Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Cultures
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ People of Baltic descent come from Estonia,
Latvia, and Lithuania.
▪ The countries of origin of these ethnic groups are
sometimes referred to as the Baltics or the Baltic
countries because each of them is located in
Europe on the Baltic Sea.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ Historical, cultural, religious, and language
differences prevent the group from being one
cultural entity.
▪ These countries represent three distinct ethnic
groups and are treated as such.
▪ The Estonians are a Finno-Ugric people whose
language is related to Finnish.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ The Union of Soviet Socialist Republics (USSR)
forcibly annexed Estonia in 1949 and maintained
control until 1991 when Estonia regained its
independence.
▪ Latvia, situated between Estonia and Lithuania on
the Baltic Sea, was independent from 1918 to
1940 when it was forcibly annexed by the USSR.
▪ Latvia regained its independence in 1991.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ Russians make up 29 percent of the population of
Latvia; the remainder is made up of
Byelorussians, Ukrainians, and Poles.
▪ Most ethnic Latvians speak a Baltic language
related to Lithuanian.
▪ Lithuania was an independent country from 1918
to 1940 when the USSR forcibly annexed it.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ In 1990, Lithuania re-declared its independence
from Soviet rule.
▪ For Lithuania, 83.5 percent are Lithuanians, 6.3
percent are Russians, 6.7 percent are Poles, and
3.7 percent other.
▪ Lithuanian is a Baltic language related to Latvian.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ The Baltic countries today are democratic,
growing economically, and are successful
compared with many other former Soviet Union
countries where poverty and dictatorship have
been predominant.
▪ In 1940, the three Baltic countries lost their
independent status to Germany and then to the
USSR in 1941.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ During this time, hundreds of thousands of
Latvians, Lithuanians, and Estonians were
deported in cattle cars to Soviet prison camps in
Siberia.
▪ Fearing death or deportation by the communist
regime, Estonians, Latvians, and Lithuanians fled
to the West by any means possible.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ The post-World War II influx of immigrants to the
United States came in 1949.
▪ Because the immigrants fled from the religious,
cultural, and political persecution of the Soviet
regime and could not return to their native
countries after World War II, the U.S. Congress
facilitated their entry by enacting laws designating
them as displaced persons.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ Many of the post-World War II refugees were
professionals.
▪ All three Baltic countries have regular song
festivals and dance festivals in the US and in the
native countries too.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ The Baltic countries are strong in the arts, and
theater, opera, music of all types, and film
continue to flourish.
▪ During the past 10 years, the three Baltic
countries have experienced a “brain-drain” to
some extent because many of their highly
educated have emigrated to the US and Europe.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Overview/Heritage
▪ Education is highly valued by people of Baltic
descent. All three Baltic countries have high
literacy rates.
▪ Education is valued in itself and is seen as a way
of improving life circumstances.
▪ These immigrants made many sacrifices so their
children could become educated. As a result, many
Americans of Baltic descent have advanced
degrees. Many are professionals in medicine and
law.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ People of Baltic descent share thoughts and
feelings readily.
▪ The stereotype of quiet, stoic individuals is
not borne out by observation or research.
▪ For example, humor can be used to relate to
these clients and is appreciated if used in the
right context.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ Clients of Baltic origin may hesitate to share
intimate thoughts and feelings related to their
cultural sense of decorum, but this does not
mean that they do not experience feelings and
emotions.
▪ They may wait to see if the health-care
professional is caring and takes the time to
actually listen to them.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ As a whole, people of Baltic descent are not
flamboyant or highly volatile, but individual
differences are always present.
▪ Some individuals enjoy touch and close contact,
while others do not.
▪ Individuals from these cultures are receptive to a
caring use of touch from family and close friends, but
they may come across as more aloof with strangers.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ People of Baltic descent give attention to the past,
present, and future.
▪ The past is revered in the sense that significant
historical events for each cultural group continue to
be celebrated and acknowledged.
▪ People of Baltic descent value frugality because they
have had hard times in the past.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ People of Baltic descent view time similarly to the
dominant American culture.
▪ Individuals of Baltic descent have become
acculturated to time awareness and deadlines; they
arrive at appointments on time. Because of their
strong work ethic and high value on work, they take
pride in the efficient and wise use of their time.
▪ Socially, however, they may be less aware of time
and tend to be late.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ Individuals of Baltic descent generally use
their American last name.
▪ First names of women end in “a” and first
names of men end in “as” or “s.” In their
native languages, the last names indicate if
the person is male or female; for females, the
last name indicates if the woman is married
or single.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ In Latvian, the typical last name ends in
“ans,” “ins,” or “e” with the endings
indicating masculine or feminine genders.
▪ Estonian names are similar to Finnish names.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Communication
▪ The father is the head of the household in the
typical family of Baltic heritage.
▪ Both men and women in the family may have
jobs and discuss major decisions.
▪ Health-care and other major decisions are
made jointly by both spouses.
▪ Women in the family are given respect, and
decision-making is done by both men and
women.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Family Roles & Organization
▪ Because education is highly valued, parents
encourage and supervise children in their school
work and progress.
▪ Corporal punishment was used by older
generations but is practiced less by younger
families.
▪ Cultural activities, such as song or dance groups
and ensembles, frequently unite people.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
The language spoken by people from the Baltic
countries is
a. The same for Latvians and Lithuanians but
different for Estonians.
b. The same for Estonians and Latvians but
different for Lithuanians.
c. Different for each country.
d. The same for each country.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
The language spoken by people from the Baltic
countries is different for each country.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Family Roles & Organization
▪ The traditional nuclear family is still the
standard in these cultural groups.
▪ Family is highly valued and divorce is still
fairly rare.
▪ Lithuanian Americans are predominantly
Roman Catholic, and their religion supports
strong family values.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Family Roles & Organization
▪ Older people are respected in the Baltic cultures.
▪ If grandparents are unable to live independently,
every effort is made to have them move in with an
adult child, usually a daughter.
▪ Nursing homes are used when needed.
▪ In America, a certain amount of respect is still
given to professionals, but each cultural group
has more of an egalitarian sense of community.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Family Roles & Organization
▪ The literature does not include information
about same-sex couples in these cultures.
▪ Because the dominant religions of the Baltic
countries do not sanction homosexuality,
few individuals and couples are openly
homosexual.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Newer immigrants from the Baltic countries should
be assessed for
a. Malaria.
b. Thalassemia.
c. Orthopedic disorders.
d. Endocrine disorders.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
Newer immigrants from the Baltic countries should
be assessed for endocrine disorders because of
radiation fallout from the Chernobyl accident.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Workforce Issues
▪ Material aspects are seen as secondary to the
more important family values.
▪ Responsibility is taken seriously and is
encouraged.
▪ People of Baltic descent adapt readily to
American values of timeliness in the workplace.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Workforce Issues
▪ People of Baltic descent have no difficulty
maintaining their sense of autonomy and readily
take on work roles, responsibility, and decision
making.
▪ They usually do not like to confront those in
authority directly and find ways to deal with
difficult situations or people through the use of
humor or deference.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Workforce Issues
▪ Recent immigrants who have lived under the
Soviet regime may not be accustomed to
making decisions for themselves or acting
autonomously.
▪ In previous governmental regimes, individuals
and their rights were not considered important.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Biocultural Ecology
▪ People of Baltic descent have white skin.
Estonians are similar to the Finns with brown hair
and eyes, but some are blonde and blue-eyed.
▪ Latvians and Lithuanians have fair complexions
with blonde hair and blue eyes.
▪ Recent immigrants from the Baltics may be at risk
for cancer because of industrial pollution and
radiation exposure from the Chernobyl nuclear
disaster in 1988.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Biocultural Ecology
▪ Some immigrants are survivors of political
torture, having spent years in prison labor
camps in Siberia.
▪ The incidence of alcoholism is high in the
Baltics.
▪ Ashkenazi Jews from the Baltic countries
may respond differently to neuroleptic agents.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic High-Risk Health Behaviors
▪ Exercise and physical activity are valued, and
people of these cultures make an effort to get a
reasonable amount of exercise.
▪ Individuals who have emigrated to the United States
in the last 15 years tend to continue to smoke.
▪ Although many people of Baltic descent maintain
jobs and are able to function, their use of alcohol is
high.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Nutrition
▪ Because many individuals who left the Baltics
after World War II experienced food shortages
and times of starvation, food is important to these
people.
▪ Recent immigrants have left the Baltics for
economic reasons and have also experienced
food shortages.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Nutrition
▪ Some foods common among this cultural group
are meats such as pork, chicken, and beef.
▪ Rye and whole grain breads are popular.
▪ Baked goods such as bacon rolls, yeast baked
goods, and rich tortes and cakes are common.
▪ Fresh fruits and vegetables are enjoyed.
▪ Potato dishes such as potato pancakes, potato
kugel, and potato dumplings are popular.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Nutrition
▪ Beets, mushrooms, and cabbage are used in
soups and sauces.
▪ Dairy products such as sour cream, butter, and
yogurt are included daily in their meals.
▪ Grain porridges are popular, especially among
Latvians who have putras porridges.
▪ The content of porridges varies according to
regions in Latvia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Nutrition
▪ Foods enjoyed by people of Baltic descent
include smoked and unsmoked sausages, and
smoked fish, eel, and pork.
