2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 1
Chapter 27
People of Brazilian Heritage
Marga Simon Coler and Maria Adriana Felix Coler
Overview, Inhabited Localities,
and Topography
Overview
Brazil, the largest country in South America, is 2695 miles
long north to south and 2691 miles wide east to west.
Its landmass is 3,286,487 square miles, or approximately
400,000 square miles less than that of the United States
(excluding Alaska) and 600,000 square miles less than
that of Canada (CIA World Factbook, 2011). All South
American countries except Chile and Ecuador border
Brazil. The eastern boundary is the Atlantic coastline.
Brazil is extremely diverse in topography. The sparsely
populated tropical Amazon valley has little variation in
temperature throughout the year, whereas the southern
districts have distinct summers and winters. The coastal
regions have high temperatures and high humidity.
Many locations also have a distinct rainy season, which
lowers the temperature. The remainder of the country
consists of high plateaus traversed with low mountain
ranges where the climate varies, with little or no rain
much of the year (CIA World Factbook, 2011).
The Instituto Brasileiro de Geografia e Estatística
(IBGE) reports the overall population of over 190 million
people (IBGE, 2010). The net migration rate is
–0.09 /1000 population (CIA World Factbook, 2011).
The modern capital, Brasilia, located in the heart of the
jungle, has over 3,789,000 people; São Paulo has over
19,960,000 people; and Rio de Janeiro has over
11,836,000 million people. Over 26 percent of the
population is under the age of 14 years, 67 percent are
between the ages of 15 and 64 years, and 7 percent are
over the age of 65 years. Life expectancy for males is 68.7
and 76 years for females (CIA World Factbook, 2011).
Heritage and Residence
Brazilian heritage is rich in its mixture of North
Americans, Portuguese, French, Dutch, Germans,
Italians, Japanese, Chinese, Africans, Arabs, and native Brazilian Indians. Mostly Germans and Italians
settled the southern states of Brazil. The Japanese
settled in São Paulo, and African blacks in Bahia,
Salvador. There has been significant mobility secondary to employment and education. The diversity of
the population in Brazil is reflected by the diversity
among Brazilians in the United States. In addition,
the variant characteristics of culture contribute to this
diversity (see chapter 2). Above all, Brazilians do not
consider themselves Hispanics despite similarities in
their ethnicity. Their native language is Portuguese.
Information about the subcultures is virtually
unidentifiable in the professional health-care literature, which tends to incorporate Brazilians into aggregate data on Hispanics. The exact number living
in the United States is unknown. However, according
to the Center for Latin American, Caribbean, and
Latino Studies (2010), the Brazilian population in the
United States is 454,000 with the largest numbers living in Florida, Massachusetts, New Jersey, California,
and Connecticut. Many have their own churches,
spiritualists, beauty shops, travel services, and support
services. The number of Brazilians seeking U.S. citizenship in 2010 was 8800, a 125 percent increase since
2001. In five years, the nonimmigrant visa issuances
have nearly tripled to more than half a million annually
(Ministério dos Relações Exteriores, 2011).
Reasons for Migration and Associated
Economic Factors
Similar to many immigrants, Brazilians come to the
United States in search of opportunities for improving
their economic situations while planning to return to
their homeland after having acquired sufficient personal wealth to live comfortably. Many send money
home to Brazil to help their families or build their
“nest egg.” Toward this end, many subsist in urban
slums without privacy and think only of earning
money. Others flee family problems, come for educational opportunities, and leave their homeland searching for a more humane life with greater dignity.
Like other immigrants, many Brazilians are underemployed after migrating, often giving up their
professions to earn money as illegal domestic workers,
waiters, and cab drivers, and in other low-paying
1
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 2
2
Aggregate Data for Cultural-Specific Groups
positions. Even these low-paying jobs pay more than
many professional workers can earn in Brazil, which
has a per capita yearly income of US$10,800 (CIA
World Factbook, 2011). Brazilian immigrants in the
United States often move to large cities where networks help find “under-the-table” wages. Overall, these
individuals represent a wide range of professions—
from law, medicine, and academics to the arts—as well
as young men and women who have enough money for
plane fare and a tourist visa and have the courage to
disappear into the fairly accessible underground network of Brazilians in the United States, if necessary.
Most Brazilians immigrating to the United States are
between the ages of 20 and 39 years of age. More men
come than women, and most are representative of
the middle and lower-middle socioeconomic groups
(Center for Latin American, Caribbean, and Latino
Studies, 2010). Children, wives, and family are frequently left behind to become slaves of work in any type
of situation. Those who are in the United States legally
include those who have married and raised families and
those who have been sent to the United States as
Brazilian government employees.
There are students, former students, and those who
get lost in the “zone” between legal entry as tourists
and illegal residence. Others emigrate because they find
it difficult to market their skills in their home country,
creating a “brain drain” in Brazil. University-educated
Brazilians are commonly employed in manual work in
the United States.
Since the visit by Secretary of State Hillary Clinton
in March 2010 shortly after the inauguration of Brazil’s
first female president, Dilma Rousseff, there have been
increasing ties between Brazilian and American academic researchers in both the private and governmental
sectors. Medical, agricultural, and technological and
professional collaboration has escalated, especially in relation to environmentally friendly research. There is an
increasing awareness against “biopiracy,” which involves
the unauthorized taking of genetic resources or traditional knowledge of indigenous communities in Brazil
by foreign researchers. This visit launched several agreements, including the Defense Cooperation Agreement,
the Bi-national Energy Working Group Joint Action
Plan, the Tropical Forests Conservation Act, and the
General Security of Information Agreement. Other
topics discussed were trade and finance, biofuels,
nonproliferation and arms control, human rights
and trafficking, international crime, and environmental
and climate change issues (U.S. Department of State,
Bureau of Western Hemisphere Affairs, Diplomacy in
Action, 2011).
an increase in the frequency of schooling. The adult
literacy rate in Brazil is estimated to be over 90 percent,
and elementary education for the underprivileged has
risen to a fifth-grade level. Still, economic reasons as
well as the lack of transportation, accessibility, and
time create insurmountable barriers for the poor. The
federal government has been trying to upgrade public
education to the extent that school buses have become
visible, but the great majority of services remains managed by private owners or offered with extra charges.
