: It is vital to have Spanish-speaking staff. In most cases it is best to use staff to interpret; and in nearly all cases it is best to avoid using children to interpret. Interactions with patients and families should be formal and concurrently warm, at least early in the relationship. Formality may decrease over time, and warmth increase. Use formal terms of address; a firm, slightly longer handshake than is customary among Anglos; and avoid prolonged eye contact. While written instructions (on medications, treatments, etc.) are important, personal instruction that is directive, active, and visual is most effective. Do not rely on brochures! Close personal space and brief, non-intimate touch makes compliance a personal favor. Emphasize present time orientation with short-term goals. Most patients ask few questions. To assess learning, ask questions; use directive active, visual instructions; self-disclosure is appropriate. Emphasize present time orientation with short-term goals. Family planning discussions should be completely private (Lieberman, Stoller, & Burg, 1997).

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Social Relations

Familism, the valuing of family considerations over individual or community needs, is a strong, almost universal value in the Hispanic community (Juarez, Ferrell, & Borneman, 1998; Lieberman et al, 1997). The nuclear family is the most basic and common social unit, but many extended families also present. It is common for several family units to live in close proximity to one another and there is usually a strong reliance on family in day to day functions and crises.

The father or oldest male (direct relative) holds the greatest power in most families and may make health decisions for others in the family. Men are expected to provide for and be in charge of their families. Though increasing numbers of women work outside the home, homemaking is the expected role. At least publicly, women are expected to manifest respect and even submission to their husbands. Privately, some women will hold a greater degree of power. However, in too many marriages, the threat of physical violence is real and under-reported (de Paula et al, 1996). Two specific gender roles should be noted here:

  • Machismo or macho is stereotypically viewed as a kind of foolish male pride in which men are depicted almost as buffoons driven to folly by male hormones. To the contrary, machismo is a defined sense of honor that is vital to the Hispanic sense of self, self-esteem, and manhood.
  • Women are idealized in some respects and oppressed in others. Family violence is not uncommon. The woman is expected to be the primary force holding the family and home together through work and cultural wisdom, the primary caregiver, and responsible for most parenting. La Virgen of Guadalupe is a powerful symbol (dark-skinned Mother of Christ) and model for Mexicans and Mexican Americans.

Upward mobility, education, and other societal forces are changing the above; yet in isolated communities and among new immigrants, little has changed. Gender roles are important to the sense of culture and al least in public, are likely to be followed. Also see childbirth and related below.

Implications: Many patients seeking medical care will have already sought help from family resources (also see Lay Healers below). Family involvement in health care is common and health care providers are strongly advised to encourage such involvement and to include the family as a resource and focus of care in health planning, whether for individuals or a community. Showing respeto to all adults is important. Health providers should understand and comply with patient and family gender roles.

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Religion

Most Hispanics are Roman Catholics and the faith and church often are involved in day to day family and community life, with activities throughout the week and all day Sunday. Spiritual and religious influences play a major role in health, illness, and daily life (Juarez et al, 1998; Zapata & Shippee-Rice, 1999). Also see Health Beliefs below. Along with Catholicism, is a concurrent belief in and use of magico-religious means of dealing with life. Candles with pictures of saints are found in many homes and are often part of altars in the living room or bedrooms. Each saint has a specialized as well as general religious function. The saint associated with cancer is St. Peregrine; with dying is St. Joseph; and with bodily ills is Our Lady of Lourdes. Candles representing La Virgen de Guadalupe or Our Lady of San Juan are very common. Photo above: Prayer in Agape waiting room 9/11/2003

Important rites include mandatory baptism of infants, which is especially important in life-threatening situations. The Rite for Annointing the Sick (sometimes termed last rites) is required in life-threatening situations.

As in other aspects of life, the church and the people's relationship with the church is changing. One dramatic area of change is the increasing number of Catholic women who, despite clear proscriptions from the church, utilize oral contraceptives.

Protestant evangelical churches are playing an increasing role in the life of Hispanic communities. In particular, Victory Temples and other such Pentecostal churches offer answers to families that are threatened by social change, crime, gang involvement, and other such modern plagues.

Implications: Churches are central to the life of the family and community, hence can be important resources in planning and delivering services. Faith and church remain powerful sources of hope and strength in the Hispanic community, especially in times of sickness.

