​People of Baltic Heritage. People of Brazilian Heritage

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Culture Larry Purnell, PhD, RN,

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FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Overview/Heritage ▪ There is little literature on Brazilian health conditions, practices, and beliefs, although there is a lot on the objective culture such as arts, music, dance, and cuisine. ▪ Brazilian heritage is rich in its mixture of Portuguese, French, Dutch, German, Italian, Japanese, Chinese, African, Arab, and native Brazilian Indians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Overview/Heritage ▪ Common knowledge among Brazilians living in the United States is that many of them are escondidos (hidden) or officially referred to as undocumented aliens. ▪ The exact number of Brazilians living in the United States is unknown. ▪ Many Brazilians subsist in urban slums without privacy and hope to earn enough money to return home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Overview/Heritage ▪ Brazilians in the US are underemployed, often giving up their professions to earn money as domestic workers, waiters, cab drivers, and other low-paying positions. ▪ Immigrants often move to large cities where many networks help find “under-the-table” wages. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Portuguese is the official language of Brazil, although dialects exist and vary. ▪ Many Brazilians continue to be of “proper” old-world orientation where true feelings are not divulged for fear of hurting the receiver of the communication. ▪ In the intimate circle of family and compatriots, sharing thoughts and feelings is common. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Young adult and adolescent Brazilians in the United States are generally more acculturated because of their desire and need to assimilate. ▪ Sharing thoughts and feelings is more common among intragenerational groups rather than intergenerational groups. ▪ Most Brazilians use touch and direct eye contact. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Women kiss each other on both cheeks when they meet and when they say good-bye. ▪ At times, women and men kiss in the same manner. ▪ Men shake each other’s hands and slap each other on the back with the other hand. This gesture frequently ends in an embrace. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Children are kissed, and there is much touching. Kissing a child frequently includes the combination of a “kiss and smell.” ▪ Spatial distancing is close. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Facial expressions and symbolic gestures are commonplace. ▪ Most Brazilians in America are futureoriented. ▪ In general, they are not punctual, especially for social occasions. ▪ However, those in professional circles are punctual. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Brazilian names are lengthy, but the modern trend is to use only the first and last names. ▪ Traditionally, names appear as first name, mother’s family name, and father’s family name. “Junior” is added to a name if the son has been named after the father and Neto if the son has been named after the grandfather (third generation). Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ When a woman marries, she may opt to drop her mother’s maiden name and her father’s name, or she may keep them both. ▪ At times de, da/do, das/dos is added to a name to denote “of” and seems to be done out of tradition. No rigid protocol is apparent. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Children who have no father are often given the mother’s maiden name to which da Silva is added, denoting that the line of paternity is unclear. ▪ In day-to-day relationships, people are called by their first name or Seu, Senhor (more respectful) preceding the first name of a man, or Dona preceding the first name of a woman. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Communication ▪ Mothers, grandmothers, or respected strangers are referred to as A Senhora, and fathers, grandfathers, and respected men are called O Senhor. ▪ Doctors are addressed as Doutor or Doutora, and professors are addressed as Professor or Professora. The latter two are followed by the first name. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Family Roles and Organization ▪ Brazilian society is one of machismo, with the middle and upper classes being patriarchal in structure. ▪ As women assert their equality, more egalitarian relationships are becoming evident. ▪ Lower socioeconomic households tend to be more matriarchal in nature. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Family Roles & Organization ▪ Older people live with one of their children when self-care is a concern. ▪ Older people are respected, seen as family counselors, and are always addressed as O Senhor or A Senhora. ▪ They are included in family activities and usually accompany their children’s families on vacation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Family Roles & Organization ▪ Godparents are a very important family extension. ▪ Poor families frequently ask their patron and patrona (employer and spouse) to be godparents to their child. ▪ The godmother is called comadre by the mother. ▪ Compadre is used in reference to the godfather. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Family Roles & Organization ▪ Although historically common in the lower socioeconomic classes, middle-class households with a single-female parent are becoming increasingly common among Brazilians in the United States. ▪ In middle-class families, the “no father” status is obscured by the child receiving the same middle and last names as the mother. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Family Roles & Organization ▪ Social status is very important in the Brazilian society, demonstrated in the titles that people use with each other, and the practice of listing both parents’ surnames. ▪ Brazilians, especially from the south and southeast of Brazil, have become more accepting of gay and lesbian relationships. ▪ Same-sex relationships may carry a stigma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Workforce Issues ▪ Brazilians value diplomacy over honesty even when they promise to attend to something the next day, knowing that it will be impossible. ▪ Professional Brazilians show up for work on time. ▪ Less educated Brazilians may find it difficult to adhere to time schedules in the American workplace. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Workforce Issues ▪ Brazilians generally respect authority and are frequently more comfortable in employment situations where rules and job specifications are well defined. ▪ Many undocumented Brazilians find employment within the Brazilian community where they may never have to learn the new language. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Workforce Issues ▪ The categorization of Brazilians in the US under the general category of “Hispanics” adds to their discomfort. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Biocultural Ecology ▪ The “typical” Brazilian is a moreno with brown skin and eyes and black or brown hair. However, individuals particularly from the southern states of Brazil may have blond hair and blue eyes. ▪ Common health conditions among Brazilians include malaria, Chagas disease, dengue fever, meningitis, yellow fever, schistosomiasis, typhoid fever, Hansen’s disease, hepatitis, tuberculosis, parasitic skin infections, cholera, cardiovascular diseases, and lactose intolerance. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Biocultural Ecology ▪ Smoking is a high-risk behavior among Brazilians living in the United States. ▪ Among men, drinking hard liquor is also prevalent. ▪ Accessibility and use of street drugs and an individual’s desperate search for quick money are other identifiable high-risk behaviors and often involve living in crowded conditions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Nutrition ▪ The mainstay of the Brazilian American’s diet continues to be rice, beans, and farina. ▪ Roast beef, fresh chicken, and seafood are sought when they are not too expensive. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Nutrition ▪ Breakfast typically consists of bread with cafe com leite (half coffee and half hot milk). ▪ Sometimes cuscus (dry cornmeal mush) is served with milk. ▪ Fruit, fruit juices, and scrambled eggs, with or without sliced hot dogs, are common special breakfast fares among middle-class families. ▪ Sweet potatoes and yams may grace a breakfast table. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Nutrition ▪ Dinner is eaten at noon. This heavy meal, consisting of beans, rice, and farina, often includes mashed potatoes and pasta. ▪ Common desserts are custard, various cornmeal pastries, fruit, and doce (a sweet paste made by boiling sugar and fruit. ▪ A vegetable and or fruit salad are also common. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Nutrition ▪ A preference, especially among young Brazilian women, is to rely on vitamins instead of food consumption to help them remain thin. ▪ In the US, food limitations are imposed by expense and inaccessibility of Brazilian mainstay foods. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Common health conditions of Brazilian immigrants include a. Schistosomiasis. b. Thalassemia. c. Glucose-6-dehydrogenous deficiency. d. Hemophilia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A Schistosomiasis is a common health condition of immigrant Brazilians, especially those coming from rural areas. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Pregnancy & Childbearing Practices ▪ Although Brazil is predominantly a Catholic country, birth control is taught and used. ▪ Women are encouraged by their physicians or clinic personnel to have tubal ligations to prevent unwanted pregnancies. ▪ Frequently, unwanted pregnancies and abortions are, in the end, left in God’s hands. ▪ Immigrants in the United States generally practice birth control. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Pregnancy & Childbearing Practices ▪ Herbal teas are used for bringing on late menstrual periods and for stimulating natural abortions. ▪ Single women may try to become pregnant to facilitate their chance of remaining permanently in the US. ▪ Pregnant women are encouraged not to do heavy work and not to swim. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Pregnancy & Childbearing Practices ▪ Taboos also warn against having sexual relations during pregnancy. ▪ Taboos generally vary according to geographic region, socioeconomic status, and ethnic background. ▪ Many Brazilian mothers prefer to give their babies powdered dry milk in place of breastfeeding. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Pregnancy & Childbearing Practices ▪ Some women often feel that their milk is fraca (weak). ▪ Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Pregnancy & Childbearing Practices ▪ A postpartum woman eats chicken soup to help her body return to normal. ▪ She is also advised not to eat spicy foods or repadura (a molasses candy) and not to drink garapa (sugar water) or caldo de cana (sugar cane juice) if she breastfeeds her infant. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Death Rituals ▪ The death of a baby or an infant, historically, has been and continues to be treated joyfully and without much sadness, for the child has died pure and is regarded as an angel. ▪ If financially possible, the families of Brazilians who die in the United States personally accompany the body to Brazil for burial in the family vault. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Death Rituals ▪ The fatalistic expression, “It was God’s will,” helps the grieving process among the rich and the poor. ▪ Older people wear black for various amounts of time depending on their relationship with the family member. ▪ Frequently, the final portrait is hung in the family chaper or near the family altar, and prayers are recited. An eternal light burns. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Death Rituals ▪ Relatives are honored on the anniversaries of their death, both at home and at Masses. ▪ Often, the family places an obituary of remembrance with or without a picture of the deceased in the local newspaper on the anniversary of the death. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Maria Miranda de Silva is reluctant to breastfeed. A common belief about breast feeding among Brazilians is that breastfeeding a. Breastfeeding causes diarrhea in the infant. b. Breastfeeding Is linked to a social stigma. c. Breast milk is weak. d. Breast milk is contaminated with iron. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Spirituality ▪ 90 percent of Brazilians are Catholic, various Protestant sects are making inroads into the Brazilian culture. ▪ A few, including Catholics, incorporate traditions of Indian animism, African cults, AfroCatholic syncretism, and Kardecism, a spiritualist religion embracing Eastern mysticism. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Spirituality ▪ Saints are asked for help, and people wear medals or little pouches of special powders around their necks. ▪ The meaning of life is found in religion, economy, fatalism, and reality. For some, life is uma luta (a battle). For others, life has an almost hedonistic attitude. ▪ The greatest source of strength for Brazilians is their immediate and extended families. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Most Brazilians do not talk about their illnesses unless the illnesses are very serious. ▪ Generally, illness is discussed only within the family. ▪ Many Brazilians feel that talking about an illness, such as cancer, negatively influences their condition. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Because many Brazilians tend to shun hospitals, their families accompany them and stay around the clock. ▪ The patient is often brought food from home. ▪ The family is the nucleus of responsibility for health care and is eager to participate in care. ▪ Brazilians are known for their self-medication practices. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Antibiotic, neuroleptic, antiemetic, and most other prescription drugs are easily obtained over the counter in Brazilian pharmacies. ▪ Once in the US, incoming Brazilians bring medicines requested by their friends and, thus, maintain the circulation of medications not available to Brazilians living in the US. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Traditional and homeopathic pharmacies are supplemented by remedios populares (folk medicines) and remedios caseiros (home medicines). ▪ Folk remedies and traditional health-care practices are intermeshed when a serious illness may be best treated by traditional caretakers. ▪ Some take homeopathic bolinhas (little white balls) prepared specifically for certain ailments. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Brazilians generally do not like to talk about pain. However, once the emotional barrier is removed, they feel relieved to be able to discuss their discomfort. ▪ Many pain-relieving medicines are available without a prescription in Brazil. ▪ Sickness is a neutral role and is considered socially exempt. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practices ▪ Nervios is the ever-present folk diagnosis that identifies weakness, craziness, and anger as principally associated with hunger. ▪ Better-educated Brazilians accept blood transfusions, organ donation, and organ transplantation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practitioners The folk-health field has many health-care practitioners: ▪ Curandeiros are divinely gifted. ▪ Rezadeiras (praying women) help exorcise illnesses. ▪ Card readers can predict fortunes. ▪ Espiritualistas are able to summon souls and spirits ▪ Conselheiros are counselors or advisors. ▪ Catimbozeiros are sorcerers. ▪ Additionally, head priestesses or priests from the AfricanBrazilian Umbanda or Xango religion, all have the power to heal their believers. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Brazilian Health-care Practitioners ▪ Brazilians in the United States tend to respect physicians and nurses. ▪ Medical education is prestigious and highly sought by aspiring university students. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Cultures Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ People of Baltic descent come from Estonia, Latvia, and Lithuania. ▪ The countries of origin of these ethnic groups are sometimes referred to as the Baltics or the Baltic countries because each of them is located in Europe on the Baltic Sea. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ Historical, cultural, religious, and language differences prevent the group from being one cultural entity. ▪ These countries represent three distinct ethnic groups and are treated as such. ▪ The Estonians are a Finno-Ugric people whose language is related to Finnish. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ The Union of Soviet Socialist Republics (USSR) forcibly annexed Estonia in 1949 and maintained control until 1991 when Estonia regained its independence. ▪ Latvia, situated between Estonia and Lithuania on the Baltic Sea, was independent from 1918 to 1940 when it was forcibly annexed by the USSR. ▪ Latvia regained its independence in 1991. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ Russians make up 29 percent of the population of Latvia; the remainder is made up of Byelorussians, Ukrainians, and Poles. ▪ Most ethnic Latvians speak a Baltic language related to Lithuanian. ▪ Lithuania was an independent country from 1918 to 1940 when the USSR forcibly annexed it. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ In 1990, Lithuania re-declared its independence from Soviet rule. ▪ For Lithuania, 83.5 percent are Lithuanians, 6.3 percent are Russians, 6.7 percent are Poles, and 3.7 percent other. ▪ Lithuanian is a Baltic language related to Latvian. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ The Baltic countries today are democratic, growing economically, and are successful compared with many other former Soviet Union countries where poverty and dictatorship have been predominant. ▪ In 1940, the three Baltic countries lost their independent status to Germany and then to the USSR in 1941. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ During this time, hundreds of thousands of Latvians, Lithuanians, and Estonians were deported in cattle cars to Soviet prison camps in Siberia. ▪ Fearing death or deportation by the communist regime, Estonians, Latvians, and Lithuanians fled to the West by any means possible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ The post-World War II influx of immigrants to the United States came in 1949. ▪ Because the immigrants fled from the religious, cultural, and political persecution of the Soviet regime and could not return to their native countries after World War II, the U.S. Congress facilitated their entry by enacting laws designating them as displaced persons. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ Many of the post-World War II refugees were professionals. ▪ All three Baltic countries have regular song festivals and dance festivals in the US and in the native countries too. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ The Baltic countries are strong in the arts, and theater, opera, music of all types, and film continue to flourish. ▪ During the past 10 years, the three Baltic countries have experienced a “brain-drain” to some extent because many of their highly educated have emigrated to the US and Europe. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Overview/Heritage ▪ Education is highly valued by people of Baltic descent. All three Baltic countries have high literacy rates. ▪ Education is valued in itself and is seen as a way of improving life circumstances. ▪ These immigrants made many sacrifices so their children could become educated. As a result, many Americans of Baltic descent have advanced degrees. Many are professionals in medicine and law. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ People of Baltic descent share thoughts and feelings readily. ▪ The stereotype of quiet, stoic individuals is not borne out by observation or research. ▪ For example, humor can be used to relate to these clients and is appreciated if used in the right context. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ Clients of Baltic origin may hesitate to share intimate thoughts and feelings related to their cultural sense of decorum, but this does not mean that they do not experience feelings and emotions. ▪ They may wait to see if the health-care professional is caring and takes the time to actually listen to them. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ As a whole, people of Baltic descent are not flamboyant or highly volatile, but individual differences are always present. ▪ Some individuals enjoy touch and close contact, while others do not. ▪ Individuals from these cultures are receptive to a caring use of touch from family and close friends, but they may come across as more aloof with strangers. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ People of Baltic descent give attention to the past, present, and future. ▪ The past is revered in the sense that significant historical events for each cultural group continue to be celebrated and acknowledged. ▪ People of Baltic descent value frugality because they have had hard times in the past. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ People of Baltic descent view time similarly to the dominant American culture. ▪ Individuals of Baltic descent have become acculturated to time awareness and deadlines; they arrive at appointments on time. Because of their strong work ethic and high value on work, they take pride in the efficient and wise use of their time. ▪ Socially, however, they may be less aware of time and tend to be late. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ Individuals of Baltic descent generally use their American last name. ▪ First names of women end in “a” and first names of men end in “as” or “s.” In their native languages, the last names indicate if the person is male or female; for females, the last name indicates if the woman is married or single. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ In Latvian, the typical last name ends in “ans,” “ins,” or “e” with the endings indicating masculine or feminine genders. ▪ Estonian names are similar to Finnish names. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Communication ▪ The father is the head of the household in the typical family of Baltic heritage. ▪ Both men and women in the family may have jobs and discuss major decisions. ▪ Health-care and other major decisions are made jointly by both spouses. ▪ Women in the family are given respect, and decision-making is done by both men and women. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Family Roles & Organization ▪ Because education is highly valued, parents encourage and supervise children in their school work and progress. ▪ Corporal punishment was used by older generations but is practiced less by younger families. ▪ Cultural activities, such as song or dance groups and ensembles, frequently unite people. