Preparation for the presentation will include synthesizing the information from readings, scientific literature, Internet resources, and other sources.
This presentation should address the following:
Rituals,
The degree of assimilation or marginalization from mainstream society, and
Health behavior and practices.
More than 200 words for each option. APA format.
nursinghealth care
309
People of Mexican
Heritage
Chapter 18
RICK ZOUCHA and CECILIA A. ZAMARRIPA
Overview, Inhabited Localities,
and Topography
OVERVIEW
People of Mexican heritage are a very diverse group geo-
graphically, historically, and culturally and are not easy to
describe. Although no specific set of characteristics can
fully describe people of Mexican heritage, some common-
alities distinguish them as an ethnic group, with many
regional variations that reflect subcultures in Mexico and
in the United States. A common term used to describe
Spanish-speaking populations in the United States,
including people of Mexican heritage, is Hispanic.
However, the term can be misleading and can encompass
many different people clustered together owing to a com-
mon heritage and lineage from Spain. Many Hispanic
people prefer to be identified by descriptors more specific
to their cultural heritage, such as Mexican, Mexican
American, Latin American, Spanish American, Chicano,
Latino, or Ladino. Therefore, when referring to Mexican
Americans, use that phrase instead of Hispanic or Latino
(Vázquez, 2001). As a broad ethnic group, people of
Mexican heritage often refer to themselves as la raza,
which means “the race.” The Spanish word for race has a
different meaning than the American interpretation of
race. The concept of la raza has brought people together
from separate worlds to make families and is about inclu-
sion (Vázquez, 2000).
HERITAGE AND RESIDENCE
Mexico, with a population of 107,449,525 (CIA, 2007), is
a blend of Spanish white and Indian, Native American,
Middle Eastern, and African. Mexican Americans are
descendants of Spanish and other European whites;
Aztec, Mayan, and other Central American Indians; and
Inca and other South American Indians as well as people
from Africa (Schmal & Madrer, 2007). Some individuals
can trace their heritage to North American Indian tribes
in the southwestern part of the United States.
Mexico City, one of the largest cities in the world, has
a population of over 20 million. Mexico is undergoing
rapid changes in business and health-care practices.
Undoubtedly, these changes have accelerated and will
continue to accelerate with the passage of the North
American Free Trade Agreement as people are more able
to move across the border to seek employment and edu-
cational opportunities.
Historically, people of Mexican heritage lived on the
land that is now known as the southwestern United
States for generations, long before the first white settlers
came to the territory. By 1853, approximately 80,000
Spanish-speaking settlers lived in the area lost by Mexico
during the Texas Rebellion, the Mexican War, and the
Gadsden Purchase. After the northern part of Mexico was
annexed to the United States, the settlers were not offi-
cially considered immigrants but were often viewed as
foreigners by incoming white Americans. By 1900,
Mexican Americans numbered approximately 200,000.
However, during the “Great Migration” between 1900
and 1930, an additional 1 million Mexicans entered the
United States. This may have been the greatest immigra-
tion of people in the history of humanity (Library of
Congress, 2005).
Hispanics, the fastest growing ethnic population in the
United States, include over 35.3 million people, or 13.2
percent of the population. Fifty-eight percent are of
Mexican heritage, with an increase from 13.5 million in
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1990 to 20.6 million in 2000 (U.S. Bureau of the Census,
2001). Mexican Americans reside predominantly in
California, Texas, Illinois, Arizona, Florida, New Mexico,
and Colorado. However, the major concentration of
Mexican Americans, totaling over 18 million, are found
in the southern and western portions of the United States
(U.S. Bureau of the Census, 2001). Ninety percent of
Mexican Americans live in urban areas such as San Diego,
Los Angeles, New York City, Chicago, and Houston,
whereas less than 10 percent reside in rural areas.
REASONS FOR MIGRATION AND ASSOCIATED
ECONOMIC FACTORS
Historically, many Mexicans left Mexico during the
Mexican Revolution to seek political, religious, and eco-
nomic freedoms (Congress, 2005). Following the
Mexican Revolution, strict limits were placed on the
Catholic Church, and until recently, clerics were not
allowed to wear their church garb in public. For many,
this restricted the expression of faith and was a minor
factor in their immigration north to the United States
(Meyer & Beezley, 2000). Since the “Great Migration,”
limited employment opportunities in Mexico, especially
in rural areas, has encouraged Mexicans to migrate to the
United States as sojourners or immigrants or with undoc-
umented status; the latter are often derogatorily referred
to as wetbacks (majodos) by the white and Mexican
American populations.
Of undocumented immigrants in the United States, an
estimated 6 million are from Mexico (Van Hook, Bean, &
Passel, 2005). Before the Immigration Reform and
Control Act of 1986, hundreds of thousands of Mexicans
crossed the border, found jobs, and settled in the United
States. Although the numbers have decreased since 1986,
border towns in Texas and California still experience large
influxes of Mexicans seeking improved employment and
educational opportunities. The tide of illegal immigration
to the United States has increased, as evidenced by the
apprehension of Mexicans attempting to enter the United
States annually, with estimates of 250,000 to 300,000 peo-
ple entering illegally (Passel, 2004).
Even though the economy of Mexico has grown, the
buying power of the peso has decreased and inflation
rates have increased faster than wages; thus, 43 percent of
the population continues to live in poverty (CIA, 2007).
Recent Mexican immigrants are more likely to live in
poverty, more pessimistic about their future, and less edu-
cated than previous immigrants. Many Mexicans are
among the very poor, with little hope of improving their
economic status. Between the years 1999 and 2000 in the
United States, the poverty rate for Hispanics was 22.6 per-
cent (U.S. Bureau of the Census, 2001).
EDUCATIONAL STATUS AND OCCUPATIONS
Many second- and third-generation Mexican Americans
have significant job skills and education. By contrast,
many, especially newer immigrants from rural areas,
have poor educational backgrounds and may place lit-
tle value on education because it is not needed to
obtain jobs in Mexico. Once in the United States, they
initially find work similar to that which they did in
their native land, including farming, ranching, mining,
oil production, construction, landscaping, and domes-
tic jobs in homes, restaurants, and hotels and motels.
Economic and educational opportunities in the United
States are attainable, which allows immigrants to pur-
sue the great American dream of a perceived better life
(Kemp, 2001). Many Mexicans and Mexican Americans
work as seasonal migrant workers, who may relocate
several times each year as they “follow the sun.”
Sometimes, their unwillingness or inability to learn
English is related to their intent to return to Mexico;
however, this may hinder their ability to obtain better
paying jobs (Fig. 18–1).
The mean educational level in Mexico is 5 years. Until
1992, Mexican children were required to attend school
through the sixth grade, but since the Mexican School
Reform Act of 1992, a ninth-grade education is required.
However, great strides have been made in educational
standards in Mexico, which now reports a 92 percent lit-
eracy rate among its population (CIA, 2007). A common
practice among parents in poor rural villages is to educate
their children in what they need to know. This group
often finds immigration to the United States to be their
most attractive option. For many Mexicans, high school
and a university education is unavailable and, in many
cases, unattainable.
Hispanics are the most undereducated ethnic group in
the United States, with only 57 percent aged 25 years or
older having a high school education, compared with
88.4 percent for non-Hispanic whites. However, that
number increased from 43 percent to 57 percent complet-
ing high school from 1993 to 2000 (U.S. Bureau of the
Census, 2001). Some migrant worker camps have free or
low-cost bilingual educational programs to assist Mexican
Americans in learning to read and write in both lan-
guages. Only 10.6 percent of Mexican Americans aged 25
years or older have a college degree. However, the number
of Hispanics who completed 4 years of college doubled
between 1990 and 2000 (U.S. Bureau of the Census,
2001).
310 • CHAPTER 18
FIGURE 18–1 A migrant worker camp on Maryland’s eastern shore.
The Sanchez family (discussed in the Case Study on line) lives in such
a camp, as do many Mexican American farm workers in the United
States.
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Communication
DOMINANT LANGUAGE AND DIALECTS
Mexico is one of the largest Spanish-speaking countries in
the world, with over 80 million speaking the language.
The dominant language of Mexicans and Mexican
Americans is Spanish. However, Mexico has 54 indige-
nous languages and more than 500 different dialects
(Spanish Language, 2007). Knowing the region from
which a Mexican American originates may help to iden-
tify the language or dialect the individual speaks. For
example, major indigenous languages besides Spanish
include Nahuatl and Otami, spoken in central Mexico;
Mayan, in the Yucatan peninsula; Maya-Quiche, in the
state of Chiapas; Zapotec and Mixtec, in the valley of
Oaxaca; Tarascan, in the state of Michoacan; and
Totonaco, in the state of Veracruz. Many of the Spanish
dialects spoken by Mexican Americans have similar word
meanings. However, the dialects of Spanish spoken by
other groups may not have the same meanings. Because
of the rural isolationist nature of many ethnic groups and
the influence of native Indian languages, the dialects are
so diverse in selected regions that it may be difficult to
understand the language, regardless of the degree of flu-
ency in Spanish.
