A B

Activities during pregnancy - The expectant mother may be discouraged from prolonged inactivity during pregnancy to prevent the fetus from becoming stuck to the uterus and causing a long and painful labor and delivery. This belief may cause conflict if pregnancy complications or hypertension dictate bedrest. In such cases, the health care provider should carefully explore both the patient's perceptions in this area and those of her family to ensure a healthy outcome for both the infant and the mother. A pregnant woman from Latin America may also avoid viewing lunar eclipses, which are believed to cause cleft palate, or stretching her arms over her head, which is believed to cause knots in the umbilical cord. She may also postpone celebrating a baby shower until after the birth to avoid courting bad luck and limit her consumption of whole milk for fear that it may cause the fetus to grow too large to permit a vaginal delivery. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.)

Aire de Oído - Earache

Symptoms
· Earache
· Fullness or popping of ears
· Ear infection

American Public Health Association: Hispanic Health Culture Sketch (http://www.apha.org/ppp/red/LatinAmeric.htm)
A review of cultural considerations for Latin Americans, especially maternal health issues.

Assistance with Care - Hispanics prefer to assist seriously ill family members in daily tasks for the duration of the illness. Such pampering, while often irksome to health care providers, is quite understandable as a means of demonstrating concern for the patient and thereby strengthening familial bonds. A male patient may also demand that family members cater to his every wish regardless of his actual level of incapacity to demonstrate that he is still in control and maintain his role as the patriarch.

Authority Figures - In Hispanic culture, authority figures are expected to know all the answers and issue commands rather than seek input from someone lower in the social hierarchy. Their authority is not to be questioned.

Azogue - Remedies containing poison. Sold in small shops catering to Hispanics, Azogue is believed to possess spiritual powers. However, it is elemental mercury, a highly toxic substance. http://www.calpoison.org/public/mercury.html for more info on mercury. http://nolead.home.mindspring.com/folkremedies.htm for more info on lead poisoning and other names for toxic remedies.)

Bilis - Bile in Blood/Anger

Symptoms
· Upset stomach
· Vomiting
· Diarrhea
· Dizziness
· Nightmares
· Migraine headaches

Birth (http://wwwdev.lemoyne.edu/pa_students/hispanicamerican.htm)
Includes a list of health beliefs regarding birth in the Hispanic culture

Breast Cancer and Hispanic American Woman (http://www.4woman.gov/faq/bc-hispanic.htm)
How common is breast cancer in Hispanic women? In the United States, breast cancer is less common in Hispanic women than it is in all other ethnic groups, with the exception of American Indian women. In addition, from 1990 to 1997 the number of Hispanic women who have been diagnosed with breast cancer has decreased. Gives statistics on breast cancer in Hispanics.

Breastfeeding - Latinas in the United States are markedly less likely to breastfeed than are non-Hispanic women. Some of the reasons include the belief that formula is a healthier alternative, a reluctance to expose the breasts in order to breastfeed, and the feeling that breastfeeding is less modern than bottle feeding. Some women who do wish to breastfeed postpone it until their milk comes in because of the concern that colostrum is not fit for the baby to consume.

Breastfeeding,advantages of - Breastfeeding is beneficial to the infant's health in that the mother's milk provides important nutrients. Colostrum, the substance secreted prior to milk production, contains key antibodies. Latinas in the United States are markedly less likely to breastfeed than are non-Hispanic women. Some of the reasons include the belief that formula is a healthier alternative, a reluctance to expose the breasts in order to breastfeed, and the feeling that breastfeeding less modern than bottle feeding. Some women who do wish to breastfeed postpone it until their milk comes in because of concern that colostrum is not fit for the baby to consume. To encourage breastfeeding, the provider should ensure privacy and educate the new mother about the health benefits to the infant.

Breastfeeding Cultural and Religious Beliefs that Shape Health Care Choices (http://wwwdev.lemoyne.edu/pa_students/hispanicamerican.htm)
La Moyna College website which includes information on Mexican, Puerto Rican, Cuban, Central/South American.

Bruja - A bruja is a witch who may be called upon to cast spells or to counteract the effects of previous witchcraft.

Body language - Body language is one of the most important elements of nonverbal communication. Hence, the health care provider should monitor his gestures, stance, and facial expressions to ensure that they are congruent with his words and do not inadvertently convey disapproval of the patient.

Border pharmacy - Hispanic patients may cross the Mexican border to obtain medications from border pharmacies. Many common medications do not require a prescription.

Bundling - In Hispanic cultures, it is common to bundle babies in multiple layers and to pile warm blankets on a person with a fever. However, such practices may lead to dangerous overheating.

C

Car seats - Explaining the importance of and proper use of car seats to Hispanic parents is extremely important because they are less likely to use these devices than other ethnic groups. Consequently, Hispanic children are at high risk for death due to motor vehicle accidents.

Casual contact - The provider should take the time to dispel the common misperception that HIV can be spread by casual contact such as hugging, kissing, or shaking hands or by contact with toilet seats, doorknobs or telephones used by an infected person. It is not spread by mosquitoes. It is also not likely to be spread through food preparation or fist fighting, although there is a remote possibility of transmission if blood contact occurs in either scenario.

Caída de Mollera - Fallen Fontanelle
This condition would generally be diagnosed as dehydration. Is commonly thought to be caused by the child falling or being dropped or bounced, or by pulling the nipple out of the child's mouth too vigorously.

Symptoms
· Colic
· Listlessness
· Infant's inability to suck
· Loss of appetite
· Vomiting
· Diarrhea
· Fever

Treatment - pushing the palate back in place; holding the child upside down over a pan of water; and/or applying a poultice, usually of fresh soap shavings, to the depression.

Cancer

Hispanic women with breast cancer benefit from Spanish-language support groups (http://www.nurseweek.com/news/features/01-01/cancer.asp)
Las Isabelas, a breast cancer support group for Hispanic women, offers members the opportunity to share their experiences with the disease in a culturally specific context. Report on success of Spanish language breast cancer support group.

Latinas at Higher Risk for Cervical Cancer than Other American Women (http://www.cap.org/media/mediainfo/archives/his_pap_release.html)
Many Latinas in the United States may be risking their lives by failing to get annual Pap smear, a lifesaving test that could reduce the likelihood of their developing cervical cancer. 1998 news report on the higher incidence of cervical CA among Hispanics.

Casual contact - HIV - The provider should take the time to dispel the common misperception that HIV can be spread by casual contact such as hugging, kissing, or shaking hands or by contact with toilet seats, doorknobs, or telephones used by an infected person. It is not spread by mosquitoes. It is also not likely to be spread through food preparation or fist fighting, although there is a remote possibility of transmission if blood contact occurs in either scenario.

Catholicism/Religion - Roman Catholicism is professed by 91.12 percent of the population, but only 11.55 percent attend church at least one time per month. (source: http://www.lhmint.org/facts/mexico/) Even Catholics who do not attend Mass on a regular basis may derive great comfort especially in times of stress from the articles and images associated with the religion. The culturally aware health care practitioner recognizes this and respects the patient's faith and may even ask he patient if he or she wishes to consult with a priest to alleviate fears or assist with end-of-life issues.

Cat's Claw (uncaria tomentosa), - a large woody vine that grows in certain tropical areas of South America. The bark has been used medicinally for centuries to treat a variety of ailments including intestinal disorders, fevers, ulcers, arthritis, and wounds. The alkoloid compounds do indeed show promise in protecting against damage to DNA and in stimulating the immune system. As such, the vine is being studied in the US in the treatment of AIDs, cancer, and viral diseases. However, the American Cancer Society cautions that it should not be used by people taking anti-ulcer, high blood pressure, anticoagulant, hormonal or insulin medications. Also, the consumer does not know the amount of active ingredient in a bottle of Cat's Claw as herbal supplements are not closely controlled like pharmaceuticals.

Chamomile tea - Benign remedies: Chamomile tea, often prescribed by traditional healers for minor stomach upset, is benign. As such, the health care provider may wish to recommend it to patients who need to consume warm liquids. Because it a soothing drink with which they are familiar, they are likely to heed such advice. URL: http://chico.rice.edu/projects/HispanicHealth/Courses/mod7/mod7.html

Chaparral or gobernadora - Chaparral, known in Spanish as gobernadora, is used a folk remedy for a variety of ailments, including arthritis, cancer, venereal disease, and tuberculosis. The herb can be administered topically as a poultice or brewed as a tea. However, it is toxic when ingested.

Children

Cultural and Religious Beliefs that Shape Health Care Choices
(http://wwwdev.lemoyne.edu/pa_students/hispanicamerican.htm)
A website which covers different topics on Hispanic Americans including a short discussion on children in Hispanic culture.

Circumcision - Far from being a universal practice, circumcision is actually quite uncommon outside the United States. In Spanish-speaking countries, it is generally only practiced by Jews or Muslims. However, Hispanic parents may have difficulty conveying their reluctance to have a son circumcised if they believe the health care provider is in favor of the procedure.

Cold and hot principles - Traditional Hispanic health beliefs equate health with balance between "hot" and "cold" elements. Hot and cold do not necessarily refer to actual temperature but rather to quality of the item. Hot illnesses or conditions can be counteracted by cold foods or medicines and vice versa.