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The language spoken by people from the Baltic countries is a. The same for Latvians and Lithuanians but different for Estonians. b. The same for Estonians and Latvians but different for Lithuanians. c. Different for each country. d. The same for each country. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C The language spoken by people from the Baltic countries is different for each country. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Family Roles & Organization ▪ The traditional nuclear family is still the standard in these cultural groups. ▪ Family is highly valued and divorce is still fairly rare. ▪ Lithuanian Americans are predominantly Roman Catholic, and their religion supports strong family values. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Family Roles & Organization ▪ Older people are respected in the Baltic cultures. ▪ If grandparents are unable to live independently, every effort is made to have them move in with an adult child, usually a daughter. ▪ Nursing homes are used when needed. ▪ In America, a certain amount of respect is still given to professionals, but each cultural group has more of an egalitarian sense of community. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Family Roles & Organization ▪ The literature does not include information about same-sex couples in these cultures. ▪ Because the dominant religions of the Baltic countries do not sanction homosexuality, few individuals and couples are openly homosexual. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Newer immigrants from the Baltic countries should be assessed for a. Malaria. b. Thalassemia. c. Orthopedic disorders. d. Endocrine disorders. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D Newer immigrants from the Baltic countries should be assessed for endocrine disorders because of radiation fallout from the Chernobyl accident. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Workforce Issues ▪ Material aspects are seen as secondary to the more important family values. ▪ Responsibility is taken seriously and is encouraged. ▪ People of Baltic descent adapt readily to American values of timeliness in the workplace. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Workforce Issues ▪ People of Baltic descent have no difficulty maintaining their sense of autonomy and readily take on work roles, responsibility, and decision making. ▪ They usually do not like to confront those in authority directly and find ways to deal with difficult situations or people through the use of humor or deference. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Workforce Issues ▪ Recent immigrants who have lived under the Soviet regime may not be accustomed to making decisions for themselves or acting autonomously. ▪ In previous governmental regimes, individuals and their rights were not considered important. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Biocultural Ecology ▪ People of Baltic descent have white skin. Estonians are similar to the Finns with brown hair and eyes, but some are blonde and blue-eyed. ▪ Latvians and Lithuanians have fair complexions with blonde hair and blue eyes. ▪ Recent immigrants from the Baltics may be at risk for cancer because of industrial pollution and radiation exposure from the Chernobyl nuclear disaster in 1988. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Biocultural Ecology ▪ Some immigrants are survivors of political torture, having spent years in prison labor camps in Siberia. ▪ The incidence of alcoholism is high in the Baltics. ▪ Ashkenazi Jews from the Baltic countries may respond differently to neuroleptic agents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic High-Risk Health Behaviors ▪ Exercise and physical activity are valued, and people of these cultures make an effort to get a reasonable amount of exercise. ▪ Individuals who have emigrated to the United States in the last 15 years tend to continue to smoke. ▪ Although many people of Baltic descent maintain jobs and are able to function, their use of alcohol is high. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Nutrition ▪ Because many individuals who left the Baltics after World War II experienced food shortages and times of starvation, food is important to these people. ▪ Recent immigrants have left the Baltics for economic reasons and have also experienced food shortages. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Nutrition ▪ Some foods common among this cultural group are meats such as pork, chicken, and beef. ▪ Rye and whole grain breads are popular. ▪ Baked goods such as bacon rolls, yeast baked goods, and rich tortes and cakes are common. ▪ Fresh fruits and vegetables are enjoyed. ▪ Potato dishes such as potato pancakes, potato kugel, and potato dumplings are popular. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Nutrition ▪ Beets, mushrooms, and cabbage are used in soups and sauces. ▪ Dairy products such as sour cream, butter, and yogurt are included daily in their meals. ▪ Grain porridges are popular, especially among Latvians who have putras porridges. ▪ The content of porridges varies according to regions in Latvia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Nutrition ▪ Foods enjoyed by people of Baltic descent include smoked and unsmoked sausages, and smoked fish, eel, and pork. ▪ The spices used are rather mild compared with those of other cultures, but foods may be high in salt content. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Pregnancy & Childbearing Practices ▪ In previous generations in the Baltics, infant mortality rates were very high. Large families were encouraged under communism. ▪ Baltic people in the US use a variety of birth control measures. ▪ Americans of Baltic descent use modern Western medicine practices obtain early prenatal medical care, and are receptive to health teaching for prenatal and postnatal care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Pregnancy & Childbearing Practices ▪ Some women and families from these cultural groups prefer natural childbirth and breastfeeding. ▪ Pregnant women are to remain calm and receive no shock or frightening news. ▪ Godparents are important in the child’s life and traditionally give gifts, including candy, to each other and guests. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Death Rituals ▪ Death is viewed as part of life, and ceremonies of the wake and funeral are linked with Christian religious services. ▪ The funeral may take place within 3 to 4 days following the death, providing time for out-of-town friends and relatives to gather. ▪ Cremation is permissible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Death Rituals ▪ The funeral is usually a Christian service, followed by a meal at which all attendees are welcomed. Burial is the usual practice. ▪ Grief is expressed by sadness, crying, and talking about the deceased with fondness and respect. ▪ Individuals from these cultures express emotions readily but not in highly dramatic ways. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Death Rituals ▪ Decorum is maintained in public and with strangers. ▪ The dead are often remembered with frequent visits to the cemetery. ▪ All Souls Day, November 2, Ve·line·s, is a significant day for Lithuanian Americans, with religious ceremonies commemorating the dead. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Spirituality ▪ Estonian Americans and Latvian Americans are predominantly Lutherans but include some Catholics, while Lithuanian Americans are predominantly Roman Catholic. ▪ All these groups celebrate major Christian religious holidays, particularly Easter and Christmas. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Spirituality ▪ Individuals of these cultures consider themselves as having spiritual roots, which may be closely linked with their high value for their language, country, and culture. ▪ Under Soviet rule, religion was forbidden; every effort to eradicate all traces of religious belief. ▪ Religion was replaced by communist dogma for 50 years. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Spirituality ▪ A very small percentage of Latvians maintain an ancient pagan religion. ▪ This religious group is called Dievtui (those with God) and has a high priest as the head of the group. ▪ Stories include myths and folk wisdom in rhyme as an important part of their content. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Spirituality ▪ Most Americans of Baltic descent consider prayer an individual expression of their faith. ▪ Many have been sustained through hardships by their strong religious faith and continue to have strong religious needs. ▪ Spiritual and religious considerations are considered private and may not be readily shared with health-care professionals. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Spirituality ▪ Clergy from the client’s church are usually welcome. ▪ Clients find considerable comfort in speaking with the clergy in times of crises and serious illness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Individuals of Baltic descent adhere to modern medical regimens and readily use the health-care system available to them. ▪ Because they consider health and well-being important, they take an active interest in healthy lifestyles, nutrition, and exercise. ▪ Fresh air is considered important, and walking, especially in natural settings such as parks, is enjoyed by all ages. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ People of Baltic descent assume responsibility for their own health. ▪ Because work is highly valued, most are in the workforce and have insurance coverage. ▪ Medical care and hospitalization are sought readily. Attempts are made to maintain health even into old age. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Recent immigrants from the Baltics to America may have different values because they lived under a communist regime in which the government “took care” of their medical needs. ▪ These immigrants often need help understanding the American health-care system and may be reluctant to use it if they have no medical insurance coverage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Chamomile and linden blossom teas may be used for fevers and colds. ▪ Honey is used for colds and sore throats. ▪ Younger people prefer to use over-the-counter cold remedies and analgesics. The use of natural substances for healing purposes is not customary among this generation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Among older Baltic immigrants, language may continue to present difficulty if they have not learned English well. ▪ Many older individuals may tolerate pain as a part of life and may not complain about it or report it. ▪ Some stigma is attached to mental illness, but medical care is sought. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Most people of Baltic descent accept physical handicaps, mental illness, and mental retardation. ▪ The family usually cares for the individual at home. ▪ Americans of Baltic descent do not enjoy the sick role and avoid it when possible. ▪ Work is highly valued and the person returns to normal responsibilities as soon as possible. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practices ▪ Most people of Baltic descent accept blood transfusions and organ donation and transplantation. ▪ The use of extraordinary means to preserve life is an individual decision, but living wills are frequently used. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practitioners ▪ Besides family members and friends providing informal traditional health practices, no traditional health-care providers are found among people of Baltic descent in the United States or in the Baltics. ▪ Because education is highly valued by people of Baltic descent, physicians, dentists, and nurses are held with respect. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practitioners ▪ Advice given to their clients is usually followed. ▪ People of Baltic descent are used to both men and women giving direct physical care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Baltic Health-care Practitioners ▪ Nurses and health-care practitioners need to provide for privacy and consider the modesty needs of female and male clients of these cultures as they would for any client. ▪ Older clients of both sexes are used to being treated with respect. 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 1 Chapter 26 People of Baltic Heritage: Estonians, Latvians, and Lithuanians Rauda Gelazis Overview, Inhabited Localities, and Topography Overview People of Baltic descent come from Estonia, Latvia, and Lithuania. The countries of origin of these ethnic groups are sometimes referred to as the Baltics or the Baltic countries because each of them is located in Europe on the Baltic Sea. Historical, cultural, religious, and language differences prevent the group from being one cultural entity. These countries represent three distinct ethnic groups and are treated as such. Estonia is on the Baltic Sea. Estonia is bordered by the Gulf of Finland in the north, Russia in the east, Latvia in the south, and the Baltic Sea in the west. The Estonians are a Finno-Ugric people whose language is related to Finnish (Raun, 1991). The Union of Soviet Socialist Republics (USSR) forcibly annexed Estonia in 1940 and maintained control until 1991, when Estonia reasserted its independence. The capital and largest city is Tallinn. Estonia’s population is 1,282,963 (CIA World Factbook, 2011a). Estonians accounted for 89 percent of the population at the beginning of Soviet rule, but by 1989, they were only 61.5 percent of the population. During this period, immigration increased the Russian population 10-fold to 30 percent (Estonia, 1993). Currently Russians comprise 25.6 percent of Estonia’s population. Estonians are 68.7 percent of the population. Belarusians (1.2 percent) and Ukranians (2.1 percent) make up the other ethnic groups in Estonia. Latvia, situated between Estonia and Lithuania on the Baltic Sea, was independent from 1918 to 1940, when it was forcibly annexed by the USSR. Latvia regained its independence in 1991. The population is 2,204,704 people, of whom only 59 percent are Latvians or Letts. Russians make up 27.8 percent of the population; the remainder is made up of Belarussians, Ukrainians, and Poles (CIA World Factbook, 2011b). About 68 percent of the Latvian population live in cities; Riga is the capital and largest city. Most ethnic Latvians speak a Baltic language related to Lithuanian. Lithuania is also on the eastern shore of the Baltic Sea. It is bordered in the north by Latvia, in the east by Belarus, in the southwest by Poland and a part of Russia (called Kaliningrad), and in the west by the Baltic Sea. Lithuania was an independent country from 1918 to 1940, when the USSR forcibly annexed it. In 1990, Lithuania redeclared its independence from Soviet rule. The Lithuanian population is 3,535,547, of whom 84 percent are Lithuanians, 4.9 percent are Russians, 6.1 percent are Poles, and 3.7 percent are other (CIA World Factbook, 2011c). The urban population is 66.6 percent of the population; 33.4 percent of the population lives in rural areas. On March 11, 1990, Lithuania reestablished its independence—the first Soviet republic to do so. On September 17, 1991, Lithuania was admitted into the United Nations. In May 2001, Lithuania was admitted into the World Trade Organization. In March 2004, Lithuania was accepted into the North Atlantic Treaty Organization (NATO), and on May 1, 2004, Lithuania joined the European Union (Lithuania, 2005, 2006). Latvia and Estonia were also accepted into NATO and the European Union in 2004 (O’Connor, 2006). Lithuanian is a Baltic language related to Latvian (Gerutis, 1969). The capital city is Vilnius; its population is 546,000 people (CIA World Factbook, 2011c). The topography of the Baltic countries consists of lowlands. Estonia has many lakes and rivers because of its glacial origin. Thirty-five percent of Estonia is forest, whereas about 10 percent of its territory includes islands in the Baltic Sea. Latvia also has many lakes and rivers, with estuaries providing ice-free commercial and fishing harbors. The highest elevation in Latvia is 984 ft. Lithuania also forms an extension of 1 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 2 2 Aggregate Data for Cultural-Specific Groups the eastern European plain, with its highest elevation at only 960 ft. It is also of glacial origin and is dotted with lakes and rivers (Lithuania, 1993). The Baltic countries today are democratic, growing economically, and successful compared with many other former Soviet Union countries in which poverty and dictatorship have been predominant (O’Connor, 2003). All three Baltic countries have established strong ties to Western democratic countries, but Russia continues to maintain a hold on other former Soviet Union countries such as Georgia. For this reason, there is concern, especially among the people of Baltic descent living in the United States, that the former Soviet regime may try to reinsert itself into leadership in the Baltics, and hence, Russian ties would once again become strong. Heritage and Residence The Baltic peoples are believed to have lived along the Baltic Sea since 2000 BC, when they settled this region (Gimbutas, 1985). The four tribes that settled along the coast of the Baltic Sea made contacts with a variety of people such as the Scandinavians, Slavs, and Finns. The Latvians and Lithuanians are the only remnants of these tribes. The other Baltic groups of Old Prussians and Yatvingians became extinct in the latter part of the Middle Ages (Sabaliauskas, 1986). Lithuania’s territory spread over a large part of eastern Europe until it made an alliance with Poland. Since then, its power declined, and in the 18th and 19th centuries, Poland and Russia ruled this territory (Gerutis, 1969). Migration from the Baltic countries to North America has been intermittent. As early as 1640, a few Latvian and Estonian settlers came with Swedes to New Sweden in Delaware and Pennsylvania. In 1687, a group of Latvian immigrants from a colony on the island of Tobago settled in Boston. Since then, a small but steady number of Latvians have settled in New York, Pennsylvania, the Midwest, and California. By 1850, the U.S. Bureau of the Census recorded 3160 Latvians and Lithuanians (American Factfinder, 2000). The two groups were counted together because they spoke a similar language. By 1870, their numbers reached 4644. Most of the early arrivals were sailors or artisans; a few were missionaries. The immigrants who came to the United States in the late 19th and early 20th centuries settled in metropolitan areas and industrial centers, or they followed jobs on the railroad or in coal mines. As a result, Latvian communities exist in New York, Boston, and Philadelphia in the Northeast; in Chicago, Milwaukee, Cleveland, and Kalamazoo and Grand Rapids, Michigan, in the Midwest; and in Los Angeles, San Francisco, Portland, Seattle, and Tacoma on the West Coast. Before 1890, immigrants were also located in the mining districts of Pennsylvania. By 1910, the largest communities of Lithuanians were in Chicago, New York, Boston, Philadelphia, and Cleveland. By 1970, over half of the Estonian American population lived in the Washington to Boston corridor, about 15 percent lived in the Great Lakes region, and 19 percent were on the West Coast (Thernstrom, 1980). Reasons for Migration and Associated Economic Factors It was not until the mid-19th century that immigration from the Baltic countries increased. One reason for this was the abolition of serfdom in the 1860s in Lithuania and the other Baltics, which lifted legal restrictions that had previously limited the mobility of villagers. Another factor was the development of the tsarist railroad by the Russian Empire. Railroads facilitated travel to Russia and points beyond. In the late 1860s, a severe famine disrupted the Lithuanian peasant economy. In 1874, the Russian government introduced a comprehensive system of conscription, and many men from the Baltics emigrated to escape service in the tsarist army. Thus, Lithuanian peasants made their way to the United States, and a migrant network began. By 1914, this network had expanded such that few villages were unaffected by the increasing migration to America. The rate of return migration was high; between 1899 and 1914, there was one departure from the Baltics for every five immigrants who returned. In 1918, all three Baltic countries declared their independence. During the years as independent countries, 1918 to 1940, much progress was made in each country (O’Connor, 2003). In 1940, the three Baltic countries lost their independent status to Germany; and then, to the USSR in 1941. During this time, hundreds of thousands of Latvians, Lithuanians, and Estonians were deported in cattle cars to Soviet prison camps in Siberia. Fearing death or deportation by the Communist regime, Estonians, Latvians, and Lithuanians fled to the West by any means possible. The post–World War II influx of immigrants to the United States came in 1949. Because the immigrants fled from the religious, cultural, and political persecution of the Soviet regime and could not return to their native countries after World War II, the U.S. Congress facilitated their entry by enacting laws designating them as displaced persons (Baskauskas, 1985). Many of these immigrants were well educated and had professional occupations. However, language barriers forced them to take positions in manual labor in the United States. Gradually, many immigrants improved their economic status. Because one of the conditions of emigration to the United States for this group was having American citizens to sponsor and accept financial responsibility for them, this group was quickly assimilated into the workforce (Baskauskas, 1985). 