CULTURALLY COMPETENT AUDIOLOGISTS

SECOND ARTICLE IN A SERIES

How much do you know about the Hispanic/Latino Community?

 Hello again. In this issue I will concentrate on the most relevant aspects of our culture.   In 2002 Victor Velez (a Hispanic Community Leader), Ruben Diaz, M.A. SLP-CCC and myself, were hired by a company called Culturally Competent Communications, owned by two Ph.D. Psychologists who wanted us to develop a training grant funded by the Health Foundation of Greater Cincinnati.  Their goal was to provide awareness, knowledge, skill sets, and application to develop and implement culturally responsive health care services for the Hispanic culture in their own clinical settings.

 Approximately, 120 participants attended different sessions. These training sessions included administrative staff, physicians, psychologists, social workers, nurses and receptionists working for a variety of health community centers, the American Red Cross, the Cincinnati Health Department, Cincinnati Children’s Hospital, the Hamilton County Head Start, Planned Parenthood, the United Way, the Deaconess Hospital, Su Casa Hispanic Center and the Bienestar Program, among others institutions.  What did they have in common? All of them are currently serving the Hispanic Community. 

 As part of the training process, we asked our attendees to share their own stereotypes about the Hispanic community.  The most common “confusion” was, how to call us: should they refer to us as “Hispanic Vs. Latino”, “Latino Vs. Chicano”. Other common assumptions included: “all Latinos eat spicy food”; why are Latinos always late for everything? Why do you take lots of “siestas” (thinking that we are lazy and we don’t like to work); why do we attend a medical appointment with the “entire family”? Why every member in the immediate family has to take part in medical decisions? Why do we drink and party so much? Why do we kiss and hug people that we just met? Why don’t we speak English if we are in “America”? Now, this can be an endless list so I stop here.

 Anyway, I was fascinated to see all of the different types of attitudes and reactions. Some of the attendees were very open and glad to have the opportunity to learn about other cultures; others were just discovering how important this “new market” can be; some others changed the way they see us and wanted to get more involved with Hispanics; and finally, a really small group thought that “even with this training, they didn’t want to deal at all with Hispanics…” period.

 ASHA (1991) stated that: when you are or you are going to be involved with multicultural populations, the objective is to recognize that “there are cross-cultural differences in beliefs about health, disorders, and delivery of clinical services that can influence how an individual would either perceive a communication disorder or accept certain treatment procedures”.

Knowledge of cultural differences could explain certain behaviors and could help to overcome possible barriers that affect your clinical practice.

Understanding the Hispanic Community

 What is a Hispanic/Latino/Chicano:

Terms like Hispanic, Latino, Chicano are very complex and frequently misunderstood. The term Hispanic is a general term used by the United Stated Census Bureau to group all the Spanish-speaking people into one category.

 The term Latino, is gaining acceptance. Some people use it to identify all the different cultures from the Americas (North America, Central America and South America) who speak Spanish.  Other refer to people of those with family members from countries that speak a Romance Languages (Spanish, Portuguese and French).

 The term Chicano, is also very complex since some people feels offended when someone refers to us like that.  However, some times it is used to describe first, second and third generation of Mexican-Americans who speak Spanish.

 All of those terms remain problematic, because for a long time Hispanic/Latinos were generally described as “Spanish-Speaking” people. However, there are a good number of Hispanic/Latinos who do not speak Spanish; instead they speak dialects (even different dialects for the same country) or Portuguese, as is the case of Brazilians, or the Catalan spoken in Barcelona, Spain, or Valenciano, spoken in Valencia, Spain.  Also, remember that people from France and Italy are considered Latin.

 When people asked me if I am “Latina”, I usually answer, “Yes, I am Colombian”, since I share the concept of to be called by our ancestry: Venezuelans, Mexicans, Peruvians, and so on.

 Demographic

According to the 2000 U.S. the U.S. Hispanic Population was 35.3 million/Latinos.  The three largest groups are Mexicans 67%, followed by Puerto Ricans 14% and Cubans 5%, California the state with the largest population, 10,966.556 people.

 The Hispanic-American Resident Population, according to 2002 U.S. Census Bureau (based on total U.S. population = 280 million people), was 12%.  The projection by years 2010 & 2050 will be 15% and 24%, respectively.

 According to the 2000 Census, the Greater Cincinnati Area Hispanic/Latino is distributed as follow:

 Hispanic/Latino population by Origin, 2000 Census Greater Cincinnati Area

 The County with the highest Hispanic/Latino population is Hamilton, followed by Clermont, Northern Kentucky and Warren.