Cold Water - During the six week post-partum period, cold foods, including ice water are avoided due to the belief that they will impede the emptying of blood from the uterus and birth canal. The new mother will also avoid acidic and spicy foods during this time to avoid excessive blood flow or cramping.

Collaborative Treatment - In the United States, patients expect a collaborative treatment approach in which they actively seek information about their conditions, question their health care providers and feel free to openly differ in opinion.

Collectivism Cultures vary in the extent to which the value individualism and or bonds with and loyalty to the group. While mainstream American culture is noted for its emphasis on independence and self-reliance, the Hispanic culture place much greater value on maintaining close ties to family and friends.

Cólico - Colic

Symptoms
· Abdominal cramps
· Indigestion
· Crying
· Stomachache
Treatment - manzanilla (chamomille) tea is often given

Latino Coalition for a Healthy California Cultural Diversity (http://www.diversityrx.org/HTML/MAP.htm)
This site, called Diversity Rx, is a resource for decreasing barriers to health care for Hispanics.

Communicating with non-native speakers - While it would be impossible to avoid all potential distortions, the health care practitioner can take some practical steps to decrease their occurrence and foster constructive communication when using an interpreter. To increase the likelihood of detecting a distortion, the health care provider should watch the patient's nonverbal communication for congruence with the message. Obviously such observation would not be possible when using a telephone interpreter.

Condom - When used properly, a latex condom protects against pregnancy and sexually transmitted diseases, including the HIV virus. It is important to educate patients on the proper use of the condom to ensure adequate protection.

Context - Hispanics belong to a high context culture in which communication is based on nuances and the surrounding circumstances rather than the literal meaning of the written or spoken word. Hence, high context cultures tend to emphasize the personal relationship between the parties, including their previous interactions and their respective positions in the social hierarchy. In contrast, low context cultures, such that of mainstream Americans, places more importance on the literal meaning of the written or spoken word.

Cravings - Antojos. It is a common belief in Hispanic cultures that a pregnant woman should indulge her food cravings to ensure a healthy pregnancy.

Cross-Cultural Funeral Rites (http://www.biomed.lib.umn.edu/hw/ccf.html)
Funeral traditions for many cultures including Hispanic cultures.

Cultural Competence.(http://www.culturediversity.org/index.html)
Transcultural Nursing basic concepts & case studies

Cultural Diversity, Alternative Medicine, and Folk Medicine (http://www.temple.edu/isllc/newfolk/medicine.html)
This essay first appeared in Perspectives from the Humanities, a bi-monthly, in-house publication of the Humanities Department at the Penn State College of Medicine and describes the necessity for and benefits of culturally diverse health care in the United States.

Curandera - The most common folk healer among Mexican Americans is the curandera, generally an older woman who is proficient in the use of herbs and prayers to counteract evil.

E

Eclipse - A common folk belief holds that if a pregnant woman views an eclipse, the baby may be born with a harelip (cleft palate).

Embrujamiento or hechizo, meaning witchcraft or hex, refers to a witch's curse that may result in bad health, miscarriage, bad luck, headache, anxiety, or depression. Victims are treated with prayer and a purification ritual known as a barrida.

Empacho - Blocked Intestine
Empacho is described as an obstruction in the stomach caused by a lump of food or gum lodged in the intestine. It is associated with eating too much or foods one does not like. Symptoms may include abdominal discomfort, constipation or diarrhea, bloating, vomiting. The blockage may be treated by stomach massage or purgatives.

Symptoms:
· Indigestion/Upset stomach
· Constipation
· Diarrhea
· Dizziness
· Nightmare
· Migraine headaches

Treatment - Rubbing the stomach or pinching the back to dislodge the bolus of food. A purgative or tea may also be given.

End-of-Life Issues - Hispanics often seek to withhold diagnoses of fatal diseases from family members to allow the terminal patient to maintain hope. They may also avoid the removal of life support from a vegetative patient based on the perception of heart rather than the brain as the seat of life. End-of-life issues may present challenges for health care workers treating terminal Hispanic patients. One of the defining elements of the American health care system is the conviction that patients have a right to know the full extent of their illness and prognosis. This value, however, often puts health care providers in direct conflict with Hispanic families who wish to withhold diagnoses of terminal diseases to avoid making the moribund patient lose hope. The belief in the overriding importance of hope is consistent with the Catholic position that faith is a virtue and the true believers may effectuate a miracle through their prayers. Another end-of-life issue that may arise with less acculturated Hispanics is the reluctance to remove life support from brain-dead patients based on the conviction that "life" comes from the heart rather than the brain.

Extended family - Unlike the mainstream American nuclear family, Hispanic families are extended to include aunts, uncles, grandparents, and other relatives. Compadres or comadres, very close male or female friends, assume an importance comparable to that of family members.

F

Fact sheet: Health Status Latino Health Status(http://www.lchc.org/health.cfm)
Informational sheet fact listing general and specific information on many diseases including HIV, mental health in Hispanics. Includes statistics etc.

Family Structure - The family is the cornerstone of the Hispanic culture. They are patriarchal with the wife and children in subordinate roles to the male head of the household. Hispanic families are generally extended to include aunts, uncles, grandparents, and other relatives.

Family members as interpreters - The use of family members as interpreters is surprisingly common given the myriad problems it entails, not the least of which is the flagrant violation of the patient's privacy. Patients may be reluctant to reveal sensitive or embarrassing information in front of a family member. Using relatives to interpret also heightens the likelihood of message distortion, a possibility with any interpreter. Distortions, which may be accidental or intentional, include the intentional or unintentional failure to convey a portion of the patient's message, the addition of statements that the patient did not actually make, or the twisting of the patient's meaning. While the use of any relative as an interpreter may be problematic, the use of younger family member can be especially damaging to the child as he or she is forced to assume a role of more authority than the adult patient, an inversion of the normal hierarchy in Hispanic culture. Moreover, the youngster is put in the extremely stressful position of hearing personal information and facing the possibility of being forced to relay bad news.

Family planning - Contraception may be a delicate topic with Hispanic patients due to the taboos against an open discussion of sexuality and the Catholic Church's prohibition against the use of birth control. The heath care provider should not assume that women who have had many children in a short period of time wish to prevent future pregnancies. Even those women who do wish to have a tubal ligation or begin using birth control may face opposition from their husbands, who associate multiple offspring with virility. The health care provider should also consider patient compliance and the common reluctance among Hispanic women to touch their bodies in determining which birth control method is most appropriate.

Family care of patient; Self care - The American health care system's emphasis on patient self-care to hasten recovery directly conflicts with Hispanics' belief that a patient should be assisted in daily tasks by his or her family for the duration of the illness. Such pampering, while often irksome to health care providers, is quite understandable as a means of demonstrating concern for the patient and thereby strengthening familial bonds. A male patient may also demand that family members cater to his every wish regardless of his actual level of incapacity to demonstrate that he is still in control and maintain his role as the patriarch.

Fatalism - Less acculturated Hispanics may hold a fatalistic view of life as controlled by divine will. Such thinking tends to discourage proactive health care and preventive measures. However, fatalism tends to diminish as acculturation increases and family income rises.

Female Modesty - Within the Hispanic culture, females are expected to remain virgins until marriage and maintain their modesty. As such, they may be reluctant to discuss reproductive issues or sexual practices and are likely to be uncomfortable having a gynecological examination by a male health care provider. As with any patient, sensitivity is paramount to ensure positive outcomes. The provider should broach delicate subjects with tact and ensure that the patient remains draped during examinations and procedures. If possible, a female provider should be available for pelvic and breast exams.

Female purity and modesty - Within the Hispanic culture, females are expected to remain virgins until marriage and maintain their modesty. As such, they may be reluctant to discuss reproductive issues or sexual practices and are likely to be uncomfortable having a gynecological examination by a male health care provider. As with any patient, sensitivity is paramount to ensure positive outcomes. The provider should broach delicate subjects with tact and ensure that the patient remains draped during examinations and procedures. If possible, a female provider should be available for pelvic and breast exams.

Folk Chiropracto - A sobador is a folk chiropractor who manipulates the patient's bones

Folk Illness

Common Latino/Hispanic Folk Illnesses
Orignal CHISPA Information

Folk Medicine, Alternative Medicine, and Cultural Diversity (http://www.temple.edu/isllc/newfolk/medicine.html)
This essay first appeared in Perspectives from the Humanities, a bi-monthly, in-house publication of the Humanities Department at the Penn State College of Medicine and, in a modified version, in the ethics column of the journal Alternative Therapies in Health and Medicine. It describes the necessity for and benefits of culturally diverse health care in the United States.

Folk Medicine in Hispanics in the Southwestern United States (http://riceinfo.rice.edu/projects/HispanicHealth/Courses/mod7/mod7.html)
Understand the origins and applications of Hispanic folk medicine; identify common Hispanic folk illnesses and their remedies; incorporate the knowledge of Hispanic folk medicine beliefs into the development of effective patient management and counseling plans. Excellent resource explaining traditional folk medicine.

