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[ANSWERED] Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland

MODULE 4 Assignment

Complete the following Case Studies :

  • Mexican case study #2
  • Puerto Rican case study #2

Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.

MEXICAN CASE STUDY #2

Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address.

Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States.

Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olga’s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables. The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer.

The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetable- picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000.

From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines.

Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out “chits” to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables.

Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance.

Study Questions

  1. Identify three socioeconomic factors that influence the health of the Gaborra family.
  2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her
  3. Identify strategies to help improve communications in English for the Gaborra family.
  4. Identify three health-teaching goals for the Gaborra
  5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda.
  6. Discuss three preventive maintenance–teaching activities that respect the Gaborra family’s belief in the hot and cold theory of disease
  7. Identify strategies for obtaining health data for the Gaborra
  8. Identify four major health problems of Mexican Americans that affect the Gaborra family.
  9. If Olga were to see a folk practitioner, which one(s) would she seek?
  10. Explain the concept of familism as exhibited in this
  11. Distinguish between the two culture-bound syndromes el ataque and susto.
  1. Discuss culturally conscious health-care advice consistent with the health- belief practices of the pregnant Mexican American
  2. Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen.
  1. Identify where the majority of Mexican Americans have settled in the United States.

PUERTO RICAN CASE STUDY #2

Carmen Medina, aged 39, lives with her husband, Raúl, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, José; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500.

The family has health insurance through Mr. Medina’s job. They live in a three- bedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medina’s do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer.

The family is having difficulty dealing with Rosa’s and Miguel’s developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is more preoccupied with the family’s financial situation. Mrs. Medina’s parents are encouraging them to return to Puerto Rico.

Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medina’s last physical examination was after she had José.

She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the family’s finances. Mrs.

Medina is Catholic and recently has been visiting her church more often.

Study Questions

  1. Explain Mrs. Medina’s attitude in her relationship with her adolescent daughter.
  2. Identify strategies to ensure that Rosa seeks prenatal
  3. Identify barriers to accessing health care for the Medina
  4. What are the high-risk behaviors exhibited by this family?
  5. What communication barriers exist in this family that affect care delivery?
  6. Discuss gender and family roles in the context of traditional Puerto Rican culture.
  7. Identify sociodemographic factors affecting the physical- and mental- health well-being for this
  8. Identify Puerto Rican folk practices appropriate for this
  9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why?
  10. If Mrs. Medina’s parents visit a health-care provider, what might they expect?
  11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr.
  12. Discuss the importance of respeto and familism in the Medina
  13. Identify culturally congruent interventions for Rosa’s
  14. Identify health-promotion and disease-prevention interventions needed for José.

Expert Answer and Explanation

Mexican case study #2

  1. “Identify three socioeconomic factors that influence the health of the Gaborra family.”

The three major socio-economic factors for the Gaborra family include education, income and physical environment (specifically where they live)

  1. “Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia.”
  • Using health promotion flyers
  • Use of native Mexican language (Spanish) to formulate the health intervention messages
  • Involvement of family members in the teaching interventions
  1. “Identify strategies to help improve communications in English for the Gaborra family.”
  • Encouraging the children and Olgas two sisters to continue with their education. This will make them more eloquent in English which they will also speak at home
  • Encouraging communication in English when at home rather than Spanish
  • Creating awareness for the Gaborra family on the importance and need of being conversant in English.
  1. “Identify three health-teaching goals for the Gaborra family.”
  • The first goal is to promote healthy nutrition habits for the family members
  • To promote awareness of drug and substance abuse (specifically cigarette and alcohol)
  • To promote awareness on the need for formal education as a being a major health determinant.
  1. “Name three interventions Olga must learn regarding fluid balance for the infant, Linda.”

According to Vega and Avva, (2019), the following interventions should be considered for a child who is in a similar state as Linda

  • Cessation of drinks like water, tea, carbonated drinks, soup, juice among others for they may worsen the diarrhea
  • Application of oral rehydration solution (ORS)
  • Cessation of baby formula for formula-fed babies until the dehydration stops.
  1. “Discuss three preventive maintenance–teaching activities that respect the Gaborra family’s belief in the hot and cold theory of disease management.”

