Post your week 10 discussion questions here.

People of Baltic Heritage.

People of Brazilian Heritage

Read chapter 26 and 27 of the class textbook and review the attached PowerPoint presentions.    Read Content chapter 26 & 27 in Davis Plus Online Website.  Once done answer the following questions;

1.   Which countries are known as the Baltic nations?

2.    Discuss how the Baltic nations view the delivery of evidence-based healthcare and their beliefs related to health and disease.

3.   Give an overview of the Brazilian heritage, how do they see health and disease and if there is any similarity between them and the Baltic nations.

You must cite at least 3 evidence-based references no older than 5 years excluding the class textbook and 2 replies to any of your peers sustained with the proper references must be posted.  A minimum of 800 words must be presented excluding the first and reference page.  

If you have any question please feel free to contact me via FNU email.

Respectfully,

Prof. Cassandre Milien, MSN

Baltic Cultures

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

1

Baltic Overview/Heritage
People of Baltic descent come from Estonia, Latvia, and Lithuania.
The countries of origin of these ethnic groups are sometimes referred to as the Baltics or the Baltic countries because each of them is located in Europe on the Baltic Sea.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
2

Baltic Overview/Heritage
Historical, cultural, religious, and language differences prevent the group from being one cultural entity.
These countries represent three distinct ethnic groups and are treated as such.
The Estonians are a Finno-Ugric people whose language is related to Finnish.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

3

Baltic Overview/Heritage
The Union of Soviet Socialist Republics (USSR) forcibly annexed Estonia in 1949 and maintained control until 1991 when Estonia regained its independence.
Latvia, situated between Estonia and Lithuania on the Baltic Sea, was independent from 1918 to 1940 when it was forcibly annexed by the USSR.
Latvia regained its independence in 1991.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
4

Baltic Overview/Heritage
Russians make up 29 percent of the population of Latvia; the remainder is made up of Byelorussians, Ukrainians, and Poles.
Most ethnic Latvians speak a Baltic language related to Lithuanian.
Lithuania was an independent country from 1918 to 1940 when the USSR forcibly annexed it.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

5

Baltic Overview/Heritage
In 1990, Lithuania re-declared its independence from Soviet rule.
For Lithuania, 83.5 percent are Lithuanians, 6.3 percent are Russians, 6.7 percent are Poles, and 3.7 percent other.
Lithuanian is a Baltic language related to Latvian.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
6

Baltic Overview/Heritage
The Baltic countries today are democratic, growing economically, and are successful compared with many other former Soviet Union countries where poverty and dictatorship have been predominant.
In 1940, the three Baltic countries lost their independent status to Germany and then to the USSR in 1941.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
7

Baltic Overview/Heritage
During this time, hundreds of thousands of Latvians, Lithuanians, and Estonians were deported in cattle cars to Soviet prison camps in Siberia.
Fearing death or deportation by the communist regime, Estonians, Latvians, and Lithuanians fled to the West by any means possible.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
8

Baltic Overview/Heritage
The post-World War II influx of immigrants to the United States came in 1949.
Because the immigrants fled from the religious, cultural, and political persecution of the Soviet regime and could not return to their native countries after World War II, the U.S. Congress facilitated their entry by enacting laws designating them as displaced persons.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

9

Baltic Overview/Heritage
Many of the post-World War II refugees were professionals.
All three Baltic countries have regular song festivals and dance festivals in the US and in the native countries too.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
10

Baltic Overview/Heritage
The Baltic countries are strong in the arts, and theater, opera, music of all types, and film continue to flourish.
During the past 10 years, the three Baltic countries have experienced a “brain-drain” to some extent because many of their highly educated have emigrated to the US and Europe.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
11

Baltic Overview/Heritage
Education is highly valued by people of Baltic descent. All three Baltic countries have high literacy rates.
Education is valued in itself and is seen as a way of improving life circumstances.
These immigrants made many sacrifices so their children could become educated. As a result, many Americans of Baltic descent have advanced degrees. Many are professionals in medicine and law.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
12

Baltic Communication
People of Baltic descent share thoughts and feelings readily.
The stereotype of quiet, stoic individuals is not borne out by observation or research.
For example, humor can be used to relate to these clients and is appreciated if used in the right context.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

13

Baltic Communication
Clients of Baltic origin may hesitate to share intimate thoughts and feelings related to their cultural sense of decorum, but this does not mean that they do not experience feelings and emotions.
They may wait to see if the health-care professional is caring and takes the time to actually listen to them.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

