health promotion strategies that can be implemented upon the predictive characteristics of the family.
My health promotion strategy program will center around a Cuban-American family called the Garcias whose primary health issues center on hypertension, and the need for greater information about the importance of establishing a healthy lifestyle. This includes the importance of screening, exercise, establishing healthy habits, and monitoring one’s lifestyle. Several members of the family indicate stress and hypertension whilst the grandmother also has cardiac disease and osteoarthritis, but is resilient to receiving information on how to alleviate her symptoms. In a similar way, Angelo, an addicted smoker, refuses to stop smoking and to deal with his chronic cough and mild chest pain, stating that, as man of the family, he has to continue working his overwhelming hours. Gerardo, the son, being active homosexually, seems to be vulnerable to AIDS; it is unclear whether or not he is acting upon that information. Lourdes, the mother and wife, is the only one who appears to be controlling her health. Nonetheless, she too suffers from hypertension.
Three dynamics need to be dealt with here:
1. A stress-reducing program implemented
2. A program, established in a non-intimidating manner, that can instruct the Garcias about the importance of regulating their health and ways in which to do this.
3. An overall format in which the former two goals and the specificities of each person’s symptoms (specifically those of the grandmother and Angelo) can be accomplished in a manner in which they will be receptive to the information.
Since cultural factors are impacting their health, as can be evidenced by Angelo refusing to recognize and address his symptoms as per the statement that he, as male, has to protect his family and as evidenced, too, by the grandmother rejecting ‘American’ knowledge, manner have to be found whereby the information can be presented to them in the context of their cultural background thus influencing them to better accept the information.
Mercedes: An unrecognized social dynamic at play here can be the distrust of Western civilization in general, and of Americans in particular, that may have been transmitted to the grandmother. Not only does Cuba have a history of harsh dictatorship (e.g. from Fulgencio Batista in the modern era), which has caused distrust against government and reliance on independence, but also worse still this Fulgencio Batista was supported by the United States. In 19561, the U.S. also warred against Cuba, and even though unsuccessful, U.S. Cuban clashes followed and many Cubans attribute Cuba’s economic decline to American interference with their Soviet support. This was exacerbated by Clinton’s intercepting migrants at sea and detaining them in migrant centers at Guantanamo Bay. It is no wonder that Mercedes, a product of that culture, and, therefore, likely ideologically imbued with their indoctrination is resilient to receiving information and advice from American health service. For all we know, she may have been told (in typical soviet-type propaganda) that their services are deceptive and destructive to Cuban survival.
Dealing with this mentality is challenging. One idea may be to direct the grandmother to a Cuban social work agency that can serve as mediator between the American health services and between their clients. In this manner, the grandmother will be more receptive to the information and more wiling to follow the recommendations, accept the drugs, and adhere to recommended interventions. Alternately, a Cuban American healthcare worker may be found to act as interpreter and mediator between the health care services and Mercedes, again in attempt to persuade her to accept and follow the treatment.
Angelo is somewhat more complex since his rationale and manner deals with the typical Cuban sentiment macho sentiment that, as man, he can and must overcome his ‘weaknesses’ in order to continue to support his family. It would be considered unmanly for him to surrender to his ‘weakness’. Another element that must be taken into consideration is the finding that a huge proportion of Cubans are uninsured. This makes them unwilling o seek medical treatment. Someone, such as Angelo, who values his money, would all the more likely to fall under such a category. An element of advice might be to again get a Cuban American social worker involved who can explain the severity of smoking to Angelo and point out that smoking is linked with disease and that he can control his own health issues by relinquishing his smoking habits.
A great percentage of Cubans who cannot afford medical treatment seek Santeria healing services for their symptoms. The Santeria tradition is an entrenched part of the Cuban heritage, and it may be possible that Angelo (and Mercedes) may be directed to some reliable Santeria outlet for assistance.
Gerardo may not be as much affected by his Cuban heritage as by the phenomena of self-denial where he may be unwilling to come to grips with the fact that he is susceptible to AIDS and may even then have the introductory symptoms of it. Gerardo’s case seems a shut one since he has vanished from the scene. Presumably, being aware of the illness, Gerardo must be willing to be helped and open to his situation before ideas can be suggested.
Lourdes, suffering from hypertension, seems to be more ‘Americanized’ than the other members of her family and hence would likely be open to any of the ‘American’ solutions for stress that run the spectrum from yoga to meditation to counseling to drugs. Psychotherapy might be her best bet given her situation, but Lourdes would likely integrate that with other interventions.
Either way, health problems cannot be separated one from the other. All are inevitably linked. The hypertension, fro instance, so prominent in various members of that family, is itself part of and causing the other problems. For that reason, strategies should be sought whereby a holistic treatment can be implemented for each member of the family according to his or her own particular personality and cultural characteristics.
Boswell, T.D. & Curtis, J.R. (1984) The Cuban-American Experience. Culture, Images and Perspectives. NJ: Rowman & Allanheld Publishers
Cuban Americans http://www.everyculture.com/multi/Bu-Dr./Cuban-Americans.html
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