▪ The spices used are rather mild compared with
those of other cultures, but foods may be high
in salt content.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Pregnancy &
Childbearing Practices
▪ In previous generations in the Baltics, infant
mortality rates were very high. Large families were
encouraged under communism.
▪ Baltic people in the US use a variety of birth control
measures.
▪ Americans of Baltic descent use modern Western
medicine practices obtain early prenatal medical
care, and are receptive to health teaching for
prenatal and postnatal care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Pregnancy &
Childbearing Practices
▪ Some women and families from these cultural
groups prefer natural childbirth and breastfeeding.
▪ Pregnant women are to remain calm and receive
no shock or frightening news.
▪ Godparents are important in the child’s life and
traditionally give gifts, including candy, to each
other and guests.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Death Rituals
▪ Death is viewed as part of life, and ceremonies of
the wake and funeral are linked with Christian
religious services.
▪ The funeral may take place within 3 to 4 days
following the death, providing time for out-of-town
friends and relatives to gather.
▪ Cremation is permissible.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Death Rituals
▪ The funeral is usually a Christian service,
followed by a meal at which all attendees are
welcomed. Burial is the usual practice.
▪ Grief is expressed by sadness, crying, and talking
about the deceased with fondness and respect.
▪ Individuals from these cultures express emotions
readily but not in highly dramatic ways.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Death Rituals
▪ Decorum is maintained in public and with
strangers.
▪ The dead are often remembered with frequent
visits to the cemetery.
▪ All Souls Day, November 2, Ve·line·s, is a
significant day for Lithuanian Americans, with
religious ceremonies commemorating the dead.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Spirituality
▪ Estonian Americans and Latvian Americans are
predominantly Lutherans but include some
Catholics, while Lithuanian Americans are
predominantly Roman Catholic.
▪ All these groups celebrate major Christian
religious holidays, particularly Easter and
Christmas.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Spirituality
▪ Individuals of these cultures consider
themselves as having spiritual roots, which
may be closely linked with their high value for
their language, country, and culture.
▪ Under Soviet rule, religion was forbidden; every
effort to eradicate all traces of religious belief.
▪ Religion was replaced by communist dogma for
50 years.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Spirituality
▪ A very small percentage of Latvians
maintain an ancient pagan religion.
▪ This religious group is called Dievtui
(those with God) and has a high priest as
the head of the group.
▪ Stories include myths and folk wisdom in
rhyme as an important part of their
content.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Spirituality
▪ Most Americans of Baltic descent consider
prayer an individual expression of their faith.
▪ Many have been sustained through hardships
by their strong religious faith and continue to
have strong religious needs.
▪ Spiritual and religious considerations are
considered private and may not be readily
shared with health-care professionals.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Spirituality
▪ Clergy from the client’s church are usually
welcome.
▪ Clients find considerable comfort in speaking
with the clergy in times of crises and serious
illness.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Individuals of Baltic descent adhere to modern
medical regimens and readily use the health-care
system available to them.
▪ Because they consider health and well-being
important, they take an active interest in healthy
lifestyles, nutrition, and exercise.
▪ Fresh air is considered important, and walking,
especially in natural settings such as parks, is
enjoyed by all ages.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ People of Baltic descent assume responsibility for
their own health.
▪ Because work is highly valued, most are in the
workforce and have insurance coverage.
▪ Medical care and hospitalization are sought
readily. Attempts are made to maintain health
even into old age.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Recent immigrants from the Baltics to America
may have different values because they lived
under a communist regime in which the
government “took care” of their medical needs.
▪ These immigrants often need help understanding
the American health-care system and may be
reluctant to use it if they have no medical
insurance coverage.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Chamomile and linden blossom teas may be used
for fevers and colds.
▪ Honey is used for colds and sore throats.
▪ Younger people prefer to use over-the-counter
cold remedies and analgesics. The use of natural
substances for healing purposes is not customary
among this generation.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Among older Baltic immigrants, language may
continue to present difficulty if they have not
learned English well.
▪ Many older individuals may tolerate pain as a part
of life and may not complain about it or report it.
▪ Some stigma is attached to mental illness, but
medical care is sought.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Most people of Baltic descent accept physical
handicaps, mental illness, and mental retardation.
▪ The family usually cares for the individual at
home.
▪ Americans of Baltic descent do not enjoy the sick
role and avoid it when possible.
▪ Work is highly valued and the person returns to
normal responsibilities as soon as possible.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practices
▪ Most people of Baltic descent accept blood
transfusions and organ donation and
transplantation.
▪ The use of extraordinary means to preserve life is
an individual decision, but living wills are
frequently used.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practitioners
▪ Besides family members and friends providing
informal traditional health practices, no traditional
health-care providers are found among people of
Baltic descent in the United States or in the
Baltics.
▪ Because education is highly valued by people of
Baltic descent, physicians, dentists, and nurses
are held with respect.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practitioners
▪ Advice given to their clients is usually followed.
▪ People of Baltic descent are used to both men
and women giving direct physical care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Baltic Health-care Practitioners
▪ Nurses and health-care practitioners need to
provide for privacy and consider the modesty
needs of female and male clients of these
cultures as they would for any client.
▪ Older clients of both sexes are used to being
treated with respect.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Overview/Heritage
▪ There is little literature on Brazilian health
conditions, practices, and beliefs, although there
is a lot on the objective culture such as arts,
music, dance, and cuisine.
▪ Brazilian heritage is rich in its mixture of
Portuguese, French, Dutch, German, Italian,
Japanese, Chinese, African, Arab, and native
Brazilian Indians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Overview/Heritage
▪ Common knowledge among Brazilians living in
the United States is that many of them are
escondidos (hidden) or officially referred to as
undocumented aliens.
▪ The exact number of Brazilians living in the
United States is unknown.
▪ Many Brazilians subsist in urban slums without
privacy and hope to earn enough money to return
home.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Overview/Heritage
▪ Brazilians in the US are underemployed, often
giving up their professions to earn money as
domestic workers, waiters, cab drivers, and
other low-paying positions.
▪ Immigrants often move to large cities where
many networks help find “under-the-table”
wages.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Portuguese is the official language of Brazil,
although dialects exist and vary.
▪ Many Brazilians continue to be of “proper” oldworld orientation where true feelings are not
divulged for fear of hurting the receiver of the
communication.
▪ In the intimate circle of family and compatriots,
sharing thoughts and feelings is common.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Young adult and adolescent Brazilians in the United
States are generally more acculturated because of
their desire and need to assimilate.
▪ Sharing thoughts and feelings is more common among
intragenerational groups rather than intergenerational
groups.
▪ Most Brazilians use touch and direct eye contact.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Women kiss each other on both cheeks when they
meet and when they say good-bye.
▪ At times, women and men kiss in the same manner.
▪ Men shake each other’s hands and slap each other
on the back with the other hand. This gesture
frequently ends in an embrace.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Children are kissed, and there is much
touching. Kissing a child frequently includes
the combination of a “kiss and smell.”
▪ Spatial distancing is close.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Facial expressions and symbolic gestures are
commonplace.
▪ Most Brazilians in America are future-oriented.
▪ In general, they are not punctual, especially for
social occasions.
▪ However, those in professional circles are punctual.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Brazilian names are lengthy, but the modern
trend is to use only the first and last names.
▪ Traditionally, names appear as first name,
mother’s family name, and father’s family name.
“Junior” is added to a name if the son has been
named after the father and Neto if the son has
been named after the grandfather (third
generation).
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ When a woman marries, she may opt to drop
her mother’s maiden name and her father’s
name, or she may keep them both.
▪ At times de, da/do, das/dos is added to a name
to denote “of” and seems to be done out of
tradition. No rigid protocol is apparent.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Children who have no father are often given the
mother’s maiden name to which da Silva is added,
denoting that the line of paternity is unclear.
▪ In day-to-day relationships, people are called by
their first name or Seu, Senhor (more respectful)
preceding the first name of a man, or Dona
preceding the first name of a woman.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Communication
▪ Mothers, grandmothers, or respected strangers
are referred to as A Senhora, and fathers,
grandfathers, and respected men are called O
Senhor.
▪ Doctors are addressed as Doutor or Doutora, and
professors are addressed as Professor or
Professora. The latter two are followed by the first
name.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Family Roles and Organization
▪ Brazilian society is one of machismo, with the
middle and upper classes being patriarchal in
structure.
▪ As women assert their equality, more egalitarian
relationships are becoming evident.
▪ Lower socioeconomic households tend to be
more matriarchal in nature.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Family Roles & Organization
▪ Older people live with one of their children when
self-care is a concern.
▪ Older people are respected, seen as family
counselors, and are always addressed as O
Senhor or A Senhora.
▪ They are included in family activities and usually
accompany their children’s families on vacation.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Family Roles & Organization
▪ Godparents are a very important family
extension.
▪ Poor families frequently ask their patron and
patrona (employer and spouse) to be godparents
to their child.
▪ The godmother is called comadre by the mother.
▪ Compadre is used in reference to the godfather.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Family Roles & Organization
▪ Although historically common in the lower
socioeconomic classes, middle-class households
with a single-female parent are becoming
increasingly common among Brazilians in the
United States.
▪ In middle-class families, the “no father” status is
obscured by the child receiving the same middle
and last names as the mother.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Family Roles & Organization
▪ Social status is very important in the Brazilian
society, demonstrated in the titles that people
use with each other, and the practice of listing
both parents’ surnames.
