Module 6
Health and Illness
A. Traditional Definitions of Health and Illness
The descendants of the original inhabitants of the North American continent and
Alaska numbered 2.9 million people, or 0.9% of the total population of the United States
in Census 2010. This number reported American Indian and Alaska Native alone and
represented a growth from 2.5 million people in 2000 (Humes, Nicholas, & Jones, 2011,
p. 4). When compared to “U.S. all races,” the American Indian/Alaska Native (AI/AN)
population lags behind in several areas, including lower educational levels and higher
unemployment rates. The AI/AN population is a young population. The median age of
the population is 28.0 years, compared with 35.3 years for all races in the United States.
The population has larger families, less health insurance (the number of AI/ANs without
health insurance is over double that for U.S. all races), and a poverty level nearly twice
that of the rest of the population. The American Indian population served by the Indian
Health Service is living longer than it did 30 or even 20 years ago. In fact, statistics on
age at death show that during 1972– 1974, life expectancy at birth for the American
Indian population was about 63.6 years and has now increased to 72.6 years, but it is still
5.2 years less than the U.S. all races life expectancy of 77.8 years (2003–2005 rates)
(U.S. Department of Health and Human Services, 2012). Diseases of the heart, malignant
neoplasm, unintentional injuries, diabetes mellitus, and chronic liver diseases and
cirrhosis are the 5 leading causes of Indian deaths in 2007.
The first time that American Indians were counted as a separate group was in the
1860 census, and the 1890 census was the first to count American Indians throughout the
country. The counting of American Indians before 1890 was limited to those living in the
general population of the various states; the American Indians residing in American
Indian territory and on American Indian reservations were not included. Alaska Natives,
in Alaska, have been counted since 1880, but until 1940 they were generally reported in
the “American Indian” racial category. The people were enumerated separately (as
Eskimo and Aleut) in 1940 in Alaska. It was not until the 1970 census that separate
response categories were used to collect data on the Eskimo and Aleut population, and
then only in Alaska.
The American Indian nations that were the largest populations include the
Cherokee, Navajo, Latin American Indian, Choctaw, Sioux, and Chippewa. The largest
Alaska Native group was Eskimo. To realize the plight of today’s American Indians, it is
necessary to journey back in time to the years when Whites settled in this land. Before
the arrival of Europeans, this country had no name but was inhabited by groups of people
who called themselves nations. The people were strong both in their knowledge of the
land and in their might as warriors. The Vikings reached the shores of this country about
A.D. 1010. They were unable to settle on the land and left after a decade of frustration.
Much later, another group of settlers, since termed the “Lost Colonies,” were repulsed.
More people came to these shores, however, and the land was taken over by Europeans.
Although each American Indian Nation or tribe had its own history and belief
system regarding HEALTH and ILLNESS and the traditional treatment of ILLNESS,
some general beliefs and practices underlie the more specific tribal ideas. The terms
HEALTH and ILLNESS are used to indicate that, among traditional people, the
connotations are holistic, as defined and discussed in Chapters 5 and 6. The data—
collected through an ongoing review of the literature and from interviews granted by
members of the groups—come from the Navajo Nation, Hopis, Cherokees, Shoshones,
and New England Indians with whom I have worked closely.
The traditional American Indian belief about HEALTH is that it reflects living in
“total harmony with nature and having the ability to survive under exceedingly difficult
circumstances” (Zuckoff, 1995). Humankind has an intimate relationship with nature
(Boyd, 1974). The Earth is considered to be a living organism—the body of a higher
individual, with a will and a desire to be well. The Earth is periodically HEALTHY and
less HEALTHY, just as human beings are. According to the American Indian belief
system, a person should treat his or her body with respect, just as the Earth should be
treated with respect. When the Earth is harmed, humankind is itself harmed and,
conversely, when humans harm themselves, they harm the Earth. The Earth gives food,
shelter, and medicine to humankind; for this reason, all things of the Earth belong to
human beings and nature. “The land belongs to life, life belongs to the land, and the land
belongs to itself.” In order to maintain HEALTH, Indians must maintain their relationship
with nature. “Mother Earth” is the friend of the American Indian, and the land belongs to
the American Indian.
According to American Indian belief, as explained by a medicine man, Rolling
Thunder, the human body is divided into 2 halves, which are seen as plus and minus (yet
another version of the concept that every whole is made of 2 opposite halves). There are
also—in every whole—2 energy poles: positive and negative. The energy of the body can
be controlled by spiritual means. It is further believed that every being has a purpose and
an identity. Every being has the power to control him- or herself and, from this force and
the belief in its potency, the spiritual power of a person is kindled.
In all American Indian cultures, disease is associated with the religious aspect of
society as supernatural powers are associated with the causing and curing of disease.
Disease is conceived of in a wide variety of ways. It is believed to occur due to a lack of
prevention, which is given by wearing or using charms; the presence of some material
object that has intruded into the body via sorcery; or the absence of the free soul from the
body (Lyon, 1996, pp. 60–61). One example of an amulet is Duklij, turquoise or green
malachite that is believed to contain supernatural qualities that ward off the evil spirits
and bring rain.
Many American Indians with traditional orientations believe there is a reason for
every sickness or pain. They believe that ILLNESS is the price to be paid either for
something that happened in the past or for something that will happen in the future. In
spite of this conviction, a sick person must still be cared for. Everything is seen as being
the result of something else, and this cause-andeffect relationship creates an eternal chain.
American Indians do not generally subscribe to the germ theory of modern medicine.
ILLNESS is something that must be. Even the person who is experiencing the ILLNESS
may not realize the reason for its occurrence, but it may, in fact, be the best possible price
to pay for the past or future event(s) (Boyd, 1974). The Hopi Indians associate ILLNESS
with evil spirits. The evil spirit responsible for an ILLNESS is identified by the medicine
man, and the remedy for the malady resides in the treatment of the evil spirit.
Chinese medicine teaches that HEALTH is a state of spiritual and physical
harmony with nature. In ancient China, the task of the physician was to prevent
ILLNESS. A first-class physician not only cured an ILLNESS but could also prevent
disease from occurring. A second-class physician had to wait for patients to become ill
before they could be treated. The physician was paid by the patient while the patient was
healthy. When illness occurred, payments stopped. Indeed, not only was the physician not
paid for services when the patient became ill, but the physician also had to provide and
pay for the needed medicine.
To understand the Chinese philosophy of HEALTH and ILLNESS, it is necessary
to look back at the age-old philosophies from which more current ideas have evolved.
The foundation rests in the religion and philosophy of Taoism. Taoism originated with a
man named Lao-Tzu, who is believed to have been born about 604 B.C. The word Tao
has several meanings: way, path, or discourse. On the spiritual level, it is the way of
ultimate reality. It is the way of all nature, the primeval law that regulates all heavenly
and earthly matters. To live according to the Tao, one must adapt oneself to the order of
nature. Chinese medical works revere the ancient sages who knew the way and “led their
lives in Tao”.
