Author(s): Andrea B. Smith, MD PhD
Reviewer(s): Community Reader, Rozy Ramirez Harborview Medical Center/University of Washington
Contributor(s): Leon Reines, Revisons, August 2003
Date Authored: September 01, 2000
Date Last Reviewed: August 01, 2003
Mexico is bordered to the North by Texas, New Mexico, Arizona and California. To the South it is bordered by Guatemala and Belize. To the East is the Caribbean Sea and the Gulf of Mexico. To the West is the Pacific Ocean. The total area of Mexico is 1,972,550 sq. km which is slightly less than three times the size of Texas. The climate varies from tropical to desert and the terrain includes high rugged mountains, deserts, low coastal plains and high plateaus. Mexico is made up of 31 states and has Mexico city as its capital.
History and Politics
Originally inhabited by many different ethnic groups from which you can mention the Mayas, Zapotec, Aztec and others, Mexico, like much of South and Central America, was colonized by the Spanish, being occupied from 1521-1810. Colonization led to both the acquisition of Spanish culture and the loss of great part of the Aztec culture, with the present day culture being a melange of the two. Mexican independence occurred September 16, 1810 and was sparked by the Napoleonic threat to acquire what was then “New Spain”. Afraid of losing their emerging culture, the “criollos” (descendants of the Spaniards born in Mexico) and the “mestizos” (descendants of the Spanish and Indian intermarriages) united in a movement known as “Los Insurgentes” which eventually overthrew Spain.
Texas at that time was sparsely inhabited, having been neglected by Spain in the years prior to the revolution. The newly formed Mexican government therefore allowed US citizens to settle there. These citizens did not adopt the Mexican language or culture and in 1829 when Mexico abolished slavery they found they could not enforce the law in the area now known as Texas. In 1835 Mexico replaced their federal system with a centralized republic in an attempt to gain more control over its regions, but this only led to Texas declaring independence in 1836. In 1845, Texas was taken into the US, leading to the Mexican-American war. This ended with the treaty of Guadalupe-Hidalgo in 1848 and resulted in the loss of Texas and part of California to the US.
Cinco de Mayo, which is commonly thought of in the US as Mexican independence day, happened in 1862 and celebrates the victory of the Mexican army over the occupational French forces. The victorious General, Ignacio Zaragoza was born in Texas, and due to his joint heritage, this holiday is celebrated in both countries. In the US it has also come to represent the accomplishments of the chicano monement, including better jobs and education.
The Mexican Revolution occurred in 1910, a century after independence from Spain. It was sparked by many things, the greatest being the unfair dictatorship of President Porfirio Diaz who had been in power for 31 years. The main leader of this revolution was Francisco I. Madero. This has led to the government of today which is a federal republic operating under a centralized government. It has an executive branch made up of the president and his cabinet, and a legislative branch made up of the Senate and the Chamber of Deputies.
|Buenos días||Good morning|
|Buenas tardes||Good afternoon|
|Perdone, no hablo español.||I am sorry I do not speak Spanish|
|Estamos esperando un intérprete||We are waiting for an interpreter.|
Greetings and Displays of Respect
Respect is very important in Latin culture. The way in which a doctor and other health workers greet and address a Latino patient may convey respect or disrespect to the patient.
In the medical culture, a greeting may serve more purposes than just a salutation or welcoming. Sometimes the greeting serves the purpose of clarifying the patient’s identity for the doctor. This can be an important part of avoiding medical errors – making certain that the chart or medical record belongs to the patient at the appointment, and that the chart does not belong to another patient who has a similar name.
For instance, a doctor who greets his patient Julio Perez by saying “Hello Julio” may be using the greeting to confirm that the patient is indeed Julio Perez, and not Jaime Perez or Juan Perez who are two of the doctor’s other patients.
It may seem appropriate to use only the patient’s first name in order to confirm identity. However, greeting the patient by using only his/her first name may convey disrespect for the patient. Greeting Julio Perez by saying Hello Señor Perez conveys respect from the doctor to the patient.
A recommendation to doctors for greeting their patients in a manner that conveys respect while still avoiding patient identification errors is to use a title and the full name, such as saying Hello Señor Julio Perez. Then, after correct patient identification is established (when it is found that the person matches the chart in hand), continue addressing the patient in the most respectful manner throughout the encounter, such as saying Señor Perez.