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Health Beliefs and Practices

In Mexico, "the expected number of years to be lived in what might be termed the equivalent of "full health'" is 62.4 years for men and 67.6 years for women. Mexico is thus 55th among 181 nations ranked by the World Health Organization (WHO) (WHO, 2000). Among all Americans, this "disability adjusted life expectancy" or DALE is 67.5 years for men and 72.6 years for women.

Physical or mental illness may be attributed to an imbalance between the person and environment. Influences include emotional, spiritual, and social state, as well as physical factors such as humoral imbalance expressed as too much "hot" or "cold" (de Paula et al, 1996; Spector, 1996). It is important to understand that belief in the concept of balance does not in any way obviate a concurrent belief in biomedical theories or practices (Zapata & Shippee-Rice, 1999). Hispanics who follow these beliefs may not express them to health professionals.

"Hot" and "cold" are intrinsic properties of various substances and conditions, and there are sometimes differences of opinion about what is "hot," what is "cold." In general, cold diseases/conditions are characterized by vasoconstriction and low metabolic rate. "Cold" diseases/conditions include menstrual cramps, frio de la matriz, coryza (rhinitis), pneumonia, empacho, and colic. "Hot" diseases/conditions are characterized by vasodilation and high metabolic rate. Pregnancy, hypertension, diabetes, acid indigestion, susto, ojo, and bilis are examples of hot conditions (Neff, 1998).

Folk illnesses are health problems associated with members of a particular group and for which the culture provides etiology, diagnosis, prevention, and regimen of healing; and which also have psychological and/or religious overtones (Neff, 1998). Folk or ethnomedical illnesses or conditions one might encounter in a Hispanic patient (de Paula et al, 1996; Lieberman et al, 1997; Neff, 1998; Schechter, Marshall, Salman, Goetz, Davies, & Liebowitz, 2000; Spector, 1996) include:

  • Antojos are cravings in a pregant woman. It is thought by many that failure to satisfy the cravings may lead to injury to the baby, including genetic defects.
  • Ataque de nervios are episodic, dramatic outbursts of negative emotion - usually in response to a current stressor (but often related to a significant childhood stressor).
  • Barrevillos are obsessions.
  • Bilis is thought to be bile flowing into the blood stream after a traumatic event, with the end result of nervousness.
  • Caida de la mollera is the presence of a sunken fontanelle in an infant.
  • Decaiminientos is fatigue and listlessness from a spiritual cause.
  • Dercernsos are fainting spells.
  • Empacho is intestinal obstruction and is characterized by abdominal pain, vomiting, constipation, anorexia, or gas and bloating. Post-partum women and infants and children are most susceptible.
  • Mal de Ojo is the "Evil Eye" that may affect infants or women. It is caused by a person with a "strong eye" (especially green or blue) looking with admiration or jealousy at another person. Mal de Ojo is avoided by touching an infant when admiring or complimenting it.
  • Nerviosimo is "sickness of the nerves" and is common and may be treated spiritually and/or medicinally.
  • Pasmo is paralysis or paresis of extremities or face and is treated with massage.
  • Susto is fright resulting in "soul loss." Susto may be acute or chronic and includes a variety of vague complaints. Women are are affected more than men.

"Cold" conditions are treated with "hot" medications and "hot" with "cold" medications, thus bringing the individual back into balance. Problems that are primarily spiritual in nature are treated with prayer and ritual. However, few Hispanics who use folk means of treating illness are troubled by simultaneously using cosmopolitan treatments such as antibiotics, antihypertensives, and so on.

Our impression is that most Hispanics, including those from traditional backgrounds, use cosmopolitan sources of health care (e.g., primary care physicians) as primary sources of health care to a far greater extent than traditional or folk sources as described below. Most research confirms this impression (e.g., Hunt, Arar, & Akana, 2000; Skaer, Robison, Sclar, & Harding, 1996).

