Alternative Medicine and the Latin American Patient

For caregivers managing Latin American immigrant patients, understanding how traditional or folk medicine relates to modern treatments is essential. What happens when self treatment doesn't work or spiritual causes are ascribed to physical symptoms? Armed with some cultural sensitivity and the right questions to ask, potentially harmful outcomes can be avoided!

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  • Specializes in cultural competency, language educator. Has 37 years experience.

"New age" describes a recent trend in the United States toward alternative solutions to those provided by science and modern medicine. This new sense of spiritualism embraces some old solutions like the mind-body connection, massage therapy, natural methods and medicines, homeopathy, yoga, candle therapy, acupuncture, and other things excluded from a typical visit to a physician's office.

This new trend in the U.S. is not so new to immigrants from Latin America. What we call "traditional" or "folk" medicine has been practiced in their home countries for a long time. These practices have coexisted with modern medicine. Practitioners of traditional remedies do not consider the traditional and modern solutions to be distinct, but rather complementary.

So we should not be surprised that some Hispanic patients may have sought natural solutions before visiting a physician's office for healing. Some patients believe strongly in curanderos or spiritual healers. Some have brought with them a system of cures passed down from generation to generation for self treatment. Supplements and special diets are popular in Latin America. Often a visit to the homeopathy shop, or even a farmer's market, provides natural medicines for certain ailments. More surprising for many U.S. healthcare providers is the belief in a direct relationship between wellness and magic. Consider the following examples of folk maladies recognizable to many Latin Americans.

Digestive Distress

Empacho is a type of indigestion identified with symptoms such as stomach pain, swelling, fever, vomiting, acid reflux, diarrhea, and lack of appetite. These are symptoms associated with ulcers. The condition is often described as a ball of undigested food stuck to the stomach wall. Some believe it's caused by an excess consumption of certain rich or greasy foods. Others say it results from forcing someone to eat something against their will.

Psychic Distress

Susto (or "fright") is an emotional illness affecting anyone at any age. Symptoms include depression, nausea, anorexia or weight loss, insomnia, hyperventilation, and nervous breakdowns. It is traced to supernatural causes. Each person has a body and a soul. If a person suffers a traumatic event, his or her soul may flee the body. The soul must be returned to the body, through magical means, or the patient's life is at risk. This condition could mask a general infestation or meningitis. Caregivers working with pediatric patients should be especially aware of this phenomenon.

Mal aire ("bad air") is a psychic form of possession resulting in respiratory problems, muscle aches, and nervous or digestive problems. It is believed that people can be taken over by deities borne by the wind or by the spirits of victims of a violent death. Since the cause is spiritual, so is the cure-rituals performed by a healer-, sometimes in combination with healing herbs like the common rue plant (ruda), sage (salvia) or rosemary (romero).

Infants

Fallen fontanelle (mollera caída) affects new born babies. Babies are born with delicate craniums which do not firm up until 7 to 19 months of age. When a baby suffers from dehydration from excessive crying, diarrhea or fever from a bacterial infection, the upper front of the cranium may sink in. In these cases, a healer might push up on the upper palate of the baby, or hang the infant upside down.

Infants are the most common victims of "evil eye" (mal de ojo) and other types of mal puesto, or hexes. This type of magic spell is performed after securing a personal object belonging to the victim such as a lock of hair or saliva. All that's required is a simple look from a powerful individual, often motivated by envy. The solution is also magical, of course. It is the caregiver's role to find a medical solution to the excessive crying, fever and other symptoms presented by infants, or time spent seeking a magical cure may allow an undiagnosed illness compromise a baby's health.

A Better Cure: Culturally Competent Interviews

Healthcare providers managing care for Latino immigrant patients need to be aware of the prevalence of alternative practices common in Latin America. Often these practices are not even on the radar screen of U.S. physicians and care givers. But imagine the health risks related to negative interactions between natural and pharmaceutical remedies. Natural remedies and supplements could interact with prescribed medications. And also consider the fact that patients may self treat or rely on the advice of a spiritual healer and thus delay a trip to a clinic or physician's office when haste is essential to effect a treatment or cure.

