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The final commentary, drawing on the others, seeks to join the issues from an explicitly bioethical perspective. . Bridging such cultural gaps, wide or narrow, will result in better physician-patient relationships and more effective care. Posttraumatic shock or anxiety may be attributed to susto (soul loss) rather than posttraumatic stress disorder. by Marcia Carteret, M. Ed. This reliance does not necessarily replace modern biomedicine; rather, herbal remedies and other non-allopathic treatments often are utilized in conjunction with Western medical care. Today, one in three farm workers are newcomers to the United States, with most of these coming from Mexico. Hispanics have different degrees of illness or health risks than whites. dissertation, University of Southern Cali-fornia, 1973. A wide array of herbs offered at La Botanica Orquida in northeast Georgia. A mother might use cooling herbs to treat diaper rash, a hot condition. Results: Teas were most commonly used for colic, upper respiratory tract symptoms, and abdominal pain. Moreover, the family itself can play an enormously important role in supporting and empowering the patient within the medical setting. Generally speaking, Latino cultures include a more family-centered decision making model than the more individualistic or autonomy-based model embraced by modern mainstream biomedical culture in the United States. Recent immigration trends have contributed heavily to the increases in the U.S. Latino population. 37% of Latinos have. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Increasing Cultural Sensitivity in Existing Treatment Approaches For Latinos, interpersonal warmth is very important, and when a therapist is experienced as "cold" or Hispanic Heritage Month, September 15 - October 15, is an important opportunity to raise awareness about these trends and more importantly, identify culturally and linguistically appropriate prevention and treatment strategies to reduce mental and substance use disorders in the Hispanic/Latino population. Her visits to your clinic have been challenging because of her limited English proficiency, late arrivals, and nonadherence to several medications. There are likely many possible reasons for this, including poverty and lack of health insurance, and thus at best irregular access to health care; cultural factors that might cause patients to delay seeing a doctor, for example, the expectation that one should tolerate pain without complaint; and a belief that certain conditions (such as pregnancy) are natural and do not require medical attention. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. The U.S. Latino population is also quite young relative to the general U.S. population; in 2007, the median age for the former was 27.6, compared to 36.6 for the latter.2. By comparison, only 35% of Hispanics 50 and older say the same - a 30-percentage-point gap. Azarcon and greta (lead salts) and azogue (mercury) compounds, which are sometimes given for teething or empacho, are contraindicated.22 Some injuries have occurred with curandero treatment of caida de la mollera (fallen fontanel). Margaret E. "Group Methods and . However, it may be more likely to mistakenly suspect child abuse than to actually encounter it in patients who use traditional treatments.23. Such patient activation or motivation for change is more challenging in foreign-born Latinos, but may be achieved through active dialogue and discussion.32 Hopeful involvement in the care plan should replace fatalism or resignation. The teach back technique should be incorporated into the cross-cultural patient encounter to ensure patient understanding of discharge instructions. Patient activation will help motivate the patient to become involved in his or her own care. 2 Although the new guidelines comprehensively address how to define, measure, and treat high blood pressure . In today's United States, these terms are often thought . Patients should be asked if they use alternative therapies, because it is not likely that such information will be volunteered. Author disclosure: No relevant financial affiliations to disclose. Significantly, some patients appear to experience greater improvement after meeting with folk practitioners than with Western doctors.14. Visit SAMHSA on Instagram 13 Kaiser, "A Provider's Handbook," 6-7. Karen Peterson-Iyer is a program specialist in health care ethics at the Markkula Center for Applied Ethics. Themes common to Latino participants were: "We are put off to one side"; "If I can't work, I can't survive"; and "Without documents, you are no one." Combination therapy generally uses multiple treatment methods at once. This inequality puts these communities at a higher risk for more severe and persistent forms of mental health conditions, because without treatment, mental health conditions often worsen. There is ample evidence that Latinos, especially those of Mexican and Central American origin, face significant obstacles to obtaining health care, especially language barriers.4 Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of patients. They are also far more likely than whites to feel that they are treated unfairly by providers or by the medical system.8, These gaps and dissatisfactions become even more troubling in the context of significant disparities in access to health insurance and to the health care system in general. Information. "7 In the context of a hospital or medical clinic, where medical terminology can be complicated and communication often takes place quickly and amidst elevated emotions, this language barrier can be especially problematic. In fact, the number of Latino physicians dramatically lags behind Latino population growth; and, according to cross-cultural health care expert Larry Purnell, Latinos are the most underrepresented major minority group in the entire U.S. health care workforce.5 This discrepancy contributes to many different linguistic and cultural hurdles for Latino patients, as well as for their health care providers. 