Folk medicine in the Southwest. Myths and medical facts

An interdisciplinary view of medical pluralism among Mexican-Americans

This article highlights the relationship between traditional, complementary, and alternative medicine (TCAM) and biomedicine, and the challenges this relationship poses to patients. Medical professionals tend to represent these systems dualistically - as mutually exclusive and in competition with one another. Patients, on the other hand, tend to make truly pluralistic health care decisions - moving freely between TCAM and biomedicine based on what they can access, what they can relate to, and what they believe works. Using their experience with Mexican immigrant and Mexican-American populations in Southwestern United States, the authors discuss strengths and weaknesses in both healthcare systems, and how medical dualism can be a significant barrier to effective healthcare. Recent literature on medical pluralism is discussed from the public health (i.e., community) and medical (i.e., provider) perspectives. These two disciplines are brought together in an attempt to deconstruct the notion that TCAM and biomedicine are diametrically opposed healthcare systems. Biomedically trained health care providers must understand, appreciate, and integrate into their practice how their patients make use of other healing practices and beliefs. Such integration is particularly essential when serving immigrant or minority populations as these groups are more likely to use a pluralistic approach in meeting their health needs.

Self-medication practices in two California Mexican communities

Although social scientists have taken up the study of medication use in both developing and developed nations, the medication practices of immigrants remain largely unstudied. In this study, qualitative research was employed in order to describe and compare self-medication practices in two California Mexican immigrant groups: families living along the border near Tijuana, Mexico, and migrant farm worker families residing in illegal encampments and substandard housing in San Diego's North County. Medication and health seeking practices were found to vary according to the specific political-economic, sociocultural, and geographic contexts in which different subpopulations of California Mexicans live. The California-Mexico border area was examined as an important context for considering self-medication behaviors, since it permits border-crossing into Tijuana for the purpose of buying Mexican pharmaceuticals at low cost without a prescription. The popularity of injections among California Mexicans and the cross-border purchasing of injectable antibiotics and vitamins are discussed as issues of particular relevance for immigrants living along the border.

Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: prevalence, associated factors, and effects of patient-clinician communication

OBJECTIVE

We examined the use of complementary and alternative medical (CAM) therapies among Chinese and Vietnamese Americans who had limited proficiency with the English language and explore the association between patient-clinician discussions about CAM therapy use and patient assessments of quality of care.

METHODS

We surveyed Chinese and Vietnamese Americans who visited 11 community health centers in 8 major cities throughout the United States.

RESULTS

Of the 4410 patients surveyed, 3258 (74%) returned completed questionnaires. Two thirds of respondents reported they had "ever used" some form of CAM therapy; however, only 7.6% of these patients had discussed their use of CAM therapies with clinicians. Among patients who had used CAM therapies during the week before their most recent visits, clinician-patient discussions about CAM therapy use were associated with better overall patient ratings of quality of care.

CONCLUSION

Use of CAM therapies was common among Chinese and Vietnamese Americans who had limited proficiency with the English language. Although discussions about CAM therapy use with clinicians were uncommon, these discussions were associated with better ratings of quality of care.

Linguistic and cultural barriers to care

CONTEXT

Primarily because of immigration, Asian Americans are one of the fastest growing and most ethnically diverse minority groups in the United States. However, little is known about their perspectives on health care quality.

OBJECTIVE

To examine factors contributing to quality of care from the perspective of Chinese- and Vietnamese-American patients with limited English language skills.

DESIGN

Qualitative study using focus groups and content analysis to determine domains of quality of care.

SETTING

Four community health centers in Massachusetts.

PARTICIPANTS

A total of 122 Chinese- and Vietnamese-American patients were interviewed in focus groups by bilingual interviewers using a standardized, translated moderator guide.

MAIN OUTCOME MEASURES

Domains of quality of care mentioned by patients in verbatim transcripts.

RESULTS

In addition to dimensions of health care quality commonly expressed by Caucasian, English-speaking patients in the United States, Chinese- and Vietnamese-American patients with limited English proficiency wanted to discuss the use of non-Western medical practices with their providers, but encountered significant barriers. They viewed providers' knowledge, inquiry, and nonjudgmental acceptance of traditional Asian medical beliefs and practices as part of quality care. Patients also considered the quality of interpreter services to be very important. They preferred using professional interpreters rather than family members, and preferred gender-concordant translators. Furthermore, they expressed the need for help in navigating health care systems and obtaining support services.

CONCLUSIONS

Cultural and linguistically appropriate health care services may lead to improved health care quality for Asian-American patients who have limited English language skills. Important aspects of quality include providers' respect for traditional health beliefs and practices, access to professional interpreters, and assistance in obtaining social services.