The solution is not to contradict or ridicule a practitioner of alternative therapies, but to work within the cultural framework of the patient. The first task is to find out if a patient is following a form of traditional or folk medicine. Review the following culturally-sensitive questions inspired by the work of Dr. Arthur Kleinman of Harvard. (Refer also to the writings of Dr Nancy Neff of the Baylor College of Medicine, and Berlin and Fowkes' LEARN method.) Underneath each question set is an explanation for the purpose behind the questions.

  • What do you think is the cause of your condition? What do you call this illness? How do you believe the problem started?

How often does a healthcare provider ask the patient what the patient thinks is wrong with them? Surely some chatty patients will share their own theories with their doctors and nurses, but doesn't the modern provider filter out this "noise" when assessing a patient's condition? Asking these questions may identify what the patient believes is the source of the problem. With this knowledge, the provider can assess the situation and work to separate the affective or emotional side from the physical ailments. Don't discount the patient's beliefs but rather dig deeper to isolate physical symptoms.

  • What remedies are you taking to cure the problem? Have you consulted anyone? Whom? A doctor? A spiritual healer? What did he or she advise? Did someone at home treat you? What did they give you? Are you taking any supplements?

These questions are intended to reveal to the healthcare provider whether the patient is following any alternative practices or taking any natural remedies or supplements. Home remedies could be dangerous when combined with pharmaceutical drugs, or they may be benign. If the remedies have no effect on a health outcome, we advise against discouraging the patients from taking them. Respect their familiar practices and beliefs. Since spiritual healers can include Catholic priests, we advise using this term instead of curandero in order not to insult a "modern-thinking" Hispanic patient.

  • What are you afraid will happen to you from this illness? What treatment do you believe you should follow? What results are you seeking?

The answers to these questions will help the healthcare provider assess whether there will be any interference between modern and traditional cures. It also provides an opportunity to anticipate what will happen to patients as they follow recommended treatments, and to discuss realistic expectations for a cure. Including any harmless practices the patient is engaged in-like drinking an herbal tea or wearing a protective amulet-is a good idea for two reasons: it shows you respect their beliefs and it may result in a positive placebo effect. Saying there is 'nothing to fear' or that 'the best thing to do for now is nothing' is not enough. Be aware that Latin American patients who leave a physician's office without a plan of action that includes medicine or supplements may not return!

The percentage of Latin American folk medicine practitioners is relatively low when compared to the huge number Hispanic patients managed by the U.S. healthcare system. But these precautions can help assimilate the recent immigrant and their families into good health and improve wellness outcomes for all patients.

Dr. Lori Madden is a professor of foreign languages with a B.A. (Hood College), M.A. (University of Delaware) and Ph.D. (University of Florida) in Spanish, Portuguese and Latin American Literature. She is on faculty at St. Petersburg College. Dr. Madden has resided in Spain, Brazil and Costa Rica. She has taught for many years educating adults in Spanish and Portuguese languages and Hispanic culture, in both academic and professional environments. She is owner of https://SLSPublications.com.

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nutella, MSN, RN

1 Article; 1,509 Posts

This is a great article and I enjoyed reading it.

Especially the questions in a cultural competent interview are interesting.

I work in end of life care, the area I work in has some percentage of Hispanic patients. When I conduct the initial nursing assessment I also ask patients how they understand their illness and depending on the culture the answer can be surprising. While physicians often assume that the patient accepts the medical model and that an illness is based on xyz, it can turn out that the patient does not accept this idea or only nods but otherwise understands that the illness is based on the supernatural or faith based requiring other "healing".

Interesting that you also mention spiritual healer - the concept of treating body/mind/soul is in fact something "old", which was pushed into background by the medical model but now gains popularity as just treating the body alone does not provide sufficient "well-being". Integrating different cultures and several concepts of "care" and "healing" will become more important.

lorimadden

2 Articles; 8 Posts

Specializes in cultural competency, language educator. Has 37 years experience.

Thank you for validating the research behind this article, and also for incorporating these ideas into your own patient interviews. It is true that you will get nods of acquiescence but this does not mean that your patient is agreeing with your point of view! The mind-body connection is a powerful one that seems to be largely ignored in busy medical practices.

sailornurse

1,231 Posts

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care. Has 39 years experience.

