CUBAN CASE STUDY Mrs. Demetilla Hernandez a 63-year- Cuban woman seeks consultation Liberty health-maintenance organization (HMO) clinic weakness, lethargy, fatigue experienced 2 months. A week ago, cooking dinner daughter, Mariana's house, momentarily lost balance slipped kitchen floor. CUBAN CASE STUDY

As a health-care provider, what are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?

Latino families are often multigenerational in their composition. As the grandmother, Mrs. Hernandez assumes control over the family meals. This is a very important part of her identity. Rather than communicating directly, food is love and emotions and feelings are communicated through food.

Q2. Describe the traditional Cuban food patterns. How would you assist Mrs. Hernandez

in developing a plan for a 1500-calorie diet and regular exercise?

People who have grown up in poor, food-insecure settings often develop patterns of eating high-calorie, high-carbohydrate comfort foods and many Latino cultures have this attitude embedded within them, particularly if the persons in question grew up under difficult circumstances. Mrs. Hernandez must be given a food plan that reflects her cultural tastes and ingredients and still satisfies her need to be a good cook.

Q3. Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?

I would try to explain to Mrs. Hernandez the medical rationale for her prescription. I would note that herbal therapy was common before current medical advances and while well-intentioned, she should avail herself of the best medical assistance possible to be healthy.

Q4. Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.

Herbs and using food as medicine are common, so is treating illnesses with food and the act of eating itself.

Q5. Explain how time orientation may influence Mrs. Hernandez's compliance with follow-up clinic visits.

Cuban culture has a very flexible attitude towards time which can be problematic both in terms of timing medication and also in terms of meeting clinic appointments.

Q6. Formulate three important goals in teaching Mrs. Hernandez and her family about health care.

Mrs. Hernandez and her family must understand the medical importance of weight reduction, the effect of food upon her blood sugar and the problems that diabetes can cause, along with the importance of sticking to a rigorously-timed medical treatment to address her ailment.

Q7. Identify the typical family and value structure among Cuban Americans.

Family, tradition, and traditional foods are all important to Cuban Americans, as is maintaining those traditions and an extended family network.

Q8. List three major health problems among Cuban Americans.

Obesity, diabetes, and side effects from home medicines used in the place of conventional medicines.

Q9. If you were the health-education specialist at the clinic, what would you teach the staff about Cuban culture to help them provide culturally-competent care?

I would try to help them understand the importance of food within Cuban culture to stress why adherence to a dietary regime might be more challenging for this ethnic group, particularly if traditional foods tended to be high in sugar and carbohydrates.

10. Discuss traditional child-rearing practices among Cuban Americans.

Child rearing is a collective endeavor, embraced by both grandparents as well as parents in an equal fashion. Mrs. Hernandez's pride in her grandchildren's prosperous plumpness is thus more difficult to eradicate than they would be in an Anglo grandmother more influenced by common mass media messages about the importance of slenderness.

MEXICAN CASE STUDY #2

Q1. Identify three socioeconomic factors that influence the health of the Gaborra family.

First and foremost, the Gaborra family is influenced by poverty which limits their ability to buy healthy food and live under stable health-promoting circumstances. They are also limited in their English proficiency which makes it difficult for them to obtain high-quality health knowledge. Finally, their migrant status makes them unable to obtain health insurance or a stable health provider.

Q2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia.

Olga can be urged to seek treatment to preserve her strength, which she needs to work; to be able to be a better mother and wife (consistent with her cultural values); and also to have more energy to find high-paying work.

Q3. Identify strategies to help improve communications in English for the Gaborra family.

Stressing the importance of learning English because 1. It will help them with their children's school work; 2. It will help their children's fluency in English and thus their futures in America; 3. It will enable all family members to obtain higher-paying jobs.

Q4. Identify three health-teaching goals for...

Name three interventions Olga must learn regarding fluid balance for the infant, Linda.
Olga needs to understand the importance of sanitary water for the child; of replenishing the child's electrolytes and fluids when the child is sick; and keeping the child protected from heat exposure (dehydration) while working in the field.

Q6. Discuss three preventive maintenance -- teaching activities that respect the Gaborra family's belief in the hot and cold theory of disease management.

Given these beliefs, the need for sanitary water (both hot and cold); keeping themselves and the baby from being over-exposed to hot and cold; and the need to ensure that the baby has appropriate fluid balance are all essential (Ortiz et al. 2007).

Q7. Identify strategies for obtaining health data for the Gaborra family.

Interviews with the family with a culturally competent translator; interviews with Roberto's teacher regarding his hygiene; and interviews with healthcare providers and healthcare records obtained during the family's visits to the ER.

Q8. Identify four major health problems of Mexican-Americans that affect the Gaborra family.

Poverty; a lack of access to preventative care because of migrant status; unsanitary living conditions; a lack of health knowledge.

Q9. If Olga were to see a folk practitioner, which one(s) would she seek?

Likely an older relative -- if not one in their own family, then in another trusted family.

Q10. Explain the concept of familism as exhibited in this family.

This family stays together under very dire circumstances -- they always function as a unit. This can be very positive in some ways but also means that Olga is less motivated than perhaps she should be to learn English and improve her employability.

Q11. Distinguish between the two culture-bound syndromes el ataque and susto.

El ataque is analogous to 'anxiety' and is the term more commonly articulated by higher-income Latinos while 'susto' or fright is a more generic term for being upset and anxious which tends to be used more amongst lower-class members of this ethnic group (Dura-Vila, & Hodes 2012)

Q12. Discuss culturally conscious health-care advice consistent with the health belief practices of the pregnant Mexican-American woman.

Stressing the importance of being a good mother (an important cultural value) and caring for the unborn child honors the values of Mexican-American woman.

Q13. Discuss two interventions to encourage Mexican-American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen.

Having clinicians go to the fields where these laborers work and provide on-site healthcare would be helpful, given the difficulties of transportation for people without access to cars working long hours. Offering free food at the clinic (such as a bag of bread, peanut butter, apples, and so forth) would be another attraction.

Q14. Identify where the majority of Mexican-Americans have settled in the United States.

Mexican-American immigrants tend to concentrate at border areas and in areas where there is low-skilled work that requires minimal labor skills: the Southwest and West.

PUERTO RICAN CASE STUDY #2

Q1. Explain Mrs. Medina's attitude in her relationship with her adolescent daughter.

Unfortunately, Mrs. Medina has a relatively paternalistic attitude towards her daughter: she is currently preventing her daughter from getting a job so the girl will be more tied to the home and is unaware that her daughter is sexually active and pregnant. Communication is poor.

Q2. Identify strategies to ensure that Rosa seeks prenatal care.

Given that Rosa wants to seem more adult, stressing that seeking prenatal care is the responsible thing for an adult expecting a child is likely to be more persuasive.

Q3. Identify barriers to accessing health care for the Medina family.

Money is 'tight;' there is a lack of concern about unhealthy behaviors amongst adults as well as adolescents; the family is unmotivated to seek care.

Q4. What are the high-risk behaviors exhibited by this family?

Unprotected sex; smoking and drinking; failing to seek professional medical help even after health issues reach clinical significance.

Q5. What communication barriers exist in this family that affect care delivery?

It is assumed that the children, especially Rosa, should remain childlike and dependent even though the children's actions and behaviors are not consistent with this assumption. Family members do not communicate with one another about health problems and do not attach enough priority to health issues to seek out professional advice.

Q6. Discuss gender and family roles in the context of traditional Puerto Rican culture.

Women's subordinate status economically is stressed, even though there may be respect for older women. An unwillingness to see Rosa as an…