The various parts of the human body correspond to the dualistic principles of yin
and yang. The inside of the body is yin; the surface of the body is yang. The front part of
the body is yin; the back is yang. The 5 ts’ang viscera—liver, heart, spleen, lungs, and
kidney—are yang; the 6 fu structures—gallbladder, stomach, large intestine, small
intestine, bladder, and “warmer”—are yin. (The “warmer” is now believed to be the
lymph system.) The diseases of winter and spring are yin; those of summer and fall are
yang. The pulses are controlled by yin and yang. If yin is too strong, the person is
nervous and apprehensive and catches colds easily. If the individual does not balance yin
and yang properly, his or her life will be short. Half of the yin forces are depleted by age
40; at 40 the body is sluggish, and at 60 the yin is totally depleted, at which time the body
deteriorates. Yin stores the vital strength of life. Yang protects the body from outside
forces, and it, too, must be carefully maintained. If yang is not cared for, the viscera are
thrown into disorder, and circulation ceases. Yin and yang cannot be injured by evil
influences. When yin and yang are sound, the person lives in peaceful interaction with
mind and body in proper order.
The Chinese view their bodies as a gift given to them by their parents and
forebears. A person’s body is not his or her personal property. It must be cared for and
well maintained. Confucius taught that “only those shall be truly revered who at the end
of their lives will return their physical bodies whole and sound.” The body is composed
of 5 solid organs (ts’ang), which collect and store secretions, and 5 hollow organs (fu),
which excrete. The heart and liver are regarded as the noble organs. The head is the
storage chamber for knowledge, the back is the home of the chest, the loins store the
kidneys, the knees storeItheImuscles, and the bones store the marrow.
The Chinese physician is aided in making a diagnosis by the appearance of the
patient’s tongue. More than 100 conditions can be determined by glossoscopic
examination. The color of the tongue and the part of the tongue that does not appear
normal are the essential clues to the diagnosis. Breast cancer has been known to the
Chinese since early times. “The disease begins with a knot in the breast, the size of a
bean, and gradually swells to the size of an egg. After seven or eight months it perforates.
When it has perforated, it is very difficult to cure”.
“Black or African American” in the 2010 census refers to a person having origins
in any of the Black racial groups of Africa. The Black racial category includes people
who marked the “Black, African American, or Negro” checkbox on the census form. It
also includes respondents who marked Sub-Saharan African entries, for example Kenyan
and Nigerian; and Afro-Caribbean entries, for example Haitian and Jamaican. The 2010
census showed that the United States population on April 1, 2010, was 308.7 million
people. Out of the total population, 38.9 million, or 13%, identified as Black alone. In
addition, 3.1Imillion people, or 1%, reported Black in combination with one or more
other races. The Black alone-or-in-combination population grew by 15%, which was
more growth than the total population and the Black alone population. Both groups
(Black alone-or-in-combination) grew at a slower rate than most other major races and
ethnic groups in the country. The majority of Blacks or African Americans alone in the
United States in 2010 lived in the South, 56.5%; 16.8% lived in the Northeast; 17.9% in
the Midwest; and 8.8% in the West. The states with the highest population of Blacks or
African Americans in 2010 were New York, 7.9%; Florida, 7.7%; Texas, 7.6%; Georgia,
3.1%; and California, 7.7% (Rastogi, Johnson, Hoeffel, & Drewery, 2011, pp. 4–9). In
2010, 84.2% of Blacks were high school graduates and for persons over 25, 19.8% were
college graduates.
Blacks are represented in every socioeconomic group; however, the 1 year
estimate released by the United States Census Bureau American Community Survey for
2010 revealed there were over 10 million Blacks or African Americans below the poverty
level 27.1% of the Black or African American population (2011). Furthermore, over half
of Black Americans live in urban areas surrounded by the symptoms of poverty—
crowded and inadequate housing, poor schools, and high crime rates. For example,
Kotlowitz (1991) described the Henry Horner Homes in Chicago as “16 high-rise
buildings which stretch over eight blocks and at last census count housed 6,000 people,
4,000 of whom are children.” The degree of social and economic change between 1990
and 2000 has been minimal. He presented 2 facts about public housing: “Public housing
served as a bulwark to segregation and as a kind of anchor for impoverished
neighborhoods” and “It was built on the cheap—the walls are a naked cinder block with
heating pipes snaking through the apartment; instead of closets, there are 8-inch
indentations in the walls without doors; and the heating system so storms out of control in
the winter that it is 85 degrees.” Situations similar to this prevail presently.
According to some sources, the first Black people to enter this country arrived a
year earlier than the Pilgrims, in 1619. Other sources claim that Blacks arrived with
Columbus in the 15th century (Bullough & Bullough, 1972, pp.I39–41). In any event, the
first Blacks who came to the North American continent did not come as slaves, but,
between 1619 and 1860, more than 4 million people were transported here as slaves. One
need read only a sampling of the many accounts of slavery to appreciate the tremendous
hardships that the captured and enslaved people experienced during that time. Not only
was the daily life of the slave very difficult, but the experience of being captured,
shackled, and transported in steerage was devastating. Many of those captured in Africa
died before they arrived here. The strongest and healthiest people were snatched from
their homes by slave dealers and transported en masse in the holds of ships to the North
American continent. In general, Black captives were not taken care of or recognized as
human beings and treated accordingly. Once here, they were sold and placed on
plantations and in homes all over the country—it was only later that the practice was
confined to the South.
Families were separated; children were wrenched from their parents and sold to
other buyers. Some slave owners bred their slaves much as farmers breed cattle today,
purchasing men to serve as studs, and judging women based on whether they would
produce the desired stock with a particular man (Haley, 1976). However, in the midst of
all this inhuman and inhumane treatment, the Black family grew and survived. Gutman
(1976), in his careful documentation of plantation and family records, traces the history
of the Black family from 1750 to 1925 and points out the existence of families and family
or kinship ties before and after the Civil War, dispelling many of the myths about the
Black family and its structure. Despite overwhelming hardships and enforced separations,
the people managed in most circumstances to maintain both family and community
awareness.
The people who came to America from West Africa brought a rich variety of
traditional beliefs and practices and came from religious traditions that respected the
spiritual power of ancestors. They worshiped a diverse pantheon of gods, who oversaw
all aspects of daily life, such as the changes of the seasons, the fertility of nature, physical
and spiritual personal health, and communal success. Initiation rites and naming rituals,
folktales, and healing practices, dance, song, and drumming were a part of the religious
heritage. Many aspects of today’s Christian religious practices are believed to have
originated in these practices. In addition, it has been estimated that between 10% and
30% of the slaves brought to America between 1711 and 1808 were Muslim. The people
brought their prayer practices, fasting and dietary practices, and their knowledge of the
Qur’an.
According to Jacques (1976), the traditional definition of HEALTH stems from
the African belief about life and the nature of being. To the African, life was a process
rather than a state. The nature of a person was viewed in terms of energy force rather than
matter. All things, whether living or dead, were believed to influence one another.
Therefore, one had the power to influence one’s destiny and that of others through the use
of behavior, whether proper or otherwise, as well as through knowledge of the person and
the world. When one possessed HEALTH, one was in harmony with nature; ILLNESS
was a state of disharmony. Traditional Black belief regarding HEALTH did not separate
the mind, body, and spirit.
Disharmony—that is, ILLNESS—was attributed to a number of sources,
primarily demons and evil spirits. These spirits were generally believed to act of their
own accord, and the goal of treatment was to remove them from the body of the ILL
person. Several methods were employed to attain this result, in addition to voodoo, which
is discussed in the next section. The traditional healers, usually women, possessed
extensive knowledge of the use of herbs and roots in the treatment of ILLNESS.
Apparently, an early form of smallpox immunization was used by slaves. Women
practiced inoculation by scraping a piece of cowpox crust into a place on a child’s arm.