Overcoming cultural barriers: Understanding Latino folk illnesses and health care issues.
(http://www.thechildrenshospital.org/publications/cfof/2000/00fall/1.cfm)
Article from Colorado on understanding folk illnesses.
When working with a Latino family, health care providers should be aware of folk illnesses and should ask the family if they suspect a certain illness.

Traditional healing practices in an urban environment (http://www.nybg.org/pr/urbanenviron.html)
The study catalogs and evaluates plants prescribed by traditional healers, documents the backgrounds of the healers and their diagnostic techniques, and examines the complexities of using traditional medical practices in the urban environment of a new country.

State Dept. of Health warns about dangerous Mexican folk remedies (lead poisoning) (http://www.doh.wa.gov/Publicat/2000_News/00-59.html)
The state Department of Health is issuing a warning about the danger of using certain types of traditional Mexican folk remedies. The remedies, known as azarcón and greta, contain high levels of lead that can make people who ingest them, especially children, very ill. 2000 report from Washington state.

Folk Beliefs about pregnancy - Folk beliefs about pregnancy, delivery and the post-partum period have been handed down to mothers-to-be for centuries. While some practices, such as use of chamomile tea to settle the stomach, persist in U.S. born and second generation Hispanics, the types of pregnancy beliefs that may perplex health care workers are more likely to be practiced by recent immigrants.

Folk Healers - For centuries Hispanic patients have sought treatment and solace from traditional healers for illnesses they perceive as having a supernatural basis or for those that do not respond to western medical intervention. These healers are often considered as having special powers bestowed upon them by God.

Folk Healer - The most common folk healer among Mexican Americans is the curandera, generally an older woman who is proficient in the use of herbs and prayers to counteract evil.

Folk Remedies used during pregnancy and delivery - Chamomile tea (té de manzanilla) may be used to calm an upset stomach. Cumin tea (té de comino) is believed to stimulate labor. (Source: Martha Burk, RN, CNM, MSN, "Cultural beliefs and health behaviors of pregnant Mexican-American women: Implications for primary care," Advances in Nursing Science, June 1995, p 49.) Because these two teas do not present health risks, the provider may recommend either as a culturally appropriate and soothing beverage for the patient. However, some herbal teas, such as wormword (té de estafiate) used to treat diarrhea or cramps, may may cause premature labor or other complications. Other remedies, such as baking soda for heartburn, may be dangerous during pregnancy. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.)

Folk Remedies - Hispanics have sought relief from illness through traditional remedies, such as herbs and teas, that have been handed down for centuries. Reliance on folk medicine is more pronounced among recent immigrants and those from rural areas.

Family and Friends - The family is the cornerstone of the Hispanic culture. They expect to be closely involved in significant events in the individual's life, especially childbirth or serious illness. Family members should be made to feel they are "in the loop" in terms of the patients progress. Friends also show their concern for a sick individual by spending as much time as possible with the patient and assisting him or her with tasks. Compadres or comadres, very close male or female friends, assume an importance comparable to that of family members. Unlike the mainstream American nuclear family, Hispanic families are extended to include aunts, uncles, grandparents, and other relatives.

Cross-Cultural Funeral Rites (http://www.biomed.lib.umn.edu/hw/ccf.html)
Funeral traditions for many cultures including Hispanic cultures.

G H

Gender Roles - Hispanics tend to have more narrowly defined gender roles than the general population. Especially among recent immigrants, the male is very much the authority figure and is the one who makes the major decisions. Women may refuse to consent to a procedure for themselves or their children without first obtaining their husband's approval. There is not much the provider can do in such instances other than respect the choices of the parties involved.

Gobernadora or chaparral - Chaparral, known in Spanish as gobernadora, is used a folk remedy for a variety of ailments, including arthritis, cancer, venereal disease, and tuberculosis. The herb can be administered topically as a poultice or brewed as a tea. However, it is toxic when ingested.

Geographic Distribution (http://www.apha.org/ppp/red/lageodis.htm)
A review of the geographic distribution of Hispanics.

General Characteristics (http://www.apha.org/ppp/red/lagenchar.htm)
A review of the health practices of Hispanic Americans.

Godparents - Catholics select Godparents to present their child at baptism and ensure that the child is raised in the faith in the event of the parents' premature death. The godmother is referred to as the child's madrina, and the godfather is referred to as the child's padrino.

Guatemala
Guatemala (http://www.apha.org/ppp/red/Guatemala.htm)
Includes characteristics, geographic distribution, literacy, and maternal health statistics and practices for Guatemalan immigrants.

H

Health Beliefs http://www.apha.org/ppp/red/labeliefs.htm
Reviews maternal and reproductive health beliefs in the Hispanic population.

Health Care Decision Making (http://www.apha.org/ppp/red/laDecision.htm)
Reviews factors contributing to health care decision making in Hispanics.

Hechizo or Embrujamiento , meaning witchcraft or hex, refers to a witch's curse that may result in bad health, miscarriage, bad luck, headache, anxiety, or depression. Victims are treated with prayer and a purification ritual known as a barrida.

HIV/AIDS: (http://www.omhrc.gov/OMH/AIDS/aidshome_new.htm)
Minority HIV/AIDS initiative, includes fact sheets and funded programs to combat HIV/AIDS in minority populations.

Heart

Latino Cardiovascular Hearth Resources (http://www.nhlbi.nih.gov/health/prof/heart/latino/latin_pg.htm)
Salud para su Corazón (For the Health of Your Heart) is an exciting new and comprehensive community-based heart-health promotion initiative from the National Heart, Lung, and Blood Institute. Teaching guides and educational materials are offered.

Fact sheet: Health Status Latino Health Status (http://www.lchc.org/health.cfm)
An informational sheet fact listing general and specific information on Heart Disease for Hispanic.

Heredity - One of the hypotheses about the prevalence of diabetes among Hispanics is that it stems from a genetic predisposition as the non-insulin type is higher among Mexican-Americans with significant indigenous rather than European ancestry. However, this explanation does not satisfactorily explain the equally high incidence among Puerto Ricans without such ancestry. (Ibid.)

High Blood Pressure - While the incidence of high blood pressure among Hispanics is comparable to that of the general population, it is more likely to be undiagnosed among Hispanics and, if diagnosed, less likely to be controlled. Because of this poorer control, Hispanics are two and half times more likely than the general population to develop end-stage renal disease. (Source: Kaiser Permanent, A Provider's Handbook on Culturally Competent Care: Latino Population, 1996)

High Context - Hispanics belong to a high context culture in which communication is based on nuances and the surrounding circumstances rather than the literal meaning of the written or spoken word. Hence, high context cultures tend to emphasize the personal relationship between the parties, including their previous interactions and their respective positions in the social hierarchy. In contrast low context cultures, such as that of mainstream Americans, places more importance on the literal meaning of the written or spoken word.

Hispanic (http://www.riverview.sioux-city.k12.ia.us/Hispanic_Folder/HISPANIC.html)
Hispanic culture lessons for elementary school children.

HIV - A recent survey from the Kaiser Family Foundation notes that although Latinos represent 13 percent of the U.S. population, they represent 19 percent of reported AIDS cases. (Source: Center for HIV, STD and TB Prevention http://www.cdc.gov/hiv/pubs/facts/hispanic.htm) Hispanic AIDS patients are diagnosed later and die more quickly than other groups. (source: Kaiser) Clearly there is a strong need for education within the community.

HIV - Human Immunodeficiency Virus.
The HIV virus is the precursor to AIDS, Acquired Immunodeficiency Syndrome. The Hispanic community now accounts for a disproportionate number of new cases of HIV infection.

HIV - casual contact
The provider should take the time to dispel the common misperception that HIV can be spread by casual contact such as hugging, kissing, or shaking hands or by contact with toilet seats, doorknobs, or telephones used by an infected person. It is not spread by mosquitoes. It is also not likely to be spread through food preparation or fist fighting, although there is a remote possibility of transmission if blood contact occurs in either scenario.

HIV - drunk
The increase in HIV infections is closely associated with substance abuse. Because intoxication may impair judgment about using adequate protection during sex, health care providers should advise patients not to engage in sexual relations while under the influence of drugs or alcohol.

HIV - information resources
The American Red Cross provides a wealth of culturally appropriate information on HIV prevention in English and Spanish. The Guía familiar para la prevención del VIH/SIDA -- Family Guide for HIV/AIDS Prevention facilitates communication about HIV/AIDS issues, including the use of alcohol and other drugs. Libro de hechos sobre el VIH/SIDA -- HIV/AIDS Facts Book is a easy-to-read reference that provides answers to questions about HIV and AIDS.

