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thereby satisfying the pica, and is not considered harmful. The mother with food cravings is advised to satisfy them. The mothers are also instructed:
1. not to lift heavy objects, 2. to take laxatives to prevent constipation, 3. to exercise often by walking frequently, 4. not to cross their legs, and 5. not to bathe in hot water. The reason for the last two admonitions is the
belief that crossing the legs and taking hot baths can cause the baby to as- sume the breech position.
If the partera knows the exact date of the mother’s last period, she is able to estimate accurately when the woman is going to deliver by calculating 8 lunar months and 27 days from the onset of the last period.
With the onset of labor, the mother contacts the partera. She goes to the birthing place—the home or clinic of the partera—or the partera goes to her home. The mother is examined vaginally to determine how far along in labor she is and the position of the baby. She is instructed to shower and to empty her bowels—with an enema, if necessary—and she is encouraged to walk and move around until the delivery is imminent. Once the mother is ready to de- liver, she is put to bed. Most of the mothers are delivered lying down in bed. If
Box 12–1 Continued
Figure 12–14 Sign for a partera.
HEALTH and ILLNESS in the Hispanic Populations ■ 305
the mother chooses to do so, however, she is delivered in a squatting or sitting position. Several home remedies may be used during labor, including comino (cumin seed) tea or canela (cinnamon) tea to stimulate labor.
The baby is stimulated if needed, and the mucus is removed from the mouth and nose as needed with the use of a bulb syringe. The cord is clamped, tied with cord ties, and cut with scissors that have been boiled and soaked in alcohol. The stump is then treated with merbromin (Mercurochrome), alcohol, or a combination of the two. The baby is weighed, and some time after the delivery it is bathed. Most parteras bind both the mother and the baby. The baby may be fed oregano or cumin tea right after birth or later to help it spit up the mucus. Eyedrops are instilled in the baby’s eyes, in compliance with state laws (silver nitrate is used most frequently).
The partera stays at the mother’s home for several hours after the delivery and then returns to check the mother and the baby the next day. If the mother delivers at the home of the partera, she generally stays 12 to 14 hours.
There are several ways of disposing of the placenta. It may just be placed in a plastic bag and thrown in the trash, or it may be buried in the yard. Some placentas are buried with a religious or folk ceremony. There are several folk reasons for the burial of the placenta. The placenta must be buried so that the animals will not eat it. If it is eaten by a dog, the mother will not be able to bear any more children. If it is thrown in the trash, the mother’s womb may become “cold.” If the baby is a girl, the placenta is buried near the home, so the daughter will not go far away. If it is a boy, it is buried far away from the home to ensure the child’s independence.
The practice of the partera continues today. Parteras in the state of Texas are licensed and registered as direct entry midwives. They are not certified as nurse midwives. In Hidalgo County in the Rio Grande Valley, there are now 10 registered parteras remaining and who continue to practice in the traditional manner. Table 12–2 presents several aspects of the demographic and health situation in the 5 counties that border Mexico in the southern part of the state along the Rio Grande River where the parteras are practicing (Texas Depart- ment of State Health Services, 2011).
The practice of the partera in the Rio Grande Valley is the life of the past, the present, and the future: “a way of life de ayer, hoy y mañana” (Castillo, 1982).
Sources: Adapted from Spector, R. (1996). Cultural diversity in health and illness (4th ed.) Stam- ford, CT: Appleton & Lange, pp. 305–325;
Castillo, J. Former director, Division of Health Related Professions. (1982, April 6). Personal Letter. Brownsville: Texas Southmost College.
HEALTH Restoration
The most popular form of HEALTH restoration used by folk healers involves herbs, especially when used as teas. The curandero knows what specific herbs to use for a problem. This information is revealed in dreams, in which the “ patron” gives suggestions.
Because the curandero has a religious orientation, much of the treatment in- cludes elements of both the Catholic and Pentecostal rituals and artifacts: offerings
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of money, penance, confession, the lighting of candles, milagros, and the laying on of hands. Massage is used in illnesses such as empacho.
Cleanings, the removal of negative forces or spirits, or limpias, are done in two ways. The first is by passing an unbroken egg over the body of the ILL person. The second method entails passing herbs tied in a bunch over the body. The back of the neck, which is considered a vulnerable spot, is given particular attention.
In contrast to the depersonalized care Mexicans expect to receive in medi- cal institutions, their relationship with and care by the curandero(a) are uniquely personal, as described in Table 12–3. This special relationship between Mexicans and the curanderos may well account for folk healers’ popularity. In addition to the close, personal relationship between patient and healer, other factors may explain the continuing belief in curanderismo:
1. The mind and body are inseparable. 2. The central problem of life is to maintain harmony, including social,
physical, and psychological aspects of the person. 3. There must be harmony between the hot and cold, wet and dry. The
treatment of ILLNESS should restore the body’s harmony, which has been lost.
4. The patient is the passive recipient of disease when the disease is caused by an external force. This external force disrupts the natural order of the internal person, and the treatment must be designed to restore this order. The causes of disharmony are evil and witches.
5. A person is related to the spirit world. When the body and soul are separated, soul loss can occur. This loss is sometimes caused by susto, a disease or illness resulting from fright, which may afflict individuals from all socioeconomic levels and lifestyles.