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 3 People of Baltic Heritage: Estonians, Latvians, and Lithuanians The Baltic immigrants continued their native traditions, which held the communities together and added diversity to the many cultural groups and organizations to which they belonged. Maintaining the cultural identities of Estonians, Latvians, and Lithuanians was important, and schools were established in the native languages to preserve their language and culture. Many youth and student groups that existed in independent Estonia, Latvia, and Lithuania, such as the Boy Scouts and student fraternities, were re-created in the United States. Many of the post–World War II refugees were professionals; thus, each group formed its own specialized ethnic association of professionals in the United States. For example, the LithuanianAmerican Federation of Engineers and Architects was formed in the 1950s and continues today (Alilunas, 1978). Each group published its own journal or newsletter; the Latvian American newspaper Laiks continues to be published today. The Lithuanian newspapers Draugas and Dirva are also still published. Folk dance and song ensembles were formed to promote the cultural identity of each country. Music and songs are particularly important to people from the Baltics. The songs are sung by people in their native lands and in America. All three Baltic countries continue to have regular song festivals and dance festivals in the United States and in the native countries as well. The Baltic countries are strong in the arts, and theater, opera, music of all types, and film continue to flourish (Lithuania, 2005; Pabriks & Purs, 2001). Since the Baltics regained independence, starting with Lithuania in 1990, immigrants have continued to come to the United States; however, restrictions in the United States and in their native countries have limited their numbers. Travel back to the Baltics is now possible without restrictions. Under Soviet rule, travel to these nations was severely restricted, was limited to 5 days in the country, and entailed entrance and exit only through Moscow. With independence has come a resurgence of interest for Americans of Baltic descent in travel to their native countries, and many have revisited their countries of origin. Economic ties continue to be established as Americans invest in the Baltic economy with a variety of projects ranging from fast food to petroleum. For example, imports such as linen, women’s suits, and amber jewelry from these countries are increasing and can now be found in stores and boutiques throughout the United States. The new freedoms mean that artistic and cultural groups from the Baltics can come to the United States to tour (Gelazis, 1994). One such group is a Latvian Boys’ Choir from Riga. Such appearances help Baltic Americans reinforce their cultural identity. Many Americans of Baltic descent become U.S. citizens, fully participate in American society while continuing to use their native language, and are involved in the 3 culture of origin through the many organizations still in existence in America. Most people of Baltic descent participate in the maintenance of their culture. Studies indicate that, for several generations, the native culture has remained important to individuals in varying degrees (Baskauskas, 1985). Therefore, it is important to assess the meaning of each individual’s cultural heritage, whether they are a first- or later-generation American of Baltic descent. In recent years, the Baltic countries have made strides in linking with the United States and Western Europe, relying less and less on old ties with Russia (Jundzis, 1999). All three Baltic countries have been accepted into NATO and the European Union. Western ties were strengthened in Lithuania in 1997 when Valdas Adamkus, a Lithuanian American, was elected president twice (Lithuania, 2005; Longworth & Bukio, 1998). In 1999, Latvians also elected an expatriate as president. Vaira Vı̄ķe-Freiberga, a retired Latvian Canadian professor, was elected president of Latvia. Estonia also has Western-oriented leadership (Smith, 2002). Educational Status and Occupations Education is highly valued by people of Baltic descent. All three Baltic countries have high literacy rates; each country’s literacy rate is above 99 percent (CIA World Factbook, 2011a, 2011b, 2011c). For small countries, the Baltic countries spend significant amounts of their budget for education. Lithuania, for example, designated 4.7 percent of its GDP for education (CIA World Factbook, 2011c). Education is valued and seen as a way of improving life circumstances. These immigrants made many sacrifices so their children could become educated. As a result, many Americans of Baltic descent have advanced degrees. Many are professionals in medicine and law. Because the Baltic countries were agrarian, early immigrants came from farming communities. These immigrants were attracted to the mining and industrial communities on the East Coast and in the Midwest. The post–World War II Baltic immigrants also settled in the industrial centers of the United States. Second- and third-generation immigrants, however, are often skilled professionals. Since the mid-1990s, the three Baltic countries have experienced a “brain-drain” to some extent because many of their highly educated citizens have emigrated to the United States and Europe. Since entrance into the European Union has made it possible for persons from the Baltics to travel to member countries to obtain jobs, many have left for countries such as Great Britain and Ireland where jobs are available. Lithuania, for example, lost about 400,000 people to emigration since 1990 (Emigrantus šauks atgal i˛ Lietuva, 2007). This is a concern in a relatively small country. The world economic crisis in 2008 affected the Baltic 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 4 4 Aggregate Data for Cultural-Specific Groups countries. The economic growth in the Baltics since 2000 has taken a downturn. The public debt in each country has risen in recent years. Latvia received substantial financial assistance from the EU and other partners in the last few years (CIA World Factbook, 2011, b). The unemployment rate in Latvia is 14.3 percent, in Lithuania it is 17.9, and in Estonia the unemployment rate is 17 percent (CIA World Factbook, 2011a, 2011b, 2011c). Young people find it particularly difficult to get jobs and are drawn to find work in the EU countries or the United States. Communication Dominant Languages and Dialects The Latvian and Lithuanian languages are among the oldest in the world—closely related but not the same. Latvian endings for nouns, for example, are shorter than those in Lithuanian. Latvian and Lithuanian are the only remnants of the ancient Indo-European language related to Sanskrit (Thieme, 1958). Estonian is more closely related to Finnish and is part of the Baltic-Finnic branch of the Uralic languages, which also includes the Hungarian language (Raun, 1991). Cultural Communication Patterns People of Baltic descent share thoughts and feelings readily. The stereotype of quiet, stoic individuals is not borne out by observation or research. For example, humor can be used to relate to these patients and is appreciated if used appropriately (Gelazis, 1994). Older individuals from these cultural groups may be first-generation Americans or immigrants who came to the United States after World War II. These individuals may not be as acculturated as younger people and may prefer to speak their own languages. Healthcare professionals need to be sure that any instructions given to these patients are well understood. Individuals from these cultural groups usually comply with medical regimens and medications as long as they understand them clearly and know the reasons for them. Patients of Baltic origin may hesitate to share intimate thoughts and feelings related to their cultural sense of decorum, but this does not mean that they do not experience feelings and emotions. They may wait to see whether the health-care professional is caring and takes the time to actually listen to them. Recent imigrants may hesitate to use the healthcare system available if they have no jobs. Because health insurance usually is part of job benefits in the United States, both old and young people may not have health insurance. This issue may be addressed as the United States looks at its health-care policies in the future. As a whole, people of Baltic descent are not flamboyant or highly volatile, but individual differences are always present. Some individuals enjoy touch and close contact, whereas others do not. Individuals from these cultures are receptive to a caring use of touch from family and close friends, but they may appear to be more aloof with strangers. Health-care professionals who help patients with crises are encouraged to use touch appropriately to convey caring and support. Temporal Relationships People of Baltic descent give attention to the past, present, and future. The past is revered in the sense that significant historical events for each cultural group continue to be celebrated and acknowledged. For example, commemorative programs are held each year when Estonian Americans celebrate their independence day on February 24, Latvian Americans on November 18, and Lithuanian Americans on February 16. These were held even during the years when the countries were oppressed under Communist rule. More recently, the new dates of independence may also be commemorated, and significant dates may be remembered. For example, January 13 is commemorated in Lithuania each year to remember the lives sacrificed in 1990 when Russian Soviet tanks rolled into Vilnius and fired upon demonstrators surrounding the television tower who were trying to keep broadcasts going in order to unite the country to press for independence from the USSR (Pečeliūnaitė, 2007). People of Baltic descent value frugality because they have had hard times in the past. Many have worked very hard since coming to the United States and have saved enough money to buy homes and pay for their children to complete college. These cultural groups are well able to plan for the future and are patient enough to persevere to reach their personal goals. People of Baltic descent view time in a way similar to that of the dominant American culture. They have become acculturated to the awareness of time and deadlines and arrive at their appointments on time. Because their work ethic is strong and work is highly valued, individuals of Baltic descent take pride in using their time wisely and being efficient. Socially, however, they may be less aware of time and tend to be late. Social and family interactions, especially those involving cultural events, are also highly valued. The view of well-being is holistic, and a balance is sought in life. Therefore, work activities are valued and so are the social and leisure time activities shared with family and friends. Format for Names Individuals of Baltic descent generally use their American last name. First names of women end in “a,” and first names of men end in “as” or “s.” In their native languages, the last name indicates whether the person is male or female; for females, the last name indicates whether the woman is married or single. In 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 5 People of Baltic Heritage: Estonians, Latvians, and Lithuanians Lithuanian, for example, the author’s last name would be Gelažienė, indicating that she is married. If the author were single, the last name would be Gelažytė. The male last name is Gelažis. The typical Lithuanian last name ends with “as” or “is.” The suffix “ienė” indicates a married woman, and the suffix “aitė” or “ytė” indicates a woman’s single status. In Latvian, the typical last name ends in “ans,” “ins,” or “e,” with the endings indicating masculine or feminine genders. Estonian names are similar to Finnish names. Family Roles and Organization Head of Household and Gender Roles The father is the head of the household in the typical family of Baltic heritage. Although both men and women in the family may have jobs and discuss major decisions, the father or father figure is still generally considered the head of the household. Health care and other major decisions are made jointly by both spouses. Women in the family are given respect, and decision making is done by both men and women (Bindokienė, 1989). Prescriptive, Restrictive, and Taboo Behaviors for Children and Adolescents The Baltic people value children, and children and adolescents are given every opportunity for growth and development. Because education is highly valued, parents encourage and supervise children in their schoolwork and progress. Corporal punishment was used by older generations but is practiced less by younger families. Cultural activities, such as song or dance groups and ensembles, frequently unite people of all ages. Religious beliefs also strongly influence family life and the rearing of children in each culture. Family Goals and Priorities The traditional nuclear family is still the standard in these cultural groups. Family is highly valued, and divorce is still fairly rare. Lithuanian Americans are predominantly Roman Catholic, and their religion supports strong family values. Because both spouses tend to work, child care may be shared by grandparents. The extended family is important, and visiting among them is frequent, but extended family members live separately. Older people are respected in the Baltic cultures. If grandparents are unable to live independently, every effort is made to have them move in with an adult child, usually a daughter. Nursing homes are used when needed. Because many women work outside the home, families may find it necessary to use long-term-care facilities to care for infirm older members. Culturally based nursing home facilities are available. For example, the Matulaitis Nursing Home in Connecticut is for older Lithuanian Americans (Gelazis, 1994). 