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Suggested Readings
(click on selection for reviews and more information)

Hispanic culture and health care: Fact, fiction, folklore

The Latino Patient: A Cultural Guide for Health Care Providers by Nilda Chong

Health Issues in the Latino Community (Jossey Bass Health Series)

Working With Latino Youth: Culture, Development, and Context



Spanish for Health Care Professionals  by William C Harvey

Medical Spanish : Interviewing the Latino Patient - A Cross Cultural Perspective by Teresa Gonzalez-Lee








The Hispanic American Community

Members of the Hispanic American community have their origins in Cuba, Central and South America, Mexico, Puerto Rico, and other Spanish speaking countries.

The majority of Hispanics are Catholic, with an increasing presence of Pentecostals.  Health is a gift from God and should not be taken for granted.  The prevention of illness is an accepted practice that is accomplished with prayer, the wearing of religious medals, or amulets, and keeping relics in the home.  Visiting shrines, offering medals and candles, offering prayers and the lighting of candles is a frequently observed practice.  Many homes have shrines with statues and pictures of Saints.  The candles are lit here and prayers are recited.

Social customs
Elders have a prestigious status in the Hispanic family because of their experience. Family members look to elders for advice. An individual who becomes sick will turn first to family members, especially elders, for support, comfort and advice. They may recommend safe, simple home remedies. 
In the traditional household, the man is the head of the family and makes all major decisions.  There is a strong sense of Paternalism what most Westerners call "Male Dominance", but the females role is equivalent and she is the Maternal powerhouse in her home. The truth is women are sacred and revered, often protected, not because she can't handle herself or has no voice, but because the solidarity of the family unit depends on her well being.

Health practices
Hispanics are far more emotionally expressive.  They expect to be pampered when ill, it is one way the family shows love and concern.  This is a present oriented society, and as such they may neglect preventive health care, and may also show up late, or not at all, for appointments. 
Most Hispanics are Catholics, and birth control methods other than rhythm are unacceptable.
Most Latin Americans see thinness as a problem and plumpness as the ideal.  Advice that a patient lose weight might not be followed because it would create a negative body image.
Hispanics are not accustomed to the profession of social workers, and rely on their families, other relatives and close friends for support and help.
Curanderismo is defined as a medical system.  It is a coherent view with historical roots that combine Aztec, Spanish, spiritualistic, homeopathic , and scientific elements.  The curandero is a holistic healer; the people who seek help from him do so for social, physical, and psychological purposes.  Since the curandero has a religious orientation, much of the treatment includes elements of both the Catholic and Pentecostal rituals and artifacts: offerings of money, penance, confessions, lighting candles, wooden or metal offerings in the shape of the afflicted anatomic part and laying on of hands. 

Personal matters should be handled only within the family.  Modestly is valued in Hispanic culture, and not just for women.  The area between the waist and knees is considered particularly private.
Typically, Hispanics look down on people who are mentally ill.  Patients with mental health concerns do not like to share this information with their relatives or friends and are shy of seeking professional help. 

To attend a woman during delivery is a woman's job, ideally the job of her mother and midwife.  Cultural tradition dictates that a husband not see his wife or child until the delivery is over and both have  been cleaned and dressed.  In general, Hispanic women prefer that their mothers attend  them in labor.
Latin American women practice the custom of postpartum lying -in period.  This period is designed to give a woman the period of rest between childbirth and returning to work.  In these cultures women traditionally did not return to office work, but to physical labor in the fields.

1- A Hispanic woman had to sign an informed consent form for a hysterectomy. The patient spoke no English and the hospital staff relied on her bilingual son to serve as the interpreter. When the son explained the procedure to the mother, he appeared to be translating accurately and indicating the proper body parts. His mother signed the consent form willingly. The next day, however, when she learned that her uterus had been removed and she could no longer bear children, she became very angry and threatened to sue the hospital. 
Because it is inappropriate for Hispanic male to discuss her private parts with his mother the embarrassed son had explained that a tumor would be removed from her abdomen and pointed to the general area. The woman became quite angry and upset because a Hispanic woman's status is derived in large part from the number of children she produces. 
Even speaking the same language is not always sufficient. Cultural rules often dictate who can discuss what with whom. In general, it is best to use a same sex interpreter when translating matters of a sexual or private nature. 

2- A 36 year old Mexican man with second degree burns on his hands and arms. The skin grafts had healed, and there was now a danger that the area would stiffen and the tissue shorten. The only way to maintain maximum mobility was through regular stretching and exercise. The nurses explained to the wife that feeding himself was an essential therapeutic exercise. She seemed to understand the nurses' explanation yet continued to cut her husband's food and put it in his mouth. 
When one of the nurses, observed this, she took the fork out of the wife's hand and told the patient to feed himself because he needed to exercise his arms and hands. The wife appeared skeptical but did not argue. When the nurse returned later, she saw the wife once again cutting her husband's food and putting it in his mouth. The nurses were irritated by the wife's assistance with tasks the patient could do himself. Fortunately a Cuban nurse on staff explained to the nurses that Hispanic men expect to be waited on. Having the patient's wife available to care for him most of the time also eased their burden. 
Failure to care for oneself is common in cultures that emphasize the family over the individual (almost all cultures other than Anglo-American). In many cases, Americans' ethnocentrism blinds them to the fact that life in a typical Hispanic household may be different than in the normal Anglo home. Hispanic cultures emphasize family interdependence over independence. For them self care is not an important concept, where someone is usually at home to care for the patient. 
In this situation, it is of greater importance that when a family member is ill, love and concern are demonstrated through care and attention. The nurses might have instructed the wife to help her husband in ways not to hinder his rehabilitation. For example, show her how to massage lotion on his hands. 

3- A home health nurse, received an angry call from a Mexican American woman after visiting her house the day before. Her infant had been crying and feverish the next morning and the woman recalled the nurse had remarked the child was adorable. The nurse's compliment and the fact that she had not touched the child, led her to concluded that the nurse had given him the evil eye. 
In Mexican culture, babies are considered weak and very susceptible to the power of an envious glance. A simple compliment without touching the child, can bring on the evil eye. Touching the person while complimenting him or her, neutralizes the power of the evil eye. 
Not all Mexicans adhere to this belief, so it is important to pay close attention to non-verbal clues from the mother. 

References : 
Fernandez V.M.: Personal interviews and experiences with patients in Venezuela, Colombia, Mexico and Cuba. 1995-1999
Galanti G.A.: Caring for Patients from Different Cultures. University of Pennsylvania Press, Philadelphia, 1991
Spector R.E.: Cultural Diversity in Health and Illness.  Appleton-Century-Crofts, New York, 1979


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