Question

George Garcia, a 23-year-old construction worker, and his wife, Anita, age 20, bring their 4-month-old daughter to the emergency room of a small community hospital. They speak broken English. They have another small child with them, as well as two older women. They are very worried about the infant, who they say has been unable to retain feedings of diluted cow's milk. Now, because of poor sucking and increased sleeping, the infant has not had anything by mouth for the last 24 hours. When asked, the parents say the infant has been sick for 3 or 4 days. The infant is listless, and her eyes are sunken. Anita is newly pregnant with her third child.

The Garcia family lives together in a small house 2 miles from the Mexican border in a predominantly Mexican American neighborhood.. The padrinosor compadres (godparents) live next door to the Garcias. The family is Catholic, and a medal of Our Lady of Guadalupe is on a chain around the older child's neck. The baby has a bracelet with a seed in it around her wrist. The 2 older women with the Garcias are the mothers of George and Anita. George's mother is a curandero, and has been treating the baby with weak specially brewed teas.

6..  Susto and empacho are 2 more conditions that may occur. Describe these, and the treatment.

7. What is the hot and cold theory of disease? How are foods used in this case? What are common foods and food rituals for this heritage group?

8. The infant is sent home with the family with instructions to provide 1 ounce of electrolyte solution every hour. The family is asked to return to the clinic the next day at 10:00 AM to be sure the baby's health is improving. Who in the family should receive the education about care for the baby? How could the temporal relationships of this heritage group affect the family's ability to carry out instructions?

9. In order to provide culturally sensitive care to Anita during her pregnancy, what pregnancy and childbearing practices should the health care professional be familiar with?

10. George was unable to go to work today because of concern for the baby's health. Describe how work is viewed by this heritage group when newly immigrated to the United States.

11. A "stereotype" is an oversimplified "conception, opinion, or belief about some aspect of an individual or group" (see the discussion on p. 8 of your text). A stereotype here in North Dakota could be that all people of Norwegian heritage say "uff-da", and eat a disgusting fish called lutefisk. Name 2 stereotypes that you have heard about people of Mexican heritage.

Answer 1

6.Susto: (scare) – Susto is a “fright sickness” caused by a frightening or traumatic experience that temporarily scares a person’s spirit from their body. Symptoms include chill, lethargy, anxiety, depression, insomnia,weight loss and irritability. Culturally stressed adults (women more often than men) are most likely to suffer from susto, although children may also be afflicted.

The onset of the disease generally follows a sudden frightening experience such as an accident, a fall, witnessing a relative’s sudden death, or any other potentially dangerous event.

The treatment includes herbal teas, covering the face with a cloth and sprinkling holy water, and spitting a mouthful of water or alcohol into the patient’s face unexpectedly, and cleansing ceremonies called limpieza performed by spiritual healers called curanderos. Treatment is considered to be a ritual involving lying down as if on a cross, with a curandero trying to summon the soul to come back to the body.

Empacho: (indigestion, or upset stomach) -

A form of stomach upset which is believed to be caused by undigested food getting stuck to the walls of the stomach or intestines causing an obstruction. It is thought to result of dietary practices including excessive eating, not chewing food completely, consuming spoiled foods, eating at the wrong time of day, or combining the wrong foods.

Symptoms include anorexia, vomiting, diarrhea, bloating, cramps, and stomachache.

Treatment includes dietary restrictions, herbal teas, abdominal massage with warm oil, and pinching the skin on the back and pulling it until it pops. Most treatments for empacho are harmless. However, multiple cases of lead toxicity have been documented among children whose empacho was treated with powdered folk remedies (called greta, azarcòn, or albayalde) containing high concentrations of lead oxide.1-2

7. Hot and cold theory Of Disease:

In the Hispanic theory of disease, ailments are thought to develop as a result of an imbalance between 2 humors: hot and cold. Based on this principle, specific diseases and conditions are classified as hot (caliente) or cold (frio). Consequently, the medications, remedies, and foods that are used to treat them are assigned descriptors accordingly. Therefore, the treatment recommended for any condition will usually have the opposite classification or properties. For instance, cold diseases are treated with hot remedies, while hot diseases are treated with cool or cold remedies.

8.Anita and particularly George”s mother should be educated about the care of child.

9. The following are the childbearing practices health care professional be familiar with to provide culturally sensitive care to Anita during her pregnancy

. Prenatal diet and nutrition Provide another opportunity for incorporating cultural concepts. Their culture practice a system of cold/hot body balance. Pregnancy is believed to be a hot condition and, therefore, foods that are considered hot are restricted. They believe the body is already out of balance and do not want to exacerbate the condition. It is important for the childbirth educator to carefully assess culturally diverse diets to ensure that the mothers receive adequate nutrition. For example, the educator can suggest foods that are rich in protein and not considered hot. Women from hot/cold-balance cultures may also refuse to take prenatal vitamins and iron supplements because they are viewed as hot. The educator may suggest taking the vitamins with a cold drink, such as juice, to balance the hot and cold Food-guide may be incorporated into the curriculum to show mothers how to eat properly by selecting nutritious items among the foods to which they are accustomed.

Pain in Childbirth

Pain and pain management throughout the course of labor is another major topic of discussion at childbirth education classes and another area where cultural awareness of the interpretation of the pain experience across cultures must be included. The idea of pain and pain management can be a source of confusion among health-care providers who are not aware of cultural differences and cultural practices in response to pain. It is very important for the childbirth educator to emphasize the fact that there is no one right way to deal with the pain of labor and that pain is a personal experience.

Just as important as the expression of pain are the cultural differences and attitudes toward the use of pain-relief strategies. Childbirth educators can ask class participants how they handle pain and if, instead of traditional medications, they use specific rituals, treatments, or methods when in pain. They may choose to share with the group how their culture views pain management and how they plan on dealing with their pain.Encouraging this type of discussion promotes cultural sensitivity and understanding among the entire group. The participants may learn a new technique to which they have never before been exposed. Additionally, the discussion promotes an understanding of cultural differences among them. Meanwhile, the educator is responsible for presenting the evidence-based information on pain-management strategies without personal bias.

Breastfeeding and Postpartum Care

The postpartum period is often discussed in detail during childbirth education classes and, again, presents a unique opportunity to appreciate the cultural diversity of the class. It is crucial for the educator to be aware of common assumptions and beliefs with regard to the postpartum period. Breastfeeding is a practice where cultural differences become apparent.. They perceive colostrum, the early milk, to be bad or spoiled. Yet, despite their custom of waiting for the appearance of the “true milk,” some women from modest cultures may be embarrassed to expose their breasts while still in the hospital and may choose to wait until they arrive home before breastfeeding. The educator must provide all of the facts to expectant parents about the importance of proper nutrition for the newborn and explain the benefits, as well as the challenges, of breastfeeding. Stressing the importance of personal choice when provided with all necessary information allows for women of all cultures to make an informed, personal decision. Open discussion about the topic will again provide the chance for women of various cultures to speak about their beliefs and preferences.