People of Greek Heritage. People of Cuban Heritage. People of Hindu Heritage. 800 words minimum

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People of Greek Ancestry IRENA PAPADOPOULOS and LARRY D. PURNELL

The Greek and Greek Cypriot diaspora is of consider- able size and is spread to all continents and numerous countries. The largest Greek community outside Greece is in America, whereas the largest Greek Cypriot commu- nity outside Greece is in Britain. The characteristics of Greek and Greek Cypriot communities vary considerably according to the time of immigration; rural, island, or urban residence; and other primary and secondary char- acteristics of culture.

Despite considerable temporal and geographic varia- tion, several core themes are common to people who retain affiliation with a Greek community: emphasis on family, honor, religion, education, and Greek heritage. The core values of honor, respect, and shame are key when considering the experience of Greeks and Greek Cypriots. Because Greeks and Greek Cypriots value warmth, expres- siveness, and spontaneity, northern Europeans are often viewed as “cold” and lacking compassion. Eye contact is generally direct, and speaking and sitting distances are closer than those of other European Americans. Whereas innermost feelings such as anxiety or depression are often shielded from outsiders, anger is expressed freely, some- times to the discomfort of those from less-expressive groups. Thus, health-care providers must not take per- sonal offense with verbal and nonverbal communication practices that are different from theirs.

Greek children are included in most family social activ- ities and tend not to be left with babysitters. The child may be disciplined through teasing, which is thought to “toughen” children and make them highly conscious of public opinion. Providers must interpret these child-rearing practices within their cultural context.

Treatment of older people reflects the themes of close- ness and respect within the family. Grandparents tend to

participate fully in family activities. Families feel respon- sible to care for their parents in old age, and children are expected to take in widowed parents. Failure to do so results in a sense of dishonor for the son and guilt for the daughter. Health-care providers need to thoroughly assess the family beliefs when considering long-term care.

In regard to the workforce, probably no single charac- teristic applies so completely to members of the Greek and Greek Cypriot communities as the emphasis on self- reliance within a family context. Greeks and Greek Cypriots in North America, Britain, Australia, and Sweden stress this trait, seen as reluctance to be told what to do and given as a major reason for their pattern of establish- ing their own businesses as soon as possible.

Two important genetic conditions, thalassemia and glucose-6-phosphate dehydrogenase (G-6-PD), are seen in relatively high proportions among Greek populations. Drugs such as aspirin, primaquine, quinidine, thiazolsul- fone, dapsone, furzolidone, nitrofural, naphthalene, tolu- idine blue, phenylhydrazine, and chloramphenicol can induce a hemolytic crisis. This threat is sufficiently severe that the World Health Organization recommends that all hospital populations in areas with high proportions of Greeks and Greek Cypriots be screened for G-6-PD defi- ciency before drug therapy is offered.

Fasting is an integral part of the Greek Orthodox reli- gion. General fast days are Wednesdays and Fridays; nowadays, these are observed only by some older people. Greek Orthodox wishing to take Holy Communion observe at least 3 days of fasting. However, people with health conditions and small children are exempt from fasting. The prevalence of lactose maldigestion among Greek adults is about 75 percent; however, milk intoler- ance is rarely seen in children. Health-care providers

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should use this knowledge when counseling clients with these conditions.

If a pregnant woman remarks that a food smells good, or if she has a craving for a particular food, it should be offered to her; otherwise the child may be “marked.” This is the usual explanation for birthmarks.

After a death in the Greek community, pictures and mirrors may be turned over. During a wake, women may sing dirges or chant. In some regions, people practice “screaming the dead,” in which they cry a lament, the miroloyi. This ritual may involve screaming, lamenting, and sobbing by female kin. After death, family and close relatives, who stay at home, mourn for 40 days. Close male relatives do not shave, as a mark of respect.