5 Older members of these cultures often come from large families. Extended families live apart because family members may have been separated in their escape from the Baltics. Many tragic events, such as the Soviet deportations of hundreds of thousands of Estonians, Latvians, and Lithuanians to Siberian concentration camps in the 1940s and later in the 1950s, separated family members forever by death and distance. When people fled their homelands to escape Communist tyranny, they emigrated to whatever free country they could. Therefore, the extended family may include members throughout the world in such faraway places as Australia, Canada, Europe, and South America. When the Baltics regained their independence, family members from the United States were able to visit their homelands for the first time in years. Before this, many Americans of Baltic descent were afraid to visit their native lands because they feared for their families and even for themselves. During the years of oppression, mail was censored, and free communication, even among relatives, was severely restricted. Many people of Baltic descent sent money and other material support home for years to help their extended families (Fainhauz, 1991). In their native countries, status was given to individuals with professions such as physicians and lawyers and those with academic degrees. In America, a certain amount of respect is still given to professionals, but each cultural group has more of an egalitarian sense of community. The preservation of Baltic culture and language holds people of varying status, education, and age together for a common purpose. Furthermore, when immigrants first came to the United States, many had to take jobs of lesser status. This increased their sensitivity for individuals of all social and economic classes. For example, some physicians had to take positions as laboratory technicians, and teachers as laborers and factory workers. This pattern continues today with new immigrants, but there is a tendency for new immigrants to stay within their professions, and English has replaced Russian in most schools in the Baltics, making transition into the United States and the United Kingdom easier than in the past. In Lithuania, for example, more people now speak English than Russian (CIA World Factbook, 2011c). Alternative Lifestyles The literature does not include information about same-sex couples in these cultures. Because the dominant religions of the Baltic countries do not sanction homosexuality, few individuals and couples are openly homosexual, making it hard to obtain statistics. Recent increases in HIV rates in former Soviet Union countries, including the Baltics, may be indicative of an increase in homosexual activity but may also indicate an increase in casual sex in heterosexuals who are more mobile today than in the past (Rowe, 2006). 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 6 6 Aggregate Data for Cultural-Specific Groups Workforce Issues Culture in the Workplace Individuals of Baltic descent value their family, culture, and beliefs and view work as important. Material aspects are seen as secondary to the more-important family values. Responsibility is taken seriously and is encouraged. Political awareness and responsibilities of citizenship are considered essential aspects of life. People of Baltic descent adapt readily to American values of timeliness in the workplace. Issues Related to Autonomy People of Baltic descent have no difficulty maintaining their sense of autonomy and readily take on work roles, responsibility, and decision making. They usually do not like to directly confront those in authority and find ways to deal with difficult situations or people through the use of humor or deference. Recent immigrants who have lived under the Soviet regime may not be accustomed to making decisions for themselves or acting autonomously. In previous governmental regimes, individuals and their rights were not considered important. For the most part, Americans of Baltic descent are fluent in English as well as their own languages. Exceptions might be identified among older people or recent immigrants. Friends, family, or community members can act as translators if absolutely necessary. The Baltics have high literacy rates. Biocultural Ecology Skin Color and Other Biological Variations People of Baltic descent have white skin. Estonians are similar to the Finns with brown hair and eyes, though some are blond and blue-eyed. Latvians and Lithuanians have fair complexions with blond hair and blue eyes. Assessment of health status is similar to that of other fair-skinned individuals. Diseases and Health Conditions Recent immigrants from Estonia, Latvia, and Lithuania may be at risk for cancer because of the current industrial pollution, including radiation exposure resulting from the Chernobyl nuclear disaster in 1988. Because Chernobyl is close to the Baltic countries, some contamination occurred in the Baltics and other Northern European countries. Furthermore, because the Soviet regime did not consider human needs over the needs of the state, nuclear waste on land or in the Baltic Sea may not yet be publicly known. This may constitute a health hazard and may affect both recent immigrants and visitors to these countries. Lithuania has had to improve safety procedures at Ignalina (Chernobyl-type reactors) in order to avoid a disaster similar to the Chernobyl experience and to protect the Lithuanian people as well as its neighbors (Lane, 2001). Some immigrants are survivors of political torture, having spent years in prison labor camps in Siberia. As a result of such experiences, their health status is affected. For example, hearing loss has occurred as a result of beatings and other torture in prisons (Gelazis, 1994). Some may show evidence of post-traumatic stress disorder (PTSD) due to past years of high stress war situations. When performing health assessments, health-care providers need to be alert to ill health resulting from the conditions that immigrants endured because of the political situations in their countries of origin. Obtaining a history of individuals and their life experiences is important. People of Baltic descent have illness rates similar to those of the general American population (CIA World Factbook, 2011a, 2011b, 2011c). Morbidity rates in the Baltic countries show that the leading causes of death are heart disease and cancer, with rates similar to those of the general population in the United States. More recently, however, as mentioned previously, as a result of industrial pollution and nuclear waste contamination brought on by the Soviet regime, cancer rates have increased in the Baltic countries. The incidence of alcoholism is high in the Baltics (British Broadcasting Corporation, 1994). For example, alcoholism is a health problem in Latvia and is partly responsible for the particularly low life expectancy for men (Pabriks & Purs, 2001). The life expectancy for Latvian men is 67.56 years, and for Latvian women, it is 78.07 years (CIA World Factbook, 2011b). Life expectancy for Estonian men is 68.02 years, and for Estonian women, it is 78.97 years (CIA World Factbook, 2011a). Life expectancy for Lithuanian men is 70.2 years, and for women, it is 80.48 years (CIA World Factbook, 2011c). Strong educational antismoking and antialcohol campaigns would help to increase the life expectancy in Latvia and the other Baltic countries. Better health also has positive consequences economically for both individuals and countries. Suicide is also increasing in the Baltics (Agence France Presse, 1995). Considerations for health-care professionals include health teaching such as decreasing smoking, changing dietary habits, and decreasing the use of alcohol. Health-care professionals should assess for a family history of heart disease, cancer, or alcoholism. Variations in Drug Metabolism In addition to the previously mentioned considerations, the Ashkenazi Jews from the Baltic countries may respond differently to neuroleptic agents (Levy, 1993). For example, in studies of the use of clozapine to treat schizophrenia, 20 percent of Jewish patients developed agranulocytosis, but this adverse reaction occurs in only 1 percent of chronic schizophrenic patients in the general population (Lieberman et al., 1990). Genetic testing reveals that a specific haplotype was found in 83 percent of patients who developed 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 7 People of Baltic Heritage: Estonians, Latvians, and Lithuanians agranulocytosis. All Ashkenazi Jewish patients affected had this haplotype, and only 8 percent did not develop this reaction. Characteristically, this haplotype is found in less than 1 percent of the white population in America (Levy, 1993). High-Risk Behaviors Cigarette smoking is decreasing in the United States and Canada; however, European countries, especially Eastern European countries, have not followed this trend. Although some Americans of Baltic descent have stopped smoking, the younger generation— those in their late 20s to 30s—has shown a similar trend to that of other Americans of the comparable age group (Gelazis, 1994). Smoking has decreased among Americans of Baltic descent in the United States, but people living in their native countries have continued to smoke. In fact, some American tobacco companies have begun negotiations with Baltic countries, such as Lithuania, for possible future investments (Linderfalk, 1996). Individuals who have emigrated to the United States since the early 1990s tend to continue to smoke. The latest statistics on smoking rates in the Baltic countries continue to remain high, as much as 45 percent of the people smoke (Gilmore et al., 2004). Another health problem is the use of alcohol. Although many people of Baltic descent maintain jobs and are able to function, their use of alcohol is high. The rate of alcoholism in the Baltic countries and other Eastern European countries is high, and drug use is on the rise (Reuters World Service, 1994). Alcohol consumption, especially beer among young adults, is actually increasing (Zaborskis, Sumskas, Maser, & Pudule, 2006). This is not to imply that alcohol abuse is a problem for all individuals of this cultural group, but the issue should be carefully assessed. Health-care professionals are encouraged to be subtle and indirect in these assessments, because denial of the problem is part of the pathology. Greater freedom to move about, especially in the European Union countries, also has implications regarding the health of persons in the Baltics. One example is that casual sex related to truck drivers carrying goods to and from other countries has raised rates of sexually transmitted disease, HIV, and tuberculosis in the Baltics and other countries. All of these diseases, particularly rising HIV rates, have dire consequences for the public-health systems of each country as well as any countries to which affected persons emigrate (Rowe, 2006). Health-Care Practices Americans of Baltic descent readily seek medical care and prefer to obtain it from professionals of their own background, when possible. Older people, who may have difficulty with English, are more at ease when they can speak with their health-care providers in their own language. 