Understand Folk Medicine's Role in the Prehospital Care of Many Mexican-Americans - Patient Care - @ JEMS.com


Understand Folk Medicine's Role in the Prehospital Care of Many Mexican-Americans

 

 
 
 

Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P | From the December 2009 Issue | Thursday, December 10, 2009


Key Terms

Aire del o_do: Air in the ear, believed to occur when exposed to cold air or strong wind

Azarcon: Lead tetroxide, used to treat some Mexican-American folk illnesses

Barrida: The sweeping, a healing ceremony that may involve rituals, herbal remedies, potions or counter-magic

Brujos/brujas: Wizards/witches

Brujeria:Witchcraft

Calentura/fiebre: Fever

Caida de la mollera: Sunken fontanel, a folk ailment seen in infants

Coyotes: Coyotes, a form witches may take to use their evil powers to cause folk ailments

Curanderos/curanderas: Male healers/female healers

Curanderismo: One of the largest and most widely used systems of folk medicine in the Mexican-American community

El don de DiÉs: The gift from God, a gift folk healers have to cure others

Empacho: Locked intestines, a common folk illness

Flema: Sputum

Gatos: Cats, a form witches may take to use their evil powers to cause folk ailments

Greta: Lead oxide, used to treat certain Mexican-American folk medicine ailments

Lechuzas: Barn owls, a form witches may take to use their evil powers to cause folk ailments

Mal de ojo: The evil eye, a folk ailment that can occur accidentally by admiring a child and not touching them

Mal natural: Folk medicineillnesses believed to benaturally occurring

Mal puesto: Ailments in folk medicine thought to be caused by witchcraft

Otitis Media/Externa: Ear infection

Not long ago, I had a young medical student accompanying me during his rotation in the emergency department. It was kind of a slow day, and many of the patients could have been treated just as well in a clinic (but that's another story altogether). It so happened that I had three patients in a row who were infants and whose parents spoke only Spanish. I went through my usual examination and treatment.

After we left the third infant and mother, the inquisitive medical student asked why I always felt the baby's head and told the mother it felt OK. Actually, I hadn't realized I was doing that, but I told her that many Mexican-American parents have concern about a folk condition called ca_da de la mollera. This condition, which presents as a sunken fontanel, is very concerning to many Mexican-American mothers.

With a wife and a mother of Mexican descent, and having practiced in a part of the country where many patients are Mexican-American, I had developed this practice of feeling the baby's fontanels and did it almost reflexively when conducting the interview in Spanish. What had become a reflexive action for me had become a learning point for the curious but unknowing student.

The Mexican-American Influence
People of Latin-American descent, now more commonly called Latinos, are among the fastest growing ethnic segment of the U.S. population. The term "Latino" doesn't necessarily refer to race, because Latinos are often of different racial groups. One of the largest segments of the Latino population includes those of Mexican descent, who now account for about 15% of the U.S. population. Although Mexican-Americans initially were concentrated in southwestern states, they now live and work throughout the entire nation.

As with all immigrant groups, Mexicans brought their customs and culture with them to the U.S. Among these are various folk medicine belief systems. Folk medicine is an alternate system of health care that's still widely practiced throughout the U.S. by many groups. Folk medicine, which means "medicine of the people," is often the way a layperson deals with health and illness.

At the center of most folk medicine beliefs is the ability or desire to obtain curing or healing. In many belief systems, certain people are thought to possess these special healing powers. This healing typically is brought about by prayer, chanting or by the use of various herbs or similar substances. Religion, spirituality and faith often play a central role. Folk medicine usually deals with health and illness, but it also satisfies many of the physical and emotional needs of the people.

Mexican-American Folk Medicine
One of the largest and most widely used systems of folk medicine in the Mexican-American community is called curanderismo -- a word derived from the Spanish verbcurar,which means "to heal" or "to cure." Curanderismo is a system of "holistic" or "folk" healing typically presided over by acurandero (male healer) or curandera (female healer) withe l don de Dios ("the gift from God" to heal others).