▪ Brazilians, especially from the south and
southeast of Brazil, have become more
accepting of gay and lesbian relationships.
▪ Same-sex relationships may carry a stigma.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Workforce Issues
▪ Brazilians value diplomacy over honesty even
when they promise to attend to something the
next day, knowing that it will be impossible.
▪ Professional Brazilians show up for work on time.
▪ Less educated Brazilians may find it difficult to
adhere to time schedules in the American
workplace.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Workforce Issues
▪ Brazilians generally respect authority and are
frequently more comfortable in employment
situations where rules and job specifications are
well defined.
▪ Many undocumented Brazilians find
employment within the Brazilian community
where they may never have to learn the new
language.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Workforce Issues
▪ The categorization of Brazilians in the US under
the general category of “Hispanics” adds to their
discomfort.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Biocultural Ecology
▪ The “typical” Brazilian is a moreno with brown skin and
eyes and black or brown hair. However, individuals
particularly from the southern states of Brazil may have
blond hair and blue eyes.
▪ Common health conditions among Brazilians include
malaria, Chagas disease, dengue fever, meningitis, yellow
fever, schistosomiasis, typhoid fever, Hansen’s disease,
hepatitis, tuberculosis, parasitic skin infections, cholera,
cardiovascular diseases, and lactose intolerance.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Biocultural Ecology
▪ Smoking is a high-risk behavior among
Brazilians living in the United States.
▪ Among men, drinking hard liquor is also
prevalent.
▪ Accessibility and use of street drugs and an
individual’s desperate search for quick money
are other identifiable high-risk behaviors and
often involve living in crowded conditions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Nutrition
▪ The mainstay of the Brazilian American’s diet
continues to be rice, beans, and farina.
▪ Roast beef, fresh chicken, and seafood are
sought when they are not too expensive.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Nutrition
▪ Breakfast typically consists of bread with cafe
com leite (half coffee and half hot milk).
▪ Sometimes cuscus (dry cornmeal mush) is
served with milk.
▪ Fruit, fruit juices, and scrambled eggs, with or
without sliced hot dogs, are common special
breakfast fares among middle-class families.
▪ Sweet potatoes and yams may grace a breakfast
table.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Nutrition
▪ Dinner is eaten at noon. This heavy meal,
consisting of beans, rice, and farina, often
includes mashed potatoes and pasta.
▪ Common desserts are custard, various
cornmeal pastries, fruit, and doce (a sweet
paste made by boiling sugar and fruit.
▪ A vegetable and or fruit salad are also
common.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Nutrition
▪ A preference, especially among young Brazilian
women, is to rely on vitamins instead of food
consumption to help them remain thin.
▪ In the US, food limitations are imposed by
expense and inaccessibility of Brazilian
mainstay foods.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Common health conditions of Brazilian immigrants
include
a. Schistosomiasis.
b. Thalassemia.
c. Glucose-6-dehydrogenous deficiency.
d. Hemophilia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Schistosomiasis is a common health condition of
immigrant Brazilians, especially those coming
from rural areas.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Pregnancy &
Childbearing Practices
▪ Although Brazil is predominantly a Catholic country,
birth control is taught and used.
▪ Women are encouraged by their physicians or clinic
personnel to have tubal ligations to prevent
unwanted pregnancies.
▪ Frequently, unwanted pregnancies and abortions
are, in the end, left in God’s hands.
▪ Immigrants in the United States generally practice
birth control.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Pregnancy &
Childbearing Practices
▪ Herbal teas are used for bringing on late
menstrual periods and for stimulating natural
abortions.
▪ Single women may try to become pregnant to
facilitate their chance of remaining permanently in
the US.
▪ Pregnant women are encouraged not to do heavy
work and not to swim.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Pregnancy &
Childbearing Practices
▪ Taboos also warn against having sexual relations
during pregnancy.
▪ Taboos generally vary according to geographic
region, socioeconomic status, and ethnic
background.
▪ Many Brazilian mothers prefer to give their
babies powdered dry milk in place of
breastfeeding.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Pregnancy &
Childbearing Practices
▪ Some women often feel that their milk is fraca
(weak).
▪ Breastfeeding is linked to a social stigma that a
mother who breastfeeds may often be thought of
as abandoned or sexually unattractive.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Pregnancy &
Childbearing Practices
▪ A postpartum woman eats chicken soup to help
her body return to normal.
▪ She is also advised not to eat spicy foods or
repadura (a molasses candy) and not to drink
garapa (sugar water) or caldo de cana (sugar
cane juice) if she breastfeeds her infant.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Death Rituals
▪ The death of a baby or an infant, historically, has
been and continues to be treated joyfully and
without much sadness, for the child has died pure
and is regarded as an angel.
▪ If financially possible, the families of Brazilians
who die in the United States personally
accompany the body to Brazil for burial in the
family vault.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Death Rituals
▪ The fatalistic expression, “It was God’s will,” helps
the grieving process among the rich and the poor.
▪ Older people wear black for various amounts of
time depending on their relationship with the
family member.
▪ Frequently, the final portrait is hung in the family
chaper or near the family altar, and prayers are
recited. An eternal light burns.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Death Rituals
▪ Relatives are honored on the anniversaries of
their death, both at home and at Masses.
▪ Often, the family places an obituary of
remembrance with or without a picture of the
deceased in the local newspaper on the
anniversary of the death.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Maria Miranda de Silva is reluctant to breastfeed. A
common belief about breast feeding among
Brazilians is that breastfeeding
a. Breastfeeding causes diarrhea in the infant.
b. Breastfeeding Is linked to a social stigma.
c. Breast milk is weak.
d. Breast milk is contaminated with iron.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: B
Breastfeeding is linked to a social stigma that a
mother who breastfeeds may often be thought of
as abandoned or sexually unattractive.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Spirituality
▪ 90 percent of Brazilians are Catholic, various
Protestant sects are making inroads into the
Brazilian culture.
▪ A few, including Catholics, incorporate traditions
of Indian animism, African cults, Afro-Catholic
syncretism, and Kardecism, a spiritualist
religion embracing Eastern mysticism.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Spirituality
▪ Saints are asked for help, and people wear
medals or little pouches of special powders
around their necks.
▪ The meaning of life is found in religion,
economy, fatalism, and reality. For some, life is
uma luta (a battle). For others, life has an almost
hedonistic attitude.
▪ The greatest source of strength for Brazilians is
their immediate and extended families.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Most Brazilians do not talk about their illnesses
unless the illnesses are very serious.
▪ Generally, illness is discussed only within the
family.
▪ Many Brazilians feel that talking about an illness,
such as cancer, negatively influences their
condition.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Because many Brazilians tend to shun
hospitals, their families accompany them and
stay around the clock.
▪ The patient is often brought food from home.
▪ The family is the nucleus of responsibility for
health care and is eager to participate in care.
▪ Brazilians are known for their self-medication
practices.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Antibiotic, neuroleptic, antiemetic, and most
other prescription drugs are easily obtained
over the counter in Brazilian pharmacies.
▪ Once in the US, incoming Brazilians bring
medicines requested by their friends and, thus,
maintain the circulation of medications not
available to Brazilians living in the US.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Traditional and homeopathic pharmacies are
supplemented by remedios populares (folk
medicines) and remedios caseiros (home
medicines).
▪ Folk remedies and traditional health-care
practices are intermeshed when a serious illness
may be best treated by traditional caretakers.
▪ Some take homeopathic bolinhas (little white
balls) prepared specifically for certain ailments.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Brazilians generally do not like to talk about pain.
However, once the emotional barrier is removed,
they feel relieved to be able to discuss their
discomfort.
▪ Many pain-relieving medicines are available
without a prescription in Brazil.
▪ Sickness is a neutral role and is considered
socially exempt.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practices
▪ Nervios is the ever-present folk diagnosis
that identifies weakness, craziness, and
anger as principally associated with
hunger.
▪ Better-educated Brazilians accept blood
transfusions, organ donation, and organ
transplantation.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practitioners
The folk-health field has many health-care practitioners:
▪ Curandeiros are divinely gifted.
▪ Rezadeiras (praying women) help exorcise illnesses.
▪ Card readers can predict fortunes.
▪ Espiritualistas are able to summon souls and spirits
▪ Conselheiros are counselors or advisors.
▪ Catimbozeiros are sorcerers.
▪ Additionally, head priestesses or priests from the AfricanBrazilian Umbanda or Xango religion, all have the power to
heal their believers.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Brazilian Health-care Practitioners
▪ Brazilians in the United States tend to
respect physicians and nurses.
▪ Medical education is prestigious and
highly sought by aspiring university
students.
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 1
Chapter 26
People of Baltic Heritage: Estonians,
Latvians, and Lithuanians
Rauda Gelazis
Overview, Inhabited Localities,
and Topography
Overview
People of Baltic descent come from Estonia, Latvia,
and Lithuania. The countries of origin of these ethnic
groups are sometimes referred to as the Baltics or the
Baltic countries because each of them is located in
Europe on the Baltic Sea. Historical, cultural, religious, and language differences prevent the group from
being one cultural entity. These countries represent
three distinct ethnic groups and are treated as such.