Radio and television programs broadcasting in Spanish
in both the United States and Mexico have helped to
standardize Spanish. For the most part, public broadcast
communication is primarily derived from Castilian
Spanish. This standardization reduces the difficulties
experienced by subcultures with multiple dialects. When
speaking in a nonnative language, health-care providers
must select words that have relatively pure meanings in
the language and avoid the use of regional slang.
Contextual speech patterns among Mexican Americans
may include a high-pitched, loud voice and a rate that
seems extremely fast to the untrained ear. The language
uses apocopation, which accounts for this rapid
speech pattern. An apocopation occurs when one word
ends with a vowel and the next word begins with a
vowel. This creates a tendency to drop the vowel ending
of the first word and results in an abbreviated, rapid-
sounding form. For example, in the Spanish phrase for
How are you?, ¿Cómo está usted? may become
¿Comestusted?. The last word, usted, is frequently
dropped. Some may find this fast speech difficult to
understand. However, if one asks the individual to enun-
ciate slowly, the effect of the apocopation or truncation
is less pronounced.
To help bridge potential communication gaps, health-
care providers need to watch the client for cues, para-
phrase words with multiple meanings, use simple sen-
tences, repeat phrases for clarity, avoid the use of regional
idiomatic phrases and expressions, and ask the client to
repeat instructions to ensure accuracy. Approaching the
Mexican American client with respect and personalismo
(being friendlike) and directing questions to the domi-
nant member of a group (usually the man) may help to
facilitate more open communication. Zoucha and Husted
(2002) found that becoming personal with the client or
family is essential to building confidence and promoting
health. The concept of personalismo may be difficult for
some health-care professionals because they are socialized
to form rigid boundaries between the caregiver and the
client and family.
CULTURAL COMMUNICATION PATTERNS
Whereas some topics such as income, salary, or invest-
ments are taboo, Mexican Americans generally like to
express their inner beliefs, feelings, and emotions once
they get to know and trust a person. Meaningful conver-
sations are important, often become loud, and seem dis-
organized. To the outsider, the situation may seem stress-
ful or hostile, but this intense emotion means the
conversants are having a good time and enjoying each
other’s company. Within the context of personalismo and
respeto, respect, health-care providers can encourage
open communication and sharing and develop the
client’s sense of trust by inquiring about family members
before proceeding with the usual business. It is important
for health-care providers to engage in “small talk” before
addressing the actual health-care concern with the client
and family (Zoucha & Reeves, 1999).
Mexican Americans place great value on closeness and
togetherness, including when they are in an in-patient
facility. They frequently touch and embrace and like to
see relatives and significant others. Touch between men
and women, between men, and between women is accept-
able. To demonstrate respect, compassion, and under-
standing, health-care providers should greet the Mexican
American client with a handshake. Once rapport is estab-
lished, providers may further demonstrate approval and
respect through backslapping, smiling, and affirmatively
nodding the head. Given the diversity of dialects and the
nuances of language, culturally congruent use of humor
is difficult to accomplish and, therefore, should be
avoided unless health-care providers are absolutely sure
there is no chance of misinterpretation. Otherwise, inap-
propriate humor may jeopardize the therapeutic relation-
ship and opportunities for health teaching and health
promotion.
Mexican Americans consider sustained eye contact
when speaking directly to an older person to be rude.
Direct eye contact with teachers or superiors may be inter-
preted as insolence. Avoiding direct eye contact with
superiors is a sign of respect. This practice may or may not
be seen with second- or third-generation Mexican
Americans. Health-care providers must take cues from the
client and family.
TEMPORAL RELATIONSHIPS
Many Mexican Americans, especially those from lower
socioeconomic groups, are necessarily present oriented.
Many individuals do not consider it important or have
the income to plan ahead financially. The trend is to live
in the “more important” here and now, because mañana
(tomorrow) cannot be predicted. With this emphasis on
living in the present, preventive health care and immu-
nizations may not be a priority. Mañana may or may not
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really mean tomorrow; it often means “not today” or
“later.”
Some Mexicans and Mexican Americans perceive time
as relative rather than categorically imperative. Deadlines
and commitments are flexible, not firm. Punctuality is
generally relaxed, especially in social situations. This con-
cept of time is innate in the Spanish language. For exam-
ple, one cannot be late for an appointment; one can only
arrive late! In addition, a few immigrants from rural envi-
ronments in which adhering to a strict time clock is
unimportant may not own a clock or even be able to tell
time.
Because of their more relaxed concept of time,
Mexican Americans may arrive late for appointments,
although the current trend is toward greater punctuality.
Health-care facilities that use an appointment system for
clients may need to make special provisions to see clients
whenever they arrive. Health-care providers must care-
fully listen for clues when discussing appointments.
Disagreeing with health-care providers who set the
appointment may be viewed as rude or impolite.
Therefore, some Mexican Americans will not tell you
directly that they cannot make the appointment. In the
context of the discussion, they may say something like
“my husband goes to work at 8:00 a.m. and the children
are off to school, then I have to do the dishes . . . .” The
health-care professional should ask: “Is 8:30 a.m. on
Thursday okay for you?” The person might say yes but the
health-care professional must still intently listen to the
conversation and then possibly negotiate a new time for
the appointment. In the conversation, the client may give
clues that they will not arrive at the intended time,
because it is important to save face and avoid being rude
by saying they will not arrive on time.
FORMAT FOR NAMES
Names in most Spanish-speaking populations seem com-
plex to those unfamiliar with the culture. A typical name
is La Señorita Olga Gaborra de Rodriguez. Gaborra is the
name of her father, and Rodriguez is her mother’s sur-
name. When she marries a man with the surname
Guiterrez, she becomes La Señora (denotes a married
woman) Olga Guiterrez de Gaborra y Rodriguez. The word
de is used to express possession, and the father’s name,
which is considered more important than the mother’s,
comes first. However, this full name is rarely used except
on formal documents and for recording the name in the
family Bible. Out of respect, most Mexican Americans are
more formal when addressing nonfamily members. Thus,
the best way to address Olga is not by her first name but
rather as Señora Guiterrez. Titles such as Don and Doña for
older respected members of the community and family
are also common. If using English while communicating
with people older than the nurse or health-care provider,
use titles such as Mr., Ms., Miss, or Mrs., as a sign of
respect.
Health-care providers must understand the role of
older people when providing care to people of Mexican
heritage. To develop confidence and personalismo, an ele-
ment of formality must exist between health-care
providers and older people. Becoming overly familiar by
using physical touch or addressing them by first names
may not be appreciated early in a relationship (Kemp,
2001). As the health-care professional develops confi-
dence in the relationship, becoming familiar may be less
of a concern. However, using the first name of an older
client may never be appropriate (Zoucha & Husted, 2000).
Family Roles and Organization
HEAD OF HOUSEHOLD AND GENDER ROLES
The typical family dominance pattern in traditional
Mexican American families is patriarchal, with evidence
of slow change toward a more egalitarian pattern in
recent years (Grothaus, 1996). Change to a more egalitar-
ian decision-making pattern is primarily identified with
more educated and higher socioeconomic families.
Machismo in the Mexican culture sees men as having
strength, valor, and self-confidence, which is a valued
trait among many. Men are seen as wiser, braver, stronger,
and more knowledgeable regarding sexual matters. The
female takes responsibility for decisions within the home
and for maintaining the family’s health. Machismo assists
in sustaining and maintaining health not only for the
man but also with implications for the health and well-
being of the family (Sobralske, 2006).
PRESCRIPTIVE, RESTRICTIVE, AND TABOO
BEHAVIORS FOR CHILDREN AND ADOLESCENTS
Children are highly valued because they ensure the con-
tinuation of the family and cultural values (Locke, 1999).
They are closely protected and not encouraged to leave
home. Even compadres (godparents) are included in the
care of the young. Each child must have godparents in
case something interferes with the parents’ ability to ful-
fill their child-rearing responsibilities. Children are taught
at an early age to respect parents and older family mem-
bers, especially grandparents. Physical punishment is
often used as a way of maintaining discipline and is some-
times considered child abuse in the United States. Using
children as interpreters in the health-care setting is dis-
couraged owing to the restrictive nature of discussing
gender-specific health assessments.