14

Baltic Communication
As a whole, people of Baltic descent are not flamboyant or highly volatile, but individual differences are always present.
Some individuals enjoy touch and close contact, while others do not.
Individuals from these cultures are receptive to a caring use of touch from family and close friends, but they may come across as more aloof with strangers.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

15

Baltic Communication
People of Baltic descent give attention to the past, present, and future.
The past is revered in the sense that significant historical events for each cultural group continue to be celebrated and acknowledged.
People of Baltic descent value frugality because they have had hard times in the past.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

16

Baltic Communication
People of Baltic descent view time similarly to the dominant American culture.
Individuals of Baltic descent have become acculturated to time awareness and deadlines; they arrive at appointments on time. Because of their strong work ethic and high value on work, they take pride in the efficient and wise use of their time.
Socially, however, they may be less aware of time and tend to be late.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

17

Baltic Communication
Individuals of Baltic descent generally use their American last name.
First names of women end in “a” and first names of men end in “as” or “s.” In their native languages, the last names indicate if the person is male or female; for females, the last name indicates if the woman is married or single.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

18

Baltic Communication
In Latvian, the typical last name ends in “ans,” “ins,” or “e” with the endings indicating masculine or feminine genders.
Estonian names are similar to Finnish names.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

19

Baltic Communication
The father is the head of the household in the typical family of Baltic heritage.
Both men and women in the family may have jobs and discuss major decisions.
Health-care and other major decisions are made jointly by both spouses.
Women in the family are given respect, and decision-making is done by both men and women.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

20

Baltic Family Roles & Organization
Because education is highly valued, parents encourage and supervise children in their school work and progress.
Corporal punishment was used by older generations but is practiced less by younger families.
Cultural activities, such as song or dance groups and ensembles, frequently unite people.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
21

ClickerCheck
The language spoken by people from the Baltic countries is
a. The same for Latvians and Lithuanians but different for Estonians.
b. The same for Estonians and Latvians but different for Lithuanians.
c. Different for each country.
d. The same for each country.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

22

Correct Answer
Correct answer: C
The language spoken by people from the Baltic countries is different for each country.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

23

Baltic Family Roles & Organization
The traditional nuclear family is still the standard in these cultural groups.
Family is highly valued and divorce is still fairly rare.
Lithuanian Americans are predominantly Roman Catholic, and their religion supports strong family values.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
24

Baltic Family Roles & Organization
Older people are respected in the Baltic cultures.
If grandparents are unable to live independently, every effort is made to have them move in with an adult child, usually a daughter.
Nursing homes are used when needed.
In America, a certain amount of respect is still given to professionals, but each cultural group has more of an egalitarian sense of community.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
25

Baltic Family Roles & Organization
The literature does not include information about same-sex couples in these cultures.
Because the dominant religions of the Baltic countries do not sanction homosexuality, few individuals and couples are openly homosexual.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
26

ClickerCheck
Newer immigrants from the Baltic countries should be assessed for
a. Malaria.
b. Thalassemia.
c. Orthopedic disorders.
d. Endocrine disorders.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

27

Correct Answer
Correct answer: D
Newer immigrants from the Baltic countries should be assessed for endocrine disorders because of radiation fallout from the Chernobyl accident.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

28

Baltic Workforce Issues
Material aspects are seen as secondary to the more important family values.
Responsibility is taken seriously and is encouraged.
People of Baltic descent adapt readily to American values of timeliness in the workplace.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
29

Baltic Workforce Issues
People of Baltic descent have no difficulty maintaining their sense of autonomy and readily take on work roles, responsibility, and decision making.
They usually do not like to confront those in authority directly and find ways to deal with difficult situations or people through the use of humor or deference.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

30

Baltic Workforce Issues
Recent immigrants who have lived under the Soviet regime may not be accustomed to making decisions for themselves or acting autonomously.
In previous governmental regimes, individuals and their rights were not considered important.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

31

Baltic Biocultural Ecology
People of Baltic descent have white skin. Estonians are similar to the Finns with brown hair and eyes, but some are blonde and blue-eyed.
Latvians and Lithuanians have fair complexions with blonde hair and blue eyes.
Recent immigrants from the Baltics may be at risk for cancer because of industrial pollution and radiation exposure from the Chernobyl nuclear disaster in 1988.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
32