In spite of the increasing governmental and constitutional intervention, middle socioeconomic families
often “stretch” their finances to register their children
in private schools, hoping for a better education. In
many areas, public schools lack necessary supplies and
other resources. Disciplining students and enforcing
punctuality are not part of their strengths. Children
and adolescents of the upper-lower socioeconomic citizens are often able to attend a parochial or an inexpensive private school. Middle- and upper- socioeconomic
students generally do not attend public schools.
Lack of competency in English makes it difficult
for professionals to pass required professional examinations in the United States. Children and professionals in Brazil are frequently taught by noncertified
individuals who had been abroad and who essentially
learned English outside of a formal classroom.
Communication
Dominant Languages and Dialects
Portuguese is the official language of Brazil and continues to dominate Brazilian communities in the
United States. Brazilian Portuguese is different from
its mother language in the meanings of certain words,
accents, and dialects. As in many countries, dialects
vary. One who is well versed in the language can frequently ascertain a compatriot’s origin. Language
from the interior regions of Brazil is a mixture of aboriginal Indian languages and Portuguese. Brazilians
from interior towns; the sertão, or the dry regions; and
the matta, or jungle; tend to abbreviate words and frequently run them together. These groups, however, are
rare among immigrants because they are the pobres,
the poor, and cannot afford to emigrate. This dominant class of the country often leads a hand-to-mouth
existence. Their speech appears rapid, is full of giria,
slang, and is difficult for outsiders to understand. The
language from the interior is filled with formal secondperson expressions such as the English old fashioned
“thou.” The Portuguese taught to foreigners no longer
emphasizes pronouns and verb endings.
Educational Status and Occupations
Cultural Communication Patterns
According to IBGE (2010), there has been improvement in the educational status of the population in
Brazil. They report a decrease of illiteracy levels and
General greetings are different from those of the
American culture in that Americans use the general
greeting “how are you?” without an expectation of
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 3
People of Brazilian Heritage
obtaining a true response; whereas Brazilians seem to
hold a strong desire to truly know the answer. Many
Brazilians continue to be of “proper” Old World orientation in which true feelings are not divulged for fear
of hurting the feelings of the receiver of the communication. Everything is said to be tudo bom, great, almost
in a stoic sense. However, in the intimate circle of
family, relatives, and friends, sharing thoughts and feelings is common. Young adult and adolescent Brazilians
in the United States are generally more acculturated because of their desire and need to assimilate into the new
culture. Among these groups, intragenerational communication is probably more common than intergenerational and transcultural communication when it
comes to sharing thoughts and feelings.
Like many of their Latin American neighbors,
Brazilians frequently use touch and usually maintain
eye contact. In the northern states, women kiss one
another on both cheeks when they meet and when
they say good-bye. Men shake each other’s hands and
slap each other on the back with the other hand. This
gesture frequently ends in an embrace. Children are
kissed, and there is much touching. Kissing a child frequently includes the combination of a “kiss and
smell.” Spatial distancing is close. Facial expressions
and symbolic gestures are commonplace. People from
the northeast tend to be more expressive than their
more-Westernized compatriots of Rio de Janeiro, São
Paulo, the south, and southeast.
3
name, and the father’s family name. When a woman
marries, she may opt to drop her mother’s maiden
name or her father’s name, keep her father’s name, or
she may keep them both. At times, de, da/do, or
das/dos is added to a name to denote “of ”; this seems
to be done out of tradition. 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. No
rigid protocol is apparent. Children who have no
father by marriage of the mother are often given their
mother’s maiden name or the name da Silva may be
added, denoting that the line of paternity is unclear.
This depends on the subculture.
In day-to-day relationships, people are called by
their first name, often with the title Seu (Senhor) preceding the first name of a man or Dona preceding the
first name of a woman. Doctors are addressed as
Doutor (male) or Doutora (female) and professors as
Professor (male) or Professora (female). The latter two
are followed by the first name.
Grandmothers and respected strangers are addressed
as A Senhora; fathers, grandfathers, and respected men
are called O Senhor, instead of the personal pronoun
“you.” In the same vein, God is referred to as O Senhor.
Family Roles and Organization
Head of Household and Gender Roles
Gender roles vary for Brazilians according to socioeconomics and education. Brazilian society had been
Temporal Relationships
Although most Brazilians in America are future
oriented, temporality in Brazil is focused on the present because of an unpredictable future. Therefore, for
emotional survival, the time factor must necessarily
be oriented toward the present. This is changing as
Brazil is obtaining world leadership status. During
the decades of inflation greater than 100 percent,
Brazilians learned to spend their money immediately
to avoid devaluation of the currency of the moment.
Presently, lavish credit card spending is the mode of
shopping.
Brazilians, in general, are not punctual. They tend to
arrive “a bit” late—from minutes to hours—especially
for social occasions. Everyone seems to know the behavior of tardiness and plans around it. Ceremonies are
often delayed for more than an hour as the audience and
participants wait for the arrival of an “important” person to give the beginning oration. Lunchtime often takes
longer than the usual 2 hours and is frequently used to
do errands. However, those in professional circles and
in the Westernized regions are punctual.
Format for Names
Brazilian names are lengthy, but the modern trend is
to use only the first and last names. Traditionally,
names appear as the first name, the mother’s family
REFLECTIVE EXERCISE 27.1
Yara Lima, age 65 years from Brazil, is visiting her sister and
brother-in-law, in the United States. She discloses to her sister,
a nurse, that she has been experiencing chills, fever, and fatigue
for two weeks. Her sister suspects malaria and takes her to
the neighborhood clinic for an evaluation by a friend who is a
physician.