The Greek Orthodox religion emphasizes faith rather than specific tenets. Easter is considered the most impor- tant of holy days, and nearly all Greeks and Greek Cypriots in America and Britain attempt to honor the day. Women often consider faith an important factor in regaining health. Family members may make “bargains” with saints, such as promises to fast, be faithful, or make church dona- tions if the saint acts on behalf of an ill family member.

Three traditional folk-healing practices are particularly notable: those related to matiasma (bad eye or evil eye),

practika (herbal remedies), and vendouses (cupping). Matiasma results from the envy or admiration of others. Whereas the eye is able to harm a wide variety of things including inanimate objects, children are particularly sus- ceptible to attack. Common symptoms of matiasma include headache, chills, irritability, restlessness, and lethargy; in extreme cases, matiasma has resulted in death.

Ponos (pain) is the cardinal symptom of ill health and an evil that needs eradication. The person in pain is not expected to suffer quietly or stoically in the presence of family. The family is relied on to find resources to relieve the pain or, failing that, to share in the experience of suf- fering. However, in the presence of outsiders, the lack of restraint in pain expression suggests lack of self-control. Although the experience of physical pain is acknowl- edged publicly, emotional pain is hidden within the pri- vacy of the family.

Many Greeks and Greek Cypriots display a general dis- trust of all professionals and may “shop around” for physicians and other professionals to obtain additional opinions. The use of several physicians simultaneously may result in untoward drug interactions from conflicting multiple drug use.

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People of Cuban Heritage DIVINA GROSSMAN and LARRY D. PURNELL

Over 1.2 million Cuban Americans live in the United States, representing the third largest Hispanic group, after Mexican Americans and Puerto Ricans. The experience of Cubans in their homeland and in the United States is dis- tinct from that of other Hispanic groups. Under the Cuban Adjustment Act of 1966, Cubans were welcomed by the U.S. Government and were provided with support. Cubans have managed to adjust to mainstream American culture while remaining close to their Cuban roots. However, young adults and adolescents who were edu- cated in Cuba with strict Communist ideation and who emigrated with their parents may find the clash in values between Cuba and their new country confusing and neg- ative.

Some Cuban Americans consider English to be their dominant language, others consider Spanish to be their dominant language, whereas still others are completely bilingual. Because many Cubans live and transact busi- ness in Spanish-speaking ethnic enclaves, they have little need or motivation to learn English and are less likely to acculturate.

Cubans value simpatia and personalismo in their interactions with others. Simpatia, the need for smooth interpersonal relationships, is characterized by courtesy, respect, and the absence of harsh criticism or confronta- tion. Personalismo emphasizes intimate interpersonal rela- tionships over impersonal bureaucratic relationships.

Conversations among Cubans are characterized by ani- mated facial expressions, direct eye contact, hand ges- tures, and gesticulations. Voices tend to be loud, with a fast rate of speech. Great emphasis is paid to current issues and problems rather than projections into the future.

Family is the most important social unit and source of emotional and physical support among Cubans. The

traditional family structure is patriarchal, although the more-acculturated families have become more egalitar- ian. La casa, the house, is considered the province of the woman, and la calle, the street, the domain of the man. Extended, multigenerational households are common, with grandparents often part of the nuclear family.

Most Cuban Americans are white. Because of their pre- dominantly European ancestry, Cuban Americans have skin, hair, and eye colors that vary from light to dark. A minority who are of African Cuban extraction are dark- skinned.

The Cuban cultural perspective of the “healthy body” is an obstacle to good nutritional practices. A healthy and beautiful Cuban infant is fat by U.S. standards. Even among adults, a little heaviness is considered attractive. Que gordo estas! (How fat you are!) is considered a compli- ment. The traditional Cuban diet, high in calories, starches, and saturated fats, predisposes individuals to the development of obesity and cardiovascular diseases.

