Chineses & Gautemalan Transcultural Health Care
Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Overview/Heritage ▪ China’s population of over 1.3 billion people is dispersed over 3.7 million square miles, with cultural values differing according to geographic location as well as other variant cultural characteristics. ▪ Chinese in the United States exceed 1.6 million people with the largest communities in California, New York, Hawaii, and Texas. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Overview/Heritage ▪ A university education is highly valued; however, few have the opportunity to achieve this life goal because of limited enrollment opportunities. ▪ Often, young adults come to Western countries to attend universities seeking more advanced prestigious educations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Overview/Heritage ▪ Many newer immigrants are professionals from Hong Kong. ▪ Chinese Confucian ideals emphasize the importance family and neighbors and reinforce the idea that all relationships embody power and rule. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Overview/Heritage ▪ Other important values are filial piety, industry, patriotism, deference to those in hierarchal positions, tolerance of others, loyalty to superiors, respect for rites and social rituals, knowledge, benevolent authority, thrift, patience, courtesy, and respect for tradition. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Communication ▪ The official language of China is Mandarin (pu tong hua), spoken by about 70% of the population, but
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other major, distinct dialects such as Cantonese, Fujianese, Shanghainese, Toishanese, and Hunanese exist. ▪ The dialects are so different that often two groups cannot understand one another verbally. ▪ The written language is the same. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Communication ▪ Most Chinese people speak in a moderate to low voice tone and consider Americans to be loud. ▪ When asked whether they understand what was just said, the Chinese invariably answer in the affirmative to avoid loss of face. ▪ The Chinese share information freely once a trusting relationship has developed. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Communication ▪ Most Chinese maintain a formal distance with each other as a form of respect. ▪ Many are uncomfortable with face-to-face communications, especially when there is direct eye contact. ▪ Titles are important to Chinese people. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Communication ▪ The family name is stated first and then the given name. ▪ Calling an individual by any name except his/her family name is impolite. If a person’s family name is Li and the given name is Ruiming, then the proper form of address is Li Ruiming. ▪ Traditional women do not use their husband’s name after they get married. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Communication ▪ Many Chinese take an English name as an additional given name because Chinese names are often difficult for Westerners to pronounce. ▪ Some give permission to use only the English name. ▪ Some switch the order of their names to be the same as those of Westerners with the family name last. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Traditionally the Chinese family was organized around the male lines. ▪ Most believe that the family is most important and, thus, each family member assumes changes in roles to achieve this harmony. ▪ Children are highly valued because of the Chinese government’s past mandate that each married couple may only have one child. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Independence is not fostered. The entire family makes decisions for the child even into young adulthood. ▪ Children born in Western countries tend to adopt the Western culture easily. ▪ Adolescents maintain their respect for elders even when they disagree with them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Children feel pressure to succeed to help improve the future of the family; thus, most children and adolescents value studying over playing and peer relationships. ▪ Children are taught to curb their expression of feelings because individuals who do not stand out are successful. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Chinese children in the USA are becoming more outspoken as they read more and watch television and movies from the Western world. ▪ The perception of family is developed through the concept of relationships. Each person is identified in relation to others in the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ The individual is not lost, just defined differently from individuals in Western cultures. ▪ Extended families are important. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Children may live with their grandparents or aunts and uncles so individual family members can obtain a better education or reduce financial burdens. ▪ Teenage pregnancy is not common, but it is increasing among Chinese in America. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ Older people are venerated and viewed as very wise. ▪ Children are expected to care for their parents when self-care becomes a concern; in China, law mandates this. ▪ The Chinese word for privacy has a negative connotation and means something underhanded, secret, and furtive. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Family Roles and Organization ▪ The one subject that is taboo is sex and anything related to sex. ▪ Same-sex relationships are not condoned. ▪ In many provinces, they are illegal and punishable by death. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Workforce Issues ▪ True equality does not exist in the Chinese mind; if more than one person is in power, then consensus is important. ▪ If the person in power is not present at decisionmaking meetings, barriers are raised, and any decisions made are negated unless the person in power agrees. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Workforce Issues ▪ Chinese adapt to the culture in the workplace quickly. ▪ They frequently call on other Chinese people to teach them and to discuss how to fit into the new culture more quickly. ▪ Autonomy is limited and is based on functioning for the good of the group. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Workforce Issues ▪ When a situation arises that requires independent decision making, many times the Chinese know what should be done but do not take action until the leader or superior gives permission. ▪ Language may be a barrier for some Chinese. ▪ The Chinese language does not have verbs that denote tense, as in Western languages. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Biocultural Ecology ▪ Skin color among Chinese is varied. Many have skin color with pink undertones; some have a yellow tone, and others are very dark. ▪ Hair is generally black and straight, but some have naturally curly hair. Most men do not have much facial or chest hair. ▪ Mongolian spots—dark bluish spots over the lower back and buttocks—are present in about 80 percent of infants. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Biocultural Ecology ▪ Bilirubin levels are usually higher in Chinese newborns with the highest levels occurring on the fifth or sixth day after birth. ▪ The Rh-negative blood group is rare. ▪ Chinese people generally have an increased sensitivity to the effects of alcohol Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Biocultural Ecology ▪ Poor metabolism of mephenytoin occurs in 15 to 20 percent of Chinese. ▪ Sensitivity to beta blockers, such as propranolol, is evidenced by a decrease in overall blood levels accompanied by a more profound response. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Biocultural Ecology ▪ Atropine sensitivity is evidenced by an increased heart rate. Increased responses to antidepressants and neuroleptics occur at lower doses. ▪ Analgesics have been found to cause increased gastrointestinal side effects, despite a decreased sensitivity to them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Biocultural Ecology ▪ Common health problems include lactose intolerance Thalassemia, hepatitis b, tuberculosis, liver cancer and pancreatic cancer, diabetes, and cardiovascular disease. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese High-Risk Health Behaviors ▪ Smoking is a high-risk behavior for many Chinese men and teenagers. ▪ Most women do not smoke. ▪ The numbers for Chinese women who smoke are increasing, especially after immigration to the United States. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Nutrition ▪ Food habits are important, and food is offered to guests at any time of the day or night. ▪ Foods served at meals have a specific order with focus on a balance for a healthy body. ▪ The typical diet is difficult to describe because each region in China has its own traditional diet. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Nutrition ▪ Traditional Chinese medicine frequently uses food and food derivatives to prevent and cure diseases and illnesses and to increase strength in weak and older people. ▪ Peanuts and soybeans are popular. ▪ Common grains include wheat, sorghum, and maize (a type of corn.) Rice is usually steamed but can be fried with eggs, vegetables, and meats. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Nutrition ▪ Fruits and vegetables may be peeled and eaten raw. ▪ Vegetables are lightly stir-fried in oil with salt and spice. ▪ Salt, oil, and oil products are important parts of the Chinese diet. ▪ Foreign-born and older people may not like ice in their drinks. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Nutrition ▪ Foods that are considered yin and yang prevent sudden imbalances. ▪ A balanced diet is considered essential for physical and emotional harmony. ▪ Chopsticks should never be stuck in the food upright because that is considered bad luck. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Pregnancy and Childbearing Practices ▪ Pregnancy is seen as women’s business, although men are beginning to demonstrate an active interest in pregnancy and the welfare of the mother and baby. ▪ Women are very modest and may insist on a female midwife or obstetrician. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Pregnancy and Childbearing Practices ▪ Pregnant women usually increase meat in their diets because their blood needs to be stronger for the fetus. ▪ Pregnant women may avoid shellfish during the first trimester because it causes allergies. ▪ Some may be unwilling to take iron: they believe that it makes the delivery more difficult. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Pregnancy and Childbearing Practices ▪ Traditional postpartum care includes 1 month of recovery, with the mother eating foods that decrease the yin (cold) energy. ▪ Many mothers do not expose themselves to the cold air and do not go outside or bathe for the first month postpartum because cold air can enter the body and cause health problems. ▪ Drinking and touching cold water are taboo for women in the postpartum period. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Pregnancy and Childbearing Practices ▪ Raw fruits and vegetables are avoided because they are considered “cold” foods. They must be cooked and be warm. ▪ Mothers eat five to six meals a day with high-nutritional ingredients including rice, soups, and seven to eight eggs. ▪ Brown sugar is commonly used because it helps rebuild blood loss. ▪ Drinking rice wine is encouraged to increase the mother’s breast-milk production. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Death Rituals ▪ Death is viewed as a part of the natural cycle of life; some believe that something good happens to them after they die. ▪ Death and bereavement traditions are centered on ancestor worship, a form of paying respect. ▪ Many believe that their spirits will never rest unless living descendants provide care for the grave and worship the memory of the deceased. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Death Rituals ▪ The dead are honored by placing food, money for the person’s spirit, or articles made of paper around the coffin. ▪ The belief that the Chinese greet death with stoicism and fatalism is a myth. ▪ The number 4 is considered unlucky because it is pronounced like the Chinese word for death. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Death Rituals ▪ The color white is associated with death and is also considered bad luck. ▪ Mourners are recognized by black armbands on their left arm and white strips of cloth tied around their heads. ▪ The purchase of life insurance may be avoided because of a fear that it is inviting death. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Spirituality ▪ The main formal religions among Chinese are Buddhism, Catholicism, Protestantism, Taoism, and Islam. ▪ Prayer is generally a source of comfort. ▪ Many use a combination of meditation, exercise, massage, and prayer. ▪ As immigration increases, many who practice Christian religions have become more visible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ While many Chinese people have made the transition to Western medicine, others maintain their roots in traditional Chinese medicine, and still others practice both types of medicine. ▪ Younger people usually do not hesitate to seek healthcare providers when necessary unless they believe that it does not work for them, then they use traditional Chinese medicine. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ Older people may try traditional Chinese medicine first and only seek Western medicine when traditional medicine does not seem to work. ▪ The Chinese tend to describe their pain in terms of more diverse body symptoms, whereas Westerners tend to describe pain locally. ▪ The Western description includes words like “stabbing” and “localized,” whereas the Chinese describe pain as “dull” and more “diffuse.” Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ Chinese cope with pain by applying oils and massage, using warmth, sleeping on the area of pain, relaxation, and aspirin. ▪ The balance between yin and yang is used to explain mental as well as physical health. Because a stigma is associated with having a family member who is mentally ill, many families initially seek the help of a folk healer. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-Care Practices ▪ Many Chinese still view mental and physical disabilities as a part of life that should be hidden. ▪ Families may be reluctant to allow autopsies because of their fear of being “cut up.” ▪ Most accept blood transfusions, organ donations, and organ transplants. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices Traditional Chinese medicine includes 5 basic substances: ▪ qi, energy ▪ xue, blood ▪ jing, essence ▪ shen, spirit ▪ jing ye, body fluids Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ Acupuncture and moxibustion are used in many treatments. Acupuncture is the insertion of needles into precise points along the channel system of flow of the qi called the 14 meridians. ▪ The system has over 400 points. Many of the same points can be used in applying pressure (acupressure) and massage (acumassage) to achieve relief from imbalances in the system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ Moxibustion is the application of heat from different sources to various points. ▪ For example, one source, such as garlic, is placed on the distal end of the needle after it is inserted through the skin, and the garlic is set on fire. Sometimes the substance is burned directly over the point without a needle insertion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practices ▪ Cupping: A heated cup or glass jar is put on the skin creating a vacuum, which causes the skin to be drawn into the cup. The heat that is generated is used to treat joint pain. ▪ Herbal therapy falls into four categories of energy (cold, hot, warm, and cool), five categories of taste (sour, bitter, sweet, pungent, and salty), and a neutral category. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practitioners ▪ Traditional Chinese medicine practitioners are shown great respect by the Chinese. In many instances, they are shown equal, if not more, respect than Western practitioners. ▪ Some distrust Western practitioners because of the pain and invasiveness of their treatments. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Chinese Health-care Practitioners ▪ Older health-care providers receive more respect than younger providers, and men usually receive more respect than women. ▪ Physicians receive the highest respect, followed closely by nurses with a university education. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Guatemalan Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ People of Guatemalan heritage comprise a growing number of Hispanic/Latino populations in the United States. ▪ Guatemalans may share a common Spanish language with other Hispanic ethnic groups. ▪ In Guatemala, 56 percent of the population lives below the poverty level. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Guatemala is inhabited by Mestizo (mixed Amerindian-Spanish – in local Spanish called Ladino) and European 59.4 percent, K’iche 9.1 percent, Kaqchikel 8.4 percent, Mam 7.9 percent, Q’eqchi 6.3 percent, other Mayan 8.6 percent, indigenous non-Mayan 0.2 percent, other 0.1 percent. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ The major languages in Guatemala include the official language, Spanish, which is spoken by 60 percent of the population, and Amerindian languages, which are spoken by the remaining 40 percent. ▪ There are 23 officially recognized Amerindian languages. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Some Mayan men do not have a formal education but are able to speak Spanish because of frequent interactions with Spanish speakers. ▪ Guatemalan people tend to value the past and live in the present, being more concerned with today than the future because the future is uncertain for many. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Time is related to the natural environment, such as sunrise, sunset, rainy season, etc. ▪ Punctuality is difficult for many because of limited transportation and unexpected family needs. ▪ Guatemalans who have a Hispanic heritage use the Spanish format for names. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ At birth, a child is given a first name (Ovidio) followed by the surname of his father (Garcia), and then the surname of his mother (Salvador), resulting in Ovidio Garcia Salvador. ▪ Men’s names remain the same through their lifetime. ▪ However, when a woman named Jovita Garcia Salvador marries Francisco Vasquez Gutierrez, she then becomes Jovita Garcia de Vasquez or simply Jovita Garcia Vasquez. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ To convey respect, address the Guatemalan in a formal manner unless otherwise requested by the patient. ▪ Male children and adults are referred to as Mr. (Señor). Females are referred to as Ms. (Señorita) or Mrs. (Señora). ▪ Guatemalans are customarily greeted with a handshake. In rural areas, people shake hands softly. ▪ To give a firm handshake indicates aggressive behavior. ▪ In the cities, the handshake tends to be more firm. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communication ▪ Guatemalans avoid direct eye contact with others, including health-care providers, which is a way of demonstrating respect and should not be misinterpreted as avoidance, low selfesteem, or disinterest. ▪ Guatemalans speak softly in public. ▪ Speaking loud is considered rude. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Many Guatemala families follow traditional roles for husbands, wives, and children, although this is changing for some. ▪ Traditionally, the man has been the head of household and is the primary “breadwinner” and provider for the family. ▪ Ultimate decision-making power resides with the man of the house. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Women’s roles have traditionally involved raising the children and caring for the home. ▪ Guatemalans place a high value on the family and extended family. ▪ Most families are nuclear. ▪ Extended family is important and may include grandparents, aunts, uncles, and cousins. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ A young woman’s 15th birthday (quinceñera) is celebrated as her passage to womanhood. ▪ Coming of age for a young man is age 18 years. ▪ Children are a gift from God and are highly valued in Guatemalan society. ▪ Sons are more valued than daughters. ▪ Children are taught to be obedient and demonstrate respect for older people. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Among Mayan communities, family members and other adults take an active part in raising a child. ▪ They believe it takes a village to raise a child to become a productive member of the community and to continue their culture. ▪ Values include being humble, content, and respectful of others, working hard, avoiding arguments, and placing the needs of the family before one’s own individual needs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ When family members are unable to take care of themselves, the expectation is that their family will take care of them. ▪ Guatemalan families who migrate to the United States do so with the hope of a better life for themselves and their children. ▪ More opportunities are available in the United States. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Catholic, protestant, and evangelical Guatemalans do not believe in homosexuality or sexual activity among the unmarried, or infidelity. ▪ Indigenous women dress conservatively with a woven long skirt (corte), blouse (huipil), a scarf (tzute), and shawl (rebozo) that promote modesty. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ A single woman is believed to be a prostitute if she is out in public alone. ▪ Despite a prevailing macho attitude with a deeprooted homophobia, some inroads have been made for gays, lesbian, and transgendered populations in Guatemala with Lesbiradas, an organization for lesbians and bisexual women. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles and Organization ▪ Larger cities in the United States offer organizations such as Ellas, a support group for Latina lesbians; El Hotline of Hola Gay, an organization with information and referrals in Spanish; and Dignity, a gay Catholic support organization. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ During the civil war in Guatemala, residents were permitted to migrate to the United States and apply for political asylum. ▪ If granted, this allowed Guatemalans to stay permanently in the United States, but they were not permitted to ever return to Guatemala. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Guatemalans may miss work due to an illness of a loved one, a need for transportation to an appointment, or lack of childcare. ▪ When a Guatemalan learns that a loved one in Guatemala is ill or has passed away, they feel compelled to return to Guatemala for an extended period of time, risking loss of their job if a leave of absence is not possible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Because punctuality is not valued in Guatemala, the Guatemalan employee in the United States may arrive for work late. ▪ They may not wear a timepiece, be able to tell time, or understand the importance of punctuality in the United States. ▪ Guatemalans tend to respect persons in positions of authority. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Workforce Issues ▪ Those of lower socioeconomic status and/or with formal education and English language skills usually acquire positions with responsibility but little authority. ▪ They prefer to get along well with others and not criticize or voice complaints when treated poorly. ▪ The Guatemalan is likely to remain in a position equal to his peers rather than seek a promotion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Most Guatemalans are a mixture of Spanish and Mayan Indian heritage. ▪ There is a small population of Black Guatemalans with ancestry from the Caribbean and Africa. ▪ This accounts for variations in skin color, facial features, hair, body structure, and other biological variations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Guatemalans who are predominately Spanish may have blonde or brown hair, fair complexion, and blue eyes and be of average or taller height with a medium to large build. ▪ Guatemalans with predominately Mayan Indian ancestry tend to have black hair, brown skin, and dark eye color and are of short height with a petite build. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ The leading causes of mortality in Guatemala are pneumonia, diarrhea, communicable diseases, diseases of the circulatory system, perinatal conditions, and tumors. ▪ Other major health problems for Guatemalans include musculoskeletal pain, abdominal pain, upper respiratory problems, headaches, rashes and itching, and eye disorders. Transcultural Health Care: A Culturally Competent Approach, 4th Edition High-Risk Health Behaviors ▪ Alcohol is the most misused substance. ▪ Guatemalan families readily participate in immunization programs for their children yet do not participate themselves. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Food to Guatemalans signifies physical, spiritual, and cultural wellness. ▪ Foods vary among Guatemalans based on cultural traditions and accessibility. ▪ Corn is highly valued in the Mayan culture. Corn is the chief crop and the basis for many food products and meals. Foods bring strength, good health, and a spiritual connection to the past. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ The Mayan diet primarily consists of maize, black beans, rice, chicken, squash, tomatoes, carrots, chilies, beets, cauliflower, lettuce, cabbage, chard, leek, onion and garlic. ▪ These foods are used to maketortillas, atole, (liquid corn drink), pinol (chicken flavored corn gruel), pepi’an (chicken stew with squash seeds, hot chilies, tomatoes, and tomatillos [small green tomato]), and caldos (soups made of chicken stock and vegetables.) Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Guatemalan food is not served spicy. A spicy hot sauce may be served alongside a meal for individuals who prefer to add it. ▪ The diet of many Guatemalans is low in protein, iron, and vitamin C. ▪ Lactose intolerance is especially prevalent among indigenous populations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Some Guatemalan families encourage their children to drink coffee with sugar when they refuse the poor tasting drinking water. ▪ This practice leads to gastritis, dehydration, and dental caries. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Guatemalans value life beginning from conception; a baby is a gift from God. ▪ Most do not believe in contraception or abortion for religious reasons. ▪ A Guatemalan woman may bear 10 or more children in her lifetime. In Guatemala, of these, many die before the age of 5 years. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Mayan midwives (comadronas) deliver 80 percent of all children born in Guatemala in the home. It is unknown how widespread this practice is in the United States. ▪ If the baby dies during delivery, the family accept it as God’s will. ▪ On the day a Guatemalan woman becomes pregnant, she and her husband share the news with respected elders of the village. Godparents are also selected at this time. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ In the 7th month of pregnancy, the woman introduces her fetus to the environment. ▪ She goes through her daily activities showing and telling her fetus about the life she leads. The mother tells the fetus to be honest and never abuse nature. ▪ If someone eats in front of the pregnant woman without offering her food, she will have a miscarriage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Children are permitted at the delivery. ▪ The woman’s husband, village leaders, and parents of the couple may be present. ▪ A single woman must not observe the birth of the baby. ▪ Mayan women do not believe in lying down to give birth or delivering in a hospital. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ A midwife and witch (brujo) may both attend the birth. ▪ The midwife helps with delivery. ▪ The brujo prays for long life, good health, and protection from the evil eye (mal ojo). ▪ A breech delivery or one in which the baby’s cord is around the neck are considered good luck. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ Following delivery, the placenta has to be burned, not buried, because it is disrespectful to the earth to do so. ▪ The placenta can be burned on a log and then the ashes used for a steam bath, temascal. ▪ To celebrate the birth of a baby, the villagers slaughter a sheep. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ The mother and baby are kept separated from others for 8 days. ▪ When the baby is born, the hands and feet are bound for 8 days. This signifies that they are meant for hard work, not for stealing. ▪ Guatemalan women may continue breastfeeding until the child reaches the age of 5 years. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ During the first 8 postpartum days, friends and extended family bring food, clothing, small animals, or wood as gifts for the newborn’s family. ▪ They also offer their services, like carrying water or chopping wood. ▪ The family of the newborn does nothing for these 8 days; their needs are taken care of by others. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Pregnancy and Childbearing Practices ▪ A bag with garlic, lime, salt, and tobacco is hung around the baby’s neck and a red thread is used to tie the umbilical cord to protect the baby, provide strength, and denote respect for the ancestors. ▪ If the baby is a female, the midwife pierces her ears at birth. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Juanita Juarez, is pregnant with her second child. The nurse recommended that she increase her milk consumption, which she has not done. He has been compliant with other dietary recommendations. The most likely reason for not increasing her milk consumption is that she a. Does not like milk. b. Cannot afford milk. c. Has lactose intolerance. d. Has fructose intolerance. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C Many Guatemalans have lactose intolerance and cannot drink milk or milk products because it caused bloating and indigestion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Many Guatemalans grow up experiencing far more death than most North Americans. ▪ They see babies and children die of malnutrition and disease, parents and grandparents die from violence, and loved ones die because the health care they needed was too far away or was too expensive. ▪ The family may decide the cost for treatment of one family member is too much and decide against it because of the financial strain on the entire family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ When death occurs in Guatemala, it is customary to place the deceased in a simple wooden coffin/casket and conduct a funeral. ▪ Graves are decorated with flowers on All Saint’s Day in memory of the deceased. ▪ Some Guatemalans relate their illness to “punishment” or impending death to “God’s will”. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ When a Guatemalan dies in the United States, the family may request repatriation because it is important for the final resting place to be the home country. ▪ Guatemalans believe in burial; they do not practice cremation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Yellow is the color of mourning. ▪ Yellow flowers are placed at the grave. ▪ Food is placed at the head for the spirit of the departed. ▪ Church bells are rung to gain favor with the gods. ▪ Ladinos mourn the dead by wearing black. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Approximately 65-80 percent of Guatemalans are Roman Catholic. ▪ Others continued to practice their Mayan religion. ▪ Still other Guatemalans combined beliefs and practices of the two. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Two practices influenced by the Spanish are guachibal and cofradia. ▪ Guachibal involves the practice of keeping an image of a Christian saint in the home and celebrating on the particular saint’s day. ▪ Cofradia refers to a “religious brotherhood” that serves to maintain the “cult” of a particular saint. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Family provides Guatemalans with meaning in their lives. ▪ Spirituality helps to explain life and the circumstances faced by Guatemalans. ▪ When illness occurs, many Guatemalans turn to their faith for strength, wisdom, and hope. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The preferred mode of treatment among Ladinos is medication administered by hypodermic injection. For example, if an infant has a cold, Ladinos believe an injection is necessary to treat it effectively. ▪ If someone has the flu, they like an intravenous infusion. Intramuscular medications are preferred to those taken orally. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Health-care seeking among Guatemalans generally occurs by first seeking advice from a mother, grandmother, or other respected elder. ▪ If this approach is unsuccessful, then the family usually seeks health care from folk healers. ▪ Modern medical care may be the last resort. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Many are fearful of hospitals. ▪ In Guatemala, when hospital care is necessary, patients are often seriously ill, resulting in death, which perpetuates the belief that “hospitals are places where patients go to die.” ▪ Guatemalans often delay seeking health care until they are incapacitated by illness, disease, or injury. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Many times, they are unaware of the dangers associated with working in agriculture in the United States. ▪ They may be exposed to pesticides and dangerous equipment without proper training. ▪ Some Guatemalans fear venipuncture because taking blood leaves the body without enough blood to keep them strong and healthy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Guatemalans tend to view health and illness in relation to their ability to perform duties associated with their roles. ▪ As long as women are functioning in their role of caring for the home and family and men are functioning in their job, then they feel “healthy”. ▪ Aches, pains, and minor illnesses that do not prevent functioning are tolerated. ▪ When an illness prevents normal functioning required for their roles, then Guatemalans view it seriously. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ The cause of debilitating illness or disease may be viewed as punishment from God rather than lack of prevention or early detection. ▪ Sometimes, early warning signs of illness or disease are ignored in hopes they will go away on their own. ▪ Family members would rather care for their loved one at home if at all possible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practices ▪ Questions related to organ donation will be puzzling and elicit fear and anxiety. ▪ The Guatemalan patient may think the healthcare provider is asking them to consent to organ donation because they are going to die rather than understanding the context to which the question applies. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Maria and Pedro bring their 3 day old male newborn baby to the pediatric clinic because he is not nursing and they are sure he is losing weight. The baby has his hands and feet bound. The nurse recognizes this Mayan custom is so that the baby will a. b. c. d. Grow up to work and not steal. Not get colic. Be a religious person in adulthood. Be safe from evil spirits. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A Traditional Guatemalans bind the baby’s hands and feet for the first 8 days of life so it will grow up to be a good worker and not steal. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners Three distinct health care systems exist in Guatemala: 1. Modern medicine 2. Ladino folk medicine 3. Indian folk medicine Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Modern medicine refers to health care provided by educated physicians and nurses. ▪ Ladino folk medicine is provided by Ladino pharmacists, spiritualists, and lay healers (curanderos). Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Mayan Indians seek medical care from Mayan shaman, herbalists, and comadronas. ▪ When Ladinos and Mayan Indians have access to modern medicine, the utilization increases. ▪ Guatemalans have great respect and admiration for health-care providers. They are viewed as authority figures with clinical expertise. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ Guatemalans expect their health-care provider to have the appearance and manners of a professional. ▪ When this is not the case, Guatemalans lose confidence in the provider. ▪ Guatemalans are very private and are not accustomed to discussing issues and concerns openly. It may take a while to develop the trust and rapport. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ They fear disclosure may result in deportation or rejection. ▪ Patients also fear confidentiality will not be maintained in the health-care setting. ▪ Guatemalan women are usually very modest. ▪ They may refuse to discuss personal issues or receive an examination by a male health-care provider. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Health-care Practitioners ▪ A male Guatemalan patient may refuse a female health-care provider. ▪ Because Guatemalans dislike conflict, they may not actually refuse care instead they may withhold personal information due to discomfort with the health-care provider.
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