Estonia is on the Baltic Sea. Estonia is bordered by
the Gulf of Finland in the north, Russia in the east,
Latvia in the south, and the Baltic Sea in the west. The
Estonians are a Finno-Ugric people whose language
is related to Finnish (Raun, 1991). The Union of
Soviet Socialist Republics (USSR) forcibly annexed
Estonia in 1940 and maintained control until 1991,
when Estonia reasserted its independence. The capital
and largest city is Tallinn. Estonia’s population is
1,282,963 (CIA World Factbook, 2011a). Estonians
accounted for 89 percent of the population at the beginning of Soviet rule, but by 1989, they were only
61.5 percent of the population. During this period,
immigration increased the Russian population 10-fold
to 30 percent (Estonia, 1993). Currently Russians
comprise 25.6 percent of Estonia’s population. Estonians are 68.7 percent of the population. Belarusians
(1.2 percent) and Ukranians (2.1 percent) make up the
other ethnic groups in Estonia.
Latvia, situated between Estonia and Lithuania on
the Baltic Sea, was independent from 1918 to 1940,
when it was forcibly annexed by the USSR. Latvia regained its independence in 1991. The population is
2,204,704 people, of whom only 59 percent are Latvians
or Letts. Russians make up 27.8 percent of the population; the remainder is made up of Belarussians,
Ukrainians, and Poles (CIA World Factbook, 2011b).
About 68 percent of the Latvian population live in
cities; Riga is the capital and largest city. Most ethnic
Latvians speak a Baltic language related to Lithuanian.
Lithuania is also on the eastern shore of the Baltic
Sea. It is bordered in the north by Latvia, in the east
by Belarus, in the southwest by Poland and a part of
Russia (called Kaliningrad), and in the west by the
Baltic Sea. Lithuania was an independent country
from 1918 to 1940, when the USSR forcibly annexed
it. In 1990, Lithuania redeclared its independence
from Soviet rule. The Lithuanian population is
3,535,547, of whom 84 percent are Lithuanians,
4.9 percent are Russians, 6.1 percent are Poles, and
3.7 percent are other (CIA World Factbook, 2011c).
The urban population is 66.6 percent of the population; 33.4 percent of the population lives in rural
areas. On March 11, 1990, Lithuania reestablished its
independence—the first Soviet republic to do so. On
September 17, 1991, Lithuania was admitted into the
United Nations. In May 2001, Lithuania was admitted
into the World Trade Organization. In March 2004,
Lithuania was accepted into the North Atlantic Treaty
Organization (NATO), and on May 1, 2004, Lithuania
joined the European Union (Lithuania, 2005, 2006).
Latvia and Estonia were also accepted into NATO and
the European Union in 2004 (O’Connor, 2006).
Lithuanian is a Baltic language related to Latvian
(Gerutis, 1969). The capital city is Vilnius; its population is 546,000 people (CIA World Factbook, 2011c).
The topography of the Baltic countries consists of
lowlands. Estonia has many lakes and rivers because
of its glacial origin. Thirty-five percent of Estonia is
forest, whereas about 10 percent of its territory includes islands in the Baltic Sea. Latvia also has many
lakes and rivers, with estuaries providing ice-free commercial and fishing harbors. The highest elevation in
Latvia is 984 ft. Lithuania also forms an extension of
1
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2
Aggregate Data for Cultural-Specific Groups
the eastern European plain, with its highest elevation
at only 960 ft. It is also of glacial origin and is dotted
with lakes and rivers (Lithuania, 1993).
The Baltic countries today are democratic, growing
economically, and successful compared with many other
former Soviet Union countries in which poverty and dictatorship have been predominant (O’Connor, 2003). All
three Baltic countries have established strong ties to
Western democratic countries, but Russia continues to
maintain a hold on other former Soviet Union countries
such as Georgia. For this reason, there is concern, especially among the people of Baltic descent living in the
United States, that the former Soviet regime may try to
reinsert itself into leadership in the Baltics, and hence,
Russian ties would once again become strong.
Heritage and Residence
The Baltic peoples are believed to have lived along the
Baltic Sea since 2000 BC, when they settled this region
(Gimbutas, 1985). The four tribes that settled along
the coast of the Baltic Sea made contacts with a variety of people such as the Scandinavians, Slavs, and
Finns. The Latvians and Lithuanians are the only
remnants of these tribes. The other Baltic groups of
Old Prussians and Yatvingians became extinct in the
latter part of the Middle Ages (Sabaliauskas, 1986).
Lithuania’s territory spread over a large part of eastern Europe until it made an alliance with Poland.
Since then, its power declined, and in the 18th and
19th centuries, Poland and Russia ruled this territory
(Gerutis, 1969).
Migration from the Baltic countries to North
America has been intermittent. As early as 1640, a
few Latvian and Estonian settlers came with Swedes
to New Sweden in Delaware and Pennsylvania. In
1687, a group of Latvian immigrants from a colony
on the island of Tobago settled in Boston. Since
then, a small but steady number of Latvians have
settled in New York, Pennsylvania, the Midwest,
and California. By 1850, the U.S. Bureau of the
Census recorded 3160 Latvians and Lithuanians
(American Factfinder, 2000). The two groups were
counted together because they spoke a similar language. By 1870, their numbers reached 4644. Most
of the early arrivals were sailors or artisans; a few
were missionaries.
The immigrants who came to the United States in the
late 19th and early 20th centuries settled in metropolitan
areas and industrial centers, or they followed jobs on the
railroad or in coal mines. As a result, Latvian communities exist in New York, Boston, and Philadelphia in
the Northeast; in Chicago, Milwaukee, Cleveland, and
Kalamazoo and Grand Rapids, Michigan, in the
Midwest; and in Los Angeles, San Francisco, Portland,
Seattle, and Tacoma on the West Coast. Before 1890,
immigrants were also located in the mining districts of
Pennsylvania. By 1910, the largest communities of
Lithuanians were in Chicago, New York, Boston,
Philadelphia, and Cleveland. By 1970, over half of the
Estonian American population lived in the Washington
to Boston corridor, about 15 percent lived in the Great
Lakes region, and 19 percent were on the West Coast
(Thernstrom, 1980).
Reasons for Migration and Associated
Economic Factors
It was not until the mid-19th century that immigration
from the Baltic countries increased. One reason for
this was the abolition of serfdom in the 1860s in
Lithuania and the other Baltics, which lifted legal restrictions that had previously limited the mobility of
villagers. Another factor was the development of
the tsarist railroad by the Russian Empire. Railroads
facilitated travel to Russia and points beyond. In the
late 1860s, a severe famine disrupted the Lithuanian
peasant economy. In 1874, the Russian government
introduced a comprehensive system of conscription,
and many men from the Baltics emigrated to escape
service in the tsarist army. Thus, Lithuanian peasants
made their way to the United States, and a migrant
network began. By 1914, this network had expanded
such that few villages were unaffected by the increasing migration to America. The rate of return migration was high; between 1899 and 1914, there was one
departure from the Baltics for every five immigrants
who returned. In 1918, all three Baltic countries
declared their independence. During the years as
independent countries, 1918 to 1940, much progress
was made in each country (O’Connor, 2003).
In 1940, the three Baltic countries lost their independent status to Germany; and then, to the USSR
in 1941. During this time, hundreds of thousands of
Latvians, Lithuanians, and Estonians were deported
in cattle cars to Soviet prison camps in Siberia. Fearing death or deportation by the Communist regime,
Estonians, Latvians, and Lithuanians fled to the
West by any means possible. The post–World War II
influx of immigrants to the United States came in
1949. Because the immigrants fled from the religious,
cultural, and political persecution of the Soviet regime
and could not return to their native countries after
World War II, the U.S. Congress facilitated their entry
by enacting laws designating them as displaced persons
(Baskauskas, 1985).
Many of these immigrants were well educated and
had professional occupations. However, language
barriers forced them to take positions in manual
labor in the United States. Gradually, many immigrants improved their economic status. Because one
of the conditions of emigration to the United States
for this group was having American citizens to sponsor and accept financial responsibility for them, this
group was quickly assimilated into the workforce
(Baskauskas, 1985).
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People of Baltic Heritage: Estonians, Latvians, and Lithuanians
The Baltic immigrants continued their native traditions, which held the communities together and added
diversity to the many cultural groups and organizations to which they belonged. Maintaining the cultural
identities of Estonians, Latvians, and Lithuanians was
important, and schools were established in the native
languages to preserve their language and culture.
Many youth and student groups that existed in independent Estonia, Latvia, and Lithuania, such as the
Boy Scouts and student fraternities, were re-created in
the United States. Many of the post–World War II
refugees were professionals; thus, each group formed
its own specialized ethnic association of professionals
in the United States. For example, the LithuanianAmerican Federation of Engineers and Architects was
formed in the 1950s and continues today (Alilunas,
1978). Each group published its own journal or
newsletter; the Latvian American newspaper Laiks
continues to be published today. The Lithuanian
newspapers Draugas and Dirva are also still published.
Folk dance and song ensembles were formed to
promote the cultural identity of each country. Music
and songs are particularly important to people from
the Baltics. The songs are sung by people in their
native lands and in America. All three Baltic countries continue to have regular song festivals and
dance festivals in the United States and in the native
countries as well. The Baltic countries are strong in
the arts, and theater, opera, music of all types, and
film continue to flourish (Lithuania, 2005; Pabriks
& Purs, 2001).