The roots of curanderismo can be traced back to Greek humoral medicine, which believed that three "humors" (wind, bile and phlegm) controlled organ function. It was revived during the Spanish Renaissance, often based on translations of the writings of Galen and Hippocrates.Curanderismowas also influenced by medieval and European witchcraft, early Arabic medicine and Judeo-Christian religious beliefs. These beliefs were brought to Mexico and the New World by the Spanish conquistadors. There, it blended with Mayan and Aztec herbal lore and health practices. Today, curanderismo is a blend of all of these cultural beliefs, accompanied by many rituals and practices of modern Christianity -- especially Roman Catholicism.

Many types of illnesses cause people to seek help from acurandero.Some may be naturally occurring (mal natural), while others are thought to be due to witchcraft (mal puesto). Part of the role of the curandero is to be an advocate for good in the struggle between good and evil. In this case, evil is Satan and those who have made secret pacts with him, namely brujos or brujas (witches). This belief is strongly supported by some tenets of Catholicism, including exorcism.

Exorcism is an uncommon Catholic ritual (not a sacrament) that expels demons or demonic possession through spiritual authority. It's rarely used in the U.S., although the practice is more common in Mexico and Latin America. Today, priests may practice exorcism only with the permission of the bishop, thus causing many believers to seek help from curanderos.

Brujas ,who can frequently take the form o flechuzas (barn owls), gatos (cats) orcoyotes (coyotes), may use their evil powers to cause a multitude of problems ranging from prolonged serious illness (physical and mental) to death, or even bad luck in business and love. They use rituals, incantations, and potions and powders, to bring on the desired illness. The agent is sometimes placed into the victim's food or drink, or it may be a powder spread across the victim's path or placed in his house or yard. Witchcraft (brujer_a) is particularly feared because it can even penetrate the sanctity of one's home.

When deemed appropriate, believers consult a curandero.The ratio of curanderos to population is very small, and people must often travel some distance and wait several days to receive healing. The healing may consist of rituals, herbal remedies, potions or counter-magic, depending upon the illness being treated. Healing often occurs in a ceremony called a barrida (the "sweeping") where eggs, lemons and various herbs, along with prayer, are often used.

In a typical barrida, an egg is swept repeatedly over the victim's body while prayers are chanted. Then the egg is placed in a glass under the victim's bed. In the morning, the egg is inspected. If it appears cooked or contains a small amount of blood, this indicates that the healing was successful.

Curanderismo & EMS
EMS personnel should understand, recognize and respect the role of folk medicine in this population, although it's important to point out that folk medicine is not necessarily limited to one socioeconomic group. Folk conditions are as real an illness to the patient who believes in curanderismoas a heart attack would be to the EMT. A survey of 405 Hispanic patients who attended a Denver medical clinic found that 91% knew what a curandero was, and 29% reported that they had visited a curandero sometime during their lives.

Knowledge of folk medicine beliefs and practices can provide prehospital personnel with valuable information about the patient. In addition, many folk illnesses have legitimate medical causes. (See Table 1 for a list of common folk conditions and their related signs and symptoms.)

Most folk remedies are harmless. However, some remedies are potentially fatal. Some of the herbal preparations (e.g.,greta, azarcon) used to treat selected Mexican-American folk ailments may contain potentially toxic levels of lead. Another potential problem is that traditional medical care may be delayed while families wait for folk remedies to work. EMS personnel may be summoned to care for an ill person after it becomes apparent to the family that folk practices aren't working. These patients may be seriously ill upon arrival of EMS.

Curanderismo Conditions
Curanderismo has a wide spectrum of illnesses and conditions. One of the most common folk illnesses is empacho ("locked" intestines). This is thought to occur due to an inflammation and blockage of the intestines with undigested food. The patient with empacho will complain of abdominal pain, constipation, belching or bloating. The treatment offered by the curandero may include the administration of a tea made of various herbal substances. Some remedies (azarcÉnorgreta) have been known to contain large quantities of lead and may prove toxic to the patient.

Another common folk illness in the Mexican-American community is mal deojo (the evil eye)often simply called ojo. Mal de ojoc an cause many symptoms and can accidentally occur by admiring an infant or child and not touching them. To prevent a child from getting mal de ojo, the person admiring the child will often go to great lengths to touch the child. If a person has mal de ojo,curandero may be called to heal the person. A barrida is often employed to treatmal de ojo.