A common hierarchy of seeking relief from lay healers begins with home remedies or seeking assistance from relatives or neighbors (especially female). A common home remedy is a tea made from various herbs, spices, or fruits; and prepared in a specific and prescribed manner (Zapata & Shippee-Rice, 1999). If the home remedy or consultation with a senora/abuela does not bring relief, and depending on the problem, help may be sought from a yerbero (herbalist), sobador (massage therapist), or partera (midwife who may also treat young children). In most cases, it is only after these are not helpful that help is sought from a cuarandero total (lay healer who intervenes in multiple dimensions, e.g., physical and spiritual) (Neff, 1998). Cuaranderos are not used or are not reported as used as much in the U.S. as in countries of origin (Neff, 1998; Zapata & Shippee-Rice, 1999). Cuarandero use may be diminished because of increased access to care or the more cosmopolitan nature of those living in the U.S.; or under-reported because of fear of misunderstanding or prosecution (of the cuarandero).

At any point in this process, help may also be sought from cosmopolitan sources such as a clinic or physician. A naturalist doctor or doctor naturalista may also be utilized. The doctor naturalista prescribes "natural" remedies, but does not usually provide the spiritual component of care the patient would expect from a cuarandero.

Note also that medications, including prescription, are shared within social networks. There are instances in which a sick person may simultaneously be using prayer, folk and/or herbal medicine, prescription medications obtained from a friend, and prescription medications prescribed by a nurse practitioner or physician. Regardless of the source of care, the patient (and family) are likely to include faith in God as a vital component of understanding of the problem and the cure (Zapata & Shippee-Rice, 1999).

In the excellent article, Folk Medicine in Hispanics in the Southwestern United States, Neff (1998) presents the below information:

Folk Remedies Everyone Should Know (+ indicates yes, with + being least and +++ being most; - indicates no, with - being least and - - - most, i.e., - - - in the safety column indicates the treatment is significantly dangerous. ? ? ? indicates the information is not known to the author.)

Note: Several people have contacted me re difficulty printing this table. No matter what I do, I cannot get this it to print properly. I suggest you paste the file into Word or whatever and print it that way. Sorry.

Spanish Name English Name Uses Efficacy Safety
Ajo Garlic Hypertension, antibiotic, cough syrup, tripaida + +++
Azarcón/ Greta Lead/mercury oxides Empacho, teething - - - - -
Damiana Damiana Aphrodisiac, frio en la matriz, chickenpox 0 +
Estafiate Wormwood Worms, colic, diarrhea, cramps, bilis, empacho + purge - -
Eucalipto Eucalyptus (Vicks Vapor Rub) Coryza, asthma, bronchitis, tuberculosis + respiratory Sx; 0 TB +
Gobernadora Chaparral Arthritis (poultice); tea for cancer, venereal disease, tuberculosis, cramps, pasmo, analgesic + as a poultice
0 as a tea
- - - (internal)
Gordolobo Mullein Cough suppressant, asthma, coryza, tuberculosis + Cough; 0 asthma, TB, coryza + + (if right species)
Manzanilla Chamomile Nausea, flatus, colic, anxiety; eyewash + except eyewash = 0 + + (if no allergy)
Orégano Oregano Coryza, expectorant, menstrual difficulties, worms 0/ + except worms = 0 +
Pasionara Passion flower Anxiety, hypertension + + + sedative + + (if right species)
Rodigiosa Bricklebush Adult onset diabetes, gallbladder disease ? ? ? ? ? ?
Ruda Rue Antispasmodic, abortifacient, empacho, insect repellent ? ? ? - - - (internal, external)
Saliva Sage Prevent hair loss, coryza, diabetes ? ? ? - - (chronic use)
Tilia Linden flower Sedative, hypertension, diaphoretic + sedative, other = ? ? ? - - (chronic use)
Tronadora Trumpet flower Adult onset diabetes, gastric symptoms, chickenpox ? ? ? ? ? ?
Yerba buena Spearmint Dyspepsia, flatus, colic, susto + + +
Zábila Aloe vera External - cuts, burns
Internal - purgative, immune stimulant
External + + +
Internal +/? ? ?
External + +
Internal - - -
Zapote blanco Sapodilla Insomnia, hypertension, malaria ? ? ? ? ? ?

Diet: The diet of Hispanics in the U. S. is variable, but certain traditional Mexican foods are common. These include rice and beans, usually prepared with lard. In many homes, tortillas are eaten at most meals, and these too usually include lard as an ingredient. Although some references (e.g., de Paula et al, p. 208) report that Mexican-Americans consume "traditionally, fresh natural ingredients," our observation in inner-city barrios in Texas is occasional fresh foods are consumed, but processed foods are more common. Meals tend to be large and "heavy." Fast foods, both American-style such as hamburgers and Mexican such as tacos de fajita are enjoyed by many. Chicken soup (caldo de pollo) is frequently given to persons who are ill or recuperating from illness. Obesity is a significant problem in Hispanic communities (U.S. Department of Health and Human Services [DHHS], 1998).

