After studying, Purnell, L. (2013) Chapters 12, 13 and 15 discuss the following:
The St. Fleur family is well respected in the Haitian community because they are religious with great moral values. They moved to the United States because of political issues in Haiti. Ronald, the youngest son of this family, is 27 years old and lives at home with his mother and father. Recently, he began having fevers and subsequently developed pneumonia. He was admitted to the hospital, where laboratory tests were HIV positive. Ronald was in shock when the doctor informed him that he was HIV positive. He confessed to the doctor that he was gay, but he could not tell his family. He said that he did not want to bring shame to the family. Because he couldnâ€™t be in a formal relationship disowning to his family and the Haitian communityâ€™s view of homosexuality, he has been very promiscuous over the years.
What are Haitiansâ€™ views of homosexuality?
If Ronaldâ€™s parents were to learn of his positive HIV status, how might they react if they are religious and traditional?
Identify three major culturally congruent strategies a healthcare provider can implement to address HIV prevention practices in the Haitian community?
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources
Use the following as a refernce: Purnell, L. (2013).
Transcultural health care: A culturally competent approach
. F A Davis Company.
2780_Ch10_178-196 16/07/12 11:45 AM Page 194
Aggregate Data for Cultural-Specific Groups
of our population and reinforced the importance of
building accessible facilities for the disabled and thus
enhance efforts to construct a harmonious society in
China (Nan, 2006). Overall, the Chinese still view
mental and physical disabilities as a part of life that
should be hidden.
The expression of the sick role depends on the level
of education of the patient. Educated Chinese people
who have been exposed to Western ideas and culture
are more likely to assume a sick role similar to that of
Westerners. However, the highly educated and acculturated may exhibit some of the traditional roles associated with illness. Each patient needs to be assessed
individually for responses to illness and for expectations of care. Traditionally, the Chinese ill person is
viewed to be passive and accepting of illness. To the
Chinese, illness is expected as a part of the life cycle.
However, they do try to avoid danger and to live as
healthy a life as possible. To the Chinese, all of life is
interconnected; therefore, they seek explanations and
connections for illness and injury in all aspects of life.
Their explanations to health-care providers may not
make sense, but the health-care provider should try to
determine those connections so they can be incorporated into treatment regimens. The Chinese believe
that because the illness or injury is caused from an imbalance, there should be a medicine or treatment that
can restore the balance. If the medicine or treatment
does not seem to do this, they may refuse to use it.
Native Chinese and Chinese Americans like treatments that are comfortable and do not hurt. Treatments that hurt are physically stressful and drain their
energy. Health-care providers who have been ill themselves can appreciate this way of thinking, because
sometimes the cure seems worse than the illness. Treatments will be more successful if they are explained in
ways that are consistent with the Chinese way of
thinking. The Chinese depend on their families and
sometimes on their friends to help them while they are
sick. These people provide much of the direct care;
health-care providers are expected to manage the care.
The family may seem to take over the life of the
sick person, and the sick person is very passive in
allowing them the control. One or two primary people
assume this responsibility, usually a spouse. Healthcare providers need to include the family members in
the plan of care and, in many instances, in the actual
delivery of care.
Blood Transfusions and Organ Donation
Modern-day Chinese accept blood transfusions, organ
donations, and organ transplants when absolutely essential, as long as they are safe and effective. Chinese
Americans have the same concerns as Americans about
blood transfusion because of the perceived high incidence of HIV and hepatitis B. No overall ethnic or religious practices prohibit the use of blood transfusions,
organ donations, or organ transplants. Of course, some
individuals may have religious or personal reasons for
denying their use.
Health Care Providers
Traditional Versus Biomedical Providers
China uses two health-care systems. One is grounded
in Western medical care, and the other is anchored in
traditional Chinese medicine. The educational preparation of physicians, nurses, and pharmacists is similar
to Western health-care education. Ancillary workers
have responsibility in the health-care system, and
the practice of midwifery is widely accepted by the
Chinese. Physicians in Chinese medicine are trained
in universities, and traditional Chinese pharmacies
remain an integral part of health care.
Status of Health-Care Providers
Traditional Chinese medicine providers are shown
great respect by the Chinese. In many instances, they
are shown equal, if not more, respect than Western
health-care providers. The Chinese may distrust
Western health-care providers because of the pain and
invasiveness of their treatments. The hierarchy among
Chinese health-care providers is similar to that of
Chinese society. Older health-care providers receive
respect from the younger providers. Men usually receive more respect than women, but that is beginning
to change. Physicians receive the highest respect, followed closely by nurses with a university education.
Other nurses with limited education are next in the
hierarchy, followed by ancillary personnel.
Health-care providers are usually given the same respect as older people in the family. Chinese children
REFLECTIVE EXERCISE 10.3
Mrs. Cheng brought her 4-year-old son, Justin, to the emergency department early one morning. She stated that her son
has had a high fever for 4 days. Her mother-in-law used traditional herbal medicine, but it was ineffective. The advanced
practice nurse diagnosed a pulmonary infection and prescribed
1. From a traditional Chinese medical perspective, how
might the nurse incorporate Western medical prescriptions while respecting Mrs. Chengâ€™s family, who wishes to
continue Chinese herbal treatments?
2. What additional cultural and socioeconomic barriers
should the nurse assess to provide culturally competent
health-care and nursing services to Justin?
3. Identify and describe traditional, nonherbal Chinese medical practices that are used to treat pulmonary disorders?
4. Describe from the traditional Chinese individual the ideal
2780_Ch10_178-196 16/07/12 11:45 AM Page 195
People of Chinese Heritage 195
recognize them as authority figures. Physicians and
nurses are viewed as individuals who can be trusted
with the health of a family member. Nurses are generally perceived as caring individuals who perform
treatments and procedures as ordered by the physician. Nursing assistants provide basic care to patients.
Adult Chinese respond to health-care providers with
respect, but if they disagree with the health-care
provider, they may not follow instructions. They may
not verbally confront the health-care provider because
they fear that either they or the provider will suffer a
loss of face.
The Chinese respect their bodies and are very modest when it comes to touch. Most Chinese women feel
uncomfortable being touched by male health-care
providers, and most seek female health-care providers.
Alexander, R.M., & Marg, A.M. (2006). Chinese women local
leaders exchange realities with WEI. Women and Environments,
Center for Reproductive Rights. (2002). China turns one child policy into law. Retrieved from http://www.crlp.org/ww_asia_
Chang, J.S. (2004). Refashioning womanhood in 1990s Taiwan:
An analysis of Taiwanese edition of cosmopolitan magazine.
Modern China, 30, 361â€“397.
Chen, S.E. (2009). Mother of the culture: Founding a Taiwanese
feminist theology. Feminist Theology, 27, 81â€“88.
Cheung, R., Nelson, W., Advincula, L., Young, C.V., & Canham,
D.L. (2005). Understanding the culture of Chinese children
and families. The Journal of School Nursing, 21(1), 3â€“9.
Chinese Ministry of Health. (2004). An about face on AIDS prevention. Retrieved from http://www.highbeam.com/doc/
Chinese Ministry of Health. (2009). Chinese factfile. Retrieved
CIA World Factbook. (2011). China. Retrieved from https://www.
Gu, W. (2006). Women of China: The human face of HIV/AIDS.
Retrieved from http://www.womenofchina.cn
Haley, G., Tan, C., & Haley, U. (1998). New Asian emperors: The
overseas Chinese, their strategies and competitive advantages.
Woburn, MA: Butterworth-Heinemann.
Halporn, R. (1992). Introduction. In C.L. Chen, W.C. Lowe,
D. Ryan, A.H. Kutscher, R. Halporn, & H. Wang (Eds.), Chinese
Americans in loss and separation (pp. vâ€“xii). New York: Foundation of Thanatology.
Ho, H.F., & Lee, H.L. (2010). Great expectations: Family educational expenditure in Taiwan vs China. European Journal of
Social Sciences, 17(4), 628â€“637.
Hu, W., & Grove, C.L. (1991). Encountering the Chinese.
Yarmouth, MA: Intercultural Press.
Huang, W. (1992). Attitudes toward death: Chinese perspectives
from the past. In C.L. Chen, W.C. Lowe, D. Ryan, A.H.
Kutscher, R. Halporn, & H. Wang (Eds.), Chinese Americans
in loss and separation (pp. 1â€“5). New York: Foundation of
Huangjuan. (2009). One-night stands accepted, few practice. Retrieved
Levy, R.A. (1993). Ethnic and racial differences in response to
medicines: Preserving individualized therapy in managed pharmaceutical programmes. Pharmaceutical Medicine, 7, 139â€“165.
Li, C. (2000). Confucianism and feminist concerns: Overcoming
the Confucian â€œGender complexâ€. Journal of Chinese Philosophy,
Lin, C.C., & Fu, V.R. (1990). A comparison of child-rearing practices among Chinese, immigrant Chinese, and CaucasianAmerican parents. Child Development, 61, 429â€“433.
Ma, G.X. (2000). Barriers to the use of health services by Chinese
Americans. Journal of Allied Health, 29(2), 64â€“70.
Mayo Clinic. (2010). Tai chi: Discover the many possible health benefits. Retrieved from http://www.mayoclinic.com/health/tai-chi/
Miller, L.C. (2000). Health of children adopted from China.
Pediatrics, 105(6), 76.
Ministry of Health of the Peopleâ€™s Republic of China. (2011).
Center for statistics information Ministry of Health, P. R. China.
Retrieved from http://www.moh.gov.cn/publicfiles/business/
Ministry of Public Health. (1992). A brief introduction to Chinaâ€™s
medical and health services. Beijing, Peopleâ€™s Republic of
Moore, R. (1990). Ethnographic assessment of pain coping perceptions. Psychosomatic Medicine, 52, 171â€“181.
Nan, C. (2006). Beijing gears up for 2008 Paralympic Games. Retrieved from http://www.btmbeijing.com
National Bureau of Statistics of China. (2011). The sixth national
population census. Retrieved from http://www.stats.gov.cn/zgrkpc/
Office of Minority Health. (2007). Asian American profiles. Retrieved from http://www.omhrc.gov/templates/browse.aspx?
Oâ€™Keefe, H., & Oâ€™Keefe, W. (1997). Chinese and Western behavioral differences: Understanding the gaps. International Journal
of Social Economics, 24, 190â€“197.
Peopleâ€™s Daily. (2002). Chinaâ€™s life expectancy averaged 71.8 year.
Retrieved from http://english.peopledaily.com.cn
Schulpen, T. (2001). Immunization status of children adopted
from China. The Lancet, 358, 2131â€“2132.
Seidel, H., Ball, J., Dains, J., & Benedict, W. (1994). Quick reference
to cultural assessment. St. Louis, MO: Mosby.
Shim, Y.H. (2001). Feminism and the discourse of sexuality in
Korea: Continuities and changes. Human Study, 24, 133â€“148.