Baltic Biocultural Ecology
Some immigrants are survivors of political torture, having spent years in prison labor camps in Siberia.
The incidence of alcoholism is high in the Baltics.
Ashkenazi Jews from the Baltic countries may respond differently to neuroleptic agents.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
33

Baltic High-Risk Health Behaviors
Exercise and physical activity are valued, and people of these cultures make an effort to get a reasonable amount of exercise.
Individuals who have emigrated to the United States in the last 15 years tend to continue to smoke.
Although many people of Baltic descent maintain jobs and are able to function, their use of alcohol is high.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

34

Baltic Nutrition
Because many individuals who left the Baltics after World War II experienced food shortages and times of starvation, food is important to these people.
Recent immigrants have left the Baltics for economic reasons and have also experienced food shortages.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
35

Baltic Nutrition
Some foods common among this cultural group are meats such as pork, chicken, and beef.
Rye and whole grain breads are popular.
Baked goods such as bacon rolls, yeast baked goods, and rich tortes and cakes are common.
Fresh fruits and vegetables are enjoyed.
Potato dishes such as potato pancakes, potato kugel, and potato dumplings are popular.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

36

Baltic Nutrition
Beets, mushrooms, and cabbage are used in soups and sauces.
Dairy products such as sour cream, butter, and yogurt are included daily in their meals.
Grain porridges are popular, especially among Latvians who have putras porridges.
The content of porridges varies according to regions in Latvia.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

37

Baltic Nutrition
Foods enjoyed by people of Baltic descent include smoked and unsmoked sausages, and smoked fish, eel, and pork.
The spices used are rather mild compared with those of other cultures, but foods may be high in salt content.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

38

Baltic Pregnancy &
Childbearing Practices
In previous generations in the Baltics, infant mortality rates were very high. Large families were encouraged under communism.
Baltic people in the US use a variety of birth control measures.
Americans of Baltic descent use modern Western medicine practices obtain early prenatal medical care, and are receptive to health teaching for prenatal and postnatal care.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
39

Baltic Pregnancy &
Childbearing Practices
Some women and families from these cultural groups prefer natural childbirth and breast-feeding.
Pregnant women are to remain calm and receive no shock or frightening news.
Godparents are important in the child’s life and traditionally give gifts, including candy, to each other and guests.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
40

Baltic Death Rituals
Death is viewed as part of life, and ceremonies of the wake and funeral are linked with Christian religious services.
The funeral may take place within 3 to 4 days following the death, providing time for out-of-town friends and relatives to gather.
Cremation is permissible.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
41

Baltic Death Rituals
The funeral is usually a Christian service, followed by a meal at which all attendees are welcomed. Burial is the usual practice.
Grief is expressed by sadness, crying, and talking about the deceased with fondness and respect.
Individuals from these cultures express emotions readily but not in highly dramatic ways.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
42

Baltic Death Rituals
Decorum is maintained in public and with strangers.
The dead are often remembered with frequent visits to the cemetery.
All Souls Day, November 2, Ve·line·s, is a significant day for Lithuanian Americans, with religious ceremonies commemorating the dead.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
43

Baltic Spirituality
Estonian Americans and Latvian Americans are predominantly Lutherans but include some Catholics, while Lithuanian Americans are predominantly Roman Catholic.
All these groups celebrate major Christian religious holidays, particularly Easter and Christmas.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

44

Baltic Spirituality
Individuals of these cultures consider themselves as having spiritual roots, which may be closely linked with their high value for their language, country, and culture.
Under Soviet rule, religion was forbidden; every effort to eradicate all traces of religious belief.
Religion was replaced by communist dogma for 50 years.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

45

Baltic Spirituality
A very small percentage of Latvians maintain an ancient pagan religion.
This religious group is called Dievtui (those with God) and has a high priest as the head of the group.
Stories include myths and folk wisdom in rhyme as an important part of their content.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

46

Baltic Spirituality
Most Americans of Baltic descent consider prayer an individual expression of their faith.
Many have been sustained through hardships by their strong religious faith and continue to have strong religious needs.
Spiritual and religious considerations are considered private and may not be readily shared with health-care professionals.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

47

Baltic Spirituality
Clergy from the client’s church are usually welcome.
Clients find considerable comfort in speaking with the clergy in times of crises and serious illness.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

48

Baltic Health-care Practices
Individuals of Baltic descent adhere to modern medical regimens and readily use the health-care system available to them.
Because they consider health and well-being important, they take an active interest in healthy lifestyles, nutrition, and exercise.
Fresh air is considered important, and walking, especially in natural settings such as parks, is enjoyed by all ages.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
49

