Mexican Americans demonstrate wide diversity in health beliefs and practices, influenced by level of education, socioeconomic status, generation, time spent in U.S., and degree of affinity to traditional Mexican culture. Those from urban settings with higher levels of education tend to have more exposure to Western medical practices; also more likely to be bicultural, selectively maintaining certain Mexican cultural factors. Diversity within this population makes it difficult to generalize about Mexican American health beliefs and practices. Mexican American health beliefs and practices discussed here from traditional perspective, understanding that individuals may subscribe to all, some, or (possibly) none of these. Mexican Americans are defined as those individuals reporting Mexican cultural heritage, who self-identify as permanent residents of U.S., regardless of legal residency status.
Nonverbal communication. Nonverbal communication strongly influenced by respeto (respect). Direct eye contact frequently avoided with authority figures such as health care providers or those with perceived class differences. Family members may demonstrate respeto by standing when provider enters room. Silence sometimes shows lack of agreement with plan of care. Touch by strangers generally unappreciated and can be very stressful or perceived as disrespectful. However, therapeutic touch an integral part of traditional healing. Handshaking considered polite and usually welcomed. Simpatía (social behavior promoting smooth relationships) may or may not translate to rapport.
Orientation toward time. Traditionally present-oriented. Time viewed as relative to situation. This flexibility allows for feeling of punctuality even when 15-10 minutes late. Social time more present-oriented than business time. More acculturated or bicultural Mexican Americans demonstrate increased concern for punctuality in themselves.
Privacy. Familialism influences privacy needs. Most sensitive issues, including health issues, kept within family. Immediate family members may serve as referents for individuals concerns. Increasingly, women do not share information about contraceptive activities with family. Males disclose less often. Self-disclosure to same gender individuals usually more comfortable.
Serious or terminal illness. Family may want to protect an ill family member from knowledge of seriousness of illness, based on strong belief in mind-body connection and concern that worry and will worsen health states. Information about gravity of illness usually handled by family spokesperson (often older daughter or son).
Activities of Daily Living
Modesty. Traditionally, Mexican Americans receive health care from women. Modesty especially pronounced in women, best respected by providing female health care providers for sensitive physical examinations. Male physicians generally excepted, but comfort level greatly enhanced by those who demonstrate sensitivity to issue of modesty. Try to respect privacy whenever possible; allow family members to assist with ADLs. Always cover patient during physical examination and explain the procedures in advance. Presence of non-essential person in examination room discouraged.
Skin care. Mexican Americans bathe daily, pay close attention to grooming and appearance. Society considered very critical of appearance. Presentation of self probably related to respect for family's reputation.
Hair care. Normally, hair washed daily. Traditionally, women wear hair long, braided during times of illness of bedrest.
Nail care. Clean and well kept.
Toileting. Privacy essential when using bathrooms. Bedpans and bedside commodes disliked as unclean and immodest.
Special clothing or amulets. Personal articles may be brought to hospital to ensure success of hospitalization and good health. Religious items, such as rosaries, frequently kept on person. Postpartum women instructed to cover their backs and to wear a faja, wide cloth band wrapped around abdomen. Respect for cultural elders may enhance use of special items among relatively acculturated Mexican Americans.
Self-care. Traditional belief that health is controlled by environment, by fate (distino), and by will of God (las manos de Dios). Clients may rely on health care providers and family members for care. Patients will perform own hygiene when asked and if able. Traditionally, family members actively involved in ADLs. Many believe self-care can adversely affect recovery. Hospital environment or policy such as restrictive visiting hours, open disapproval of traditional caregiving activities, or patient activity expectations, such as early ambulation, that are in direct opposition to traditional beliefs and practices, can impede caregiving role of family
Food beliefs and rituals. Traditional food beliefs, traced to Galen's humoral theory, based on belied that body's four humors, blood, phlegm, yellow bile, and black bile must be kept in balance using qualities of heat, colt, moisture, and dryness. Certain illnesses considered hot or cold states and treated with foods that complement those states. Humoral theory does not refer to temperature of foodstuff but to effects certain substances though to have on body. Patients may refuse certain foods due to these beliefs.
Food prescriptions. Soup (caldo de pollo) and herbal teas frequently administered to speed recuperation. Yerba Buena used as general tonic; chamomile used to treat gastric upset, especially for colic in newborn. Milder, lighter foods frequently encourages during illness and recuperation, with less consumption of chiles or meats.
Pain. Patients tend not to complain of pain. Assess pain by nonverbal cues. Mexican Americans prize inner control and self-endurance. For some men, expressing pain shows weakness and possible loss of respect. Expression of pain socially more acceptable in women; however, stoicism common.
Dyspnea. Tendency to feel that something is very wrong if oxygen required.
Nausea/Vomiting. Symptom will be disclosed if asked. See discussion of dehydration below.
