Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ More than a billion people inhabit India.
▪ Eighty percent of the population are Hindus,
followers of Hinduism.
▪ Other significant religious groups include Sikhs,
Moslems, and Christians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ Different religious sectors share many common
cultural beliefs and practices.
▪ Immigrants to the United States come
predominantly from urban areas, including all
major Indian states.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ Most recent immigrants are highly educated.
▪ More than 1,600,000 Asian Indians are living in
the United States.
▪ Most come to the United States to attain a higher
standard of living, better working conditions, and
job opportunities.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Asian Indian languages fall into two main
groups: Indo-Aryan in the north and
Dravidian in the south.
▪ Hindi, with 1,652 dialectical variations, is the
national language along with English.
▪ Women often speak in a soft voice, making it
harder to understand what they say.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Men may become intense and loud when
they converse with other family members.
▪ Women avoid direct eye contact with men.
▪ Direct eye contact with older people and
authority figures may be considered a sign of
disrespect.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Touching and embracing are not acceptable
for displaying affection.
▪ Even between spouses, a public display of
affection such as hugging or kissing is
frowned upon, being considered strictly a
private matter.
▪ Temporality is past-, present-, and future–
oriented.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Punctuality in keeping scheduled appointments
may not be considered important.
▪ Older family members are usually not
addressed by name but as elder brother, sister,
aunt, or uncle.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ A woman never addresses a man by name
because the woman is not considered an
equal or superior.
▪ Strangers are greeted with folded hands and a
head bow that respects their personal
territory
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ No institution in India is more important than the
family.
▪ The hierarchical structure of authority is the
patriarchal joint family based on the principle of
superiority of men over women.
▪ The male head of the family is legitimized and
considered sacred by caste and religion, which
delineate relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Central relationships are based on continuation
and expansion of the male lineage through
inheritance and ancestor worship, related to the
father-son and brother-brother relationships.
▪ A matrilineal system exists in a few areas in the
southwestern and northeastern regions of the
country; however, power rests with the men in
the woman’s family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ A submissive and acquiescent role is expected of
women in the first few years of married life with
little or no participation in decision-making.
▪ Strict norms govern contact and communication
with the men of the family, including a woman’s
husband.
▪ Parents strongly encourage and emphasize
scholastic achievement in fields that promise
good employment and a high social status.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Although many parents expect and accept the
Westernization of their children, the question of
marriage is still a concern for parents who have
opinions about how their children should be
married, whether “arranged” or partly arranged.
▪ Hindu parents or Indians from all religious
traditions want their children to marry other
Indians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Arranged marriages at a young age are
considered most desirable for women.
▪ The practice of an arranged marriage continues
in the United States in order to minimize the
stress associated with differences in castes,
lifestyles, and expectations between the male
and female hierarchy.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ The two major types of transfer of material wealth
accompanying marriage are bride price and a
dowry.
▪ Bride price is payment in cash and other
materials to the bride’s father in exchange for
authority over the woman, which passes from her
kin group to the bridegroom’s kin group.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ In the joint family structure, Hindu women are
considered “outsiders” and are socialized and
incorporated in such a way that “jointness” and
residence are not broken up.
▪ A close relationship between the husband and
wife is disapproved because it induces favoring
the nuclear family and dissolving the joint family.
▪ A marriage is regarded as indissoluble.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Older family members are held in reverence and
cared for by their children when self-care
becomes a concern.
▪ Single-parent, blended, and communal families
are not well accepted by Hindus.
▪ Homosexuality may cause a social stigma.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
A male nurse is giving dietary discharge
instructions to Mrs. Mukhopadhya. She she does
not maintain eye contact with the nurse. This
means she is
a. Embarrassed.
b. Does not understand.
c. Demonstrating respect.
d. Does not care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
Out of respect, traditional Hindus do not maintain
eye contact with authority figures, nor do females
maintain eye content with men.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Workforce Issues
▪ At work, Hindus adopt American practices and
cultural habits.
▪ Hierarchies of age, gender, and caste prescribe
transactions among Hindus.
▪ At work, relationships are a reproduction of the
authority-dependence characteristic of family and
social relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Workforce Issues
▪ In seeking to establish a personal and
benevolent relationship, Hindus may be seen
as too eager to please, ingratiating, or docile, all
antithetical to the task of assertion and
independence.
▪ Women avoid direct eye contact with men.
▪ Direct eye contact with older people and
authority figures is a sign of disrespect.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Indian diversity of physical types and can be
divided into three general groups according to
the color of their skin:
▪ White in the north and northwest,
▪ Yellow in areas bordering Tibet and Assam, and
▪ Black in the south.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Indids (whites) have a light-brown skin color,
wavy black hair, dark or light brown eyes, are tall
or of medium height, and are either
dolichocephalic (long-headed) or brachycephalic
(short-headed).
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Melanids, often referred to as the Dravidians and
are the population of southern India, have dark
skin ranging from light brown to black, elongated
heads, broad noses, thick lips, and black, wavy
hair.
▪ They are usually shorter than 5 feet 6 inches tall.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Common health conditions of Asian Indians
include malaria, filiariasis, tubersulosis,
pneumonia, cardiovascular diseases, rheumatic
heart disease, sickle cell anemia, dental disease,
lactose intolerance, cancer of the cheek, nose,
and mouth, breast and stomach cancer,
ichthyosis vulgaris, beriberi, thiamine deficiency,
goiter, osteomalacia, dropsy, and flurosis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Many individuals require lower doses of lithium,
antidepressants, and neuroleptics, and they may
experience side effects even with the lower
doses.
▪ They are also more sensitive to the adverse
effects of alcohol consumption, resulting in
marked facial flushing, palpitations, and
tachycardia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu High-risk health Behaviors
▪ Alcoholism and cigarette smoking among Hindu
Americans, especially among men, cause
significant health problems.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Dietary habits are complex and regionally varied. Most
believe that food was created by the Supreme Being for
the benefit of man.
▪ The influence of religion is pervasive in food selection,
customs, and preparation methods.
▪ Classification of regional food habits can be two-fold
based on the types of cereals and fresh foods
consumed.
▪ In the first category are rice and bread eaters; in the
second category are vegetarians and non-vegetarians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Vegetarianism is firmly rooted in culture.
▪ The term non-vegetarian is used to describe anyone
who eats meat, eggs, poultry, fish, and sometimes
cheese.
▪ Many Brahmins in North India consider eating meat to
be religiously sanctioned.
▪ In some parts of India, eating fish is acceptable to
Brahmins, whereas in other parts eating meat is
sacrilegious.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Dietary staples include rice, wheat, jowar, bajra,
jute, oilseeds, peanuts, millet, maize, peas,
sugarcane, coconut, and mustard.
▪ Cereals supply 70 to 90 percent of the total
caloric requirements.
▪ A variety of pulses or lentils, cooked
vegetables, meat, fish, eggs, and dairy products
are also consumed.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Heavily spiced (curry) dishes with vegetables,
meat, fish, or eggs are favored, and hot pickles
and condiments are common.
▪ Spice choices include garlic, ginger, turmeric,
tamarind, cumin, coriander, and mustard seed.
▪ Vegetable choices include onions, tomatoes,
potatoes, green leaves, okra, green beans, and
root vegetables.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ In North India, wheat is the staple food. Other
cereals are jowar, bajra, and ragi, consumed in
porridges, gruels, and rotis (baked pancakes).
▪ People from Punjab do not favor fish, and people
from the south generally dislike the idea of meat
of any kind.
▪ In Saurashtra in the south, fish, fowl, flesh, and
eggs are taboo practically everywhere.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Women generally serve the food but may eat
separately from men.
▪ Women are not allowed to cook during their
menstrual periods or have contact with other
members of the family.
▪ Foremost among the perceptions of Hindus is
the belief that certain foods are “hot” and others
are “cold,” and therefore, they should only be
eaten during certain seasons and not in
combination.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Geographic differences in the hot and cold
perceptions are dramatic.
▪ Many foods considered hot in the north are
considered cold in the south. Such perceptions
and distinctions are based on how specific
foods are thought to affect body functions.
▪ Failure to observe rules related to the hot and
cold theory of diseases results in illness.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ Birth control methods include intrauterine devices,
condoms, and rhythm and withdrawal methods.
▪ Grandmothers, mothers, and mothers-in-law are
considered to have expert knowledge in the use of home
remedies during pregnancy and the postpartum period.
▪ Many older women frequently travel to the United States
to assist new mothers in antenatal and postnatal care that
is consistent with traditional customs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ The birth of a son is a blessing because the son
carries the family name and takes care of the
parents in their old age.
▪ The birth of a daughter is cause for worry and
concern because of the traditions associated with
dowry, a ritual that can impoverish the lives of
those who are less affluent.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ No taboo against the father being in the delivery
room exists, but men are usually not present
during birthing.
