Download Culturally Competent Services for Hispanic/Latino

Latinos
Things to keep in mind while servicing Latino families
Involve family members: Hispanic/Latino families traditionally emphasize
interdependence over independence and cooperation over competition. Family members
are more likely to be involved in the treatment and decision-making process for a
consumer of services. Allow for several family and friends to participate in a
consultation, and communicate with the group. The consumer may not be the key
decision-maker for describing symptoms, deciding among treatment options, or
complying with recommended treatment. Determine the matriarch and patriarch, and
notice if the acculturated children or non-family members are the spokespeople.
Show respect: Always be respectful, and explain without condescending. Health
providers, as authority figures, need to take seriously the responsibility and
respeto conferred on them by many Hispanic/Latino patients. One way Hispanic/Latinos
show respect is to avoid eye contact with authority figures. Do not misinterpret this
respectful behavior as a sign of disinterest. Address elders in traditional ways (such as
below eye level if you are younger than they are), and be mindful of parents and elders
when an acculturated child or a health mediator is the spokesperson. The older
Hispanic/Latino adult patient may terminate treatment if he or she perceives that respect
is not being shown.
Get personal: Hispanic/Latinos typically prefer being closer to each other in space than
non-Hispanic/Latino whites do. When non-Hispanic/Latino providers place themselves
two feet or more distance away from their Hispanic/Latino patients, they may be
perceived as not only physically distant but also uninterested and detached. Overcome
such perceptions by sitting closer, leaning forward, giving a comforting pat on the
shoulder, or other gestures that indicate an interest in the patient.
Encourage the asking of questions: Out of a sense of respeto, many Hispanic/Latino
patients will avoid disagreeing with or expressing doubts to their health care provider
about the treatment they are receiving. They may be reluctant to ask questions or admit
they are confused about instructions or treatment. There is a cultural taboo against
expressing negative feelings directly. This taboo may manifest itself in a patient's
withholding information, not following treatment orders, or terminating medical care.
Respect traditional healing approaches:
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Some Hispanic/Latino people believe that disease is caused by an imbalance
between hot and cold principles. Health is maintained by avoiding exposure to
extreme temperatures and by consuming appropriate foods and beverages.
Examples of "hot" diseases or states are pregnancy, hypertension, diabetes, and
indigestion. "Cold" disease examples include menstrual cramps, pneumonia, and
colic. The goal of treatment is to restore balance. "Cold" diseases are treated with
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"hot" remedies, and vice versa. Inter- and intra-group variations exist with regard
to beliefs about the hot and cold theory of disease.
Traditional medicine in most Hispanic/Latino countries has an extensive list of
folk remedies. Examples include using garlic to treat hypertension and cough;
chamomile to treat nausea, gas, colic, and anxiety; a purgative tea combined with
stomach massage to cure lack of appetite, stomach pains, or diarrhea; and
peppermint to treat dyspepsia and gas.
Providers may encounter the concept of a bilongo or hex, for which the proper
diagnosis and treatment require consulting a santero/santera or healer.
The evil eye (mal de ojo) appears in several Hispanic/Latino cultures. In children,
it is thought to cause vomiting, fever, crying, and restlessness. It is believed to be
brought on by an admiring look from a person with a strong eye. It can be
diagnosed and treated with a barrida (Puerto Rico) or limpia (Mexico)—a
sweeping of the body with eggs, lemons, and bay leaves, accompanied by prayer.
Familia : Hispanic/Latino families traditionally emphasize interdependence over
independence and cooperation over competition. Therefore family members are likely to
be involved in the treatment and decision-making process for a patient. Including family
members in the consultation is often critical to the care of the patient and may contribute
to a patient ability to adhere to the recommended treatment. Hispanic/Latinos include
many people in their extended families, not only parents and siblings, but grandparents,
aunts, uncles, cousins and compadres, close friends, and godparents (padrinos) of the
family's children. When ill or injured, Hispanic/Latino people frequently consult with
other family members and often ask them to come along to medical visits.
Hispanic/Latino extended families and the support role they play for patients may run
counter to certain institutional rules, such as hospital policies that limit patients to two
visitors.
Respeto (respect): For Hispanic/Latinos the intimate confines of extended families,
close-knit Hispanic/Latino communities, and traditional patriarchal networks are
mediated by respeto (respect). Respeto implies a mutual and reciprocal deference.
Respeto dictates appropriate deferential behavior towards others based on age, sex, social
position, economic status, and authority. Older adults expect respect from those younger,
men from women, adults from children, teachers from students, employers from
employees, and so on.
Personalismo: Hispanic/Latinos tend to stress the importance of personal relationships,
which is why so many Hispanic/Latinos continue to rely on community-based
organizations and clinics for their primary care. Warm, friendly, and personal providers
who take an active interest in the patient life are more likely to earn the loyalty, respect,
and confidence of their clients. How are you doing today? How did your daughter's
graduation go?" Such a greeting implies personalismo, conveying to the patient that the
provider is interested in her/him as a person .
Confianza (trust): Over time, by respecting the patient's culture and showing personal
interest, a health care provider can expect to win confianza (trust). When there is
confianza, Hispanic/Latinos will value the time they spend talking with their health care
providers and believe what they say. Confianza means that the provider will have their
best interests at heart.
Espiritu- (spirit), body, and mind: Health care professionals often work within the
structures of mainstream medicine, which provides separate physical and mental health
care. Hispanic/Latino culture, on the other hand, tends to view health from a more
synergistic point of view. This view is expressed as the continuum of body, mind, and
espiritu(spirit).
Traditional Medicine -Within the Hispanic/Latino community there is an extensive
practice of traditional medicine carried out by curanderas, espiritistas, or healers. In
urbanized barrios this tradition has been carried on in part by Hispanic/Latino
pharmacists, familiar with both traditional treatments like TE de manzanilla (chamomile
tea) as well as modern prescription medicines such as antibiotics. Many Hispanic/Latinos
will use traditional medicine in combination with other approaches.
Distance from family and inter-generational family conflict
Migration and separation from family may cause stress in Hispanic/Latino patients who
are used to making decisions in collaboration with other family members. The values of
young immigrant workers or couples newly arrived in the United States may clash with
those of other family members. Similarly, teenagers who quickly acculturate to the
United States and the manners of their peers may demand to be treated as individuals and
show signs of typical adolescent conflict with their parents and other relatives who
maintain traditional values and customs.
The desire for personalismo in the provider-patient relationship
Hispanic/Latino loyalty to the individual provider has significant implications for
continuity of care. If a health care professional leaves a health center for another in close
proximity, their Hispanic/Latino patients may follow him/her to the new setting. If the
health professional leaves the area however, their Hispanic/Latino patients may stop
treatment, unless the provider has made introductions to the new health care provider and
established a transitional relationship between them based on personalismo.
Unfortunately, personalismo tends to conflict with the health system trend towards
managed care, the eight-minute visit, and physician rotations in public clinics.
Resource Consulted: Management Sciences for Health