Since the Baltics regained independence, starting
with Lithuania in 1990, immigrants have continued to
come to the United States; however, restrictions in
the United States and in their native countries have
limited their numbers. Travel back to the Baltics is
now possible without restrictions. Under Soviet rule,
travel to these nations was severely restricted, was
limited to 5 days in the country, and entailed entrance
and exit only through Moscow. With independence has
come a resurgence of interest for Americans of Baltic
descent in travel to their native countries, and many
have revisited their countries of origin. Economic ties
continue to be established as Americans invest in the
Baltic economy with a variety of projects ranging from
fast food to petroleum. For example, imports such as
linen, women’s suits, and amber jewelry from these
countries are increasing and can now be found in
stores and boutiques throughout the United States.
The new freedoms mean that artistic and cultural
groups from the Baltics can come to the United States
to tour (Gelazis, 1994). One such group is a Latvian
Boys’ Choir from Riga. Such appearances help Baltic
Americans reinforce their cultural identity. Many
Americans of Baltic descent become U.S. citizens,
fully participate in American society while continuing
to use their native language, and are involved in the
3
culture of origin through the many organizations still
in existence in America.
Most people of Baltic descent participate in the
maintenance of their culture. Studies indicate that,
for several generations, the native culture has remained important to individuals in varying degrees
(Baskauskas, 1985). Therefore, it is important to assess the meaning of each individual’s cultural heritage, whether they are a first- or later-generation
American of Baltic descent.
In recent years, the Baltic countries have made strides
in linking with the United States and Western Europe,
relying less and less on old ties with Russia (Jundzis,
1999). All three Baltic countries have been accepted
into NATO and the European Union. Western ties
were strengthened in Lithuania in 1997 when Valdas
Adamkus, a Lithuanian American, was elected president twice (Lithuania, 2005; Longworth & Bukio, 1998).
In 1999, Latvians also elected an expatriate as president.
Vaira Vı̄ķe-Freiberga, a retired Latvian Canadian professor, was elected president of Latvia. Estonia also has
Western-oriented leadership (Smith, 2002).
Educational Status and Occupations
Education is highly valued by people of Baltic descent. All three Baltic countries have high literacy
rates; each country’s literacy rate is above 99 percent
(CIA World Factbook, 2011a, 2011b, 2011c). For
small countries, the Baltic countries spend significant
amounts of their budget for education. Lithuania, for
example, designated 4.7 percent of its GDP for education (CIA World Factbook, 2011c). Education is
valued and seen as a way of improving life circumstances. These immigrants made many sacrifices so
their children could become educated. As a result,
many Americans of Baltic descent have advanced degrees. Many are professionals in medicine and law.
Because the Baltic countries were agrarian, early immigrants came from farming communities. These immigrants were attracted to the mining and industrial
communities on the East Coast and in the Midwest. The
post–World War II Baltic immigrants also settled in the
industrial centers of the United States. Second- and
third-generation immigrants, however, are often skilled
professionals.
Since the mid-1990s, the three Baltic countries have
experienced a “brain-drain” to some extent because
many of their highly educated citizens have emigrated
to the United States and Europe. Since entrance into
the European Union has made it possible for persons
from the Baltics to travel to member countries to obtain jobs, many have left for countries such as Great
Britain and Ireland where jobs are available. Lithuania, for example, lost about 400,000 people to emigration since 1990 (Emigrantus šauks atgal i˛ Lietuva,
2007). This is a concern in a relatively small country.
The world economic crisis in 2008 affected the Baltic
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4
Aggregate Data for Cultural-Specific Groups
countries. The economic growth in the Baltics since
2000 has taken a downturn. The public debt in each
country has risen in recent years. Latvia received
substantial financial assistance from the EU and
other partners in the last few years (CIA World Factbook, 2011, b). The unemployment rate in Latvia is
14.3 percent, in Lithuania it is 17.9, and in Estonia
the unemployment rate is 17 percent (CIA World
Factbook, 2011a, 2011b, 2011c). Young people find
it particularly difficult to get jobs and are drawn to
find work in the EU countries or the United States.
Communication
Dominant Languages and Dialects
The Latvian and Lithuanian languages are among the
oldest in the world—closely related but not the same.
Latvian endings for nouns, for example, are shorter
than those in Lithuanian. Latvian and Lithuanian are
the only remnants of the ancient Indo-European language related to Sanskrit (Thieme, 1958). Estonian is
more closely related to Finnish and is part of the
Baltic-Finnic branch of the Uralic languages, which
also includes the Hungarian language (Raun, 1991).
Cultural Communication Patterns
People of Baltic descent share thoughts and feelings
readily. The stereotype of quiet, stoic individuals is
not borne out by observation or research. For example, humor can be used to relate to these patients and
is appreciated if used appropriately (Gelazis, 1994).
Older individuals from these cultural groups may be
first-generation Americans or immigrants who came
to the United States after World War II. These individuals may not be as acculturated as younger people
and may prefer to speak their own languages. Healthcare professionals need to be sure that any instructions
given to these patients are well understood. Individuals
from these cultural groups usually comply with medical regimens and medications as long as they understand them clearly and know the reasons for them.
Patients of Baltic origin may hesitate to share intimate thoughts and feelings related to their cultural
sense of decorum, but this does not mean that they do
not experience feelings and emotions. They may wait
to see whether the health-care professional is caring
and takes the time to actually listen to them.
Recent imigrants may hesitate to use the healthcare system available if they have no jobs. Because
health insurance usually is part of job benefits in the
United States, both old and young people may not
have health insurance. This issue may be addressed as
the United States looks at its health-care policies in
the future.
As a whole, people of Baltic descent are not flamboyant or highly volatile, but individual differences are
always present. Some individuals enjoy touch and
close contact, whereas others do not. Individuals from
these cultures are receptive to a caring use of touch
from family and close friends, but they may appear to
be more aloof with strangers. Health-care professionals who help patients with crises are encouraged to use
touch appropriately to convey caring and support.
Temporal Relationships
People of Baltic descent give attention to the past,
present, and future. The past is revered in the sense
that significant historical events for each cultural
group continue to be celebrated and acknowledged.
For example, commemorative programs are held each
year when Estonian Americans celebrate their independence day on February 24, Latvian Americans
on November 18, and Lithuanian Americans on
February 16. These were held even during the years
when the countries were oppressed under Communist
rule. More recently, the new dates of independence
may also be commemorated, and significant dates may
be remembered. For example, January 13 is commemorated in Lithuania each year to remember the lives
sacrificed in 1990 when Russian Soviet tanks rolled
into Vilnius and fired upon demonstrators surrounding the television tower who were trying to keep
broadcasts going in order to unite the country to press
for independence from the USSR (Pečeliūnaitė, 2007).
People of Baltic descent value frugality because
they have had hard times in the past. Many have
worked very hard since coming to the United States
and have saved enough money to buy homes and pay
for their children to complete college. These cultural
groups are well able to plan for the future and are patient enough to persevere to reach their personal goals.
People of Baltic descent view time in a way similar
to that of the dominant American culture. They have
become acculturated to the awareness of time and
deadlines and arrive at their appointments on time.
Because their work ethic is strong and work is highly
valued, individuals of Baltic descent take pride in
using their time wisely and being efficient. Socially,
however, they may be less aware of time and tend to
be late.
Social and family interactions, especially those involving cultural events, are also highly valued. The
view of well-being is holistic, and a balance is sought
in life. Therefore, work activities are valued and so are
the social and leisure time activities shared with family
and friends.
Format for Names
Individuals of Baltic descent generally use their
American last name. First names of women end in
“a,” and first names of men end in “as” or “s.” In their
native languages, the last name indicates whether the
person is male or female; for females, the last name
indicates whether the woman is married or single. In
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People of Baltic Heritage: Estonians, Latvians, and Lithuanians
Lithuanian, for example, the author’s last name would
be Gelažienė, indicating that she is married. If the
author were single, the last name would be Gelažytė.
The male last name is Gelažis. The typical Lithuanian
last name ends with “as” or “is.” The suffix “ienė” indicates a married woman, and the suffix “aitė” or
“ytė” indicates a woman’s single status. In Latvian, the
typical last name ends in “ans,” “ins,” or “e,” with
the endings indicating masculine or feminine genders.
Estonian names are similar to Finnish names.
Family Roles and Organization
Head of Household and Gender Roles
The father is the head of the household in the typical
family of Baltic heritage. Although both men and
women in the family may have jobs and discuss major
decisions, the father or father figure is still generally
considered the head of the household. Health care
and other major decisions are made jointly by both
spouses. Women in the family are given respect, and
decision making is done by both men and women
(Bindokienė, 1989).
Prescriptive, Restrictive, and Taboo Behaviors
for Children and Adolescents
The Baltic people value children, and children and
adolescents are given every opportunity for growth
and development. Because education is highly valued,
parents encourage and supervise children in their
schoolwork and progress. Corporal punishment was
used by older generations but is practiced less by
younger families. Cultural activities, such as song or
dance groups and ensembles, frequently unite people
of all ages. Religious beliefs also strongly influence
family life and the rearing of children in each culture.
Family Goals and Priorities
The traditional nuclear family is still the standard in
these cultural groups. Family is highly valued, and
divorce is still fairly rare. Lithuanian Americans are
predominantly Roman Catholic, and their religion
supports strong family values. Because both spouses
tend to work, child care may be shared by grandparents. The extended family is important, and visiting
among them is frequent, but extended family members
live separately.