The Red Cross has developed a comic book, ¿Quién Será? - Who Will it Be?, to educate adolescents on HIV prevention. URL: http://www.redcross.org/services/hss/hivaids/hispanic.html

The Body site provides numerous resources on HIV/AIDS including interest and support groups, a discussion forum monitored by health professionals, and information in English and Spanish. URL:
http://www.thebody.com/index.shtml

HIV - risk factors
Researchers point to machismo as a key factor in the high incidence of HIV infection among Latinos. The "macho" man too often seeks to prove his masculinity by having sex with many women and refusing to wear a condom. A recent study found that Latino married men (18%) are two times more likely to have multiple partners than are non-Latino whites (9%). 60% of unmarried Latino men reported multiple sexual partners in the last 12 months. (Source: Marín BV, Gómez CA, Hearst N. Multiple heterosexual partners and condom use among Hispanics and non-Hispanic whites. Family Planning Perspectives. 1993;25:170-174. )

Another study found that only 20% of Hispanic men with multiple partners used a condom regularly with their primary partner and 29% did so with their secondary partner. (Source: Sabogal F, Faigeles B, Catania JA. Multiple sex partners among Hispanics in the United States: the National AIDS Behavioral Surveys. Family Planning Perspectives. 1993;25:257-262. )

Too often HIV and AIDS are seen as afflictions of homosexual men. Hispanic men who have sex with other men fail to practice safe sex because they do not perceive themselves as homosexual if they do not play the receptor role. Because homosexuality is unaccepted in the Hispanic community, bisexual men generally do not tell their girlfriends and wives about their risky behavior.

Machismo, coupled with an expectation of female purity, modesty and submissiveness, discourages women from taking steps to protect themselves by inquiring about their men's other partners and initiating condom use. According to a recent study, 67% of Hispanic women reported never use condoms with their steady partner. (Source: Gómez CA, Marín BV. Gender, culture and power: barriers to HIV prevention strategies for women. Journal of Sex Research (in press)).

Homosexual - Exhibiting a sexual preference for the same gender. In traditional Hispanic communities, homosexuality is not condoned.

Hot and Cold Health Theory (May also link to folk beliefs and pregnancy) During the 16th century, the Spanish introduced into Latin America a health theory based on maintaining balance between hot and cold. Hot and cold do not necessarily refer to actual temperature but rather to qualities, such as the origin, color, or therapeutic benefit of food or medications. Items that are considered "hot" in one country or region, may be considered "cold" in another. Hot illnesses or conditions can be counteracted by cold foods or medicines and vice versa. Pregnancy is considered a "hot" state. Therefore a pregnant woman will avoid consuming "hot" foods or medicines to avoid harming the fetus. The difficulty with this belief system is that it can result in an unbalanced diet. In addition, a pregnant woman may avoid iron supplements and prenatal vitamins, which are considered "hot." However, the astute health care provider may encourage her to take them with a "cold" beverage such as fruit juice to counteract the effect.

Hot foods include chocolate, garlic, alcoholic drinks, and corn meal. Cold foods include bananas, coconuts and sugar cane. (Source: http://thehealthgroup.com/herbs/folk.html).

Hot illnesses include constipation, diarrhea, intestinal cramps, vomiting, and pregnancy, while cold ones include arthritis, colds, gastric complaints and menstruation. (Source: http://thehealthgroup.com/herbs/folk.html) Cold foods are used to counteract hot illnesses and vice versa.

Hot medications, herbs and teas include anise, aspirin, iron supplements, penicillin and prenatal vitamins. Cold remedies include linden flower (flor de lilo), mannitol, mastic bark (almacigo), milk of magnesium, nightshade (yerba mora), chamomile tea, honey and lemon. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.) Graphics: Picture of hot foods/cold foods URL: http://thehealthgroup.com/herbs/folk.html

Husband's permission - Hispanic families are generally patriarchal with the wife and children in subordinate roles to the male head of the household. While the wife treats minor ailments and makes the day-to-day health choices for the family, the husband makes the major decisions.

I J K L

Informal - Hispanics convey respect by maintaining a polite formality with strangers, seniors and persons in authority positions. Such individuals should be addressed by their titles and last names rather than first names unless they request otherwise.

Information resources HIV -

The American Red Cross provides a wealth of culturally appropriate information on HIV prevention in English and Spanish. The Guía familiar para la prevención del VIH/SIDA -- Family Guide for HIV/AIDS Prevention facilitates communication about HIV/AIDS issues, including the use of alcohol and other drugs. Libro de hechos sobre el VIH/SIDA -- HIV/AIDS Facts Book is a easy-to-read reference that provides answers to questions about HIV and AIDS.

The Red Cross has developed a comic book, ¿Quién Será? - Who Will it Be?, to educate adolescents on HIV prevention. URL: http://www.redcross.org/services/hss/hivaids/hispanic.html

The Body site provides numerous resources on HIV/AIDS including interest and support groups, a discussion forum monitored by health professionals, and information in English and Spanish. URL:
http://www.thebody.com/index.shtml

Intermediador - An intermediador is a medium who may heal illness by prescribing herbs and prayers or treat supernaturally induced afflictions by communicating with the dead.

Interpretation - Patients may be reluctant to reveal sensitive or embarrassing information in front of a family member, especially if the interpreter is a child. Moreover, the use of minors as interpreters is potentially damaging not only to the patient but also to the child as he or she is forced to assume a role of more authority than the adult patient, an inversion of the normal hierarchy in Hispanic culture. In addition, the youngster is put in the extremely stressful position of hearing personal information and facing the possibility of being forced to relay bad news.

Interpreter - An interpreter orally translates from English to another language. However, he or she may also take a more active role as a cultural mediator, who also "translates" variables such as health care practices and definitions of illness, which vary from culture to culture.

Interpreter working with - When working with an interpreter, the practitioner should look at the patient rather than the interpreter and pause between utterances. While listening to the interpretation, he or she should not be alarmed if some of the messages are longer in Spanish. The interpreter is not necessarily embellishing the message as Spanish tends to be much wordier than English. For example, a page of typed text in English would equate to about a page and a half in Spanish.

Interpreters as Family members - The use of family members as interpreters is surprisingly common given the myriad problems it entails, not the least of which is the flagrant violation of the patient's privacy. Patients may be reluctant to reveal sensitive or embarrassing information in front of a family member. Using relatives to interpret also heightens the likelihood of message distortion, a possibility with any interpreter. Distortions, which may be accidental or intentional, include the intentional or unintentional failure to convey a portion of the patient's message, the addition of statements that the patient did not actually make, or the twisting of the patient's meaning. While the use of any relative as an interpreter may be problematic, the use of younger family member can be especially damaging to the child as he or she is forced to assume a role of more authority than the adult patient, an inversion of the normal hierarchy in Hispanic culture. Moreover, the youngster is put in the extremely stressful position of hearing personal information and facing the possibility of being forced to relay bad news.

Language interpretation Text: The inability to speak or read English well often constitutes a barrier to care for recent immigrants and elderly monolingual Spanish-speakers. Language difficulties impede diagnosis, the communication of instructions to the patient, and informed consent for procedures. Health care practitioners have adopted a variety of methods to address these problems, including asking family members and non-medical staff members or even janitors to interpret, using a telephone interpreter through AT&T language line, employing professional medical interpreters, and assigning bilingual medical personnel when available. Each approach has both positives and negatives.

Last names - Hispanics use their father's last name followed by their mother's maiden name. When filing charts, the legal last name that should be used is the paternal one, which appears second-to-last. When a woman marries, however, she may drop the maternal last name and add her husband's paternal last name with "de" between the two.

Latino Coalition for a Healthy California Cultural Diversity (http://www.diversityrx.org/HTML/MAP.htm)
This site, called Diversity Rx, is a resource for decreasing barriers to health care for Hispanics.

Lead Poisoning from Mexican Folk Remedies -- California (http://www.cdc.gov/mmwr/preview/mmwrhtml/00000164.htm)
Because of lead poisoning cases, the Los Angeles County Department of Health Services surveyed residents of six predominantly Hispanic, geographically representative census tracts in an attempt to estimate exposure to and knowledge of azarcon and greta (lead oxide). 1This 1983 article on lead in folk remedies, is distributed by the MMWR.

State Dept. of Health warns about dangerous Mexican folk remedies (lead poisoning) (http://www.doh.wa.gov/Publicat/2000_News/00-59.html)
The state Department of Health is issuing a warning about the danger of using certain types of traditional Mexican folk remedies. The remedies, known as azarcón and greta, contain high levels of lead that can make people who ingest them, especially children, very ill. 2000 report from Washington state.

Kinesics - Gestures and facial expressions, along with gesticulations, eye contact and appearance comprise the subset of kinesics. While Mexican and mainstream American speakers share many of the same gestures, such as shaking the head to indicate disagreement, there are a few that differ. For instance, a Mexican or Mexican American patient may perceive a health care provider with his or her hands on the hips as more disapproving and perhaps hostile than would a typical Anglo patient. A Hispanic patient or visitor may employ more expansive gesticulations and expressive facial expressions than an Anglo in that the Hispanic culture encourages emotional expressiveness. In addition, the eye contact a Hispanic maintains with a health care provider may be less both in terms of frequency and length of gaze than that of an Anglo patient but markedly more than that of an Asian patient. Avoiding direct eye contact with the health care provider, an authority figure, conveys respect.

M N O

Machismo
Machismo has both a positive and negative side. On the one hand, the concept dictates that Hispanic men are expected to behave valiantly to protect the wellfare and honor of their families. However, machismo frequently also entails the active subjugation of women, heavy drinking and the practice of high risk activities to "prove" one's manliness.