Pregnancy, childbirth, and child-rearing: As noted earlier, increasing numbers of Latinas are practicing family planning. Pregnancy is viewed as natural, and despite a tendency to seek prenatal care late in pregnancy or in some cases, not seeking care until delivery, birth outcome statistics for this population are good (de Paula et al, 1996). The extended family and community exert a strong influence on health practices related to pregnancy and childbirth. Women who work outside the home usually continue to do so only if absolutely necessary. When going to clinic for prenatal care it is relatively common for women to be accompanied by their husbands; and more common for them to be accompanied by a sister, mother, or other female relative. Female relatives tend to play a significantly supportive role throughout pregnancy and into the post natal period or la cuarentena.

Some Latinas moan during delivery and there is no effort to be silent. Breastfeeding is more common among new immigrants, but our observation is that breastfeeding is increasingly popular among those who have lived in the U.S. for extended periods of time or second or third generation Latinas.

Child-rearing is primarily the womanís responsibility in most families. Both female and male children are encouraged to be stoic from an early age. (There is little crying or fear shown in immunization clinics in Hispanic communities.) Paradoxically, many Hispanic homes are warm and protective toward the children. Familism is a thread throughout Hispanic life, including in child-rearing. Older children often have significant responsibility for younger siblings or relatives, and from all outward appearances, do not find this burdensome. Among Hispanics, children seem generally to be enjoyed and even treasured across generations.

Dying and Death Practices: The family (except for pregnant women) is often significantly involved in caring for a family member who is dying. Women tend to do most of the actual care, while men seem to stay in another room or outside, but still, are always there. In addition, many parishes have an active auxiliary, and members may be involved in caring for the person who is dying or supporting the family in the care. Autopsies and organ donations are usually resisted, especially by Catholics, but also by others. Public expression of grief is expected under some circumstances, especially among women (de Paula et al, 1996), but stoicism is also valued.

Disease prevention and health promotion: Traditionally, neither prevention nor promotion are valued; and this contributes to higher prevalence of chronic illnesses such as diabetes and hypertension, as well as waiting to seek care until illness has progressed (Neff, 1998). However, in recent years there seems to be increasing acceptance of these concepts. For example, it is increasingly common for new immigrants or visitors from Mexico to come to a community clinic reporting diagnosis and treatment for these disorders in Mexico. Still, the presence of chronic illness and risk factors such as obesity coupled with the overarching problem of difficulty accessing services, result in preventable morbidity and mortality (DHHS, 1998; Neff, 1998). A vaccination record from Mexico (translated) is found at the end of this document.

Implications: Some Hispanics have unique traditional health beliefs and practices and these are practiced to varying degrees. Having an understanding of these is helpful in assessing and understanding Hispanic patients and communities. Some traditional practices are helpful and some are harmful. Many persons who follow these practices are reluctant to share their beliefs with nurses or physicians, hence building trust and resisting judgment is essential to practice in these communities. Disease prevention (and detection) and health promotion need to encouraged and promoted in Hispanic communities. Assessment of health beliefs and practices is facilitated by use of a brief tool such as that developed by Tripp-Reimer, Brink, & Saunders (1984):

Brief Assessment of Patient/Family Perceptions of Health Problems

  • What do you think caused your problem?
  • Do you have an explanation for why it started when it did?
  • What does your sickness do to you; how does it work?
  • How severe is your sickness? How long do you expect it to last?
  • What problems has your sickness caused you?
  • What do you fear about your sickness?
  • What kind of treatment do you think you should receive?
  • What are the most important results you hope to receive from this treatment?
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Health Problems

This discussion of common health problems of Hispanics living in the United States focuses on those who hold traditional beliefs, such as first generation, new immigrants, and older persons; and also on Hispanics of lower socio-economic status, even though they may be second or third generation. Health problems most consistently documented in the literature (DHHS, 1998; Lieberman et al, 1997; Neff, 1998; Spector, 1996) are:

