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Cultural considerations when working with Mexicans

This is an excerpt from Cultural Competence in Sports Medicine by Lorin Cartwright & Rene Shingles.

Mexicans have a unique culture of their own. It is important for the athletic trainer to understand the similarities and the differences of this culture to one's own, avoid the generalization that everyone adheres to the same beliefs that are part of this culture, and keep an open mind when working with athletes whose culture may be different than their own.

Demographic and Cultural Background Information

The acculturation process varies for each person and culture. This section addresses the history of the country of origin and immigration, primary languages and communication, family structure, daily living and food practices, and spiritual or religious orientation.

Brief History of Country of Origin and Immigration

Mexicans are descendents of Central American Indians, Native Americans, Spanish, Africans, and Europeans. Spanish people came to Mexico (see figure 9.1) as explorers, looted gold and riches from the Aztec Indians, and claimed it for Spain. Other tribes supported the Spanish in conquering the Aztecs.

First-generation Mexican immigrants were able to freely move back and forth between the United States and Mexico until the mid-1940s (Ngai, 2004; Lipson, Dibble, & Minarik, 1996; Downes, 1997).Once it became illegal to cross the border, many Mexicans stayed in the United States but maintained their culture and values. Immigrants who try to cross the border illegally are under stress of getting caught, being deported, or dying.

Mexicans have come to the United States to be with family members who immigrated previously and for employment opportunities, health care, and education. First-generation immigrants have often found only temporary work in fields, doing physical labor, or taking on jobs that Americans refuse to do (Lipson et al., 1996; Downes, 1997). Second- and third-generation immigrants have been able to find white-collar jobs that require college education.

Today the majority of Mexican immigrants to the United States live in Arizona, California, Colorado, Illinois, Florida, New Mexico, and Texas (Purnell & Paulanka, 2003). The majority of Mexicans live in cities, and many fail to complete a high school education; Los Angeles is the U.S. city with the largest Mexican population (Spector, 2004).

Primary Languages and Communication Styles

Mexicans speak a variety of languages, including Spanish, English, and an indigenous Indian language (e.g., Nahuatl and Maya) (Purnell & Paulanka, 2005; Erickson D'Avanzo & Geissler, 2003; Lipson et al., 1996). There are several dialects of Spanish and of the Indian language.

Dos and Don'ts

• Don't address a person by his or her first name unless you have received permission to do so.
• Do greet with Señor (male), Señora (married female), or Señorita (unmarried female).
• If you must wave, do so with the palm down so as to not offend the person.
• Don't point at a person; doing so is considered disrespectful (Rundle, Carvalho, & Robinson, 1999).
• Do shake hands, and always start with the oldest person first (Malat, 2003).

Distinctive to This Culture

• Mexican people are soft spoken.
• A raised voice is thought to indicate anger; staying calm is a respected virtue (Malat, 2003).
• Silence tends to be a part of the evaluation of words that have been said (Malat).
• Mexican people may seem to agree when they really do not; nodding may mean nothing more than respect for the athletic trainer (Malat).
• The mother's and father's surnames will be the surname of the child; the father's name will come first (Malat).
• Personal distance is close (1.5 to 4 feet, or 0.5 to 1.2 meters).
• Women may greet each other with a kiss or cheek-to-cheek hug even if it is their first meeting (Malat).

Family Structure

It is not uncommon to see three generations living under the same roof. Everyone is expected to contribute, including the youngest and oldest members. The needs of the family are deemed more important than the needs of the individual (Downes, 1997).

Distinctive to This Culture

• Machismo is a stereotype for Mexican males, so keep an open mind not to stereotype each person with this attitude (Purnell & Paulanka, 2005).
• A large family is thought to be a sign of machismo because the man of the house has sexual prowess (Purnell & Paulanka, 2003).
• Adults are respected for their knowledge.
• Members of an extended family may live close to one another as a way to maintain cultural identity.
• The extended family can also give support in times of health care needs (Purnell & Paulanka, 2005).
• The Mexican male is expected to provide for his family financially, whereas women are expected to take care of the children and run the home, but in many households both adults work.
• Decision making is primarily the responsibility of the adult male, but all close adults may be consulted.
• An athletic trainer may find her- or himself in a small group of family members while sharing medical information (Purnell & Paulanka, 2005; Lipson et al., 1996).

Daily Living and Food Practices

Mexicans are oriented toward present time; they are focused on “right now” rather than on the past or on future events or outcomes. Thus a Mexican athlete who completes a questionnaire regarding health may not share past medical conditions or illnesses if they are thought to have no bearing on how the athlete feels now. This tendency may make it more challenging for an athletic trainer to treat an illness or condition.