Madrina - Godmother.

Mal de Ojo - Evil eye
Mal de ojo or evil eye most often affects vulnerable victims such as children. It is believed to be caused either intentionally or unintentionally by the stare of someone who envies or admires the victim without touching him or her. Symptoms may include insomnia, fever, headaches, vomiting, or diarrhea. If the cause was unintentional, the person who initially stared at the victim may be asked to touch him or her to restore health. If unintentional, mal de ojo may be treated by ritual. URL:http://www.luckymojo.com/evileye.html

Symptoms
· Sudden reversal in physical or emotional well-being of an infant
· Vomiting
· Fever
· Crying
· Restlessness
· Nervousness

Treatment - a limpia or cleansing, by sweeping the body with a raw, unbroken egg to extract the "heat"

Mal Puesto - Hex

Symptoms
· Unexplainable physical or emotional disorder
· Insomnia
· Strange behavior

Mal de aire or Sereno refers to the harmful effects of bad air or night air which may be cold or damp. Symptoms may include cold or flu, cramps, headache, stiff neck, dizziness and are generally treated with herbal teas.

Symptoms
· Nausea
· Vomiting
· Fever
· Headache
· Dizziness
· Earache
· Facial paralysis
· Twitching of facial muscles

Mal de Latido - Palpitations

Symptoms
· Fast or slow heartbeat
· Chest pain
· Weakness
· Pulsating of the stomach

Maternal Health Beliefs (http://www.apha.org/ppp/red/labeliefs.htm)

Maternal Care of Guatemalans (http://www.apha.org/ppp/red/Guatemala.htm)

Mental Health Services Issues for Hispanics/Latinos in Rural America (http://www.inmotionmagazine.com/soto4.html)
This article focuses on mental health-related problems and concerns facing the Hispanic/Latino in rural America.

Midwife - A partera is a midwife who also treats young children. She may recommend herbs during pregnancy or delivery.

Miracles and Prayer - The belief in the possibility of miracles is fundamental to Catholicism. Practitioners may wish to pray, light candles, perform a difficult act such as crawling to a shrine on their knees, or make a pilgrimage to a holy site to encourage a favorite saint to intercede on their behalf.

Miracle - The belief in the possibility of miracles is fundamental to Catholicism. Practitioners may wish to pray, light candles, perform a difficult act such as crawling to a shrine on their knees, or make a pilgrimage to a holy site to encourage a favorite saint to intercede on their behalf.

Multiple pregnancies - Latinas tend to begin childbearing at an earlier age and continue longer than do women from other ethnic groups. In addition, their pregnancies tend to be much closer together.

N

Nonverbal communication - This focus on intangibles also explains why such patients tend to be rather indirect and may perceive very direct communication as overly cold or confrontational. It also highlights the importance of nonverbal cues, such as the provider's tone of voice, facial expressions, gestures, and distance from the patient.

O

Office of Minority Health(http://www.omhrc.gov/)
The Office of Minority Health (OMH) advises the Secretary and the Office of Public Health and Science (OPHS) on public health issues affecting Hispanics/Latinos.

Open expressions of emotion - Hispanic cultures tend to encourage emotional expressiveness. This is especially true in labor and delivery, during which it is common for a Mexican woman to cry out loudly.

P Q

Pain expression

Cultural and Religious Beliefs that Shape Health Care Choices (http://wwwdev.lemoyne.edu/pa_students/hispanicamerican.htm)

Pap Smear/ Papanicolaou - Hispanic women are far less likely to have Pap Smears than the general population. However, their rates of cervical cancer are markedly higher, twice as high as that of white women. (Source: A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics, Estrella Press, 2001.)

Paralanguage - In addition to kinesics, nonverbal communication also includes paralanguage and proxemics. Paralanguage, in spoken language, refers to vocal elements such as tone of voice and emphasis, while in written text it refers to emphasis features such as highlighting, italics, and bolding.

Partera - A partera is a midwife who also treats young children. She may recommend herbs during pregnancy or delivery.

Personal relationships - A closely related concept to confianza is that of personalismo, the emphasis on personal relationships. The health care provider can strengthen communication with his or her Hispanic patient by inquiring about the patient's family and interests before discussing purely health-related issues.

Personal Concern - Within the Hispanic culture, relationships must be established before meaningful dialogue can take place. Hispanic patients place more emphasis on their relationship with a particular health care provider than with the HMO or the clinic as an institution.

Poison

Lead Poisoning from Mexican Folk Remedies -- California (http://www.cdc.gov/mmwr/preview/mmwrhtml/00000164.htm)
Because of lead poisoning cases, the Los Angeles County Department of Health Services surveyed residents of six predominantly Hispanic, geographically representative census tracts in an attempt to estimate exposure to and knowledge of azarcon and greta (lead oxide). 1983 article on lead in folk remedies, distributed by the MMWR.

Lead Poisoning (http://www.calpoison.org/public/lead.html)
The California Poison Control System (CPCS) is a statewide network of trained experts who provide the public and health professionals with toll-free hotline(1 800 876-4766) information and advice about treating poisonings 24 hours a day, everyday - free of charge.

State Dept. of Health warns about dangerous Mexican folk remedies (lead poisoning) (http://www.doh.wa.gov/Publicat/2000_News/00-59.html)
The state Department of Health is issuing a warning about the danger of using certain types of traditional Mexican folk remedies. The remedies, known as azarcón and greta, contain high levels of lead that can make people who ingest them, especially children, very ill. 2000 report from Washington state.

Iron poisoning.(http://www.calpoison.org/public/iron.html)
The California Poison Control System (CPCS) is a statewide network of trained experts who provide the public and health professionals with toll-free hotline(1 800 876-4766) information and advice about treating poisonings 24 hours a day, everyday - free of charge.

Mercury poisoning. (http://www.calpoison.org/public/mercury.html)
The California Poison Control System (CPCS) is a statewide network of trained experts who provide the public and health professionals with toll-free hotline(1 800 876-4766) information and advice about treating poisonings 24 hours a day, everyday - free of charge.

The California Poison Control System (http://www.calpoison.org/)
The California Poison Control System(CPCS) is a statewide network of trained experts who provide the public and health professionals with toll-free hotline (1 800 876-4766) information and advice about treating poisonings 24 hours a day, everyday - free of charge.

Post-Partum Period - The cuarenta is forty day period after giving birth during which a new mother rests quietly to allow her uterus to return to its normal state. She avoids physical activity and bathing and requires the assistance of family members to care for the infant and keep up with household activities. Foods that are acidic, spicy or considered "cool" are avoided for fear they would interfere with proper menstrual flow. Some new mothers may follow a special diet beginning with herbal teas and gradually incorporating small pieces of chicken or eating corn gruel to restore energy. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.)

Post Traumatic Stress Disorder Immigrants from war torn regions, such as Colombia are at risk for Post-Traumatic Stress Disorder, or PTSD. PTSD, is defined by the National Center for PTSD as "a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, abuse (sexual, physical, emotional, ritual), and violent personal assaults like rape." Their website goes on to state "People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life." (http://www.ncptsd.org/faq.html)

Prayer and miracles - The belief in the possibility of miracles is fundamental to Catholicism. Practitioners may wish to pray, light candles, perform a difficult act such as crawling to a shrine on their knees, or make a pilgrimage to a holy site to encourage a favorite saint to intercede on their behalf.

Prenatal care - In Hispanic cultures, physician visits are perceived as a response to an illness. Pregnancy, however, is viewed as a normal and welcome life event rather than a condition requiring early medical treatment. Consequently, Latinas, especially Mexican-Americans, have a lower rate of first-trimester care than all other ethnic groups. (Source: "Initiation of prenatal care by low-income Hispanic women in Houston," Public Health Reports; Hyattsville; Nov/Dec 1996; Byrd, Theresa L; Mullen, Patricia Dolan; Selwyn, Beatrice J; Lorimor, Ronald.)

Pregnancy - activities during - The expectant mother may be discouraged from prolonged inactivity during pregnancy to prevent the fetus from becoming stuck to the uterus and causing a long and painful labor and delivery. This belief may cause conflict if pregnancy complications or hypertension dictate bedrest. In such cases, the health care provider should carefully explore both the patient's perceptions in this area and those of her family to ensure a healthy outcome for both the infant and the mother. A pregnant woman from Latin America may also avoid viewing lunar eclipses, which are believed to cause cleft palate, or stretching her arms over her head, which is believed to cause knots in the umbilical cord. She may also postpone celebrating a baby shower until after the birth to avoid courting bad luck and limit her consumption of whole milk for fear that it may cause the fetus to grow too large to permit a vaginal delivery. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.)

Pregnancy and childbirth - Pregnancy and childbirth are generally greeted as joyous events in the Hispanic culture. Men perceive the ability to produce many children as a sign of virility, while women derive status from their role as mothers. Not surprisingly, Hispanics have a higher fertility rate than other ethnic groups. While Latinas in the United States average 94 births per 1,000 women, the number for the general population is only 68.5. (Source: Kaiser 1996.) One of the reasons Latinas have more children is that they tend to begin childbearing at an earlier age than non-Hispanic women and continue for longer.