▪ Because self-control is valued, women suppress
their feelings and emotions during labor and
delivery.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Certain “hot” foods like eggs, jaggery, coconut,
groundnut, maize, mango, papaya, fruit, and meat are
avoided during pregnancy because of a fear of abortion
caused by heating the body or inducing uterine
hemorrhage.
▪ Pregnancy is a time of increased body heat; hence, “cold”
foods, such as milk, yogurt, and fruits, are considered
good. Buttermilk and green leafy vegetables are avoided
because of the belief that these foods cause joint pain,
body aches, and flatulence.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Burning sensations during urination, scanty urine,
or a white vaginal discharge are considered
serious signs of significant overheating.
▪ Overeating and consumption of high-protein
foods, including milk, are avoided because such
foods result in an exaggerated growth of the
baby that may lead to a difficult delivery.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Morning sickness is caused by an increase in
body heat.
▪ Anemia caused by iron deficiency is one of the
nutritional disorders affecting women of
childbearing age. This condition may be
aggravated because of the practice of reducing
the consumption of leafy vegetables to avoid
producing a dark-skinned baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Childbearing Practices
▪ After the birth, both the mother and the baby
undergo purification rites leading to the 11th day.
▪ The baby is officially named on the 11th day
during the “cradle ceremony,” and several rituals
are performed to protect the baby from evil spirits
and to ensure longevity.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Childbearing Practices
▪ The postpartum mother is considered to be impure and is
confined to a warm room and often keeps the windows
closed to protect her against cold drafts. Exposure to air
conditioners and fans, even in warm weather, may be
considered dangerous.
▪ The pollution lasts for 10 days. This period of
necessitated and mandatory confinement assists in
bonding between the mother and the newborn. It provides
the mother with adequate rest and time to tend to the
baby’s needs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ A sponge bath for the newborn is recommended
until the umbilical cord falls off.
▪ Soft massage to the extremities is recommended
before bathing the infant.
▪ Washing the infant’s hair daily is believed to
improve the quality of the hair.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ During the postpartum period, hot foods, such as
brinjals, drumsticks, dried fish, dhal, and greens,
are good for lactation.
▪ Cold foods, such as buttermilk and curds,
gourds, squashes, tomatoes, and potatoes, are
restricted because they produce gas. Cold foods
are thought to produce diarrhea and indigestion
in the infant.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ Abstentions are primarily practiced for the baby’s
health; harmful influences might be transmitted
through the mother’s breast milk. Some believe
that colostrum is unsuited for infants. Most
women think that the milk does not “descend to
the breast” until their ritual bath on the third day
and, as a result, newborns are fed sugar water or
milk expressed from a lactating woman.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ Breast milk is commonly supplemented with
cow’s milk and diluted with sugar water. A
child’s stomach is considered weak as a result
of diarrhea; therefore, the child is given diluted
milk.
▪ Sources of protein, such as eggs, curds, and
meat are avoided because they might adversely
affect the baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ The mother’s diet the first few days is restricted
to liquids, rice, gruel, and bread.
▪ Boiled rice, eggplant, curry, and tamarind juice
are added to the diet between 6 months and a
year after the birth of the baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ A tenet of Hinduism is that the soul survives the
death; death is a rebirth.
▪ The death rite is called antyesti, or last rites.
▪ The priest pours water into the mouth of the
deceased and blesses the body by tying a thread
around the neck or wrist.
▪ The eldest son completes prayers for ancestral
souls, but all male descendants perform the rites;
each offers balls of rice on behalf of the
deceased ancestor.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ The body is usually cremated rather than
interred.
▪ The ashes are immersed or sprinkled in the holy
rivers. Such immersions are of great benefit to
the souls of the dead.
▪ Hindus may save their family’s ashes to later
scatter them in holy rivers when they return to
their homeland.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ Women may respond to the death of a loved one
with loud wailing, moaning, and beating their
chests in front of the corpse, attesting their
inability to bear the thought of being left behind to
handle situations by themselves.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Hinduism, the largest religion and oldest tradition
practiced in India, represents a set of beliefs and a
definite social organization.
▪ Hinduism denotes belief in the authority of Vedas and
other sacred writings of the ancient sages, immortality
of the soul and a future life, existence of a Supreme
God, the theory of karma and rebirth, theory of the four
stages of life, and the theory of four Purusarthas, or
ends of human endeavor.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Orthodox Hindus view society as divinely
ordained on the basis of the four castes: (a)
Brahmin, the highest caste, priests and
scholars, emerged from the head of God; (b)
Kshtriya, warriors, from the arms; (c) Vaisya,
merchants, from the waist; and (d) Sudra,
menials, from the feet of God.
▪ Hindu legal codes are based on the caste
system.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Women often fast one day a week or for a lunar month
to fulfill a vow made to a deity in supplication for a
particular blessing.
▪ Wives frequently fast to secure the continued health of
their husbands and families.
▪ Shrines may be set up in the living room, dining room,
or in a back room or in a closet.
▪ The shrine typically contains representations or
symbols of one or more deities.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
The wife of Mr. Ganganna ask the nurse to arrange
antyesti for her critically ill husband. The nurse
recognizes that antyesti is
a. Last rights.
b. A Hindu religious leader.
c. A traditional Hindu healer.
d. A strength enhancing special drink.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Antyesti is last rights among Hindus.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Physical examinations are especially traumatic to
women who may not have experienced or heard
about Pap tests and mammography exams.
▪ Most individuals believe that illnesses attack an
individual through the mind, body, and soul.
▪ Some believe that too much sexual activity and
worry are associated with tuberculosis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Suffering of any kind produces hope, which is essential to
life.
▪ To maintain harmony between self and the supernatural
world, the belief that one can do little to restore health by
oneself provides a basis for ceremonies and rituals.
▪ Worshiping goddesses, pilgrimages to holy places, and
pouring water at the roots of sacred trees have medicinal
effects in healing the sick person and in appeasing the
planets to help prevent illnesses and misfortunes.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ In Ayurveda, the traditional system of medicine in India,
the primary emphasis is on the prevention of illnesses.
Individuals have to be aware of their own health needs.
▪ One of the principles of Ayurveda includes the art of living
and proper health care, advocating that one’s health is a
personal responsibility.
▪ The key to health is an orderly daily life in which personal
hygiene, diet, work, and sleep and rest patterns are
regulated.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ A common health problem is self-medication.
▪ Those migrating to America are accustomed to
self-medicating and may bring medications with
them or obtain medications through relatives and
friends.
▪ The traditional healers use Ayurvedic, Siddha,
and Unani medical systems all of which are
based on the Tridosha theory.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ The Ayurvedic system uses herbs and roots; the
Siddha system, practiced mainly in the southern
part of India, uses medicines; and the Unani
system, similar to the Siddha, is practiced by
Muslims.
▪ According to the Tridosha theory, the body is
made up of modifications of the five elements:
air, space, fire, water, and earth.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Because of their religious beliefs of karma,
Hindus may attempt to be stoic and may not
exhibit symptoms of pain.
▪ Pain is attributed to God’s will, the wrath of God,
or a punishment from God and is to be borne
with courage.
▪ Family may not want to disclose the gravity of an
illness to the patient or discuss impending
disability or death for fear of the patient’s
vulnerability and loss of hope, resulting in death.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ The sick role is assumed without any feeling of
guilt or ineptness in doing one’s tasks.
▪ The individual is cared for and relieved of
responsibilities for that time.
▪ Psychological distress may be demonstrated
through somatization, which is common,
especially in women.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Because of the stigma attached to seeking
professional psychiatric help, many do not
access the health-care system for mental health
problems.
▪ Mental illness is considered to be God’s will.
▪ No Hindu policy exists that prevents receiving
blood or blood products.
▪ Donating and receiving organs are acceptable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ Although Hindus in general have a favorable attitude
toward American physicians and the quality of medical
care received in the United States, relatives and friends
are usually consulted before health-care professionals.
▪ Physicians are considered omnipotent because God
grants cures through physicians.
▪ Clients tend to be subservient and may not openly
question physicians’ behavior or treatment.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ Physician is also viewed like an older person in the
family; a protective, authoritative, and responsible
relationship; and a parent-child relationship.
▪ Mental health traditional healers such as Vaids, practice
an empirical system of indigenous medicine; mantarwadis
cure through astrology and charms; and patris act as
mediums for spirits and demons.
▪ Women are especially modest, generally seeking female
health-care providers for gynecologic examinations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ The Republic of Cuba is a multiracial society with
people of primarily Spanish and African origins.
▪ Other ethnocultural groups include Chinese,
Haitians, and Eastern Europeans.