When the physician greets Mrs. Lima by her first name, she
gasps and says nothing. When asked how she is doing she answers tudo bom. She finally admits to experiencing chills, fever,
and fatigue but says that she is not worried and prefers to
wait until she returns to Brazil next month to be seen by a
curandeiro because she does not have the money for an
American physician.
1. How should the physician have greeted this patient upon
meeting her the first time?
2. Tudo bom is a common Brazilian phrase. What does it
mean?
3. If Mrs. Lima does have malaria, what advice would you give
her for further prevention?
4. What is a curandeiro?
5. Besides money, what other reasons might Mrs. Lima want
to see a curandeiro?
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 4
4
Aggregate Data for Cultural-Specific Groups
one of machismo, with the middle and upper classes
being patriarchal in structure. Generally, women enjoy
equality as is evident by a female president elected in
2010. Lower socioeconomic households tend to be
more matriarchal in nature.
Social status is very important in the Brazilian society. This is well demonstrated in the titles that people
use with one another and the practice of listing both
parents’ surnames. Class separation is discretely maintained by literacy status.
Children are important in Brazilian families. A
wealthier family may raise the child of a poorer relative. These children often enter the family in a secondclass capacity, are sent to public or less-expensive
private schools, and are taught to help around the
house during their free time. Although no documentation substantiates the state of immigrant Brazilian
adolescents, they seem to be vulnerable in their
attempt to be accepted and Americanized.
Family Goals and Priorities
In Brazil, the goals of the family are unity and success.
Among middle and upper socioeconomic citizens, a
good education for children is sought; whereas among
lower socioeconomic citizens, the goal is survival. This
is increasingly changing as public education becomes
stronger. Night school is a very important asset for individuals who, in the past, had little future. A good
example is the household empregada, live-in housekeeper, who worked for a family for little money. Increasingly these housekeepers are hard to find and
almost nonexistent in Southern Brazil, where similar
per diem workers are paid a good hourly wage. For
upper and middle (and increasingly lower) socioeconomic Brazilians, the outcome of education is to enter
the workforce as a university graduate.
Family members living in the same household in
Brazil and abroad pool their money so that priority
needs can be met. Priorities may include a new washing machine, a 15th-birthday celebration, or the electric bill. The Brazilian father frequently sets his son
up in business. For example, a physician father might
buy a farm and set his son up in aquaculture, while
holding on to the financial reins until the son becomes
self-sufficient. Parents with a business of their own,
such as a beauty parlor or bar, frequently train their
daughters or sons to take over. Whereas a sense of responsibility and loyalty to family and country is
strong, a sense of responsibility to political causes
may be weak. In the latter scenario, loyalty can easily
be bought.
Older people live with one of their children when
self-care becomes a concern; nursing home placement
is uncommon. Older adults are respected and are
often seen as family counselors. They are included in
family activities such as child care and frequently accompany their children’s families on vacation. Older
people receive benefits such as free public bus fares
and special lines in banks and supermarkets. The waiting lines often have benches. Frequently, designated
parking spaces are denoted for older people in shopping centers and other public areas. This respect for
older people is displayed by the younger generations
who help them secure priority places wherever they
are. Younger generations commonly give up their seats
to older people on public transportation.
Brazilians are loyal to their extended families and
help relatives. The extended family is very important
in Brazil, where a jeitinho, knack, is frequently procured for employment or in housing relatives in any
situation, which can vary from the government or a
bank to helping a relative get into a special university
or school. Family businesses are common, even
among lower and middle socioeconomic citizens, in
which everyone pools their money to live comfortably.
Godparents (madrinha/padrinho) are a very important family extension. Poor families frequently ask
their patron and patrona, employer and his wife, to be
godparents to their child. Godparent’s responsibilities
include helping to provide clothing and schooling and
caring for the child in case of the parent’s death, or
in times of need. The godmother is called comadre;
compadre refers to the godfather.
Alternative Lifestyles
Although historically common in the lower socioeconomic classes, middle socioeconomic households with
a single female parent are becoming increasingly common among Brazilians. The society has also become
more accepting of gay and lesbian relationships. Gay
and lesbian newsletters and journals exist. National
and regional conferences, videos, and other informational materials publicize their movements. AIDS
and safe sex are frequent topics of their seminars and
political movements.
Workforce Issues
Culture in the Workplace
Brazilians value diplomacy over honesty, even when
they promise to attend to something the next day,
knowing that it will be impossible. This is due, in part,
to their fatalistic beliefs and, in part, to “save face.”
Most Brazilians report on time to work. However, in
northern and northeastern Brazil where life often represents a struggle and telephone lines frequently break
and collapse, people are more flexible regarding time
commitments and accepting of a person who may not
appear for work or who leaves work early during
lunch or at the end of a day. This flexibility in time
fosters early closings of businesses or offices, with employees going home before the day’s work is completed. When questioned about when a key person will
return, a favorite answer is d’aqui a pouco, a little while
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 5
People of Brazilian Heritage
from now. This may mean five minutes to a half hour,
to the next workday. Thus, immigrant Brazilians may
find it difficult to adhere to the rigid time schedules in
the North American workplace. Necessities of immediate and extended family members frequently take
priority over work, as exemplified by a son or daughter having to take his or her mother to the physician
during working hours.
Issues Related to Autonomy
Some Brazilians may have a difficult time adapting to
English in the United States if they have not had good
instruction before entering the country. English intonation and the pronunciation of certain words are
particularly difficult. Many undocumented Brazilians
find employment within the Brazilian community
where they may never have to learn English. Finding
regular employment is difficult when one is unsure of
the language or aware of one’s accent. In addition,
categorizing Brazilians under the general category of
Hispanics adds to their discomfort.
Brazilians generally respect authority and are frequently more comfortable in employment situations
in which rules and job specifications are well defined.
Brazilians tend to have a lesser sense of responsibility
than that seen in the dominant American culture. For
example, when educated people believe that they can
do something more efficiently, they are apt not to ask
permission from their supervisor to do what they believe is required to complete the job. Brazilian work
culture is not as “rigid” as that of the United States.