These children appeared to have a far lower incidence of smallpox than those who did not
receive the immunization.
The largest emerging majority group in the United States is composed of
theIHispanic or Latino populations. According to the 2010 Census, of theI308.7 million
people who resided in the United States on April 1, 2010, 50.5Imillion—16%—were of
Hispanic or Latino origin. The Hispanic population was 13% of the total population in
2000. In fact, more than half of the growth in the total population of the United States
between 2000 and 2010 was due to the increase in the Hispanic population. About three-
quarters of Hispanics reported as Mexican, Puerto Rican, or Cuban origin. More than
three-quarters of the Hispanic population lived in the West or South; 41% of Hispanics
lived in the West and 36% lived in the South. The Northeast and Midwest accounted for
14% and 9%, respectively, of the Hispanic population.
There are conflicting reports about the traditional meaning of HEALTH among
Mexicans. Some sources maintain that HEALTH is considered to be purely the result of
“good luck” and that a person loses his or her health if that luck changes (Welch, Comer,
& Steinman, 1973, p. 205). Some people describe HEALTH as a reward for good
behavior. Seen in this context, HEALTH is a gift from God and should not be taken for
granted. People are expected to maintain their own equilibrium in the universe by
performing in the proper way, eating the proper foods, and working the proper amount of
time. The protection of HEALTH is an accepted practice that is accomplished with
prayer, the wearing of religious medals or amulets, and the keeping of relics in the home.
Herbs and spices can be used to enhance this form of prevention, as can exemplary
behavior (Lucero, 1975).ILLNESS is seen as an imbalance in an individual’s body or as
punishment meted out for wrongdoing.
There are no specific rules for knowing who in the community uses the services
of folk healers. Not all Mexicans do, and not all Mexicans believe in their precepts.
Initially, it was thought that only the poor used a folk healer, or curandero, because they
were unable to get treatment from the larger, institutionalized health care establishments.
It now appears, however, that the use of HEALERS occurs widely throughout the
Mexican population. Some people try to use HEALERS exclusively, whereas others use
them along with modern medical care. The HEALERS do not usually advertise, but they
are well known throughout the population because of informal community and kinship
networks.
B. Traditional Methods of Healing
The traditional HEALER of Native America is the medicine man or woman, and
American Indians, by and large, have maintained their faith in him or her over the ages.
The medicine men and women are wise in the ways of the land and of nature. They know
well the interrelationships of human beings, the Earth, and the universe. They know the
ways of the plants and animals, the sun, the moon, and the stars. Medicine men and
women take time to determine first the cause of an ILLNESS and then the proper
treatment. To determine the cause and treatment of an ILLNESS, they perform special
ceremonies, which may take up to several days. A medicine man or woman is also known
among many people as a Kusiut, a “learned one.” The acquisition of full shamanic
powers takes many years, often as many as 30 years of training before one has the ability
to cure illness. The shaman’s power is accumulated through solitary vision quests and
fasts repeated over the years. The purification rituals include scrubbing oneself in
freezing cold water and ingesting emetics.
The medicine man or woman of the Hopis uses meditation in determining the
cause of an ILLNESS and sometimes even uses a crystal ball as the focal point for
meditation. At other times, the medicine man or woman chews on the root of
jimsonweed, a powerful herb that produces a trance. The Hopis claim that this herb gives
the medicine man or woman a vision of the evil that has caused a sickness. Once the
meditation is concluded, the medicine man or woman is able to prescribe the proper
herbal treatment. For example, fever is cured by a plant that smells like lightning; the
Hopi phrase for fever is “lightning sickness”.
The Navajo Indians consider disease to be the result of breaking a taboo or the
attack of a witch. The exact cause is diagnosed by divination, as is the ritual of treatment.
There are 3 types of divination: motion in the hand (the most common form and often
practiced by women), stargazing, and listening. The function of the diagnostician is first
to determine the cause of the ILLNESS and then to recommend the treatment—that is,
the type of chant that will be effective and the medicine man or woman who can best do
it. A medicine man or woman may be called on to treat obvious symptoms, whereas the
diagnostician is called on to ascertain the cause of the ILLNESS. (A person is considered
wise if the diagnostician is called first.) Often, the same medicine man or woman can
practice both divination (diagnosis) and the singing (treatment). When any form of
divination is used in making the diagnosis, the diagnostician meets with the family,
discusses the patient’s condition, and determines the fee.
Unlike motion in the hand, stargazing can and must be learned. Sand paintings are
often but not always made during stargazing. If they are not made, it is either because the
sick person cannot afford to have one done or because there is not enough time to make
one. The stargazer prays the star prayer to the star spirit, asking it to show the cause of
the ILLNESS. During stargazing, singing begins and the star throws a ray of light that
determines the cause of the patient’s ILLNESS. If the ray of light is white or yellow, the
patient will recover; if it is red, the illness is serious. If a white light falls on the patient’s
home, the person will recover; if the home is dark, the patient will die.
The main effects of the singer are psychological. During the chant, the patient
feels cared for in a deeply personal way as the center of the singer’s attention, since the
patient’s problem is the reason for the singer’s presence. When the singer tells the patient
recovery will occur and the reason for the ILLNESS, the patient has faith in what is
heard. The singer is regarded as a distinguished authority and as a person of eminence
with the gift of learning from the holy people. He or she is considered to be more than a
mere mortal. The ceremony—surrounded by such high levels of prestige, mysticism, and
power— takes the sick person into its circle, ultimately becoming one with the holy
people by participating in the sing that is held on the patient’s behalf. The patient once
again comes into harmony with the universe and subsequently becomes free of all ILLS
and evil.
C. Current Health Care Problems
Today, American Indians are faced with a number of health-related problems and
health disparities. Many of the old ways of diagnosing and treating illness have not
survived the migrations and changing ways of life of the people. Because these skills
often have been lost and because modern health care facilities are not always available,
American Indian people are frequently caught in limbo when it comes to obtaining
adequate health care. Many of the illnesses that are familiar among White patients may
manifest themselves differently in American Indian patients. Native peoples experience
higher disease rates and lower life expectancy than any other racial or ethnic group in the
country. The rates of diabetes, mental disorders, cardiovascular disease, pneumonia,
influenza, and injuries of Indians are exponentially higher, the infant mortality rate is
150% greater for Indians than that of White infants. As alluded to at the beginning of this
chapter, suicide rates among the young are high—a rate that is more than 3 times that of
the general population (Nieves, 2007, p. A-9) and life expectancy is 5 years less than the
rest of the U.S. population. The impact of this is felt throughout the community. In
addition, at least one third of American Indians exist in a state of abject poverty. With
this destitution come poor living conditions and attendant problems, as well as diseases of
the poor—including malnutrition, tuberculosis, and high maternal and infant death rates.
Poverty and isolated living serve as further barriers that keep American Indians from
using limited health care facilities even when they are available.
The American Indian and Alaska Native people have long experienced lower
health status when compared with other Americans. Lower life expectancy and the
disproportionate disease burden exist perhaps because of inadequate education,
disproportionate poverty, discrimination in the delivery of health services, and cultural
differences. These are broad quality-of-life issues rooted in economic adversity and poor
social conditions. American Indians and Alaska Natives born today have a life
expectancy that is 2.4 years less than the U.S. population of all races (74.5 to 76.9 years,
respectively). American Indian and Alaska Native infants die at a rate of nearly 10 per
every 1,000 live births, as compared to 7 per 1,000 for the U.S. population (2001–2003
rates). Given the higher health status enjoyed by most Americans, the lingering health
disparities of American Indians and Alaska Natives are troubling. In trying to account for
the disparities, health care experts, policymakers, and tribal leaders are looking at many
factors that impact the health of Indian people, including the adequacy of funding for the
American Indian health care delivery system.