Shrestha, M., & Weber, K.E. (1994). Reflection of Confucianism,
Hinduism, and Buddhism on gender relations and gender specific occupation in Thai society. Journal of Population and Social Studies, 5(1â€“2), 31â€“54.
Smith, C.S. (2002, April 30). Beware of cross-cultural faux pas in
China. New York Times.
Tan, C.M. (1992). Treating life-threatening illness in children. In
C.L. Chen, W.C. Lowe, D. Ryan, A.H. Kutscher, R. Halporn,
& H. Wang (Eds.), Chinese Americans in loss and separation
(pp. 26â€“33). New York: Foundation of Thanatology.
USAID. (2010). HIV/AIDS health profile. Retrieved from http://
www.usaid.gov/our work/global health/aids/countries/asia/china_
U.S. Census Bureau. (2006). Selected population profile in the
United States. Retrieved from http://factfinder.census.gov/
U.S. Citizenship and Immigration Services. (2011). Immigration
and Nationality Act. Retrieved from http://www.uscis.gov/
Wang, Y. (2011a). Press release on major figures of the 2010 National
Population Census. Retrieved from http://www.womenofchina.cn
2780_Ch10_178-196 16/07/12 11:45 AM Page 196
Aggregate Data for Cultural-Specific Groups
Wang, Y. (2011b). AIDS deaths hit â€œpeakâ€ as 7,700 die. Retrieved
Wang, Y. (2011c). Maternal, infant death rates drop in Chinaâ€™s remote count. Retrieved from http://www.womenofchina.cn/
Women of China. (2006a). Employment status of women.
Retrieved from http://www.womenofchina.cn
Women of China. (2006b). Survey of divorce rates in different countries. Retrieved from http://www.womenofchina.cn
Women of China. (2006c). HIV test mandatory. Retrieved from
Women of China. (2006d). Women and childrenâ€™s health care services. Retrieved from http://www.womenofchina.cn
XinHua News Agency. (2006). Official calls for more efforts to curb
gender imbalance. Retrieved from http://english.peopledaily.
Yang, Z. (2011). Chinese smokers not prepared to face hasty smoking ban. Retrieved from http://www.womenofchina.cn/html/
Ying, Y., & Miller, L.S. (1992). Help-seeking behavior and attitude
of Chinese Americans regarding psychological problems.
American Journal of Community Psychology 20(4), 549â€“556.
Yu, E.S., Edwin, H., Chen, K., Kim, K., & Sawsan, A. (2002).
Smoking among Chinese Americans: Behavior, knowledge, and
beliefs. American Journal of Public Health, 92(6), 1007â€“1013.
Zhang, J., Casswell, S., & Cai, H. (2008). Increased drinking in a
metropolitan city in China: A study of alcohol consumption
patterns and changes. Addiction, 103(3), 416â€“423.
Zhang, S. (2011). Non-infectious chronic diseases become major
health threat, claiming 85% of deaths in China. Retrieved from
Zhuhong, A. (2006). Population and family planning law of the Peopleâ€™s
Republic of China. Retrieved from http://www.womenofchina.cn
Zhuhong, A. (2009a). Survey shows more teens have sexual experience. Retrieved from http://www.womenofchina.cn/html/
Zhuhong, A. (2009b). Abortion issue causes for concern. Retrieved
For case studies, review questions, and additional
information, go to
2780_Ch11_197-213 16/07/12 11:45 AM Page 197
People of Cuban Heritage
Larry D. Purnell and Jorge Gil
Overview, Inhabited Localities,
The Republic of Cuba, with a population of over
11 million people, is located 90 miles south of Key West,
Florida (CIA World Factbook, 2011). Approximately
the size of Pennsylvania, it is the largest island in the
West Indies. The capital, Havana, is the largest city.
Fidel Castro was president of this communist country
from 1959 until 2008, at which time he resigned due to
health problems. Major agricultural products and industries include sugar, petroleum, tobacco, textiles,
nickel, copper, cement, and fertilizer. Cuba is a multiracial society, with a population of primarily Spanish and
African origins; other significant ethnic groups include
Chinese, Haitians, and Eastern Europeans (CIA World
Over 1.6 million Cuban Americans live in the
United States, representing the third largest Hispanic
group, after Mexican Americans and Puerto Ricans
(U.S. Census Bureau, 2009). Cubans in Miami-Dade
County, Floridaâ€”the dominant center of Cuban
settlementâ€”are credited with the areaâ€™s socioeconomic transformation (Boswell, 2002). In this ethnic
enclave, Cubans have created businesses and rejuvenated the economy, leading some to speak of the
â€œgreat Cuban miracle.â€ The distinctive Cuban culture
is evidenced by their music, dance, and art. Cubans
have made a number of dances popular, including
the rumba, the cha-cha, the guaracha, the bolero, and
the conga. The classical ballerina, Alicia Alonso,
was a Cuban dancer famous for, among other things,
her portrayal in the ballet Carmen. The film Fresa y
Chocolate (Strawberries and Chocolate) won the Silver
Bear Award at the Berlin Film Festival in February
1995 (Cultural Orientation Resource Center, 2002).
The experience of Cubans in their homeland and
in the United States is distinct from that of other Hispanic groups. The history and culture of Cuba and
the Cuban people have been heavily influenced by
Spain, the United States, the Soviet Union, and,
through the slave trade in Cubaâ€™s sugar industry, West
African groups such as the Yoruba.
Cuba was under Spanish control from 1511 until
1898, making it one of Spainâ€™s last colonies in the New
World. Control of the sugar industry by Spanish peninsulares (individuals born in Spain) was challenged by
the growing class of criollo landowners (individuals of
Spanish ancestry born in Cuba) and the independentista movement. This absentee ownership created political turmoil and social imbalances that gave rise to
the Cuban national character. The mistrust of government reinforced a strong personalistic tradition, a sense
of national identity evolving from family and interpersonal relationships (Szapocznik & Hernandez, 1988).
Unlike most other immigrant groups, under the
Cuban Adjustment Act of 1966, Cubans were welcomed by the U.S. government and were provided
with support from the Cuban Refugee Program begun
by the Kennedy administration. Cubans engaged in a
wide range of entrepreneurial activity, in both sales
and services, within the shelter of the Cuban community. Consequently, newer Cuban immigrants found
networks of support and were somewhat protected
from the difficulties associated with a competitive
labor market. There is a common feeling of thankfulness and appreciation among newer Cuban generations in the United States and also from the first
cohort of Cuban immigrants who arrived in the early
1960s. Cubans in the United States are a strong presence, not only economically but also politically.
An exile ideology, a preoccupation with events in
Cuba, and militant opposition to the regime of Fidel
Castro characterize their predominant political stance.
Overwhelmingly, Cuban Americans tend to be conservative, Republican, and anti-Communist. They have
demonstrated high voter turnout and tend to vote in
blocs during local and national elections (National
Council of la Raza, 2011).
Cubans have managed to adjust to mainstream
American culture while remaining close to their
Cuban roots. However, young adults and adolescents
who were educated in Cuba with strict Communist
2780_Ch11_197-213 16/07/12 11:45 AM Page 198
Aggregate Data for Cultural-Specific Groups
ideation and who emigrated with their parents may
find the clash in values between Cuba and their new
country confusing and negative. The bicultural Cuban
American population can help in their adjustment.
Many Cubans outside Cuba possess a strong ethnic
identity, speak Spanish, and adhere to traditional
Cuban values and practices at home while working in
the dominant culture of their new homeland.
From the late 1800s to mid-1900s, Cuba was considered one of the most prosperous countries in Latin
America. The economy was based on treaties mainly
with United States, France, and Spain. Taxes were collected from people at a high rates compared with those
of countries from the â€œfirst world.â€ At the same time,
construction of new buildings and roads increased.
Since the 1959 Communist Revolution of Castro, the
island has based its economy on subsidies from communist countries such as the former Soviet Union and
China. With perestroika (literally translated, â€œrestructuringâ€) in 1988 by ex-president Mikhail Gorbachev,
Cuba tried without success to implement changes in
Cuban economy today is primarily based on
tourism and gastronomy. Recently, the government
established taxes for so-called â€œprivate businesses,â€ but
because Cuba has no experience with a capitalist
economy, its government does not know how to implement the taxation system. The general population
cannot pay these excessively high taxes and continue
to depend on their families en el extranjero: those who
reside outside Cuba.
Heritage and Residence
Ethnically, Cubans are 61.1 percent white, 24.8 percent
mulatto or mestizo, and 10.1 percent black (CIA
World Factbook, 2011). The native Arawak Indian
population that inhabited the island when Columbus
landed in 1492 died from diseases brought by Spanish
settlers. Cubans have a rich historical heritage. Spain
launched its conquest of Mexico from Cuba in 1519.
During the Spanish colonial period (1511â€“1898),
Spanish boats stopped in Havana on their way to
Mexico and Central America. In the 19th century, the
Monroe Doctrine led to a special relationship between
Cuba and the United States. The U.S. military controlled the island from 1898 to 1902. In 1902, Cuba
was a politically independent capitalist state. In 1959,
Fidel Castro led a revolution to free Cuba of the
U.S.-backed dictator Fulgencio Batista and subsequently established a totalitarian Communist government, which still controls the country through the sole
party, the Cuban Communist Party (PCC).
Most Cuban Americans reside in four states:
Florida, New Jersey, California, and New York.
The largest proportion live in Florida, especially in
Miami-Dade County. The Cuban American population is aging, with a median age of 43.6 years and
more than 20 percent over 65 years old. By comparison, Mexicans, Puerto Ricans, and Central and South
Americans living in the United States have median
ages between 11 to 16 years younger than the average
for Cuban Americans. The higher median age is explained by lower fertility rates of Cuban American
women and the older age of those who immigrate
from Cuba (Boswell, 2002; Martinez, 2002).
About two-thirds of Cuban Americans residing in
the United States were born in Cuba, making this group
a largely immigrant population as compared with other
Hispanic groups. To illustrate, only 32 percent of Cuban
Americans were born in the United States, compared
with 64 percent for Mexican Americans and 60 percent
for Puerto Ricans (Boswell, 2002).
Based on the 2010 U.S. Census, the total estimated
Cuban population in the United States is almost
1.6 million, which is the third largest Hispanic population in this country (U.S. Census Bureau, 2010). The
largest is the Mexican population with a total of almost 30 million people, followed by Puerto Ricans
with over 4 million. The major concentration of
Cubans is located in Miami-Dade County, Florida,
with 778,389 (U.S. Census Bureau, 2010)â€”almost half
of the total estimated number of Cuban Americans.
The second concentration of Cubans is located in
New York City with a total of 42,414, followed by
Texas with 36,945. (U.S. Census Bureau, 2010). Places
like South Dakota and Alaska have smaller Cuban
populations with 134 and 740, respectively (U.S. Census
Reasons for Migration and Associated
Approximately 1 million Cubans immigrated to the
United States between 1959 and 1980; fewer than
200,000 arrived between 1990 and 2000. In the first
2 decades of the earlier period, most arrived on the
U.S. mainland after the 1959 revolution that brought
Fidel Castro to power and changed the social, economic, and political landscape of Cuba. Although the
American government has defined the exodus as a
political rather than an economic migration, a combination of these factors provided the motivation for
migration. The desire for personal freedom, the hope
of refuge and political exile, and the promise of
economic opportunities have been the main reasons
for Cuban immigration.