Constipation/diarrhea. Will be disclosed of asked. Some believe diarrhea beneficial purging of cause of illness and may not agree with use of medications to stop it. Information about dehydration required; especially important in management of children with diarrhea. Herbal teas will excepted as healing agents and may be effective means of correcting dehydration. Traditional diet usually adequate to avoid constipation.
Fatigue. In Mexico, siesta is rest period that occurs after midday meal. Some in U.S. choose to rest after lunch and in areas with large percentage of Mexican Americans, this practice continues in abbreviated form. Major difference with lifestyle in Mexico is 30 to 60 minute noontime work break in U.S. that does not allow time for return home. Many women report exhaustion, related to multiple roles (domestic work, motherhood, and outside work). Presence of grandmother in household instrumental in decreasing workload on Mexican American women.
Depression. Not easily disclosed, seen as mental illness, sign of weakness, and embarrassment to family. Depression most common response to stress in Mexican Americans.
Self-care for symptom management. Informal health care system in Mexico and other Latin countries include self-medication. In theory, prescriptions required for all medications such as antibiotics and steroids, but in practice sale of drugs is uncontrolled. Pharmacist is, in effect, physician-surrogate.
Birth Rituals/Care of the New Mother/Baby
Pregnancy care. Barriers to prenatal care include fear of health care system, financial constraints, and lack of transportation. Many women believe pregnancy not an illness and prenatal care unnecessary. Other seek prenatal care for reassurance of fetal well-being. Early and regular prenatal care usually associated with high socioeconomic and educational levels and acculturation to Western health care belief system. Paradoxically, Mexican American women with late or no prenatal care experience have surprisingly healthy birth outcomes.
Many Women from lower socioeconomic levels attend clinics staffed by nurse practitioners, physicians or nurse midwifes, with physicians and midwives supervising deliveries. Women with adequate financial resource generally choose obstetricians.
Familialism (strong attachment to nuclear and extended family) provides supportive and respectful environment for pregnant women. Women who are attentive mothers are highly respected. Expectant mother discouraged from heavy work and harmful activities such as smoking, drinking, or drug use.
Encouraged to frequently rest, walk, eat well, and get plenty of sleep. Finances permitting. less acculturated women readily relinquish other roles to insure healthy birth outcome. More acculturated women with outside jobs report more role conflict. Common for grandmothers to move into nuclear family homes during last weeks of pregnancy and for weeks following delivery (sometimes coming from great distances). Grandmother or other female family members assume domestic roles and assist pregnant women and new mother in health maintenance and restoration. Prenatal care has very broad meaning to Mexican American women, including informal home care from family members.
Pregnant women protected from folk illnesses such as Mal de ojo (evil eye), susto (fright), and antojos (cravings). See Illness Beliefs. Often, folk medicine carried from Mexico by mothers and grandmothers and used within confines of extended family. This information usually not shared with practitioners. More acculturated women sometimes reluctantly report belief in these practices as unexplainable but effective.
Birth recuperation. Traditional 40-day period of recuperation call la cuarentena. Women cared for by other women, but expected to care for new born. Domestic chores taken on by female relatives or friends. New mothers discouraged from taking showers for several days, also discouraged from getting out of bed for first few hours after birth and then only to use bathroom. Light foods provided, including caldo de pollo, herbal teas, and tortillas. Beans avoided.
Life in U.S. rarely offers luxury of la cuarentena. Economic needs and separation from extended family lead many women to resume domestic or work activities within first two weeks. Some women feel la cuarentena unduly restrictive and old-fashioned, but make efforts to comply to some degree as shod of respect to women who assist.
Primary religious/spiritual affiliation. Approximately 80-90% Roman Catholics. Virgin of Guadelupe powerful popular religious image as dark skinned mother of Christ. Religious symbol unique to Mexico and Mexican Americans, Virgin of Guadelupe perceived as model of motherhood, peace, faith, strength, and endurance. Many direct their religious promises (mandas) and prayers to her.
Usual religious/spiritual practices. Daily prayer common. Baptism of infants mandated; especially urgent if prognosis grave. Rite for Anointing of the Sick mandatory if prognosis grave. Family or patient may request that amputated limb be buried in the consecrated ground. Attendance in Catholic church services also shown to be sporadic, even among very traditional people. Many homes contain small shrines for personal prayer. Religiosity declines with acculturation.
Use of spiritual healing/healers. See Illness Beliefs.
Causes of physical/mental illness. No clear separation of physical and mental illness. Disease based on imbalance between individual and environment. Emotional, spiritual, social, and physical factors considered. Humoral theory, God, spirituality, and interpersonal relationships all con contribute to illness. Mexican Americans may seek biomedical health care for severe symptoms while utilizing folk healing measures to deal with chronic symptoms and spiritual or psychic influences. Example of folk illness:
Caidia de mollera (sunken fontanelle). Condition of infants that can occur until anterior fontanelle closes. Cuased by bouncing or dropping infant, or removing nipple too roughly from its mouth.