Older people are respected in the Baltic cultures. If
grandparents are unable to live independently, every
effort is made to have them move in with an adult child,
usually a daughter. Nursing homes are used when
needed. Because many women work outside the home,
families may find it necessary to use long-term-care
facilities to care for infirm older members. Culturally
based nursing home facilities are available. For example,
the Matulaitis Nursing Home in Connecticut is for
older Lithuanian Americans (Gelazis, 1994).
5
Older members of these cultures often come from
large families. Extended families live apart because
family members may have been separated in their escape
from the Baltics. Many tragic events, such as the Soviet
deportations of hundreds of thousands of Estonians,
Latvians, and Lithuanians to Siberian concentration
camps in the 1940s and later in the 1950s, separated
family members forever by death and distance. When
people fled their homelands to escape Communist
tyranny, they emigrated to whatever free country they
could. Therefore, the extended family may include members throughout the world in such faraway places as
Australia, Canada, Europe, and South America.
When the Baltics regained their independence,
family members from the United States were able to
visit their homelands for the first time in years. Before
this, many Americans of Baltic descent were afraid to
visit their native lands because they feared for their
families and even for themselves. During the years of
oppression, mail was censored, and free communication, even among relatives, was severely restricted.
Many people of Baltic descent sent money and other
material support home for years to help their extended
families (Fainhauz, 1991).
In their native countries, status was given to individuals with professions such as physicians and lawyers
and those with academic degrees. In America, a certain
amount of respect is still given to professionals, but
each cultural group has more of an egalitarian sense
of community. The preservation of Baltic culture and
language holds people of varying status, education,
and age together for a common purpose. Furthermore,
when immigrants first came to the United States, many
had to take jobs of lesser status. This increased their
sensitivity for individuals of all social and economic
classes. For example, some physicians had to take positions as laboratory technicians, and teachers as laborers and factory workers. This pattern continues today
with new immigrants, but there is a tendency for new
immigrants to stay within their professions, and English has replaced Russian in most schools in the Baltics,
making transition into the United States and the
United Kingdom easier than in the past. In Lithuania,
for example, more people now speak English than
Russian (CIA World Factbook, 2011c).
Alternative Lifestyles
The literature does not include information about
same-sex couples in these cultures. Because the dominant religions of the Baltic countries do not sanction
homosexuality, few individuals and couples are openly
homosexual, making it hard to obtain statistics. Recent
increases in HIV rates in former Soviet Union countries, including the Baltics, may be indicative of an
increase in homosexual activity but may also indicate
an increase in casual sex in heterosexuals who are more
mobile today than in the past (Rowe, 2006).
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Aggregate Data for Cultural-Specific Groups
Workforce Issues
Culture in the Workplace
Individuals of Baltic descent value their family, culture,
and beliefs and view work as important. Material aspects
are seen as secondary to the more-important family values. Responsibility is taken seriously and is encouraged.
Political awareness and responsibilities of citizenship are considered essential aspects of life. People of
Baltic descent adapt readily to American values of
timeliness in the workplace.
Issues Related to Autonomy
People of Baltic descent have no difficulty maintaining
their sense of autonomy and readily take on work
roles, responsibility, and decision making. They usually
do not like to directly confront those in authority and
find ways to deal with difficult situations or people
through the use of humor or deference.
Recent immigrants who have lived under the Soviet
regime may not be accustomed to making decisions
for themselves or acting autonomously. In previous
governmental regimes, individuals and their rights
were not considered important.
For the most part, Americans of Baltic descent are
fluent in English as well as their own languages.
Exceptions might be identified among older people or
recent immigrants. Friends, family, or community
members can act as translators if absolutely necessary.
The Baltics have high literacy rates.
Biocultural Ecology
Skin Color and Other Biological Variations
People of Baltic descent have white skin. Estonians
are similar to the Finns with brown hair and eyes,
though some are blond and blue-eyed. Latvians and
Lithuanians have fair complexions with blond hair
and blue eyes. Assessment of health status is similar
to that of other fair-skinned individuals.
Diseases and Health Conditions
Recent immigrants from Estonia, Latvia, and Lithuania
may be at risk for cancer because of the current industrial pollution, including radiation exposure resulting
from the Chernobyl nuclear disaster in 1988. Because
Chernobyl is close to the Baltic countries, some contamination occurred in the Baltics and other Northern
European countries. Furthermore, because the Soviet
regime did not consider human needs over the needs of
the state, nuclear waste on land or in the Baltic Sea may
not yet be publicly known. This may constitute a health
hazard and may affect both recent immigrants and visitors to these countries. Lithuania has had to improve
safety procedures at Ignalina (Chernobyl-type reactors)
in order to avoid a disaster similar to the Chernobyl experience and to protect the Lithuanian people as well as
its neighbors (Lane, 2001).
Some immigrants are survivors of political torture,
having spent years in prison labor camps in Siberia. As
a result of such experiences, their health status is
affected. For example, hearing loss has occurred as a
result of beatings and other torture in prisons (Gelazis,
1994). Some may show evidence of post-traumatic
stress disorder (PTSD) due to past years of high stress
war situations. When performing health assessments,
health-care providers need to be alert to ill health resulting from the conditions that immigrants endured
because of the political situations in their countries of
origin. Obtaining a history of individuals and their life
experiences is important.
People of Baltic descent have illness rates similar to
those of the general American population (CIA World
Factbook, 2011a, 2011b, 2011c). Morbidity rates in the
Baltic countries show that the leading causes of death
are heart disease and cancer, with rates similar to those
of the general population in the United States. More
recently, however, as mentioned previously, as a result
of industrial pollution and nuclear waste contamination brought on by the Soviet regime, cancer rates have
increased in the Baltic countries.
The incidence of alcoholism is high in the Baltics
(British Broadcasting Corporation, 1994). For example,
alcoholism is a health problem in Latvia and is partly
responsible for the particularly low life expectancy
for men (Pabriks & Purs, 2001). The life expectancy for
Latvian men is 67.56 years, and for Latvian women, it
is 78.07 years (CIA World Factbook, 2011b). Life
expectancy for Estonian men is 68.02 years, and for
Estonian women, it is 78.97 years (CIA World Factbook, 2011a). Life expectancy for Lithuanian men is
70.2 years, and for women, it is 80.48 years (CIA World
Factbook, 2011c). Strong educational antismoking
and antialcohol campaigns would help to increase the
life expectancy in Latvia and the other Baltic countries.
Better health also has positive consequences economically for both individuals and countries. Suicide is also
increasing in the Baltics (Agence France Presse, 1995).
Considerations for health-care professionals include
health teaching such as decreasing smoking, changing
dietary habits, and decreasing the use of alcohol.
Health-care professionals should assess for a family
history of heart disease, cancer, or alcoholism.
Variations in Drug Metabolism
In addition to the previously mentioned considerations, the Ashkenazi Jews from the Baltic countries
may respond differently to neuroleptic agents (Levy,
1993). For example, in studies of the use of clozapine
to treat schizophrenia, 20 percent of Jewish patients
developed agranulocytosis, but this adverse reaction
occurs in only 1 percent of chronic schizophrenic patients in the general population (Lieberman et al.,
1990). Genetic testing reveals that a specific haplotype
was found in 83 percent of patients who developed
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People of Baltic Heritage: Estonians, Latvians, and Lithuanians
agranulocytosis. All Ashkenazi Jewish patients affected had this haplotype, and only 8 percent did not
develop this reaction. Characteristically, this haplotype is found in less than 1 percent of the white
population in America (Levy, 1993).
High-Risk Behaviors
Cigarette smoking is decreasing in the United States
and Canada; however, European countries, especially
Eastern European countries, have not followed this
trend. Although some Americans of Baltic descent
have stopped smoking, the younger generation—
those in their late 20s to 30s—has shown a similar trend
to that of other Americans of the comparable age
group (Gelazis, 1994). Smoking has decreased among
Americans of Baltic descent in the United States, but
people living in their native countries have continued
to smoke. In fact, some American tobacco companies
have begun negotiations with Baltic countries, such as
Lithuania, for possible future investments (Linderfalk,
1996). Individuals who have emigrated to the United
States since the early 1990s tend to continue to smoke.
The latest statistics on smoking rates in the Baltic
countries continue to remain high, as much as 45 percent of the people smoke (Gilmore et al., 2004).
Another health problem is the use of alcohol.
Although many people of Baltic descent maintain
jobs and are able to function, their use of alcohol is
high. The rate of alcoholism in the Baltic countries
and other Eastern European countries is high, and
drug use is on the rise (Reuters World Service, 1994).
Alcohol consumption, especially beer among young
adults, is actually increasing (Zaborskis, Sumskas,
Maser, & Pudule, 2006). This is not to imply that
alcohol abuse is a problem for all individuals of this
cultural group, but the issue should be carefully
assessed. Health-care professionals are encouraged to
be subtle and indirect in these assessments, because
denial of the problem is part of the pathology.
Greater freedom to move about, especially in the European Union countries, also has implications regarding
the health of persons in the Baltics. One example is that
casual sex related to truck drivers carrying goods to and
from other countries has raised rates of sexually transmitted disease, HIV, and tuberculosis in the Baltics and
other countries. All of these diseases, particularly rising
HIV rates, have dire consequences for the public-health
systems of each country as well as any countries to
which affected persons emigrate (Rowe, 2006).