The family in this population is often a nuclear family, with strong biological and
large extended family networks. Children are taught to respect traditions, and community
organizations are growing in strength and numbers. Many American Indians tend to use
traditional medicines and HEALERS and are knowledgeable about these resources.
People may frequently be treated by a traditional medicine man or woman. The sweat
lodge and herbs are frequently used to treat mental symptoms. Several diagnostic
techniques include the use of divination, conjuring, and stargazing. “Ghost sickness” is a
culture bound syndrome that affects some American Indians. This mental health problem
involves a preoccupation with death, an intense fear of ghosts and the deceased and is
associated with witchcraft. It is thought to be caused by the touch of a ghost. The ghosts
of the recently departed may cause illness or even death among the living. Symptoms
include bad dreams, weakness, feelings of danger, loss of appetite, and confusion.
Another problem related to alcohol abuse in the American Indian people is
domestic violence, sexual abuse, and the battering of women. A battered woman is one
who is physically assaulted by her husband, boyfriend, or another significant other. The
assault may consist of a push; severe, even permanent injury; sexual abuse; child abuse;
or neglect. Once the pattern of abuse is established, subsequent episodes tend to get
worse. This abuse is not traditional in American Indian life but has evolved. True
American Indian love is based on a tradition of mutual respect and the belief that men
and women are part of an ordered universe where the people should live in peace. In the
traditional American Indian home, children were raised to respect their parents, and they
were not corporally punished. Violence toward women was not practiced. In modern
times, however, the sanctions and protections against domestic violence have decreased,
and the women are far more vulnerable. Many women are reluctant to admit that they are
victims of abuse because they believe that they will be blamed for the assault. Hence, the
beatings continue. A number of services are available to women who are victims, such as
safe houses and support groups. It is believed that the long-range solution to this problem
lies in teaching children to love—to nurture children and give them self-esteem, to teach
boys to love and respect women, and to give girls a sense of worth. Amnesty
International calls sexual abuse against American Indian women a “maze of injustice.” It
is “the failure to protect Indigenous women from sexual violence in the USA.” The
disproportionate impact on American Indian women is derived from disparate
communities that vary with respect to law enforcement, jurisdiction, and health care and
support services.
More than 50% of American Indians live in urban areas; for example, in Seattle,
Washington, there are over 15,000 American Indians. Although this population is not
particularly dense, its rates of diphtheria, tuberculosis, otitis media with subsequent
hearing defects, alcohol abuse, inadequate immunization, iron-deficiency anemia,
childhood developmental lags, mental health problems (including depression, anxiety,
and coping difficulties), and caries and other dental problems are high. As in all
dysfunctional families, problems arise that are related to marital difficulties and financial
strain, which usually are brought about by unemployment and the lack of education or
knowledge of special skills. The tension often is compounded further by alcoholism.
Some historical differences in health care relate to geographic locations.
American Indians living in the eastern part of this country and in most urban areas are not
covered by the services of the Indian Health Service, services that are available to
American Indians living on reservations in the West. In 1923, tribal government—under
the control of the Bureau of Indian Affairs—was begun by the Navajos, who established
treaties with the U.S. government, but in the areas of health and education the United
States did not honor these treaties. Health services on the reservations were inadequate.
Consequently, the people were sent to outside institutions for the treatment of illnesses,
such as tuberculosis and mental health problems. As recently as 1930, the vast Navajo
lands had only 7 hospitals with 25 beds each. Not until 1955 were American Indians
finally offered concentrated services with modern physicians. Only since 1965 have more
comprehensive services been available to the Navajos.
In many instances, people who were born in the United States into families
established here for generations are largely indistinguishable from the general population
in their health care beliefs. Other groups, however, especially new immigrants, differ
from the general population on many social and healthrelated issues. Table 10–3
compares selected health indicators in the Asian/ Pacific Islander population with people
of all races. In most of the selected categories, the rates for the Asian/Pacific Islander
population are lower thanIthose for theIgeneral population. For example, Asians/Pacific
Islanders have a lower rate of births to women receiving third trimester or no prenatal
care; a lower rate of live births to teenagers, lower infant mortality, a lower incidence of
cancer, and lower rates of homicide and suicide.
Language difficulties and adherence to native Chinese culture compound
problems already associated with poverty, crowding, and poor health. Many people still
prefer the traditional forms of Chinese medicine and seek help from Chinatown
“physicians” who treat them with traditional herbs and other methods. Often, Asian
people do not seek help from the Western system at all. Others use Chinese methods in
conjunction with Western methods of health care, although the Chinese find many
aspects of Western medicine distasteful. For example, they cannot understand why so
many diagnostic tests, some of which are painful, are necessary. They do, however,
accept the practice of immunization and the use of x-rays. An example of a modern
health care practice that may cause a problem is the drawing of blood.
Chinese people may not understand why the often frequent taking of blood
samples, considered routine in Western medicine, is necessary. Blood is seen as the
source of life for the entire body, and it is believed that blood is not regenerated. The
Asian reluctance to have blood drawn for diagnostic tests may have its roots in the
revered teachings of Confucius. The Chinese people also believe that a good physician
should be able to make a diagnosis simply by examining a person. Consequently, they do
not react well to the often painful procedures used in Western diagnostic workups. Some
people—because ofItheir distaste for the drawing of blood—leave the Western system
rather thanItolerate the pain. The Chinese have deep respect for their bodies and believe
that it is best to die with their bodies intact. For this reason, many people refuse surgery
or consent to it only under the most dire circumstances. This reluctance to undergo
intrusive surgical procedures has deep implications for those concerned with providing
health care to Asian Americans.
Much action has been taken in recent years to make Western health care more
available and appealing to the Asian populations. In Boston, for example, there is a health
clinic staffed primarily by Chinese dialects–speaking, and other Asian languages nurses
and physicians who work as paid employees and as volunteers. Most of the common
health-related pamphlets have been translated into Chinese languages and into
Vietnamese, Cambodian, and Laotian, and they are distributed to the patients. Booklets
on such topics as breast self-examination and smoking cessation are available. Since the
languages spoken in the clinic are Mandarin Chinese, other dialects and languages the
problem of interpreters has been largely eliminated. The care is personal, and the patients
are made to feel comfortable. Unnecessary and painful tests are avoided as much as
possible. In addition, the clinic, which is open for long hours, provides social services and
employment placements and is quite popular with the community. Although it began as a
part-time, storefront operation, the clinic is now housed in its own building.
Asian Americans, a group that constituted 4.8% of the resident U.S. population in
the 2010 census, are for the most part well represented in the enrollment in health
professions, as illustrated in Table 10–5. Today, persons who desire to be physicians in
China have the option of studying either Chinese or Western medicine. If they select
Western medicine, a limited amount of Chinese medicine is also taught. As Chinese
traditional medicine is becoming better recognized and better understood in the United
States, more doors are being opened to those who prefer or understand this mode of
treatment.