FAMILY GOALS AND PRIORITIES
V I G N E T T E 1 8 . 1
Mr. Perez is a 76-year-old Mexican American who was
recently diagnosed with a slow heartbeat requiring an
implanted pacemaker. Mr. Perez has been married for
51 years and has 6 adult children (three daughters aged 50,
48, and 42; three sons aged 47, 45, and 36), 11 grandchil-
dren; and 2 great grandchildren. The youngest boy lives three
houses down from Mr. and Mrs. Perez. The other children,
except the second-oldest daughter, live within 3 to 10 miles
from their parents. The second-oldest daughter is a registered
nurse and lives out of state. All members of the family except
for Mr. Perez were born in the United States. He was born in
Monterrey, Mexico, and immigrated to the United States at
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the age of 18 in order to work and send money back to the
family in Mexico. Mr. Perez has returned to Mexico through-
out the years to visit and has lived in Texas ever since. Mr.
Perez is retired from work in a machine shop. Mr. Perez has
one living older brother who lives within 5 miles. All mem-
bers of the family speak Spanish and English fluently.
The Perez family is Catholic, as evidenced by the religious
items hanging on the wall and prayer books and rosary on the
coffee table. Statues of St. Jude and Our Lady of Guadalupe
are on the living room table. Mr. and Mrs. Perez have made
many mandas (bequests) to pray for the health of the family,
including one to thank God for the healthy birth of all the
children, especially after the doctor had discouraged them
from having any children after the complicated birth of their
first child. The family attends Mass together every Sunday
morning and then meets for breakfast chorizo at a local
restaurant frequented by many of their church’s other parish-
ioner families. Mr. Perez believes his health and the health of
his family are in the hands of God.
The Perez family lives in a modest four-bedroom ranch
home that they bought 22 years ago. The home is located in a
predominantly Mexican American neighborhood located in
La Loma section of town. Mr. and Mrs. Perez are active in the
church and neighborhood community. The Perez home is
usually occupied by many people and has always been the
gathering place for the family.
During his years of employment, Mr. Perez was the sole
provider for the family and now receives social security
checks and a pension. Mrs. Perez is also retired and receives
a small pension for a short work period as a teacher’s aide. Mr.
and Mrs. Perez count on their nurse daughter to guide them
and advise on their health care. Mr. Perez visits a curandero
for medicinal folk remedies. Mrs. Perez is the provider of spir-
itual, physical, and emotional care for the family. In addition,
their nurse daughter is always present during any major surg-
eries or procedures. Mrs. Perez and her daughter the nurse
will be caring for Mr. Perez during his procedure for a pace-
maker.
1. Explain the significance of family and kinship for the
Perez family.
2. Describe the importance of religion and God for the
Perez family.
3. Identify two stereotypes about Mexican Americans that
were dispelled in this case with the Perez family.
4. What is the role of Mrs. Perez in this family?
The concept of familism is an all-encompassing value
among Mexicans, for whom the traditional family is still
the foundation of society. Family takes precedence over
work and all other aspects of life. In many Mexican fami-
lies, it is often said “God first, then family.” The dominant
Western health-care culture stresses including the client
and family in the plan of care. Mexicans are strong propo-
nents of this family care concept, which includes the
extended family. By including all family members, health-
care providers can build greater trust and confidence and,
in turn, increase compliance with health-care regimens
and prescriptions (Wells, Cagle, & Bradley, 2006).
Blended communal families are almost the norm in
lower socioeconomic groups and in migrant-worker
camps. Single, divorced, and never-married male and
female children usually live with their parents or extended
families, regardless of economics. Extended kinship is
common through padrinos, godparents who may be close
friends are usually considered family members (Zoucha &
Zamarripa, 1997). Thus, the words brother, sister, aunt,
and uncle do not necessarily mean that they are related
by blood. For many men, having children is evidence of
their virility and a sign of machismo.
When grandparents and older parents are unable to live
on their own, they generally move in with their children.
The extended family structure and the Mexicans’ obliga-
tion to visit sick friends and relatives encourage large num-
bers to visit hospitalized family members and friends. This
practice may necessitate that health-care providers relax
strict visiting policies in health-care facilities.
Social status is highly valued among Mexican
Americans, and a person who holds an academic degree
or position with an impressive title commands great
respect and admiration from family, friends, and the com-
munity. Good manners, a family, and family lineage, as
indicated by extensive family names, also confer high sta-
tus for Mexicans.
ALTERNATIVE LIFESTYLES
Twenty-six percent of Mexican families in the United
States live in poverty, and many are headed by a single
female parent. This percentage is lower than that for
other minority groups in the United States (U.S. Bureau of
the Census, 2001). Because the Hispanic cultural norm is
for a pregnant woman to marry, Mexicans are more likely
to marry at a young age. Yet, common law marriages
(unidos) are frequently practiced and readily accepted,
with many couples living together their entire lives.
Although homosexual behavior occurs in every soci-
ety, The Williams Project reported that five states
(California, Texas, New York, Florida, and Illinios) have
the highest number of same-sex Latino couples, totaling
100,796, living together in the United States (Gates, Lau,
& Sears, 2006). Newspapers from Houston, Texas;
Washington, D.C.; and Chicago, Illinois, report on the
efforts of Hispanic lesbian and gay organizations in the
areas of HIV and AIDS (La SIDA in Spanish) and life part-
ner benefits. In Mexico, antihate groups raised serious
concerns about killings of homosexual men, causing
many to remain closeted (Redding, 1999). In Mexico,
machismo plays a large part in the phobic attitudes toward
gay behavior. Larger cities in the United States may have
Ellas, a support group for Latina Lesbians; El Hotline of
Hola Gay, which provides referrals and information in
Spanish; or Dignity, for gay Catholics. Health-care
providers who wish to refer gay and lesbian clients to a
support group may use such agencies.
Workforce Issues
CULTURE IN THE WORKPLACE
In the United States, Hispanics are the most underrepre-
sented minority group in the health-care workforce.
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Although over 13 percent of the American population is
of Hispanic origin, only 1.8 percent of registered nurses
are from Hispanic heritage (National Sample Survey of
Registered Nurses, 2004). Cultural differences that influ-
ence workforce issues include values regarding family,
pedagogical approach to education, emotional sensitiv-
ity, views toward status, aesthetics, ethics, balance of
work and leisure, attitudes toward direction and delega-
tion, sense of control, views about competition, and
time.
People educated in Mexico are likely to have been
exposed to pedagogical approaches that include rote
memorization and an emphasis on theory with little prac-
tical application taught within a rigid, broad curriculum.
American educational systems usually emphasize an ana-
lytical approach, practical applications, and a narrow, in-
depth specialization. Thus, additional training may be
needed for some Mexicans when they come to the United
States.
Because family is a first priority for most Mexicans,
activities that involve family members usually take prior-
ity over work issues. Putting up a tough business front
may be seen as a weakness in the Mexican culture.
Because of this separation of work from emotions in
American culture, most Mexican Americans tend to shun
confrontation for fear of losing face. Many are very sensi-
tive to differences of opinion, which are perceived as dis-
rupting harmony in the workplace. People of Mexican
heritage find it important to keep peace in relationships
in the workplace.
For many Mexicans, truth is tempered by diplomacy
and tact. When a service is promised for tomorrow, even
when they know the service will not be completed tomor-
row, it is promised to please, not to deceive. Thus, for
many Mexicans, truth is seen as a relative concept,
whereas for most European Americans, truth is an
absolute value and people are expected to give direct yes
and no answers. These conflicting perspectives about
truth can complicate treatment regimens and commit-
ment to the completion of work assignments. Intentions
must be clarified and, at times, altered to meet the needs
of the changing and multicultural workforce.
For most Mexicans, work is viewed as a necessity for
survival and may not be highly valued in itself, whereas
money is for enjoying life. Most Mexican Americans
place a higher value on other life activities. Material
objects are usually necessities and not ends in them-
selves. The concept of responsibility is based on values
related to attending to the immediate needs of family
and friends rather than on the work ethic. For most
Mexicans, titles and positions may be more important
than money.
Many Mexicans believe that time is relative and elastic,
with flexible deadlines, rather than stressing punctuality
and timeliness. In Mexico, shop hours may be posted but
not rigidly respected. A business that is supposed to open
at 8:00 a.m. opens when the owner arrives; a posted time
of 8:00 a.m. may mean the business will open at 8:30
a.m., later, or not at all. The same attitude toward time is
evidenced in reporting to work and in keeping social
engagements and medical appointments. If people
believe that an exact time is truly important, such as the
time an airplane leaves, then they may keep to a schedule.
The real challenge for employers is to stress the impor-
tance and necessity of work schedules and punctuality in
the American workforce.
ISSUES RELATED TO AUTONOMY
Many Mexican Americans respond to direction and dele-
gation differently from European Americans. Many newer
immigrants are used to having traditional autocratic
managers who assign tasks but not authority, although
this practice is beginning to change with more American-
managed companies relocating to Mexico. A Mexican
worker who is not accustomed to responsibility may have
difficulty assuming accountability for decisions. The indi-
vidual may be sensitive to the American practice of check-
ing on employees’ work.