Pretty good article. Just want to add that in Mexican-Americans we also have another type of healer : sobador or a lay massage therapist. Usually found by word of mouth. Another version of "ojo" or evil eye can occur when you admire someone such as when you see a cute child. If you say "what a pretty little girl", you MUST touch the child's head/hair as you say it or they may become ill. Also depending on the degree of acculturation &/or education may influence the belief systems of individuals. I still make chamomile tea for colds, fresh mint tea for upset stomach, (every house we lived in to this day my mom has had mint plants "Yerba Buena which means good plant) from oregano for bad cough. The treatment for empacho is performed by a sobador & included pinching the back & pulling if toes until they popped. For fevers, my mom used to slice a potatoe & dip the slices in brown vinegar then applied to forehead secured with a red handkerchief. Very similar results to the old alcohol sponging done in the late 1970s.

lorimadden

2 Articles; 8 Posts

Specializes in cultural competency, language educator. Has 37 years experience.

Thank you for your clarifications! muy interesante...

Hello, a very interesting article. In Latin America there are different management of health and treatment of disease. Each country has its customs, based on religious magical beliefs inherited from the indigenous race and the African race; allowing religious syncretism that leads, in many cases the individual and collective behavior of the population on the issue of self-care in health and healthy lifestyles.

The use of beverages, plants, massages, prayers are part of the activity of care, but mixed with the use of allopathic medicine, use both types of medicine for the restitution of Health.

You can not generalize that all Latin Americans manage their health only based on their beliefs. In each country it handled differently. What we can say is that alternative therapies are an essential part of self-care in each of our countries.

AuraPérezEscalante

University Professor

Caracas, Venezuela

lorimadden

2 Articles; 8 Posts

Specializes in cultural competency, language educator. Has 37 years experience.

Thank you for your comments! I agree that it is dangerous to overgeneralize; it leads to mistaken assumptions. That's why it's best to have a frank discussion with patients to find out the "why" as well as the "what" they are doing. Statistics show that the percentage of Latinos in the U.S. who embrace alternative and spiritual therapies is relatively low. I did discover something very interesting in my research. The incidence of alternative practices was a bit higher among Cuban Americans than among other groups. This can be explained by the persistence of Santeria practices in the U.S. I say this at the risk of overgeneralizing, so please re-read my initial statement! :-) Again, thanks for your insights.

Moss1222

20 Posts

Specializes in Education. Has 30 years experience.

This article and the comments are helpful for me. I'm an RN from the suburbs in the USA and going to Nicaragua for a medical mission trip this summer. I'm going to be helping with medical clinics and will be with three doctors and another nurse. Does anyone have recommendations for two things: Spanish lessons relating to medical things (I've looked and found little-I'm a beginner), and websites or articles to broaden my preparation for diseases, or other things I don't even know to ask about. I've been to the same location x2, but not doing medical things at all. Thanks!

lorimadden

2 Articles; 8 Posts

Specializes in cultural competency, language educator. Has 37 years experience.

Hello "Moss1222",

Congratulations on your humanitarian service! I'm sure your work is much appreciated.

Finding a solution to preparing for this sort of trip is difficult. I teach at a Florida college and we also recognize the need for Medical Spanish...I am now developing just such a course for our Healthcare program students this coming Fall. Not many states offer occupational Spanish programs for healthcare--Texas and North Carolina come to mind. In fact, there is a void in the market which is why I created a company (SLS Publications) to design cultural competency and Spanish language training for such purposes. We've launched a culture program for nurses and we're working on the language side now.

If you can't find a local community college to meet your needs, consider looking into a language school at your destination in Nicaragua. We've worked with small Spanish language institutes abroad and they are good, practical sources of language education. They focus on oral communication so you don't bogged down with grammar and the personnel are excellent sources of information about their local communities. If you research any of these schools, be sure to ask the school for references from U.S. travelers that can vouch for the quality of their education and then contact the references personally before making a decision. You don't need to go through a U.S. school program to study abroad if you don't need the credits, and you can save money this way, too.

Does anyone else have any idea for Moss1222? (It might help to know your geographic location when soliciting suggestions.) Has anyone traveled recently to Nicaragua to give our friend a 'heads-up' about vaccinations, safety and other precautions?

-Lori Madden