Pregnancy and delivery - folk remedies used during - Chamomile tea (té de manzanilla) may be used to calm an upset stomach. Cumin tea (té de comino) is believed to stimulate labor. (Source: Martha Burk, RN, CNM, MSN, "Cultural beliefs and health behaviors of pregnant Mexican-American women: Implications for primary care," Advances in Nursing Science, June 1995, p 49.) Because these two teas do not present health risks, the provider may recommend either as a culturally appropriate and soothing beverage for the patient. However, some herbal teas, such as wormword (té de estafiate) used to treat diarrhea or cramps, may may cause premature labor or other complications. Other remedies, such as baking soda for heartburn, may be dangerous during pregnancy. (Source: Minerva R. DePacheco, MSN, WHNP-C and Marianne H. Hutti, DNS, WHNP-C, Cultural Beliefs and Health Care Practices of Childbearing Puerto Rican Women and Mexican American Women: A Review of the Literature," Mother Baby Journal, January 1998, Vol 3, No1, p 20.)

Prenatal care - Latinas generally seek prenatal care at much later stages of pregnancy than do non-Hispanics. This tendency may be partially explained by the perception of pregnancy as a normal phenomenon rather than a condition necessitating medical treatment. Because Latinas are modest about their bodies, they may prefer a female health care provider for prenatal exams. However, recent studies have shown that the gender and ethnicity of the health care provider are less important factors in a Hispanic woman decision to seek care as are obstacles such as long wait time, difficulty contacting the doctor, and the prohibition against bringing their children with them to the appointment. (Source: Handler A, et al. 1996. "Women's satisfaction with prenatal care settings: A focus group study." Birth 23 (1) 31-37.) Expectant mothers may be referred to the National Hispanic Prenatal Hotline at 800-504-7081 for culturally appropriate prenatal advice. In spite of later prenatal care, Latinas have low levels of infant mortality and an incidence of low birth-weight babies comparable to that of the general population. (Kaiser, p 35) Possible explanations include lower levels of alcohol use and smoking compared to the general population, significant familial support, and positive genetic effects. (Ibid.) Pregnant Hispanic patients tend to comply well with medical directions they understand and perceive as beneficial as they are very committed to producing having healthy children.

Present orientation: The Hispanic culture is more present oriented rather than future oriented. While mainstream Americans spend much of their time thinking of, worrying about and planning for the future, Hispanics live more in the present. This may partially explain the reluctance of Hispanic patients to take preventive health measures, such as yearly check-ups. On the other hand, such commonplace failure to have routine screenings may stem from lack of awareness or understanding of the benefits of early detection.

Preventive Care - Hispanic patient are far less likely to have regular physical examinations or practice preventive health care than the general population. This tendency may stem from a present rather than future time orientation, a lack of awareness or understanding of the benefits of early detection, and a perception of external locus of control which places responsibility on the health care "expert" rather than the patient.

Proxemics means the distance between speakers. Anglo Americans prefer a "bubble" of personal space of between themselves and others of at least two feet. They feel crowded and uncomfortable with persons who stand closer and may actually back away to maintain a more comfortable distance. Hispanics, in contrast, prefer significantly less distance between themselves and their conversational partners. In fact, they view a person who stands several feet away as being cold and rejecting.

Public policy: (http://www.omhrc.gov/)

Punctuality - As a general rule, Hispanics have a more flexible attitude towards time than do Anglo Americans. They are much less ruled by the clock but become more time focused with increasing acculturation. A Hispanic patient may arrive late due to a lesser concern with punctuality. However, it is worth pointing out that tardiness may also stem from unreliable transportation or lack of childcare while the parent is absent.

R

Reasons for not wanting to breastfeed - Latinas in the United States are markedly less likely to breastfeed than are non-Hispanic women. Some of the reasons include the belief that formula is a healthier alternative, a reluctance to expose the breasts in order to breastfeed, and the feeling that breastfeeding is less modern than bottle feeding. Some women who do wish to breastfeed postpone it until their milk comes in because of the concern that colostrum is not fit for the baby to consume.

Recipe

Arroz Con Pollo (http://mexicanfood.about.com/gi/dynamic/offsite.htm?site=http://www.floras%2Dhideout.com/recipes/mxp/lowfat/25.html)
Recipe for Arroz Con Pollo from the Ladies' Home Journal

Chicken Chickpea Stew (http://www.hispaniconline.com/lstyles/food&rest/stew.html)
Chicken Chickpea Stew uses a combination of herbs, spices and sugar to enhance the ingredients and help flavor the stew while keeping the fat low.

Five Bean Salad - (http://www.hispaniconline.com/lstyles/food&rest/salad.html)
Five Bean Salad is delicious hot or cold and can be prepared the day before and refrigerated overnight.

Delicious Heart-Healthy Latino Recipes (http://www.nhlbi.nih.gov/health/public/heart/other/sp_recip.htm)
This is one of the links from the above site. It is a recipe book for Hispanic style recipes.

Spicy Black Bean Tortilla Pie (http://mexicanfood.about.com/gi/dynamic/offsite.htm?site=http://www.floras%2Dhideout.com/recipes/mxp/lowfat/239.html)
Sharing a Hispanic recipe

Regular physical examinations - Hispanic patient are far less likely to have regular physical examinations or practice preventive health care than the general population. This tendency may stem from a present rather than future time orientation, a lack of awareness or understanding of the benefits of early detection, and a perception of external locus of control which places responsibility on the health care "expert" rather than the patient.

Reluctance to discuss emotional problems - Hispanics are quite protective of family privacy. They are reluctant to discuss issues pertaining to mental health, behavioral problems, or family discord with outsiders.

Remedies - Hispanics have sought relief from illness through traditional remedies, such as herbs and teas, that have been handed down for centuries. Reliance on folk medicine is more pronounced among recent immigrants and those from rural areas.

Respect - Because high context communication is impacted by each person's place within the social hierarchy, recognizing such relationships and conveying the appropriate respect or respeto is key. Adults should be addressed using usted, the formal "you," rather than tú, the form reserved for close friends and children. They should be addressed by their title and last name rather than by their first name. Appropriate forms include Señor Gutierrez for Mr. Gutierrez, Señora Medina for Mrs. Medina and Señorita Remedios for Miss Remedios. Professionals are generally addressed by their profession followed by the last name. For instance, an engineer named Pedro Santos would be addressed as Ingeniero Santos (Engineer Santos) rather than Señor Santos (Mr. Santos). Seniors expect even greater deference and may be addressed by the title Don for a man or Doña for a woman followed by the first name. For instance, Eugenio Rivera may be called either Señor Rivera or Don Eugenio.

Respect for authority - In the Hispanic culture, the social distance between someone in a position of power, such as a health care provider, and someone in a lower position, such as a patient is quite large. As such, authority figures occupy a position of near reverence. They are expected to know all the answers and issue commands rather than seek input from someone lower in the social hierarchy. Their authority is not to be questioned. The implications for health care are clear. Although mainstream Americans prefer a more participative format in which they ask the provider questions and feel free to disagree or even seek a second opinion, the Hispanic patient has been conditioned to accept what the nurse or doctor says without question or complaint. The culturally aware practitioner will take this phenomenon into account, making sure the patient is not simply agreeing to a procedure he or she does not truly want.

Risk factors HIV-

Researchers point to machismo as a key factor in the high incidence of HIV infection among Latinos. The "macho" man too often seeks to prove his masculinity by having sex with many women and refusing to wear a condom. A recent study found that Latino married men (18%) are two times more likely to have multiple partners than are non-Latino whites (9%). 60% of unmarried Latino men reported multiple sexual partners in the last 12 months. (Source: Marín BV, Gómez CA, Hearst N. Multiple heterosexual partners and condom use among Hispanics and non-Hispanic whites. Family Planning Perspectives. 1993;25:170-174. )

Another study found that only 20% of Hispanic men with multiple partners used a condom regularly with their primary partner and 29% did so with their secondary partner. (Source: Sabogal F, Faigeles B, Catania JA. Multiple sex partners among Hispanics in the United States: the National AIDS Behavioral Surveys. Family Planning Perspectives. 1993;25:257-262. )

Too often HIV and AIDS are seen as afflictions of homosexual men. Hispanic men who have sex with other men fail to practice safe sex because they do not perceive themselves as homosexual if they do not play the receptor role. Because homosexuality is unaccepted in the Hispanic community, bisexual men generally do not tell their girlfriends and wives about their risky behavior.

Machismo, coupled with an expectation of female purity, modesty and submissiveness, discourages women from taking steps to protect themselves by inquiring about their men's other partners and initiating condom use. According to a recent study, 67% of Hispanic women reported never use condoms with their steady partner. (Source: Gómez CA, Marín BV. Gender, culture and power: barriers to HIV prevention strategies for women. Journal of Sex Research (in press)).