Baltic Health-care Practices
People of Baltic descent assume responsibility for their own health.
Because work is highly valued, most are in the workforce and have insurance coverage.
Medical care and hospitalization are sought readily. Attempts are made to maintain health even into old age.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
50

Baltic Health-care Practices
Recent immigrants from the Baltics to America may have different values because they lived under a communist regime in which the government “took care” of their medical needs.
These immigrants often need help understanding the American health-care system and may be reluctant to use it if they have no medical insurance coverage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
51

Baltic Health-care Practices
Chamomile and linden blossom teas may be used for fevers and colds.
Honey is used for colds and sore throats.
Younger people prefer to use over-the-counter cold remedies and analgesics. The use of natural substances for healing purposes is not customary among this generation.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
52

Baltic Health-care Practices
Among older Baltic immigrants, language may continue to present difficulty if they have not learned English well.
Many older individuals may tolerate pain as a part of life and may not complain about it or report it.
Some stigma is attached to mental illness, but medical care is sought.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
53

Baltic Health-care Practices
Most people of Baltic descent accept physical handicaps, mental illness, and mental retardation.
The family usually cares for the individual at home.
Americans of Baltic descent do not enjoy the sick role and avoid it when possible.
Work is highly valued and the person returns to normal responsibilities as soon as possible.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
54

Baltic Health-care Practices
Most people of Baltic descent accept blood transfusions and organ donation and transplantation.
The use of extraordinary means to preserve life is an individual decision, but living wills are frequently used.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
55

Baltic Health-care Practitioners
Besides family members and friends providing informal traditional health practices, no traditional health-care providers are found among people of Baltic descent in the United States or in the Baltics.
Because education is highly valued by people of Baltic descent, physicians, dentists, and nurses are held with respect.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
56

Baltic Health-care Practitioners
Advice given to their clients is usually followed.
People of Baltic descent are used to both men and women giving direct physical care.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

57

Baltic Health-care Practitioners
Nurses and health-care practitioners need to provide for privacy and consider the modesty needs of female and male clients of these cultures as they would for any client.
Older clients of both sexes are used to being treated with respect.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Culture
Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage
There is little literature on Brazilian health conditions, practices, and beliefs, although there is a lot on the objective culture such as arts, music, dance, and cuisine.
Brazilian heritage is rich in its mixture of Portuguese, French, Dutch, German, Italian, Japanese, Chinese, African, Arab, and native Brazilian Indians.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage
Common knowledge among Brazilians living in the United States is that many of them are escondidos (hidden) or officially referred to as undocumented aliens.
The exact number of Brazilians living in the United States is unknown.
Many Brazilians subsist in urban slums without privacy and hope to earn enough money to return home.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage
Brazilians in the US are underemployed, often giving up their professions to earn money as domestic workers, waiters, cab drivers, and other low-paying positions.
Immigrants often move to large cities where many networks help find “under-the-table” wages.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Portuguese is the official language of Brazil, although dialects exist and vary.
Many Brazilians continue to be of “proper” old-world orientation where true feelings are not divulged for fear of hurting the receiver of the communication.
In the intimate circle of family and compatriots, sharing thoughts and feelings is common.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication

Young adult and adolescent Brazilians in the United States are generally more acculturated because of their desire and need to assimilate.
Sharing thoughts and feelings is more common among intragenerational groups rather than intergenerational groups.
Most Brazilians use touch and direct eye contact.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication

Women kiss each other on both cheeks when they meet and when they say good-bye.
At times, women and men kiss in the same manner.
Men shake each other’s hands and slap each other on the back with the other hand. This gesture frequently ends in an embrace.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Children are kissed, and there is much touching. Kissing a child frequently includes the combination of a “kiss and smell.”
Spatial distancing is close.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Facial expressions and symbolic gestures are commonplace.
Most Brazilians in America are future-oriented.
In general, they are not punctual, especially for social occasions.
However, those in professional circles are punctual.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Brazilian names are lengthy, but the modern trend is to use only the first and last names.
Traditionally, names appear as first name, mother’s family name, and father’s family name. “Junior” is added to a name if the son has been named after the father and Neto if the son has been named after the grandfather (third generation).