Many Black people experience wide, deep health disparities— factors such as the
lack of access to health services, low income, and a tendency to self-treat illness and to
wait until symptoms are so severe that a doctor must be seen (Weissman, Betancourt,
Green, et al. 2011). When statistical adjustments are made for age, Blacks exceed Whites
in the average number of days spent in acute care settings, on bed rest, and in restricted
activity. Adolescent pregnancy is a major concern with the population. The risk of infant
mortality and low birth weight are also greater in the community, as is the rate of low-
birth-weight babies. Table 11–2 compares selected health status indicators for Blacks and
all races. It illustrates that the birth rate is higher, that the percentages of women not
getting early prenatal care and third-trimester or no prenatal care are higher, and that the
percentage of teenage births to women under 18 is nearly double, as is the infant
mortality rate.
D. The Indian Health Service
The IHS is an agency within the U.S. Department of Health and Human Services.
It is responsible for providing federal health services to American Indians and Alaska
Natives. The provision of health services to members of federally recognized tribes grew
out of the special government-to-government relationship between the federal
government and Indian tribes. This relationship was established in 1787. It is based on
Article I, Section 8, of the Constitution and has been given form and substance by
numerous treaties, laws, Supreme Court decisions, and executive orders. The IHS is the
principal federal health care provider and health advocate for American Indian people. Its
goal is to raise their health status to the highest possible level.
Preventive measures involving environmental, educational, and outreach activities
are combined with therapeutic measures into a single national health system. Within
these broad categories are special initiatives in traditional medicine, elder care, women’s
health, the care of children and adolescents, injury prevention, domestic violence and
child abuse, health care financing, state health care, sanitation facilities, and oral health.
Most IHS funds are appropriated for American Indians who live on or near reservations.
Congress also has authorized programs that provide some access to care for American
Indians who live in urban areas.
IHS services are provided directly and through tribally contracted and operated
health programs. Health services also include health care purchased from private
providers. The federal system consists of 28 hospitals, 58 health centers, 31 health
stations, and 5 school centers. There are also 17 tribal hospitals, 235 tribal health centers,
166 Alaska village clinics, 92 tribal health stations, and 28 tribal school health centers. In
addition, 34 urban Indian health projects provide a variety of health and referral services.
Approximately 600,000 American Indians and Alaska Natives reside in counties served
by urban Indian health programs. IHS serves the members of 565 federally recognized
tribes and 2 million American Indians and Alaska Natives residing on or near
reservations.
A factor that inhibits the American Indian use of White-dominated health services
is a deep, cultural problem: American Indians suffer disease when they come into contact
with White health care providers. American Indians feel uneasy because for too many
years they have been the victim of haphazard care and disrespectful treatment. All too
often, conflict arises between what the American Indians perceive their illness to be and
what the physicians diagnose.
American Indians, like most people, do not enjoy long waits in clinics; separation
from their families; the unfamiliar, regimented environment of the hospital; or the
unfamiliar behavior of the nurses and physicians, who often display demeaning and
demanding attitudes. Their response to this treatment varies. Sometimes, they remain
silent; other times, they leave and do not return. Many American Indians request that, if
the ailment is not an emergency, they be allowed to see the medicine man or woman first
and then receive treatment from a physician. Often, when a sick person is afraid of
receiving the care of a physician, the medicine man or woman encourages the person to
go to the hospital.
However, the National Sample Survey of Registered Nurses 2008 prepared by the
Bureau of Health Professions of the Health Resources Administration provides relevant
information regarding the demographic profile of American Registered Nurses. It
estimates that the registered nurse population in the United States in 2008 was 3,063,162,
with 2,596,599 registered nurses employed in nursing. Of this number, 83.2% were
White nonHispanic and 0.3% were AI/AN (non-Hispanic) (United States Department of
Health and Human Services, Health Resources and Services, 2010). Given that in 2010
the White population was 63% of the total population and AI/AN (non-Hispanic) people
comprised 0.9% of the resident population; this is a clear indication that there is not
demographic parity in the percentage of AI/AN (non-Hispanic) people in nursing. This
demographic picture and the percentages in the tables demonstrate a situation that is an
ongoing concern. Somnath and Shipman, who reviewed a total of 55 studies, found that
minority patients tend to receive better interpersonal care from practitioners of their own
race or ethnicity, particularly in primary care and mental health settings, and that non–
English speaking patients experience better interpersonal care, greater medical
comprehension, and greater likelihood of keeping follow-up appointments when they see
a language-concordant practitioner.
E. Methods of Health Restoration
There are countless ways by which HEALTH is maintained. One example is the
practices involved in daily nutrition. Foods, such as thousand-year eggs, are ingested on a
daily basis. There are strict rules governing food combinations and foods that must be
eaten preceding and after life events, such as childbirth and surgery. Daily exercise is also
important, and many people participate in formal exercise programs, such as tai chi.
The Chinese often prepare amulets to prevent evil spirits and protect HEALTH.
These amulets consist of a charm with an idol or a Chinese character painted in red or
black ink and written on a strip of yellow paper. These amulets are hung over a door or
pasted on a curtain or wall, worn in the hair, or placed in a red bag and pinned on
clothing. The paper may be burned and theIashes mixed in hot tea and swallowed to ward
off evil. Jade is believed to beIthe most precious of all stones because it is seen as the
giver of children, HEALTH immortality, wisdom, power, victory, growth, and food. Jade
charms are worn to bring HEALTH and, should they turn dull or break, the wearer will
surely meet misfortune. The charm prevents harm and accidents. Children are kept safe
with jade charms, and adults are made pure, just, humane, and intelligent by wearing
them.
Acupuncture is an ancient Chinese practice of puncturing the body to cure disease
or relieve pain. The body is punctured with special metal needles at points that are
precisely predetermined for the treatment of specific symptoms. According to one source,
the earliest use of this method was recorded between 106 B.C. and A.D. 200. According
to other sources, however, it was used even earlier. This treatment modality stems from
diagnostic procedures described earlier. The most important aspect of the practice of
acupuncture is the acquired skill and ability to know precisely where to puncture the skin.
Nine needles are used in acupuncture, each with a specific purpose. The following is a
list of the needles and their purposes.
The specific points of the body into which the needles are inserted are known as
meridians. Acupuncture is based on the concept that certain meridians extend internally
throughout the body in a fixed network. There are 365 points on the skin where these
lines emerge. Since all the networks merge and have their outlets on the skin, the way to
treat internal problems is to puncture the meridians, which are also categorically
identified in terms of yin and yang, as are the diseases. The treatment goal is to restore
the balance of yin and yang.
Moxibustion has been practiced for as long as acupuncture. Its purpose, too, is to
restore the proper balance of yin and yang. Moxibustion is based on the therapeutic value
of heat, whereas acupuncture is a cold treatment. Acupuncture is used mainly in diseases
in which there is an excess of yang, and moxibustion isIused in diseases in which there is
an excess of yin. Moxibustion is performed by heating pulverized wormwood and
passing this concoction above the skin, but not touching it, over certain specific
meridians. Great caution must be used in this application because it cannot be applied to
all the meridians that are used for acupuncture. Moxibustion is believed to be most useful
during the period of labor and delivery, if applied properly.