  • Difficulty in accessing and utilizing the healthcare system may be viewed as both a singular health problem and a highly significant etiology in or contributor to other health problems. Factors contributing to difficulty accessing services include language barriers, low rate of medical insurance coverage, low incomes, and limited knowledge of health services (Chavez, Hubbell, & Mishra, 1999).
  • Diabetes is about twice as common among Hispanics as among Anglos.
  • Obesity is more common among Hispanics (especially women) than in the general population.
  • Latinas with breast cancer tend to have larger tumors and/or metastatic disease than do Anglo women.
  • Causes of death nationally among Hispanics are (in decreasing order) heart disease, cancer, injuries, stroke, homicide, liver disease, pneumonia/influenza, diabetes, HIV infection, and perinatal conditions (Spector, 1996).

Implications: Any health planning for Hispanics should consider the issue of access to care in all phases of planning.

Teaching Tip: Patient information and other materials in Spanish are available online the American Academy of Family Physicians at http://www.familydoctor.org/ - click Spanish/ Espanol for patient handouts on specific health problems. The handouts run 2-4 pages each - which is a little more than most patients can digest; but still, more succinct (hence more usable) than most such sites. Excellent resource. The English section is one of those useless 5-10 clicks/topic sites that cannot reasonably be printed as a handout.

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Health Risks and Screening Recommendations for Immigrants from Latin America (Ackerman, 1997; Gavagan & Brodyaga, 1998; Kemp, Kwan-Gett, & Kovarik, unpublished; Uphold & Graham, 1998).

Not all the below apply to Mexicans, among whom the primary risks are malnutrition, especially obesity, and chronic disease such as diabetes and heart disease. However, readers should keep in mind that circumstances and climate vary in Mexico, hence malaria, etc. is a risk for some, but not others. Moreover, there is a significant influx of people from other Central American countries (especially Honduras) and both immigrants and others in immigrant communities may be at risk for problems that are not yet documented. Please see the Infectious Diseases site for updated information on infectious diseases.

Caribbean Islands

  • Angiostrongyliasis
  • Arbovirus encephalitis
  • Chromomycosis
  • Dengue Fever
  • Granuloma inguinale or Donovanosis
  • HIV/AIDS
  • Trichuriasis

Tropical Latin America

  • Cryptococcosis
  • Cryptosporidiosis
  • Dracunculiasis (Guinea worm disease)
  • Filariasis
  • Leprosy
  • Leptospirosis
  • Lobomycosis
  • Malaria
  • Mucocutaneous Leishmaniasis (Espundia)
  • Mycetoma (maduramycosis, actinomycetoma
  • Paracoccidioidomycosis
  • Strongylodiasis
  • Trichuriasis (trichocephaliasis or whipworm)
  • Tungiasis
  • Yaws (frambesia)
  • Yellow fever

Temperate South America and Andes Mountains

  • Bartonellosis (Oroya fever)
  • Chagas' Disease or American trypanosomiais
  • Echinococcosis (Hydatid disease)
  • Hantavirus pulmonary syndrome
  • Hemorrhagic fevers, South American (Junin HF, Machupo HF, and other HFs)
  • Leishmaniasis
  • Plague
  • Trematodes, liver-dwelling (fascioliasis)
  • Typhus

