MEXICAN CASE STUDY #2 Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olga’s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables. The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetable picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines. Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out “chits” to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance. Study Questions 1. Identify three socioeconomic factors that influence the health of the Gaborra family. 2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia. 3. Identify strategies to help improve communications in English for the Gaborra family. 4. Identify three health-teaching goals for the Gaborra family. 5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda. 6. Discuss three preventive maintenance–teaching activities that respect the Gaborra family’s belief in the hot and cold theory of disease management. 7. Identify strategies for obtaining health data for the Gaborra family. 8. Identify four major health problems of Mexican Americans that affect the Gaborra family. 9. If Olga were to see a folk practitioner, which one(s) would she seek? 10. Explain the concept of familism as exhibited in this family. 11. Distinguish between the two culture-bound syndromes el ataque and susto. 12. Discuss culturally conscious health-care advice consistent with the healthbelief practices of the pregnant Mexican American woman. 13. Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen. 14. Identify where the majority of Mexican Americans have settled in the United States. PUERTO RICAN CASE STUDY #2 Carmen Medina, aged 39, lives with her husband, Raúl, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, José; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medina’s job. They live in a threebedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medina’s do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosa’s and Miguel’s developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is more preoccupied with the family’s financial situation. Mrs. Medina’s parents are encouraging them to return to Puerto Rico. Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medina’s last physical examination was after she had José. She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the family’s finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions 1. Explain Mrs. Medina’s attitude in her relationship with her adolescent daughter. 2. Identify strategies to ensure that Rosa seeks prenatal care. 3. Identify barriers to accessing health care for the Medina family. 4. What are the high-risk behaviors exhibited by this family? 5. What communication barriers exist in this family that affect care delivery? 6. Discuss gender and family roles in the context of traditional Puerto Rican culture. 7. Identify sociodemographic factors affecting the physical- and mentalhealth well-being for this family. 8. Identify Puerto Rican folk practices appropriate for this family. 9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why? 10. If Mrs. Medina’s parents visit a health-care provider, what might they expect? 11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina. 12. Discuss the importance of respeto and familism in the Medina family. 13. Identify culturally congruent interventions for Rosa’s pregnancy. 14. Identify health-promotion and disease-prevention interventions needed for José.