Herbology is an interesting subject. The gathering season of an herb was
important for its effect. It was believed that some herbs were more effective if gathered at
night and that others were more effective if gathered at dawn. The ancient sages
understood quite well the dynamics of growth. It is known today that a plant may not be
effective if the dew has been allowed to dry on its leaves. The herbalist believes that the
ginseng root must be harvested only at midnight in a full moon if it is to have therapeutic
value. Ginseng’s therapeutic value is due to its nonspecific action. The herb, which is
derived from the root of a plant that resembles a person, is recommended for use in more
than 2Idozen ailments, including anemia, colics, depression, indigestion, impotence, and
rheumatism (Wallnöfer & von Rottauscher, 1972). It has maintained its reputation for
centuries and continues to be a highly valued and widely used substance.
The physician was the primary HEALER in Chinese medicine. Physicians who
had to treat women encountered numerous difficulties because men were not allowed to
touch women directly who were not family members. Thus, a diagnosis might be made
through a ribbon that was attached to the woman’s wrist. As an alternative to
demonstrating areas of pain or discomfort on a woman’s body, an alabaster figure was
substituted. The area of pain was pointed out on the figurine.
Babies are generally breast-fed because neither cow’s milk nor goat’s milk is
acceptable to the Chinese. Sometimes, children are nursed for as long as 4 or 5Iyears.
However, the practice is now varying as more women are working. Since early time the
Chinese have known about and practiced immunization against smallpox. A child was
inoculated with the live virus from the crust of a pustule from a smallpox victim. The
crust was ground into a powder, and this powder was subsequently blown into the nose of
the healthy child through the lumen of a small tube. If the child was healthy, he or she did
not generally develop a full-blown case of smallpox but, instead, acquired immunity to
this dreaded disease.
The following sections present examples of practices employed presently or in
earlier generations to maintain and protect HEALTH and to treat various types of
maladies to restore HEALTH. This discussion cannot encompass all the types of care
given to and by the members of the Black community but instead presents a sample of the
richness of the traditional HEALTH practices that have survived over the years.
Essentially, HEALTH is maintained with proper diet—that is, eating 3I nutritious meals a
day, including a hot breakfast. Rest and a clean environment also are important.
Laxatives were and are used to keep the system “running” or “open”.
Asafetida—rotten flesh that looks like a dried-out sponge—is worn around the
neck to prevent the contraction of contagious diseases. Cod liver oil is taken to prevent
colds. A sulfur and molasses preparation is used in the spring because it is believed that
at the start of a new season, people are more susceptible to illness. This preparation is
rubbed up and down the back, not taken internally. A physician is not consulted routinely
and is not generally regarded as the person to whom one goes for the prevention of
disease.
Numerous types of poultices are employed to fight infection and inflammation.
The poultices are placed on the part of the body that is painful or infected to draw out the
cause of the affliction. One type of poultice is made of potatoes. The potatoes are sliced
or grated and placed in a bag, which is placed on the affected area of the body. The
potatoes turn black; as this occurs, the disease goes away. It is believed that, as these
potatoes spoil, they produce a penicillin mold that is able to destroy the infectious
organism. Another type of poultice is prepared from cornmeal and peach leaves, which
are cooked together and placed either in a bag or in a piece of flannel cloth. The cornmeal
ferments and combines with an enzyme in the peach leaves to produce an antiseptic that
destroys the bacteria and hastens the healing process. A third poultice, made with onions,
is used to heal infections, and a flaxseed poultice is used to treat earaches.
In many traditional Black communities, folk medicine previously practiced in
Africa may still be employed. The methods have been tried and tested and are still relied
on. Healers or voodoo practitioners make no class or status distinctions among their
patients, treating everyone fairly and honestly. This tradition of equality of care and
perceived effectiveness accounts for the faith placed in the practices of the HEALER and
in other methods. In fact, the home remedies used by some members of the Black
community have been employed for many generations. Another reason for their ongoing
use is that hospitals are distant from people who live in rural areas. By the time they
might get to the hospital, they would be dead, yet many of the people who continue to use
these remedies live in urban areas close to hospitals—sometimes even world-renowned
hospitals. Nonetheless, the use of folk medicine persists, and many people avoid the local
hospital except in extreme emergencies.
Voodoo, or Voudou. Voodoo, or American voudou, is a belief system often
alluded to but rarely described in any detail (Davis, 1998). At various times, patients may
mention terms such as fix, hex, or spell. It is not clear whether voodoo is fully practiced
today, but there is some evidence in the literature that there are people who still believe
and practice it to some extent (Wintrob, 1972). It also has been reported that many Black
people continue to fear voodoo and believe that when they become ILL they have been
“fixed.” Voodoo involves 2Iforms of magic: white magic, described as harmless, and
black magic, which is quite dangerous. Belief in magic is, of course, ancient.
Many Blacks believe in the power of some people to HEAL and help others, and
there are many reports of numerous HEALERS among the communities. This reliance on
HEALERS reflects the deep religious faith of the people. (Maya Angelou vividly
describes this phenomenon in her book I Know Why the Caged Bird Sings.) For example,
many Blacks followed the Pentecostal movement long before its present more general
popularity. Similarly, people often went to tent meetings and had an all-consuming belief
in the HEALING powers of religion.
F. Mexicans
The United States shares a 2,000-mile-long border with Mexico, which, in spite of
walls and tightened security, remains easily crossed in both directions. The flow of
people, goods, and ideas across it has a powerful impact on both countries. Americans of
Hispanic origin, according to the 2010 census, numbered atIleast 308.7 million people; of
this number, 63.0% were of Mexican origin (Ennis, Rios-Vargas, & Albert, 2011, p. 3).
The Mexicans have been in the United States for a long time, moving from Mexico and
later intermarrying with Indians and Spanish people in the southwestern parts of what is
now the United States. Santa Fe, New Mexico, was settled in 1609. Most of the
descendants of these early settlers now live in Arizona, California, Colorado, New
Mexico, and Texas. A large number of Mexicans also live in Illinois, Indiana, Kansas,
Michigan, Missouri, Nebraska, New York, Ohio, Utah, Washington, and Wisconsin,
where most arrived as migrant farm workers.
While located there as temporary farm workers, they found permanent jobs and
stayed. Contrary to the popular views that Mexicans live in rural areas, most live in urban
areas. Mexicans are employed in all types of jobs. Few, however, have high- paying or
high-status jobs in labor or management. The majority work in factories, mines, and
construction; others are employed in farm work and service areas. At present, only a
small—though growing—number are employed in clerical and professional areas. The
number of unemployed in this group is high, and the earnings ofIthose employed are well
below the national average. The education of Mexicans, like that of most minorities in the
United States, lags behind that of most of the population. Many Mexicans fail to
complete high school. In the past few years, this situation has begun to change, and
Mexican children are being encouraged to stay in school, go on to college, and enter the
professions.
G. Puerto Ricans
Puerto Rican migrants to the United States mainland are American citizens, albeit
with a different language and culture. They are neither immigrants nor aliens. According
to the 2010 census, 9.2% of the Hispanic population are Puerto Ricans (Ennis, Rios-
Vargas, & Albert, 2011, p. 3). Most live on the East Coast, with the greatest number
living in New York City and metropolitan New Jersey. Most Puerto Ricans migrate to
search for a better life or because relatives, particularly spouses and parents, have
migrated previously. Life on the island of Puerto Rico is difficult because there is a high
level of unemployment. Puerto Ricans are not well known or understood by the majority
of people in the continental United States. Little is known about their cultural identity.
Mainlanders tend to forget that Puerto Rico is, for the most part, a poor island whose
people have many problems. When many Puerto Ricans migrate to the mainland, they
bring many of their problems— especially those with poor health and social
circumstance.