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
When a woman marries, she may opt to drop her mother’s maiden name and her father’s name, or she may keep them both.
At times de, da/do, das/dos is added to a name to denote “of” and seems to be done out of tradition. No rigid protocol is apparent.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Children who have no father are often given the mother’s maiden name to which da Silva is added, denoting that the line of paternity is unclear.
In day-to-day relationships, people are called by their first name or Seu, Senhor (more respectful) preceding the first name of a man, or Dona preceding the first name of a woman.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company

Brazilian Communication
Mothers, grandmothers, or respected strangers are referred to as A Senhora, and fathers, grandfathers, and respected men are called O Senhor.
Doctors are addressed as Doutor or Doutora, and professors are addressed as Professor or Professora. The latter two are followed by the first name.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles and Organization
Brazilian society is one of machismo, with the middle and upper classes being patriarchal in structure.
As women assert their equality, more egalitarian relationships are becoming evident.
Lower socioeconomic households tend to be more matriarchal in nature.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization
Older people live with one of their children when self-care is a concern.
Older people are respected, seen as family counselors, and are always addressed as O Senhor or A Senhora.
They are included in family activities and usually accompany their children’s families on vacation.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization
Godparents are a very important family extension.
Poor families frequently ask their patron and patrona (employer and spouse) to be godparents to their child.
The godmother is called comadre by the mother.
Compadre is used in reference to the godfather.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization
Although historically common in the lower socioeconomic classes, middle-class households with a single-female parent are becoming increasingly common among Brazilians in the United States.
In middle-class families, the “no father” status is obscured by the child receiving the same middle and last names as the mother.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization
Social status is very important in the Brazilian society, demonstrated in the titles that people use with each other, and the practice of listing both parents’ surnames.
Brazilians, especially from the south and southeast of Brazil, have become more accepting of gay and lesbian relationships.
Same-sex relationships may carry a stigma.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues
Brazilians value diplomacy over honesty even when they promise to attend to something the next day, knowing that it will be impossible.
Professional Brazilians show up for work on time.
Less educated Brazilians may find it difficult to adhere to time schedules in the American workplace.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues
Brazilians generally respect authority and are frequently more comfortable in employment situations where rules and job specifications are well defined.
Many undocumented Brazilians find employment within the Brazilian community where they may never have to learn the new language.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues
The categorization of Brazilians in the US under the general category of “Hispanics” adds to their discomfort.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Biocultural Ecology
The “typical” Brazilian is a moreno with brown skin and eyes and black or brown hair. However, individuals particularly from the southern states of Brazil may have blond hair and blue eyes.
Common health conditions among Brazilians include malaria, Chagas disease, dengue fever, meningitis, yellow fever, schistosomiasis, typhoid fever, Hansen’s disease, hepatitis, tuberculosis, parasitic skin infections, cholera, cardiovascular diseases, and lactose intolerance.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Biocultural Ecology
Smoking is a high-risk behavior among Brazilians living in the United States.
Among men, drinking hard liquor is also prevalent.
Accessibility and use of street drugs and an individual’s desperate search for quick money are other identifiable high-risk behaviors and often involve living in crowded conditions.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition
The mainstay of the Brazilian American’s diet continues to be rice, beans, and farina.
Roast beef, fresh chicken, and seafood are sought when they are not too expensive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition
Breakfast typically consists of bread with cafe com leite (half coffee and half hot milk).
Sometimes cuscus (dry cornmeal mush) is served with milk.
Fruit, fruit juices, and scrambled eggs, with or without sliced hot dogs, are common special breakfast fares among middle-class families.
Sweet potatoes and yams may grace a breakfast table.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition
Dinner is eaten at noon. This heavy meal, consisting of beans, rice, and farina, often includes mashed potatoes and pasta.
Common desserts are custard, various cornmeal pastries, fruit, and doce (a sweet paste made by boiling sugar and fruit.
A vegetable and or fruit salad are also common.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition
A preference, especially among young Brazilian women, is to rely on vitamins instead of food consumption to help them remain thin.
In the US, food limitations are imposed by expense and inaccessibility of Brazilian mainstay foods.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
Common health conditions of Brazilian immigrants include
Schistosomiasis.
Thalassemia.
Glucose-6-dehydrogenous deficiency.
Hemophilia.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: A
Schistosomiasis is a common health condition of immigrant Brazilians, especially those coming from rural areas.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices
Although Brazil is predominantly a Catholic country, birth control is taught and used.