Mexicans who were born and educated in the United
States usually have no difficulty communicating with
others in the workplace. When better-educated Mexican
immigrants arrive in the United States, they usually speak
some English. Newer immigrants from lower socioeco-
nomic groups have the most difficulty acculturating in
the workplace and may have greater difficulty with the
English language.
Biocultural Ecology
SKIN COLOR AND OTHER BIOLOGICAL
VARIATIONS
Because Mexican Americans draw their heritage from
Spanish and French peoples and various North American
and Central American Indian tribes and Africans, few
physical characteristics give this group a distinct identity.
Some individuals with a predominant Spanish back-
ground might have light-colored skin, blond hair, and
blue eyes, whereas people from indigenous Indian back-
grounds may have black hair, dark eyes, and cinnamon-
colored skin. Intermarriages among these groups have
created a diverse gene pool and have not produced a
typical-appearing Mexican.
Cyanosis and decreased hemoglobin levels are more
difficult to detect in dark-skinned people, whose skin
appears ashen instead of the bluish color seen in light-
skinned people. To observe for these conditions in dark-
skinned Mexicans, the practitioner must examine the
sclera, conjunctiva, buccal mucosa, tongue, lips, nailbeds,
palms of the hands, and soles of the feet. Jaundice, like-
wise, is more difficult to detect in darker-skinned people.
Thus, the practitioner needs to observe the conjunctiva
and the buccal mucosa for patches of bilirubin pigment in
dark-skinned Mexicans.
DISEASES AND HEALTH CONDITIONS
Common health problems most consistently docu-
mented in the literature for both people from Mexico and
Mexican Americans are difficulty in assessing and utiliz-
ing health care, malnutrition, malaria (in some places),
cancer, alcoholism, drug abuse, obesity, hypertension,
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diabetes, heart disease, adolescent pregnancy, dental dis-
ease, and HIV and AIDS (Kemp, 2001). In Mexican
American migrant-worker populations, infectious, com-
municable, and parasitic diseases continue to be major
health risks. Substandard housing conditions and
employment in low-paying jobs have perpetuated higher
rates of tuberculosis in Mexican Americans. Intestinal
parasitosis, amoebic dysentery, and bacterial diarrhea
(Shigella) are common among Mexican immigrants (Kim-
Godwin, Alexander, Felton, Mackey, & Kasakoff, 2006).
Newer Mexican immigrants from coastal lowland
swamp areas and from some mountainous areas where
mosquitoes are more prevalent may also have a higher
incidence of malaria. People from high mountain terrains
may have increased red blood cell counts on immigration
to the United States (Centers for Disease Control and
Prevention [CDC], 2006). Health-care providers must take
these topographic factors into consideration when per-
forming health screening for symptoms of anemia, lassi-
tude, failure to thrive, and weight loss among Mexican
immigrants.
Cardiovascular disease is the leading cause of death
and disability in minority populations, including
Mexican Americans (Kurian & Cardarelli, 2007).
However, current research shows that despite the adverse
cardiovascular risk profile, including the incidence of obe-
sity, diabetes, and untreated hypertension, Mexican
Americans have a lower rate of coronary heart disease
mortality than nonwhite Hispanics (Pandey, Labarthe,
Goff, Chan, & Nichaman, 2001). Cardiovascular risk fac-
tors are influenced by behavioral, cultural, and social fac-
tors. Mexican Americans have the highest prevalence of
no leisure time physical activity (Kurian & Cardarelli,
2007). In addition, poor health, low social support, lack
of educational and occupational opportunities, low access
to health care, and discrimination contribute to the risk
factors associated with cardiovascular disease (Kemp,
2001).
Mexican Americans have five times the rate of diabetes
mellitus, with an increased incidence of related complica-
tions, as that in European American cohort groups. In
addition, health-care professionals working with Mexican
immigrants and Mexican Americans should offer screen-
ing and teach clients preventive measures regarding pesti-
cides and communicable and infectious diseases because
many of these people work with chemicals and live in
crowded housing conditions.
VARIATIONS IN DRUG METABOLISM
Because of the mixed heritage of many Mexican
Americans, it may be more difficult to determine a thera-
peutic dose of selected drugs. Several studies report differ-
ences in absorption, distribution, metabolism, and excre-
tion of drugs, including alcohol, in some Hispanic
populations. The mixed heritage of Mexican Americans
makes it more difficult to generalize drug metabolism.
Few studies include only one subgroup of Hispanics;
therefore, health-care providers need to consider some
notable differences when prescribing medications.
Hispanics require lower doses of antidepressants and
experience greater side effects than non-Hispanic whites.
High-Risk Behaviors
Alcohol plays an important part in the Mexican culture.
Many of this group’s colorful lifestyle celebrations include
alcohol consumption. Men overall drink in greater pro-
portion than women, but this trend is changing owing to
acculturation. Mexican American women are consuming
more alcohol than their mothers or grandmothers
(Collins & McNair, 2002).
Because of these drinking patterns, alcoholism repre-
sents a crucial health problem for many Mexicans. More-
acculturated Hispanics consume more alcoholic beverages
than non-Hispanic whites, possibly expecting alcohol to
make them more socially acceptable and extroverted. Low
acculturation and distorted self-image problems have spe-
cial implications for nursing and health care.
Marijuana is the number-two drug used by Mexican
Americans because it is readily available in their native
land and easily accessible from people who work in farm-
ing and ranching occupations. Some adults who can
afford drugs use cocaine and heroin, and the younger
population uses inhalants (Eden & Aguilar, 1989).
The trend toward decreasing cigarette smoking in the
United States is extending to the Mexican American cul-
ture, in which cigarette smoking rates have steadily
declined for both men and women between 1990 and
2004 (CDC, 2007). However, the reported decrease in cig-
arette smoking rates for Mexican American men and
women should not promote a sense of complacancy for
nurses and health-care professionals.
HEALTH-CARE PRACTICES
Responsibility for health promotion and safety may be a
major threat for those of Mexican heritage accustomed to
depending on the family unit and traditional means of
providing health care. Continuing disparities in health
and health-seeking behaviors have been reported in sev-
eral studies. Lower socioeconomic conditions and accul-
turation are responsible for Latina women being over-
weight, exhibiting hypertension, experiencing high
cholesterol levels, and having increased smoking behav-
iors (Kemp, 2001). Latino men are less likely to have can-
cer screening or physical examinations than their non-
Latino white counterparts. High-risk health behaviors
such as drinking and driving, cigarette smoking, sedentary
lifestyle, and nonuse of seat belts increase with fewer years
of educational attainment. Through educational programs
and enforcement of state laws, more Mexicans are begin-
ning to use seat belts; however, it is still common to see
their children traveling unrestrained in automobiles.
Nutrition
MEANING OF FOOD
As in many other ethnic groups, Mexicans and Mexican
Americans celebrate with food. Mexican foods are rich in
color, flavor, texture, and spiciness. Any occasion—births,
birthdays, Sundays, religious holidays, official and unofficial
holidays, and anniversaries of deaths—is seen as a time to
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celebrate with food and enjoy the companionship of fam-
ily and friends. Because food is a primary form of social-
ization in the Mexican culture, Mexican Americans may
have difficulty adhering to a prescribed diet for illnesses
such as diabetes mellitus and cardiovascular disease.
Health-care professionals must seek creative alternatives
and negotiate types of foods consumed with individuals
and families in relation to these concerns.
COMMON FOODS AND FOOD RITUALS
The Mexican American diet is extremely varied and may
depend on the individual’s region of origin in Mexico.
Thus, one needs to ask the individual specifically about
his or her dietary habits. The staples of the Mexican
American diet are rice (arroz), beans, and tortillas, which
are made from corn (maíz) treated with calcium carbon-
ate. However, in many parts of the United States, only
flour tortillas are available. Even though the diet is low in
calcium derived from milk and milk products, tortillas
treated with calcium carbonate provide essential dietary
calcium. Popular Mexican American foods are eggs
(huevos), pork (puerco), chicken (pollo), sausage (chorizo);
lard (lardo), mint (menta), chili peppers (chile), onions
(cebollas), tomatoes (tomates), squash (calabaza), canned
fruit (fruta de lata), mint tea (hierbabuena), chamomile tea
(té de camomile or manzanilla), carbonated beverages
(bebidas de gaseosa), beer (cerveza), cola-flavored soft
drinks, sweetened packaged drink mixes (agua fresa) that
are high in sugar (azucar), sweetened breakfast cereals
(cereales de desayuno); potatoes (papas), bread (pan), corn
(maíz), gelatin (gelatina), custard (flan), and other sweets
(dulces). Other common dishes include chili, enchiladas,
tamales, tostadas, chicken mole, arroz con pollo, refried
beans, tacos, tripe soup (Menudo) and other soups (caldos).