4Center for Disease Control and Prevention, "Leading Causes of Death," accessed at www.cdc.gov/men/lcod/index.htm; and Richard Allen Williams, "Cultural Diversity, Health Care Disparities, and Cultural Competency in American Medicine," Journal of the American Academy of Orthopedic Surgeons, Vol. Your efforts pay off at the next visit, when Maria expresses much more interest in controlling her diabetes and shows personal warmth that was missing from earlier encounters. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. Neurocysticercosis is the most common cause of seizures in Latino immigrants. savoie's real cajun dressing mix; PURPOSE Though patient variables are likely to play an important role in the undertreatment of depression, little is known of patients' perceptions of standard depression treatments. To sign up for updates or to access your subscriber preferences, please enter your contact information. al., "Culture, Illness, and Care," 252. Additionally, within this family-centric decision making structure, there may be particular gender-based roles. Find treatment facilities confidentially and anonymously, 24/7, National Helpline1-800-662-HELP (4357) For instance, a doctor could perceive as evasive a patient who declines to make direct eye contact, when in fact,that patient may be demonstrating respect for the doctor's position and authority. Conveying medical instructions to patients with limited English skills can be frustrating. ", In 2007, the total U.S. Hispanic or Latino population surpassed 45 million, or 15 percent of the total U.S. population. "1 The term does not refer only to Spanish speakers, however; many people usually thought of as "Hispanic"-the people of Brazil, for instance, or those from indigenous Mexican communities-often do not speak Spanish at all, or at least not as their primary language. For example . placed on religious beliefs in the maintenance of health and the treatment of illness. Obesity and genetic factors increase risk. Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. In spite of the large and rapidly increasing size of the U.S. Latino population, there has been no corresponding influx of Latinos working in the U.S. health care system. Talk. These include simpata (kindness), personalismo (friendliness), and respeto (respect).25 Simpata emphasizes politeness and conflict avoidance. 3 Essentially, a curandero or curandera removes mental, emotional, physical and spiritual illnesses or imbalances. Case 1: Delinquency or a Mental Health Problem: The Case of Pablo Sanchez, Case 3: From Chronic to Critical: End-of-Life Decisions. Although the program ended in 1964, the immigration trend has continued to the present day, and many of these immigrants work as migrant laborers in the U.S. agricultural system. A little more than 45 percent of all births in Mexico are Cesarean sections, which makes it one of the world's leaders in the practice. Become an expert on our coaching methods, internal systems, processes, and technology. High cholesterol or dyslipidemia (unhealthy blood fat levels) . Remedies used for common pediatric illnesses and for the traditional folk illnesses: mal ojo(evil eye), empacho(blocked intestine), mollera caida(fallen fontanelle), and susto(fright). Thus, when working with diverse populations in the United States . Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). She has three grown children: two still live in Mexico, and the third lives in a distant U.S. city. In either case, they are treated with the opposite hot or cold treatment. Allow extra visit time for patients with limited English proficiency, Hire bilingual staff and physicians, and encourage existing staff to learn Spanish, Make printed and Web-based cultural information available to staff, Offer flexible scheduling: patients may be seen in sign-in order rather than fixed appointments, Post bilingual or Spanish-language signage, Provide cultural sensitivity training for staff (e.g., monthly lunchtime discussions, in-service training, a bulletin board devoted to cultural issues, ethnic food potlucks), Provide culture-specific interventions in nursing care plans, Provide interpretation services for patients with limited English, proficiency (required under Title VI of the 1964 Civil Rights Act); whenever possible, try to avoid using patient's family or friends as interpreters, Provide Spanish-language medical handouts and patient forms, Recognize Latino holidays (e.g., Cinco de Mayo [May 5], Day of the Three Kings [January 6]). 