Liberty health-maintenance organization (HMO)

Mrs. Demetilla Hernandez is a 63-year-old Cuban woman who seeks consultation at the Liberty health-maintenance organization (HMO) clinic because of weakness, lethargy, and fatigue that she has experienced for the last 2 months. A week ago, while cooking dinner at her daughter, Mariana’s house, she momentarily lost her balance and slipped on the kitchen floor. Although Mrs. Hernandez sustained only a mild bruise on her leg, her daughter insisted on taking her to the clinic for a check-up because of her persistent symptoms.
Mrs. Hernandez, widowed 4 years ago when her husband died of a heart attack, lives with Mariana, aged 40. Mariana is divorced and has three children: Luis, age 15; Carolina, age 10; and Sofia, age 7. Since moving into Mariana’s house, Mrs. Hernandez has been managing the household while Mariana is at work. Mrs. Hernandez prepares the family’s meals, attends to the children when they come home from school, and performs light housekeeping chores. Mariana is employed full-time as a supervisor at the local telephone company. The family, originally from Cuba, has been living in Miami for 12 years. Carolina and Sofia were born in Miami, but Luis came from Cuba with his parents when he was 3 years old. Mrs. Hernandez, who does not speak English, converses with her daughter and grandchildren in Spanish. Although the children and their mother occasionally speak English among themselves, the family’s language at home is Spanish.
At the Liberty HMO clinic, Mrs. Hernandez was diagnosed with essential hypertension and non–insulin-dependent diabetes mellitus. The physician prescribed an oral hypoglycemic drug and advised Mrs. Hernandez to exercise daily and to limit her food intake to 1500 calories a day. Mrs. Hernandez was concerned because she usually prepares traditional Cuban meals at home and was not sure whether she could tolerate being on a diet. Besides, she explained to Mariana, she thought the dishes she prepares are very “healthy.” Proof of that, she stated, is that her three grandchildren are plump and nice-looking. Mrs. Hernandez told her daughter that, instead of buying the prescribed medicine, perhaps she should go to the botanica and obtain some herbs that would help lower her blood sugar.

  1. What are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?
  2. How would you assist Mrs. Hernandez in developing a plan for a 1500-calorie diet and regular exercise?
  3. Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?
  4. Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.

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Sample Answer

 

 

 

Cuban Communication Patterns:

  • High Context: Cuban communication is often high-context, meaning that much of the meaning is conveyed through nonverbal cues, social context, and established relationships. Directness is not always preferred; instead, communication may be more indirect and nuanced. Building rapport and trust is crucial.
  • Family-Centric: Family plays a central role in Cuban culture. Decisions about health and well-being are often made collectively within the family. It’s essential to involve Mariana and potentially other family members in Mrs. Hernandez’s care plan.
  • Respect for Elders: Older adults are typically held in high esteem. It’s crucial to address Mrs. Hernandez respectfully and acknowledge her experience and wisdom. Avoid being dismissive of her beliefs or practices.

 

Full Answer Section

 

 

 

 

  • Spanish Language: Mrs. Hernandez’s primary language is Spanish. It’s vital to ensure clear communication by using a qualified interpreter if needed, or by providing written materials in Spanish. Avoid relying on family members to translate medical information, as this can lead to inaccuracies and misunderstandings.
  • Personalismo: Cubans often value personal connections. Taking the time to engage in friendly conversation and showing genuine interest in Mrs. Hernandez’s life and family can build trust and rapport.

2. Assisting Mrs. Hernandez with Diet and Exercise:

  • Culturally Appropriate Diet: Work with a registered dietitian or nutritionist who is familiar with Cuban cuisine to develop a 1500-calorie meal plan that incorporates traditional Cuban dishes in a healthy way. Focus on portion control and modifications to recipes rather than completely eliminating familiar foods. For example, suggest healthier cooking methods (baking instead of frying) and emphasize the importance of fruits, vegetables, and lean protein.
  • Family Involvement: Involve Mariana in the dietary plan, as she is responsible for preparing the meals. Educate the entire family about healthy eating habits to support Mrs. Hernandez’s efforts.
  • Gradual Changes: Suggest gradual changes to Mrs. Hernandez’s diet and exercise routine, rather than making drastic changes all at once. This approach is more likely to be successful in the long term.
  • Accessible Exercise: Explore exercise options that are appropriate for Mrs. Hernandez’s age and physical condition. Walking, dancing, or gentle stretching can be good options. Encourage her to participate in activities she enjoys.
  • Practical Tips: Provide practical tips for grocery shopping, meal preparation, and portion control. Offer resources in Spanish if available.

3. Addressing Herbal Remedies:

  • Respectful Approach: Acknowledge Mrs. Hernandez’s belief in herbal remedies and avoid dismissing her concerns. Explain that while some herbs may have medicinal properties, it’s essential to understand the potential risks and interactions with other medications.
  • Open Dialogue: Engage in an open dialogue with Mrs. Hernandez about her desire to use herbs. Explore her reasons for preferring herbs over the prescribed medication.
  • Education: Provide accurate and unbiased information about the prescribed oral hypoglycemic agent and its benefits. Explain how it works to lower blood sugar and the importance of taking it as directed.
  • Collaboration: If Mrs. Hernandez is still interested in using herbs, encourage her to discuss this with her doctor. Some herbal remedies can interact with medications or have adverse effects. A collaborative approach that integrates both conventional and complementary therapies, if appropriate, might be considered. However, emphasize that the prescribed medication is essential for managing her diabetes.

4. Common Cuban Folk Practices:

  • Herbal Remedies (Botanica): As mentioned, Cuban families often use herbal remedies for various ailments. The botanica is a store that specializes in herbs, spices, and other traditional healing products.
  • Santería: Santería is an Afro-Cuban religion that incorporates elements of Catholicism and African beliefs. It involves rituals, offerings, and consultations with spiritual healers to address physical and emotional health issues.
  • Home Remedies: Cuban families often have traditional home remedies for common ailments, such as teas, poultices, or soups.
  • Cupping: Cupping is a traditional practice that involves placing heated cups on the skin to create suction. It is believed to draw out toxins and promote healing.
  • Belief in “Hot” and “Cold” Imbalances: Some Cubans may believe that illnesses are caused by imbalances in “hot” and “cold” energies in the body. This belief system can influence food choices and other health practices.

It’s crucial to approach these practices with cultural sensitivity and respect. Avoid making judgments or dismissing them as “unscientific.” Instead, focus on understanding the patient’s beliefs and integrating them into the care plan whenever possible.

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