Soups (caldos) are varied in nature and may include
chicken, beef, and pork with vegetables.
Mealtimes vary among different subgroups of Mexican
Americans. Whereas many individuals adopt North
American schedules and eating habits, many continue
their native practices, especially those in rural settings
and migrant-worker camps. For these groups, breakfast is
usually fruit, perhaps cheese, or bread alone or in some
combination. A snack may be taken in midmorning
before the main meal of the day, which is eaten from 2 to
3 p.m. and, in rural areas especially, may last for 2 hours
or more. Mealtime is an occasion for socialization and
keeping family members informed about each other. The
evening meal is usually late and is taken between 9 and
9:30 p.m. Health-care providers must consider Mexican
Americans’ mealtimes when teaching clients about med-
ication and dietary regimens related to diabetes mellitus
and other illnesses.
DIETARY PRACTICES FOR HEALTH PROMOTION
A dominant health-care practice for Mexicans and many
Mexican Americans is the hot-and-cold theory of food
selection. This theory is a major aspect of health promo-
tion and illness and disease prevention and treatment.
According to this theory, illness or trauma may require
adjustments in the hot-and-cold balance of foods to restore
body equilibrium. The hot-and-cold theory of foods is
described under Health-Care Practices, later in this chapter.
NUTRITIONAL DEFICIENCIES AND
FOOD LIMITATIONS
In lower socioeconomic groups, wide-scale vitamin A
deficiency and iron deficiency anemia exist (Mendoza,
Ventura, Saldivar, Baisden, & Martorell, 1992). Some
Mexican and Mexican Americans have lactose intoler-
ance, which may cause problems for schools and health-
care organizations that provide milk in the diet because of
its high calcium content.
Because major Mexican foods and their ingredients are
available throughout the United States, native food prac-
tices may not change much when Mexicans immigrate.
Of course, Mexican foods are extremely popular through-
out the United States and are eaten by many Americans
because of the strong flavors, spiciness, and color. Table 18–1
lists the Mexican names of popular foods, their descrip-
tion, and ingredients. Individual adaptations to these
preparations commonly occur.
Pregnancy and Childbearing
Practices
FERTILITY PRACTICES AND VIEWS
TOWARD PREGNANCY
Mexican American birth rates were 24.9 or 677,621 live
births in 2004; the numbers of births have continued to
rise every year since 1989 (National Vital Statistics Report,
2004). Multiple births are common, especially in the eco-
nomically disadvantaged groups. Men view a large num-
ber of children as proof of their virility. The optimal child-
bearing age for Mexican women is between 19 and 24
years. Fertility practices of Mexican Americans are con-
nected with their predominantly Catholic religious
beliefs and their tendency to be modest. Some women
practice the belief that prolonged infant breastfeeding is a
method of birth control. Abortion in many communities
is considered morally wrong and is practiced (theoreti-
cally) only in extreme circumstances to keep the mother’s
life intact. However, legal and illegal abortions are com-
mon in some parts of Mexico and the United States.
Despite the strong influence of the Catholic Church over
fertility practices, being Catholic does not prevent some
Mexican American women from using contraceptives,
sterilization, or abortion for unwanted pregnancies.
Diaphragms, foams, and creams are not commonly
used for birth control practice, mostly because they are
not approved by Catholic doctrine and partly because of
the belief that women are not supposed to touch their
genitals. Birth control pills are unacceptable because they
are an artificial means of birth control. Physicians’ offices
and clinics that see large numbers of migrant workers on
the Delmarva Peninsula on the U.S. east coast report that
many younger female clients are using Norplant (lev-
onorgestrel; a long-term contraceptive system) for birth
control. Men are reluctant to use condoms because they
are associated with prostitutes and because of the belief
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that they should be used only for disease control. A
woman may reject the use of a condom and find it offen-
sive because it means that she is “dirty.” Family planning
is one area in which health-care providers can help the
family to identify more realistic outcomes consistent with
current economic resources and family goals.
Foreign-born Mexicans are less likely to give birth to low-
birth-weight babies than U.S.-born Mexican women, even
though U.S.-born mothers are usually of higher socioeco-
nomic status and receive more prenatal care. Research sug-
gests that better nutritional intake and lower prevalence of
smoking and alcohol use are some reasons for these protec-
tive outcomes (American Public Health Association, 2002).
Because pregnancy among Mexican Americans is viewed
as natural and desirable, many women do not seek prenatal
evaluations. In addition, because prenatal care is not avail-
able to every woman in Mexico, some women do not know
about the need for prenatal care. With the extended family
network and the woman’s role of maintaining the health
status of family members, many pregnant women seek fam-
ily advice before seeking medical care. Thus, familism may
deter and hinder early prenatal check-ups. To encourage
prenatal check-ups, health-care providers can encourage
female relatives and husbands to accompany the pregnant
woman for health screening and incorporate advice from
family members into health teaching and preventive care
services. Using videos with Spanish-speaking Mexican
Americans is one culturally effective way for incorporating
health education, especially for those clients who have a
limited understanding of English. In addition, incorporat-
ing cultural brokers known to the Mexican American fam-
ily may help to empower clients and reduce conflict for
Mexicans and Mexican Americans.
PRESCRIPTIVE, RESTRICTIVE, AND TABOO
PRACTICES IN THE CHILDBEARING FAMILY
Beliefs related to the hot-and-cold theory of disease pre-
vention and health maintenance influence conception,
pregnancy, and postpartum rituals. For instance, during
pregnancy, a woman is more likely to favor hot foods,
which are believed to provide warmth for the fetus and
enable the baby to be born into a warm and loving envi-
ronment (Eggenberger, Grassley, & Restrepo, 2006). Cold
foods and environments are preferred during the men-
strual cycle and in the immediate postdelivery period.
Many pregnant women sleep on their backs to protect the
infant from harm, keep the vaginal canal well lubricated
by having frequent intercourse to facilitate an easier
birth, and keep active to ensure a smaller baby and to pre-
vent a decrease in the amount of amniotic fluid (Burk,
Wieser, & Keegan, 1995). An important activity restric-
tion is that pregnant women should not walk in the
moonlight because it might cause a birth deformity. To
prevent birth deformities, pregnant women may wear a
safety pin, metal key, or some other metal object on their
abdomen (Villarruel & Ortiz de Montellano, 1992). Other
beliefs include avoiding cold air, not reaching over the
head in order to prevent the baby’s cord from wrapping
around its neck, and avoiding lunar eclipses because they
may result in deformities.
In more traditional Mexican families, the father is not
included in the delivery experience and should not see the
mother or baby until after both have been cleaned and
dressed. This practice is based on the fear that harm may
come to the mother, baby, or both. Integrating men into the
birthing of a child is a process that requires changing social
habits in relation to cultural aspects of life and gender roles.
For many, the presence of men during delivery is considered
an uninvited intrusion into the Mexican culture. Among
less-traditional and more-acculturated Mexican Americans,
men participate in prenatal classes and assist in the delivery
room. However, based on personal experiences, men who
provide support during delivery may receive friendly gibing
from their male counterparts for taking the role of the wife’s
mother (personal communication, Larry Purnell, June 2007).
In any event, health-care providers must respect Mexicans’
decision to not have men in the delivery room.
PEOPLE OF MEXICAN HERITAGE • 317
T A B L E 18.1 Mexican Foods
Common Name Description Ingredients
Arroz con pollo Chicken with rice Chicken baked, boiled, or fried and served over boiled or fried rice
Chili Chili Same as the United States but tends to be more spicy
Chili con carne Chili with meat Chili with beef or pork
Chili con salsa Chili with sauce Chili with a sauce that contains no meat
Dulces Sweets Candy and desserts usually high in sugar, lard, and eggs
Enchiladas Enchiladas Tortilla rolled and stuffed with meat or cheese and a spicy sauce
Papas fritas Fried potatoes Potatoes usually fried in lard
Flan Flan Popular dessert made of egg custard; may be filled with fruit or cheese
Gelatina Gelatin Popular dessert made with sugar, eggs, and jelly
Pollo con molé Chicken molé Chicken with a sauce made of hot spices, chocolate, and chili
Salchica or chorizo Sausage Sausage almost always made with pork and spices
Tacos Tacos Tortilla folded around meat or cheese
Tamales Tamales Fried or boiled chopped meat, peppers, cornmeal, and hot spices
Tortilla Tortilla A thin unleavened bread made with cornmeal and treated with lime
(calcium carbonate)
Tostadas Tostadas Toast that may have a spicy sauce
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During labor, traditional Mexican women may be
quite vocal and are taught to avoid breathing air in
through the mouth because it can cause the uterus to rise
up. Immediately after birth, they may place their legs
together to prevent air from entering the womb (Olds,
London, & Ladewig, 2000). Health-care providers can
help the Mexican pregnant woman have a better delivery
by encouraging attendance at prenatal classes.