Roman Catholicism is professed by 91.12 percent of the population, but only 11.55 percent attend church at least one time per month. (source: http://www.lhmint.org/facts/mexico/) Even Catholics who do not attend Mass on a regular basis may derive great comfort especially in times of stress from the articles and images associated with the religion. The culturally aware health care practitioner recognizes this and respects the patient's faith and may even ask he patient if he or she wishes to consult with a priest to alleviate fears or assist with end-of-life issues.

S

Sereno or Mal de aire refers to the harmful effects of bad air or night air which may be cold or damp. Symptoms may include cold or flu, cramps, headache, stiff neck, dizziness and are generally treated with herbal teas.

Self care; Family care of patient - The American health care system's emphasis on patient self-care to hasten recovery directly conflicts with Hispanics' belief that a patient should be assisted in daily tasks by his or her family for the duration of the illness. Such pampering, while often irksome to health care providers, is quite understandable as a means of demonstrating concern for the patient and thereby strengthening familial bonds. A male patient may also demand that family members cater to his every wish regardless of his actual level of incapacity to demonstrate that he is still in control and maintain his role as the patriarch.

Sharing of needles - Use of infected needles is a common method of HIV transmission among intravenous drug users.

Silence - A Hispanic patient who remains silent or nods may not be conveying agreement of acceptance of the health care providers suggestions. He or she may be reluctant to express disagreement or confusion to an authority figure.

Easy-to-Read English/Spanish Booklets on Heart Health(http://www.nhlbi.nih.gov/health/public/heart/other/sp-page.htm)
Spanish/ English books for consumers regarding heart health.

Smoking

 

Fact sheet: Health Status Latino Health Status (http://www.lchc.org/health.cfm)
An informational sheet fact listing general and specific information on smoking tobacco. A short paragraph on statistics along with statistics about other disease in Hispanics.

Hispanics and Tobacco (http://www.cdc.gov/tobacco/sgr/sgr_1998/sgr-min-fs-hsp.htm)
General and specific information on the health risks of smoking tobacco. Excellent overview of Hispanics and smoking, includes statistics.

Social relationships Cultural and Religious Beliefs that Shape Health Care Choices (http://wwwdev.lemoyne.edu/pa_students/hispanicamerican.htm)

Sobador - A sobador is a folk chiropractor who manipulates the patient's bones

Sueros - serum In some Spanish-speaking countries, such as Mexico, doctors may prescribe the injection of sueros or serum rather than pills to treat illness. A patient accustomed to receiving shots may come to expect them as part of the treatment and be disappointed by a less invasive approach. The word suero is used to describe any intravenous fluids.

Susto - Fright/Shock. Also known as "soul loss"
Susto is fear or shock caused by a frightening or upsetting incident that is believed to dislodge the victim's soul. Symptoms may include insomnia, irritability, diarrhea, depression, vomiting, lack of appetite, or miscarriage. The most common treatment is a purification ritual known as a barrida. The healer may also recommend herbal teas.

Caused by a traumatic experience which can be major (witnessing a death) or simple (someone startles you.)
Symptoms
· Malaise
· Fever
· Insomnia
· Irritability
· Nightmares
· Depression
· Anxiety
Treatment - done by a curandero, and involves "sweeping" and prayers.

T

Time Orientation - As a general rule, Hispanics have a more flexible attitude towards time than do Anglo Americans. They are much less ruled by the clock but become more time focused with increasing acculturation. While mainstream Americans spend much of their time thinking of, worrying about and planning for the future, Hispanics live more in the present. This present-time orientation may partially explain the reluctance of Hispanic patients to take preventive health measures, such as yearly check-ups.

Time as a Relative Factor - As a general rule, Hispanics have a more flexible attitude towards time than do Anglo Americans. They are much less ruled by the clock but become more time focused with increasing acculturation.

Tobacco

Hispanics and Tobacco (http://www.cdc.gov/tobacco/sgr/sgr_1998/sgr-min-fs-hsp.htm)
General and specific information on the health risks of smoking tobacco. Excellent overview of Hispanics and smoking, includes statistics.

Too abrupt - Because of the importance of trust in the Hispanic culture it is imperative to establish rapport with the patient prior to asking probing questions or addressing sensitive matters. The provider can foster a positive relationship by taking the time to engage in some "small talk," asking polite general questions about the patient's family.

Transcultural Nursing (http://www.culturediversity.org/index.html)
Sharing with nurses and other healthcare professionals experiences and thoughts concerning the complexities involved in caring for people from diverse cultural backgrounds. Our hope is to give you some idea of the range of cultural behaviors and the need to understand people's actions from their own cultural perspective in health and illness.

Traditional Hispanic Diet - The traditional Hispanic diet has some very healthful features including the high level of fiber and reliance on vegetable rather than animal proteins However, it includes few dairy products and leafy green vegetables. As Hispanics become more acculturated to the United States, their diet tends to become increasingly unhealthy, incorporating high levels of fat and sugar.

Tristeza - Sadness

Symptoms
· Sadness
· Crying
· Depression
· Loneliness

Trust - Within a high context culture, the establishment of trust or confianza is critical before meaningful communication can take place. Such trust is usually built up over time and may be more difficult to establish in today's managed care environment. The health care provider should be aware that patients from high context cultures may be uncomfortable seeing a new doctor and should smooth the transition from the previous provider.

U

Uña del gato - Remedies that may be harmful in combination with other medications.

Uncaria Tomentosa (cat's claw), - a large woody vine that grows in certain tropical areas of South America. The bark has been used medicinally for centuries to treat a variety of ailments including intestinal disorders, fevers, ulcers, arthritis, and wounds. The alkoloid compounds do indeed show promise in protecting against damage to DNA and in stimulating the immune system. As such, the vine is being studied in the US in the treatment of AIDs, cancer, and viral diseases. However, the American Cancer Society cautions that it should not be used by people taking anti-ulcer, high blood pressure, anticoagulant, hormonal or insulin medications. Also, the consumer does not know the amount of active ingredient in a bottle of Cat's Claw as herbal supplements are not closely controlled like pharmaceuticals.

V

Virgin of Guadalupe - One of the most important figures among Mexicans and Mexican-Americans is the Virgin of Guadalupe, the Patron Saint of Mexico. According to legend, Mary, the mother of Jesus Christ, appeared in Tenochtitlan (now part of Mexico City) in the sixteen century to a Juan Diego an Indian peasant. When Juan Diego requested a sign that he could use to prove the miraculous sighting, Mary presented him with a bouquet of roses, which he wrapped in his shawl. When he unwrapped the shawl to reveal the flowers, he found that they had disappeared leaving an image of Mary in the cloth. News of the event helped the Spaniards convert the indigenous peoples to Catholicism, marking a turning point in the history of the country. The Basilica of Our Lady of Guadalupe was built at the site to honor Mary's appearance. Believers make pilgrimages to the shrine, often on their knees, to ask the Virgin to cure them or their families in exchange for some form of penance. Known as mandas, these transactions have been credited with many miracles.

Virgin Mary - The Virgin Mary, the mother of Jesus Christ is revered by Catholics, especially Mexicans and Mexican-Americans as they believe she appeared in Mexico in the 16th century. Mary is often referred to in Mexico as la Virgin de Guadalupe, the Virgin of Guadalupe, or la Reina de México, the Queen of Mexico.

Uña del gato - Remedies that may be harmful in combination with other medications.

Uncaria Tomentosa (cat's claw), - a large woody vine that grows in certain tropical areas of South America. The bark has been used medicinally for centuries to treat a variety of ailments including intestinal disorders, fevers, ulcers, arthritis, and wounds. The alkoloid compounds do indeed show promise in protecting against damage to DNA and in stimulating the immune system. As such, the vine is being studied in the US in the treatment of AIDs, cancer, and viral diseases. However, the American Cancer Society cautions that it should not be used by people taking anti-ulcer, high blood pressure, anticoagulant, hormonal or insulin medications. Also, the consumer does not know the amount of active ingredient in a bottle of Cat's Claw as herbal supplements are not closely controlled like pharmaceuticals.

W X Y Z

Working with an interpreter - When working with an interpreter, the practitioner should look at the patient rather than the interpreter and pause between utterances. While listening to the interpretation, he or she should not be alarmed if some of the messages are longer in Spanish. The interpreter is not necessarily embellishing the message as Spanish tends to be much wordier than English. For example, a page of typed text in English would equate to about a page and a half in Spanish.

Yerbera - A yerbero (male) or yerbera (female) is an herbalist who prescribes herbal remedies for both physically and supernaturally induced ailments.

Hispanic Patient Care Resources

Books, Articles, reference material on Allied Health and Cultural Diversity -- (http://libwww.cabrillo.cc.ca.us/html/ALH100multi.html)
Cabrillo College Library webpage for Allied Health and cultural diversity

Cross Cultural Health Care Program (http://www.xculture.org)
Through a combination of cultural competency trainings, interpreter trainings, research projects, community coalition building, and other services, the CCHCP serves as a bridge between communities and health care institutions to ensure full access to quality health care that is culturally and linguistically appropriate.