▪ Spain, the United States, and the Soviet Union
significantly influence Cuba’s history and culture.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Mistrust of government has reinforced a strong
personalistic tradition and sense of national
identity evolving from family and interpersonal
relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Desire for personal freedom, hope of refuge,
political exile, and promise of economic
opportunities prompted migration.
▪ Cubans in the United States take great pride in
their heritage and tend to be conservative,
Republican, and anticommunist.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Many possess a strong ethnic identity,
speak Spanish, and adhere to traditional
Cuban values and practices..
▪ The highest concentration of Cubans is in
Florida, although significant numbers live in
New Jersey, New York, Illinois, and
California.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Many Cubans live and transact business in
Spanish-speaking enclaves.
▪ While the second generation speaks Spanish,
many converse with friends or peers in
“Spanglish,” a mixture of Spanish and English.
▪ The highly educated are more likely to speak
English at home.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Many value simpatía and personalismo in their
interactions with others.
▪ Simpatía, the need for smooth interpersonal
relationships, is characterized by courtesy, respect,
and the absence of criticism or confrontation.
▪ Personalismo, the importance of intimate
interpersonal relationships, is valued over
impersonal bureaucratic relationships.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Choteo, a lighthearted attitude with teasing,
bantering, and exaggerating is often observed
in their communications with others.
▪ Conversations are characterized by animated
facial expressions, direct eye contact, hand
gestures, and gesticulations.
▪ Voices tend to be loud, and the rate of
speech is fast.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Touching, handshakes, and hugs are
acceptable among family, friends, and
acquaintances and may be used to express
gratitude to the caregiver.
▪ Touch is common between people of the
same gender; older men and women rarely
touch in public.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Most tend to emphasize current issues and
problems rather than future ones.
▪ Hora cubana (Cuban time) refers to a flexible period
that stretches 1 to 2 hours beyond designated clock
time.
▪ Most Cubans use two surnames representing the
mother and father’s family names.
▪ Married women may also add the husband’s name.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Traditional family structure is patriarchal,
characterized by a dominant and assertive male
and a passive, dependent female.
▪ Traditionally, Cuban wives stay at home, manage
the household, and care for children, whereas
husbands are expected to work, provide
financially, and make major decisions for the
family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Honor is attained by fulfilling family obligations and
treating others with respeto (respect).
▪ Vergüenza, a consciousness of public opinion and the
judgment of the entire community, is considered more
important for women than for men.
▪ Machismo dictates that men display physical strength,
bravery, and virility and be the spokesperson, even
though they might not make the decisions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ La familia (the family, nuclear and extended,
including godparents) is the most important
source of emotional and physical support.
▪ Multigenerational (3 to 4 generations)
households are common, including a high
proportion of people 65 years and older who live
with their relatives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ According to U.S. standards, Cuban parents tend to
pamper and overprotect their children.
▪ Children are expected to study, respect their parents, and
follow el buen camino (the straight and narrow).
▪ Boys are expected to learn a trade or prepare for work
and to stay away from vices.
▪ Girls are expected “to remain honorable while single,” to
prepare for marriage, to avoid the opposite sex, and not
to go out without a chaperone.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ When a daughter reaches 15 years, a
quinceaneras, or elaborate 15th birthday party, is
typically held to celebrate this rite of passage for
the daughter.
▪ Adolescents may undergo an identity crisis and
reject their heritage causing parents to feel their
authority is being challenged.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Little information is available on homosexuality.
▪ Same-sex behaviors among men may be
regarded as a sign of virility and power rather
than homosexual behavior.
▪ The gay lifestyle is contradictory to the machismo
orientation of this culture. Same-sex couples may
be alienated from their families.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
A 22-year-old from Cuba comes to the prenatal
clinic for the first time. She introduces herself as
Elena Florencia Gonzalez Portillo. The
receptionist should ask what
a. Is your husband’s surname?
b. Is your husband’s last name?
c. Name do you wish to be called?
d. What is your legal name?
▪
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
The legal name is what should be used for recordkeeping.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Workforce Issues
▪ Cuban ethnic enclaves with a familiar language
and culture have created numerous employment
opportunities for recent Cuban immigrants.
▪ A source of tension is the tendency of Cubans to
speak Spanish with other Cuban or Hispanic
coworkers. Speaking the same language allows
them to form a common bond, relieve anxieties at
work, and feel comfortable with one another.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Workforce Issues
▪ Traditional Cubans recognize supervisors as authority
figures and treat them with respect and deference.
▪ Cubans value a structure characterized by
personalismo, one that is oriented around people rather
than around concepts or ideas.
▪ Personal relationships at work are considered an
extension of family relationships.
▪ Because of the emphasis on the job or task in the
American workplace, many Cubans view this workplace
as being too individualistic, businesslike, and detached.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Biocultural Ecology
▪ Most Cubans are white, and only 5 percent are black with
physical features similar to those of African Americans.
▪ Cuban Americans tend to have lower incidences of
diabetes mellitus, obesity, and hypertension than other
Hispanic groups or whites.
▪ Because of their diet, which is high in sugar, many exhibit
a high prevalence of tooth loss, filled teeth, gingival
inflammations, and periodontitis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Biocultural Ecology
▪ Commonly occurring health conditions of Cubans
are hypertension, coronary artery disease,
obesity, diabetes mellitus, and lung cancer.
▪ Specific information related to drug metabolism is
limited; however, in general, many require lower
doses of antidepressants and experience greater
side effects than non-Hispanic white populations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American High-risk Health
Behaviors
▪ Cuban Americans tend to exhibit a higher
incidence of smoking than other Hispanic or
European groups.
▪ Alcohol use is greater among males than females
and among younger versus older groups.
▪ Violent deaths account for high mortality rates
among adolescents and young adults.
▪ Suicide rates also exceed those of the white nonHispanic population.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
▪ The nurse is using an interpreter to interview the
parents of a 6-year-old Cuban, Leonardo, who
has stomach pain. The nurse should direct
questions to
▪ A. The father.
▪ B. The mother.
▪ C. The interpreter.
▪ D. Both parents.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
The nurse should address the questions to both
parents to demonstrate respect to both of them.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Nutrition
▪ Food allows families to reaffirm kinship ties,
promotes a sense of community, and
perpetuates customs and heritage.
▪ Staple foods include root crops like yams,
yuca, malanga, and boniato; plantains; and
grains.
▪ Many dishes are prepared with olive oil, garlic,
tomato sauce, vinegar, wine, lime juice
(sofrito), and spices.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Nutrition
▪ Meat is usually marinated in lemon, lime, sour
orange, or grapefruit juice before cooking.
▪ A leisurely noon meal (almuerzo) and a late
evening dinner (comida), sometimes as late as 10
or 11 PM, are often customary.
▪ Being overweight is seen as positive, healthy, and
sexually attractive.
▪ Food allows families to reaffirm kinship ties,
promotes a sense of community, and perpetuates
customs and heritage.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Cuban women’s fertility rate is lower than that of
other Hispanic American women. Cuba’s current
reproductive rate is among the lowest in the
developing world.
▪ Even before the revolution, Cuba had the lowest
birthrate in Latin America.
▪ The low fertility rate has been attributed to many
women in the workforce.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Preterm births and neonatal and post-neonatal
deaths are lower among Cuban American
women than among other Hispanic American
groups.
▪ Prenatal care is higher than among other
Hispanic and white non-Hispanics.
▪ Mothers tend to use advice about child health
given by their spouses, mothers, mothers-in-law,
and clerks and pharmacists.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Childbirth is a time for celebration with family
members and friends congregating in the
hospital.
▪ Traditionally, men have not attended the births of
their children, but younger, more acculturated,
fathers are frequently present.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ During the postpartum period, ambulation,
exposure to cold, and bare feet place the mother
at risk for infection.
▪ Family members and relatives often care for the
mother and baby for about 4 weeks postpartum.
▪ Most women consider breast-feeding better than
bottle feeding; approximately half choose to
breast-feed.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Cutting the infant’s hair or nails in the first 3
months is believed to cause blindness and
deafness.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ In death, as in life, the support of the extended
family network is paramount.
▪ Bereavement is expressed openly as loud crying
with other physical manifestations of grief.
▪ Death is often seen as a part of life and some,
especially men, may approach death stoically.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ The dying person is typically attended by a large
gathering of relatives and friends.
▪ In Catholic families, individual and group prayers
are held for the dying to provide a peaceful
passage to the hereafter.
▪ Religious artifacts such as rosary beads,
crucifixes, or estampitas (little statues of saints)
are placed in the dying person’s room.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ For adherents of Santería, death rites may
include animal sacrifice, chants, and ceremonial
gestures.
▪ Candles are lighted after death to illuminate the
path of the spirit to the afterlife.
▪ A velorio (wake) lasts 2 to 3 days and is usually
held at a funeral parlor or in the home where
friends and relatives gather to support the
bereaved family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ Burial in a cemetery is common practice,
although some may choose cremation.