The postpartum preference for a warm environment
may restrict postpartum women from bathing or washing
their hair for up to 40 days. Although postpartum women
may not take showers or sit in a bathtub, this does not
mean that they do not bathe. They take sitz baths, wash
their hair with a washcloth, and take sponge baths. Other
postpartum practices include wearing a heavy cotton
abdominal binder, cord, or girdle to prevent air from
entering the uterus; covering one’s ears, head, shoulders,
and feet to prevent blindness, mastitis, frigidity, or steril-
ity; and avoiding acidic foods to protect the baby from
harm (Olds, London, & Ladewig, 2000).
When the baby is born, special attention is given to
the umbilicus; the mother may place a belt around the
umbilicus (ombliguero) to prevent the naval from pop-
ping out when the child cries. Cutting the baby’s nails in
the first 3 months is thought to cause blindness and
deafness.
Health-care providers need to make special provisions
to provide culturally congruent health teaching for lactat-
ing women who work with or are exposed to pesticides,
such as dichlorodiphenyldichlorothene (DDE), the most
stable derivative from the pesticide DDT. High DDE levels
among lactating women have a direct correlation with a
decrease in lactation and increase in breast cancer, espe-
cially in women who have had more than one pregnancy
and previous lactation (Gladen & Rogan, 1995). Education
level and degree of acculturation are key issues when
developing health education and interventions for risk
reduction.
Death Rituals
DEATH RITUALS AND EXPECTATIONS
Mexicans often have a stoic acceptance of the way
things are and view death as a natural part of life and the
will of God (Eggenberger et al., 2006). Death practices
are primarily an adaptation of their religion. Family
members may arrive in large numbers at the hospital or
home in times of illness or an approaching death. In
more-traditional families, family members may take
turns sitting vigil over the sick or dying person. Autopsy
is acceptable as long as the body is treated with respect.
Burial is the common practice; cremation is an individ-
ual choice.
RESPONSES TO DEATH AND GRIEF
When a person dies, the word travels rapidly, and family
and friends travel from long distances to get to the
funeral. They may gather for a velorio, a festive watch
over the body of the deceased person before burial. Some
Mexican Americans bury the body within 24 hours,
which is required by law in Mexico.
More-traditional grieving families may engage in
protection of the dying and bereaved such as small chil-
dren who have difficulty dealing with the death
(Andrews & Boyle, 2003). Mexican Americans encour-
age expressions of feeling during the grieving process.
In these cases, health-care providers can assist the per-
son by providing support and privacy during the
bereavement.
Spirituality
DOMINANT RELIGION AND USE OF PRAYER
The predominant religion of most Mexicans and
Mexican Americans is Catholicism. The major religions
in Mexico are Roman Catholic, 89 percent; Protestant, 6
percent; and other, 5 percent of the population. Since the
mid-1980s, other religious groups such as Mormons,
Jehovah’s Witnesses, Seventh Day Adventists, Presbyteri-
ans, and Baptists have been gaining in popularity in
Mexico (CIA, 2007). Although many Mexicans and
Mexican Americans may not appear to be practicing their
faith on a daily basis, they may still consider themselves
devout Catholics, and their religion has a major influ-
ence on health-care practices and beliefs. For many,
Catholic religious practices are influenced by indigenous
Indian practices.
Newer immigrant Mexican Americans may continue
their traditional practice of having two marriage cere-
monies, especially in lower socioeconomic groups. A civil
ceremony is performed whenever two people decide to
make a union. When the family gets enough money for a
religious ceremony, they schedule an elaborate celebra-
tion within the church. Common practice, especially in
rural Mexican villages and some rural villages in the
southwestern United States, is to post a handwritten sign
on the local church announcing the marriage, with an
invitation for all to attend.
Frequency of prayer is highly individualized for most
Mexican Americans. Even though some do not attend
church on a regular basis, they may have an altar in their
homes and say prayers several times each day, a practice
more common among rural isolationists.
MEANING OF LIFE AND INDIVIDUAL
SOURCES OF STRENGTH
The family is foremost to most Mexicans, and individuals
get strength from family ties and relationships.
Individuals may speak in terms of a person’s soul or spirit
(alma or espiritu) when they refer to one’s inner qualities.
These inner qualities represent the person’s dignity and
must be protected at all costs in times of both wellness
and illness. In addition, Mexicans derive great pride and
strength from their nationality, which embraces a long
and rich history of traditions.
Leisure is considered essential for a full life, and work is
a necessity to make money for enjoying life. Mexican
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Americans pride themselves on good manners, etiquette,
and grooming as signs of respect. Because the overall
outlook for many Mexicans is one of fatalism, pride may
be taken in stoic acceptance of life’s adversities.
SPIRITUAL BELIEFS AND HEALTH-CARE
PRACTICES
Most Mexicans enjoy talking about their soul or spirit,
especially in times of illness, whereas many health-care
providers may feel uncomfortable talking about spiritual-
ity. This tendency may communicate to Mexicans that
the health-care provider has suspect intentions, is insen-
sitive, and is not really interested in them as individuals.
It may be common for a person needing care in the home
or hospital to have a statue of a patron saint or a candle
with a picture of the saint. Rosaries may be present, and at
times, the family may pray as a group. Depending on the
confidence maintained with the family and client, a
health-care professional may be asked to join in the
prayer. If time permits, it is very appropriate to pray with
the family even if only for a few minutes. This action pro-
motes confidence in the relationship and can have a pos-
itive impact on the health and well-being of the client
and family (Zoucha, 2007).
Health-Care Practices
V I G N E T T E 1 8 . 3
Juan Diaz is a 26-year-old Mexican man who was recently
diagnosed with a herniated lumbar disc after a work-related
injury. An emergency room physician has recommended back
surgery and physical therapy. Juan is unmarried and is a
recent immigrant from Oaxaca, Mexico. Juan is an undocu-
mented worker and has been working for a construction com-
pany doing roofing and bricklaying. Juan’s family resides in
Mexico. His parents, maternal grandparents, five sisters, and
two brothers live in a small two-bedroom stone home in
Oaxaca. Juan is the oldest of the children and has come to the
United States to work and send money back to the family.
Juan’s dad is being treated for tuberculosis and needs money
to pay for health care. Juan is also trying to earn enough
money to bring his dad to the United States for tuberculosis
treatment. Juan speaks mainly Spanish with limited ability in
English.
Juan is a devout Catholic who attends Mass weekly and
prays the rosary to La Virgen de Guadalupe daily. Juan often
blesses himself with holy water he brought from San Juan de
Los Lagos. Juan believes that God will heal him and that his
health is in the hands of God.
Juan is sharing the rent on a three-bedroom apartment with
five other migrant workers from Mexico. The apartment is
located 10 miles from his job where new homes are being
built outside the city. Juan usually takes two buses to work.
One of the migrant workers has an uncle who helped secure
the jobs for them. Juan and his coworkers cook and eat dinner
together most evenings and enjoy drinking cervezas (beer) on
the weekends.
Juan has saved money from working over the past 11
months but is worried about health-care coverage. He usually
goes to a local clinic for his health-care needs. His friends
suggested that he should visit a bruja because he might have
had a spell cast upon him. He and his friends believe that the
bruja can rid him of the spell and heal him. Juan’s friends are
able to help take care of him on weekends only because of
their weekday 12-hour work schedules. Juan has an uncle
from Mexico who is trying to get money together for a trip up
PEOPLE OF MEXICAN HERITAGE • 319
V I G N E T T E 1 8 . 2
Mrs. Lopez is a 65-year-old Mexican American recently diag-
nosed with breast cancer who will undergo a radical mastec-
tomy and chemotherapy. Mrs. Lopez is recently widowed and
is grieving for her husband of 50 years. Mrs. Lopez has 7 chil-
dren (3 daughters aged 49, 44, and 41; 4 sons aged 47, 45,
43, and 39), 8 grandchildren, and 20 great grandchildren. The
youngest son lives at home with his mother along with his
wife and four children. The other children live within 10
blocks. Mrs. Lopez spends a lot of time helping to care for the
grandchildren while her children work. The five youngest
members of the family were born in the United States, and the
rest of the family was born in Vera Cruz, Mexico. Mrs. Perez
has never worked outside of the home and receives survivor
benefits from her husband’s pension. The only job she has
ever done is baby-sitting for neighbors, nieces, and nephews.
Mrs. Lopez has one living brother who lives 5 miles away and
a sister who died of breast cancer 7 years ago.