Phrases of Courtesy in Nine Languages: A Tool for Medical Providers
This language learning tool features videos of native speakers saying phrases of courtesy in nine languages, including Spanish. Phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a learning speed. The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. View Spanish videos.
Studies indicate that Hispanics expect a caregiver to show warmth to a patient and family members and should not be strictly business (Zouchay). A physician should be attentive, take their time, show respect, and if possible communicate in Spanish. Some simple phrases are listed above for those who do not know any Spanish. Hispanics also have more respect for care givers if they exhibit confidence.
Family Life and Kinship Structure
Although Mexican families tend to be Patriarchal, it is the mother who is in charge of health care (Gonzalez-Swafford). Home remedies are passed on from mother to daughter. When a family member is sick, it is a family crisis and often there will be many people to whom the in charge of health care, for more difficult and chronic treatments, it is often important to physician will have to explain the disease process (Davidhizar). Although the mother is the one convince the father that this is necessary.
Adulthood and Old Age
For information on geriatrics and older Hispanic/Latino Americans, see Stanford’s Ethnogeriatrics Health and Health Care of Hispanic/Latino American Older Adults. This is an on-line learning module, but you can download the module as a PDF and print the cultural profile by filling out a short survey. Additional cultures and geriatric information also available on their site.
Nutrition and Food
Food is often used to cure illness as will be discussed later (Gonzalez-Swafford). Here we list some foods as they are categorized for healing.
|Cold Foods||Hot Foods|
|Dairy products||Expensive Meats
(beef, water fowl, fish, mutton)
(goat, chicken, rabbit)
Mexicans are often very religious with the most common religion being Catholicism. The virgin of Guadalupe is considered their patron saint after she appeared to the Indian Juan Diego on December 12 over 400 years ago. This day continues to be celebrated annually with prayers and thousands of pilgrims going to the Guadalupean Basilica where this miracle is said to have occurred.
The Aztec religion, as it was practiced before colonization is all but gone. They believed in a vital force of “tona” that separated living from non-living matter. They were animists with multiple gods. They also had a strong belief in balance and in supernatural powers which can still be seen today in some of the traditional medical beliefs.
Traditional Medical Practices
Traditional medicine in Mexico is based on the Greek belief, brought by the Spaniards, in the four humors: blood, phlegm, black bile and yellow bile. A balance of these is believed to be needed for good health (Reinert). These beliefs were brought over by the Spanish during colonization, and over the years combined with some of the already existing ones to form a belief, which is based on a balance between hot and cold. When someone is sick, it is because they are out of balance, having either too much heat or cold. Correction of this balance is by consumption of foods or herbs of the opposite quality. Hot and cold as far as healing goes, has nothing to do with the actual physical temperature of the food and definitions of this can vary depending on the region in Mexico the individual is from. Awareness of these beliefs is important when prescribing medicine since they too are categorized as hot and cold. For example, penicillin is considered a “hot” medicine and if given for a “hot” disease such as fever it is less likely that the patient will be compliant. Another example is vitamin C which is considered a cold food and therefore inappropriate treatment for a “cold” disease like an upper respiratory tract infection. “Cold” diseases are ones that have invisible symptoms and include earaches, arthritis, stomach cramps and a chest cold. Hot diseases have more visible symptoms and include empacho (indigestion), colico (nausea, vomiting and abdominal cramp), stomach ulcers, fever, headache and sore throat. Since these categories may vary depending on where the patient is from it is often best just to ask if there is any contraindication to taking a medicine according to their beliefs.
Supernatural powers are also believed to cause disease. An example of this is “mal de ojo” or the evil eye (see below). With diseases caused by supernatural forces, non-supernatural cures are not believed to be helpful and often have poor compliance. Therefore it is important to point out the natural cause of the disease and why the prescribed treatment will be beneficial. Another common example of a supernatural diseases is susto (fright sickness).
The main traditional healer is known as a curanderas and is believed to get her power from God. Less used traditional healers include the Yerberos (herbalists) and Sobadores (masseuses). Curanderas view illness in a religious and social context, and are used more for diseases that have a supernatural cause (Fisherman et al).
Empacho is a form of stomach upset which is believed to be caused by a bolus of undigested food (Fishman et al). This can happen by eating the wrong foods at the wrong time of the day or eating undercooked foods. Symptoms include anorexia, vomiting, diarrhea bloating, indigestion, and constipation. The most common treatment is massaging the stomach or back, pinching the skin of the back and pulling it until it pops.