Empacho (intestinal obstruction) Abdominal pain. Vomiting, constipation, loss of appetite, or bloating caused by adherence of food to intestinal walls. Infants, children, adolescents, and women in immediate postpartum period are at risk.
Mall de ojo (evil eye). Sudden downturn in physical or emotional condition of an infant or young child ( and sometimes in adults) believed to be caused by "admiration" (jealousy) of person with powerful eyes. Green-eyed individuals believed to be capable of inflicting mal de ojo. To admire an infant without touching puts infant at increased risk for mal de ojo.
Susto (fright, shock). General malaise, insomnia, irritability, depression, nightmares, and wasting away caused by fright or emotional shock.
Antojos (cravings). Failure to satisfy food craving in pregnant woman believed to caused defect or injury to fetus. For example "strawberry nevus" may be explained by unsatisfied craving for strawberries.
Causes of genetic defects. Usually described as will of God. Also described as response to unacceptable behavior or by not satisfying antojos. Shame may be associated with genetic defects. Physical disability usually more accepted than mental retardation. Institutionalization uncommon. Family takes care of disabled members.
Sick role. Illness seen as social crisis and experience of entire group. Sick roles clearly defined and family caregiving accepted. More acculturated ill person may be caught between belief in maintaining independence and settling into more dependent sick role. Often attempt to merge these two perspectives. Women may experience more somatic complaints, such as fatigue.
Home and folk remedies. Curandismo, use of traditional Mexican healers, exists among many Mexican Americans, however to lesser degree than in rural areas of Mexico. Most Mexican Americans use biomedicine, sometimes with folk healing methods at home or from know tradition healer, particularly in Southwestern U.S. Concurrent use of traditional healers is usually not disclosed to Western medicine providers, possibly out of respeto, respect for authority and power of health care providers.
Curanderos. Attempt to correct imbalances by using prayers, pledges to religious or supernatural forces, and rituals involving candles, artifacts (such as eggs), herbal baths. Includes belief in humoral theory of disease. Curandera, or female folk healer, believed to be chosen by God to heal. Some of these individuals are listed in mental health agencies as "ethnopsychologist" or "ethnotherapist" in areas with large Mexican American Populations.
Yerbalistas (Herbalists). Herbalism dating from pre-Colombian times, plays key role in home remedies. Diagnoses made and herbal prescriptions brought home and made into broth or tea for patient to drink. Herbalism experiencing rebirth in U.S.
Sobadoras (masseuses). Sobadoras are female healers who use massage or manipulation of bones and joints to correct musculoskeletal imbalances. They are frequently also parteras, women who assist in pregnancy care and birth. Many sobadoras skilled in external rotation of fetus from breech to head down presentation.
As noted earlier, patients do not readily volunteer their belief in folk health system. Younger generations may have little belief in or knowledge of folk illnesses, remedies or healers. However, information can be obtained by talking and showing interest and acceptance of certain practices, such as use of herbs and teas. Herbal medications can have powerful physiologic effects, some toxic. Many common herbs also have Spanish names. Often patient cannot identify herbal treatment by name.
There are also spiritual ceremonies for relief of symptoms and causative factors. One very common treatment for mal de ojo (evil eye) or susto (shock) is passage of unbroken raw egg over ill person, using sign of cross, candles, and associated prayer. Believed that illness will pass into egg and out of ill person's body.
Empacho (intestinal blockage) can be treated by massage of olive oil, warmed in spoon, then mixed with baking soda or powder in sobradora's hands. Patient lies down and is massaged front, than back. At end of massage, skin in center of back is pulled up until it makes a popping sound.
Combination of humoral and herbal medicine traditionally passed on from mother to daughter throughout successive generations. Continues to be used in U.S. by traditional Mexican Americans as alternative for minor medical, psychosocial, and chronic problems.
Acceptance of procedures. During pregnancy, medications (including iron and vitamins) sometimes seen as potentially dangerous and avoided. Other women will take vitamins and iron during pregnancy, but cease taking them immediately after delivery, believing they will causes excessive weight gain.
May believe reason for hospitalization is only to have particular symptom alleviated. "Doctors have that power" based on book learning and technology. Patients cooperative and supportive and will not interfere with hospital routine. Procedures usually accepted if practitioner trusted.
Care Seeking. Home care usually provided by female members of household. Many will not seek medical assistance until home remedies have failed and illness interferes with ability to meet role expectations. More acculturated individuals with adequate health insurance will seek medical assistance sooner. May believe illnesses not being treated unless medication prescribed. Specific diets should be discussed and could be emphasized as "prescriptions." Limited or lack of health care related to low financial resources, inadequate transportations, fear of legal authorities (in undocumented individuals), or perceived lack of respeto. Some Mexican Americans travel to Mexico for health care, probably related to need to be with extended family and distrust of U.S. health care practices.
Source: Lipson, Juliene G., Dibble, Suzanne L., Minarik, Pamela A. Culture & Nursing Care: A Pocket Guide. The Regents. 1996