▪ The deceased are customarily remembered and
honored on their birthdays or death anniversaries
by lighting candles, offering prayers or masses,
bringing flowers to the grave, or gathering with
family members at the grave site.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Approximately 85 percent of Cuban Americans
are Roman Catholic; the remaining 15 percent
are Protestants, Jews, and believers in African
Cuban Santería.
▪ Roman Catholicism is personalistic and
characterized by devotion and intimate,
confiding relationships with the Virgin Mary,
Jesus, and the saints.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Significant religious holidays include Noche
Buena (Christmas Eve), Christmas, Los Tres
Reyes Magos (Three Kings Day), and the
festivals of the La Caridad del Cobre and Santa
Barbara.
▪ Santería is a 300-year-old African Cuban
religious system that combines Roman Catholic
elements with ancient Yoruba tribal beliefs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Followers of Santería believe in the magical and
medicinal properties of flowers, herbs, weeds, twigs,
and leaves.
▪ Sweet herbs such as manzanilla, verbena, and
mejorana are used for attracting good luck, love,
money, and prosperity.
▪ Bitter herbs such as apasote, zarzaparilla, and yerba
bruja are used to banish evil and negative energies.
Santería is viewed as a link to the past and is used to
cope with physical and emotional problems.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Physical complaints may be diagnosed and
treated by a physician, whereas the santero may
assist in balancing and neutralizing the various
aspects of the illness.
▪ Deeply held religious beliefs provide guidance
and strength during the long and difficult process
of migration and adaptation and continue to play
an important role in their day-to-day lives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Belief in a higher power is evident in practices
used to maintain health and well-being or cure
illness, such as using magical herbs, special
prayers or chants, ritual cleansing, and
sacrificial offerings.
▪ Many tend to be fatalistic, believing that they
lack control over circumstances influencing
their lives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ African Cubans may seek biomedical care for
organic diseases but consult a santero for
spiritual or emotional crises.
▪ Conditions such as decensos (fainting spells) or
barrenillos (obsessions) may be treated solely by
a santero or simultaneously with a physician.
▪ Many tend to seek help only in response to crisis
situations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Many Cuban Americans rely on the family as the
primary source of health advice.
▪ Older women provide traditional home remedies
such as herbal teas or mixtures to relieve mild or
moderate symptoms or cure common ailments.
▪ Older Cuban Americans were socialized into a
strong health ideology and successful primary
care system while still in Cuba.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Use of preventive services in the US is generally
determined more by access to care than by acculturation.
▪ Many Cuban Americans use traditional medicinal plants
in the form of teas, potions, salves, or poultices. In Cuban
communities, stores called botanicas sell herbs,
ointments, oils, powders, incenses, and religious figurines
to relieve maladies, bring luck, drive away evil spirits, or
break curses.
▪ Santería necklaces and animals used for ritual sacrifice
are often available at botanicas.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Blood transfusions and organ donations
are usually acceptable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care
Practitioners
▪ Both traditional and biomedical care are acceptable.
▪ Folk remedies may be used at home, but if the condition
persists, folk practitioners such as santeros and biomedical
practitioners may be used either simultaneously or
successively.
▪ Santeros may prescribe treatment or perform rituals to
enable ill people to recover by invoking supernatural deities
to intervene to help make them well.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Irish American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ The Republic of Ireland, also known as Eire and
the Emerald Isle, covers most of the island
bearing its name.
▪ The remainder of the island, Northern Ireland, is
part of Great Britain.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ During the potato famine between 1846 and
1848, thousands of Irish died from malnutrition,
typhus, dysentery, and scurvy; millions
immigrated to America.
▪ Over 38 million people of Irish descent live in the
United States.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ Most Irish immigrants initially settled in industrial
areas in the northeastern United States along the
Atlantic coast.
▪ The Irish attained success in America because
they spoke the same language, had the same
physical appearance as other European
Americans, and mastered the political system.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ The major languages spoken in Ireland are
English and Irish (Gaelic); the latter is the
official language and is spoken primarily in
West Ireland.
▪ The Irish enjoy puns, riddles, limericks, and
storytelling.
▪ This Irish accent has a nasal quality, spoken
with a strong inflection on the first syllable of
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ When one becomes accustomed to hearing
the Irish-accented English used by newer
immigrants, there is little difficulty in
understanding the speaker.
▪ Irish is low-context English, using many words
to express a thought.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Some common Gaelic words and their
meanings are shamrock for “emblem,” limer
for “folklore character,” colleen or lassie for
“girl,” sonsie or sonsy for “handsome,” cess for
“luck,” brogue for “shoe,” dudeen for “pipe
tobacco,” and paddy for “Irishman.”
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Even though most Irish delight in telling long
stories, when discussing personal matters,
they are much less expressive unless they are
talking with close friends and family.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Humility and emotional reserve are
considered virtues.
▪ Displays of emotion and affection in public are
avoided and are often difficult in private.
▪ Even then, many are still reluctant to express
their innermost thoughts and feelings.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ To many, caring actions are more important than
verbal expressions.
▪ Direct eye contact when speaking with each other.
▪ Not maintaining eye contact may be interpreted as a
sign of disrespect, guilt, or evidence that the other
person cannot be trusted.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Personal space is important to the Irish, who may
require greater distance in spatial relationships than
other ethnocultural groups.
▪ Although the Irish may be less physically expressive
with hand and body gesturing, facial expressions are
readily displayed, with frequent smiling even during
times of adversity.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ The Irish in America, with their strong sense of
tradition, are typically past-oriented.
▪ They have an allegiance to the past, their ancestors,
and their history.
▪ While respecting the past, they balance “being” with
“doing,” and they plan for the future by investing in
education and saving money.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communication
▪ Many Irish see time as being elastic and flexible.
▪ Mac before a family name means “son of,” whereas
the letter O in front of a name means “descended
from.”
▪ Women usually take the name of their husband
when they marry. Some keep their last name and
other use both their surname and that of her
husband.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles and Organization
▪ The traditional Irish family is nuclear with parents
and children living in the same household.
▪ Irish families emphasize independence and selfreliance in children.
▪ Boys are allowed and expected to be more
aggressive than girls, who are raised to be
respectable, responsible, and resilient.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles and Organization
▪ Children are expected to have self-restraint and
self-discipline and to be respectful and obedient
to their parents, elders, church, and community
figures.
▪ Adolescent years are a time for experiencing
emotional autonomy, independence, and
attachment outside the family while remaining
loyal to the family and maintaining the traditional
Irish belief in the importance of family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles and Organization
▪ Provisions are made in Irish homes for care of
elderly family members, a task that becomes
increasingly difficult when both parents work
outside the home.
▪ Irish respect the experience of elderly people and
seek their counsel for decision-making.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles and Organization
▪ The Irish value physical strength, endurance,
work, the ability to perform work, children, and
the ability to provide their children with the
needed education to attain respectable
socioeconomic status and accomplishments.
▪ Same-sex relationships continue to carry a
stigma for some.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ Because cultural differences between Ireland and
the United States are minimal, Irish assimilate
into the American workforce easily.
▪ When change is necessary to improve the status
quo, the Irish readily relinquish traditional beliefs
and adjust to the workforce.
▪ Even though the Irish are typical of past-oriented
groups in other ways, they tended to question the
status quo of the American workforce.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Workforce Issues
▪ The low contextual use of language, where most
of the message is in an explicit mode rather than
an implicit mode, enhances pragmatic
communications in the workforce.
▪ Personal space is important to the Irish, who may
require greater distance in spatial relationships
than other ethnocultural groups.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
The Irish are noted for their low-context English.
Low contexted language means
a. Few words are used to express a thought.
b. May words are used to express a thought.
c. Nonverbal communication is common.
d. Nonverbal communication is rare.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: B
Low contexted English means that the majority of
the message is verbal and many words are used
to express a thought.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Most Irish have dark hair and fair skin or red hair,
ruddy cheeks, and fair skin; however, other
variations exist in hair and skin color.
▪ The fair complexion of the Irish places them at
risk for skin cancer.
▪ The Irish are taller and broader in stature than
average European Americans, Asians, or Pacific
Islanders.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Because mining is an important economic activity
in Ireland, miners are at increased risk for
respiratory diseases.
▪ The cool maritime climate of Ireland increases
susceptibility to respiratory diseases.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Commonly occurring health conditions for Irish
Americans are coronary heart disease,
phenylketonuria, osteoporosis, alcoholism, and
skin cancer.
▪ The major cause of infant mortality in Ireland is
congenital abnormalities.
▪ Other conditions with a high incidence among
Irish newborns are phenylketonuria (PKU), neural
tube defects, and fetal alcohol syndrome.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-Risk Health Behaviors
▪ Smoking has been identified as a major risk
factor causing premature mortality from cancer
in Ireland and among the Irish in America.
