In our daily healthcare work, we meet with people who are from cultures different from ours. Various groups possess and portray different values, customs, and behaviors. It is essential to take this into consideration in order to provide effective healthcare without bias on stereotypes of a certain community. On this note, I got a chance to review R.A., a Latin American male friend in his mid-30s. He has a Mexican background and moved to the United States to search for a new productive life. R.A is a person of interest in the interview because Mexicans are popularly moving into the US either legally or illegally and this makes them an important portion of the society. His family moved into the current location when he was 12 years old. As a person significantly grows in his childhood, R.A. portrayed this by embracing the Mexican culture and bringing it to the US. In their current location, they tried to adapt to the different culture and combine both English and Spanish customs. The interview was conducted on the basis of cultural assessment according to Purnell’s model of cultural competence. R.A. provided details on the various domains of culture that this model highlights and the results were as follows.
Purnell’s Model
Larry Purnell (2002) developed the framework when he realized that his students showed gaps in the knowledge of different cultures of the patients they cared for. The presentation takes a circular form in four layers. The innermost layer represents the person, the second layer the family, the third one is the community and the outer layer is the global society. This framework divides the person into twelve domains. This paper describes these domains as they apply to R.A.
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Overview of Heritage
This section refers to the concepts relating to the country of origin. It includes the impacts on occupations, politics, health, educational status, and rationale for migration (Purnell, 2002). Both parents of R.A. were born and raised in the Hispanic group in Mexico. Although the country experiences heated politics, education is an important aspect of society. Children are supposed to attend the mandatory free education in public schools. Mexico has many outbreaks of diseases and the healthcare system is not as advanced as in the US. R.A. revealed that the reason for migrating was to evade the poor living conditions in Mexico. The gap between the rich and poor is wide and thus the search for opportunities elsewhere.
Communication
This section includes both verbal and non-verbal use of language. The latter refers to the use of gestures, spatial distances, eye contact, and formality that are viewed as normal in the culture (Purnell, 2002). In R.A.’s household, the language being used is Spanish. In this culture, spatial distance is short, about an arm’s length. When women greet in a social setting, they pat each other on the left arm or kiss on one chick. Men shake hands formally and when they know someone well, they go to a more traditional hug and back patting. R.A. revealed that in his culture, casual touching on the arm or shoulders is not a sign of sexual harassment but a sign of affection. They maintain eye contact and smile while talking in a low voice is considered lack of interest. Mexican’s are always addressed using the last name, with the first only when invited.
Family Roles and Organization
This domain discusses the relationship of people inside and outside the family. They include roles such as heading the house, gender roles, child-bearing, and duties of the children. According to R.A., the husband is the head of the family and the sole breadwinner. After work, the man can go out and join friends. The role of the woman is to carry out domestic chores and includes child rearing and caring for the family. The kids help with household duties. Overall, Latinos value family teachings and live in large settings.
Workforce Issues
This domain analyzes the way an individual is assimilated and how lifestyle such as gender roles, individualism, and communication styles affect this. R.A.’s community considers the males as having a higher status than the rest. They make major decisions and are leaders of households. Women are always overlooked and work inside the house and their decisions are considered inferior. This makes it problematic with Hispanic men who have to work under female bosses. They feel that they are controlled by the people they rule over at home.
Biocultural Ecology
In this category, Purnell uses his model to describe the biological and physical variations amongst cultural groups. Latinos describe themselves with their skin color, with most considering being Caucasian while a few being black (Campbell, 2003). Some also attribute themselves to the indigenous groups. According to R.A., the major medical problem in his family is obesity. He links this to the sedentary life they came to get in the US and the high intake of fast foods that are laden with high calories. He also says that some conditions such as diabetes have also started creeping in.
High-risk Behaviors
The behaviors that are considered high-risk are the lifestyles that might cause ruin to the health of an individual. They include the use of alcohol, tobacco, recreational drugs, avoiding safety measures, and lack of physical activities (Purnell, 2002). When asked whether he uses recreational drugs, R.A. smiles and says he enjoys it. This can be highly attributed to the fact that he is Mexican, a country known for its illegal drugs. He affirms that this is a huge problem in the culture. He also states that Latinos are risk takers and do not employ safety measures most of the time. High fatality rates are high among the Latinos as they use the seatbelt least.