The hot and cold theory mainly focuses on the functional balance of the body, where an imbalance between the hot and cold aspects, causes negative health issues. One of the preventive teaching activities using this theory is proper nutrition. A balanced diet in most cases will consist of foods that bring about an optimum hot and cold balance. Therefore, this theory can be used to promote healthy eating. Engaging in physical exercises is another preventive activity which can be encouraged while considering the hot and cold theory. Dissuasion of drugs and substance abuse is the third preventive maintenance activity that can be considered as capturing the hot and cold theory of disease management. The three preventive measures can be looked at from the angle of providing a balance between hot and cold within the body, leading to optimum health

  1. “Identify strategies for obtaining health data for the Gaborra family.”
  • Health data can be obtained directly from Pablo and Olga
  • Health data can also be obtained from the schools where Roberto, Florencia, or Rosa attend
  • A healthcare worker can also obtain data from the place of work where the Gaborra family work.
  1. “Identify four major health problems of Mexican Americans that affect the Gaborra family.”

The four major health problems faced by the Gaborra family that are also prevalent to most Mexican Americans include;

  • Tuberculosis, which is one of the leading illnesses faced by Hispanics.
  • Lack of information on matters health
  • Low access to medical services
  • Lack of proper nutrition
  1. “If Olga were to see a folk practitioner, which one(s) would she seek?”

Curandera, a traditional female Mexican healer

  1. “Explain the concept of familism as exhibited in this family.”

Familism is a concept where the family interests are given more precedence above individual interests (Zeiders et al., 2016). From the case provided, the instances of familism can be seen when Olga’s sisters have to forgo school just to take care of the baby when Olga is picking vegetables at the farm. Another instance is when the family visits their relatives in Texas annually buying them gifts despite their financial challenges. The visitation is also done at the expense of Roberto forgoing his clinical visits and medication refills.

  1. “Distinguish between the two culture-bound syndromes el ataque and susto.”

El ataque and susto, the two culture-bound syndromes for the Hispanics have different aspects attached to them. El ataque or usually referred to as Ataque de Nervios is regarded as an attack of the nerves and associated with emotional breakdown (Wong, 2017). The symptoms include; crying, easy agitation screaming among others. It is usually associated with women but men are also reported to face similar symptoms. Susto, on the other hand, is known as spirit attacks, with symptoms ranging from listlessness, diarrhea, fever among others. Therefore, from the case, Linda can be said to be experiencing susto.

  1. “Discuss culturally conscious health-care advice consistent with the health belief practices of the pregnant Mexican American woman.”

For pregnant Mexican-American women, it is a common belief that cravings during pregnancy (which is normal) need to be satisfied lest the unborn child develops some developmental disorders (Hopkins, Yeoman & Ritenbaugh, 2018). It is indeed very important for pregnant women to have proper nutrition during pregnancy to assist in providing nutrients to the unborn baby which will, in turn, assist the development of the fetus while still in the womb.

  1. “Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen. “

Consistent follow up for patients with tuberculosis is essential Follow-up using strategies like phone calls, can assist a patient to adhere to their treatment regimen. Educating the patients on the need for clinic appointments and compliance with medication can also encourage the patients. For a disease like tuberculosis, a patient can be motivated by being informed on the repercussions of not adhering to the treatment regimen.

  1. “Identify where the majority of Mexican Americans have settled in the United States.”

Texas, New Mexico, and California are the states with the highest Mexican American population

 

Puerto Rican case study #2

  1. “Explain Mrs. Medina’s attitude in her relationship with her adolescent daughter.”

Mrs. Medina seems too authoritative with her adolescent daughter which makes her more open with her grandparents rather than Mrs. Medina. It may also explain why the daughter does not want to disclose her pregnancy to the family yet.

  1. “Identify strategies to ensure that Rosa seeks prenatal care.”

One of the strategies is by approaching her grandparents who Rosa is close to, to have them convince Rosa on seeking prenatal care. Another strategy is by informing Rosa about the advantages and disadvantages of prenatal care, especially during teenage pregnancy.

  1. “Identify barriers to accessing health care for the Medina family.”

Some of the barriers to accessing healthcare for the Medina family include,

  • Lack of culturally competent care
  • Inaccessible healthcare services due to economic factors
  • Lack of information on matters’ health.
  1. “What are the high-risk behaviors exhibited by this family?”
  • Substance abuse mainly alcohol and cigarettes
  • Family and work-related stress
  1. “What communication barriers exist in this family that affects care delivery?”
  • Poor or no feedback from Mr. Medina
  • The authoritarian stance by Mrs. Medina which makes communication be one way most of the times
  • Lack of down-up communication between the children and the parents which causes them to not express their issues
  1. “Discuss gender and family roles in the context of traditional Puerto Rican culture.”