▪ The use of alcohol and intravenous drugs are
major health problems among Irish Americans.
▪ Alcohol problems in Ireland are among the
highest internationally.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
High-Risk Health Behaviors
▪ Alcoholism researchers generally agree that
Irish ancestry puts individuals at risk for
developing drinking problems.
▪ Irish pubs are popular establishments that have
become synonymous with alcohol intake, lively
music, and a vivacious time.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Irish food is unpretentious and wholesome if eaten in
recommended proportions.
▪ Food is an important part of health maintenance and
celebrations.
▪ Vitamins are commonly used as a dietary supplement.
▪ Meat, potatoes, and vegetables are dietary staples.
▪ Lamb, mutton, pork, and poultry are common meats.
▪ Seafood includes salmon, mussels, mackerel, oysters,
and scallops.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Popular Irish dishes include Irish stew made with
lamb, potatoes, and onions.
▪ Potatoes are used in a variety of ways.
Colcannon is made with hot potatoes, mashed
with cabbage, butter, and milk, and seasoned
with nutmeg. This dish may be served at
Halloween.
▪ Champ is a popular dish made with mashed
potatoes and scallions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Potato cakes, made with mashed potatoes, flour,
salt, and butter, are shaped into patties and fried
in bacon grease.
▪ Potato cakes are served hot or cold with butter
and sometimes with molasses or maple syrup.
▪ Another popular dish is Dublin coddle, made with
bacon, pork sausage, potatoes, and onions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Oatmeal is popular in Ireland.
▪ Soda bread, another popular food, is made with
flour, baking soda, salt, sugar, cream of tartar,
and sour milk.
▪ Mealtimes are important occasions for Irish
families to socialize and discuss family concerns.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Meals are eaten three times a day with a large
breakfast in rural areas, lunch around noon, and
a late dinner.
▪ Some Irish Americans continue the afternoon
tradition of “tea,” a light sandwich or biscuit with
hot tea.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Health conditions with a high prevalence among
Irish and Irish Americans include all of the
following except
a. Alcohol misuse.
b. PKU
c. Skin cancer
d. Aortic anyerisms
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
No documentation exists that indicate Irish and
Irish American have an increased risk for Aortic
aneurysms.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Pregnancy and Childbearing Practices
▪ Not eating a well-balanced diet or not eating the right
kinds of food may cause the baby to be deformed.
▪ A belief common to many other ethnic groups is that the
mother should not reach over her head during pregnancy
because the baby’s cord may wrap around its neck.
▪ A taboo behavior in the past, which some women still
respect, is that if the pregnant woman sees or
experiences a tragedy during pregnancy, a congenital
anomaly may occur.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Pregnancy and Childbearing Practices
▪ Eating a well-balanced diet after delivery
continues to be a prescriptive practice for
ensuring a healthy baby and maintaining the
mother’s health.
▪ Plenty of rest, fresh air, and sunshine are also
important for maintaining the mother’s health.
▪ Going to bed with wet hair or wet feet causes
illness in the mother.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
▪ The Irish are fatalists and acknowledge the
inevitability of death.
▪ The American emphasis on technology and dying
in the hospital may be incongruent with the Irish
American belief that family members should stay
with the dying person.
▪ Whereas men are expected to be more stoical in
their bereavement, women are more expressive.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
▪ A wake continues as an important phenomenon
in contemporary Irish families and is a time of
melancholy, rejoicing, pain, and hopefulness.
The occasion is a celebration of the person’s life.
▪ Cremation is an individual choice, and there are
no proscriptions against autopsy, if required.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ The predominant religion of most Irish is
Catholicism, and the church is a source of
strength and solace.
▪ Other religions common among Irish in America
include various Protestant denominations, such
as the Church of Ireland, Presbyterian, Quaker,
and Episcopalian.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ In times of illness, Irish Catholics receive the
Sacrament of the Sick, which includes anointing,
communion, and a blessing by the priest.
▪ The Eucharist, a small wafer made from flour and
water, is given to the sick as the food of healing
and health.
▪ Family members can participate if they wish.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ Attending Mass daily is a common practice
among many traditional and devout Irish Catholic
families.
▪ Prayer is an individual and private matter.
▪ In times of illness, the clergy may offer prayers
with the sick as well as with the family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ For Catholics, holy day worship begins at 4 PM
the evening preceding the holy day of
obligation; all Sundays are considered holy
days.
▪ The obligation to fast and abstain from meat on
specified days is relinquished during times of
illness.
▪ Some Irish may wear religious medals to
maintain health.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
▪ Many Irish use denial as a way of coping with
physical and psychological problems.
▪ The Irish view of life is illustrated in the belief that
life is black with long suffering, and the less said
about it, the better.
▪ Many Irish ignore symptoms and delay seeking
medical attention until symptoms interfere with
the ability to carry out activities of daily living.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
▪ Irish Americans limit and understate problems
and handle problems by using denial.
▪ Because Irish people may not be very descriptive
about their symptoms, treatment may be more
difficult.
▪ Illness or injury may be linked to guilt and
considered to be the result of having done
something morally wrong.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
▪ Most Irish believe one is obligated to use
ordinary means to preserve life.
▪ Extraordinary means may be withheld to allow
the person to die a natural death.
▪ The sick person and family define extraordinary
means; finances, quality of life, and effects on the
family usually influence the decision.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
▪ In most Irish families, nuclear family members
are consulted first about health problems.
▪ Mothers and older women are usually sought for
their knowledge of folk practices to alleviate
common problems, such as colds.
▪ Having a strong religious faith, keeping one’s feet
warm and dry, dressing warmly, eating a
balanced diet, getting enough sleep, and
exercising are important for staying healthy.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
Irish practices include—
▪
▪
▪
▪
▪
▪
Wearing religious medals to prevent illness
Using cough syrup made from honey and whiskey
Taking honey and lemon for a sore throat
Drinking hot tea with whiskey and eating toast for a cold
Drinking hot tea for nausea
Putting a damp cloth on the forehead for a headache.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practices
▪ The behavioral response of the Irish to pain is
stoic, usually ignoring or minimizing it.
▪ One explanation for high rates of mental illness
may be associated with the Irish having difficulty
describing emotions and expressing feelings.
▪ Blood transfusions are acceptable to most Irish
Americans.
▪ Many participate in organ donation and indicate
their willingness to do so on their driver’s
licenses.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Health-care Practitioners
▪ The Irish respect all health-care professionals.
▪ Although the Irish are not noted for being overly
modest, some may prefer to receive intimate
care from someone of the same gender.
▪ In general, men and women may care for each
other in health-care settings as long as privacy
and sensitivity are maintained.
Chapter 30
People of Greek Heritage
Irena Papadopoulos and Larry D. Purnell We wish to acknowledge Maria
Athanasopoulou’s contribution in obtaining data that helped to update this chapter.
Overview, Inhabited Localities, and Topography
Overview
This chapter presents two groups of people with Greek heritage. The first group refers to those people or
their ancestors who emigrated from Greece. The second group originated in Cyprus. Both groups share
the same history and have a common language and re- ligion. The Greek and Greek Cypriot diaspora is of
considerable size and is spread to all continents and numerous countries. The largest Greek community
outside Greece is in America; the largest Greek Cypriot community outside Greece is in Britain.
Therefore, the main focus of this chapter is on the large Greek American community, with a secondary
focus on the British Cypriot community. Although ge- ographic location and social context are important,
many of the issues and principles discussed in this chapter can be applied to the broader diaspora. When
the term American is used in this chapter, it refers to residents of both Canada and the United States.
Greece, a small country in southern Europe with a climate similar to that of southern California, covers
slightly more than 50,000 square miles (131,940 sq km) and has a population of over 10.7 million (CIA
World Factbook, 2011a). The capital, Athens, has a popula- tion of 3.252 million. The population is 93
percent Greek and the rest other. Greece does not collect data on ethnicity (CIA World Factbook, 2011a).
The land is very mountainous with small patches of fertile land separated by hills, mountains, and a
plethora of small and medium-sized islands. The main crops are wheat, grapes, olives, cotton, and
tobacco. Geopolitical boundaries have shifted dramatically over time. Greeks struggled under 400 years
of Turkish rule, which ended in 1829. At that time, the Peloponnese, central Greece, and some of the
Aegean Islands were freed. Later, Thessaly, Macedonia, Crete, the Ionian Islands, Epirus, Thrace, and the
Dodecanese were
incorporated into Greece’s boundaries. Greece joined the European Union in 1981.
