physical barriers You overcome to obtain health care

  • Mexican case study #2
  • Puerto Rican case study #2

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Pablo Gaborra, aged 32, and his wife, Olga,
aged 24, live in a migrant-worker camp on
the eastern shore of Maryland. They have tw
o children: Roberto, aged 7, and Linda, aged
18 months. Olga’s two younger sisters, Floren
cia, aged 16, and Rosa, aged 12, live with
them. Another distant relative, Rodolpho, ag
ed 28, comes and goes several times each
year and seems to have no fixed address.
Pablo and Olga, born in Mexico, have lived
in the United States for 13 years, first
in Texas for 6 years and then in Delaware fo
r 1 year, before moving to the eastern shore
of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were
born in the United States.
Pablo completed the sixth grade and Olga
the third grade in Mexico. Pablo can
read and write enough English to function at
a satisfactory level. Olga knows a few
English words but sees no reason for l
earning English, even though free classes are
available in the community. Olga
’s sisters have attended school
in the United States and
can speak English with varying degrees of
fluency. Roberto attends school in the local
community but is having great difficulty w
ith his educational endeavors. The family
speaks only Spanish at home. Not much is
known about the distant relative, Rodolpho,
except that he is from Mexico, speaks mi
nimal English, drinks beer heavily, and
occasionally works picking vegetables. The Ga
borra family lives in a trailer on a large
vegetable farm. The house has cold runni
ng water but no hot water, has an indoor
bathroom without a shower or bathtub, a
nd is heated with a wood-burning stove. The
trailer park has an outside shower, wh
ich the family uses in the summer.
The entire family picks asparagus, squash, peppers, cabbage, and spinach at
various times during the year. Olga takes the
infant, Linda, with her to the field, where
her sisters take turns watching the baby a
nd picking vegetables. When the vegetable-
picking season is over, Pablo helps the farmer
to maintain machinery and make repairs on
the property. Their inco
me last year was $30,000.
From the middle of April until the
end of May, the children attend school
sporadically because they are needed to
help pick vegetables. During December and
January, the entire Gaborra family travels to
Texas to visit relatives and friends, taking
them many presents. They return home in early February with numerous pills and herbal
Olga was diagnosed with anemia when she had an obscure health problem with
her last pregnancy. Because she frequently
complains of feeling tired and weak, the
farmer gave her the job of handing out “chits”
to the vegetable picker
s so that she did not
have to do the more-strenuous work of picking vegetables.
Pablo has had tuberculosis for years a
nd sporadically takes medication from a
local clinic. When he is not traveling or is t
oo busy picking vegetables to make the trip to
the clinic for refills, he generally takes his medicine. Twice last year, the family had to
take Linda to the local emergency room because she had diarrhea and was listless and
unable to take liquids. The Gaborra family s
ubscribes to the hot and cold theory of
disease and health-prevention maintenance.
Study Questions
Identify three socioeconomic factors
that influence the health of the
Gaborra family.
Name three health-teaching interven
tions the health-care provider might
use to encourage Olga to seek treatment for her anemia.
Identify strategies to help improve
communications in English for the
Gaborra family.
Identify three health-teaching
goals for the Gaborra family.
Name three interventions Olga must
learn regarding fluid balance for the
infant, Linda.
Discuss three preventive maintenanc
e–teaching activities that respect the
Gaborra family’s belief in the hot an
d cold theory of disease management.
Identify strategies for obtaining h
ealth data for the Gaborra family.
Identify four major health problems of
Mexican Americans that affect the
Gaborra family.
If Olga were to see a folk practitioner, which one(s) would she seek?
Explain the concept of familism
as exhibited in this family.
11.       Distinguish       between       the
two culture-bound syndromes
el ataque
Discuss culturally conscious health-car
e advice consistent with the health-
belief practices of the pregnant Mexican American woman.
Discuss two interventions to encour
age Mexican American clients with
tuberculosis to keep clinic appointment
s and to comply with the prescribed
medication regimen.
Identify where the majority of Mexican Americans have settled in the
United States.
Mr. Begay, aged 78, lives with his wife in
a traditional Navajo hogan. He has lived in
the same area all his life and worked as
a uranium miner until the government closed
the mines. His hogan has neither electricity
nor running water. Heat is provided by a
fire, which is also used for cooking. Lighting
is obtained from propane lanterns. Water
is hauled from a windmill site 20 miles aw
ay and stored in 50-gallon steel drums.
Because the windmill freezes and the roads are
often too muddy to travel in the winter,
sometimes he must travel an additional 10 miles to the trading post to obtain water.
Because Mr. Begay does not own a car, he must depend on transportation from
extended family members who live in the same vicinity.
Mr. Begay has continually experienced
shortness of breath,
and it is getting
worse. He has been hospitalized with pne
umonia several times as a result of the
uranium poisoning. He had a cholecystectomy at
age 62. His diet is traditional and is
supplemented by canned foods, which ar
e obtained at the trading post.
All health care is obtained at the Publ
ic Health Service Hospital in Shiprock.
Neither Mr. Begay nor his wife obtain routin
e preventive-health care. He was admitted
from the clinic to the hospital
with a diagnosis of pneumonia.
Mr. Begay shows clinical improvement after initial intravenous antibiotic
therapy. However, his mental status continue
s to decline. His family feels that he
should see a traditional medicine man a
nd discusses this with his physician. The
physician agrees and allows Mr. Begay to
go to see the medicine man. Several
members of the nursing staff disagree with
the physician’s decision and have requested
a patient-care conference with
the physician. The physician agrees to the conference.
Study Questions
1.    Identify three physical barriers Mr. Be
gay must overcome to obtain health care.
2.    Discuss the benefits of Mr. Bega
y’s seeing the traditional medicine man.
3.    Identify some potential negative outcomes of Mr. Begay’s seeing the traditional
medicine man.
Identify culturally relevant interventions to
reduce the potential for the recurrence of
5.    Identify at least two majo
r health risks that the Begays
face, based on their current
6.    Discuss potential outcomes fo
r negotiation during the conference.
7.    Mr. Begay’s diet is described as traditi
onal Navajo. What foods
are included in this
8.    Because of his continued need for
oxygen, what services do you anticipate for Mr.
Begay when he returns home?
9.    What might the nurse do to encourag
e preventive-health measures for the Begay
10.   Identify at least three types of
traditional Navajo healers.
11.   Identify contextual speech patterns of the Navajo Indians.
12.   Distinguish differences in ge
nder roles among Navajo Indians.
13.   Identify two culturally congruent teac
hing methods for the Navajo client.
14.   Discuss the meaning of the First Laugh Ceremony for the Navajo.
15.   Identify two culturally congruent approach
es for discussing a fatal illness with a
Navajo client.

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