 Migration Profiles

There are different groups within this population, which include: US born; long-term residents and recently arrived immigrants (some of them staying temporally in the country.

Additionally, there is diversity in the profiles of this Hispanic migration.  For example, due to the number of Mexicans residing in the U.S. and their different socio-economic backgrounds, they take positions that range from high executives in companies to agricultural, restaurants and construction.  Puerto Ricans are US Citizens at birth and they enjoy the US privileges.  Cubans first migrations to US were mostly well-educated, middle-class or higher citizens.  South Americans tend to bring higher labor skills.  A large number of Centro-Americans are farmers, domestic workers, child care providers, office cleaners and other low skill positions.  Please do not stereotype these profiles, since there are many executives and very well educated Hispanic/Latinos working for all kinds of financial institutions, hospitals, universities, international companies, etc.  

 Cultural Values, beliefs, traditions and rituals

In US many people mistakenly assume that all Hispanics are the same and share the same beliefs and customs.  Although we may share a language and many beliefs and customs, each country is different.  Each country has unique customs.  Also, people differ by social and economic class, and whether they come from an urban or a rural area.

 Hispanic Families

Hispanics are a very family oriented culture.  Second and third generations are considered close family members.  The Father’s role is being the head of the household and the final decision-maker. Protector of their mother and sister. The mother’s role is been the primary caregiver. She is responsible for the support of children and elders.  She is respected by her life experience and taking decisions about a child’s health care and preservation and transmission of culture (Cortes, 1991).  Even if the mother makes health care decisions, in some cases the decisions involve the whole family. The elderly’s Hispanics role is being treated respectfully and formally. There is a reverence for them. They are actively involved in the Education and care of children, they usually live with the oldest son/daughter, a married daughter or a single son/daughter, usually live in their parent’s home until they get married or leave town because of their job or college. That is why most of the elderly Hispanics live with their families until they die, versus at a nursing home or retirement community center.

 Second and third cousins are also considered part of the close family.  As well the godfathers, whose role is important when the parents die or can take it care of the children for economic reasons.  It is common to see “hijos de crianza”, who live with their close relatives for many years (without singing any legal documents for adoption or guardianship), instead of going to live in a foster home.

 The Hispanic/Latino culture is characterized for being, warm and friendly (“simpático”).  People and relationship are more important than time, work or money. Display of passion and emotions in public is acceptable.  There is a lot of formalism, especially for the elderly Hispanics. Children are taught the importance of respect and the proper way to relate to others on the basis of age, sex and social class.  Direct eye contact is sometimes avoided with authority figures.  Direct questioning of authority is discouraged and would create discomfort.  If feelings of trust, acceptance and confidence (“confianza”) can be gained by the family, Latinos will become less formal and more open.  In emotional crises, family is the most important support.  Hispanics express their loss by crying openly.

 Sexuality

Children and preadolescent “protected” from sexual information.   Adults never talk to children about sex.  Direct sexual talk is basically unacceptable and is considered rude.  Indirect communication and nonverbal ways are used to explain sexual situations.  Sexual conversations are “taboo” from the Church to home.  Although, this concept has changed through time, there are many traditional communities and rural areas where sex is still a taboo.

 During puberty, the male adolescent is considered “a little man (“un hombrecito”).  Sexual experimentation is tolerated. Smoking tobacco and drinking alcohol socially acceptable. Males are to be knowledgeable, dominant in relations (“machistas”).  Teach his wife everything about sex.  They deal with the outside world and provide for his family

 On the other hand, the female adolescent is considered a “Little lady” (“una señorita”).  The “Marianismo” is widely used for some families (values relating to virginity).  Virginity is protected by the family and sexual experimentation is not tolerated.  The ideal Latina woman in the past was considered innocent, naïve and self-sacrifice; however this mentality is also changing.  Elder and middle age women, otherwise, behave more conservatively; they feel shame (“verguenza”) and embarrassment relating to female body parts.

Today, young people are more open, independent, and looking for equality.  Women are better educated now and work outside of their homes. Couples get divorced easier, and live within unmarried relationships more frequently.

 Privacy

Most sensitive issues are kept within the family.  Women tend to not share information about contraceptives.  Males don't disclose health information.  Women are expected to behave in a manner that maintains the family's social respectability. For this reason; a small percent of women do not report any domestic violence. 