The Lopez family members are Catholics. Mrs. Lopez is a
very devout Catholic and attends Mass daily at the church two
blocks away. The children attend Mass with the family on
occasional Sundays. Mrs. Lopez prays the rosary and novenas
so that God will take care of her and her family. Mrs. Lopez is
a good cook and prepares dinner every evening for her son
and his family. The daughter-in-law helps cook the meals even
after a full day of work. Mrs. Lopez and her family live in a
three-bedroom wood frame house. The home is located in a
Mexican American neighborhood 2 miles from the Mexican
border in San Juan, Texas.
Mrs. Lopez does not have any work experience and is
grateful her husband left a small but substantial life insur-
ance policy. Mrs. Lopez receives help with shopping and
rides to the doctor from her youngest daughter and many
comadres. One of her comadres is a curandera who has
been offering Mrs. Lopez herbs and teas to help healing.
Mrs. Lopez enjoys making tamales in her kitchen along with
her family and comadres. All of the Lopez children and
comadres have committed to help Mrs. Lopez during and
after her surgery.
1. When the home health nurse comes to assess Mrs.
Lopez’s incision and teaches about Jackson Pratt drain
care, who should be included in the teaching and why?
2. Explain the importance of familism to the Lopez family.
3. Mrs. Lopez has been offered herbal tea by the curan-
dera while the home nurse is making a visit. Should the
nurse intervene to stop this practice? Please provide
rationale for your answer.
4. The nurse is making a visit when the family is praying
the rosary together for the health of Mrs. Lopez. The
nurse is invited to join. What should the nurse do in
this situation?
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to help Juan as he recovers. Juan will require home physical
therapy and nursing care after his surgery.
1. The home care case manager, a registered nurse, is
sending a physical therapist to the home. What should
the nurse consider?
2. What does the nurse need to know about where Juan
and his family are from in Mexico?
3. Identify potential communication needs of Juan, his
friends, and his visiting family.
4. Juan is concerned about letting his boss down because
of his illness. Why is Juan concerned about this with
his boss?
HEALTH-SEEKING BELIEFS AND BEHAVIORS
The family is the most credible source of health informa-
tion and the most significant impediment to positive
health-seeking behavior. Mexican Americans’ fatalistic
worldview and external locus of control are closely tied to
health-seeking behaviors. Because expressions of negative
feelings are considered impolite, Mexicans may be reluc-
tant to complain about health problems or to place blame
on the individual for poor health. If a person becomes
seriously ill, that is just the way things are; all events are
acts of God (Eggenberger et al., 2006). This belief system
may impair the dominant view of communications and
hinder health teaching, health promotion, and disease
prevention practices. Therefore, it is imperative for
health-care professionals to plan health promoting activ-
ities and teaching that are consistent with this belief but
encourage health. For instance, if a person believes that
the illness is due to a punishment from God, it may be
possible to ask to be forgiven by God, thereby restoring
health. This may be an opportune time to call a priest or
minister for official recognition of forgiveness.
RESPONSIBILITY FOR HEALTH CARE
To many Mexicans, good health may mean the ability to
keep working and have a general feeing of well-being
(Zoucha, 1998). Illness may occur when the person can
no longer work or take care of the family. Therefore,
many Mexicans may not seek health care until they are
incapacitated and unable to go about the activities of
daily living. Unfortunately, many people of Mexican her-
itage may not know and understand the occupational
dangers inherent in their daily work. Migrant workers are
often unaware of the dangers of pesticides and the poten-
tially dangerous agricultural machinery. Health-care pro-
fessionals must serve as advocates for these people regard-
ing occupational safety. Often, the companies do not tell
the workers of the dangers of the work, or the workers
may not understand owing to the inability of the com-
pany officials to speak the language of the workers.
The use of over-the-counter medicine may pose a sig-
nificant health problem related to self-care for many
Mexican Americans. In part, this is a carryover from
Mexico’s practice of allowing over-the-counter purchases
of antibiotics, intramuscular injections, intravenous flu-
ids, birth control pills, and other medications that require
a prescription in the United States. Often, Mexican immi-
grants bring these medications across the border and
share them with friends. In addition, friends and relatives
in Mexico send drugs through the mail. To protect clients
from contradictory or potentiating effects of prescribed
treatments, health-care providers need to ask clients
about prescription and nonprescription medications they
may be taking.
FOLK AND TRADITIONAL PRACTICES
Mexican Americans engage in folk medicine practices and
use a variety of prayers, herbal teas, and poultices to treat
illnesses. Many of these practices are regionally specific
and vary between and among families. The Mexican
Ministerio de Salud Publica y Asistencia Social (Ministry of
Public Health and Social Assistance) publishes an exten-
sive manual on herbal medicines that are readily available
in Mexico. Lower socioeconomic groups and well-edu-
cated upper and middle socioeconomic Mexicans to some
degree practice traditional and folk medicine. Many of
these practices are harmless, but some may contradict or
potentiate therapeutic interventions. Thus, as with the
use of other prescription and nonprescription drugs dis-
cussed earlier, it is essential for health-care providers to
be aware of these practices and to take them into consid-
eration when providing treatments (Rivera, Anaya, &
Meza, 2003). The provider must ask the Mexican
American client specifically whether she or he is using
folk medicine.
To provide culturally competent care, health-care prac-
titioners must be aware of the hot-and-cold theory of dis-
ease when prescribing treatment modalities and when
providing health teaching. According to this theory,
many diseases are caused by a disruption in the hot-and-
cold balance of the body. Thus, eating foods of the oppo-
site variety may either cure or prevent specific hot-and-
cold illnesses and conditions. Physical or mental illness
may be attributed to an imbalance between the person
and the environment. Influences include emotional, spir-
itual, and social state, as well as physical factors such as
humoral imbalance expressed as either too much hot or
cold. As health-care providers, it is important to under-
stand that if people of Mexican heritage believe in the
hot-and-cold theory, it means that they do not believe or
use professional Western practices (Spector, 2004). Unless
a level of trust and confidence is maintained, Mexicans
who follow these beliefs may not express them to health
professionals (Zoucha & Husted, 2000).
Hot and cold are viewed as specific properties of vari-
ous substances and conditions, and sometimes opinions
differ about what is hot and what is cold in the Mexican
community. In general, cold diseases or conditions are
characterized by vasoconstriction and a lower metabolic
rate. Cold diseases or conditions include menstrual
cramps, frio de la matriz, rhinitis (coryza), pneumonia,
empacho, cancer, malaria, earaches, arthritis, pneumonia
and other pulmonary conditions, headaches, and muscu-
loskeletal conditions and colic. Common hot foods used
to treat cold diseases and conditions include cheeses,
liquor, beef, pork, spicy foods, eggs, grains other than bar-
ley, vitamins, tobacco, and onions (Kemp, 2001).
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Hot diseases and conditions may be characterized
by vasodilation and a higher metabolic rate. Pregnancy,
hypertension, diabetes, acid indigestion, susto, mal de ojo
(bad eye or evil eye), bilis (imbalance of bile, which runs
into the blood stream), infection, diarrhea, sore throats,
stomach ulcers, liver conditions, kidney problems, and
fever may be examples of hot conditions. Common cold
foods used to treat hot diseases and conditions include
fresh fruits and vegetables, dairy products (even though
fresh fruits and dairy products may cause diarrhea), barley
water, fish, chicken, goat meat, and dried fruits (Neff,
1998).
Folk practitioners are consulted for several notable
conditions. Mal de ojo is a folk illness that occurs when
one person (usually older) looks at another (usually a
child) in an admiring fashion. Another example of mal de
ojo is if a person admires something about a baby or
child, such as beautiful eyes or hair. Such eye contact can
be either voluntary or involuntary. Symptoms are
numerous, ranging from fever, anorexia, and vomiting to
irritability. The spell can be broken if the person doing
the admiring touches the person admired while it is hap-
pening. Children are more susceptible to this condition
than women, and women are more susceptible than
men. To prevent mal de ojo, the child wears a bracelet
with a seed (ojo de venado) or a bag of seeds pinned to the
clothes (Kemp, 2001).
Another childhood condition often treated by folk
practitioners is caida de la mollera (fallen fontanel). The
condition has numerous causes, which may include
removing the nursing infant too harshly from the nipple
or handling an infant too roughly. Symptoms range from
irritability to failure to thrive. To cure the condition, the
child is held upside down by the legs.
Susto (magical fright or soul loss) is associated with
epilepsy, tuberculosis, and other infectious diseases and is
caused by the loss of spirit from the body. The illness is
also believed to be caused by a fright or by the soul being
frightened out of the person. This culture-bound disorder
may be psychological, physical, or physiological in
nature. Symptoms may include anxiety, depression, loss
of appetite, excessive sleep, bad dreams, feelings of sad-
ness, and lack of motivation. Treatment sometimes
includes elaborate ceremonies at a crossroads with herbs
and holy water to return the spirit to the body (R.
Zamarripa, personal communication, April 2006).