Portes and Bach (1985) identified six stages of
Cuban immigration to the United States:
1. First stage: Departures from January 1959 to
October 1962. When Fidel Castro overthrew the
government of Fulgencio Batista in January 1959,
approximately 250,000 landowners, industrialists,
2780_Ch11_197-213 16/07/12 11:45 AM Page 199
People of Cuban Heritage
professionals, and merchants left on commercial
flights from Havana for the United States.
(2004) characterized two significant groups in this
Operation Pedro Pan. In the early 1960s, some
14,000 Cuban children and teens were flown to the
United States without their parents through Operation
Pedro Pan. Triggered by fears that their children would
be made wards of the state and forced to participate
in counterrevolutionary activities, Cuban parents sent
their children to the United States. The Pedro Pan children were placed with foster families and relocated to
different parts of the country; some never saw their
parents again (Conde, 1999). Although a number of
children were eventually reunited with their parents,
many suffered years of isolation and estrangement
from their families.
Balseros: The term balseros was derived from balsa
(raft), denoting the arrival of Cubans in the 1990s
using homemade rafts. This wave of migration
was preceded by deteriorating living conditions in
Cuba, with long electric power outages and
chronic shortages of food and basic necessities.
Of 35,000 balseros who were allowed by the Castro government to leave in 1994, only 30,000 were
estimated to have arrived in the United States.
Many did not survive the crossing because of
dehydration or boats that capsized. The mostcelebrated case was that of 5-year-old Elian
Gonzalez, who was rescued floating on an inner
tube after his mother and others perished when
their boat capsized (Skaine, 2004).
Immigrating through other countries: From 2001 until
the present, increasing numbers of Cubans have
been immigrating by land through Mexico,
Canada, Spain, or other countries (Skaine, 2004).
2. Second stage: Departures from November 1962 to
September 1965. The confrontation between
Cuba and the United States over Russian missiles
in Cuba ended all direct flights from Cuba to the
United States. At this time, about 56,000 people
left on small boats and rafts because no direct
transportation was available.
3. Third stage: Departures from October 1965 to
April 1973. Cuba and the United States reached
an understanding in which an airlift was allowed
from Varadero Beach, Cuba, to Miami. These
â€œfreedom flightsâ€ or â€œfamily reunification
flightsâ€ provided the opportunity for about
297,000 people to immigrate.
4. Fourth stage: Departures from May 1973 to
September 1978. The Cuban government unilaterally ended the airlift. Travel to Spain, Mexico,
and Jamaica became the only means of leaving
Cuba. About 39,000 people arrived in the
United States on commercial flights by way
of these countries.
5. Fifth stage: Departures from October 1978 to
March 1980. Fidel Castro allowed political prisoners from Cuban jails to leave with their families.
About 10,000 people arrived in this manner on
airplane flights, boats, and rafts.
6. Sixth stage: Departures from April to September
1980. The Cuban government again allowed a
massive boatlift from the Mariel Harbor in Cuba
to Key West, Florida. Approximately 125,000
people arrived (known as the Marielitos), including people with criminal records, homosexuals,
deaf-mutes, lepers, and patients from mental
institutions. About 5000, or 4 percent, of these
were hard-core criminals, causing an increase in
the levels of violent crime in the metropolitan
Miami and New York areas.
In the decade from 1990 to 2000, a total of 191,506
Cuban immigrants entered the United States (U.S. Immigration and Naturalization Service, 2000). Skaine
Two immigration accords signed by the United States
and Cuba set a limit of 20,000 visas annually for Cuban
immigrants and stipulated that any illegal immigrants
will be repatriated. At present, U.S. law enforces the
wet-foot/dry-foot policy with Cuban refugees. This
means that if a Cuban refugee reaches dry land in the
United States, that individual will be awarded legal immigrant status. This policy has generated some resentment from other immigrant groups such as Mexicans
and Haitians, who are not awarded similar status even
if they manage to arrive on dry land in the United States
In the 3 decades of Cuban immigration, significant
change has been observed in the waves of immigrants,
from the elite classes of the first stage, called the golden
exiles, to the Marielitos of the sixth stage and the
balseros of the 1990s. Each wave is distinct: The earliest waves of immigrants represented higher educational and economic status in Cuba than subsequent
waves; the later groups were more representative of
the Cuban population. The motivation for immigration also changed from the desire to escape political
and religious persecution in the earlier waves to the
hope for economic improvement in the later waves
Educational Status and Occupations
The level of educational attainment of Cuban Americans
is higher than that of other Hispanic groups. About
22 percent of Cuban Americans are college graduates,
compared with 7 percent for Mexican Americans,
12 percent for Puerto Ricans, and 16 percent for Central
and South Americans. The educational preparation of
Cuban Americans is reflected in their median income,
2780_Ch11_197-213 16/07/12 11:45 AM Page 200
Aggregate Data for Cultural-Specific Groups
which is also higher than that of other Hispanic groups.
The median household income for Cubans is $38,000,
higher than for other Hispanics ($36,000) but lower than
for non-Hispanic whites ($48,000). Native-born Cubans
have a higher median income than non-Hispanic whites
($50,000 vs. $48,000). Among foreign-born Cubans,
those who arrived before 1980 have the highest median
income ($38,000). However, those who arrived between
1980 and 1990 have a lower median income compared
with those who arrived in 1990 or later ($30,000 vs.
$33,000). Cubans living outside Florida have a higher
median income than those living in Florida ($44,000 vs.
$36,000) (Pew Hispanic Center, 2006). Relatively high
proportions of Cubans work in wholesale and retail
trade, banking and credit agencies, insurance, real estate,
and finance. A larger proportion of Cuban Americans
are found in higher-paying managerial and professional
jobs (24 percent), compared with Mexican Americans
(12 percent), Puerto Ricans (17 percent), and Central
and South Americans (15 percent). Conversely, in lowerpaying jobs as operators, fabricators, handlers, and
farmers, Cuban Americans have a smaller proportion
(18 percent) than that of Mexican Americans (18 percent),
Puerto Ricans (21 percent), and Central and South
Americans (24 percent) (Boswell, 2002).
Dominant Language and Dialects
Language is often used as an index of assimilation of
an immigrant group into the dominant culture. Virtually all first-generation Cubans in the United States
speak Spanish as their first language, although Cuban
Spanish varies somewhat in choice of words and pronunciation from the Spanish spoken in Spain and
Central and South America.
Some Cuban Americans consider English to be
their dominant language, others consider Spanish to
be their dominant language, and yet others are completely bilingual. Because many Cubans live and
transact business in Spanish-speaking ethnic enclaves,
they have little need or motivation to learn English
and are less likely to acculturate. Many, like one of the
authors, speak Spanglish, a mixture of Spanish and
English with phrases such as Have a buen dia; Hola,
donde va today? (Have a good day; Hello, where are
you going?). The large number and variety of Spanishlanguage media, including newspapers, magazines,
and radio programs, also reflect some Cuban immigrantsâ€™ preference for Spanish over English. A stroll
through Little Havana in Miami or Little Havana
North along New Jerseyâ€™s Union Cityâ€“west New York
corridor, as well as other places in the United States,
reveals that Spanish is reflected in billboard and poster
advertisements. Signs announcing joyeria (jewelry
store), carniceria (butcher shop), muebleria (furniture
store), farmacia (drugstore), or zapateria (shoe store)
are quite commonplace. In addition, Cubans in
the United States have incorporated into their everyday Spanish many English words, such as futbol, rosbif, coctel, sueter, frigidaire, and bridge. For Cuban
Americans, Spanglish becomes a reflection of both
their Cuban and their American heritages.
Cultural Communication Patterns
Like other Hispanic groups, Cubans value simpatia and
personalismo in their interactions with others. Simpatia
refers to the need for smooth interpersonal relationships and is characterized by courtesy, respect, and the
absence of harsh criticism or confrontation. Personalismo emphasizes intimate interpersonal relationships
over impersonal bureaucratic relationships. Choteo, a
lighthearted attitude with teasing, bantering, and exaggerating, may often be observed in the way Cubans
communicate with one another (Bernal, 1994).
Conversations among Cubans are characterized by
animated facial expressions, direct eye contact, hand
gestures, and gesticulations. Voices tend to be loud
and the rate of speech faster than may be observed
with non-Cuban groups. Linguistically, the use of the
second-person form usted to address older people and
authority figures has fallen into disuse, replaced by the
familiar form tu, although some older people prefer
the formal use of language, especially in hierarchal realtionships such as with health professionals. The use
of tu in interpersonal situations serves to reduce distance and promotes personalismo. Touching, in the
form of handshakes or hugs, is acceptable among
family, friends, and acquaintances. In the health-care
setting, patients and family members may hug or
kiss the health-care provider to express gratitude and
Cubans feel a sense of â€œspecialnessâ€ about themselves and their culture that may be conveyed in communication with others. This sense of specialness
arises from pride in their unique culture, a fusion of
European and African; the geopolitical importance
of Cuba in relation to powerful countries in history;
and the exceptional success they have achieved in
adapting to their new environment. This sense of specialness, combined with the fast rate and loud volume
of speech, may sometimes be interpreted as arrogance
or grandiosity in a non-Cuban cultural context
Cubans tend to be present oriented compared with
future-oriented European Americans. A greater emphasis is paid to current issues and problems than
on projections into the future. In the clinical setting,
health-care providers must realize that Cuban patients tend to be motivated to seek help in response
to crisis situations. Hence, visits to health-care
providers for resolution of a crisis must be used
2780_Ch11_197-213 16/07/12 11:45 AM Page 201
People of Cuban Heritage
REFLECTIVE EXERCISE 11.1
Pedro is a 12-year-old child who arrived from Cuba 6 months
ago. He flew from the island with his parents and a 4-year-old
sister. He lives now with his paternal grandparents in the Coral
Gables area of Miami. He started school one week after he
came from Cuba in a local public school. â€œPedrito,â€ as he is
called by his family and close friends, used to do very well in
school. He had received several accommodations from his
teachers, always had good grades, was very friendly and active
socially, was always a team player, and had several awards in
For the past 4 or 5 months, he appears to be lonely and
quiet. His mother approached him once and asked him what
changed his attitude. Pedrito told her that he does not understand English, the teachers talk too fast, and when he asks
questions, several children in the classroom laugh at him. He
told his mother that he wants to go back to Cuba, hates his
new country, and will no longer go to school.