Table 12–2 Selected Health Facts in Selected Counties along the U.S./Mexico Border, Rio Grande Valley, Texas: 2008
County
Population
Hispanic (%)
Per capita Income ($)
Below Poverty Level (%)
Live Births
Licensed Lay Midwives (2010)
Fetal Deaths
Cameron 393,355 87.1 21,387 33.5 8,153 4 47 Hidalgo 724,971 91.2 19,721 34.8 17,137 10 114 Starr 62,648 97.9 15,452 36.8 1,343 0 6 Zapata 14,314 89 18,849 26.2 318 0 2 Webb 238,269 95.2 22,831 26.6 5,933 3 29
Source: Texas Department of State Health Services. (2011). 2008 Health Facts Profiles for Texas. Retrieved from http://www.dshs.state.tx.us/chs/cfs/2008/2008-Health-Facts-Profiles-for-Texas/, July 11, 2011; Texas Department of State Health Services. (2011). Midwife, Direct Entry (DEM) by County of Residence 2010. Retrieved from http://www.dshs.state.tx.us/chs/hprc/tables/Midwife,-Direct-Entry-%28DEM%29-by-County-of-Residence— September,-2010/, December 4, 2011.
HEALTH and ILLNESS in the Hispanic Populations ■ 307
Table 12–3 Comparison between Curanderos, Parteras, and Other Traditional Healers and Allopathic Health Care Providers
Curanderos, Parteras, and Other Traditional Healers
Allopathic Health Care Providers
1. Maintain informal, friendly, affective relationship with entire family
1. Businesslike, formal relationship; deal only with the patient
2. Make house calls day or night 2. Patient must go to physician’s office or clinic, and only during the day; may have to wait for hours to be seen; home visits are rarely made
3. For diagnosis, consult with head of house, create a mood of awe, talk to all family members; are not authoritarian, have social rapport, build expectation of cure
3. Rest of family is usually ignored; deal solely with the ill person, and may deal only with the sick part of the patient; authoritarian manner creates fear
4. Are generally less expensive than physicians
4. More expensive than curanderos
5. Have ties to the “world of the sacred”; have rapport with the symbolic, spiritual, creative, or holy force
5. Secular; pay little attention to the religious beliefs or meaning of an illness
6. Share the world view of the patient— that is, speak the same language, live in the same neighborhood or in some similar socioeconomic conditions, may know the same people, understand the patient’s lifestyle
6. Generally do not share the world view of the patient—that is, may not speak the same language, do not live in the same neighborhood, do not understand the patient’s socioeconomic conditions or lifestyle
6. The responsibility for recovery is shared by the ILL person, the family, and the curandero(a).
7. The natural world is not clearly distinguished from the supernatural world. Thus, the curandero(a) can coerce, curse, and appease the spir- its. The curandero(a) places more emphasis on his or her connections with the sacred and the gift of healing than on personal properties. (Such personal properties might include social status, a large home, and expensive material goods.)
Several types of emotional illnesses are found among the traditional peo- ple from Hispanic communities. These are further divided into mental illness (in which the illness is not judged) and moral illness (in which others can judge the victim). The causes of mental illness and examples of the illness they cause are as follows:
■ heredity—epilepsy (epilepsia) ■ hex—evil eye (mal ojo) ■ worry—anxiety (tirisia)
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■ fright—hysteria (histeria) ■ blow to the head—craziness (locura)
The causes of moral illness and examples of the illness they cause are as follows:
■ vice—use of drugs (drogadicto) ■ character weakness—alcoholism (alcoholismo) ■ emotions—jealousy (celos) and/or rage (coraje) (Spencer, Nichols,
Lipkin, et al., 1993, p. 133)
Ethnopharmacologic teas may be used to treat these maladies and amulets may be worn or religious rituals followed to prevent or treat them. The following are examples of herbs that may be purchased in grocery stores, markets, and botanicas, and are used as teas to treat the listed maladies:
■ camomile tea, Manzanilla, used to cure fright ■ spearmint tea, Yerb Buena, used to treat nervousness ■ orange leaves, Te de narranjo, used as a sedative to treat nervousness ■ sweet basil, Albacar, used to treat fright and to ward off evil spirits
(Spencer, Nichols, Lipkin, et al., 1993, p. 133)
The HEALTH beliefs and practices discussed here are prevalent today (2012). I recently spoke with an immigrant from a small village in Mexico and inquired about curanderismo. He was excited to know that I was familiar with the prac- tice and was proud to share his knowledge and experiences.
■ Puerto Ricans Puerto Rican migrants to the United States mainland are American citizens, albeit with a different language and culture. They are neither immigrants nor aliens. According to the 2010 census, 9.2% of the Hispanic population are Puerto Ricans (Ennis, Rios-Vargas, & Albert, 2011, p. 3). Most live on the East Coast, with the greatest number living in New York City and metropolitan New Jersey. Most Puerto Ricans migrate to search for a better life or because relatives, particularly spouses and parents, have migrated previously. Life on the island of Puerto Rico is difficult because there is a high level of unemployment. Puerto Ricans are not well known or understood by the majority of people in the continental United States. Little is known about their cultural identity. Mainlanders tend to forget that Puerto Rico is, for the most part, a poor island whose people have many problems. When many Puerto Ricans migrate to the mainland, they bring many of their problems— especially those with poor health and social circumstance (Cohen, 1972).
Puerto Ricans, along with Cubans, constitute the most recent major im- migration group to these shores. They cover the spectrum of racial differences and have practiced racial intermarriage. Many are Catholic, but some belong to Protestant sects.
Many people from Puerto Rico perceive HEALTH and ILLNESS and use folk healers and remedies in ways similar to those used by other Hispanics, whereas