A common pediatric folk illness that concerns parents is caida de la mollera (sunken fontanel). Thought to occur when the nipple is pulled suddenly from the infant's mouth, this is believed to cause the soft palate to be pulled down, which in turn causes the anterior fontanel to be drawn down. Treatment is often initiated by the mother or grandmother and involves sucking vigorously on the anterior fontanel. This treatment may result in bruising on the head and may be mistakenly interpreted as a sign of child abuse. If a curandero is summoned, they may push up on the soft palate during a healing ceremony, effectively curing the illness. An alternate folk treatment for caida de la mollera is to turn the baby upside down for approximately one minute and then tap the baby's feet three times. This will reportedly elevate the fontanel to its normal position.

The sunken anterior fontanel seen with caida de la mallera may actually be a symptom of dehydration. EMS personnel should look for other symptoms of dehydration, including tachycardia, dry mucous membranes and decreased urine production.

Another condition is aire del oido (air in the ear). This is believed to occur when a person, especially a child, is exposed to cold air or a strong wind. Air enters the ear and causes the condition. The patient will complain of earache, altered hearing and headache. The folk treatment for aire del oidois to roll a piece of paper into a cone, place the small end of the cone into the ear canal and light the large end with a match. The flame will create a vacuum that will evacuate the offending air from the ear. Aire del oido may be mistaken for a legitimate ear infection (otitis media otitis externa).

In addition to the "illnesses" described above, several signs and symptoms of traditional illnesses cause increased concern in many members of the Mexican-American population. Fever (calenturaorfiebre) is always worrisome. Many see fever as a disease in and of itself and not as a symptom of a much broader process, such as infection. I ncreased sputum (flema) is also often a cause for concern and may be thought to be an illness in itself. This belief can be traced back to one the three "humors" of Greek medicine.

Summary
EMS personnel may often hear complaints from this population that, on the surface, appear trivial. The presence of a fever in a young child may be a real emergency in the mind of the mother. Although the child may have other symptoms, such as diarrhea, fever is the symptom about which the mother will be most concerned. Respect this concern.

Never be condescending. When assessing a patient, always consider the possible belief in folk medicine. This is especially true if the history or chief complaint reveals any of the folk concerns described above. Folk medicine is certainly not practiced by all Mexican-Americans. However, to those who do believe, it's as real as any traditional medical illness. JEMS

References
1. Bledsoe BE: "Folk Medicine and EMS: The Mexican-American Experience." Texas EMS Magazine. 24(2):18Ï21, 2003.
2. Mangos JA: "Folk Medicine in Texas." Texas Medicine. 82(10):25-27, 1986.
3. Hentges K; Shields CE, Cantu C: "Folk medicine and medical practice." Texas Medicine. 82(10):27-29, 1986.
4. U.S. Catholic Church: Catechism of the Catholic Church. Citta del Vaticano: Libreria Editrice Vaticana; 1673:445, 1994.
5. Padilla R, Gomez V, Biggerstaff SL, et al: "Use of curanderismo in a public health care system." Archives of Internal Medicine. 161(10):1336Ï1340, 2001.
6. Ripley GO: "Mexican-American Folk Remedies: Their place in health care." Texas Medicine. 82(11):41-44, 1986.
7. DiBellonia RR, Marcus S, Shih R, et al: "Curanderismo: Consequences of folk medicine." Pediatric Emergency Care. 24(4):228Ï229, 2008.
8. Marsh WW, Eberle M: "Curanderismo associated with fatal outcome in a child with leukemia." Texas Medicine. 83(2):38-40, 1987.
9. "Leads from the MMWR. Lead poisoning from Mexican folk remedies -- California." JAMA. 250(23):3149, 1983.

This article originally appeared in December 2009 JEMS as "Faith in a Cure: Understanding the role folk medicine plays in prehospital care of many Mexican-Americans."




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Related Topics: Patient Care, Medical Emergencies, Special Patients, Patient Management, folk medicine, curanderismo, Bryan E. Bledsoe, Jems Features

 
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Bryan Bledsoe, DO, FACEP, FAAEM, EMT-PDr. Bledsoe is an emergency physician and Professor of Emergency Medicine and Director of the EMS fellowship at the University of Nevada School of Medicine in Las Vegas. He is the author of numerous EMS textbooks and articles.

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