7 Americans of Baltic descent are health conscious and believe that a well-balanced lifestyle maintains health and well-being. For example, well-being among Lithuanian Americans is typically described as a holistic concept—that is, a state of being in which the person’s physical, spiritual, psychological, and social health are in balance (Gelazis, 1994). Moderation is perceived as desirable in living a healthy life. Natural foods are preferred, and whenever possible, vegetables and fruits are homegrown. These are then preserved for use throughout the year. Exercise and physical activity are valued, and people of these cultures make an effort to get a reasonable amount of exercise. Sports are also considered an important part of maintaining one’s culture. Participation in sporting activities promotes a sense of unity and cultural identity along with being an important part of a healthy lifestyle. Young people in particular are encouraged to be active in sports, and team sports are organized and encouraged. For example, Latvians enjoy soccer, whereas Lithuanians have volleyball and basketball teams. Teams from Chicago, Cleveland, and Toronto have tournaments or sports festivals (Sporto Šventės in Lithuanian) featuring track and field events and team sports such as volleyball. Several years ago, a sports festival was held in Lithuania in which Lithuanian Americans joined Lithuanians from all over the world in a variety of sports events for the first time in over 50 years. Latvians and Estonians have similar events. The Baltic countries favor sports such as basketball and soccer and such Olympic events as running, bicycling, and ice skating. Lithuania boasts of professional basketball players who came to the United States to play professional basketball successfully. One example is Arvydas Sabonis, who has been in the National Basketball Association (NBA) for over a decade. He founded a basketball school in Lithuania that gives scholarships for general education and room and board to disadvantaged children (Daukša, 2006). Some people, as they get older, become more sedentary and may need to be encouraged to be as active as possible. Most Americans enjoy walking and the outdoors, and health-care professionals can encourage such activities. Older Baltic Americans tend to stay as active as possible; in fact, many enjoy gardening. Women take pride in having beautiful flower gardens, with the rue (rūta in Lithuanian) plant having a special place in Lithuanian gardens. Such activities should also be encouraged as a form of exercise. Nutrition Meaning of Food As previously mentioned, before World War II, the Baltic countries were largely agrarian. Industrialization started before World War II when these 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 8 8 Aggregate Data for Cultural-Specific Groups countries were forcibly annexed into the USSR. At that time, all private ownership ceased, and farms were collectivized. The Americans of Baltic descent who came to the United States in the late 1940s and early 1950s have roots in the villages of Estonia, Latvia, and Lithuania. Although many came from towns and cities and had professions, many others were farmers. Because many individuals who left the Baltics after World War II experienced food shortages and times of starvation, food is important to these people. Recent immigrants have left the Baltics for economic reasons and have also experienced food shortages. Common Foods and Food Rituals Some foods common among this cultural group are meats such as pork, chicken, and beef. Rye and whole-grain breads are popular. Baked goods such as bacon rolls, yeast-baked goods, and rich tortes and cakes are common. Fresh fruits and vegetables are enjoyed. Potato dishes such as pancakes, kugel, and dumplings are popular in the home and at festive events. Beets, mushrooms, and cabbage are used in soups and sauces. Dairy products such as sour cream, butter, and yogurt are included daily in their meals (Gelazis, 1994). Grain porridges are popular, especially among Latvians who have putras (porridges). The content of porridges varies according to regions in Latvia. Food is a symbol of the culture. Foods enjoyed by people of Baltic descent include smoked and unsmoked sausages and smoked fish, eel, and pork. The spices used are rather mild compared with those of other cultures, but foods may be high in salt content. Food is also connected with festive occasions and celebrations. Certain foods are associated with particular holidays. For example, Latvians serve gray peas on New Year’s Eve. These must be completely eaten because they signify tears, and one does not want any tears to follow them into the new year. Because Lithuanians are mostly Roman Catholic, many foods relate to Catholic holidays. For example, the meal on Christmas Eve is meatless and includes 12 different foods representing the 12 apostles of Christ. Straw is placed under the tablecloth, symbolizing the manger in which Christ was born. The Christmas wafer is shared with each family member. All family members make an effort to be present at the Christmas Eve meal, which is shared together. After the dinner, the family attends Midnight Mass. People of Baltic descent are becoming acculturated into American food choices and habits. Rituals related to food may include certain holidays, but no set rituals are used on a daily basis. The noon meal was the largest meal of the day in an agrarian society. This practice may no longer exist, but health-care providers can encourage it when possible, especially for retired or older people. Dietary Practices for Health Promotion Individuals of Baltic descent enjoy natural, fresh fruits and vegetables and prefer they be homegrown. Diets tend to be well balanced. Health teaching may be necessary regarding salt, fat, and cholesterol content because many of the preferred foods are high in these components. Nutritional Deficiencies and Food Limitations Nutritional deficiencies are similar to those of the general population in the United States. Some individuals of Baltic descent may have deficits as a result of food or nutrient deprivation earlier in life. For example, some age groups may have a greater incidence of dental caries caused by a lack of calcium at a crucial stage of life. There are no major limitations of food availability for Baltic people in America. However, socioeconomic conditions may prevent some individuals from obtaining a balanced diet. Pregnancy and Childbearing Practices Fertility Practices and Views Toward Pregnancy The fertility practices of these cultural groups mirror those of the general population of the United States. The families of younger generations are smaller, and even Lithuanian Americans who are Roman Catholic use birth control practices. In the Baltic countries, a variety of factors cause low birth rates. Under Soviet rule, large families were encouraged, and mothers who gave birth to many children were rewarded with state medals (Gelazis, 1994). Since regaining independence, the Baltic countries have experienced economic difficulties, and many goods, including medical supplies and medications, are scarce. For this reason, many birth control methods are not available to Estonians, Latvians, and Lithuanians. Therefore, abortion rates are high (Priest, 1994); No up-to-date information about abortion rates could be found. In 1998, Latvia and other Baltic countries had a negative population growth. In addition, Latvia had 15.2 infant deaths per 1000 births that same year. In 2009 the infant mortality rate was 8.42 (CIA World Factbook, 2011b). This compares very unfavorably with other European countries such as Sweden, which had 4 infant deaths per 1000 births in 1998 (Pabriks & Purs, 2001). The Baltics need to address these health issues and educate people about prenatal care and birth control methods to reduce both abortion and infant mortality rates. 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 9 People of Baltic Heritage: Estonians, Latvians, and Lithuanians Prescriptive, Restrictive, and Taboo Practices in the Childbearing Family Americans of Baltic descent use modern Western medicine practices, are likely to obtain early prenatal medical care, and are likely to be receptive to health teaching for prenatal and postnatal care. Because they prefer natural processes, some women and families from these cultural groups prefer natural childbirth and breastfeeding. Statistics of these preferences are not available, but research indicates that well-being is defined by Lithuanian Americans as a holistic, well-balanced approach to life (Gelazis, 1994). Some older individuals of Baltic descent may remember and still believe in past restrictive beliefs about pregnancy. For example, pregnant women are to remain calm and receive no shock or frightening news. In the past, once the child was born, ceremonies and rites included the father’s greeting the child into the family. Now, these rites have given way to Christian baptism ceremonies. The godparents are important in the child’s life and traditionally give gifts, including candy, to each other and guests. Prenatal care in the Baltic countries today leaves much to be desired. These countries are struggling to improve standards of health care but, unfortunately, have not yet caught up to U.S. standards. Prenatal vitamins may not be available, and the diet may be low in calcium and protein owing to shortages of meats (Trickey, 1993). Death Rituals Death Rituals and Expectations Death is viewed as part of life, and ceremonies of the wake and funeral are linked with Christian religious services. Life and death events are very important and expressed socially within the community. The death of a family member is a loss to the community, which is typically close knit. The funeral may take place within 3 to 4 days following the death, providing time for out-of-town friends and relatives to gather. Family, friends, and community members want to be present at the wake and the funeral ceremony. At the wake, organizations to which the deceased belonged send representatives to express their loss to the family. The funeral is usually a Christian service, followed by a meal at which all attendees are welcomed. Burial is the usual practice. Cremation is permissible now, even among Roman Catholics, especially if the deceased expressed a wish to have his or her ashes taken to the homeland (Fainhauz, 1991). Responses to Death and Grief Grief is expressed by sadness, crying, and talking about the deceased with fondness and respect. Individuals from these cultures express emotions readily but not in highly dramatic ways. Decorum is maintained 9 in public and with strangers. The dead are often remembered with frequent visits to the cemetery. Roman Catholics have masses said for their deceased relatives on a regular basis, particularly at the anniversary of their deaths. All Souls’ Day, November 2, Vėlinės, is a significant day for Lithuanian Americans, with religious ceremonies commemorating the dead. In Lithuania on this day, candles are lit at the graves, which are decorated. Family and friends in each village and town gather