REFLECTIVE EXERCISE 27.2
Three graduate students from a university in the United States
went to Northeastern Brazil for a clinical experience in international nursing. Rich, who spoke the language, decided to
learn about Brazilian health services by helping a man whose
acquaintance he made at a cookout given by the American
dono (owner) of the granja (small farm). Severino de Silva, the
sole employee of the farm, filled the position of a caretaker
and cared for the animals, and performed farming duties, and
repairs. As part of his contract, Severino had his house rentfree with utilities paid for by the patron (employer). He lived in
the house with his wife and two children, ages 15 and 9 years.
Severino worked hard and was honest. Although he loved
taking care of the fruit trees and vegetable garden, he did not
enjoy taking care of the livestock. He tended the chickens,
provided the dono and his family with eggs, and sold the rest.
On weekends Severino would “go out” and sometimes did
not return home. Yet, he reported for work each morning.
Sadly, when the dono and his family went away for an
extended period, he received reports from his neighbors and
friends that the farm was “falling apart”; the dog became emaciated as did the rest of the animals. Although Severino was
5
permitted to sell the harvest and keep the income, it seemed
to the neighbors that the reason the animals were becoming
so emaciated was because not only did Severino use the
money from the harvest, but he also spent some of the animal
food allowance for weekend drinking bouts.
Severino’s behavior deviated during the patron’s absences,
in spite of the fact that he was appropriate when the owner
returned. Severino’s wife and children would not discuss their
concerns, although she would burst into tears when asked
about her husband’s behavior. Severino’s decompensation
became increasingly visible over the years. Once his wife
came crying to the patron, stating that Severino claimed the
furniture was being moved by ghosts.
1. How should Rich initially greet Severino?
2. How does the Brazilian culture address high-risk
behaviors?
3. Is sharing mental health issues, thoughts, and feelings
acceptable among Brazilian families? Among outsiders?
4. Rich is an outsider to this family and the Brazilian culture.
How might Rich approach Severino to seek help for his
alcohol misuse?
5. What value does the Brazilian culture place on family?
6. Should Rich elicit help from Severino’s wife to address his
alcohol intake?
7. What treatment options are available for alcohol and drug
misuse in Brazil?
Biocultural Ecology
Skin Color and Other Biological Variations
The “typical” Brazilian is a moreno, characterized by
brown skin and eyes and black or brown hair (Telles,
2004). However, individuals from the southern states
of Brazil may have blond hair and blue eyes due to a
strong European heritage. Asian Brazilians, most of
whom emigrated from Japan, now total more than
9 percent of the population and most live in the state
of São Paulo (CIA: World Factbook, 2011). It is not
unusual to see a Japanese first name with a Portuguese
last name or vice versa. A diverse gene pool of native
Indians and a multitude of other nationalities make
it impossible to actually describe a typical Brazilian.
Diseases and Health Conditions
The overall infant mortality rate in Brazil is 21.17 per
1000 live births with male infant mortality being
24.63/1000 and female infant mortality significantly
lower at 17.53/1000. Causes of death among children
under age 5 years, in descending order, are diarrheal
disease, measles, malaria, pneumonia, and injuries.
The overall causes of death among adults, in descending order, are ischemic heart disease, cerebrovascular
disease, violence, diabetes mellitus, lower respiratory infections, chronic obstructive lung disease, hypertensive
heart disease, road traffic accidents, and inflammatory
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 6
6
Aggregate Data for Cultural-Specific Groups
heart disease (Pan American Health Organization,
2010). In addition, a number of infectious and parasitic diseases continue to plague Brazil and include
tuberculosis, malaria, Chagas disease, leishmaniasis,
dengue fever, schistosomiasis, typhoid fever, hepatitis,
and cholera (Centers for Disease Control and Prevention, 2010). Because intestinal worms are common in
Brazilian immigrants, parasitic diseases should be
considered when health assessments are taken. No
data were found addressing the overall health conditions for Brazilians residing in the United States.
Interviews with Brazilian Americans have substantiated that the incidence of gastrointestinal illnesses increase when Brazilians first move to the United States.
Changes in eating habits from the long and ample
midday dinner to fast foods have left Brazilians in
America with numerous gastric complaints. Different
methods of milk pasteurization, along with a genetic
tendency toward lactose intolerance, can contribute
to some of these gastric problems. Many Brazilians’
stomachs do not tolerate foods served in American
salad bars. Personal interviews report an increased incidence of allergies, especially in children of Brazilian
immigrants.
Variations in Drug Metabolism
Although recent studies and citations note drugresponse variations for some ethnic groups from
environmental, cultural, psychosocial, and genetic
factors, specific studies on the Brazilian population
are not available. However, Levy (1993), in his review
of ethnic and racial differences, identified poor and
rapid drug metabolizers by race and ethnicity. In this
process, he identified various classes of medicines
and linked the rate of metabolic activity to race and
ethnicity. Unfortunately, the typical Brazilian cannot
be classified as black, Hispanic, Chinese, or white
because of the racial mix. A study of Brazilians in
this respect is indicated.
High-Risk Behaviors
Because Brazilian immigrants frequently settle in
Brazilian enclaves in large cities in the United States,
they are subject to the same risk factors as any socially
vulnerable urban subpopulation. The greatest risks
are violence, drugs, and crime. Adolescents run the
risk of resolving their adolescent identity crises by
either banding together or joining other gangs.
Because cigarette smoking had been a part of the
Brazilian culture, 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 include living in
crowded ghetto conditions where rent is inexpensive.
The undocumented status of Brazilian immigrants
places them at high risk for nonassimilation into the
culture of the community in which they live.
Another risk factor, especially for adolescents, is that
of contracting HIV or other sexually transmitted infections. The only endemic disease following Brazilians
to the United States, and for which documentation
is found, is HIV. The Brazilian Health Department
last reported the prevalence of HIV as 0.6 percent percent of the population between ages 15 and 49 years
(0.4 percent women and 0.08 percent men) but varies
from area to area (Brasil, Ministério da Saúde, 2010).