Religion

2/3rds of U.S. are Roman Catholic.  Latin America the figure approaches 80 %.  Some practice fundamentalist faiths. Growing number of Protestants and a small umber are Jewish. Very few have no faith foundation. The belief in the Virgin Mary is essential in our countries. It is a common belief God or at the very least “supernatural” forces are directly involved in illness.  Folk religion (“Espiritismo”) is the belief in good and evil spirits that can affect one’s life.  Saints, sacred sites, pilgrimages, pay promises, miraculous cures are the central features of the Hispanic belief system.

 Time

I think time is one of the biggest differences between both cultures: we “walk” instead of “running” all the time, and we enjoy life now and do not worry inordinately about tomorrow.  When I talk with my friends and relatives, we agree that in our countries we have more time to relax, rest, enjoy our life and share more with our families.   We have concluded that factors such as: distance, availability to get help (maid, grandmother at home, family relatives living close by, and the schedules, facilitated and gave us more time to do things that usually we are unable to do.  The concept of taking naps (“Siestas”)  is of course something that we still practice, but keep in mind that Hispanic/Latino culture is a very hard working people, especially when they come to USA.  The main purpose to come to the US is to take advantage of the opportunities, and work to send money to the less fortunate family members in their country of origin. 

 Schedules play an important role since most of the offices in the small & medium size cities open from 8 to 12 and 2 to 6pm, and usually close for lunch. Of course, this routine and schedule vary from country to country. For example, Spain closes to the public from 12 m to 4 pm.  So, people have the opportunity to go home to take a nap and have a big lunch with their families (remember, most of the time, food is prepared by someone else, and most of the products are organic, fresh and ready to eat, nice, isn’t it?  I miss that…

 This is not the only advantage of having time for a nice lunch.  Since the biggest meal is at lunch, and the small meal is in the evenings, with all of the walking (short distances, absence of extreme climate changes (no seasons), and a lot of dancing and exercise) people have the entire afternoon to burn the calories they consumed at their lunches.

 Celebrations

·         Cinco de Mayo: USA and Mexico

·         Carnivals and “ferias” (Exuberantly with parades, floats, costumes, music, and dancing in the streets)

·         Semana Santa (Holy Week)

·         Día de Los Muertos ( Day of the Dead)

·         Navidad y Año Nuevo (Christmas and New Year are major fiestas)

·         Dia de Las Madres (Mother's Day considered a very important holiday.  Date varies from country to country)

·         Independence days

·         And several Catholic celebrations 

 Immigrants from other Latin American countries bring their unique holidays with them. The U.S. Congress has established Sept. 15 to Oct. 15 as U.S. Hispanic Heritage Month.

 Language

Even if it will be a full article only for language differences, bilingual issues, interpreters, etc. It is necessary talk about general aspects of language.

As I mentioned before, most of the Latino American countries speak Spanish, but it doesn’t mean we can understand each other.  In each country, there are many accents, indigenous language and Spanish dialects, even variations in meanings and names that vary from city to city, and country to country.

When I lived in Mexico for one year, I was obligated to change my vocabulary in order to communicate more clearly with my clients.  While I was doing my ABRs to the newborn babies, I couldn’t use the same terminology I used routinely when I was in my country, because Mexican moms aren’t going to understand me.  Some examples are: “Mamila” instead of “Tetero” (for baby bottle); or “popote” instead of “pitillo” (for straw).  Plus, other vocabulary to name fruits, vegetables, daily activities, etc. An example is the variety of words used in different countries to describe public transportation: “buseta” in Colombia, “guaga” en Cuba “camion” in Mexico. 

These variations in Language from country to country make even more difficult the communication within Latino Community residing in US.  Even for each Hispanic home, there exist variations for inside and outside their houses, such as the “Spanglish” (mixture of Spanish and English) dialects.

Plus, I am not counting that only in the US itself, data suggested that more than 70 languages are spoken (Spanish appears to be predominant), and that some third or fourth generation Latinos might not speak the Spanish language at all.

For these reasons and many others (that will be explained in future articles), it is very important that interpreters and translators not only be knowledgeable of both languages (native and second languages), but also understand the cultures and traditions in different Latino American countries.

 Language is not the only barrier, there is a cultural shock when a new immigrant arrived to this or any other country, because they are not only exposed to a new language, but a new medical, political, social, legal, financial, and educational systems.

 Gloria E. Valencia, MA-CCC-A

 All the references and sources for this article are available upon request.

Next issue: Medical aspect of the Hispanic/Latino Community: diseases and health conditions, high risks behaviors, health care practices, barriers to Health Care