for prayers, hymns, and religious services. In the United States, Lithuanian Americans pray for their deceased family members and friends and make every effort to visit the cemeteries (Gelazis, 1994). Spirituality Dominant Religion and Use of Prayer Estonian Americans and Latvian Americans are predominantly Lutherans, but some are Catholics, whereas Lithuanian Americans are predominantly Roman Catholic. All these groups celebrate major Christian religious holidays, particularly Easter and Christmas. Individuals of these cultures consider themselves as having spiritual roots, which may be closely linked with the value they place in their language, country, and culture. Americans of Baltic descent have many concerns about the state of religion and the values of Estonians, Latvians, and Lithuanians. Under Soviet rule, all forms of religion were forbidden, and the Communist government made every effort to eradicate all traces of religious belief. Religion was replaced by Communist dogma for 50 years. Thus, several generations of Estonians, Latvians, and Lithuanians have grown up hearing antireligious propaganda most of their lives. Only the older generation maintained strong religious beliefs. Now that the Baltic countries are independent, efforts are being made to reintroduce religious values. Religious groups from America have sent missionaries to these and other Eastern European countries. Although Christianity has been the religion of the Baltics for hundreds of years, the ancient religion, wherein elements of nature were worshipped, still has an influence, as evidenced in their respect for nature and ecology. To this day, some pagan holidays are commemorated in the form of Christian holidays. For example, St. John’s Eve (June 21) is celebrated by all Baltics and is part of the celebration of the summer solstice. Latvians and Estonians in particular celebrate this holiday with special songs, dances, bonfires, and decorations. A very small percentage of Latvians maintain their ancient pagan religion, called Dievtui (those with God), which has a high priest as its head. Stories include myths and folk wisdom in rhyme as an important part of their content. Most Americans of Baltic descent consider prayer to be an individual expression of their faith. The nurse 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 10 10 Aggregate Data for Cultural-Specific Groups or health-care professional should allow the client and family to take the lead with regard to prayer. Because prayer is individualized, some patients welcome time for individual or shared prayer, whereas others do not wish to pray. Many have been sustained through hardships by their strong religious faith and continue to have strong religious needs. Meaning of Life and Individual Sources of Strength Americans of Baltic descent are a spiritual people, and religion is a source of strength. In addition, the family and the community of Estonian Americans, Latvian Americans, and Lithuanian Americans, as well as their cultural and national identity, are significant sources of support, pride, and strength. Enormous effort goes into preserving their language, culture, customs, and traditions. The changes in their native countries brought about by the Soviet rule are a source of pain for people of Baltic descent. Contact with their homeland and their people has increased their awareness of differences in values, and many are concerned about these differences. Spiritual Beliefs and Health-Care Practices Spiritual and religious considerations are considered private and may not be readily shared with health-care professionals. A trusting relationship with the individual must be established before deep spiritual beliefs are shared. Clergy from the client’s church are usually welcome; thus, the nurse may wish to contact the church. Patients find considerable comfort in speaking with the clergy in times of crises and serious illness (Gelazis, 1994). Health-Care Practices Health-Seeking Beliefs and Behaviors Individuals of Baltic descent adhere to modern medical regimens and readily use the health-care system available to them. Because they consider health and well-being important, they take an active interest in healthy lifestyles, nutrition, and exercise. As noted previously, natural foods such as rye and whole-grain breads, fruits, and vegetables are preferred. Fresh air is considered important, and walking, especially in natural settings such as parks, is enjoyed by all ages. The Baltic countries were improving economically until 2008. Estonia, in particular, made the fastest progress economically with the help of investments from Scandinavian countries. By 1993, Estonian trade had reoriented itself toward Western markets. Estonian exports are processed goods based mostly on timber, textiles, and food rather than heavy industry. Latvia and Lithuania, however, continue to have agricultural and natural resources as the basis for foreign trade (O’Connor, 2003). Economic growth has both health-care and political consequences. For example, a growing economy encourages professionals to remain in the country, where health needs can be addressed and economically supported through their political stability. The Communist or Socialist parties, for example, can appeal more easily to populations in which economic need is greatly felt and experienced. Democratic processes and government are easier to maintain when the economy is stable and growing. The Baltics need a sound economy as a basis for political growth. In the past year the economies of each of the Baltic countries have begun to rebound from the worldwide economic crisis of 2008/2009, and slight growth is evident (CIA World Factbook, 2011a, 2011b, 2011c). Responsibility for Health Care People of Baltic descent assume responsibility for their own health. Because work is highly valued, most are in the workforce and have insurance coverage. Individuals are generally well informed by their physician, friends, and the community about available resources. Because these people place a high value on family, family members are concerned about one another and help one another obtain medical and dental care when needed. Because Baltic Americans take a holistic approach to life and health, and cultural roots enter into wellness and health promotion, they encourage youth groups to participate in sports and camps. At a campsite, Ganezers, in Michigan, Latvian American youth can learn the Latvian language, history, and other cultural practices while participating in swimming and other outdoor sports and activities. In addition, folk songs and dances are part of the program. Several similar camps are located in New Jersey, New York, and western states. Lithuanian Americans and Estonian Americans have comparable summer camps. Scouting is part of each cultural group, and selected activities encourage the use of the native language, customs, and songs. Christian youth groups also hold summer and winter camps with outdoor activities. For example, the Lithuanian American group, Ateitis, fosters Christian and cultural values and physical activities. Their goal is to have well-rounded, Christian Lithuanian American citizens who are healthy and aware of their cultural roots while respectful of political values associated with U.S. citizenship. Medical care and hospitalization are sought readily. Attempts are made to maintain health even into old age. Baltic countries have recently developed a growing interest in “natural” and vegetarian diets, yoga, alternative medicine, and swimming, even in icy waters. This is the result of Eastern philosophy and influence. However, the standards of medical care available in the Baltic countries at present are below those of the United States. 2780_BC_Ch26_001-012 03/07/12 9:53 AM Page 11 People of Baltic Heritage: Estonians, Latvians, and Lithuanians People in the United States, Canada, and other countries send money, medical supplies, and medications to Estonia, Latvia, and Lithuania to help with the shortages, but the current state of health care is poor. In the past, the U.S. State Department issued warnings to travelers about the poor medical care available in these countries. In 1994, a U.S. Lithuanian– sponsored clinic opened in Vilnius. The clinic provides health care for travelers who need medical attention; treatment is covered by U.S. medical coverage plans (Economist Intelligence Unit, 1994). Recent immigrants from the Baltics to America may have different values because they lived under a Communist regime in which the government “took care” of their medical needs in a health-care system that was very different from that of the United States. These immigrants often need help understanding the American health-care system and may be reluctant to use it if they have no medical insurance coverage. Folk and Traditional Practices Individuals of Baltic descent use less folk medicine than they did in the past. Older Americans of Baltic descent are more likely to use more-current healing practices. Chamomile and linden blossom teas may be used for fevers and colds (Gelazis, 1994); honey is used for colds and sore throats. The nurse or health-care provider should ask about teas or folk remedies that may have been used before the client sought medical help. Younger people prefer to use over-the-counter cold remedies and analgesics. The use of natural substances for healing purposes is not customary among this generation. Barriers to Health Care People of Baltic descent have few problems obtaining access to health care. Among older Baltic immigrants, language may continue to present difficulty if they have not learned English well. However, most have friends and relatives who are willing to help by translating. Most recent immigrants who may have parttime jobs and have no health-care coverage may need help in finding medical and health care, such as free clinics, that are available to them. Cultural Responses to Health and Illness Many older people of Baltic descent had lives with hardships both before and after coming to America. Many individuals may tolerate pain as a part of life and may not complain about it or report it. Healthcare professionals need to assess older patients for postoperative pain. Some stigma is attached to mental illness, but medical care is sought. The family encourages compliance with prescription medications and treatments. Most people of Baltic descent accept physical handicaps, mental illness, and mental retardation. The 11 family usually cares for the individual at home. The community is also supportive. Americans of Baltic descent do not enjoy the sick role and avoid it when possible. Work is highly valued, and the person returns to normal responsibilities as soon as possible. This attitude may be a problem if prolonged rest is required. The nurse or health-care professional needs to understand individual responses to illness and the sick role. Blood Transfusions and Organ Donation Most people of Baltic descent accept blood transfusions and organ donation and transplantation. The use of extraordinary means to preserve life is an individual decision, but living wills are frequently used. In some instances, it may be up to the nurse to inform the patient and family of their rights; the advocate role of the nurse can be exercised if necessary. Health-Care Providers Traditional Versus Biomedical Providers The literature reports no variations in beliefs that Baltic American health-care providers have toward each other. As with other cohort groups, variation between and among different groups of health-care providers may be significant. Besides family members a…
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