1 The term does not refer only to Spanish speakers, however; many people usually thought of as "Hispanic"-the people of Brazil, for instance, or those from indigenous Mexican communities-often do not speak Spanish at all, or at least not as their primary language. The commentaries provide perspective and insight on what went right, what went wrong, and how things might have gone differently in these culturally challenging situations. These broad generalizations are just that: broad generalizations. In addition, diet and exercise do not have a prominent place in the daily activities of the Hispanic family. needs and experience of less acculturated Latino clients who are mostly from Mexico and Central America, and represent a large segment of the Latino community in Southern California. Cold linseed tea and hibiscus flower tea for diabetes. Our Health. These may include antioxidants, probiotics, or a combination of medications to target any of the contributing factors. Because many health beliefs and behaviors are culturally-based, it follows that when two different cultures come together in a health care setting, a collision of expectations often occurs. In one survey of Mexican American nurses, family support was identified as one of the most important areas to which health care providers should attend while caring for Latino patients. In some studies, the rate of non-adherence ranges between 31% and 44% among Latinos (Lanouette et al., 2009). 35% less heart disease and 49% less cancer; A lower death rate overall, but about a 50% higher death rate from diabetes; 24% more poorly controlled high blood pressure; 23% more obesity; 28% less colorectal screening. 15 supp. Double or hyphenated Latino surnames may seem complicated, with the father's name preceding the mother's. These terms are derived from the Spanish verb curar, which means to heal. She says that since her husband died, she has lost interest in what might happen to her in the future. As with any circumscribed ethnic group, there is, of course, enormous cultural heterogeneity among Latino patients-to the point where it seems almost ludicrous to try to identify broad cultural tendencies across such diversity. However, the most useful technique is teach back or show me: having patients repeat their care instructions until they do it correctly. National Prevention Week is a SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance use and mental health issues. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Rather than operating on the ideal of an informed, active individual who makes decisions based on his or her own personal good, many Latino cultures consider as paramount the individual's obligation to the family and broader community. The aim of this study is to examine surgical management and overall mortality among different subgroups of women who self-identify as Hispanic. By the year 2050 that figure is expected to rise to 24 percent of the total U.S. population. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. Animal-based medicines are also used, including snake oil, which is obtained from the fat of snake skins, and bufo toad medicine, which contains a powerful psychedelic. Lack of third party reimbursement for professional interpreter services exacerbates this problem. www.behaviorfrontiers.com. The point deserves emphasis: Health care providers must be cautious not to oversimplify the values, customs, and beliefs that characterize any ethnic group-especially one as heterogeneous as Latinos. From the upstairs hallway of our home, I watched my great-aunt prepare for the cleansing. (Kaiser Foundation Health Plan, 2001): 4. First-generation immigrants are likely to seek out curanderos, whereas their children may scoff at the idea. High level of belly fat or metabolic syndrome. These materials focus on the challenges that can confront Hispanics in American health care settings. Addressing patients properly can be another challenge. A chaperone is often appreciated if a same-sex physician is not available. Abdominal pain may be attributed to empacho, or food stuck in the intestine. Religion can be a protective factor for mental health in Latinx/Hispanic communities (faith, prayer) but can also contribute to the stigma against mental illness and treatment (demons, lack of faith, sinful behavior), so targeting religious institutions to help encourage good mental health and treatment-seeking is important. Among U.S. states, New Mexico has the highest percentage of Hispanic ancestry, at 47 percent (as of July 1, 2012). In a 2002 report from the Institute of Medicine, more than 175 studies were cited to document this disparity.6 In an attempt to address this problem, the National Standards for Culturally and Linguistically Appropriate Services (CLAS) were released in 2001 by the Office of Minority Health of the U.S. Department of Health and Human Services.7 Fourteen guidelines were published, which were organized around three main themes: culturally competent care, language access services, and organizational supports. The Immigration Reform and Control Act of 1986 granted amnesty to immigrants who came to the U.S. before 1982; but the northward trend from Mexico and other parts of Latin America has continued since then, and many who have crossed the U.S.-Mexican border now live in the United States illegally. Keeping these cautionary notes in mind, the cases and commentaries in this section seek to address numerous issues that arise in the course of providing clinical health care for Latino patients of various backgrounds. America is rapidly changing as a cultural collision between Latino and white culture transforms lives on both sides of the border. Hispanic refers to people who speak Spanish and/or are descended from Spanish-speaking populations, while Latino refers to people who are from or descended from people from Latin America. Cross-cultural interviewing can be facilitated by following specific guidelines, and several mnemonics have been developed for use by physicians. Topics. Some trials examined overall CAM use, whereas others looked at. As with any patient, Latinos should be treated as individuals first, while exploring possible cultural distinctions. One exception is the Methods for the Epidemiology of Child and Adolescent . The term "Latino" has become more commonly used in recent years to describe those whose primary ethnic heritage stems from Latin America. SAMHSA Blog. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service . Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. Fluegelman, Andrew, ed. The agency is contracted with the leading insurance carriers and works diligently to secure contracts with additional funding sources on an on-going basis. Recent immigrants often feel lonely and can have culture shock, fears of deportation, and financial problems; depressed mood may manifest as headaches and somatic symptoms. Compared to White people, Hispanic/Latino people are less likely to receive treatment for depression, anxiety, and other behavioral problems. Copyright 2023 American Academy of Family Physicians. , may be one strategy to increase treatment . Specifically, to Latin America, to people from the Caribbean, South America, and Central America. Hispanic and Latino are often used interchangeably though they actually mean two different things. Again, it is imperative to stress that these values represent broad generalizations that may or may not apply to any individual patient or in any given situation. In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. In Santa Clara County the figure is 25.7 percent-over a quarter of the total population. Materials are available in English and Spanish. You then schedule a return visit, during which an interpreter will be available. She agrees to start taking medications, but does not refill her prescriptions or lose weight. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care. Missing data was handled using this carry-forward method. Stigma of psychological treatment, belief that problems should be addressed at the family level (familismo), a misunderstanding or belief that treatment will not help with a child's behaviors, a . Genetics, environment, and life experiences can all have an impact on . Other healing specialties include yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists).21, Symptoms are often interpreted differently based on cultural presuppositions. Instituting more culturally competent care is likely to improve treatment adherence and health outcomes. Identifying behavioral health problems is very important to the plan. These instructions can be studied by the patient or translated when time permits. National Prevention Week 2020 is about Our Lives. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Emotional distress often presents with headaches (dolor de cabeza) or other physical symptoms instead of depressed mood.9 Consequently, a high index of suspicion is needed to recognize adjustment reactions or depression. 1 (Sept. 2007). Cysticercosis is caused by consumption of contaminated with pork tapeworm. Some cultural barriers may be overcome by using the teach back technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. Home remedies, along with "lay healers" are also an integral part of the healthcare regimen for families in this culture. Addiction is a chronic, yet treatable brain condition similar to other chronic illnesses like diabetes. Moreover, 32.7 percent (nearly one-third) of all U.S. Latinos completely lacked health insurance that year, compared with 15.3 percent in the general population; and nearly half of Latinos reported being uninsured at some point during the previous year.9 Latinos are nearly two and a half times more likely than whites to report that they have no regular doctor.10 Even among many insured Latinos, coverage and care are far from adequate. Yet Latinos are at particular risk for diabetes mellitus, tuberculosis, hypertension, HIV/AIDS, alcoholism, cirrhosis, and death from violence.4 There is also a disproportionately high prevalence of acute care in the treatment of Latinos; that is, too often patients delay medical care until their conditions worsen and necessitate immediate attention. | Mar 1, 2011. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. By 1852, over 25,000 Chinese immigrants had arrived, and by 1880, over . According to Pew Research, a law passed by Congress in 1976 defined Hispanics as . As Hispanics continue their ascent as the largest and fastest growing minority group in the U.S., tension points between the healthcare and the Hispanic communities are growing as well, fueled by the lack of outreach from the former to the latter. When in doubt, the best policy is to ask the patient how he or she would like to be addressed.26. Using the LEARN model, you listen to her story about her poor control of diabetes and frustration with her diet. Hayes-Bautista relayed that one important theme presented in the collaborative workshops is how . The cases and reflections illustrate the kinds of challenges patients and health care professionals face when they come from different cultures and speak different languages. 