Health-Care Practices
Americans of Baltic descent readily seek medical care
and prefer to obtain it from professionals of their own
background, when possible. Older people, who may
have difficulty with English, are more at ease when
they can speak with their health-care providers in their
own language.
7
Americans of Baltic descent are health conscious
and believe that a well-balanced lifestyle maintains
health and well-being. For example, well-being among
Lithuanian Americans is typically described as a holistic concept—that is, a state of being in which the
person’s physical, spiritual, psychological, and social
health are in balance (Gelazis, 1994). Moderation is
perceived as desirable in living a healthy life. Natural
foods are preferred, and whenever possible, vegetables
and fruits are homegrown. These are then preserved
for use throughout the year.
Exercise and physical activity are valued, and people
of these cultures make an effort to get a reasonable
amount of exercise. Sports are also considered an important part of maintaining one’s culture. Participation in sporting activities promotes a sense of unity
and cultural identity along with being an important
part of a healthy lifestyle. Young people in particular
are encouraged to be active in sports, and team sports
are organized and encouraged. For example, Latvians
enjoy soccer, whereas Lithuanians have volleyball and
basketball teams. Teams from Chicago, Cleveland,
and Toronto have tournaments or sports festivals
(Sporto Šventės in Lithuanian) featuring track and
field events and team sports such as volleyball. Several
years ago, a sports festival was held in Lithuania in
which Lithuanian Americans joined Lithuanians from
all over the world in a variety of sports events for the
first time in over 50 years. Latvians and Estonians
have similar events.
The Baltic countries favor sports such as basketball
and soccer and such Olympic events as running, bicycling, and ice skating. Lithuania boasts of professional
basketball players who came to the United States to
play professional basketball successfully. One example
is Arvydas Sabonis, who has been in the National
Basketball Association (NBA) for over a decade. He
founded a basketball school in Lithuania that gives
scholarships for general education and room and board
to disadvantaged children (Daukša, 2006).
Some people, as they get older, become more sedentary and may need to be encouraged to be as active as
possible. Most Americans enjoy walking and the outdoors, and health-care professionals can encourage
such activities. Older Baltic Americans tend to stay as
active as possible; in fact, many enjoy gardening.
Women take pride in having beautiful flower gardens,
with the rue (rūta in Lithuanian) plant having a special
place in Lithuanian gardens. Such activities should
also be encouraged as a form of exercise.
Nutrition
Meaning of Food
As previously mentioned, before World War II,
the Baltic countries were largely agrarian. Industrialization started before World War II when these
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Aggregate Data for Cultural-Specific Groups
countries were forcibly annexed into the USSR. At
that time, all private ownership ceased, and farms
were collectivized. The Americans of Baltic descent
who came to the United States in the late 1940s and
early 1950s have roots in the villages of Estonia,
Latvia, and Lithuania. Although many came from
towns and cities and had professions, many others
were farmers. Because many individuals who left the
Baltics after World War II experienced food shortages and times of starvation, food is important to
these people. Recent immigrants have left the Baltics
for economic reasons and have also experienced
food shortages.
Common Foods and Food Rituals
Some foods common among this cultural group are
meats such as pork, chicken, and beef. Rye and
whole-grain breads are popular. Baked goods such
as bacon rolls, yeast-baked goods, and rich tortes
and cakes are common. Fresh fruits and vegetables
are enjoyed. Potato dishes such as pancakes, kugel,
and dumplings are popular in the home and at festive
events. Beets, mushrooms, and cabbage are used in
soups and sauces. Dairy products such as sour
cream, butter, and yogurt are included daily in their
meals (Gelazis, 1994). Grain porridges are popular,
especially among Latvians who have putras (porridges). The content of porridges varies according to
regions in Latvia.
Food is a symbol of the culture. Foods enjoyed
by people of Baltic descent include smoked and
unsmoked sausages and smoked fish, eel, and pork.
The spices used are rather mild compared with
those of other cultures, but foods may be high
in salt content. Food is also connected with festive
occasions and celebrations. Certain foods are associated with particular holidays. For example, Latvians
serve gray peas on New Year’s Eve. These must
be completely eaten because they signify tears,
and one does not want any tears to follow them
into the new year.
Because Lithuanians are mostly Roman Catholic,
many foods relate to Catholic holidays. For example,
the meal on Christmas Eve is meatless and includes
12 different foods representing the 12 apostles
of Christ. Straw is placed under the tablecloth,
symbolizing the manger in which Christ was born.
The Christmas wafer is shared with each family
member. All family members make an effort to
be present at the Christmas Eve meal, which is
shared together. After the dinner, the family attends
Midnight Mass.
People of Baltic descent are becoming acculturated
into American food choices and habits. Rituals related
to food may include certain holidays, but no set rituals
are used on a daily basis. The noon meal was the
largest meal of the day in an agrarian society. This
practice may no longer exist, but health-care providers
can encourage it when possible, especially for retired
or older people.
Dietary Practices for Health Promotion
Individuals of Baltic descent enjoy natural, fresh fruits
and vegetables and prefer they be homegrown. Diets
tend to be well balanced. Health teaching may be necessary regarding salt, fat, and cholesterol content because many of the preferred foods are high in these
components.
Nutritional Deficiencies and Food Limitations
Nutritional deficiencies are similar to those of the
general population in the United States. Some individuals of Baltic descent may have deficits as a result
of food or nutrient deprivation earlier in life. For
example, some age groups may have a greater incidence of dental caries caused by a lack of calcium
at a crucial stage of life.
There are no major limitations of food availability
for Baltic people in America. However, socioeconomic
conditions may prevent some individuals from obtaining a balanced diet.
Pregnancy and Childbearing
Practices
Fertility Practices and Views Toward Pregnancy
The fertility practices of these cultural groups mirror
those of the general population of the United States.
The families of younger generations are smaller, and
even Lithuanian Americans who are Roman Catholic
use birth control practices. In the Baltic countries, a
variety of factors cause low birth rates. Under Soviet
rule, large families were encouraged, and mothers who
gave birth to many children were rewarded with state
medals (Gelazis, 1994).
Since regaining independence, the Baltic countries
have experienced economic difficulties, and many
goods, including medical supplies and medications,
are scarce. For this reason, many birth control methods are not available to Estonians, Latvians, and
Lithuanians. Therefore, abortion rates are high
(Priest, 1994); No up-to-date information about
abortion rates could be found. In 1998, Latvia and
other Baltic countries had a negative population
growth. In addition, Latvia had 15.2 infant deaths
per 1000 births that same year. In 2009 the infant
mortality rate was 8.42 (CIA World Factbook,
2011b). This compares very unfavorably with other
European countries such as Sweden, which had
4 infant deaths per 1000 births in 1998 (Pabriks &
Purs, 2001). The Baltics need to address these health
issues and educate people about prenatal care and
birth control methods to reduce both abortion and
infant mortality rates.
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People of Baltic Heritage: Estonians, Latvians, and Lithuanians
Prescriptive, Restrictive, and Taboo Practices
in the Childbearing Family
Americans of Baltic descent use modern Western
medicine practices, are likely to obtain early prenatal
medical care, and are likely to be receptive to health
teaching for prenatal and postnatal care. Because they
prefer natural processes, some women and families
from these cultural groups prefer natural childbirth
and breastfeeding. Statistics of these preferences are
not available, but research indicates that well-being is
defined by Lithuanian Americans as a holistic,
well-balanced approach to life (Gelazis, 1994).
Some older individuals of Baltic descent may remember and still believe in past restrictive beliefs
about pregnancy. For example, pregnant women are
to remain calm and receive no shock or frightening
news. In the past, once the child was born, ceremonies
and rites included the father’s greeting the child into
the family. Now, these rites have given way to Christian baptism ceremonies. The godparents are important in the child’s life and traditionally give gifts,
including candy, to each other and guests.
Prenatal care in the Baltic countries today leaves
much to be desired. These countries are struggling to
improve standards of health care but, unfortunately,
have not yet caught up to U.S. standards. Prenatal
vitamins may not be available, and the diet may be low
in calcium and protein owing to shortages of meats
(Trickey, 1993).
Death Rituals
Death Rituals and Expectations
Death is viewed as part of life, and ceremonies of the
wake and funeral are linked with Christian religious
services. Life and death events are very important and
expressed socially within the community. The death
of a family member is a loss to the community, which
is typically close knit. The funeral may take place
within 3 to 4 days following the death, providing time
for out-of-town friends and relatives to gather. Family,
friends, and community members want to be present
at the wake and the funeral ceremony. At the wake,
organizations to which the deceased belonged send
representatives to express their loss to the family. The
funeral is usually a Christian service, followed by a
meal at which all attendees are welcomed. Burial is the
usual practice. Cremation is permissible now, even
among Roman Catholics, especially if the deceased
expressed a wish to have his or her ashes taken to the
homeland (Fainhauz, 1991).
Responses to Death and Grief
Grief is expressed by sadness, crying, and talking
about the deceased with fondness and respect. Individuals from these cultures express emotions readily but
not in highly dramatic ways. Decorum is maintained
9
in public and with strangers. The dead are often remembered with frequent visits to the cemetery. Roman
Catholics have masses said for their deceased relatives
on a regular basis, particularly at the anniversary of
their deaths. All Souls’ Day, November 2, Vėlinės, is a
significant day for Lithuanian Americans, with religious ceremonies commemorating the dead. In Lithuania on this day, candles are lit at the graves, which are
decorated. Family and friends in each village and town
gather for prayers, hymns, and religious services. In the
United States, Lithuanian Americans pray for their
deceased family members and friends and make every
effort to visit the cemeteries (Gelazis, 1994).