Cyprus, located in the most eastern part of the Mediterranean Sea, is a small mountainous island with an
area of 3572 square miles (9251 sq km). The capital is Nicosia with a population of 240,000 people. The
total population of Cypriots is 1,240,000 million of whom 77 percent are Greek Cypriots, 18 percent are
Turkish Cypriots, and 5 percent other (CIA World Factbook, 2011b). Since the entry of Cyprus into the
European Union, a significant increase of economic migrants and asylum seekers has been recorded
(Cyprus Statistical Services, 2011). Cyprus has a rich history and culture, the result of many influences
over 9000 years. Mycenean and Achaean Greeks settled in Cyprus around the 14th century B.C. After the
Trojan War, legendary Greek heroes visited the island, where they were associated with the founding of
great cities such as Salamis, Kourion, and Paphos. The Achaean Greeks had a profound and lasting
influence on the culture of Cyprus, introducing their language, religion, and customs. After the death of
Christ, St. Paul trav- eled to Cyprus, where he was joined by St. Barnabas and St. Mark. The island was
the first country to have a Christian ruler when Sergius Paulus was converted. The Greek Orthodox
Church stems from Cyprus.
Cyprus gained its independence from Britain in 1960; however, the Constitution of the Republic of
Cyprus proved unworkable, making a smooth imple- mentation impossible. Following episodes of ethnic
conflict between Greek and Turkish Cypriots, Cyprus was divided in 1974 following the invasion of
Turkey. Almost half the population was displaced, with Greek Cypriots settling in the south and west of
the island and Turkish Cypriots settling in the north and east.
The characteristics of members of the Greek and Greek Cypriot communities vary considerably according to the time of immigration (with earlier immi- grants being predominantly younger, rural males), the
characteristics of the site of immigration (rural,
1
2 Aggregate Data for Cultural-Specific Groups
island, or urban), the variant cultural characteristics (refer to chapter 1 in this book ), and the number of
generations since initial immigration. Despite consid- erable temporal and geographic variation, several
core themes are common to people who retain affiliation with a Greek community—emphasis on family,
honor, religion, education, and Greek heritage.
The core values of philotimo (honor and respect) and endropi (shame) are key when considering the
experience of Greeks and Greek Cypriots. Although values of honor and shame are found in all societies,
these attain immense importance among Mediterranean groups. Although philotimo is a characteristic of
one’s family, community, and nation, it most centrally implies con- cern for other human beings.
Philotimo is a Greek’s sense of honor and worth, derived from one’s self- image, reflected image
(respect), and sense of pride. Philotimo is enhanced through courage, strength, fulfilling family
obligations, competition with other people, hospitality, and right behavior. Shame results
REFLECTIVE EXERCISE 30.1
Mr. Marios Stavrakis is a 49-year-old Greek who arrived in NewYork from Crete at the age of 21.After working
very hard doing different jobs for a number of years he saved enough money with which he started a business
with his best friend Mr. Soteris Ioannou, who is also his son’s godfather. As the busi- ness grew the partners
spent less time with each other since each one had separate responsibilities within the company.
About a year ago Mr. Stavrakis developed signs of depres- sion. His wife noticed that he was worried about
something, was frequently anxious, and at the same time appeared to have less energy and vitality than
usual.When he started ne- glecting the business he so much loved and had worked so hard to make
successful, his wife insisted that he see a doctor. Mr. Stavrakis was prescribed antidepressants but took the
medication infrequently and then he stopped it all together.
His condition deteriorated and he began to obsessively talk about philotimo.When he eventually saw a
psychiatrist he explained that he discovered that his best friend and business partner was making deals
behind his back and that he was embezzling money from the company. He had suspected this some time ago
but did not want to report his best friend to the police while at the same time he could not deal with his anger
and disappointment as he felt totally betrayed by a man whom he trusted.
from any conduct that is considered deviant. The sys- tem of honor and shame in the Mediterranean countries derives from the complementary opposition of the sexes, the solidarity of the family, and the
relation- ships of hostility and competition between unrelated or unconnected families.
Heritage and Residence
Today, Greeks in America are a composite of three immigrant groups: an older group who came before or
just after World War I, a second group who arrived after the relaxation of immigration laws in the mid1960s and who constitute the main group in the Greek American community, and the American-born children and grandchildren of these immigrants.
The earlier Greek immigrants congregated for the most part in the western states of Utah, Colorado, and
Nevada, where they worked in mines and on railroad crews; in the New England states of New
Hampshire, Massachusetts, and Connecticut, where they worked in shoe and textile factories; and in the
large northern cities of Chicago, Detroit, Toledo, Milwaukee, Philadelphia, Buffalo, Cleveland, and New
York, where they worked in factories or found jobs as shoe shiners or peddlers. The greatest proportion of
Greeks in America contin- ues to live in the Northeast and the Midwest. Most live in large urban areas
such as New York and Chicago. Whereas new immigrants still tend to gravi- tate toward the established
Greek communities in cities, many Greeks in America have relocated to the suburbs (Moskos, 1989). The
Greek communities in the United States and Canada are the biggest Greek diasporic communities. It is
estimated that there are 1.2 million people of Greek heritage living in the United States and around
350,000 in Canada (Kitroef, 2009).
Reasons for Migration and Associated
Economic Factors
Significant Greek migration occurred during the late 19th and early 20th centuries. During this period,
mi- gration depleted the population of Greece by about one-fifth. Economic factors were largely
responsible for this mass exodus. In the latter part of the 19th century, Greece suffered a major economic
crisis resulting from a nearly complete failure of its major crop, currants; relatively heavy governmental
taxation to sustain an army against hostilities with Turkey; and family pres- sure on fathers and brothers
to supply a substantial dowry for unmarried women in the family. Before the 1880s, relatively few Greek
immigrants entered the United States. It was not until the start of the 20th century that massive numbers
of Greek immi- grants came to America.
Between 1900 and 1920, almost 350,000 Greeks came to America, 95 percent of them men (Scourby,
1984). They came with dreams of economic opportunity in
1.
2.
3.
How has the belief about the importance of philotimo influenced the behavior of Mr. Stavrakis?
Why was Mr. Stavrakis reluctant to report his friend to the police? What cultural values influenced
his actions?
Why did he not seek medical help and why was he eventually persuaded by his wife to see a doctor?
America, hoping to make enough money to provide good dowries for their sisters and daughters and to be
able to return to Greece with enough money to live comfortably in their villages. At the time, Greece was
beleaguered by turbulent internal politics and was a difficult place for the average Greek peasant to earn a
decent living.
Most Greek migrants planned to stay in the United States for a short period of time, and one in four of
them managed to achieve this. As the arrival of young Greek women—potential wives—post 1920s
increased, a number of men decided to put more permanent roots in their host country. With growing
communities, and the establishment of small family businesses, Greek migrants began to integrate into
American society (Kitroef, 2009).
Legislation passed in 1921 and 1924 transformed America’s open-door policy toward European immigrants into a closed-door policy greatly affecting the number of Greek immigrants who came into the
country. While in 1921, 28,000 Greek immigrants came to America, the next year, the quota of Greeks
allowed into the country was reduced to 100. This was raised to 307 in 1929, and remained at that level
for three decades (Moskos, 1989). Greek immigrants who had cared little about becoming American
citizens saw citizenship as the only chance to bring other family members to America or to be able to
return to America after visiting Greece. In addition, because fewer people were emigrating from Greece,
member- ship in the Greek American community consisted of increasing numbers of American-born
Greeks.
During most of the 1930s, the number of Greeks returning to Greece exceeded the number coming to
America (Moskos, 1989). Despite the economic down- turn in the United States, Greeks in America
managed to invest a great deal of energy in their communities. Greek-language schools were started for
their chil- dren, the Greek Orthodox Archdiocese centralized, and charitable organizations were
established for the poor. When the Great Depression came, however, everyone in America was affected,
including the Greek immigrants. Many businesses failed, jobs were lost, and fortunes disappeared.
The Italian invasion of Greece in 1940 precipi- tated Greece’s entry into World War II and a great
outpouring of support from the Greek American community for the home country. After America entered the war in 1941, the intermingling of Greek and American interests produced a combination of
American patriotism with Greek ethnic pride, which underscored the great love that Greeks in America
felt for both their home and their adopted countries. The immigration laws, however, kept the actual
number of new Greek immigrants to a minimum until the 1950s (U.S. Immigration and Naturaliza- tion
Service, 1993).
Although the quota system was maintained, special legislation in 1953 allowed those who had been displaced by the war and those who wished to reunite with their families to enter America. In addition,
countries were allowed to “borrow” on quotas for future years. As a result, approximately 70,000 Greeks
entered the United States between World War II and 1965. During this time, the immigration laws dating
from the 1920s were liberalized. This large influx rejuvenated the Greek American community’s ties to
Greece and changed the composition of the Greek community from Greeks with American citizenship to
Americans of Greek descent. By this time, the third generation of Greek Americans was being born. The
Immigration Act of 1965 lifted the earlier restrictive quotas, allowing more Greeks to immigrate to
America.