Many Cuban folk beliefs and practices surround preg- nancy. Some Cuban women believe that they have to eat for two during the pregnancy and end up gaining exces- sive weight. Some believe that morning sickness is cured by eating coffee grounds; that eating a lot of fruit ensures that the baby will be born with a smooth com- plexion; and that wearing necklaces during pregnancy causes the umbilical cord to be wrapped around the baby’s neck.

Although, traditionally, it was not acceptable for Cuban men to attend the birth of their children, the younger and more-acculturated Cuban fathers tend to be present to support their wives during labor and delivery. In the postpartum period, ambulation, exposure to cold, and going barefoot place the mother at risk for infection.

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Thus, family members and relatives often care for the mother and baby for about 4 weeks postpartum.

Bereavement is expressed openly among Cuban Americans, with loud crying and other physical manifes- tations of grief considered socially acceptable. Death is an occasion for relatives living far away to visit and commis- erate with the bereaved family. Women from the immedi- ate family usually dress in black during the period of mourning. Approximately 85 percent of Cuban Americans are Roman Catholics, with the remaining 15 percent being Protestants, Jews, and believers in the African Cuban prac- tice of Santeria. Roman Catholicism as practiced by Cubans is personalistic, rather than institutional, in nature. The religious practice of Cuban Catholics is char- acterized by devotion and intimate, confiding relation- ships with the Virgin Mary, Jesus, and the saints.

Santeria is a 300-year-old African Cuban religious sys- tem that combines elements of Roman Catholicism with ancient Yoruba tribal beliefs and practices. Followers of Santeria believe in the magical and medicinal properties of flowers, herbs, weeds, twigs, and leaves. Sweet herbs are used for attracting good luck, love, money, and prosperity. Bitter herbs are used to banish evil and negative energies.

When someone is sick, that person’s physical com- plaints may be diagnosed and treated by a physician, but the santero may be summoned to assist in balancing and neutralizing the various aspects of the illness. Compared with their peers from previous migration waves, recent

Cuban immigrants may be less likely to be Catholic. Further, large numbers of Cubans consider themselves adherents of Catholicism and Santeria simultaneously.

When Cuban clients consult health-care providers, in all likelihood, they have already tried some folk remedies recommended by older women in their family or obtained from a botanica. Most folk remedies are harm- less and do not interfere with biomedical treatment. Health-care providers should be alert to the frequent prac- tice of sharing prescription medications in families and among relatives. Cubans may use traditional medicinal plants in the form of teas, potions, salves, or poultices.

Barriers to accessing health care among Cubans include language, poverty, time lag, and transportation, especially if they do not live in an urban environment. Others indicate that the red tape and paper work required by health-care facilities are deterrents to accessing care, especially preventive care and health wellness checkups. For some, overdependence on family and folk practices may also be a barrier to accessing care.

Among Cuban Americans, dependency is a culturally acceptable sick role. Sick family members are showered with attention and support. Cuban Americans tend to express their pain and discomfort. Verbal complaints, moaning, crying, and groaning are culturally appropriate ways of dealing with pain. The expression of pain itself may serve a pain-relieving function and may not necessar- ily signify a need for administration of pain medication.

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People of Hindu Heritage LARRY D. PURNELL

Hindus represent a segment of Asian Indians that includes Sikhs, Punjabis, Moslems, and Christians. Different religious sectors share many common cultural beliefs and practices, and they differ according to the pri- mary and secondary characteristics of culture. Asian Indians leave their country for a variety of reasons, the most important of which is to attain a higher standard of living. The prospect of greater material prosperity, com- bined with better working conditions, enhances the appeal of a wider range of job opportunities in the United States.

Women are expected to strictly follow deference cus- toms—that is, direct eye contact is avoided with men, although men can have direct eye contact with one another. Direct eye contact with older people and author- ity figures may be considered a sign of disrespect. Touching and embracing are not acceptable for displaying affection. Even between spouses, a public display of affec- tion such as hugging or kissing is frowned upon.