Nutrition
The concepts in this framework involve the perceptions of the culture towards food when someone is ill, availability of food, and rituals associated with such. R.A. told me that the Mexican-Americans perceive health as God’s reward or luck. Nevertheless, the maintenance of health is achieved by taking some meals. In the daily lives, rice and beans prepared with lard are common. Afternoon meals include soup, rice, and chicken or meat. In addition, tortilla or “arepa” is an accompaniment used with every meal. In case a person becomes ill, they take chicken soup (ganilla). They eat three times a day, or sometimes four, with the afternoon meal being the most important. Hispanics believe that giving a child the food with wrong temperature results to illness and thus mothers withhold food that might make their kids sick (Campbell, 2003).
Pregnancy and Childbearing Practices
This domain describes the fertility, delivery, and post-partum practices (Purnell, 2002). When asked about this, R.A. seemed to lack much explanation. This is because childbearing is left on the woman mainly in this culture. However, he was clear that the culture considers pregnancy a natural phenomenon and may not seek care until the day of delivery. There is a great influence from the extended family and community on maternity health practices. Women are often accompanied by female relatives, particularly sister, mother, or auntie, during prenatal care visits. R.A. noted that the families in that culture are always warm and protective for the children with familyism having influence even in child-rearing. Birth control is often practiced.
Death Rituals
Purnell (2002) uses this domain to decide how cultures view death, the rituals practiced, and the preparations for the burial. When I asked about the funeral cultures in his culture, R.A. explained that the procedures involve a mass conducted by a priest in the church. It is acceptable for women to openly show their expression of grief while the men are prohibited by the norms to break into tears. Traditional burial then follows as the relatives and friends join the family for the process.
Spirituality
The domain of spirituality refers to the use of prayer, formal religious beliefs, and other religious affiliations (Purnell, 2002). R.A. tells me that his family are Roman Catholics according to their Hispanic background. In fact, over 80% of Mexicans are from this affiliation. R.A. and his parents go to church services every Sunday as they are staunch Christians. Spirituality is a central aspect of the Mexican-American culture as it is used in the maintenance of health, everyday life, and a means of coping with bereavement and stress. The church is also a source of hope and strength in the community.
Health Care Practices
This domain explains the issues relating to traditional practices of health, barriers to access to healthcare, and the type of treatment that the culture accepts. When I asked him if he believed in traditional or modern medicine, R.A. responded by saying that in the Hispanic community, folk medicine holds an important aspect in the lives of many. The culture provides the diagnosis and treatment of illnesses with religious or psychological overtones. Using home remedies is common and the patients may prefer to consult a “curandero (folk healer) (Crouch, 2004).” R.A. told me that the major barrier to access to healthcare is the language barrier. Very few doctors understand or are Spanish.
Health Care Practitioners
This final domain describes how the culture views the healthcare practitioner and the role of gender and type of professionals used. According to R.A., healthcare professionals such as nurses, doctors and traditional practitioners are revered in the culture. Their work is respected regardless of gender. In case of a serious illness, the Latinos go for the services of a qualified practitioner, but in minor cases, they value folk medicine.
Conclusion
The interview was educative as I came to learn so much about the culture of Hispanic-Americans through R.A. This brings to life the idea of cultural differences that exist in our society and proves the gap that Purnell talked about. It is therefore imperative for the healthcare practitioners to have this information about cultures in order to offer a non-biased care. This means that cultural competence should be a major requirement in the profession.
References
Campbell, C.R. (2003). Two eagles in the sun: A guide to U.S Hispanic culture. (3rd ed., pp. 26-38). Houston, Texas: Two Eagles Pr.
Crouch, N. (2004). Mexicans & Americans: Cracking the culture code. London, England: Nicholas Brealey Publishing.
Purnell, L. (2008). The Purnell model for cultural competence. Journal of transcultural nursing, 13(3), 193-196.