According to the Puerto Rican culture, the men are supposed to be the primary providers of the family. Any income generated by the female members is only used as a supplement. The females are regarded as the primary “caretakers” of the family where they are in charge of in-house chores and taking care of the children and the elderly (Purnell & Paulanka, 2013).

  1. “Identify sociodemographic factors affecting the physical- and mental health well-being of this family.”

The family being a low-income family, it can be observed that they are having issues catering for their elderly parents which may, in turn, have a negative health impact on their parents. Likewise, due to their economic status, the family appears to be constantly stressed, which may be a factor contributing to Mrs. Medina having hypertension and the engagement of substances by Mr. Medina and their eldest son. It can be seen that because of poor communication between the parents and their daughter Rosa, she has been engaging in sexual activities at a young age leading to early teenage pregnancy and she may also be exposed to getting sexually transmitted infections.

  1. “Identify Puerto Rican folk practices appropriate for this family. “

The hot and cold theory can be helpful to the Medinas family in assisting them to seek optimum health. Seeking of mental and emotional balance by understanding the culture-based symptoms of ataque de nervios and Susto can also assist the family in the restoration of their mental health status.

  1. “If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why? “

The Medina family would consider a spiritual healer, specifically from their church, given that they are Christians of Catholic orientation.

  1. “If Mrs. Medina’s parents visit a health-care provider, what might they expect?”

It is likely that the health-care provider may not be in a position to properly communicate with them in their native language and offer culturally competent care.

  1. “Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina.”

Using the hot and cold theory is an ideal method that can be used to assist Mr. Medina to comply with Western health prescriptions. The hot and cold theory is a common theory used in health among the Latino and Puerto Rican community (Nesbeth et al., 2019).

  1. “Discuss the importance of respecto and familism in the Medina family.”

For the Medina family, the concept of respect and familism comes in handy in putting the stress experienced by the family in check. Respecto allows the family members to maintain a high level of respect amongst one another with familism making sure that all family members play their role in promoting the overall wellbeing of the family (Nesbeth et al., 2019).

  1. “Identify culturally congruent interventions for Rosa’s pregnancy.”

Some of the recommended interventions for Rosa’s pregnancy include prenatal check-ups, ensuring intake of proper nutrition, provision of useful information on her pregnancy and family support.

  1. “Identify health-promotion and disease-prevention interventions needed for José. “

For José, it is important to ensure that he receives his vaccinations to prevent the occurrence of infections such as the respiratory infection he previously had. It is also important to take José to a pediatric clinic for physical check-ups often and also have his allergies checked for proper interventions to be applied.  Mr. Medina should also be cautioned from smoking around the house or anywhere close to José since it may have negative health and developmental impact on José (Peterson & Hecht, 2017).

References

Hopkins, A. L., Yeoman, M., & Ritenbaugh, C. (2018). Healthy foods prepared at home: Diet and support as protective strategies during pregnancy for Hispanic women. Ecology of food and nutrition57(2), 140-161.

Nesbeth, C., Alonso, W., Agboto, V., Acevedo, M., & Nchako, E. (2019). Family engagement: A model for improved health outcomes in Puerto Rico.

Peterson, L. A., & Hecht, S. S. (2017). Tobacco, E-Cigarettes and Child Health. Current opinion in pediatrics29(2), 225.

Purnell, L., & Paulanka, B. (2013). Transcultural health care: A culturally competent approach (4th ed.). Philadelphia: F. A. Davis.

Vega, R. M., & Avva, U. (2019). Pediatric Dehydration. In StatPearls [Internet]. StatPearls Publishing.

Wong, M. J. (2017). Culture-bound syndromes: Racial/ethnic differences in the experience and expression of Ataques de nervios (Doctoral dissertation, UCLA).

Zeiders, K. H., Updegraff, K. A., Umaña‐Taylor, A. J., McHale, S. M., & Padilla, J. (2016). Familism values, family time, and Mexican‐Origin young adults’ depressive symptoms. Journal of Marriage and Family78(1), 91-106.

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