Women are encouraged by their physicians or clinic personnel to have tubal ligations to prevent unwanted pregnancies.
Frequently, unwanted pregnancies and abortions are, in the end, left in God’s hands.
Immigrants in the United States generally practice birth control.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices
Herbal teas are used for bringing on late menstrual periods and for stimulating natural abortions.
Single women may try to become pregnant to facilitate their chance of remaining permanently in the US.
Pregnant women are encouraged not to do heavy work and not to swim.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices
Taboos also warn against having sexual relations during pregnancy.
Taboos generally vary according to geographic region, socioeconomic status, and ethnic background.
Many Brazilian mothers prefer to give their babies powdered dry milk in place of breastfeeding.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices
Some women often feel that their milk is fraca (weak).
Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices
A postpartum woman eats chicken soup to help her body return to normal.
She is also advised not to eat spicy foods or repadura (a molasses candy) and not to drink garapa (sugar water) or caldo de cana (sugar cane juice) if she breastfeeds her infant.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals
The death of a baby or an infant, historically, has been and continues to be treated joyfully and without much sadness, for the child has died pure and is regarded as an angel.
If financially possible, the families of Brazilians who die in the United States personally accompany the body to Brazil for burial in the family vault.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals
The fatalistic expression, “It was God’s will,” helps the grieving process among the rich and the poor.
Older people wear black for various amounts of time depending on their relationship with the family member.
Frequently, the final portrait is hung in the family chaper or near the family altar, and prayers are recited. An eternal light burns.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals
Relatives are honored on the anniversaries of their death, both at home and at Masses.
Often, the family places an obituary of remembrance with or without a picture of the deceased in the local newspaper on the anniversary of the death.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck
Maria Miranda de Silva is reluctant to breastfeed. A common belief about breast feeding among Brazilians is that breastfeeding
Breastfeeding causes diarrhea in the infant.
Breastfeeding Is linked to a social stigma.
Breast milk is weak.
Breast milk is contaminated with iron.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer
Correct answer: B
Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Spirituality
90 percent of Brazilians are Catholic, various Protestant sects are making inroads into the Brazilian culture.
A few, including Catholics, incorporate traditions of Indian animism, African cults, Afro-Catholic syncretism, and Kardecism, a spiritualist religion embracing Eastern mysticism.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Spirituality
Saints are asked for help, and people wear medals or little pouches of special powders around their necks.
The meaning of life is found in religion, economy, fatalism, and reality. For some, life is uma luta (a battle). For others, life has an almost hedonistic attitude.
The greatest source of strength for Brazilians is their immediate and extended families.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Most Brazilians do not talk about their illnesses unless the illnesses are very serious.
Generally, illness is discussed only within the family.
Many Brazilians feel that talking about an illness, such as cancer, negatively influences their condition.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Because many Brazilians tend to shun hospitals, their families accompany them and stay around the clock.
The patient is often brought food from home.
The family is the nucleus of responsibility for health care and is eager to participate in care.
Brazilians are known for their self-medication practices.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Antibiotic, neuroleptic, antiemetic, and most other prescription drugs are easily obtained over the counter in Brazilian pharmacies.
Once in the US, incoming Brazilians bring medicines requested by their friends and, thus, maintain the circulation of medications not available to Brazilians living in the US.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Traditional and homeopathic pharmacies are supplemented by remedios populares (folk medicines) and remedios caseiros (home medicines).
Folk remedies and traditional health-care practices are intermeshed when a serious illness may be best treated by traditional caretakers.
Some take homeopathic bolinhas (little white balls) prepared specifically for certain ailments.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Brazilians generally do not like to talk about pain. However, once the emotional barrier is removed, they feel relieved to be able to discuss their discomfort.
Many pain-relieving medicines are available without a prescription in Brazil.
Sickness is a neutral role and is considered socially exempt.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices
Nervios is the ever-present folk diagnosis that identifies weakness, craziness, and anger as principally associated with hunger.
Better-educated Brazilians accept blood transfusions, organ donation, and organ transplantation.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practitioners
The folk-health field has many health-care practitioners:
Curandeiros are divinely gifted.
Rezadeiras (praying women) help exorcise illnesses.
Card readers can predict fortunes.
Espiritualistas are able to summon souls and spirits
Conselheiros are counselors or advisors.
Catimbozeiros are sorcerers.
Additionally, head priestesses or priests from the African-Brazilian Umbanda or Xango religion, all have the power to heal their believers.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practitioners
Brazilians in the United States tend to respect physicians and nurses.
Medical education is prestigious and highly sought by aspiring university students.

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