Puerto Ricans, along with Cubans, constitute the most recent major immigration
group to these shores. They cover the spectrum of racial differences and have practiced
racial intermarriage. Many are Catholic, but some belong to Protestant sects. Many
people from Puerto Rico perceive HEALTH and ILLNESS and use folk healers and
remedies in ways similar to those used by other Hispanics, whereas others practice
santeria. Most studies on HEALTH and ILLNESS beliefs and HEALING have been
conducted on Mexicans. It is not easy to find information about the beliefs of Puerto
Ricans. Much of the information presented here was gleaned from students and patients.
Both groups feel that their beliefs should be known by health care deliverers. One
student, whose mother is a healer and is teaching her daughter the art, corroborated much
of the following material.
Many of these diseases or disharmonies were mentioned in the section on
Mexican approaches. Nonetheless, there are subtle differences in the ways folk diseases
are perceived by Mexicans and Puerto Ricans. For example, although diseases are
classified as hot and cold, treatments—that is, food and medications—are categorized as
hot (caliente), cold (frio), and cool (fresco). Cold illnesses are treated with hot remedies;
hot diseases are treated with cold or cool remedies. Table 12–5 lists the major illnesses,
foods, and medicines and herbs associated with the hot-cold system as it is applied
among Puerto Ricans in the United States.
Puerto Ricans also share with others of Hispanic origin a number of beliefs in
spirits and spiritualism. They believe that mental illness is caused primarily by evil spirits
and forces. People with such disorders are preferably treated by a “spiritualist medium”
(Cohen, 1972). The psychiatric clinic is known as the place where locos, mentally ill
people, go. This attitude is exemplified in the Puerto Rican approach to visions and the
like. The social and cultural environment encourages the acceptance of having visions
and hearing voices. In the dominant culture of the continental United States, when one
has visions or hears voices, one is encouraged to see a psychiatrist. When a Puerto Rican
regards this experience as a problem, he or she may seek help through Santeria.
Santeria is the form of Latin American magic that had its birth in Nigeria, the
country of origin of the Yoruba people, who were brought to the New World as slaves
over 400 years ago. The Santeria, or santero, may use storytelling as a way of helping
people cope with day-to-day difficulties (Flores-Peña, 1991). They brought with them
their traditional religion, which was in time synthesized with Catholic images. The
believers continue to worship in the traditional way, especially in Puerto Rico, Cuba, and
Brazil. The Yorubas identified their gods—Orishas— with the Christian saints and
invested in these saints the same supernatural powers of gods.
Santeria is a structured system consisting of espiritismo (spiritualism), which is
practiced by gypsies and mediums who claim to have facultades (sacred abilities). These
special facultades provide them with the “license” to practice. The status or positions of
the practitioners form a hierarchy: The head is the babalow, a male; second is the
presidente, the head medium; and third are the santeros. Novices are the “believers.” The
facultades are given to the healer from protective Catholic saints, who have African
names and are known as protecciones. Santeria can be practiced in storefronts,
basements, homes, and even college dormitories. Santeros dress in white robes for
ceremonies and wear special beaded bracelets as a sign of their identity.
The santero is an important person, respecting the patient and not gossiping about
either the patient or his or her problems. Anyone can pour his or her heart out with no
worry of being labeled or judged. The santero is able to tell a person what the problem is,
prescribe the proper treatment, and tell the person what to do, how to do it, and when to
do it. A study in New York found that 73% of the Puerto Rican patients in an outpatient
mental health clinic reported having visited a santero. Often, a sick person is taken to a
psychiatrist by his or her family to be “calmed down” and prepared for treatment by a
santero. Families may become angry if the psychiatrist does not encourage belief in God
and prayer during work with the patient. Because of cultural differences and beliefs, a
psychiatrist may diagnose as illness what Puerto Ricans may define as health. Frequently,
a spiritualist treats the “mental illness” of a patient as facultades, which makes the patient
a “special person.” Thus, esteem is granted to the patient as a form of treatment. I visited
a santero in Los Angeles with the hope of his granting me an interview. Instead, he
argued that if I wanted to know about his practice I should “sit,” so I did. He proceeded to
examine my head and palms, throw and read cowrie shells, tell me a story, and asked me
to interpret it. Once this was accomplished, he recommended certain interventions. His
manner was extremely calming and, when he interpreted the story with me, IIdiscovered
his uncanny ability to read habits and behavior.
H. German Americans
It is by no means indicative of the HEALTH and ILLNESS beliefs of the entire
German American and Polish American communities. It is included here to demonstrate
the type of data that can be gleaned using an “emic” (a description of behavior dependent
on the person’s categorization of the action) approach to collecting data. It cannot be
generalized, but it allows the reader to grasp the diversity of beliefs that surround us.
Since 1830 more than 7 million Germans have immigrated to the United States. There are
presently 50.7 million Americans, or 16.4% of the population, who claim German
ancestry. California, Texas, and Pennsylvania have the largest numbers of people with
German ancestry. The Germans represent a cross section of German society and have
come from all social strata and walks of life. Some people have come to escape poverty,
others have come for religious or political reasons, and still others have come to take
advantage of the opportunity to open up the new lands. Many were recruited to come
here, as were the Germans who settled in the German enclaves in Texas. The immigrants
represented all religions, including primarily Lutherans, Catholics, and Jews. They
represented the rich and the poor, the educated and the ignorant, and were of all ages.
Present-day descendants are farmers, educators, and artists. The Germans brought to the
United States the cultural diversity and folkways they observed in Germany. The
tradition of the Christmas tree and the festivals of Corpus Christi, Kinderfeste (children’s
feast), and Sangerfeste (singing festival) all originated in Germany.
The German ethnic community is the second largest in the state of Texas and is
exceeded only by the Mexican community. Germans have been immigrating to Texas
since 1840 and continue to arrive. They are predominantly Catholic, Lutheran, and
Methodist. Many of these people have maintained their German identity. The major
German communities in Texas are Victoria, Cuero, Gonzales, New Braunfels, and
Fredericksburg. During the European freedom revolutions of 1830 and 1848, Texas was
quite popular, especially in Germany, and was seen as a “wild and fabulous land.” For
tradition-bound German families, however, the abandonment of the homeland was
difficult. They were enticed, however, by the hopes of economic and social improvement
and political idealism. An additional reason for the mass migration was the
overpopulation of Germany and the immigrants’ desire to escape an imminent European
catastrophe. By the 1840s, several thousand northern Germans had come to Texas, and
another large migration occurred in 1890. This second cluster of people came because
there was severe crop failure in Russianoccupied Germany, and the Russian language had
become a required subject in German schools. Other German migrations occurred from
1903 to 1905.
Among the Germans, health is described as more than not being ill but as a state
of well-being—physically and emotionally—the ability to do your duty, positive energy
to do things, and the ability to do, think, and act the way you would like, to go and
congregate, to enjoy life. Illness may be described as the absence of well-being: pain,
malfunction of body organs, not being able to do what you want, a blessing from God to
suffer, and a disorder of body, imbalance.
Most German Americans believe in the germ theory of infection and in stress-
related theories. Other causes of illness are identified, however, such as drafts,
environmental changes, and belief in the evil eye and punishment from God. The
methods of maintaining health include the requirement of dressing properly for the
season, proper nutrition, and the wearing of shawls to protect oneself from drafts—also,
the taking of cod-liver oil, exercise, and hard work. Methods for preventing illness
include wearing an asafetida bag around the neck in the winter to prevent colds,
scapulars, religious practices, sleeping with the windows open, and cleanliness.