1. Do you think Pedritoâ€™s behavior is a common pattern in all
immigrant kids during the process of acculturation? Explain
2. What is the best action for the parents to take?
3. Describe three consequences of Pedritoâ€™s behavior for his
future professional and personal development if his parents do not take early measures to try to help him.
as opportunities for teaching and promotion of
Hora cubana (Cuban time) refers to a flexible time
period that stretches from 1 to 2 hours beyond the designated clock time. A Cuban understands that when
a party starts at 8 p.m., the socially acceptable time to
arrive is between 9 and 10 p.m. However, families who
have acculturated to American values may adhere to
a more rigid clock time. When setting up appointments for clinic visits, the health-care provider must
determine the patientâ€™s level of acculturation with respect to time and make arrangements for flexible
scheduling, if necessary.
Format for Names
Modeled after Spanish and other Latin American
societies, Cubans use two surnames, representing the
motherâ€™s and the fatherâ€™s sides of the family. For example, a woman may use the name Regina Morales
Colon, indicating that her patrilineal surname is
Morales and her matrilineal surname is Colon. When a
Cuban woman marries, she adds de and her husbandâ€™s
name after her fatherâ€™s surname and drops her
motherâ€™s surname. In the previous example, if Regina
marries Mr. Ordonez, her name will be Regina
Morales de Ordonez (Skaine, 2004). When addressing
Cuban patients, especially the elderly, the healthcare provider should use the formal rather than the
familiar form, unless told otherwise. In the previous
example, the appropriate appellation would be SeÃ±ora
Morales, or Mrs. Morales, instead of Regina.
Cubans translate English, Russian, or any other
language in their own â€œCuban way,â€ and this is true
for names as well. Some examples of common terms
that have been adapted from other languages are
Naivy (like U.S. Navy), Yusimi (You see me), and
Yeneisy (Yeah, neinâ€”German for â€œnoâ€ and â€œseeâ€).
Family Roles and Organization
Head Of Household And Gender Roles
As among most Hispanic/Latino populations, family is
the most important social unit among Cubans and
Cuban Americans. The traditional Cuban family structure is patriarchal, characterized by a dominant and aggressive male and a passive, dependent female, although
the more acculturated families in the United States have
become more egalitarian. La casa, the house, is considered the province of the woman, and la calle, the street,
the domain of the man. La calle includes everything
outside the home, which is considered a proper testing
ground for masculinity but dangerous and inappropriate
for women. Traditionally, Cuban wives are expected to
stay at home, manage the household, and care for the
children. Husbands are expected to work, provide, and
make major decisions for the family. However, with acculturation and more women working outside the home,
egalitarian decision making prevails in the United States.
Cultural values acquired through 4 centuries of
Spanish domination influence the behavior of Cuban
men and women toward one another. The concept of
honor is described as personal goodness or virtue,
which can be lost or diminished by an immoral or unworthy act. Honor is maintained mainly by fulfilling
family obligations and by treating others with respeto
(respect). Verguenza, a consciousness of public opinion and the judgment of the entire community, is
considered more important for women than men.
Machismo dictates that men display physical strength,
bravery, and virility.
In Cuba, the transition from an agricultural to an
industrial economy, the rising educational attainment
of women, the increased participation of women in
the workforce, and the passage of the Family Code of
1975 resulted in more gender equality and parity
beween men and women with respect to marriage,
divorce, property relations, and sharing of household
responsibilities (Skaine, 2004).
Since the massive migration from Cuba to the
United States in 1959, the traditional Cuban family
has undergone a transition to a less male-dominated,
less segregated, and more egalitarian structure. Cuban
women who arrived in the United States were
frequently the first in the family to find jobs and
contribute to the survival of the family. According to
2780_Ch11_197-213 16/07/12 11:45 AM Page 202
Aggregate Data for Cultural-Specific Groups
Gallagher (1980), Cuban immigrant women were
more receptive to life in the United States, more
flexible, and more readily hired for jobs than men.
Eventually, as their contributions to the familyâ€™s economic well-being increased, the womenâ€™s power to make
decisions was enhanced. Cuban American women have
the highest rate of labor participation when compared
with all other groups of women in the United States
(Suarez, 1993). Thus, contemporary Cuban families
from the 1980s to the present may demonstrate greater
gender equality in decision making for the family.
Prescriptive, Restrictive, and
Taboo Practices for Children
Cuban parents tend to pamper and overprotect their
children, showering them with love and attention.
Among Cubans, the expectation is that children study
and respect their parents and older people. Children
are encouraged to acquire knowledge and learning
porque eso no te lo puede quitar nadie (because no one
can take that away from you) (Bernal, 1994).
When a Cuban daughter reaches the age of 15 years,
a quince, or 15th birthday party, is typically held to celebrate this rite of passage. Socially, the quince is indicative of the young womanâ€™s readiness for courting by a
novio (boyfriend). In Cuba, as among many families in
the United States, the quince is celebrated with food,
music, and dancing among family and friends. In
Miamiâ€™s Cuban enclave, as well as in other cities, the
quince is a major social event. Parents may save up for
years to prepare for a daughterâ€™s quince, which has
today evolved into a large, extravagant party.
Many Cuban adolescents may undergo an identity
crisis, not knowing whether they are fully Cuban or
American. During this time, they may reject traditional
cultural values, and parents may feel threatened when
their authority is being challenged. The opposing values
and demands of their Cuban heritage and American society create a potential for tension and conflict between
Cuban adolescents and their parents. Some examples
are the Cuban practice of chaperoning unmarried couples when they date. Unmarried daughters are expected
to live at home with the family until they marry.
Family Goals and Priorities
Cubans have tightly knit nuclear families that allow
for inclusion of relatives and padrinos (godparents).
La familia (the family) is the most important source
of emotional and physical support for its members.
Extended, multigenerational households are common,
with grandparents often being part of the nuclear
family. Compared with other Hispanic ethnic or cultural groups, Cubans have the lowest proportion of
families with children. Cubans also have the highest
proportion of people aged 65 and older who live with
their relatives. The high proportion of older people
living with family members has led to the typical
three-generation Cuban family (Perez, 2002).
A system of personal relationships known as compadrazgo is also typical. A set of godparents, or compadres, is selected for each child who is baptized and
confirmed. Compadres tend to be close friends or relatives of the childâ€™s natural parents and may be counted
on for moral or financial assistance. Compadres are usually considered part of the Cuban family, whether or not
a true blood relationship exists.
In recent years, as Cubans have become more acculturated to American society, and as the children of
Cuban immigrants have become more Americanized
and more economically successful than their parents,
family dynamics, expectations, and behaviors are changing. Multigenerational living arrangements are markedly
declining, with increased numbers of older adults becoming more independent and living alone. Despite
these trends, the need and desire for frequent family contact through daily telephone calls and frequent visits are
still predominant. Although more likely now to be living
alone, older Cuban adults have close interactions
not only with their children but also with grandchildren,
siblings, cousins, and other relatives (Martinez, 2002).
There is a high proportion of divorced women among
Cuban Americans compared with other Hispanic and
non-Hispanic groups in the United States. In spite of
this, Cubans have the highest percentage of children
under 18 years living with both parents, a low percentage of families headed by women with no husbands
present, and the lowest rate of mothers and children
living within a larger family unit. One explanation for
these patterns may be that divorced Cuban women return to their parentsâ€™ home, but because they typically
have fewer children, they do not tend to be accompanied by children (Perez, 2002).
In dealing with some Cuban Americans, healthcare providers may hear the term Marielito used in a
derogatory manner to refer to the estimated 4 percent
of the 125,000 Cubans who arrived during the Mariel
boatlift. Because some of the Marielitos were hardcore criminals released from Cuban jails, the increased
levels of crime in metropolitan Miami and New York
have been attributed in part to their arrival. Although
very few of them were criminals, unfortunately, the
negative attitudes toward them have been extended to
Cuban Americans as a group. The Marielitos were
predominantly single, black, working-class Cuban
males, in contrast to the professional and managerial
workers of earlier waves of migration.
Little or no data are available on the occurrence of
homosexuality among Cuban Americans, although the
gay lifestyle would be contradictory to the prevailing
machismo orientation of Cuban culture. Same-sex
2780_Ch11_197-213 16/07/12 11:46 AM Page 203
People of Cuban Heritage
REFLECTIVE EXERCISE 11.2
Alberto Gonzaga is a 43-year-old Cuban American male.
He migrated 18 years ago with his wife and 3-year-old son,
Alberto. Before he emigrated to the United States, Mr. Gonzaga
was imprisoned in Cuba for political reasons. He did not complete the 20-year sentence imposed by the Castro regime
and was released from jail after 12 years for good behavior.
He was immediately granted a U.S. visa for himself and his
family. Since his arrival, he has been an active member of the
Republican Party and has participated in the local Miami area
in the anticommunist movement. His son is now 21, and he
still lives with his parents, helping them financially. He works
full-time and pursues a law degree in a local college. There
have been several confrontations between Mr. Gonzaga and
his son. The new, more liberal â€œopenâ€ era has brought Cuban
musicians from the island to perform in public concerts in
Miami. Mr. Gonzaga is totally opposed to this. He claims that
â€œthese Communist musicians will take our money and our
taxes and give it to Castroâ€ and prohibits his son from going to
the concerts. Alberto states that music has nothing to do with
politics and that many of these musicians are opposed to the
regime, but this is a way to travel outside Cuba and earn some
money. He confronts his father, telling him that he is an adult
and he will go to the concerts, despite his fatherâ€™s opposition.
1. How different is the Cuban population that migrated
20 years ago compared with those who arrived 5 or
6 years ago?
2. Are the children of the Cubans who arrived in the 1980s
maintaining their traditions? Is their way of thinking the
same as their parentsâ€™?
3. What could be the consequences of the confrontations
between Mr. Gonzaga and his son?
4. Is the Castro government still separating the family even
outside Cuba, or is this situation just a matter of character?
couples living together may be alienated from their families, especially among first-generation Cubans who adhere closely to traditional gender roles and family values.
Undoubtedly, gay and lesbian films such as Gay Cuba,
Strawberry and Chocolate, and La Carne de Rey and the
Miami Gay and Lesbian Film Festival are attempts at
making alternative lifestyles more acceptable. Given the
stigma associated with homosexuality in this culture, a
matter-of-fact, nonjudgmental approach must be used
by health-care providers when questioning Cuban
patients regarding sexual orientation or sexual practices.
Culture in the Workplace
Cubans have enjoyed enormous economic success in the
United States. Twenty percent of first-generation Cuban
Americans and 43 percent of second-generation Cuban
Americans are college graduates. The high educational
achievement is reflected in the large proportionsâ€”
53 percent for first-generation Cuban Americans and
75 percent for second-generation Cuban Americansâ€”
who are employed in managerial and technical jobs, the
two highest-paying occupational categories (Boswell,
2002). Cuban families also have proportionately more
people participating in the labor force and earning a
higher median income than Mexican, Puerto Rican, or
Central and South American families (Boswell, 2002).