Whereas the U.S. Census 2000 reported that 1,153,307 people of Greek descent lived in America, in
2006, 12,723 Greeks emigrated to the United States (Statistical Yearbook, 2006). The decline in Greek
im- migration to the United States is attributed to several factors that are largely economic. Improvement
of economic conditions in Greece has lessened the impe- tus to emigrate. Canada and Australia have more
lenient visa requirements than the United States. Finally, with the entry of Greece into the European
Union (EU) in 1981, Greeks were able to freely move within the EU, thus reducing the number of people
emigrating to the United States to an estimated 2000 per year. Greece in the 21st century is changing from
a country of outward emigration to one of inward immigration.
Immigration for Greek Cypriots is a very old phe- nomenon (Panayides, 1988). This is exemplified by the
figures from a survey published by the Ministry of Education in Cyprus and cited by the Cyprus High
Commission in Britain (1986), which numbered the Cypriot population in London as 208 in 1911; 1059
in 1931; 10,208 in 1941; 41,898 in 1961; and 78,476 in 1964. The first major group of Greek Cypriots
who emigrated to Britain arrived in the 1930s. Because Cyprus was a British colony, young men seeking
employment made their way to Britain and primarily settled in the Camden Town and Soho areas of
London but later spread to Islington, Hackney, and northward to Haringey.
The second wave of emigration occurred in 1960 to 1961 when 25,000 Cypriots left for Britain when
Cyprus became a republic. This number was reduced to less than 2000 a year after the Commonwealth
Immigrants Act of 1962. The last wave of emigration occurred in 1974 following the troubles between the
Turkish and the Greek Cypriots, when an estimated 50 percent of Cypriot people became refugees in their
own country. By 1974, an estimated 120,000 Cypriots were in Britain, of whom five out of six were of
Greek origin and the remainder of Turkish origin.
People of Greek Heritage 3
4 Aggregate Data for Cultural-Specific Groups
In 1986, the Cyprus High Commission reported that some 200,000 Cypriot-born people and descendants
of Cypriots (Greek and Turkish) were living in Britain. In 1996, the Greek Orthodox Archdiocese in
Great Britain reported that London alone was home to more than 250,000 Greek and Greek Cypriot
people. These figures were derived from church attendance, numbers of wed- dings, baptisms, and
funerals performed, as well as by the number of children attending the church-run and independent Greek
schools. In addition to the London- based Greek Cypriot population, large communities are found in
many other British cities, particularly Birmingham, Bristol, Manchester, Great Yarmouth, and Glasgow.
The Greek and Greek Cypriot commu- nities in Great Britain continue to increase, and in 2011 they are
estimated to be in excess of 300,000.
Educational Status and Occupations
Most early Greek and Greek Cypriot immigrants were poor men who had limited education. However,
they had a very strong work ethic, determination, and eth- nic pride. Their achievements are evident in the
schooling patterns of Greek immigrants and fostered by the competitive dimension of the Greek
character. Greek children are expected to succeed in school. This attitude is fostered by an achievement
orientation, high educational and occupational aspirations, a cohesive family unit that exhorts children to
succeed, nationalistic identification with the cultural glories of ancient Greece, and private schools that
teach the Greek language and culture (Marjoribanks, 1994). Typically, this pattern of achievement
continues into adulthood and is reflected in career success. Most third-generation Greeks in America have
at- tended college. During the 1965 immigration, Greeks coming to America included educated
professionals and students in professional fields such as engineer- ing, medicine and surgery, and other
academic areas (Moskos, 1989).
A common theme (repeated so often it has become an archetype) is that of Greek parents who came from
an impoverished land with no money or education. Lacking English language skills, most of these immigrants had no recourse except to accept low-paying jobs as peddlers pushing carts and shoe shiners. Greek
and Greek Cypriot men disliked working for others and considered it a violation of pride (philotimo).
They were industrious and frugal and eventually saved enough money to start their own businesses, such
as restaurants and cigar and candy stores (Lovell-Troy, 1990). In Britain, a number of Greek Cypriots
estab- lished small clothing factories, and some opened food shops specializing in foods imported from
Cyprus. Greek and Greek Cypriot people take pride in con- trolling their own businesses and have done
very well economically. Initially, they sought these opportuni- ties to save money to return to their
homeland, but the
more successful they became, the more likely they were to remain in America and Britain.
In America, Greek immigrants who earned only mar- ginal wages were more likely to return to Greece.
This description represents the typical pattern in the eastern and northern parts of America. In the west,
men worked on railroads and in mines and exhibited greater rates of marriage outside the Greek
community because of their smaller numbers in these more-remote commu- nities. Often, once they had
settled, worked hard, and acquired some capital, these Greeks too became entre- preneurs, opening shops
and small businesses and even- tually acquiring American citizenship.
In the United States, Greek immigrants attained middle-class status more rapidly than most of their fellow
immigrants. As America grew more affluent in the 1920s, so did the Greek immigrants. During the 1950s,
even more Greeks in America ascended into the middle class. American-born Greeks held mostly whitecollar jobs, and many Greek immigrants owned small businesses. Professions such as engineering,
medicine, pharmacy, scientific research, and teaching are favored by Greek Americans (Kunkelman,
1990). Second and subsequent generations of Greeks and Greek Cypriots continue to establish their own
or run family businesses (Kapa Research, 2007), although more of them are currently entering professions
such as medicine, accounting, and law.
Communication
Dominant Languages and Dialects
Although all Greeks, whether in Greece, Cyprus, or the diaspora, use the same form of written Greek,
regional and country variations in spoken Greek do exist. Diasporic Greek communities regard the retention of the Greek language as an essential part of their Greek identity, so numerous efforts are continually
being made to encourage second and subsequent generations to speak Greek. Papadopoulos and Papadopoulos (2000) surveyed young British-born Greeks and Greek Cypriots living in Britain to determine how they defined themselves in terms of ethnic identity. Of the 94 people who responded, 87
defined themselves as British Greek/Greek Cypriots or just Greek/Greek Cypriots. Forty-six reported that
they spoke Greek fluently, 35 spoke enough to “get by,” and 10 spoke “basic” Greek. Only three
respondents reported not being able to speak any Greek. The spread of the Greek language is achieved by
attending Greek-language schools, using Greek in the home, and regularly visiting Greece or Cyprus.
Robins and Askoy (2001) argued that people of second and sub- sequent generations of any migrant
community who are able to speak their mother tongue are more suc- cessful as they achieve greater
cultural mobility. Knowledge of both Greek and English (or any other
language, depending on the country of residence) en- ables people of Greek heritage to move through the
cultural spaces both of their ancestors and of their adopted country. This is a helpful and nourishing
process for both the individual and the collective.
Cultural Communication Patterns
Because Greeks and Greek Cypriots value warmth, expressiveness, and spontaneity, northern Europeans
are often viewed as “cold” and lacking compassion. Protection of family members and maintenance of
family solidarity tend to be foremost among their values. As a consequence, they are often friendly but
somewhat superficial and distant with those considered “outsiders.”
Greek and Greek Cypriot people tend to be expres- sive in both speech and gestures. They embrace
family, friends, and others to indicate solidarity. Eye contact is generally direct, and speaking and sitting
distances are closer than those of other European Americans. They gesture frequently with their hands
while talk- ing. Whereas innermost feelings such as anxiety or de- pression are often shielded from
outsiders, anger is expressed freely, sometimes to the discomfort of those from less-expressive groups.
In health-care situations, patients often appear to be compliant in the presence of the health-care worker,
but this may be only a superficial compliance, employed to ensure a smooth relationship. Greeks consider
deeds to be much more important than what one says.
Temporal Relationships
Greeks and Greek Cypriots demonstrate a variety of temporal orientations. First, they are oriented to the
past because they are highly conscious of the glories of ancient Greece. They are present oriented with regard to philotimo, family life, and situations involving family members. Finally, they tend to be future
ori- ented with regard to educational and occupational achievements.
Greek Americans differentiate between “Greek time,” which is used in family and social situations, and
“American time,” which is used in business situa- tions. Greek time emphasizes participating in activities
until they reach a natural breaking point, whereas American time emphasizes punctuality.
Format for Names
It is customary for honorific titles to be given to mem- bers of the community who are older people or
oth- erwise respected. Terms such as Thia (aunt), Kyria (Mrs.), or Giagia (grandma) may be used. For
Greeks and Greek Cypriots everywhere, having a Greek name is an important sign of their heritage. First
names come either from the Bible, such as Maria and Petros (Peter), or from ancient Greek mythology
and history,
such as Eleni (Helen) and Alexandros (Alexander). Ideally, first daughters are named for the mother’s
mother, and first sons after the father’s father. Follow- ing tradition, middle names are the first name of
the father; thus, all children of Stavros might carry his first name as their middle name.
