One thing that professionals may find surprising as they work with the Spanish-speaking Latino population is the prevalence of health-related beliefs. By health-related beliefs, I am referring to beliefs regarding the origin of an illness or symptoms as well as remedies for them. In the coming weeks, I will discuss a few of these beliefs. However, before doing so it is important to emphasize again that not all Latinos hold to them and it would be an over-generalization to treat these patients as though they did. Instead, Spanish for healthcare professionals instructors need to encourage their students to use this information as a resource for when the patient presents with these beliefs rather than automatically attributing them to all Latinos. Nonetheless, it is true that there are certain factors which increase the likelihood of a person having traditional ideas. In this post, I will talk about these factors in relation to the U.S. Hispanic population.
Place / country of origin
It is fairly common sense that where one is from forms one´s beliefs and traditions. Living in Spain has allowed me to experience some of that first hand. Times when I have been sick, people have blamed it on me not wearing a scarf. If I did not get better, it was attributed to me not eating raw onion and breathing in eucalyptus vapor. I am not saying that there is not an element of truth or wisdom in what was said but that those are by no means traditional beliefs where I grew up. Quite the contrary: wearing a scarf was for when it snowed and, when one was sick, they took medicine and ate chicken noodle soup with saltine crackers. Nevertheless, even though beliefs differ from country to country, some countries are more likely to give rise to a larger gamut. For example, Guatemala, the Dominican Republic and Mexico tend to have higher incidences of health-related folklore, possibly due to factors such as higher numbers of indigenous and rural populations, than others such as Argentina or Cuba.
However, it is not only the country of origin that makes the difference, but also the place within that country. For example, someone from a small, rural village in Mexico will not have the same beliefs as someone from Mexico City. Whether due to isolation, lower levels of education, higher percentages of indigenous populations or higher value on tradition, rural zones tend towards more health-related beliefs.
In the United States, most Latino immigrants are from Mexico. However, depending on the region or city, there are also high rates of immigration from the Dominican Republic, Guatemala, El Salvador, Cuba, Colombia and Peru. Puerto Rico was intentionally left off the list since many who were born there speak English and tend to not request a Spanish-speaking medical provider. In terms of rural or urban origin, despite a recent shift that has increased the number of Latino immigrants from urban zones, most immigrants still come from rural regions.
A general characteristic of education is presenting fact-based truth and demystifying natural occurrences. While many children may believe that thunder is “God moving around His furniture”, through education they learn that it is actually from vibrations that travel through the air caused by lightning. Though at times there is truth behind some folkloric beliefs, it is not always the case. Hence as people begin to study and learn, they start to weigh their cultural beliefs against the information they are being presented with and, oftentimes, abandon those beliefs. This is especially true when the person is educated in a setting where cultural and folkloric beliefs are devalued or are even mocked (as what often occurs in the U.S.). Thus, the general truth becomes: the higher the education level, the fewer folkloric beliefs a person tends to have.
In terms of education levels among the Spanish-speaking population in the United States, 67.7% of foreign born Latinos (the group most likely to present in clinic as Spanish-only) have the equivalent of at least a high school diploma as compared to 92.5% non-hispanic whites and 85% of the population as a whole.
A characteristic of old wives´ tales is that they tend to be told by those who fit the trait of old (intended as a pun and not intended to be derogatory). Folklore and tradition is passed from generation to generation. However, technology, whether it be the Internet, television or the increased publication of books and newspapers, has increased the access to information for people all over the world. Though this information would seem to be offered equally to everyone, younger people tend to seek more information from outside sources (i.e. not Grandma or local villagers) and tend to be more apt to change based on the information they receive. In the end, it can almost be seen as an informal education and implies that those who are younger will hold to fewer beliefs. It also means that some beliefs are “in danger” of dying out. Since, according to the 2010 census, most immigrants who arrive to the US are young (under 25), it would be expected that their age would reduce the amounts of health-related beliefs they hold or at least make them more receptive to contradictions to those beliefs.
No, this is not a repeat of age. Generation refers to a family´s history in the United States. First generation encompasses those who immigrated to the United States but were born elsewhere; second generation refers to those who were the first of their family to be born in the United States but the second to live there, etc. The first generation, having left their culture and met with unfamiliar beliefs, will acculturate to some extent or not as time passes. Of all the generations, they are the most culturally similar to a country that is not the United States and the least likely to fully leave behind folkloric beliefs from their country of origin (however, the extent to which they do depends on the extent of their acculturation). Each subsequent generation tends to be more similar to the United States culture and set of beliefs than the one before it, leaving behind the traditional beliefs of their ancestors. In the United States, most patients who wish to be seen in the healthcare setting in Spanish rather than English are first generation. According to Young (2005), 72% of the Latino immigrants (first generation) speak Spanish only whereas only 7% of the second generation and 1% of the third generation primarily speak Spanish.
Time in the United States
Along with the idea of generation and acculturation, the longer an immigrant is in the United States, the more likely they are to have similar views as the U.S. population regarding health and wellness. Physicians in areas with high rates of new immigrants, such as the states of North Carolina, South Carolina, Georgia, Tennessee and Arkansas, will be more likely to encounter Latinos who hold to more health-related beliefs than in areas where most immigrants have been for twenty to thirty years, such as the West Coast.
Previous experiences in the healthcare setting
Previous experiences in healthcare settings as well as the way medical professionals treated the patient´s health-related beliefs play a role in how they expect to relate to their current medical professional regarding these beliefs. Did the patient have access to a standard healthcare system where he or she was living previously? Did they tend to visit a doctor or a curandero when they were ill? How did the medical staff respond to their health-related beliefs? These are all factors which will play into a patient´s expectation of the physician´s familiarity with their beliefs and of how they should be treated.
As can be seen, many factors play into how many and what beliefs a patient may hold. The medical professional should not attempt to assume what a patient believes or not, but rather use information regarding beliefs or order to respond adequately to patients´ concerns or to foresee some possible questions the patient may be too afraid to ask.
Chong, Nilda (2002). The Latino Patient: A cultural guide for health care providers. Intercultural Press: London
Werner, David, Carol Thurman, Jane Maxwell y Lisa De Avila (1995). Donde no hay doctor, 2º ed., Berkeley, CA: Hesperian Foundation.
Young, Richard (2005): “The growing Hispanic population in South Carolina: Trends and issues”. Institute for Public Services and Policy Research, <http://www.ipspr.sc.edu/publication/Population%20In%20SC.pdf>