Their strong entrepreneurial abilities tend to be concentrated in construction, transportation, textiles, wholesale, and retail trades. The existence of several Cuban
ethnic enclaves with a familiar language and culture has
created numerous employment opportunities for recent
A frequent source of tension in the workplace 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. In Blank and Slippâ€™s (1994) study, one Cuban
supervisor asserted, â€œOthers should know that we tend
to go back and forth in languageâ€”Spanish when weâ€™re
talking personally and English when itâ€™s professional.â€
Issues Related to Autonomy
Traditional Cubans tend to be hierarchical in their relationships, recognizing supervisors or superiors as authority figures and treating them with respect and
deference. In mainstream American culture, collegial relationships, in which workers can exercise initiative,
question the supervisor, and participate in decision making, may make Cubans uncomfortable. Cubans value a
structure characterized by personalismoâ€”that is, one that
is oriented around people rather than around concepts
or ideas. For Cubans, personal relationships at work are
considered an extension of family relationships. Cuban
workers may function best in a working environment
that is warm and friendly and fosters personalismo. Because of the emphasis on the job or task in the American
workplace, many Cubans view this workplace as being
too individualistic, business-like, and detached. In the
past, the language barrier may have insulated Cuban
Americans from the dominant culture, retarded acculturation, and fostered some interethnic tensions; as the
ability to speak English and acculturation increases,
Cuban Americans have fewer interethnic tensions.
Skin Color and Other Biological Variations
Most Cuban Americans are white. Because of their predominantly European ancestry, Cuban Americans have
skin, hair, and eye colors that vary from light to dark.
A minority, who are of African Cuban extraction, are
dark-skinned and may have physical features similar to
those of African Americans.
2780_Ch11_197-213 16/07/12 11:46 AM Page 204
Aggregate Data for Cultural-Specific Groups
REFLECTIVE EXERCISE 11.3
Pablo Perez is a 42-year-old Cuban immigrant. He arrived in the
United States 2 years ago with his wife and a 10-year-old daughter. He was a successful physician in Cuba and was selected to
travel outside the island in 1991 to Spain to assist in an international congress. He also was chosen to provide medical services
in Senegal in 2002. Both times, he returned to Cubaâ€”the first
time because his mother was in bad health (she died a short
time later), and the second time because he had a wife and
daughter waiting for him. In 2006, he and his wife were selected
to go to Venezuela. After 2 years there, where he demonstrated
an excellent professional and communist attitude, the consulate
allowed their daughter to join them.
This was the chance Dr. Perez was waiting for. He and his
family immediately headed north, crossed the Mexican border
into the United States, and settled in Las Vegas. Both Dr. and
Mrs. Perez each have two full-time jobs. They have had problems
learning the language. Dr. Perez has taken the medical boards
twice, but he failed both times. He has told his wife that if they
moved to Miami, it will be better for them because there are
more Hispanic people there, the weather is better, and the
support system is greater. Do you think that Dr. and Mrs. Perezâ€™s
behavior in Venezuela is a common pattern among Cuban
professionals who are trying to get into the United States?
1. How different is the Cuban health system compared to
that of the United States?
2. Explain the options that Dr. and Mrs. Perez have for joining
the health-care field again in the United States?
3. Do you think that moving to Miami will solve Dr. and
Mrs. Perezâ€™s problems?
Diseases and Health Conditions
Nathâ€™s (2005) analysis of data from the Hispanic
Health and Nutrition Examination Survey (HHANES)
reported that, among Cuban Americans, major health
conditions are a high prevalence of coronary heart
disease, hypertension, overweight or obesity, type 2
diabetes mellitus, and depression. Twenty-nine percent
of Cuban American men and 34 percent of Cuban
American women are overweight, compared with
25 percent and 37 percent of Puerto Rican males and
females, respectively, and 30 percent and 39 percent of
Mexican American males and females, respectively. The
same study found that 16 percent of Cuban Americans
aged 45 to 74 had diabetes mellitus, compared with
26 percent of Puerto Ricans and 24 percent of Mexican
In a comparison of hypertension-related mortality
among Hispanic groups, Cuban Americans were
found to have the lowest death rate and Puerto
Ricans had the highest death rate. In addition,
age-standardized hypertension-related mortality rates
in Cuban Americans were 39 percent lower than
those for non-Hispanic whites (Centers for Disease
Control and Prevention, 2006).
Variations in Drug Metabolism
Although some studies have reported differences in
drug metabolism among Hispanics, little or no data
specific to Cuban Americans are available.
Devieux and colleagues (2005) at Florida International University conducted an assessment of HIV
risk behaviors of adolescents participating in an HIV
risk-reduction intervention. Of the 137 participants in
the interview assessment, 81 were African American
teens and 57 were Cuban American teens. Cuban
American teens reported more unprotected sex acts
and more anal sex acts in the 6 months prior to the interview than did African American teens. The groups
were similar on the total number of sexual partners and
sex acts reported. Regarding drug use, a greater proportion of Cuban American teens reported using drugs in
the 6 months prior than did African American teens,
and more Cuban American teens reported engaging in
unprotected sex while using drugs than did African
American teens. The authors speculate that higher acculturation of Cuban American teens, and accompanying family conflict, may account for the relatively
more risky behaviors among Cuban American teens.
More research is needed to clarify the processes leading
teens of different backgrounds to initiate and maintain
risky behaviors and to identify the most effective ways
to intervene to reduce risk (Devieux et al., 2005).
The HHANES findings also revealed that drinking
alcohol was significantly more common among
Cuban males than females and among younger versus
older Cuban groups, a pattern that was similar to that
in Mexicans and Puerto Ricans. Among middle-aged
and older Cuban males, who tend to be relatively well
educated and have higher incomes compared with the
younger, more recent Cuban immigrants, control of
intoxication is important. Among Cuban women, the
proportion of lifelong abstainers increased significantly from the younger to the older groups (Black &
Smoking is responsible for 87 percent of the lung
cancer deaths in the United States. Overall, lung cancer is the leading cause of cancer deaths among Hispanics. Lung cancer deaths are about three times
higher for Hispanic men (23.1 per 100,000) than for
Hispanic women (7.7 per 100,000). The rates of lung
cancer deaths per 100,000 were higher among Cuban
American men (33.7) than among Puerto Rican (28.3)
and Mexican American (21.9) men (Centers for Disease Control and Prevention, 2011).
An obstacle to good nutritional practices is the Cuban
cultural perspective of the â€œhealthy body.â€ A healthy
and beautiful Cuban infant is fat. Even among adults,
a little heaviness is considered attractive. Que gordo
2780_Ch11_197-213 16/07/12 11:46 AM Page 205
People of Cuban Heritage
estas! (How fat you are!) is considered a compliment.
The traditional Cuban dietâ€”high in calories, starches,
and saturated fatsâ€”predisposes individuals to the development of obesity. In Cuba, health care is viewed
as a basic human right and occupies a prominent
place in the Cuban governmentâ€™s domestic and foreign
policies. Polyclinics in communities are the basic unit
of health care. Physicianâ€“nurse teams attend patients
in these polyclinics, as well as in the home, school,
day-care center, and workplace.
In the United States, Cubans exhibit high levels of
preventive health behaviors, as evidenced by routine
physical examinations within the last 2 years. The utilization of preventive services was usually associated
with accessibility, which, in turn, was significantly influenced by education, annual income, and age (Solis,
Marks, Garcia, & Shelton, 1990).
Lopez and Masse (1993) found that unmarried
Cuban American women who had little recreational activity tended to have a higher mean weight. In addition,
in contrast to Mexican American and Puerto Rican
women, body fatness in Cuban American women was
not significantly associated with income (Lopez &
Meaning of Food
Besides satisfying hunger, food has a powerful social
meaning among Cuban Americans, allowing families
to reaffirm kinship ties, promote a sense of community, and perpetuate their customs and heritage. To
grasp this fully, one needs only to observe multigenerational families assembled for dinner on a Saturday
or Sunday evening in a Cuban restaurant in Miamiâ€™s
Little Havana or Cuban friends sharing a cup of cafe
cubano and pastelitos at a stand-up sidewalk counter.
In Miami alone, the demand for Cuban food and
food products has resulted in the establishment of
about 400 Latin restaurants, mostly Cuban, and some
700 bodegas, or grocery stores. Other Cuban enclaves
paint a similar picture.
Common Foods and Food Rituals
Cuban foods reflect the environmental influences of
Cubaâ€™s tropical climate and agriculture, the historical
influences of Spanish colonial rule, the African slave
trade, and the Arawak Indiansâ€™ cultivation methods.
Typical staple foods are root crops like yams, yucca,
malanga, and boniato; plantains; and grains. Traditional Spanish dishes like arroz con pollo and paella
are frequently served. Many dishes are prepared with
olive oil, garlic, tomato sauce, vinegar, wine, lime juice
(called sofrito), and spices. Meat is usually marinated
in lemon, lime, sour orange, or grapefruit juice before
cooking (Kittler & Sucher, 2008).
The main course in Cuban meals is meat, usually
pork or chicken. Some popular entrees are roast pork
(lechon), fried pork chunks (masas de puerco), sirloin
steak (palomilla), shredded beef (ropa vieja), pot roast
(boliche), and roasted chicken (pollo asado). A roasted
suckling pig is traditionally served on Christmas Eve,
New Yearâ€™s Day, and other festive celebrations. Black
beans are prepared with a sauce containing fat, pork,
and spices. Ripe plantains (platanos maduros) or green
plantains (platanos verdes) are served fried. Fried green
plantains (tostones or mariquita) may also be smashed
between a brown paper bag and the fist (un cartucho y
el puno), giving them the familiar name platanos a punetazo. Desserts are rich and very sweet, such as custard
(flan), egg pudding (natilla), rice pudding (arroz con
leche), coconut pudding (pudin de coco), or bread
pudding (pudin de pan) (Kittler & Sucher, 2008).
Beverages may include sugar cane juice (guarapo),
iced coconut milk (coco frio), milkshakes (batidos),
Cuban soft drinks such as Iron Beer or Materva,
sangria, or beer. The strong and bittersweet coffee
called cafe cubano is a standard drink after meals and
throughout the day, whether at home, in restaurants,
or in other social situations. In the United States,
Cubans may drink the cafe cubano as cortadito or with
a dash of milk to cut the strength and bittersweet
taste. A traditional Cuban meal includes a generous
helping of white rice with black beans or black bean
soup, fried plantains, roasted pork or fried chicken, a
tuber such as malanga or yucca, followed by dessert
and espresso. Thus, the typical diet is high in calories,
starches, and saturated fats. As in Spain and other
Hispanic countries, a leisurely noon meal (almuerzo)
and a late evening dinner (comida), sometimes as late
as 10 or 11 p.m., are customary.
Nutritional Deficiencies and Food Limitations
As seen in Figure 11-1, the major food groups are well
represented in the Cuban diet; however, leafy green
vegetables may be lacking in the average Cuban meal.
Therefore, when assessing the nutritional adequacy of
a Cuban patientâ€™s diet, the health-care provider must
ensure sufficient fiber content.