Most Hindus have become part of the skilled workforce in America. Hard work, interest in saving and investment, and business acumen enable many to become financially successful. Because of their educational and professional backgrounds, it is not difficult for most to find suitable employment and improve their economic status.

Adolescents face tremendous pressure to keep up the image of “whiz kids” and to meet the expectations of their parents, which may override individual aptitudes and choices. This may create anxiety and frustration, thereby leading to failure and anger toward parents, which may dispose adolescents to use drugs as a coping strategy.

Vegetarianism is firmly rooted in the culture and the term nonvegetarian is used to describe anyone who eats

meat, eggs, poultry, fish, and cheese. Foremost among the perceptions of Hindus is the belief that certain foods are “hot” and others “cold” and, therefore, should be eaten only during certain seasons and not in combination. The geographic differences in the hot and cold perceptions are dramatic; many foods considered hot in the north are considered cold in the south. Such perceptions and dis- tinctions are based on how specific foods are thought to affect body functions. Dietary habits within the Indian subcontinent are complex, regionally varied, and strongly influenced by religion.

Physical examinations and procedures, particularly pelvic examinations, are especially traumatic to Hindu American women who may not have experienced or heard about these examinations in the past. It is impor- tant to explain the procedures, provide privacy, and assign a female health-care provider to decrease the stress and discomfort associated with a pelvic examination.

Childbirth is a social and religious event in the Hindu culture. Pregnancy rituals are performed during specific months of pregnancy to protect the pregnant mother and the unborn child from evil spirits. The birth of a son is con- sidered a blessing, not only because the son carries the fam- ily name but also because he is expected to care for his par- ents in their old age. Furthermore, a son is also required for the performance of many sacred rituals. In contrast, the birth of a daughter is cause for worry and concern because of traditions associated with dowry, a ritual that can impov- erish the lives of those who are less affluent.

Hindus prefer to die at home. The eldest son is respon- sible for the funeral rites and completes prayers for ances- tral souls. Death is considered rebirth. Women may respond to the death of a loved one with loud wailing, moaning, and beating their chests in front of the corpse,

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attesting their inability to bear the thought of being left behind to handle situations by themselves. This is signifi- cant for women because widowhood is considered inaus- picious. Health-care providers need to offer support and understanding of the Hindu culture with respect for death and grief beliefs.

Hinduism is both a religious and a social system. The philosophical explanation of caste as the gradual progress of the individual soul to a state of union with the divine principle was made to concur with the social explanation of caste as the division of humankind into complemen- tary functional groups. Health-care providers must under- stand the Hindu religious beliefs and practices to provide culturally congruent care for Hindu clients.

Within the traditional system of medicine in India, the primary emphasis is on the prevention of illnesses. Individuals are responsible for meeting their own health needs. One of the principles of Ayurveda includes the art of living and proper health care, advocating that one’s health is a personal responsibility.

Because of religious beliefs related to karma, Hindus attempt to be stoic and may not exhibit symptoms of pain. Furthermore, pain is attributed to God’s will, the

wrath of God, or a punishment from God and is to be borne with courage. As a result, health-care providers may need to rely more on the nonverbal aspects of pain when assessing the comfort needs of Hindu clients.

Because of the stigma attached to seeking professional psychiatric help, many Hindus do not access the health- care system for mental-health problems. Instead, family and friends seem to be the best help, and there is a general belief that time is the best healer. Physical and mental ill- nesses are considered God’s will and are associated with a fatalistic attitude. The sick role is assumed without any feelings of guilt or ineptness in doing one’s tasks.

Women generally seek female health-care providers for gynecological examinations. Health-care providers need to respect their clients’ modesty by providing adequate privacy and assigning same-gender caregivers whenever possible. In the area of mental health, traditional healers, such as Vaids, practice an empirical system of indigenous medicine; mantarwadis cure through astrology and charms; and patris act as mediums for spirits and demons. Health-care providers must specifically ask whether their Hindu clients are using these folk practitioners and what treatments have been prescribed.

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