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...
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