Pregnancy and Childbearing
Fertility Practices and Views Toward Pregnancy
The low fertility rate of Cuban women, which is consistent in every maternal age group, has been attributed to three factors (Perez, 2002):
1. Cuban American women have a high rate of labor
2. Before the revolution, Cuba had the lowest birth
rate in Latin America.
3. Cubaâ€™s current reproductive rate is among the
lowest in the developing world.
In an analysis of HHANES data, Stroup-Benham
and Trevino (1991) found that only 9 percent of Cuban
2780_Ch11_197-213 16/07/12 11:46 AM Page 206
Aggregate Data for Cultural-Specific Groups
American women took oral contraceptives, compared
with 11 percent among Puerto Ricans and 20 percent
among Mexican Americans. In the same study, hysterectomies, oophorectomies, and tubal ligations were
found to be less common among Cuban American
women than among either Mexican American or
Puerto Rican women. Based on these data, Cuban
American women appear to be at greatest risk for unintended pregnancies. Paradoxically, they have the lowest birth rate among the three groups of Hispanic
women (Stroup-Benham & Trevino, 1991). A possible
explanation for this inconsistency may be the high divorce rate and the high labor force participation rate
among Cuban American women. No more recent data
on Cuban American women could be found.
Many Cuban folk beliefs and practices surround
pregnancy. For example, some Cuban women believe
that they have to eat for two during the pregnancy and
end up gaining excessive weight. Some believe that
morning sickness is cured by eating coffee grounds,
that eating a lot of fruit ensures that the baby will be
born with a smooth complexion, and that wearing
necklaces during pregnancy causes the umbilical cord
to be wrapped around the babyâ€™s neck.
Among Cuban Americans, childbirth is a time for
celebration. Family members and friends congregate in
the hospital, awaiting the delivery of the baby. Although
traditionally it was not acceptable for Cuban men to attend the birth of their children, the younger and more
acculturated Cuban fathers tend to be present to support their wives during labor and delivery. In the postpartum period, it is believed that ambulation, exposure
to cold, and going barefoot place the mother at risk for
infection. Because of this, family members and relatives
often care for the mother and baby for about 4 weeks
Prescriptive, Restrictive, and Taboo Practices
in the Childbearing Family
Cuban Americans participate in prenatal care if it is
affordable. Rest is encouraged, and abstaining from
strenuous activities and loud noises is recommended.
Fresh fruits are encouraged for the health of the
mother and the fetus. More acculturated fathers participate in prenatal classes and support the mother in
the delivery room. Breastfeeding among Cuban
American women is becoming more popular than
in the past. Most do a combination of breast- and
bottle-feeding (Varela, 2005).
Thomas and DeSantis (1995) related the early introduction of solid foods and prolonged bottle-feeding of
Cuban children to the traditional Cuban beliefs that
â€œa fat child is a healthy childâ€ and that breastfeeding
may contribute to a deformity or asymmetry of the
breasts. In the same study, 97 percent of Cuban mothers
indicated that they administer vitamin preparations to
promote the healthy development of their children.
Cuban mothers also used advice about child health
given by their spouses, mothers, mothers-in-law, and
clerks and pharmacists who sold them over-thecounter drugs (Thomas & DeSantis, 1995).
Traditionally, postpartum mothers and their infants
are not supposed to leave the house for 41 days. This
initial postpartum period is a time for mothers to rest
and devote their energies to caring for the baby. The
new motherâ€™s immediate familyâ€”mother and sistersâ€”
help care for the new mother and baby. The mother is
sheltered from bad news and any stress that could
harm her or her baby. She is also encouraged to eat
more to foster milk production (Varela, 2005).
Death Rituals And Expectations
In death, as in life, the support of the extended family
network is important. Whether in the hospital or at
home, the dying person is typically surrounded by a
large gathering of relatives and friends. In Catholic
families, individual and group prayers are offered for
the dying to provide a peaceful passage to the hereafter. Religious artifacts such as rosary beads, crucifixes, and estampitas (little statues of saints) are placed
in the dying personâ€™s room.
Depending on the dying personâ€™s religious beliefs,
a Catholic priest, a Protestant minister, a rabbi, or a
santero may be summoned to the deathbed to perform
appropriate death rites. For adherents of SanterÃa,
death rites may include animal sacrifice, chants, and
ceremonial gestures. Health-care providers need to be
open-minded and responsive to both the physical and
the psychosocial needs of the dying and the bereaved
and, regardless of religious beliefs, accord them the
utmost respect and privacy.
After a personâ€™s death, candles are lighted to illuminate the path of the spirit to the afterlife. A wake, or
velorio, is usually held at a funeral parlor, where friends
and relatives gather to support the bereaved family.
The wake lasts for 2 to 3 days until the funeral. Burial
in a cemetery is the common practice for Cuban
Catholics, although some may choose cremation.
Responses to Death and Grief
Bereavement is expressed openly among Cuban Americans, with loud crying and other physical manifestations of grief considered socially acceptable. Death is
an occasion for relatives living far away to visit and
commiserate with the bereaved family. Women from
the immediate family usually dress in black during the
period of mourning. Visitors make offerings of candles and floral wreaths (coronas), provide assistance
with household chores, and attend to visitors or
funeral arrangements. Cuban Americans customarily
remember and honor the deceased on their birthdays
or death anniversaries by lighting candles, offering
2780_Ch11_197-213 16/07/12 11:46 AM Page 207
People of Cuban Heritage
prayers or masses, bringing flowers to the grave, or
gathering with family members at the grave site.
Dominant Religion and Use of Prayer
Approximately 85 percent of Cuban Americans are
Roman Catholics, with the remaining 15 percent being
Protestants, Jews, and believers in the African Cuban
practice of SanterÃa. The original habitants in Cuba
were the Guanatayabes Indians, located mainly in the
center-west area of the island, and the Taino Indians,
mainly in the east side. When Spaniards arrived, they
not only abused and killed the Indians, but they also
imposed their Catholic religion. This religion continued
in Cuba for many years and was combined with some
Christian practices during the colonization period.
The Roman Catholic Church has been an important source of support, especially for first-generation
Cuban immigrants. A number of predominantly
Cuban parishes with Cuban clergy are located in
Florida and New Jersey, where large Cuban populations reside. The Roman Catholic Church has exerted
an important influence on Cuban families by providing educational opportunities in Catholic schools.
Many Cuban parents, especially the upper middle
class, prefer to have their children educated in private
Roman Catholicism as practiced by Cubans is personal rather than institutional in nature. The religious
practice of Cuban Catholics is characterized by devotion and intimate, confiding relationships with the
Virgin Mary, Jesus, and the saints.
Some families may have shrines dedicated to La
Caridad del Cobre (the patron saint of Cuba) or other
saints at the entrance to their homes, in their yards, or
in commercial establishments. The three favorite saints
that are enshrined are Santa Barbara, San Lazaro, and
La Caridad del Cobre. Inside the home, crucifixes and
pictures or statues depicting images of saints may be
found. When someone is ill, small pictures of saints,
called estampitas, may be placed under the pillow or
at the sick personâ€™s bedside.
Significant religious holidays for Cuban families include Christmas, Los Tres Reyes Magos (Three Kingsâ€™
Day), and the festivals of the La Caridad del Cobre and
Santa Barbara. The Cuban community usually celebrates the feast of La Caridad del Cobre (September 8)
by transporting the statue of the patron saint on a boat
to a specific location, where a mass is held in her honor.
Cuban families also celebrate Christmas Eve (Noche
Buena) with a traditional Cuban meal. Typically, a
pig is cooked all day in a wooden box lined in metal
(una caja china) and set in the backyard. The pig is
placed at the bottom of the box and is covered with
charcoal. The meat is served with black beans and
rice, yucca, and turones (Spanish dessert). The evening
concludes with the family attending Midnight Mass
(Misa de Gallo).
With the arrival of slaves from Africa in the late
1700s and early 1800s, a new type of religious practice
emerged in Cuba. One group from the Bantu tribe in
the Congo were called palos (sticks) by the Spaniards
because they used sticks for their religious practices.
Today, the paleros (plural for people who practice the
religion with sticks and who perform black magic) are
viewed in a negative way, representing a â€œbadâ€ type of
African Cuban religion. Another group of slaves came
from the Carabali tribe from South Nigeria (also
known as the Abakua tribe). They still exist today, but
they do not have a negative reputation like the paleros.
In addition, other groups of slaves mixed with the
criollos (native Cubans born from Spaniards and Indians), Spaniards, French, and other ethnicities who
were already residing in Cuba in the mid-1800s. Because of this extensive mixture of races and ethnicities,
Cubans say that en Cuba el que no tiene de Congo tiene
de Carabali (in Cuba if you donâ€™t have it from Congo,
you will have it from Carabali), denoting that wonderful
combination of cultures.
Another African Cuban religion is the Yoruba/
Lucumi. Yoruba is an African dialect also known as
Lucumi. The minister is known as â€œOlorishaâ€ or owner
of Orisa or Orisha, the saints. The different types of
Orishas are Eleggua, Ogun, Oshun, Babalu-Aye,
Chango, Oya, Obatala, Yemaya, and Orula. When this
priest initiates other priests, they are known as
babalorishas (the father of Orishas) or Iyalorishas
(the mother of Orishas). The Supreme Priest is
known as Ifa, the Father who knows the secret. Ifas
are commonly known among the general population
as Babalaos or, correctly said, Babalawo. They are
the most widely seen santeros in Cuba and the ones
from whom people seek help with their health or a
Santeria, or Regla de Ocha, is a 300-year-old
African Cuban religious system that combines elements of Roman Catholicism with ancient Yoruba
tribal beliefs and practices. Santeria originated among
the Yoruba people of Nigeria, who brought their
beliefs with them when they arrived in the New
World as slaves. As a condition of their entry into the
West Indies, slaves were required to be baptized as
Roman Catholics (Perez y Pena, 1998). In the process
of adapting to their new non-African environment,
the slaves altered their beliefs to incorporate those
of their predominantly Catholic masters. Santeria
evolved from two main cultural antecedents: the worship of the orishas among the Yoruba tribe of Nigeria
and the cult of saints from the Roman Catholicism of
Spain. Through their exposure to the Catholic religion, the slaves came to associate their African gods,
called orishas, with the Roman Catholic saints, or
santos. The worship of the orishas and the associated
2780_Ch11_197-213 16/07/12 11:46 AM Page 208
Aggregate Data for Cultural-Specific Groups
beliefs, rituals, incantations, magic, and spirit possession are central to Santeria.
Table 11-1 displays the seven African powers, or
main orishas (Martinez & Wetli, 1982). The Yoruba
deity of fire and thunder, called Chango, became identified with Santa Barbara, the patron saint of the
Spanish artillery, who appeared in Catholic lithographs in red, the color of the orisha (Sandoval, 1979).
Chango, the most popular god in Santeria, controls
thunder, violent storms, lightning, and fire. The six
other orishas, the Catholic saints with whom they are
identified, and their corresponding functions and
powers are also shown in Table 11-1.