8Holly Mead et. The largest and fastest growing minority population in the United States today is commonly referred to as "Hispanic" or "Latino." This traditional food is high in fiber and pectin and lowers lipid levels by binding bile acids; when eaten with other foods, it reduces the glycemic index of the meal by 50 percent. Intense but brief release of emotion thought to be caused by family conflict or anger, No immediate treatment other than calming the patient, Childhood condition characterized by irritability and diarrhea thought to be caused by abrupt withdrawal from the mother's breast, Holding the child upside down or applying gentle pressure to the hard palate, Constipation, cramps, or vomiting thought to be caused by overeating, Abdominal massage and herbal purgative teas; an egg passed over the abdomen supposedly sticks to the affected area, Steam inhalation and herbal treatments, including eucalyptus and mullein (gordolobo), Pelvic congestion and decreased libido thought to be caused by insufficient rest after childbirth, Cold air that is thought to cause respiratory infections and earaches, Steam baths, hot compresses, stimulating herbal teas, A hex cast on children, sometimes unconsciously, that is thought to be caused by the admiring gaze of someone more powerful, The hex can be broken if the person responsible for the hex touches the child, or if a healer passes an egg over the child's body; the egg is then broken into a bowl of water and placed under the child's bed; child may wear charms for protection, Unnatural illness that is not easily explained, Temporary paralysis of the face or limbs, often thought to be caused by a sudden hot-cold imbalance, Posttraumatic illness (e.g., shock, insomnia, depression, anxiety), Barrida ritual purification ceremony (herbs used to sweep patient's body) repeated until the patient improves, Eaten to alleviate hypertension and prevent arteriosclerosis; garlic juice is applied to stings and spider bites, Anticoagulant effect at high doses; avoid high doses in patients taking coumadin (Warfarin); high doses can cause heartburn and bad breath; reduces effectiveness of saquinavir (Invirase), Boiled flowers are used externally on bruises, For topical and homeopathic use only; avoid internal use (except for homeopathic preparations, which are considered safe); increased gastroenteritis and dyspnea risk with ingestion, Hepatotoxicity risk from pyrrolizidine alkaloids (in leaves) with high or prolonged doses, Spice used as antispasmodic and for upper respiratory infections; although promoted as a hypoglycemic agent, recent research is conflicting, Use with caution in patients taking hepatotoxic drugs; safe in usual food quantities, Cilantro (cilantro [leaf] or coriander [seed]), Tea used for anxiety, stomach cramps, and inflamed gums; more recently popularized for increasing the urinary excretion of heavy metals, No safety concerns, although there have been recalls because of salmonella and pesticide contamination, Oil used topically for toothache and bad breath, Eugenol in clove oil may affect blood clotting; toxic if ingested, especially in children, Tea or syrup used as an expectorant, a diuretic, and for constipation, liver problems, and gall stones; also used to induce menstruation, High doses may cause vomiting; avoid in pregnancy; no known interactions, Leaf tea used for anxiety and lethargy, most popular as an aphrodisiac, Theoretical concern of cyanogenic glycoside toxicity with higher doses, Tea used for intestinal parasites; herb is added to beans to prevent flatulence, Chenopodium oil is also used as an antihelmintic but may be toxic (ascaridole content), Tea used for upset stomach and menstrual cramps, and to prevent diarrhea, Long-term ingestion causes absinthism (trembling, vertigo, thirst, delirium); thujone in the essential oil is neurotoxic and may cause seizures, Boiled leaves used for asthma in vaporizers; popular in lozenges for sore throat; also sometimes used as topical disinfectant, Ingesting eucalyptus oil may cause vomiting, diarrhea, delirium, and convulsions; avoid using in vaporizers for children younger than six years, Tea used to treat cough and sore throat; one study reports use for otitis, No known safety concerns (insufficient data) or drug interactions, High doses may cause anticoagulant effects and excess gas or bloating, Fruit juice used for fever, upper respiratory infection (classic cooling herb), and hypertension, Weed leaf used externally for burns, bruises, mouth sores, and hemorrhoids; tea taken orally for respiratory infections, Eaten as part of diet; has antidiabetic, anti-inflammatory, and laxative properties; also used as hangover treatment and for hyperlipidemia, May inhibit drug absorption; excess consumption may cause diarrhea and nausea, Leaf tea used to treat cough, indigestion, and, Safe in small quantities in food, but contains monoterpene ketones, which can cause toxicity (intestinal irritation, kidney damage, abortion, seizures), Toxic herb used to induce menstruation and abort fetuses, Toxic; avoid oral use; may cause renal and hepatic damage; furocoumarins can cause skin photosensitivity, Tea from dried flowers used to relieve cough, Yerba buena (mints, including spearmint and, Mint tea relieves upset stomach and headaches, Safe in usual quantities, but spearmint oil is a mucous membrane irritant and potentially toxic when ingested, Topical use for burns; occasionally ingested, Safe for topical use; juice is relatively safe; ingestion of aloe resin (a purgative) may cause diarrhea, hypoglycemia, hypokalemia, and prolonged bleeding; potential interactions with hypoglycemics and cardiac glycosides, Safe as a food seasoning, toxic alveolitis reported from inhaling lemongrass oil, A Physician's Practical Guide to Culturally Competent Care, Hispanic Center of Excellence (Baylor College of Medicine and University of Texas-Pan American), Language Line Services (interpreter services), Office of Minority Health: Cultural Competency, Office of Minority Health: National Standards for Culturally and Linguistically Appropriate Services (CLAS), Oregon Health & Science University: Spanish education handouts for clinicians, Tool for Assessing Cultural Competence Training (TACCT) Resource Guide, Transcultural Nursing: Diversity in Health and Illness, University of Washington Medical Center: Culture Clues tip sheets.