The role and meaning of susto in Mexican Americans' explanatory model of type 2 diabetes

This article examines the role and meaning of susto (fright) in Mexican Americans' explanatory model (EM) of type 2 diabetes. This analysis is based on a study of the health beliefs about type 2 diabetes mellitus among Mexican Americans living in El Paso County, Texas, on the U.S.-Mexico border. Susto was described as an event that could change the bodily state, causing a susceptible person to be more vulnerable to the onset of type 2 diabetes after some unspecified time. The study results illustrate the integration of multiple etiologies into Mexican Americans' EMs of diabetes and illustrate how the environment affects the way in which these explanations are manifested. Acculturation of biomedical system beliefs into the traditional Mexican health belief system has resulted in a synthesis of both systems and a blending of the participants' explanation of type 2 diabetes.

The importance of cultural and linguistic issues in the emergency care of children

BACKGROUND

Rapid growth in the diversity of the US population makes it increasingly likely that emergency clinicians will encounter greater numbers of patients from different cultures, but little is known about the importance of culture and language in the emergency care of children.

OBJECTIVE

To conduct a critical review and synthesis of published studies on culture and language in the emergency care of children.

METHODS

PubMed was used to perform a literature search (using 17 search terms) of all articles on culture, language, and the emergency care of children published in English or Spanish from 1966 to 1999.

RESULTS

More than 2000 citations initially were identified; consensus review yielded 400 papers that were photocopied. A final database of 117 articles revealed the following: certain normative cultural values, such as the Navajo hozhooji (the importance of thinking and speaking positively), can have profound effects on informed consent and discussions of medical risk. For limited English proficient children and their families, studies document that medical interpreters frequently are not used, there is a lack of trained interpreters, there are more access barriers, and those who need but do not get interpreters have poor understanding of their diagnosis and treatment. Numerous folk illnesses, such as among Latinos, can affect care, because symptoms often overlap with important biomedical conditions, the first clinical contact may be with folk healers, and certain folk remedies are harmful or even fatal. Certain parent beliefs and practices can result in serious morbidity and fatalities (from lead poisoning, liver failure, and other causes), costly or unnecessary medical evaluations (eg, Fenugreek teas), and clinical findings easily confused with child abuse (eg, coining). Biased provider attitudes and practices can have profound clinical consequences, including ethnic disparities in prescriptions, analgesia, test ordering, sexual history taking, asthma care quality, and diagnostic evaluations.

CONCLUSIONS

Failure to appreciate the importance of culture and language in pediatric emergencies can result in multiple adverse consequences, including difficulties with informed consent, miscommunication, inadequate understanding of diagnoses and treatment by families, dissatisfaction with care, preventable morbidity and mortality, unnecessary child abuse evaluations, lower quality of care, clinician bias, and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluations.

Caida de mollera among children of Mexican migrant workers: implications for the study of folk illnesses

Information about the folk illness caida de mollera was collected from Mexican and Mexican American migrant mothers who had treated their children for the illness, and from physicians in a clinic that served this population. These physicians believed that the vast majority of the sets of symptoms were worthy of medical attention and could be life threatening if not treated. This research report concurs with other studies that suggest that although Mexican folk illnesses are conceptualized to have folk-social and psychological causes, they are also seen to have biological causes and physiological symptoms that can be treated by biomedical methods. This report outlines a model for understanding aspects of folk illnesses that includes folk vs. biomedical ideas about disease, causes vs. symptoms, and psychological vs. physiological aspects of sickness. It also suggests that the kinds of questions anthropologists ask about these illnesses may need to be modified--shifting away from questions about treatments of causes and refocusing on those about the treatment of physiological symptoms--if we are to more fully understand home approaches to the management of these illnesses.

Dementia in older minority populations. Issues of prevalence, diagnosis, and treatment

Dementia continues to be a major disease that affects older Americans. It has been estimated that up to 25% of all community-dwelling elderly individuals in the United States suffer from signs or symptoms of dementia. Little, however, has been written on dementia as it relates to older minority populations. The purpose of this article is to discuss the prevalence of dementia in elderly minority populations, describe some of the unique issues related to the diagnosis and treatment of dementia in these populations, and make recommendations aimed toward improving the quality of life for elderly minority individuals with dementia.

Folk remedies and child abuse: a review with emphasis on caida de mollera and its relationship to shaken baby syndrome

OBJECTIVE

There were two objectives: first, to make the reader familiar with folk remedies that might be confused with child abuse; second, to challenge the idea existing in the literature that treatment for the Hispanic folk illness caida de mollera can cause the injuries seen in the shaken baby syndrome.

METHOD

Literature review and analysis with case application were used.

RESULTS

A wide variety of folk remedies with potential for confusion with child abuse were found to exist, and were described. Treatment for caida de mollera was found to consist of a number of gentle, nonviolent maneuvers quite different from the violent shaking believed to cause shaken baby syndrome.

CONCLUSIONS

Familiarity with folk remedies will help differentiate them from child abuse. The child protection community would benefit from realizing that treatment for caida de mollera is an improbable cause of shaken baby syndrome injuries.