When people decide to practice Santeria, their orishas become known to them and must be worshipped
throughout their lives. Followers of Santeria 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.
Adherents of Santeria also believe in the power of
consecrated objects such as stones (otanes) in which
the orishas reside. Necklaces, bracelets, and charms
may be given by santeros to their patients to protect
them from evil and strengthen their well-being.
Sacrifice, or ebo (pronounced â€œegboâ€ or â€œigboâ€), is
a central ritual in Santeria. The main purpose of ebo
is to establish communication between the spirits and
human beings. The initiation of a santero involves the
sacrifice of a four-legged animal and a series of rites
lasting 7 days. Transition through major life events
such as birth, death, and marriage requires ritual sacrifices to appease the gods and solicit their support.
Sacrificial objects in Santeria include plants, foods,
and animals. Plants and foods include plantains,
malanga, yam, okra, flour, gourds, and ground blackeyed peas wrapped in plantain leaves. Animals used
for sacrifice, such as hens, birds, lambs, or goats, are
killed by wringing the head or severing the carotid arteries with a knife. The animalâ€™s blood is offered as a
type of communion with the deities. In 1993, the
Supreme Court struck down antiâ€“animal sacrifice
laws in Hialeah, Florida, and recognized the right of
a Santeria sanctuary, the Church of Chango Eyife, to
offer an animal sacrifice as a religious sacrament
Santeria, viewed as a link to the past, is used among
Cubans and other Hispanic groups to cope with physical and emotional problems. When someone is sick,
that personâ€™s physical complaints may be diagnosed
and treated by a physician, but the santero may be
summoned to assist in balancing and neutralizing the
â™â™â—— Table 11-1 Seven African Powers or Main Orishas
Holy Child of Atocha
Guardian of entrances,
roads, and paths; Trickster
Blindness, paralysis, and
Our Lady of Mercy
Death, suicide by fire
Our Lady of Charity
Our Lady of Regla
Father of all human
beings; gives advice; is
source of energy,
wisdom, purity, and
Warrior deity; controls
thunder and violent
storms, lightning, and fire
Deity that controls
money and love, makes
Primary mother of the
womanhood, owns seas
Patron of the sick,
especially diseases of
Warrior deity, owns all
metals and weapons
Blood of goats; black rooster;
smoked fish; smoked junia; yams;
White pigeons; white canaries;
female goat; plums; yam puree
social and domestic
Roosters; goats; lambs; apples;
Leprosy, gangrene, skin
Ducks; lambs; female goats;
watermelons; black-eyed peas
Violent death (such
as an automobile
Spotted rooster; snakes; cigars;
pennies; glasses of water
Source: Adapted from Martinez, R., & Wetli, C. (1982). Santeria: A magicoreligious system of Afro-Cuban origin.
American Journal of Social Psychiatry, 2(3), 34, with permission.
Female goat; white chickens;
Blood and feathers; young bulls;
roosters; steel knife; railroad
2780_Ch11_197-213 16/07/12 11:46 AM Page 209
People of Cuban Heritage
various aspects of the illness. Santeria is actively practiced in Miami, New York, New Jersey, and California
where Cubans and Haitians reside.
In eliciting a complete history from patients, healthcare providers must include information regarding the
type of religion being practiced, if any. Patientsâ€™ religious beliefs and practices must be viewed in an open,
sincere, and nonjudgmental manner. In the hospital
setting, maintenance of privacy is important if patients and families need to perform certain rituals or
prayers. A visit from a priest, rabbi, or santero may
provide a sense of psychological support and spiritual
well-being. At times, santeros have been known to
make sacrificial offerings at the patientâ€™s hospital bedside. As long as standards of safety and sanitation
are maintained, families must be allowed space
and privacy to be able to engage in specific religious
In Cuba today, 4 decades of Fidel Castroâ€™s revolution have significantly affected religious beliefs and
practices. Only about 30 to 40 percent of Cubans are
Catholic, whereas Santeria has about 55 to 60 percent
adherents. The multiple groups that follow syncretic
Santeria practices include Abakua, Yoruba, Regla
Conga, Regla Ocha, Regla Arara, Regla Arada, and
Yebbe. Thus, compared with their peers from previous
migration waves, recent Cuban immigrants may be
less likely to be Catholic. Further, large numbers of
Cubans consider themselves adherents of Catholicism
and Santeria simultaneously (Ramos, 2002).
remedies advised by older women in their family or
obtained from a botanica. Most folk remedies are
harmless and do not interfere with biomedical treatment. In most cases, patients may be encouraged to
continue using these remedies, such as herbal teas.
Encourage patients to report the use of specific teas
and herbs. For example, chamomile tea may increase
bleeding time, while jaborandi may decrease bleeding
time. Other teas and herbs may increase or decrease
glucose metabolism. Health-care providers should be
alert to the frequent practice of sharing prescription
medications in families and among relatives. A family
member who found an antibiotic effective in curing an
ailment may share the medication with another relative suffering from the same symptoms. The health
history must always include assessment of past or
present medication use, whether traditional, over-thecounter, or prescription. Appropriate explanations
must be given regarding the actions and adverse
effects of drugs and the reasons why they cannot be
shared with other family members.
Health-Seeking Beliefs and Behaviors
As in other Latin American communities, the family
is the most important source of strength, identity,
and emotional security. Cubans usually rely on a
network of family members and relatives for assistance in times of need. The sense of specialness
Cubans feel, stemming from pride in their culture
and their remarkable success in adapting to their
new country, is, likewise, a source of self-esteem and
self-identity. For many Cubans, deeply held religious
beliefs have provided 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.
As in other Latin American societies, Cubans rely on
the family as the primary source of health advice. Typically, the older women in the family are sought out
for information, such as traditional home remedies for
common ailments. Herbal teas or mixtures may be
prepared to relieve mild or moderate symptoms. Concurrently or alternatively, a santero may be consulted,
or a trip to the botanica may be warranted to obtain
Socialized into a strong health ideology and successful primary-care system in Cuba, Cubans are able
to use biomedical services as primary or secondary
sources of care. Cuba has a regionalized, hierarchically organized, national health system that provides
universal coverage and standardization of services. An
innovative family practice program assigns physicians
and nurses to city blocks and remote communities to
promote physical fitness, detect risk factors for disease,
and cure disease. In the United States, many Cuban
clinics have evolved into health maintenance organizations (HMOs).
Spiritual Beliefs and Health-Care Practices
Responsibility for Health Care
Many Cubans tend to be fatalistic, feeling that they
lack control over circumstances influencing their lives.
The belief in a higher power is evident in a variety of
practicesâ€”such as using magical herbs, special
prayers or chants, ritual cleansing, and sacrificial
offeringsâ€”that Cubans may engage in for the purpose
of maintaining health and well-being or curing illness.
When Cuban patients consult health-care providers,
in all likelihood they have already tried some folk
Most Cuban Americans access the health-care system
for preventive care and health screenings. Cubans
with a more recent history of immigration to the
United States are accustomed to preventive health activities as part of the Cuban governmental services
under Castro. Practices for healthy living, including
avoiding stress and bad news and avoiding extremes
of hot and cold, are important for health maintenance. Most take full advantage of vaccinations.
Meaning of Life and Individual Sources
2780_Ch11_197-213 16/07/12 11:46 AM Page 210
Aggregate Data for Cultural-Specific Groups
Folk and Traditional Practices
Cubans may use traditional medicinal plants in the
form of teas, potions, salves, or poultices. As noted
above, in Cuban communities like Little Havana in
Miami, stores called botanicas sell a variety of herbs,
ointments, oils, powders, incenses, and religious figurines to relieve maladies, bring luck, drive away evil
spirits, or break curses. In addition, Santeria necklaces
and animals used for ritual sacrifice are available at
botanicas (Fig. 11-1).
Herbal teas that may be used to treat common ailments include the following:
Cosimiento de anis (anise): to relieve stomachaches,
flatulence, and baby colic; also to calm nerves.
Cosimiento de limon con miel de abeja (lemon
and honey): to relieve cough and respiratory
Cosimiento de apasote (pumpkin seed): to treat
Cosimiento de canela (cinnamon): to relieve cough,
respiratory congestion, and menstrual cramps.
Cosimiento de manzanilla (chamomile): to relieve
Cosimiento de naranja agria (sour orange): to relieve
cough and respiratory congestion.
Cosimiento de savila (aloe vera): to relieve
Cosimiento de tilo (linden leaves): to calm nerves.
Cosimiento de yerba buena (spearmint leaves): to
relieve stomachaches and calm nerves.
Chamomile tea: to calm nerves and calm babies
Fruits and vegetables, abundant in the natural
tropical environment of Cuba, may include the
Chayote (vegetable): to calm nerves.
Zanaoria (carrots): to help problems with vision.
Toronja y ajo (grapefruit and garlic): to lower blood
Papaya y toronja y pina (papaya, grapefruit,
and pineapple): to eliminate gastrointestinal
Remolacha (beets): to treat influenza and anemia.
Cascara de mandarina (fruit): to relieve cough.
Other home remedies may include the following:
Agua con sal (salt water): to relieve sore throat.
Agua de coco (coconut water): to relieve kidney
problems and infections.
Agua raja (turpentine): to relieve pain in sore muscles and joints.
Bicarbonato, limon, y agua (baking soda, lemon,
and water): to relieve stomach upset or
Cebo de carnero (fat of lamb): to treat contusions
and swelling; applied directly on the skin.
Mantequilla (butter): to soothe pain; applied directly
Clara de huevos (egg white): to promote hair growth;
applied directly over scalp.
Cuban families may use an azabache, la manito de
coral, or ojitos de Santa Lucia for various protective
purposes. The azabache is a black stone placed on infants and children as a bracelet or pin to protect them
from the evil eye. La manito de coral, symbolic of the
hand of God protecting a person, may also be worn
as a necklace or bracelet. Los ojitos de Santa Lucia, or
the eyes of Saint Lucy, may be hung on a bracelet or
necklace for prevention of blindness and protection
from the evil eye.
Barriers to Health Care
Figure 11-1 In Cuban communities, botanicas such as this
one sell herbs, ointments, oils, powders, incenses, and religious
figurines to relieve maladies, bring luck, or drive away evil
Poverty and lack of financial resources may be a barrier to health care for Cuban families. Other barriers
include language, time lag, and transportation,
especially if they do not live in an urban environment. Others indicate that the red tape and paperwork required by health-care facilities are deterrents
to accessing care, especially preventive care and
health wellness checkups. For some, overdependence
on family and folk practices may also be a barrier to
2780_Ch11_197-213 16/07/12 11:46 AM Page 211
People of Cuban Heritage
Cultural Responses to Health and Illness
Because of the many losses they experienced in leaving
their homeland and the difficulties associated with
adaptation to a new culture and environment, Cuban
immigrants may suffer from loneliness, depression,
anger, anxiety, insecurity, and health problems. In
evaluating Cuban families, Bernal (1994) suggested
that health-care providers assess the following:
1. Migration phase associated with the family. It is
important to know how long the family has lived
in the United States and the reasons for migration.