Caida de mollera means sunken fontanel and is believed to be caused by pulling a baby away from the breast or bottle too quickly, having the baby fall to the ground or carrying the baby incorrectly. Symptoms include poor suck, irritability, sunken eyes, vomiting and diarrhea. The treatments include pushing up on the baby’s palate with a finger, holding the baby upside down over a pan of water and slapping the bottoms of his feet, and apply a poultice to the fontanel.
Susto or fright sickness is caused by a traumatic or frightening experience. Symptoms include lethargy anxiety, depression, insomnia, and irritability. Treatment includes herbal teas, covering the face with a cloth and sprinkling holy water, and spitting a mouthful of water or alcohol into the patients face unexpectedly.
Mal ojo or evil eye is caused by a person with a “strong eye” and occurs when someone admires a child without touching them. The cure involves passing an egg over the body and then placing it in a bowl under the child’s pillow overnight. If the egg is cooked in the morning then the child had “mal de ojo”.
Mal puesto is when someone uses witchcraft to put a bad disease on a person. The hex can be placed by a bruja (witch) or someone who knows about witchcraft. Symptoms can be varied and the cure involves prayers, massages, herbs, making crosses on the arms with olive oil and chili powder, and medicinal enemas.
Problems and Remedies
- Cold water compresses over the head, neck and groins
- Tepid baths
- Alcohol rub or bath
- Lots of liquids
- Give teas
- Remove clothes
- Herbal teas, especially oregano, cinnamon, eucalyptus, and chamomile (sometimes with honey)
- Honey and lemon
- Combination teas of several herbs
- Rice water
- Increase clear liquids, no milk or food
- Herbal teas, especially mint and chamomile
- Suero (dehydration solution made of water, sugar, lemon or banana)
- Stop all food and give clear liquids such as rice water, 7-up, water and sugar, pedialyte, and fruit juice
- Herbal teas, especially mint and chamomile
- Chamomile drops or wash for the eyes
- Breast-milk drops in the eyes
- Wash with warm water
- Special diet (vegetable soup and fresh fruits, carrot juice, or eliminate flour tortillas, bread and sodas)
- Skin Rash
- Apply cornstarch
- Alcohol rub or bath at night
- Apply various substances such as baby lotion, water with baking soda amica lemon oatmeal powder, or rub with watermelon shell
- If due to allergy, change soap, rinse kids’ laundry well, or use cotton clothes
- Frequent daily baths
- Minor wounds
- Wash with soap and water
- Cover with bandage
- Clean with lemon juice
- Minor burns
- Wash with or place in cold water
- Apply pork lard, cooking oil, or butter
- Aloe vera
- Raw onions
- Apply toothpaste
- Egg white
- Cooked beans
Experience with Western Medicine in Home Country
Western medicine can be found in the larger cities in Mexico, which is comparable to that found in the United States. Like the United States, patients need money to get this medical care and often the poor will turn to the less expensive traditional medicine. Even among those that can afford Western medicine the traditions of the family are respected and often a combination of Western and traditional medicine is used.
Experience with Western Medicine in the United States
Both cultural and economic factors effect the access of Mexican-Americans to health care in the United States. Only 37% have health insurance (1991, Davidhizar) and yet they use the emergency room twice as much. This is partly due to the fact that they are twice as likely to be poor with 38% of Hispanic vs. 14% of non-Hispanic whites living below the poverty level. It is also important to note that a third of the Hispanic population in the United States are children less than 15 years of age (Mikhail) and should be covered by Medicaid.
Another factor in health care in the United States is the use of the traditional healer. One study showed that 17% of Hispanics sought health care initially from a folk healer with 32% using health care professionals and the rest self-treating. Since it is not only in the initial stage of the disease that a folk healer will be used, the percent that use them overall is even larger. Another interesting fact is that 72% of people who receive care from a folk healer do not tell this to their physician. Although most of the folk cures are harmless and even sometimes helpful, it is important to know if a patient is using a folk cure because some remedies such as greta and azarcon contain lead and can be harmful (Mikhail).
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Fishman BM, Bobo L, Kosub K, Womeodu RJ. Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans. Am J Med Sci. 1993 Sep;306(3):160-6. Review.
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