In health-care situations, it is not appropriate to call older women or men by their first names. The prefix
“Kyria” (Mrs) or “Kyrie” (Mr) should be used with the first name, for example, Kyria Maria or Kyrie
Alexandre; the preferred mode of address is to use their surname preceded by Mr., Mrs., or Miss.
Family Roles and Organization
Head of Household and Gender Roles
The father is considered the head of the household in Greek and Greek Cypriot families. However, the
com- plexity of household dynamics is noted in the well- known folk phrase “the man is the head, but the
wife is the neck that decides which way the head will turn.” This saying acknowledges the primacy of
fathers in the public sphere and the strong influence of women in the private sphere. In recent years,
increased recog- nition of a trend toward more equality in decision making has occurred.
Most important, however, in consideration of gen- der roles are the complementary values of honor
(philotimo) and shame (endropi). These core values tend to set the pattern for the family and for the
enactment of gender roles. Although the educational levels of women have often matched those of their
brothers in the past, women usually did not work out- side the home, particularly after they married. A
woman may, however, have worked in her husband’s store or restaurant. Women of later generations who
obtained professional degrees tended to work after their children were in school. The roles of husband and
wife are characterized by mutual respect (a part- nership). However, their relationship is less signifi- cant
than that of the family as a unit. Fathers are responsible for providing for the family, whereas women are
responsible for management of the home and children. Traditionally, the cleanliness and order of the
home reflect the moral character of the woman.
Prescriptive, Restrictive, and Taboo Behaviors
for Children and Adolescents
Children are included in most family social activities and tend not to be left with babysitters. The child is
the recipient of intense affection, helpful interventions, and strong admiration. The child may be
disciplined through teasing, which is believed to “toughen” chil- dren and make them highly conscious of
public opin- ion. The family environment has been identified as strongly pressuring for dependence and
achievement.
People of Greek Heritage 5
6 Aggregate Data for Cultural-Specific Groups REFLECTIVE
EXERCISE 30.2
Mr. Andreas Georgiou was born in the United States in 1955. His parents had left Greece in 1952 to join his
father’s brother, who had migrated a few years earlier.They both worked in his uncle’s small restaurant until
they were able to open their own in partnership with his uncle.Andreas has two younger sisters. His parents
spent whatever little time they had helping at the local Greek Orthodox Church and insisted that he and his
sis- ters attend the Saturday Greek school. Andreas remembers his father saying,“We must never forget
where we come from.” He also remembers how protective his parents were, particularly toward his sisters
who, in his view, did not have the freedoms he had.“My parents always said that young women with sexual
freedom have bad reputations and decent men do not want to marry them.” Both his sisters did well at school
and were able to find good jobs and good husbands. He stud- ied art at the university and has his own
printing business.Ten years ago,Andreas suffered from depression.“This started when I found out that my
second child was severely disabled.
I could not cope with it.We consulted numerous specialists searching for a cure.We prayed and prayed.At
first,I could not speak about my son to anyone other than my closest family. I never shared my emotional
turmoil with my work col- leagues, and this was a major stress for me. When I eventually had to share my
‘secret,’ they were all very understanding.”
Today,Andreas was visiting his therapist for the last time.The therapist had helped him work through his selfblame, anxiety, and sadness. He has come to love his son for who he is.
grades in high school. Adolescents in more-traditional families may experience stress as the differences in
family and peer values precipitate family conflict. In fact, suppression of personal freedom by parents is a
major risk factor for suicidal attempts among Greek and Greek Cypriot adolescent girls (Beratis, 1990).
Additional areas of high stress for Greek adolescents include extreme dependence on the family, intense
pressure for school achievement, and a lack of sexual education in the home.
Family Goals and Priorities
Greek and Greek Cypriot families tend to be very close. Within the family, members are expected to
express unlimited respect, concern, and loyalty. Sym-betheri (in-laws) are considered first-degree
relatives. Family solidarity is the context in which the values of honor and shame are measured. Prestige
is connected to the idea that honor is not individualistic but collective. Because a person loses honor if kin
act improperly, the honor of each family member is a matter of concern for all family members.
Older people hold positions of respect within the Greek and Greek Cypriot communities. Their stories,
whether as pioneers, veterans, or hard-working busi- nessmen, are well known throughout the
community. Their notable deeds are heralded and documented in community histories, which are usually
maintained by the Greek Orthodox churches in each local commu- nity. Treatment of the giagia
(grandmother) and the pappou (grandfather) reflects the themes of closeness and respect emphasized in
the family. Grandparents tend to participate fully in family activities. Families feel responsible for caring
for their parents in old age, and children are expected to take in widowed parents. Failure to do so results
in a sense of dishonor for the son and guilt for the daughter. If the older person is ill, living with the
family is the first preference, fol- lowed by residential-care facilities. Although living alone is often the
least-preferred residential pattern, many older people are choosing to live alone in their own home,
supported by family, friends, and health- care providers. Older Greek and Greek Cypriot wid- ows and
widowers, particularly those who speak little or no English, may experience social isolation if they do not
have close contact with their children.
An important role is that of fictive kin, termed koumbari (coparents), who serve as sponsors in either (or
both) of two religious ceremonies: baptism and marriage. Ideally, the baptismal sponsor also serves as the
sponsor of the child’s marriage. The relationship of sponsor is so important that families who are joined
by this bond of fictive kinship are prohibited from intermarrying, although this is not always ad- hered to
nowadays.
The basis of social status and prestige is family philo- timo and cohesiveness. However, social status is
also
1.
2.
3.
What cultural values drove Andreas’ parents after their migration to the United States?
Why were his parents so protective toward their daughters?
What cultural values might have led Andreas to feel so devastated that he tried to hide his son’s
disabilities?
The family goals of achievement are directed toward and internalized by the children.
Greek American and British Greek Cypriot fami- lies stay intact longer than other American or British
families because adolescents, particularly young women, tend to reside with their parents until they get
married. Formerly, men did not marry until their sisters’ prika (dowry) was established and they had
married. Among first-generation immigrants, single men often returned to Greece or Cyprus for a bride. A
proxenistra (matchmaker) and the families, pending the approval of the young person involved, usually
arranged these marriages. Today, spouse selection is left to the young person, with parental approval.
Girls have considerably less freedom than their brothers in dating, and it is common for them to be
prohibited from dating until they are in the upper
received from attributes such as wealth, educational achievement, and achievements of its members.
Honor is the social worth of the family as judged by the com- munity. A family’s status and integrity are
validated when they support one another during times of misfor- tune such as poverty or dishonor.
Alternative Lifestyles
Greek and Greek Cypriot communities tend to be relatively conservative. As a consequence, alternative
lifestyles encompassing premarital sex, same-sex relationships, and to a lesser extent divorce, are considered sources of concern for family members and the community. A number of religious and community support organizations in the United States and elsewhere provide support (See Resources on
DavisPlus). No specific information or resources specific to Greek gay, lesbian, and transgendered people
in the United States could be located. The only resources in Greece and Cyprus were travel sites that
provided little information on cultural beliefs and values.
Workforce Issues
Culture in the Workplace
In the United States, the high achievement orienta- tion and work ethic have resulted in Greeks serving as
a “model” ethnic group. However, more-recent immigrants with little education have not been as
upwardly mobile. Workforce issues in which the in- terplay between gender and poverty are at work have
been well described. Although incidents of discrim- ination and segregation, including acts of physical
violence and murder directed at Greek immigrants, were common early in the 20th century, less discrim-
ination occurs in the workplace today. The Greeks’ and Greek Cypriots’ rapid, selective acculturation has
been addressed in earlier sections on migration, occupation, and education.
Issues Related to Autonomy
Probably no single characteristic applies so completely to members of the Greek and Greek Cypriot
commu- nities as the emphasis on self-reliance within a family context. Greeks and Greek Cypriots in
North Amer- ica, Britain, Australia, and Sweden stress this trait. It is seen as reluctance to be told what to
do and is given as a major reason for their pattern of establishing their own businesses as soon as
possible.
Biocultural Ecology
Skin Color and Other Biological Variations
Greeks and Greek Cypriots are most commonly of medium stature, shorter than northern Europeans but
taller than other populations of southern Europe. Although some Greeks are blue eyed and blond, usually
People of Greek Heritage 7 those
from the northern provinces of Greece, most
Greeks have dark hair and dark skin.
Diseases and Health Conditions
Current causes of death among Greeks and Greek Cypriots are those of developed countries and include
cancer and cardiovascular and cerebrovascular dis- eases (World Health Organization, 1994).
Since the early 1970s, an increase in diabetes and heart disease has occurred in both Greece and Cyprus.
Tokas (1995) reported that in Cyprus, 2000 people die each year from heart disease, whereas each year
600 Greek Cypriots are sent abroad for cardiac sur- gery. In a s...
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