Information about political and social pressures
that prompted the move should be elicited. Because
family members acculturate at different rates, the
level of acculturation should also be determined.
2. Degree of connectedness to the culture of origin.
Conflicts in value orientations must be identified
when assessing Cuban families. For example, the
varying expectations between mainstream American and Cuban cultures with respect to dependence and independence may give rise to tension
3. Differentiation between stresses of migration, differences in cultural values, and family developmental conflicts. In a clinical situation, health-care
providers must be able to recognize whether the
patientsâ€™ responses are due to migration-related
problems, value orientation conflicts, or dysfunctional family development.
Among Cuban Americans, dependency is a culturally acceptable sick role. Sick family members are
showered with attention and support. Frequently, a
hospitalized Cuban patient will have a room full of
flower arrangements and visitors. Favorite dishes may
be brought to the hospital from home. The extended
family network is relied on to temporarily assume the
household chores and other tasks usually performed
by the sick person. Family members are consulted and
typically participate in decision making relative to the
Cuban Americans tend to seek help in response to
crisis situations. The experience of pain constitutes a
signal of a physical disturbance that warrants consultation with a traditional or a biomedical healer. Similar to other Hispanic patients, Cuban Americans tend
to express their pain and discomfort. Verbal complaints, moaning, crying, and groaning are culturally
appropriate ways of dealing with pain. The expression
of pain itself may serve a pain-relieving function and
may not necessarily signify a need for administration
of pain medication.
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
REFLECTIVE EXERCISE 11.4
Consuegro Luna is a retired 72-year-old Cuban American. She
arrived in the United States in the early 1960s after Castroâ€™s
Cuban Revolution. Her entire family lives in Miami, and she has
no family connections in Cuba. However, she has deep emotional roots to her beloved island. Lately, she has become depressed because she is afraid she will die without ever seeing
Cuba again. She sees her primary physician, but apparently is
not adherent to the therapy.
1. What would be her primary physicianâ€™s best approach
for Mrs. Luna?
2. Based on her Cuban cultural background, how would
you involve Mrs. Lunaâ€™s family in her treatment?
3. Besides her nutrition and prescribed/over-the-counter
medications, what other information could be relevant
for the treatment of Mrs. Luna?
solely by a santero or simultaneously with a physician.
The trance state achieved through Santeria enables the
patient to act out emotional problems in a manner
that is nonthreatening to the personâ€™s self-esteem.
Blood Transfusions and Organ Donation
Receiving blood transfusions and organ donations is
usually acceptable for Cubans. This is probably due to
their experience with the sophisticated, high-technology
medical-care system in Cuba.
Traditional Versus Biomedical Providers
As with many other cultural groups, Cubans use
both traditional and biomedical care. Initially, folk
remedies may be used at home to treat an ailment or
illness. If the condition persists, folk practitioners
such as santeros and biomedical practitioners may
be used either simultaneously or successively. When
seeing Cuban patients, health-care providers must
always ask about the use of folk remedies and consultations with folk practitioners to prevent conflicting
Although Santeria was once associated with the
lower, uneducated classes in Cuba, it has emerged as
a viable and dynamic religious and health system
among middle-class Cubans in the United States. The
santero may prescribe treatment or perform the appropriate rituals or ceremonies to enable ill people to recover. The santero may invoke various types of
supernatural deities to intervene in their lives and
make them well. Often, the santero is seen simultaneously with allopathic practitioners, sometimes without
the knowledge of the other one.
2780_Ch11_197-213 16/07/12 11:46 AM Page 212
Aggregate Data for Cultural-Specific Groups
Many Cubans consult a family physician for primary
care. Before the revolution, Cuba had an organized,
government-supported health program that provided
medical care to most citizens. Since the 1959 revolution,
the Cuban government has articulated a fundamental
principle that health care is a right of all and a responsibility of the state. Thus, a national health-care system
provides universal coverage, equitable geographic distribution of health-care facilities, and standardization
of health services.
Cuban families in Miami gained access to primary health-care services predominantly through
private health practitioners and private clinics,
whereas in Union City, the main sources of health
care were private health practitioners. An extensive
network of privately owned and operated health
clinics exist in Dade County, mainly located in
Miamiâ€™s Cuban ethnic enclaves: Little Havana and
Hialeah. The private health clinics are believed to be
popular among the Cubans because they provide
services that are culturally sensitive to Cuban needs,
such as emphasis on the family, use of the Spanish
language, focus on preventive health-care behaviors,
and low cost.
Status of Health-Care Providers
Although Hispanics, including Cubans, represent
13 percent of the U.S. population, they are seriously
underrepresented in the health occupations. In the
National Sample Survey of Registered Nurses (RNs)
(U.S. Department of Health and Human Services,
2008), of over 3 million registered nurses, only 3.6 percent are Hispanic. Cubans generally have respect for all
health professionals, including nurses. Respect and trust
are increased if the nurse know some Spanish.
Batista, C. (December 20, 2010) Cubans are skeptic from speech of
Castro. Retrieved from http://www.elnuevoherald.com/2010/
Bernal, G. (1994). Cuban families. In M. Uriarte-Gaston & J. CanasMartinez (Eds.). Cubans in the United States (pp. 135â€“156).
Boston: Center for the Study of the Cuban Community.
Black, S.A., & Markides, K.S. (1994). Aging and generational patterns of alcohol consumption among Mexican Americans,
Cuban Americans and mainland Puerto Ricans. International
Aging and Human Development, 39(2), 97â€“103.
Blank, R., & Slipp, S. (1994). Voices of diversity (pp. 63â€“64).
New York: American Management Association.
Boswell, T.D. (2002). A demographic profile of Cuban Americans.
Miami, FL: Cuban American National Council.
Centers for Disease Control and Prevention. (2006). Hypertensionrelated mortality among Hispanic subpoopulationsâ€”United States,
1995â€“2002. MMWR Morbidity and Mortality Weekly Report,
Centers for Disease Control and Prevention. (2011). Smoking and
tobacco use. Retrieved from http://www.cdc.gov/search.do?
CIA World FactBook. (2011). Retrieved from https://www.cia.gov/
Conde, Y.M. (1999). Operation Pedro Pan: The untold exodus of
14,048 Cuban children. New York: Routledge.
Cultural Orientation Resource Center. (2002). The Cubans: Their history and culture. Retrieved from http://www.culturalorientation.
Devieux, J.G., Malow, R.M., Ergon-Perez, E., Samuels, D., Rojas, P.,
Kushal, S.R., & Jean-Gilles, M. (2005). Research findingsâ€”
Research on behavioral and combined treatments for drug abuse.
Journal of Social Work Practices in Addiction, 2(1), 69â€“83.
Gallagher, P.L. (1980). The Cuban exile: A socio-political analysis.
New York: Arno Press.
Gonzalez, A.M. (1995, June 11). Santeria still shrouded in secrecy.
The Miami Herald, pp. 1Bâ€“5B.
Kittler, P., & Sucher, K. (2008). Food and culture in America
(3rd ed.). Belmont, CA: Wadsworth Publishing Co.
Lopez, L.M., & Masse, B.R. (1993). Income, body fatness, and fat
patterns in Hispanic women from the Hispanic Health and
Nutrition Examination Survey. Health Care for Women International, 14, 117â€“128.
Martinez, I L. (2002). The elder in the Cuban family. Making
sense of the real and ideal. Journal of Comparative Family
Studies, 33(3), 359â€“375.
Martinez, R., & Wetli, C. (1982). Santeria: A magico-religious system of Afro-Cuban origin. The American Journal of Social
Psychiatry, 2(3), 496â€“503.
Nath, S.D. (2005). Coronary heart disease risk factors among
Cuban Americans. Ethnicity and Disease, 15, 607â€“614.
National Council of la Raza. (2011) Retrieved from http://www.
Perez, L. (2002). Cuban families in the United States. In R.L. Taylor
(Ed.), Minority families in the United States: A multicultural perspective (pp. 95â€“112). Englewood Cliffs, NJ: Prentice Hall.
Perez y Pena, A. (1998). Cuban Santeria, Haitian Vodun, Puerto
Rican spiritualism: A multiculturalist inquiry into syncretism.
Journal for the Scientific Study of Religion, 37(1), 15â€“27.
Pew Hispanic Center. (2006). Cubans in the United States.
Retrieved from http://pewhispanic.org/files/factsheets/23.pdf
Portes, A., & Bach, R.L. (1985). Latin journey: Cuban and Mexican
immigrants in the United States. Berkeley: University of
Ramos, M.A. (2002). Religion and religiosity in Cuba: Past, present, and future. Cuba Occasional Paper Series. Washington,
DC: Trinity College.
Sandoval, M. (1979). Santeria as a mental health care system: An
historical overview. Social Science and Medicine, 13, 137â€“151.
Skaine, R. (2004). The Cuban family. Custom and change in an
era of hardship. Jefferson, NC: McFarland & Co.
Solis, J.M., Marks, G., Garcia, M., & Shelton, D. (1990). Acculturation, access to care, and use of preventive services by Hispanics:
Findings from HHANES 1982â€“84. American Journal of Public
Health, 80(Suppl.), 11â€“19.
Stroup-Benham, C.A., & Trevino, F.M. (1991). Reproductive characteristics of Mexican-American, mainland Puerto Rican, and
Cuban-American women. Journal of the American Medical
Association, 265(2), 222â€“226.
Suarez, Z.E. (1993). Cuban Americans. From golden exiles to social undesirables. In H.P. McAdoo (Ed.), Family ethnicity:
Strength in diversity (pp. 164â€“176). Newbury Park, CA: Sage
2780_Ch11_197-213 16/07/12 11:46 AM Page 213
People of Cuban Heritage
Szapocznik, J., & Hernandez, R. (1988). The Cuban American
family. In C.H. Mindel, R.W. Habenstein, & R. Wright (Eds.),
Ethnic families in America (3rd ed., pp. 160â€“172). New York:
Thomas, J.T., & DeSantis, L. (1995). Feeding and weaning practices of Cuban and Haitian immigrant mothers. Journal of
Transcultural Nursing, 6(2), 34â€“42.
U.S. Census Bureau. (2010). Hispanic or Latino origin by specific
origin. Retrieved from http://factfinder.census.gov/servlet/
U.S. Department of Health and Human Services. (2008). The registered nurse population: National sample survey of registered
nurses. Washington, DC: U.S. Government Printing Office.
U.S. Immigration and Naturalization Service. (2000). Immigrants,
fiscal year 2000. In Statistical yearbook of the INS (pp. 1â€“67).
Varela, L. (2005). Cubans. In J. Lipson & S.L. Dibble (Eds.), Culture
and clinical care (2nd ed., pp. 121â€“131).
For reflective exercises, review questions, and additional
information, go to
Purchase answer to see full