Cultural Assessment in Nursing: a guide for locating resources, (http://www.stkate.edu/library/guides/nursing.html)
Guidelines for Finding Books, Booklist Finding, Articles, and Web Sites on cultural assessment.
Culturally Competent Health Care book resources (http://www.sunyit.edu/library/html/culturedmed/bib/cultcomp/index.html)
State University of New York Institute of Technology bibliographies list for culturally competent health care

Culture & Health: Online and Print Sources (http://www.csbsju.edu/library/internet/nsgcultr.html)
A list of culture and health resources compiled by Peggy Roske of College of Saint Benedict, Saint John's University


Data base for organizations, programs, documents (http://www.omhrc.gov/OMH/maindb.htm)
Health Materials information from the Department of Health and Human Service, data base search page.

Health Occupation Programs in California Community Colleges (http://www.healthoccupations.org/ccchealth/index.html)
A website for health occupation programs in California Community Colleges

Health Professions Education: Issues in Cultural Competence (http://www.culturalhealing.com/healthprofessions.htm)
Bibliographic References

Medical Dictionary - English - Spanish - Other Languages(http://allserv.rug.ac.be/~rvdstich/eugloss/ES/lijst.html)
List and Glossary of medical terms: Spanish

Medical Journals- (http://www.sciencekomm.at/journals/medicine/med-bio.html)
25,000 links to journals, association and databases

Office of Minority Health of the Department of Health and Human Services- (http://www.omhrc.gov/)
A website on Minority Health issues.

Spanish Language Links

The following Vocabulary Assistants are available for you:

• Colors (Download PC version, Download Mac version)
• Conditions (Download PC version, Download Mac version)
• Environment (Download PC version, Download Mac version)
  
• Examination (Download PC version, Download Mac version)
• Gynecological (Download PC version, Download Mac version)
  
• Illnesses (Download PC version, Download Mac version)
• Insurance (Download PC version, Download Mac version)
• Pain (Download PC version, Download Mac version)
• Pharmacy (Download PC version, Download Mac version)
• Professionals (Download PC version, Download Mac version)
• Relatives (Download PC version, Download Mac version)
• Symptoms (Download PC version, Download Mac version)
• Verbs (Download PC version, Download Mac version)
• Weight loss (Download PC version, Download Mac version)

The following Spanish language practices are available for you:

• Male Body Parts (Download PC version, Download Mac version)
• Female Body Parts (Download PC version, Download Mac version)
• Female Reproductive Organs (Download PC version, Download Mac version)
• Male Reproductive Organs (Download PC version, Download Mac version)
  
• Internal Organs Front (Download PC version, Download Mac version)
  
• Internal Organs Back (Download PC version, Download Mac version)
  

Other Spanish practices:

Foreign Language Lab site, LBCC - Spanish Language

BBC Languages Site Interactive Spanish lessons that include audio and video with fun, imaginative activities. (http://www.bbc.co.uk/education/languages/spanish/index.shtml)

Sample activity: (http://www.bbc.co.uk/education/languages/spanish/suenos/buying_things/index.shtml)

Business Spanish Free Spanish tutorials that cover more than 100 business themes as well as various cultural aspects, business etiquette, grammar, and conversation. (http://www.businessspanish.com/Homepage/Free10.htm)

Spanish Vocabulary Builder:(http://home.earthlink.net/~mikcar)
A visual, verbal and textual Spanish Vocabulary Builder. (RealPlayer)

Spanish Tutor Practice your usage of the verbs "Ser" and "Estar" using the Award Winning Cougars.net Spanish Tutor. (http://www.cougars.net/cgi-bin/spanish/SerEstar.pl)

A Base for Learning Foreign Languages. (http://www.wuziegames.com/foreignlanguages.html#spnlng)
A listing of web resources for learning Spanish and other languages.

Learn Plus interactive Spanish instruction: small fee - (http://www.learnplus.com/spanish/spanish1.html)

Learn a Language with Eloquence! (http://www.elok.com/)
Web site includes some free services: pen-pal, on-line dictionaries, vocabulary lists. French, German, Italian, and Spanish.

Modelo virtual de disección de la rana (Virtual Frog Dissection Kit) (http://george.lbl.gov/vfrog/spanish/dissect.html)
This site allows you to "dissect" a frog and learn about its skeleton and organs in Spanish (as well as other languages).

Destinos: An Introduction to Spanish. (http://www.learner.org/resources/resource.html?uid=75)
Learn Spanish with this mysterious and entertaining Spanish soap opera, which takes you to Mexico, Spain, Puerto Rico, and Argentina.

Cross Cultural Health Care Program (translation service) (http://www.xculture.org/translation/index.html)
Offers a service to translate for educational materials.

MedSpanish For the Emergency Department (http://www.vtmednet.org/medspanish/)
Excellent medical Spanish for the Emergency Department site.

Medical Spanish-English Translator Form (http://www.erworld.com/medspan.htm)
Excellent medical Spanish for diagnosis and treatment.

E.L.Easton, Materials for Teaching and Learning Languages(http://eleaston.com/lannguages.html)
Links for learning Spanish and other languages

Spanish Medical Vocabulary (http://www.studyspanish.com/travel/spanishhelper/medical/)

Discussion Forum

The CHISPA Discussion Forum serves as a way to communicate with other Allied Health Professionals. Please post your thoughts and ideas related to this project and respond to other posts as well.

Enter the Forum

ABOUT CHISPA

CHISPA Project Information

CHISPA e-learning environment is designed to teach Allied Health professionals how to approach Hispanic patients in a culturally appropriate manner. CHISPA consists of three components: Interactive CD, Website, Train the Trainer and Activities Manual.

1. Interactive CD
CHISPA interactive CD is available to any faculty or trainer in an academic institution or health care facility free of charge, provided that (1)CHISPA is integrated into the Academic Training Curriculum, and (2) and that it is available to students free of charge or for minimal CD duplication cost. If you are interested in using the CD with your students / staff please fill out the CHISPA package request form.

The CD includes six components

a. Patient scenarios - Patient scenarios in which students / users take the role of Allied Health professionals to respond to Hispanic patients in various situations including: diabetes, a new baby, a wrist injury, hospice care, high blood pressure, HIV, and pregnancy. Throughout the simulations the following features are available:

b. Language Practices
CHISPA e-learning environment includes 32 language practices. The practices include vocabulary assistants for a variety of medical terms by category, as well as practices anatomical terms. These practices are also available on the CHISPA Web site

c. Did You Know That?
This section includes additional information about 61 topics related to Hispanic culture. This information can be accessed alphabetically from the CHISPA main menu, or by topic upon completion of each patient scenario as related to the concepts introduced in the scenario. Did You Know That content is also integrated into the e-pocketbook on this Web site.

d. Hyperlinks
CHISPA e-learning environment includes an alphabetical access to all hyperlinks used throughout the patient scenarios. Hyperlinks content is also integrated into the e-pocketbook on this Web site.

e. Internet Modules
There are three modules aimed at the development of basic Internet skills: * Browser Basics *Email * Web page evaluation

f. Follow Up Activities
Each scenario is accompanied by follow up activities for further work with students. CHISPA main menu includes an alphabetical list of the follow up activities available for all scenarios. All activities are included in the Train the Trainer and Activities Manual and available to download.

2. CHISPA Web site - http://itdc.lbcc.edu/chispa

The CHISPA Website is where you are at right now. It includes support material for Allied Health professionals who would like information on ways to better understand the Hispanic patient. The Website consists of parts linked from CHISPA home page including E-Pocketbook for Hispanic Patient Care, Hispanic Care Resources, Spanish Language Tools and Practices, Train the Trainer, and a Discussion Forum - a communication tools for Allied Health Professionals to communicate with each other about CHISPA related topics and how they use CHISPA in their school / facility.

3. Train the Trainer and Activities Manual
The "Train the Trainer Manual" contains detailed instructions of activities which can be used in conjunction with the scenarios. They are designed to give the learner more in-depth understanding of the concepts presented in the scenarios. Reproducible handouts are included in the Appendix. There are also two detailed charts which will enable the trainer to select appropriate activities by topic, scenario, and type of learning activity.

CHISPA's Team

CHISPA E-learning Environment was created by the Instructional Technology Development Center (ITDC) at Long Beach City College with funds from the Center for the Health Professions, University of California, San Francisco, through grants from The California Endowment and the California HealthCare Foundation.

For questions / comments, please contact chispa@lbcc.edu or click on the name links below.

CHISPA's Team includes the following professionals:

Project Director and Instructional Designer:
Amit Schitai

Project Monitor:
Leticia Suarez

Content Experts and Interactive Writers:
Sigrid Sexton
Zenny Pancho
Nita Slater
Karen Faulkner
Geri Ann Galanti, - Author, "Train the Trainer Manual"

Project Consultants:
Geri Ann Galanti,
Brenda Harrell

Researcher / Analyst:
Karen Faulkner

Liguist / Translator:
Luis Martinez

Production Team:

Multimedia Author: Monika Mravec
Graphic Artists: Justin Robertson, C.C. Sadler
Web Programmer: Leslie Heber
Computer Technologists: Jenny Ryyppa, Tim Ngo
Audio Production: Jenny Ryyppa, Monika Mravec, Mitch Touch
Quality assurance and testing: HelpDesk team at ITDC