Nutrition
Meaning of Food
Food is important in the celebration of all rites among
Brazilians. Food and its counterpart, hunger, are often
viewed as symbols that determine social relations. Food
has symbolic content, is used as a reward or punishment, and establishes and maintains social relations.
Common Foods and Food Rituals
The mainstay of the Brazilian American’s diet continues to be rice, beans, farina, and cuscus, a dry, cornmeal mush. Beef, chicken, and seafood are sought
when they are not too expensive. Cafe de manha,
REFLECTIVE EXERCISE 27.3
Ana, age 27 years from Brazil, has a bachelor degree in social
work. With a 3-month tourist visa, her plans were to visit
family members, including her madrinha and padrinho, and to
travel throughout the northeastern part of the United States.
Between exciting visits to landmarks and visiting famous universities she knew from textbooks and authors she had read,
Ana started thinking about ways to better her own career
prospects. She talked with her family to make a more thorough plan. She could stay where she was or she could get a
new start, which evinced feelings of leaving friends in Brazil
and facing unfamiliar situations. She planned to enroll in a continuing education program during the summer as a way of
testing her abilities with the English language. However, she
needed to support herself somehow.
Using her 3-month tourist visa, she could enroll at the
university, but she did not have a Social Security number or
authorization to work. Therefore, there were not many options in terms of jobs. Her family helped her find a job in a demanding, fast-paced Italian restaurant requiring 8 to 10 hours
of work each day. After work, she had a 1-hour walk home,
often in snow. For the first time since she arrived in the United
States, she thought about her country of origin—Brazil, with
its tropical weather with two seasons instead of four. She
missed harbor walks in her hometown but recognized the
beauty of snow, which reminded her about Christmas movies
she used to watch when she was younger. “I’m here now,” she
realized, “it’s real.”
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 7
People of Brazilian Heritage
With demanding long workdays and not getting home until
midnight, she realized that school would not be a priority.
Besides, just a smile and memorized greetings to communicate
with customers was not a good assessment tool to measure
her proficiency in English. Customers strained to understand
her as evidenced by wrinkled foreheads and other facial
expressions. She realized she had to improve her language skills
if she were to remain on her goal to continue her education.
1. What are madrinha and padrinho?
2. What are the immigration issues facing Ana with a
3-month visa?
3. What might happen if it is discovered that Ana is working
and collecting payment “under-the-table”?
4. What are some positive aspects if Ana decides to
immigrate?
5. What are some negative aspects if Ana decides to
immigrate?
6. What evidence do you see of familism in this reflective
exercise?
7. Identify some community resources that could facilitate
Ana’s acculturation.
breakfast, typically consists of bread with cafe com
leite, half coffee and half hot milk. Sometimes, cuscus
is served with milk. Fruit, fruit juices, and scrambled
eggs are common breakfast fares among middle
socioeconomic families. Sometimes, sweet potatoes,
yams, and macaxeira, cassava, grace the table. Cold
cereals have become a favorite breakfast in many
middle socioeconomic homes.
O almoco, lunch, is eaten around noontime. This
heavy meal, consisting of beans, rice, and farina, often
includes puree, mashed potatoes, and macarão, pasta.
Desserts such as pudim de leite, custard, various
cornmeal pastries, fruit, and doce, a sweet paste made
by boiling sugar and fruit or fruit pulp, are common,
especially during late June when the holidays of
St. Anthony, St. John, and St. Peter are celebrated.
A typical vegetable salad traditionally consists of
finely cubed carrots, potatoes, and shushu, a summer
squash–like plant. A fruit salad with finely cubed
fruits is also common. This picture is rapidly changing
as various salads, fruit salads, or sliced fruits without
sugar appear on the table. Almoco in a middle socioeconomic home has at least one course of meat,
chicken, or fish. Beef is preferred very well done. Here,
too, the trend is changing as the Brazilian populace
becomes more nutrition conscious; less red meat
and green salads and vegetables are more common.
Brazilian “self-service” restaurants frequented by
many of the working class have tempting salad bars.
There is a clear tendency for all meals to become more
Westernized with an awareness of good nutrition.
After a heavy, tiring midday meal, a noontime nap
is often welcome. The noon hour is customarily 2 to
7
2.5 hours long. The workday, however, begins early
and often lasts until 5:30 or 6:00 p.m. Jantar, supper,
is light and generally eaten late in the evening.
In Brazil, goma. a manioc starch, fills the stomach.
In fact, the manioc root may be viewed as the symbolic plant, which, when made into gruel, fills babies’
stomachs for mothers who can no longer provide
breast milk because of chronic malnutrition. This
nutritionally unfortified gruel is used by all socioeconomic groups as a traditional satisfier for hungry
babies. Brazilians in the United States have joined the
North American populace in their use of pizza and
fast-food places such as McDonalds and Dunkin’
Donuts. The food is fast, liked by all in the family, and
easy to put on the table by working dads and moms.
For the many single Brazilians, it surpasses going
home, cooking, and the like, although traditional
cuscus, which is easily prepared and is culturally
satisfying, still graces the Brazilian table at home.
Dietary Practices for Health Promotion
Brazilians have become vitamin and health food conscious. However, this luxury is often not available to
those who have immigrated to North America for fast
money. Legal residents generally become health food
consumers. The preference, especially among young
Brazilian women, is to rely on vitamins instead of a
heavy diet to help them remain thin.
Nutritional Deficiencies and Food Limitations
Individuals in lower socioeconomic groups frequently
experience nutritional deficiencies. Undocumented
Brazilians who are here to earn fast money may experience malnutrition. Many native fruits are expensive,
as are other special foods that are common to the
Brazilian diet. Food limitations are imposed by
expense and lack of availability of Brazilian mainstay
foods. However, many Brazilian communities in the
United States have ethnic markets and restaurants.
Large chain supermarkets often carry a section of
ethnic foods, some of which are reasonably priced.
Pregnancy and Childbearing
Practices
Fertility Practices and Views Toward Pregnancy
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.