Latin America as a Whole

  • Amebiasis
  • Anisakiasis
  • Arbovirus encephalitis
  • Ascariasis
  • Bacillus cereus
  • Botulism
  • Campylobacter enteritis
  • Cestode infections: See tapeworm.
  • Chagas' Disease or American trypanosomiais
  • Clostridium botulinum and C. perfringens
  • Coccidioidomycosis
  • Cryptococcosis
  • Cryptosporidiosis
  • Cutaneous larva migrans
  • Dengue Fever
  • Diphtheria
  • Encephalitis (see Arbovirus encephalitis)
  • Enteric fever: See typhoid fever.
  • Enterobiasis or Pinworm infection
  • Enterovirus exanthems
  • Escherichia coli
  • Giardiasis
  • Histoplasmosis
  • HIV/AIDS
  • Hookworm
  • Hydatid disease: See echinococcus
  • Hymenolepiasis
  • Leishmaniasis: See visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis (espundia)
  • Leprosy
  • Lobomycosis
  • Malnutrition
  • Meningitis, chronic and recurrent
  • Meningoencephalitis
  • Mucocutaneous Leishmaniasis (Espundia)
  • Mycetoma (maduramycosis, actinomycetoma)
  • Myiasis
  • Naegleria infection
  • Paracoccidioidomycosis (South American Blastomycosis)
  • Pertussis or whooping cough
  • Pinta (mal de pinto, carate)
  • Pinworms: See enterobiasis.
  • Pneumonia: See anthrax, ascariasis, blastomycosis, coccidioidomycosis, histoplasmosis, HIV/AIDS,legionellosis, paragonimiasis, plague, psittacosis, Q fever, typhus, strongyloidiasis, tuberculosis. Note other, more common causes.
  • Psittacosis
  • Q fever
  • Rickettsioses
  • Rotavirus
  • Salmonellosis
  • Shigellosis or bacillary dysentary
  • Sporotrichosis
  • Staphylococcus aureus infection
    Strongylodiasis
  • Subcutaneous mycotic infection: See mycetoma.
  • Syphilis (Venereal and epidemic)
  • Tapeworms and cysticercosis
  • Tetanus
  • Toxocariasis
  • Toxoplasmosis
  • Trichinosis (trichinella)
  • Trichuriasis (trichocephaliasis or whipworm)
  • Tuberculosis
  • Tungiasis
  • Typhoid and paratyphoid fever (sometimes termed enteric fever)
  • Vibrio parahaemolyticus
  • Yaws (frambesia)
  • Yellow fever

Recommended Laboratory and Other Tests for Immigrants from Mexico

  • Nutritional assessment
  • PPD (Note that having had a BCG vaccination [1] may confound the Mantoux/PPD by causing variable results and [2] does not contraindicate PPD as is sometimes thought [Uphold & Graham, 1998].)
  • Consider hemoglobin or hematocrit

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Summary

Understanding some broad parameters of a culture is important to providing quality care to individuals, families, and communities. While there are variations within Hispanic cultures, there also are constants. Among the most significant are:

  • Familism
  • Spanish language
  • Faith in God
  • Difficulty accessing care

While there are other similarities or constants that should be considered in providing care to this population, these four listed above emerge as generally most significant in planning and implementing care. All should be included in all phases of care.

Mariano
Robert Earl Keen, Jr.

The man outside he works for me, his name is Mariano
He cuts and trims the grass for me he makes the flowers bloom
He says that he comes from a place not far from Guanajuato
Thats two days on a bus from here, a lifetime from this room.

I fix his meals and talk to him in my old broken spanish
He points at things and tells me names of things I can't recall
Sometimes I just can't but help but wonder who this man is
And if when he is gone will he'll remember me at all

I watch him close he works just like a piston in an engine
He only stops to take a drink and smoke a cigarette
When the day is ended, I look outside my window
There on the horizon, Mariano's silhouette

He sits upon a stone in a south-easterly direction
I know my charts I know that he is thinking of his home
I've never been the sort to say I'm in to intuition
But I swear I see the faces of the ones he calls his own

Their skin is brown as potters clay, their eyes void of expression
Their hair is black as widow's dreams, their dreams are all but gone
They're ancient as a vision of a sacrificial virgin
Innocent as crying from a baby being born

They hover around a dying flame and pray for his protection
Their prayers are all but answered by his letters in the mail
He sends them colored figures that he cuts from strips of paper
And all his weekly wages, saving nothing for himself

It's been a while since I have seen the face of Mariano
The border guards they came one day and took him far away
I hope that he is safe down there at home in Guanajuato
I worry though I read there's revolution every day

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Helpful Links: 7/2003 - went through 15 links listed here - nearly all non-functioning - one left. They come and go on the net!

http://www.paho.org/ Pan American Health Organization. Information on countries, health statistics, and related.

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References

Ackerman, L. K. (1997). Health problems of refugees. Journal of the American Board of Family Practice, 10(5), 337-348.

De Paula, T., Lagana, K., & Gonzalez-Ramirez, L. (1996). Mexican Americans. In J. G. Lipson, S. L. Dibble, & P. A. Minarik (Eds.). Culture & nursing care (pp. 203-221). San Francisco: UCSF Nursing Press.