Empacho (blocked intestines) may result from an incor-
rect balance of hot and cold foods, causing a lump of food
to stick in the gastrointestinal tract. To make the diagno-
sis, the healer may place a fresh egg on the abdomen. If
the egg appears to stick to a particular area, this confirms
the diagnosis. Older women usually treat the condition in
children by massaging their stomach and back to dislodge
the food bolus and to promote its continued passage
through the body.
Health-care practitioners are cautioned against diag-
nosing psychiatric illnesses too readily in the Mexican
population. The syndromes mal ojo and susto are culture
bound and are potential sources of diagnostic bias. The
potential culture-bound mental illness must be under-
stood in the context of the culture and the unique symp-
toms that accompany each illness.
BARRIERS TO HEALTH CARE
Thirty-two percent of Mexican Americans, compared
with 14 percent of the U.S. population in general, do not
have health insurance (U.S. Bureau of the Census, 2001).
A number of factors may account for this high percent-
age of uninsured individuals. First, many Mexican
Americans constitute the working poor and are unable to
purchase insurance. Second, many are migratory and do
not qualify for Medicaid. Third, many have an undocu-
mented status and are afraid to apply for health insur-
ance. Fourth, even though insurance is available in their
native homeland, it is very expensive and not part of the
culture.
Whereas wealthier Mexican Americans have little diffi-
culty accessing health care in the United States, lower
socioeconomic groups may experience significant barri-
ers, including inadequate financial resources, lack of
insurance and transportation, limited knowledge regard-
ing available services, language difficulties, and the cul-
ture of health-care organizations. Like many other immi-
grant groups who lack a primary provider, Mexican
Americans may use emergency rooms for minor illnesses.
Health-care providers have the opportunity to improve
the care of Mexican Americans by explaining the health-
care system, incorporating a primary-care provider when-
ever possible, using an interpreter of the same gender,
securing a cultural broker, and assisting clients in locating
culturally specific mental health programs (Zoucha &
Husted, 2000).
CULTURAL RESPONSES TO HEALTH AND ILLNESS
Good health to many Mexican Americans is to be free of
pain, able to work, and spend time with the family. In
addition, good health is a gift from God and from living a
good life (Zoucha, 1998).
Mexicans and Mexican Americans tend to perceive
pain as a necessary part of life, and enduring the pain is
often viewed as a sign of strength. Men commonly toler-
ate pain until it becomes extreme (Luckmann, 1999).
Often, pain is viewed as the will of God and is tolerated as
long as the person can work and care for the family. These
attitudes toward pain delay seeking treatment; many
hope that the pain will simply go away. Research has
shown that many Mexican Americans experience more
pain than other ethnic groups, but that they report the
occurrence of pain less frequently and endure pain longer
(Sobralske & Katz, 2005). Six themes have emerged that
describe culturally specific attributes of Mexican Americans
experiencing pain:
Mexicans accept and anticipate pain as a necessary
part of life.
They are obligated to endure pain in the perfor-
mance of duties.
The ability to endure pain and to suffer stoically is
valued.
The type and amount of pain a person experiences
is divinely predetermined.
Pain and suffering are a consequence of immoral
behavior.
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Methods to alleviate pain are directed toward main-
taining balance within the person and the sur-
rounding environment (Villarruel & Ortiz de
Montellano, 1992).
By using these themes, health-care providers can evaluate
Mexicans experiencing pain within their cultural frame-
work and provide culturally specific interventions.
Because long-term-care facilities in Mexico are rare and
tend to be crowded, understaffed, and expensive, many
Mexican Americans may not consider long-term care as a
viable option for a family member. In addition, because of
the importance of extended family, Mexican Americans
may prefer to care for their family members with mental
illness, physical handicaps, and extended physical ill-
nesses at home. In Mexican American culture, someone
with a mental illness is not looked on with scorn or
blamed for their condition because mental illness, like
physical illness, is viewed as God’s will. It is common to
accept those with mental illness and care for them in the
context of the family until the illness is so bad that they
cannot be managed in the home (Zoucha & Husted,
2000).
Mexicans can readily enter the sick role without per-
sonal feelings of inadequacy or blame. A person can enter
the sick role with any acceptable excuse and be relieved of
life’s responsibilities. Other family members willingly
take over the sick person’s obligations during his or her
time of illness.
BLOOD TRANSFUSIONS AND
ORGAN DONATION
Extraordinary means to preserve life are frowned on in
the Mexican and Mexican American cultures, and ordi-
nary means are commonly used to preserve life.
Extraordinary means are defined and determined by the
individual, taking into account such factors as finances,
education, and availability of services.
Blood transfusions are acceptable if the individual and
the family agree that the transfusion is necessary. Organ
donation, although not deemed morally wrong, is not a
common practice and is usually restricted to cadaver
donations, because donating an organ while the person is
still alive means that the body is not whole. Acceptance of
organ transplant as a treatment option is seen primarily
among more-educated people. One reason that organ
transplant is unacceptable to some groups is the belief
that mal aire (bad air) enters the body if it is left open too
long during surgery and increases the potential for the
development of cancer.
Health-Care Practitioners
TRADITIONAL VERSUS BIOMEDICAL
PRACTITIONERS
Educated physicians and nurses are often seen as out-
siders, especially among newer immigrants. However,
health-care professionals are viewed as knowledgeable and
respected because of their education (Zoucha & Husted,
2002). To overcome this initial awkwardness, health-care
providers should attempt to get to know the client on a
more personal level and gain confidence before initiating
treatment regimens. Engaging in small talk unrelated to
the health-care encounter before obtaining a health his-
tory or providing health education is advised. Health-care
providers must respect this cultural practice to achieve an
optimal outcome from the encounter.
Folk practitioners, who are usually well known by the
family, are usually consulted before and during biomed-
ical treatment. Numerous illnesses and conditions are
caused by witchcraft. Specific rituals are carried out to
eliminate the evils from the body. Lower socioeconomic
and newer immigrants are more likely to use folk practi-
tioners, but well-educated upper- and middle-class peo-
ple also visit folk practitioners and brujas (witches) on a
regular basis (Torres, 2001). Although often no contra-
dictions or contraindications to folk remedies exist,
health-care providers must always consider clients’ use
of these practitioners to prevent conflicting treatment
regimens.
Even though the Catholic Church preaches against
some types of folk practitioners, they are common and
meet yearly for several days in Catemaco, Veracruz. Folk
practitioners include the curandero, who may receive their
talents from God or serve an apprenticeship with an estab-
lished practitioner. The curandero has great respect from
the community, accepts no monetary payment (but may
accept gifts), is usually a member of the extended family,
and treats many traditional illnesses. A curandero does not
usually treat illnesses caused by witchcraft.
The yerbero (also spelled jerbero) is a folk healer with
specialized training in growing herbs, teas, and roots and
who prescribes these remedies for prevention and cure of
illnesses. A yerbero may suggest that the person go to a
botanica (herb shop) for specific herbs. In addition, these
folk practitioners frequently prescribe the use of laxatives.
A sobador subscribes to treatment methods similar to
those of a Western chiropractor. The sobador treats ill-
nesses, primarily affecting the joints and musculoskeletal
system, with massage and manipulation.
Even though Mexicans like closeness and touch within
the context of family, most tend to be modest in other
settings. Women are not supposed to expose their bodies
to men or even to other women. Female clients may expe-
rience embarrassment when it is necessary to touch their
genitals or may refuse to have pelvic examinations as a
routine part of a health assessment. Men may have strong
feelings about modesty as well, especially in front of
women, and may be reluctant to disrobe completely for
an examination. Mexican Americans often desire that
members of the same gender provide intimate care (C.
Zamarripa, personal communication, March 2002).
Health-care providers must keep in mind clients’ need for
modesty when disrobing or being examined. Thus, only
the body part being examined should be exposed, and
direct care should be provided in private. Whenever pos-
sible, a same-gender caregiver should be assigned to
Mexican Americans.
STATUS OF HEALTH-CARE PROVIDERS
Mexican American clients have great respect for health-
care providers because of their training and experience.
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They expect health-care providers to project a profes-
sional image and be well groomed and dressed in attire
that reflects their professional status (Zoucha, 2002).
Whereas they have great respect for health-care providers,
some Mexican Americans may distrust them out of fear
that they will disclose their undocumented status.
Health-care practitioners who incorporate folk practition-
ers, the concept of personalismo, and respect into their
approaches to care of Mexican American clients will gain
their clients’ confidence and be able to obtain more thor-
ough assessments.
Health-care providers can demonstrate respect for
Mexican American clients by greeting the client with a
handshake, touching the client, or holding the client’s
hand, all of which help to build trust in the therapeutic
relationship. Providing information and involving the
family in decisions regarding health; listening to the indi-
vidual’s concerns; and treating the individual with person-
alismo, which stresses warmth and personal relationships,
also fosters trust.
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