Herbal teas are used for bringing on late menstrual
periods and for stimulating natural abortions. Brazil
is a fatalistic country, so unwanted pregnancies and
abortions are, in the end, left in God’s hands. Fatalism,
however, is mixed with a strong sense of realism.
Therefore, immigrants in the United States generally
practice birth control so pregnancy will not interfere
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 8
8
Aggregate Data for Cultural-Specific Groups
with their reason for coming to the United States. At
times, single women try to become pregnant to facilitate their chance of remaining permanently in the
United States because the baby is a U.S. citizen by
having been born in that country. This opportunity
may be somewhat enhanced if the child is born here
and has been able to attend school. Thus, fertility
practices among immigrant Brazilians are a matter of
convenience with a traditional fatalistic overtone.
Brazilians are aware of the overpopulation problem, and modern middle socioeconomic Brazilians
like to have a casal, a family of one boy and one
girl. Pregnancies are generally accepted fatalistically
(God’s will). Frequent topics of conversation among
northeastern Brazilian women in the lower socioeconomic groups are pregnancy, abortion, stillbirths, and
child mortality. Pregnancies among immigrants are
treated according to the mother’s beliefs. Stories tell
of pregnant women returning home to their families
to receive care and to have their babies in Brazil and
of mothers who have expectations that their North
American–born children will have dual citizenship.
Prescriptive, Restrictive, and Taboo Practices
in the Childbearing Family
Many restrictions are related to pregnancy. Women are
encouraged not to do heavy work and not to swim.
Taboos also warn against having sexual relations during
pregnancy. Some foods are to be avoided, and specific
foods are recommended during pregnancy. Taboos generally vary according to geographic region, socioeconomic class, and ethnic background. Thus, a list of
taboo foods cannot be listed and the health-care
provider needs to specifically ask about taboo foods.
Whenever possible, women in Brazil go to a maternidade, a hospital specializing in obstetrics, for prenatal care and to have their children. These maternity
hospitals vary in quality and quantity of services.
Generally hospitals for the lower socioeconomic citizens and university hospitals provide excellent, modern services, such as regular prenatal visits with
physicians. There are, however, private hospitals with
unsanitary conditions and flies due to lack of screening. Cesarean sections are common. All licensed
nurses practice midwifery. Use of sedation is common
and preferred by many over natural childbirth. Lay
parteiras, midwives, deliver babies at home when transportation or money is not available.
Since the 1950s, scientific evidence has demonstrated
that artificially fed infants have much higher rates of
morbidity and mortality than those who are breastfed.
Breast milk contains immunoglobulins, phagocytes,
T-lymphocytes, enzymes such as lysozymes, and many
other factors, including cells, antibodies, hormones, and
other important constituents not present in infant
formula, that help protect the infant against infection.
Yet, many Brazilian mothers prefer to give their babies
powdered formula instead of breast milk. Middle socioeconomic women wish to regain their figures as soon
as possible. Lower socioeconomic women often feel
that their milk is fraca, weak. Even though powdered
milk formula exposes babies to contaminated water,
overdilution, and contaminated utensils, many working
mothers prefer its convenience. New customs continue
to evolve as bottle-feeding replaces breastfeeding.
Breastfeeding is still linked to a social stigma; a mother
who breastfeeds may often be thought of as abandoned
or sexually unattractive.
In the Brazilian culture, a postpartum woman eats
chicken soup to help her body return to normal. She
is also advised not to eat spicy foods or rapadura, a
molasses candy, and not to drink garapa, sugar water,
or caldo de cana, sugarcane juice if she breastfeeds
her infant.
Death Rituals
Death Rituals and Expectations
Death rituals in Brazil frequently follow religious prescriptions. However, in the interior especially, it is rare
to see a hearse or a funeral parlor. In those areas, the
deceased, especially in the lower socioeconomic groups,
are kept at home until the body is buried. A photographer may be called to take a picture of the body in the
coffin, which, after some touching up to make it look
natural, may be used as a photo to adorn the living
room wall, along with photos of other deceased relatives. The deceased frequently appear in visions and
dreams to inform intimate survivors of their needs.
Bones of a loved one are sometimes buried in the
same plot as other family members to keep the family
together. A great fear is to have a body destroyed or
mutilated so that all the parts are not together. Those
in power, such as police or other oppressors, sometimes take advantage of this belief to subdue believers
who are generally in the lower socioeconomic groups.
If possible, the family carries the coffin to the cemetery, which is usually on the outskirts of a community
and separated by a solid cement wall. Cemeteries consist of specially purchased family lots containing vaults
in which the dead are placed. In addition, unmarked
2-foot graves are provided for the unclaimed and poor.
Many Brazilians prefer to be placed in a coffin rather
than risk being buried alive in a vault. Everyone’s desire is to be buried in his or her own coffin, regardless
of whether it is lined with silk or cardboard. Coffins
are frequently not nailed shut to facilitate escape.
Coffins may be pink, blue, or white, with specially
designed coffins for babies and children. Babies and
children are buried with their eyes open so that they
may see God and His angels. Frequently, children are
buried holding candles to light their way. The death of
a baby or an infant historically has been, and continues
to be, treated joyfully and without much sadness, for
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 9
People of Brazilian Heritage
the child died pure and is regarded as an angel. Children
are dressed in white with their hair curled, and ribbons
or garlands are interwoven. The mouth is fixed into a
smile, and the hands are folded. Flowers fill the coffin,
and notes to the Virgin Mary or a saint may be tucked
into the hands. A festive celebration, the Wake of the
Angels, is a mixture of joy and sadness. One may still
see children in their best clothes carrying the coffin to
the cemetery, representing a procession of the angels.
The custom of wrapping the dead body in its personal
hammock for burial is still practiced among lower
socioeconomic citizens in the interior of Brazil.
If financially possible, families of Brazilians who die
in the United States personally accompany the body
to Brazil for burial in the family vault. If family members cannot come from the United States, relatives
meet at the airport upon the body’s arrival in Brazil.