Hispanic mothers' beliefs and practices regarding selected children's health problems

The purpose of this study was to identify and describe the Hispanic mothers' initial sources of advice and help with children's illnesses; beliefs about the etiology and seriousness of certain children's illnesses, namely, fever, cough, diarrhea, vomiting, conjunctivitis, skin rash, minor wounds, and burns; practices for the management of these children's health problems, including the use of home remedies, if any. Interviews were conducted with 100 women of Hispanic origin who had at least one child age 5 years or less and who were attending a community clinic in a rural area of central California. Mothers' beliefs about problem etiologies varied widely and revealed several misconceptions, folk beliefs, and lack of knowledge. The findings also revealed that only 32% of the mothers used or would use health professionals as the initial source of advice or help with children's problems. The majority of the subjects (81%) admitted to using home remedies to manage children's problems; 17% sought the help of a folk healer (mainly for the treatment of empacho). The various types of home remedies used by mothers were described and included the ingestion or application of certain foods, fluids, herbal teas, or other materials as well as methods to eliminate the perceived causes of the problems. It is important to note that 11% of the mothers had used azarcon or greta (substances containing lead) for treating empacho and other stomach problems in children. The need for culturally responsive and sensitive health care is discussed.

Research report: susto and pesticide poisoning among Florida farmworkers

This paper discusses research designed to investigate farmworker interpretation of a serious incident of pesticide poisoning, specifically, whether this incident was considered to precipitate the Mexican folk illness "susto." The study revealed that a total of 23% of the population interviewed felt that they definitely or possibly had developed susto as a result of the pesticide exposure. These patients complained of more residual symptoms from the pesticide exposure than did those who had been affected by the poisoning but who did not feel they suffered from susto. The findings have implications for medical providers working with these populations. A self diagnosis of "susto" may indicate that a patient is indeed sicker than other indicators suggest, and point to a need for increased follow-up.

Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans

Patients' cultural beliefs may affect acceptance of health care, compliance, and treatment outcomes. This article discusses cultural views of health and illness, folk beliefs and customs, cultural barriers to care, and alternative health-care systems, with particular emphasis on Mexican Americans and African Americans, including curanderismo, rootwork, and voodoo. Physicians who wish to provide appropriate and acceptable care in a cross-cultural setting should integrate these beliefs with conventional medicine.

The cultural construction of childhood diarrhoea in rural Nicaragua: relevance for epidemiology and health promotion

As a component of a series of studies of childhood diarrhoea in rural Nicaragua, lay knowledge regarding the condition and its appropriate management has been investigated through semistructured interviews with 70 mothers. These data have been combined with information from focus group discussions and observations from investigators who have been resident in the study area for many years. For any episode of childhood diarrhoea, the lay nosology influences the treatment path followed. Thus for some types of diarrhoea, treatment at a health centre or health post and the use of rehydration fluids is seen to be appropriate, while for other types the use of traditional healers or home-based treatment, often explicitly without the use of rehydration fluids, is applicable. The implications of lay nosological systems for the interpretation of epidemiological studies and for the implementation of health promotion programmes are discussed.

Empacho in four Latino groups: a study of intra- and inter-cultural variation in beliefs

It is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in the methods used to study the cultures. This paper describes a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs. A series of standard interview schedules were used to study Latin American beliefs about empacho in Guatemala, Mexico, and in the United States (Mexican-Americans and Puerto Ricans). Results showed consistency in beliefs about empacho both within and between the four samples.

Flatology

Advances in flatology are often close-lipped but of note. Cultural constraints and scatologic implications at times impede meaningful research. Historical and contemporary perspectives on flatus range from the biblical and theatrical, to paleontologic and environmental concerns, to the omninauseant legal and psychiatric sequelae. The current state of flatal physiology, pathophysiology, and diagnosis of aberrancy are reviewed. Flatoanalysis, air-flow studies, and flatulograms are discussed, as well as various remedies.

Clinical implications of a folk illness: empacho in mainland Puerto Ricans

The study of folk illnesses provides insight into client health beliefs and behaviors. This paper describes the expression of empacho in children living in a mainland Puerto Rican community. Etiology, symptom presentation, and treatment options in various health care sectors, as well as an investigation of overlapping folk/biomedical symptom domains are described. Implications regarding health and health care in the multicultural setting are discussed.

A study of four medicinal plant complexes of Mexico and adjacent United States

A survey of medicinal herbs in markets of central and northern Mexico and southwestern United States revealed the existence of plant complexes of different species sharing common names, morphological and aromatic characteristics, and uses. Four complexes (with the "label" species listed first) discussed include: "cachani" with Roldana sessilifolia, Iostephane madrensis, Liatris punctata, Psacalium sp., and Potentilla sp.; "chuchupate" with Ligusticum porteri and Myroxylon balsamum; "hierba anís" with Tagetes lucida, T. filifolia, T. micrantha, Artemisia dracunculus, Pimpinella anisum, and Illicium verum; and "matarique" with Psacalium decompositum, P. peltatum, P. sinuatum, P. sp., and Acourtia thurberi. The distribution analysis of utilization and natural occurrence of plants in each complex indicated the presence of a dominant or "label" plant whose use extended beyond its natural range and which had substitutes derived from local plants that were not registered far beyond their respective natural ranges.