• Foods most common in the Mexican diet include rice, beans, onions, fruits, potatoes, fish, meats, tortillas, and plantains.
• Prepackaged food is not viewed favorably; tortillas, for example, are not store bought but made from scratch.
• Many Mexicans are lactose intolerant.
• Malnutrition is prevalent among Mexicans who are poor (Erickson D'Avanzo & Geissler, 2003).
• Foods are classified as hot or cold, depending not on temperature but on how each reacts within the body.
• Foods considered hot include peppers, cereal, oils, liquor, coffee, tea, ice, and some fruits (Downes, 1997).
• Foods considered cold include water, vegetables, dairy, meats, citrus fruits, and tropical fruits. Some foods can be either hot or cold depending on how they are prepared (Downes, 1997).
• First-generation immigrants believe that an illness considered cold should be treated by hot foods and vice versa.

Spiritual or Religious Orientation

About 90 percent of Mexicans are Catholic (Erickson D'Avanzo & Geissler, 2003); the secondary religion is Protestantism. Less than five percent of people also adhere to espiritism,a form of belief in God and spirits. Adherents communicate with spirits via a séance while in a trance or channeling (Kardec, 2007). People involved in espiritism believe that they are supported and enriched through prayer and belief.

Health Care Information

This section presents the particulars of Mexican health culture in the following categories: biocultural assessment, common sensitivities and conditions, beliefs about illness, preventive health practices, symptom management, and treatments. We would do well to remember, however, that all cultures have their own variations, whether in skin color, health beliefs, sensitivities, conditions, or health threats.

Biocultural Assessment

• Mexicans have a rich, blended genetic history that includes Central Americans, Native Americans, Spanish, Africans, and various Indian tribes.
• Skin tone ranges from very light to a dark brown. Dark skin tones may pose a challenge for the athletic trainer examining for cyanosis or jaundice. It may be easiest to do so by using the palms, soles of the feet, inside of the lip, nail beds, or sclera of the eyes.
• Depending on the genetic history, eye color can be blue or brown.
• Depending upon genetic history, hair may be straight and black or blond. Those with black hair have genetics that may be more closely related to indigenous Indians (Purnell and Paulanka, 2005). Blond hair may have resulted from Spanish background (Purnell and Paulanka, 2005).

Common Sensitivities and Conditions

• Mexico's mixed heritage makes it difficult to determine therapeutic doses of certain drugs (Purnell & Paulanka, 2003).
• Mexicans are more sensitive to antidepressants than are members of most cultures (Purnell & Paulanka, 2005).
• Antihypertensive drugs may not work as well in Mexican people.
• Mexicans have high rates of cancer, heart disease, and alcohol and drug abuse.
• Illnesses and conditions common among Mexicans that athletic trainers are familiar with include hypertension, type 1 diabetes, HIV/AIDS, and lactose intolerance.
• The following conditions affecting Mexicans may be less familiar to some athletic trainers: amoebic dysentery, intestinal parasites, malaria, dengue (Purnell & Paulanka, 2003, 2005; Downes, 1997; Spector, 2004) The appendix provides a more comprehensive list of signs and symptoms.

Beliefs About Illness

In traditional Mexican culture, it is believed that illness results from three causes: sin, imbalance, and witchcraft. Acculturated immigrants are accepting of Western medicine.

Distinctive to This Culture

• It is thought that physical and mental illness is God's way of conveying unhappiness with a person; this view posits a strong external locus of control over illness.
• A person with an emotional illness may then causea physical illness in their body from too much stress.
• Life is about balance, and imbalance may make a person sick.
• Each person is responsible for maintaining his or her balance.
• Mexicans believe that illness can result from an imbalance of hot and cold; this belief is tied to the four body humors (blood, yellow bile, phlegm, and black bile). An imbalance in the humors is thought to cause either physical or emotional illness.
• Other illnesses include espanto (shock), susto (fright), mal de ojo (the “evil eye”), and mal aire (bad air caused by exposure to drafts).
• There is a belief in Mexican culture in the supernatural or witchcraft (Lipson et al., 1996).
• Envidia refers to envy (Spector, 2004). When a person is successful, it is kept quiet because others may envy him or her, thus resulting in illness due to good fortune. A spiritual healer (espiritualista) is used to resolve these forms of witchcraft illness.
• Touching a child's head is believed to cause an illness called caida de la mollera, which involvesdehydration and vomiting and results in a fallen fontanel(Downes, 1997). In reality, the dehydration of the child can cause serious illness and death, but the dehydration is more often caused by diarrhea. Thus an athletic trainer must be careful to explain when touching of the head is necessary.

More Excerpts From Cultural Competence in Sports Medicine

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