Responses to Death and Grief
Responses to death and grief depend on the family. To
a poor family, a continuously suffering person is rescued. The fatalistic expression, “It was God’s will,” helps
grieving among the rich and the poor. Older people
wear black for various lengths of time depending on the
relationship of the family member. Frequently, the final
portrait is hung in the family chapel or near the family
altar, and prayers are recited. An eternal light burns. 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 for several years. Anojamento is the
Brazilian term for deep mourning or grief.
Spirituality
Dominant Religion and Use of Prayer
Seventy-four percent of Brazilians are nominally
Roman Catholic, 15 percent Protestant, 1.3 percent
Spiritualist, 0.3 percent Bantu/voodoo, 1.8 percent
other, and 7.4 percent unspecified (CIA World Factbook, 2011). Jewish temples and synagogues and
structures of various Eastern religions are also present
in Brazil. Spiritualism often occurs in the form of
Afro-Brazilian sects and the Universal Church of the
Reign of God. Spirits and souls are called to intervene
for various problems of health, life, and death. Although most traditional religions are represented in
Brazil, prayer is an individual matter. The family altar
is a common site of prayer. Frequently, saints and
“Our Lady” are asked for help.
Meaning of Life and Individual Sources
of Strength
The meaning of life for most Brazilians and Brazilian
Americans is found in religion, economy, fatalism, and
reality. For some, life is uma luta, a battle. For others,
9
life is an almost-hedonistic attitude. Women and children, and often men, dance the native dances the
minute familiar music is played, often by an impromptu band of three or four playing Brazilian instruments.
Brazilians in general are hard workers during the
week while waiting for weekend activities. Social gatherings are the most common way to socialize, meeting
in public places such as beaches, shopping malls,
parks, and bars/restaurants. The greatest source of
strength for Brazilians is their immediate and extended families. Tradition and folk religion are other
sources of strength.
Spiritual Beliefs and Health-Care Practices
Curandeiros (folk healers), or similar special healers,
exorcise and pray for the wellness of their patients.
Saints are asked for help, and some people wear
medals or little pouches of special powders around
their necks to ward off bad spirits. Rezadeiras, or spiritual leaders, also have a strong influence on health
practices among populations of small towns, especially in the northeastern region of Brazil.
Health-Care Practices
Health-Seeking Beliefs and Behaviors
Health care in Brazil is provided by both private and
government institutions. The Ministry for Health and
Ageing administers national health policy. Free health
care at the point of entry into the system is provided
by the public health system known as Sistema Uificado
da Saúde [Unified System of health] (WHO/PAHO,
2011). Health-seeking behaviors among Brazilians living in the United States are increasing. Information
about safe sex is frequently sought to prevent sexually
transmitted infections. A paradigm shift from acute
care to preventive care is evident among Brazilians in
Brazil and in the United States.
Responsibility for Health Care
The family is the nucleus of responsibility for health
care. Brazilians in Brazil and in the United States
are joining the Western approach for taking responsibility for their own health promotion and wellness.
Lower socioeconomic citizens seem to value prevention but frequently lack the resources for accessing
these services.
Brazilians are familiar with private and public insurance options. In Brazil, national health insurance
is mandatory for each salaried person and her or his
family. Middle and upper socioeconomic Brazilians
frequently select private plans. Society still borders on
feudalism in the north and northeast where the patrão,
employer, assumes responsibility for meeting the person’s medical needs. This responsibility frequently extends to the employee’s family, wherever they reside.
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 10
10
Aggregate Data for Cultural-Specific Groups
Blood Transfusions and Organ Donation
Similar to the United States and other parts of the
world, acceptance of blood transfusions, organ donation, and organ transplantation depends on religious
credence and individual preference. The same is true
for blood transfusions.
Self-Medication Practices
Because Brazilians tend to self-medicate, the procurement of health care is often avoided or delayed in the
United States. Consulting with someone who has the
same condition or with friends who know someone
who has a similar condition may be the first step. A
trip to the local pharmacist may be the second. Middle
and upper socioeconomic Brazilians frequently select
private plans. Society still borders on feudalism in the
north and northeast, where the patrão (employer) assumes responsibility for meeting the person’s medical
needs. This responsibility frequently extends to the
employee’s family, wherever they reside.
Antibiotic, neuroleptic, antiemetic, and most other
prescription drugs are easily obtained over the counter
in Brazilian pharmacies. Many prefer and use homeopathic medicines and herbs. Once in the United States,
it becomes difficult to obtain the many drugs readily
available in Brazil. Consequently, incoming Brazilians
often bring medicines requested by their friends and,
thus, maintain the circulation of medications not available to Brazilians living in the United States.
Pain/Sick Role
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 in Brazil
without a prescription. Frequently, a person living in
the United States requiring these on a regular basis
can request that friends or friends of friends bring a
supply from Brazil.
Most Brazilians do not work if they are seriously ill.
Sickness is a neutral role and is considered socially
exempt—free of guilt, blame, and responsibility. Illness
is looked at from a fatalistic point of view. Nervos, an
ever-present folk diagnosis, identifies weakness, craziness, and anger associated principally with hunger.
Among lower socioeconomic citizens, the term doença
dos nervos refers to an all-encompassing illness. This
diagnosis reveals, and simultaneously conceals, the
truth of the existence of a still-struggling people.
Mental Health and Disabilities
In Brazil, people with physical and mental handicaps
are usually cared for and kept at home. However, people
with physical handicaps can be seen begging on street
corners. Both physical and emotional rehabilitation facilities are available, but access is difficult. Although the
literature contains little data regarding how Brazilians
view mental illness in general, mental health care and
services are available in the private and public sectors in
Brazil. Thus, one might expect at least a minimal acceptance of mental illness among Brazilian immigrants
residing in the United States.
Following the trend of many European and North
American health systems, substandard public mental
hospitals have been closed or modernized, and the responsibility for treating mental illness has fallen into
the realm of the community health system. Drug treatment centers exist for those who are habituated. Some
university and private inpatient or day-treatment facilities offer modern psychiatric treatment. A slow trend
toward family-based psychiatric services is apparent.