I. Italian Americans
The Italian American community is made up of immigrants who came here from
mainland Italy and from Sicily and Sardinia and other Mediterranean islands that are part
of Italy. The number of Americans claiming Italian ancestry is over 18 million. Over 77%
of the people, 5 years and older, speak Italian at home and 39.6% speak English less than
very well. Fifty-one percent of people of Italian ancestry reside in the Northeast (U.S.
Census Bureau, 2001, p. 46). Italian Americans indeed have a proud heritage in the
United States, for America was “founded” by an Italian—Christopher Columbus; named
for an Italian—Amerigo Vespucci; and explored by several Italian explorers, including
Verrazano, Cabot, and Tonti.
Between 1820 and 1990, over 5 million people from Italy immigrated to the
United States (Lefcowitz, 1990, p. 6). The peak years were from 1901 to 1920, and only a
small number of people continue to come today. Italians came to this country to escape
poverty and to search for a better life in a country where they expected to reap rewards
for their hard labor. The early years were not easy, but people chose to remain in this
country and not return to Italy. Italians tended to live in neighborhood enclaves, and these
neighborhoods, such as the North End in Boston and Little Italy in New York, still exist
as Italian neighborhoods. Although the younger generation may have moved out, they
still return home to maintain family, community, and ethnic ties.
Italians tend to present their symptoms to their fullest point and to expect
immediate treatment for ailments. In terms of traditional beliefs, they may view the cause
of illness to be one of the following: (1) winds and currents that bear diseases, (2)
contagion or contamination, (3) heredity, (4) supernatural or human causes, and (5)
psychosomatic interactions. One such traditional Italian belief contends that moving air,
in the form of drafts, causes irritation and then a cold that can lead to pneumonia. A
belief an elderly person may express in terms of cancer surgery is that it is not a good
idea to have surgery because surgery exposes the inner body to the air, and if the cancer
is exposed to the air the person is going to die quicker. Just as drafts are considered to be
a cause of illness, fresh air is considered to be vital for the maintenance of health. Homes
and the workplace must be well ventilated to prevent illness from occurring.
Two genetic diseases commonly seen among Italians are (1) favism, a severe
hemolytic anemia caused by deficiency of the X-linked enzyme glucose6- phosphate
dehydrogenase and triggered by the eating of fava beans, and (2) the thalassemia
syndromes, also hemolytic anemias that include Cooley’s anemia (or beta-thalassemia)
and alpha-thalassemia (Ragucci, 1981, p. 222). Language problems frequently occur
when elderly or new Italian immigrants are seeking care. Often, due to modesty, people
are reluctant to answer the questions asked through interpreters, and gathering of
pertinent data is very difficult.
J. Polish Americans
The first people immigrating to this country from Poland came with Germans in
1608 to Jamestown, Virginia, to help develop the timber industry. Since that time,
Poland, too, has given America one of its largest ethnic groups, with over 10.l million
people claiming Polish ancestry. The peak year for Polish immigration was 1921, and
well over 578,875 people immigrated here. Many of the people arriving before 1890
came for economic reasons. Those coming here since that time have come for both
economic and political reasons and for religious freedom. Polish heroes include Casimir
Pulaski and Thaddeus Kosciuszko, who were heroes in the American Revolution. The
major influx of Poles to the United States began in 1870 and ended in 1913. The people
who arrived were mainly peasants seeking food and release from the political oppression
of 3 foreign governments in Poland. The immigrants who came both before and after this
mass migration were better educated and not as poor. In the United States, Polish
immigrants lived in poor conditions either because they had no choice or because that
was the way they were able to meet their own priorities.
They were seen by other Americans to live as animals and were often mocked and
called stupid. Quite often, the Polish people spoke and understood several European
languages but had difficulty learning English and were therefore scorned. Polish people
shared the problem as a community and banded together in tight enclaves called
“Polonia.” They attempted to be as self-sufficient as possible. They worked at preserving
their native culture, and voluntary Polish ghettos grew up in close proximity to the parish
church (Green, 1980, pp. 787–803). Over 85.5% of those 5 years and older speak Polish
at home and 50.3% speak English less than very well. Thirty-seven percent of people of
Polish ancestry reside in the Northeast, as well as 37% in the Midwest.
The first collective Polish immigration to America was in 1854, when
100Ifamilies came to Texas. They landed in Galveston, where a few in the party
remained. The rest traveled in a procession northwestward, taking with them a few
belongings, such as featherbeds, crude farm implements, and a cross from their parish
church. Their dream was to live on the fertile lands of Texas and raise crops, speak their
own language, educate their children, and worship God as they pleased. This dream did
not materialize, and members of the band grew discouraged. Some of the immigrants
remained in Victoria and others went to San Antonio.
Much of the history of the Polish people in Texas is written around the founding
and the location of the various church parishes. For example, in 1873 the Parish of the
Nativity of the Blessed Virgin Mary was begun in Cestohowa. Within this church above
the main altar is a large picture of the Virgin Mary of Czestochowa. This picture was
taken to the church from Panna Maria. It is a copy of the famous Black Madonna of
Czestochowa, Poland, a city 65 miles east of where the immigrants to Texas originated.
The Black Madonna is a beloved, miraculous image and a source of faith to the Polish
people. The Shrine of Our Lady in Czestochowa, Poland, is one of the largest shrines in
the world.
Since the 14th century, that picture had been the object of veneration and devotion
of Polish Catholics. It is claimed to have been painted by Saint Luke the Evangelist. Its
origin is traced to the 5th or 6th century and is the oldest picture of the Virgin in the
world. The scars on the face date from 1430, when bandits struck it with a sword. The
history, traditions, and miracles of Czestochowa are the heritage of the Polish people
(Dworaczyk, 1979). One woman I interviewed said she had been ill with a fatal disease.
The entire time that she lay close to death she prayed to the Virgin. When she finally did
recover, she made a pilgrimage back to her homeland in Poland and visited the shrine to
give thanks to the Virgin. The woman was positive that this was the source of her
recovery.
The definitions of HEALTH among the Polish people I interviewed included
“feeling okay—as a whole—body, spirit, everything a person cannot separate”; “happy,
until war, do not need doctor, do not need medicine”; “active, able to work, feel good, do
what I want to do”; and “good spirit, good to everybody, never cross.” The definitions of
ILLNESS may include “something wrong with body, mind, or spirit”; “one wrong affects
them all”; “not capable of working, see the doctor often”; “not right, something ailing
you”; “not active”; “feeling bad”; and “opposite of health, not doing what I want to do.”
The methods for maintaining HEALTH include maintaining a happy home, being kind
and loving, eating healthy food, remaining pure, walking, exercising, wearing proper
clothing, eating a well-balanced diet, trying not to worry, having faith in God, being
active, dressing warmly, going to bed early, and working hard.
The methods for preventing ILLNESS include cleanliness, the wearing of
scapulars, avoiding drafts, following the proper diet, not gossiping, keeping away from
people with colds, and wearing medals because “God is with you all the time to protect
you and take care of you.” Other ideas about ILLNESS include the beliefs that
ILLNESSES are caused by poor diets and that the evil eye may well exist as a causative
factor. This belief was attributed to the older generations and is not regarded as prevalent
among younger Polish Americans.