Central Intelligence Agency (1998). World factbook [Online], Available:

http://www.odci.gov/cia/publications/factbook/

Chavez, L. R., Hubbell, F. A., & Mishra, S. I. (1999). Ethnography and breast cancer control among Latinas and Anglo women in southern California. In R. A. Hahn (Ed.). Anthropology in public health (pp. 117-141). New York: Oxford University Press.

Gavagan, T. & Brodyaga, L. (1998). Medical Care for immigrants and refugees. American Family Physician, 57(5), 1061-1068.

Geissler, E. M. (1998). Cultural assessment. St. Louis: Mosby.

Hunt, L.M., Arar, N.H., & Akana, L.L. (2000). Herbs, prayer, and insulin: Use of medical and alternative treatments by a group of Mexican-American diabetes patients. Journal of Family Practice. 49(3), 216-223.

Juarez, G., Ferrell, B., & Borneman, T. (1998). Perceptions of quality of life in Hispanic patients with cancer. Cancer Practice, 6(6), 318-324.

Kemp, C.E., Kwan-Gett, T.S., & Kovarik, C. (Unpublished). Infectious Diseases of Refugees Immigrants and Travelers. Elsevier Science.

Kemp, C. E. (1999). Terminal illness: A guide to nursing care. Philadelphia: Lippincott-Williams & Wilkins.

Lieberman, L. S., Stoller, E. P., & Burg, M. A. (1997). Womenís health care: Cross-cultural encounters within the medical system. Journal of the Florida Medical Association, 84(6), 364-373.

Lipson, J. G.. (1996). Culturally competent nursing care. In J. G. Lipson, S. L. Dibble, & P. A. Minarik (Eds.). Culture & nursing care (pp. 1-6). San Francisco: UCSF Nursing Press.

Neff, N. (1998). Folk medicine in Hispanics in the Southwestern United States [Online], Available: http://192.147.157.49/galaxy/Community/Health/Family-Health/Hispanic-Health.html

Noah: New York Online Access to Health. (1999). Available: http://www.noah.cuny.edu/.

Pan American Health Organization. (1999). Available: http://www.paho.org/

Pew Hispanic Center (2005). Estimate of the size and characteristics of the undocumented population. Retrieved 3/21/2005 from http://pewhispanic.org/.

Preston, J. (1999, May 30). Lead dust in the wind withers Mexican children. New York Times, p. A8.

Rangel, E. (1999, May 26). Working toward the middle. The Dallas Morning News, pp. D1, D10.

Schechter, D.S., Marshall, R., Salman, E., Goetz, D., Davies, S., & Liebowitz, M.R. (2000). Ataque de nervios and history of childhood trauma. Journal of Trauma and Stress. 13(3), 529-534.

Skaer TL, Robison LM, Sclar DA, Harding GH (1996). Utilization of curanderos among foreign born Mexican-American women attending migrant health clinics. Journal of Cultural Diversity, 3(2), 29-34

Spector, R. E. (1996). Cultural diversity in health and illness (4th ed.). Stamford, CT: Appleton & Lange.

Tripp-Reimer, T., Brink, P.J., & Saunders, J.M. (1984). Cultural asessment: Content and process. Nursing Outlook, 32(2), 78 82.

United States Department of Health and Human Services (1998). Frequently asked questions. Available: http://www.4women.gov/faq/latina.htm

Uphold, C. R. & Graham, M. V. (1998). Clinical guidelines in family practice (3rd ed.). Gainesville, Florida: Barmarrae Books.

World Health Organization (2000). Healthy life expectancy rankings. Accessed on the World Wide Web on October 14, 2000 at http://www-nt.who.int/whosis/statistics/dale/dale.cfm?path=statistics,dale&language=english

Zapata, J. & Shippee-Rice, R. (1999). The use of folk healing and healers by six Latinos living in New England. Journal of Transcultural Nursing, 10(2), 136-142.


Vaccination Record from Mexico

Mexican Medicine

Look up medications from Mexico. This external site is all in Spanish, but generic names are easily identified: http://www.facmed.unam.mx/bmnd/plm/otros/default.htm - we are also having good results simply searching for medications through the Yahoo! search field.

Medical/Spanish site @ South Texas Community College: http://www.stcc.cc.tx.us/library/guides/medicalspanish.htm

 

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