Barriers to Health Care
At times, support services for legal and undocumented
Brazilians in the United States are hard to find for those
who do not have language skills or the self-esteem to
become assimilated into the culture of their newly
found environments. In fact, language is one of the
major problems for these immigrants. They neglect to
learn English and get by in their enclave community,
which may be detrimental to accessing health-care
facilities. Those with a good command of the language
can more readily incorporate new technical terms
into their vocabulary. Much health-care information
is translated into Portuguese, although much more
material exists for Hispanics.
Another barrier to health care for Brazilians in the
United States is its cost. This, combined with lack of
knowledge about the health-care system and facilities
impedes both legal and undocumented residents.
Most Brazilians do not talk about their illnesses unless
these 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. The authors are not aware of
whether this is denial or an actual, culturally selfimposed restriction, perhaps linked with some fear of
prejudice. For example, patients with gastric cancer
may insist they are in good health.
Because many Brazilians tend to shun hospitals,
the family remains with the patient when hospitalization is a necessity. The patient is often brought food
from home. Brazilian families are eager to participate
in patient care and, thus, can be taught various
procedures and care activities.
Health-Care Providers
Folk and Traditional Practices
The Brazilian culture is rich in folk practices that vary
with geographic region, ethnic background, socioeconomic factors, and generation. Traditional and homeopathic pharmacies are supplemented by remedios
populares, folk medicines, and remedios caseiros, home
2780_BC_Ch27_001-011 03/07/12 9:53 AM Page 11
People of Brazilian Heritage
medicines. In Brazil, open-air markets have stands
that specialize in herbs and home medicines. Traditional schools of pharmacy grow, sell, and teach
courses on folk remedies. Home remedies such as
herbal teas, mixtures, and syrup with lemon and
honey are used frequently to decrease illness symptoms. Prolonged symptoms or more-serious indications of disease are common precedents in the search
for medical attention. Folk remedies and traditional
health-care practices become intermeshed, such as
when a serious illness may be treated best by traditional caretakers. Some patients are prescribed homeopathic bolinhas, little white balls, prepared for specific
ailments. Curandeiros (folk healers) generally treat the
poor, who have little faith in public clinics with their
endless lines and long waiting periods. Herbs, roots,
leaf teas, and salves are common cures for ailments.
Traditional Versus Biomedical Providers
The Brazilian folk-health field has many types of
health-care providers: Curandeiros are divinely gifted,
and, rezadeiras (praying women) help exorcise an
illness. There are also card readers who can predict
fortunes, espiritualistas are able to summon souls and
spirits, conselheiros are counselors or advisors, and
catimbozeiros are sorcerers. In addition, the mae or pai
de santo are head priestesses or priests from the
African Brazilian Umbanda or Xango religion. All
have the power to heal their believers.
Status of Health-Care Providers
In Brazil, nurses employed in private practice or in private physician-owned clinics are not as respected as others and are frequently treated as lower-class individuals
by their employers. The advent of nursing diagnosis has
helped strengthen the profession and has promoted assertiveness in nursing practice. Although physicians are
still generally seen as the leaders of health care, nurses,
social workers, physiotherapists, and nutritionists are
evolving as independent professional providers.
The advanced practice role of the nurse is not common in Brazil. However, nursing is beginning to recruit
individuals to act in such roles via the master’s and doctoral programs in nursing that exist in Brazil. Healthcare professionals seem to mutually respect each other.
11
This seems particularly true among university faculties.
The medical profession does not restrict according to
gender. Nursing, however, continues to be predominantly female. Generally, Brazilians seek a good physician rather than basing their choice on the professional’s
gender. Some women prefer female physicians for gynecology and obstetrics.
Brazilians in the United States tend to respect
physicians and nurses. Medical education is prestigious and highly sought after by aspiring university
students.
REFERENCES
Brasil Ministério da Saúde. [Brazil Ministry of Health]. (2011). Retrieved from http://portal.saude.gov.br/portal/saude/profissional/
area.cfm?id_area=1483
Center for Latin American, Caribbean, and Latino Studies.
(2010). Brazilians in the United States. Retrieved from
http://web.gc.cuny.edu/lastudies
Centers for Disease Control and Prevention. (2010). Emerging Infectious Diseases. Retrieved from http://www.cdc.gov/ncidod/
eid/vol4no1/momen.htm
CIA. (2011). World FactBook: Brazil. Retrieved from https://www.
cia.gov/library/publications/the-world-factbook/geos/br.html
Instituto Brasileiro de Geografia e Estatística [Brazilian Institute
of Geography and Statistics] (IBGE). 2010. Retrieved from
http://www.ibge.gov.br/english/
Levy, R. (1993). Ethnic and racial differences in response to medicines: Preserving individualized therapy in managed pharmaceutical programmes. Pharmaceutical Medicine, 7, 139–165.
Ministério dos Relações Exteriores [Ministry of External Relations]. (2011). Retrieved from http://www.itamaraty.gov.br/
Pan American Health Organization. (2006). Mortality Country
Fact Sheet: Brazil. Retrieved from http://www.who.int/gender/
violence/who_multicountry_study/fact_sheets/Brazil2.pdf
Telles, E. E. (2004). Race in another America: The significance of
skin color in Brazil. Princeton, NJ: Princeton University Press.
U.S. Department of State, Bureau of Western Hemisphere Affairs.
Background Note. Brazil. (March 8, 2011). Retrieved from
http://www.state.gov/r/pa/ei/bgn/35640.htm
World Health Organization. (2011). Pan American Health Organization. Retrieved from http://new.paho.org/hq/index.php?
option=com_content&task=view&
For case studies, review questions, and additional
information, go to
http://davisplus.fadavis.com.
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
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 2
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).
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 3
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
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 4
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
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 5
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).
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 6
6
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
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 7
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
2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 8
8
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 Def...
Purchase answer to see full
attachment