Spirituality
Dominant Religion and Use of Prayer
Estonian Americans and Latvian Americans are predominantly Lutherans, but some are Catholics,
whereas Lithuanian Americans are predominantly
Roman Catholic. All these groups celebrate major
Christian religious holidays, particularly Easter and
Christmas. Individuals of these cultures consider
themselves as having spiritual roots, which may be
closely linked with the value they place in their
language, country, and culture.
Americans of Baltic descent have many concerns
about the state of religion and the values of Estonians,
Latvians, and Lithuanians. Under Soviet rule, all
forms of religion were forbidden, and the Communist
government made every effort to eradicate all traces
of religious belief. Religion was replaced by Communist dogma for 50 years. Thus, several generations of
Estonians, Latvians, and Lithuanians have grown up
hearing antireligious propaganda most of their lives.
Only the older generation maintained strong religious
beliefs. Now that the Baltic countries are independent,
efforts are being made to reintroduce religious values.
Religious groups from America have sent missionaries
to these and other Eastern European countries.
Although Christianity has been the religion of the
Baltics for hundreds of years, the ancient religion,
wherein elements of nature were worshipped, still has
an influence, as evidenced in their respect for nature
and ecology. To this day, some pagan holidays are
commemorated in the form of Christian holidays. For
example, St. John’s Eve (June 21) is celebrated by all
Baltics and is part of the celebration of the summer
solstice. Latvians and Estonians in particular celebrate
this holiday with special songs, dances, bonfires, and
decorations. A very small percentage of Latvians
maintain their ancient pagan religion, called Dievtui
(those with God), which has a high priest as its head.
Stories include myths and folk wisdom in rhyme as an
important part of their content.
Most Americans of Baltic descent consider prayer
to be an individual expression of their faith. The nurse
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Aggregate Data for Cultural-Specific Groups
or health-care professional should allow the client and
family to take the lead with regard to prayer. Because
prayer is individualized, some patients welcome time
for individual or shared prayer, whereas others do not
wish to pray. Many have been sustained through hardships by their strong religious faith and continue to
have strong religious needs.
Meaning of Life and Individual Sources
of Strength
Americans of Baltic descent are a spiritual people, and
religion is a source of strength. In addition, the family
and the community of Estonian Americans, Latvian
Americans, and Lithuanian Americans, as well as
their cultural and national identity, are significant
sources of support, pride, and strength. Enormous
effort goes into preserving their language, culture,
customs, and traditions.
The changes in their native countries brought about
by the Soviet rule are a source of pain for people of
Baltic descent. Contact with their homeland and their
people has increased their awareness of differences in
values, and many are concerned about these differences.
Spiritual Beliefs and Health-Care Practices
Spiritual and religious considerations are considered
private and may not be readily shared with health-care
professionals. A trusting relationship with the individual must be established before deep spiritual beliefs
are shared. Clergy from the client’s church are usually
welcome; thus, the nurse may wish to contact the
church. Patients find considerable comfort in speaking
with the clergy in times of crises and serious illness
(Gelazis, 1994).
Health-Care Practices
Health-Seeking Beliefs and Behaviors
Individuals of Baltic descent adhere to modern medical regimens and readily use the health-care system
available to them. Because they consider health and
well-being important, they take an active interest in
healthy lifestyles, nutrition, and exercise. As noted previously, natural foods such as rye and whole-grain
breads, fruits, and vegetables are preferred. Fresh air
is considered important, and walking, especially in
natural settings such as parks, is enjoyed by all ages.
The Baltic countries were improving economically
until 2008. Estonia, in particular, made the fastest
progress economically with the help of investments
from Scandinavian countries. By 1993, Estonian trade
had reoriented itself toward Western markets. Estonian exports are processed goods based mostly on
timber, textiles, and food rather than heavy industry.
Latvia and Lithuania, however, continue to have agricultural and natural resources as the basis for foreign
trade (O’Connor, 2003). Economic growth has both
health-care and political consequences. For example,
a growing economy encourages professionals to remain in the country, where health needs can be addressed and economically supported through their
political stability. The Communist or Socialist parties,
for example, can appeal more easily to populations in
which economic need is greatly felt and experienced.
Democratic processes and government are easier to
maintain when the economy is stable and growing.
The Baltics need a sound economy as a basis for political growth. In the past year the economies of each
of the Baltic countries have begun to rebound from
the worldwide economic crisis of 2008/2009, and
slight growth is evident (CIA World Factbook, 2011a,
2011b, 2011c).
Responsibility for Health Care
People of Baltic descent assume responsibility for
their own health. Because work is highly valued, most
are in the workforce and have insurance coverage. Individuals are generally well informed by their physician, friends, and the community about available
resources. Because these people place a high value on
family, family members are concerned about one another and help one another obtain medical and dental
care when needed.
Because Baltic Americans take a holistic approach to
life and health, and cultural roots enter into wellness and
health promotion, they encourage youth groups to participate in sports and camps. At a campsite, Ganezers,
in Michigan, Latvian American youth can learn the
Latvian language, history, and other cultural practices
while participating in swimming and other outdoor
sports and activities. In addition, folk songs and dances
are part of the program. Several similar camps are
located in New Jersey, New York, and western states.
Lithuanian Americans and Estonian Americans
have comparable summer camps. Scouting is part of
each cultural group, and selected activities encourage
the use of the native language, customs, and songs.
Christian youth groups also hold summer and winter
camps with outdoor activities. For example, the
Lithuanian American group, Ateitis, fosters Christian
and cultural values and physical activities. Their goal is
to have well-rounded, Christian Lithuanian American
citizens who are healthy and aware of their cultural
roots while respectful of political values associated with
U.S. citizenship.
Medical care and hospitalization are sought readily.
Attempts are made to maintain health even into old
age. Baltic countries have recently developed a growing
interest in “natural” and vegetarian diets, yoga, alternative medicine, and swimming, even in icy waters.
This is the result of Eastern philosophy and influence.
However, the standards of medical care available in the
Baltic countries at present are below those of the
United States.
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People of Baltic Heritage: Estonians, Latvians, and Lithuanians
People in the United States, Canada, and other
countries send money, medical supplies, and medications to Estonia, Latvia, and Lithuania to help with
the shortages, but the current state of health care is
poor. In the past, the U.S. State Department issued
warnings to travelers about the poor medical care available in these countries. In 1994, a U.S. Lithuanian–
sponsored clinic opened in Vilnius. The clinic provides
health care for travelers who need medical attention;
treatment is covered by U.S. medical coverage plans
(Economist Intelligence Unit, 1994).
Recent immigrants from the Baltics to America
may have different values because they lived under a
Communist regime in which the government “took
care” of their medical needs in a health-care system
that was very different from that of the United States.
These immigrants often need help understanding the
American health-care system and may be reluctant to
use it if they have no medical insurance coverage.
Folk and Traditional Practices
Individuals of Baltic descent use less folk medicine than
they did in the past. Older Americans of Baltic descent
are more likely to use more-current healing practices.
Chamomile and linden blossom teas may be used for
fevers and colds (Gelazis, 1994); honey is used for colds
and sore throats. The nurse or health-care provider
should ask about teas or folk remedies that may have
been used before the client sought medical help.
Younger people prefer to use over-the-counter cold
remedies and analgesics. The use of natural substances
for healing purposes is not customary among this
generation.
Barriers to Health Care
People of Baltic descent have few problems obtaining
access to health care. Among older Baltic immigrants,
language may continue to present difficulty if they
have not learned English well. However, most have
friends and relatives who are willing to help by translating. Most recent immigrants who may have parttime jobs and have no health-care coverage may need
help in finding medical and health care, such as free
clinics, that are available to them.
Cultural Responses to Health and Illness
Many older people of Baltic descent had lives with
hardships both before and after coming to America.
Many individuals may tolerate pain as a part of life
and may not complain about it or report it. Healthcare professionals need to assess older patients for
postoperative pain.
Some stigma is attached to mental illness, but medical care is sought. The family encourages compliance
with prescription medications and treatments.
Most people of Baltic descent accept physical
handicaps, mental illness, and mental retardation. The
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family usually cares for the individual at home. The
community is also supportive.
Americans of Baltic descent do not enjoy the sick
role and avoid it when possible. Work is highly valued,
and the person returns to normal responsibilities as
soon as possible. This attitude may be a problem if
prolonged rest is required. The nurse or health-care
professional needs to understand individual responses
to illness and the sick role.
Blood Transfusions and Organ Donation
Most people of Baltic descent accept blood transfusions and organ donation and transplantation. The
use of extraordinary means to preserve life is an individual decision, but living wills are frequently used. In
some instances, it may be up to the nurse to inform
the patient and family of their rights; the advocate role
of the nurse can be exercised if necessary.
Health-Care Providers
Traditional Versus Biomedical Providers
The literature reports no variations in beliefs that
Baltic American health-care providers have toward
each other. As with other cohort groups, variation between and among different groups of health-care
providers may be significant. Besides family me...
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