People of Greek, Hindu, and Cuban Heritage

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

ORDER A PLAGIARISM FREE PAPER NOW

Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Overview/Heritage ▪ More than a billion people inhabit India. ▪ Eighty percent of the population are Hindus, followers of Hinduism. ▪ Other significant religious groups include Sikhs, Moslems, and Christians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Overview/Heritage ▪ Different religious sectors share many common cultural beliefs and practices. ▪ Immigrants to the United States come predominantly from urban areas, including all major Indian states. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Overview/Heritage ▪ Most recent immigrants are highly educated. ▪ More than 1,600,000 Asian Indians are living in the United States. ▪ Most come to the United States to attain a higher standard of living, better working conditions, and job opportunities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Communication ▪ Asian Indian languages fall into two main groups: Indo-Aryan in the north and Dravidian in the south. ▪ Hindi, with 1,652 dialectical variations, is the national language along with English. ▪ Women often speak in a soft voice, making it harder to understand what they say. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Communication ▪ Men may become intense and loud when they converse with other family members. ▪ Women avoid direct eye contact with men. ▪ Direct eye contact with older people and authority figures may be considered a sign of disrespect. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Communication ▪ Touching and embracing are not acceptable for displaying affection. ▪ Even between spouses, a public display of affection such as hugging or kissing is frowned upon, being considered strictly a private matter. ▪ Temporality is past-, present-, and future– oriented. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Communication ▪ Punctuality in keeping scheduled appointments may not be considered important. ▪ Older family members are usually not addressed by name but as elder brother, sister, aunt, or uncle. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Communication ▪ A woman never addresses a man by name because the woman is not considered an equal or superior. ▪ Strangers are greeted with folded hands and a head bow that respects their personal territory Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ No institution in India is more important than the family. ▪ The hierarchical structure of authority is the patriarchal joint family based on the principle of superiority of men over women. ▪ The male head of the family is legitimized and considered sacred by caste and religion, which delineate relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ Central relationships are based on continuation and expansion of the male lineage through inheritance and ancestor worship, related to the father-son and brother-brother relationships. ▪ A matrilineal system exists in a few areas in the southwestern and northeastern regions of the country; however, power rests with the men in the woman’s family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ A submissive and acquiescent role is expected of women in the first few years of married life with little or no participation in decision-making. ▪ Strict norms govern contact and communication with the men of the family, including a woman’s husband. ▪ Parents strongly encourage and emphasize scholastic achievement in fields that promise good employment and a high social status. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ Although many parents expect and accept the Westernization of their children, the question of marriage is still a concern for parents who have opinions about how their children should be married, whether “arranged” or partly arranged. ▪ Hindu parents or Indians from all religious traditions want their children to marry other Indians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ Arranged marriages at a young age are considered most desirable for women. ▪ The practice of an arranged marriage continues in the United States in order to minimize the stress associated with differences in castes, lifestyles, and expectations between the male and female hierarchy. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ The two major types of transfer of material wealth accompanying marriage are bride price and a dowry. ▪ Bride price is payment in cash and other materials to the bride’s father in exchange for authority over the woman, which passes from her kin group to the bridegroom’s kin group. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ In the joint family structure, Hindu women are considered “outsiders” and are socialized and incorporated in such a way that “jointness” and residence are not broken up. ▪ A close relationship between the husband and wife is disapproved because it induces favoring the nuclear family and dissolving the joint family. ▪ A marriage is regarded as indissoluble. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Family Roles & Organization ▪ Older family members are held in reverence and cared for by their children when self-care becomes a concern. ▪ Single-parent, blended, and communal families are not well accepted by Hindus. ▪ Homosexuality may cause a social stigma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck A male nurse is giving dietary discharge instructions to Mrs. Mukhopadhya. She she does not maintain eye contact with the nurse. This means she is a. Embarrassed. b. Does not understand. c. Demonstrating respect. d. Does not care. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C Out of respect, traditional Hindus do not maintain eye contact with authority figures, nor do females maintain eye content with men. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Workforce Issues ▪ At work, Hindus adopt American practices and cultural habits. ▪ Hierarchies of age, gender, and caste prescribe transactions among Hindus. ▪ At work, relationships are a reproduction of the authority-dependence characteristic of family and social relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Workforce Issues ▪ In seeking to establish a personal and benevolent relationship, Hindus may be seen as too eager to please, ingratiating, or docile, all antithetical to the task of assertion and independence. ▪ Women avoid direct eye contact with men. ▪ Direct eye contact with older people and authority figures is a sign of disrespect. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Biocultural Ecology ▪ Indian diversity of physical types and can be divided into three general groups according to the color of their skin: ▪ White in the north and northwest, ▪ Yellow in areas bordering Tibet and Assam, and ▪ Black in the south. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Biocultural Ecology ▪ Indids (whites) have a light-brown skin color, wavy black hair, dark or light brown eyes, are tall or of medium height, and are either dolichocephalic (long-headed) or brachycephalic (short-headed). Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Biocultural Ecology ▪ Melanids, often referred to as the Dravidians and are the population of southern India, have dark skin ranging from light brown to black, elongated heads, broad noses, thick lips, and black, wavy hair. ▪ They are usually shorter than 5 feet 6 inches tall. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Biocultural Ecology ▪ Common health conditions of Asian Indians include malaria, filiariasis, tubersulosis, pneumonia, cardiovascular diseases, rheumatic heart disease, sickle cell anemia, dental disease, lactose intolerance, cancer of the cheek, nose, and mouth, breast and stomach cancer, ichthyosis vulgaris, beriberi, thiamine deficiency, goiter, osteomalacia, dropsy, and flurosis. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Biocultural Ecology ▪ Many individuals require lower doses of lithium, antidepressants, and neuroleptics, and they may experience side effects even with the lower doses. ▪ They are also more sensitive to the adverse effects of alcohol consumption, resulting in marked facial flushing, palpitations, and tachycardia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu High-risk health Behaviors ▪ Alcoholism and cigarette smoking among Hindu Americans, especially among men, cause significant health problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Dietary habits are complex and regionally varied. Most believe that food was created by the Supreme Being for the benefit of man. ▪ The influence of religion is pervasive in food selection, customs, and preparation methods. ▪ Classification of regional food habits can be two-fold based on the types of cereals and fresh foods consumed. ▪ In the first category are rice and bread eaters; in the second category are vegetarians and non-vegetarians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Vegetarianism is firmly rooted in culture. ▪ The term non-vegetarian is used to describe anyone who eats meat, eggs, poultry, fish, and sometimes cheese. ▪ Many Brahmins in North India consider eating meat to be religiously sanctioned. ▪ In some parts of India, eating fish is acceptable to Brahmins, whereas in other parts eating meat is sacrilegious. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Dietary staples include rice, wheat, jowar, bajra, jute, oilseeds, peanuts, millet, maize, peas, sugarcane, coconut, and mustard. ▪ Cereals supply 70 to 90 percent of the total caloric requirements. ▪ A variety of pulses or lentils, cooked vegetables, meat, fish, eggs, and dairy products are also consumed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Heavily spiced (curry) dishes with vegetables, meat, fish, or eggs are favored, and hot pickles and condiments are common. ▪ Spice choices include garlic, ginger, turmeric, tamarind, cumin, coriander, and mustard seed. ▪ Vegetable choices include onions, tomatoes, potatoes, green leaves, okra, green beans, and root vegetables. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ In North India, wheat is the staple food. Other cereals are jowar, bajra, and ragi, consumed in porridges, gruels, and rotis (baked pancakes). ▪ People from Punjab do not favor fish, and people from the south generally dislike the idea of meat of any kind. ▪ In Saurashtra in the south, fish, fowl, flesh, and eggs are taboo practically everywhere. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Women generally serve the food but may eat separately from men. ▪ Women are not allowed to cook during their menstrual periods or have contact with other members of the family. ▪ Foremost among the perceptions of Hindus is the belief that certain foods are “hot” and others are “cold,” and therefore, they should only be eaten during certain seasons and not in combination. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Nutrition ▪ Geographic differences in the hot and cold perceptions are dramatic. ▪ Many foods considered hot in the north are considered cold in the south. Such perceptions and distinctions are based on how specific foods are thought to affect body functions. ▪ Failure to observe rules related to the hot and cold theory of diseases results in illness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy and Childbearing Practices ▪ Birth control methods include intrauterine devices, condoms, and rhythm and withdrawal methods. ▪ Grandmothers, mothers, and mothers-in-law are considered to have expert knowledge in the use of home remedies during pregnancy and the postpartum period. ▪ Many older women frequently travel to the United States to assist new mothers in antenatal and postnatal care that is consistent with traditional customs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy and Childbearing Practices ▪ The birth of a son is a blessing because the son carries the family name and takes care of the parents in their old age. ▪ The birth of a daughter is cause for worry and concern because of the traditions associated with dowry, a ritual that can impoverish the lives of those who are less affluent. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy and Childbearing Practices ▪ No taboo against the father being in the delivery room exists, but men are usually not present during birthing. ▪ Because self-control is valued, women suppress their feelings and emotions during labor and delivery. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy & Childbearing Practices ▪ Certain “hot” foods like eggs, jaggery, coconut, groundnut, maize, mango, papaya, fruit, and meat are avoided during pregnancy because of a fear of abortion caused by heating the body or inducing uterine hemorrhage. ▪ Pregnancy is a time of increased body heat; hence, “cold” foods, such as milk, yogurt, and fruits, are considered good. Buttermilk and green leafy vegetables are avoided because of the belief that these foods cause joint pain, body aches, and flatulence. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy & Childbearing Practices ▪ Burning sensations during urination, scanty urine, or a white vaginal discharge are considered serious signs of significant overheating. ▪ Overeating and consumption of high-protein foods, including milk, are avoided because such foods result in an exaggerated growth of the baby that may lead to a difficult delivery. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Pregnancy & Childbearing Practices ▪ Morning sickness is caused by an increase in body heat. ▪ Anemia caused by iron deficiency is one of the nutritional disorders affecting women of childbearing age. This condition may be aggravated because of the practice of reducing the consumption of leafy vegetables to avoid producing a dark-skinned baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Childbearing Practices ▪ After the birth, both the mother and the baby undergo purification rites leading to the 11th day. ▪ The baby is officially named on the 11th day during the “cradle ceremony,” and several rituals are performed to protect the baby from evil spirits and to ensure longevity. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Childbearing Practices ▪ The postpartum mother is considered to be impure and is confined to a warm room and often keeps the windows closed to protect her against cold drafts. Exposure to air conditioners and fans, even in warm weather, may be considered dangerous. ▪ The pollution lasts for 10 days. This period of necessitated and mandatory confinement assists in bonding between the mother and the newborn. It provides the mother with adequate rest and time to tend to the baby’s needs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ A sponge bath for the newborn is recommended until the umbilical cord falls off. ▪ Soft massage to the extremities is recommended before bathing the infant. ▪ Washing the infant’s hair daily is believed to improve the quality of the hair. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ During the postpartum period, hot foods, such as brinjals, drumsticks, dried fish, dhal, and greens, are good for lactation. ▪ Cold foods, such as buttermilk and curds, gourds, squashes, tomatoes, and potatoes, are restricted because they produce gas. Cold foods are thought to produce diarrhea and indigestion in the infant. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ Abstentions are primarily practiced for the baby’s health; harmful influences might be transmitted through the mother’s breast milk. Some believe that colostrum is unsuited for infants. Most women think that the milk does not “descend to the breast” until their ritual bath on the third day and, as a result, newborns are fed sugar water or milk expressed from a lactating woman. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ Breast milk is commonly supplemented with cow’s milk and diluted with sugar water. A child’s stomach is considered weak as a result of diarrhea; therefore, the child is given diluted milk. ▪ Sources of protein, such as eggs, curds, and meat are avoided because they might adversely affect the baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ The mother’s diet the first few days is restricted to liquids, rice, gruel, and bread. ▪ Boiled rice, eggplant, curry, and tamarind juice are added to the diet between 6 months and a year after the birth of the baby. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Death Rituals ▪ A tenet of Hinduism is that the soul survives the death; death is a rebirth. ▪ The death rite is called antyesti, or last rites. ▪ The priest pours water into the mouth of the deceased and blesses the body by tying a thread around the neck or wrist. ▪ The eldest son completes prayers for ancestral souls, but all male descendants perform the rites; each offers balls of rice on behalf of the deceased ancestor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Death Rituals ▪ The body is usually cremated rather than interred. ▪ The ashes are immersed or sprinkled in the holy rivers. Such immersions are of great benefit to the souls of the dead. ▪ Hindus may save their family’s ashes to later scatter them in holy rivers when they return to their homeland. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Death Rituals ▪ Women may respond to the death of a loved one with loud wailing, moaning, and beating their chests in front of the corpse, attesting their inability to bear the thought of being left behind to handle situations by themselves. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Spirituality ▪ Hinduism, the largest religion and oldest tradition practiced in India, represents a set of beliefs and a definite social organization. ▪ Hinduism denotes belief in the authority of Vedas and other sacred writings of the ancient sages, immortality of the soul and a future life, existence of a Supreme God, the theory of karma and rebirth, theory of the four stages of life, and the theory of four Purusarthas, or ends of human endeavor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Spirituality ▪ Orthodox Hindus view society as divinely ordained on the basis of the four castes: (a) Brahmin, the highest caste, priests and scholars, emerged from the head of God; (b) Kshtriya, warriors, from the arms; (c) Vaisya, merchants, from the waist; and (d) Sudra, menials, from the feet of God. ▪ Hindu legal codes are based on the caste system. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Spirituality ▪ Women often fast one day a week or for a lunar month to fulfill a vow made to a deity in supplication for a particular blessing. ▪ Wives frequently fast to secure the continued health of their husbands and families. ▪ Shrines may be set up in the living room, dining room, or in a back room or in a closet. ▪ The shrine typically contains representations or symbols of one or more deities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck The wife of Mr. Ganganna ask the nurse to arrange antyesti for her critically ill husband. The nurse recognizes that antyesti is a. Last rights. b. A Hindu religious leader. c. A traditional Hindu healer. d. A strength enhancing special drink. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A Antyesti is last rights among Hindus. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ Physical examinations are especially traumatic to women who may not have experienced or heard about Pap tests and mammography exams. ▪ Most individuals believe that illnesses attack an individual through the mind, body, and soul. ▪ Some believe that too much sexual activity and worry are associated with tuberculosis. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ Suffering of any kind produces hope, which is essential to life. ▪ To maintain harmony between self and the supernatural world, the belief that one can do little to restore health by oneself provides a basis for ceremonies and rituals. ▪ Worshiping goddesses, pilgrimages to holy places, and pouring water at the roots of sacred trees have medicinal effects in healing the sick person and in appeasing the planets to help prevent illnesses and misfortunes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ In Ayurveda, the traditional system of medicine in India, the primary emphasis is on the prevention of illnesses. Individuals have to be aware of their own health needs. ▪ One of the principles of Ayurveda includes the art of living and proper health care, advocating that one’s health is a personal responsibility. ▪ The key to health is an orderly daily life in which personal hygiene, diet, work, and sleep and rest patterns are regulated. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ A common health problem is self-medication. ▪ Those migrating to America are accustomed to self-medicating and may bring medications with them or obtain medications through relatives and friends. ▪ The traditional healers use Ayurvedic, Siddha, and Unani medical systems all of which are based on the Tridosha theory. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ The Ayurvedic system uses herbs and roots; the Siddha system, practiced mainly in the southern part of India, uses medicines; and the Unani system, similar to the Siddha, is practiced by Muslims. ▪ According to the Tridosha theory, the body is made up of modifications of the five elements: air, space, fire, water, and earth. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ Because of their religious beliefs of karma, Hindus may attempt to be stoic and may not exhibit symptoms of pain. ▪ Pain is attributed to God’s will, the wrath of God, or a punishment from God and is to be borne with courage. ▪ Family may not want to disclose the gravity of an illness to the patient or discuss impending disability or death for fear of the patient’s vulnerability and loss of hope, resulting in death. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practitioners ▪ The sick role is assumed without any feeling of guilt or ineptness in doing one’s tasks. ▪ The individual is cared for and relieved of responsibilities for that time. ▪ Psychological distress may be demonstrated through somatization, which is common, especially in women. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practices ▪ Because of the stigma attached to seeking professional psychiatric help, many do not access the health-care system for mental health problems. ▪ Mental illness is considered to be God’s will. ▪ No Hindu policy exists that prevents receiving blood or blood products. ▪ Donating and receiving organs are acceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practitioners ▪ Although Hindus in general have a favorable attitude toward American physicians and the quality of medical care received in the United States, relatives and friends are usually consulted before health-care professionals. ▪ Physicians are considered omnipotent because God grants cures through physicians. ▪ Clients tend to be subservient and may not openly question physicians’ behavior or treatment. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hindu Health-care Practitioners ▪ Physician is also viewed like an older person in the family; a protective, authoritative, and responsible relationship; and a parent-child relationship. ▪ Mental health traditional healers such as Vaids, practice an empirical system of indigenous medicine; mantarwadis cure through astrology and charms; and patris act as mediums for spirits and demons. ▪ Women are especially modest, generally seeking female health-care providers for gynecologic examinations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Overview/Heritage ▪ The Republic of Cuba is a multiracial society with people of primarily Spanish and African origins. ▪ Other ethnocultural groups include Chinese, Haitians, and Eastern Europeans. ▪ Spain, the United States, and the Soviet Union significantly influence Cuba’s history and culture. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Overview/Heritage ▪ Mistrust of government has reinforced a strong personalistic tradition and sense of national identity evolving from family and interpersonal relationships. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Overview/Heritage ▪ Desire for personal freedom, hope of refuge, political exile, and promise of economic opportunities prompted migration. ▪ Cubans in the United States take great pride in their heritage and tend to be conservative, Republican, and anticommunist. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Overview/Heritage ▪ Many possess a strong ethnic identity, speak Spanish, and adhere to traditional Cuban values and practices.. ▪ The highest concentration of Cubans is in Florida, although significant numbers live in New Jersey, New York, Illinois, and California. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Communication ▪ Many Cubans live and transact business in Spanish-speaking enclaves. ▪ While the second generation speaks Spanish, many converse with friends or peers in “Spanglish,” a mixture of Spanish and English. ▪ The highly educated are more likely to speak English at home. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Communication ▪ Many value simpatía and personalismo in their interactions with others. ▪ Simpatía, the need for smooth interpersonal relationships, is characterized by courtesy, respect, and the absence of criticism or confrontation. ▪ Personalismo, the importance of intimate interpersonal relationships, is valued over impersonal bureaucratic relationships. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Communication ▪ Choteo, a lighthearted attitude with teasing, bantering, and exaggerating is often observed in their communications with others. ▪ Conversations are characterized by animated facial expressions, direct eye contact, hand gestures, and gesticulations. ▪ Voices tend to be loud, and the rate of speech is fast. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Communication ▪ Touching, handshakes, and hugs are acceptable among family, friends, and acquaintances and may be used to express gratitude to the caregiver. ▪ Touch is common between people of the same gender; older men and women rarely touch in public. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Communication ▪ Most tend to emphasize current issues and problems rather than future ones. ▪ Hora cubana (Cuban time) refers to a flexible period that stretches 1 to 2 hours beyond designated clock time. ▪ Most Cubans use two surnames representing the mother and father’s family names. ▪ Married women may also add the husband’s name. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ Traditional family structure is patriarchal, characterized by a dominant and assertive male and a passive, dependent female. ▪ Traditionally, Cuban wives stay at home, manage the household, and care for children, whereas husbands are expected to work, provide financially, and make major decisions for the family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ Honor is attained by fulfilling family obligations and treating others with respeto (respect). ▪ Vergüenza, a consciousness of public opinion and the judgment of the entire community, is considered more important for women than for men. ▪ Machismo dictates that men display physical strength, bravery, and virility and be the spokesperson, even though they might not make the decisions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ La familia (the family, nuclear and extended, including godparents) is the most important source of emotional and physical support. ▪ Multigenerational (3 to 4 generations) households are common, including a high proportion of people 65 years and older who live with their relatives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ According to U.S. standards, Cuban parents tend to pamper and overprotect their children. ▪ Children are expected to study, respect their parents, and follow el buen camino (the straight and narrow). ▪ Boys are expected to learn a trade or prepare for work and to stay away from vices. ▪ Girls are expected “to remain honorable while single,” to prepare for marriage, to avoid the opposite sex, and not to go out without a chaperone. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ When a daughter reaches 15 years, a quinceaneras, or elaborate 15th birthday party, is typically held to celebrate this rite of passage for the daughter. ▪ Adolescents may undergo an identity crisis and reject their heritage causing parents to feel their authority is being challenged. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Family Roles and Organization ▪ Little information is available on homosexuality. ▪ Same-sex behaviors among men may be regarded as a sign of virility and power rather than homosexual behavior. ▪ The gay lifestyle is contradictory to the machismo orientation of this culture. Same-sex couples may be alienated from their families. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck A 22-year-old from Cuba comes to the prenatal clinic for the first time. She introduces herself as Elena Florencia Gonzalez Portillo. The receptionist should ask what a. Is your husband’s surname? b. Is your husband’s last name? c. Name do you wish to be called? d. What is your legal name? ▪ Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D The legal name is what should be used for recordkeeping. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Workforce Issues ▪ Cuban ethnic enclaves with a familiar language and culture have created numerous employment opportunities for recent Cuban immigrants. ▪ A source of tension is the tendency of Cubans to speak Spanish with other Cuban or Hispanic coworkers. Speaking the same language allows them to form a common bond, relieve anxieties at work, and feel comfortable with one another. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Workforce Issues ▪ Traditional Cubans recognize supervisors as authority figures and treat them with respect and deference. ▪ Cubans value a structure characterized by personalismo, one that is oriented around people rather than around concepts or ideas. ▪ Personal relationships at work are considered an extension of family relationships. ▪ Because of the emphasis on the job or task in the American workplace, many Cubans view this workplace as being too individualistic, businesslike, and detached. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Biocultural Ecology ▪ Most Cubans are white, and only 5 percent are black with physical features similar to those of African Americans. ▪ Cuban Americans tend to have lower incidences of diabetes mellitus, obesity, and hypertension than other Hispanic groups or whites. ▪ Because of their diet, which is high in sugar, many exhibit a high prevalence of tooth loss, filled teeth, gingival inflammations, and periodontitis. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Biocultural Ecology ▪ Commonly occurring health conditions of Cubans are hypertension, coronary artery disease, obesity, diabetes mellitus, and lung cancer. ▪ Specific information related to drug metabolism is limited; however, in general, many require lower doses of antidepressants and experience greater side effects than non-Hispanic white populations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American High-risk Health Behaviors ▪ Cuban Americans tend to exhibit a higher incidence of smoking than other Hispanic or European groups. ▪ Alcohol use is greater among males than females and among younger versus older groups. ▪ Violent deaths account for high mortality rates among adolescents and young adults. ▪ Suicide rates also exceed those of the white nonHispanic population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck ▪ The nurse is using an interpreter to interview the parents of a 6-year-old Cuban, Leonardo, who has stomach pain. The nurse should direct questions to ▪ A. The father. ▪ B. The mother. ▪ C. The interpreter. ▪ D. Both parents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: D The nurse should address the questions to both parents to demonstrate respect to both of them. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Nutrition ▪ Food allows families to reaffirm kinship ties, promotes a sense of community, and perpetuates customs and heritage. ▪ Staple foods include root crops like yams, yuca, malanga, and boniato; plantains; and grains. ▪ Many dishes are prepared with olive oil, garlic, tomato sauce, vinegar, wine, lime juice (sofrito), and spices. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Nutrition ▪ Meat is usually marinated in lemon, lime, sour orange, or grapefruit juice before cooking. ▪ A leisurely noon meal (almuerzo) and a late evening dinner (comida), sometimes as late as 10 or 11 PM, are often customary. ▪ Being overweight is seen as positive, healthy, and sexually attractive. ▪ Food allows families to reaffirm kinship ties, promotes a sense of community, and perpetuates customs and heritage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Pregnancy and Childbearing Practices ▪ Cuban women’s fertility rate is lower than that of other Hispanic American women. Cuba’s current reproductive rate is among the lowest in the developing world. ▪ Even before the revolution, Cuba had the lowest birthrate in Latin America. ▪ The low fertility rate has been attributed to many women in the workforce. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Pregnancy and Childbearing Practices ▪ Preterm births and neonatal and post-neonatal deaths are lower among Cuban American women than among other Hispanic American groups. ▪ Prenatal care is higher than among other Hispanic and white non-Hispanics. ▪ Mothers tend to use advice about child health given by their spouses, mothers, mothers-in-law, and clerks and pharmacists. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Pregnancy and Childbearing Practices ▪ Childbirth is a time for celebration with family members and friends congregating in the hospital. ▪ Traditionally, men have not attended the births of their children, but younger, more acculturated, fathers are frequently present. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Pregnancy and Childbearing Practices ▪ During the postpartum period, ambulation, exposure to cold, and bare feet place the mother at risk for infection. ▪ Family members and relatives often care for the mother and baby for about 4 weeks postpartum. ▪ Most women consider breast-feeding better than bottle feeding; approximately half choose to breast-feed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Pregnancy and Childbearing Practices ▪ Cutting the infant’s hair or nails in the first 3 months is believed to cause blindness and deafness. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Death Rituals ▪ In death, as in life, the support of the extended family network is paramount. ▪ Bereavement is expressed openly as loud crying with other physical manifestations of grief. ▪ Death is often seen as a part of life and some, especially men, may approach death stoically. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Death Rituals ▪ The dying person is typically attended by a large gathering of relatives and friends. ▪ In Catholic families, individual and group prayers are held for the dying to provide a peaceful passage to the hereafter. ▪ Religious artifacts such as rosary beads, crucifixes, or estampitas (little statues of saints) are placed in the dying person’s room. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Death Rituals ▪ For adherents of Santería, death rites may include animal sacrifice, chants, and ceremonial gestures. ▪ Candles are lighted after death to illuminate the path of the spirit to the afterlife. ▪ A velorio (wake) lasts 2 to 3 days and is usually held at a funeral parlor or in the home where friends and relatives gather to support the bereaved family. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Death Rituals ▪ Burial in a cemetery is common practice, although some may choose cremation. ▪ The deceased are customarily remembered and honored on their birthdays or death anniversaries by lighting candles, offering prayers or masses, bringing flowers to the grave, or gathering with family members at the grave site. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Spirituality ▪ Approximately 85 percent of Cuban Americans are Roman Catholic; the remaining 15 percent are Protestants, Jews, and believers in African Cuban Santería. ▪ Roman Catholicism is personalistic and characterized by devotion and intimate, confiding relationships with the Virgin Mary, Jesus, and the saints. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Spirituality ▪ Significant religious holidays include Noche Buena (Christmas Eve), Christmas, Los Tres Reyes Magos (Three Kings Day), and the festivals of the La Caridad del Cobre and Santa Barbara. ▪ Santería is a 300-year-old African Cuban religious system that combines Roman Catholic elements with ancient Yoruba tribal beliefs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Spirituality ▪ Followers of Santería believe in the magical and medicinal properties of flowers, herbs, weeds, twigs, and leaves. ▪ Sweet herbs such as manzanilla, verbena, and mejorana are used for attracting good luck, love, money, and prosperity. ▪ Bitter herbs such as apasote, zarzaparilla, and yerba bruja are used to banish evil and negative energies. Santería is viewed as a link to the past and is used to cope with physical and emotional problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Spirituality ▪ Physical complaints may be diagnosed and treated by a physician, whereas the santero may assist in balancing and neutralizing the various aspects of the illness. ▪ Deeply held religious beliefs provide guidance and strength during the long and difficult process of migration and adaptation and continue to play an important role in their day-to-day lives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Spirituality ▪ Belief in a higher power is evident in practices used to maintain health and well-being or cure illness, such as using magical herbs, special prayers or chants, ritual cleansing, and sacrificial offerings. ▪ Many tend to be fatalistic, believing that they lack control over circumstances influencing their lives. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Health-care Practices ▪ African Cubans may seek biomedical care for organic diseases but consult a santero for spiritual or emotional crises. ▪ Conditions such as decensos (fainting spells) or barrenillos (obsessions) may be treated solely by a santero or simultaneously with a physician. ▪ Many tend to seek help only in response to crisis situations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Health-care Practices ▪ Many Cuban Americans rely on the family as the primary source of health advice. ▪ Older women provide traditional home remedies such as herbal teas or mixtures to relieve mild or moderate symptoms or cure common ailments. ▪ Older Cuban Americans were socialized into a strong health ideology and successful primary care system while still in Cuba. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Health-care Practices ▪ Use of preventive services in the US is generally determined more by access to care than by acculturation. ▪ Many Cuban Americans use traditional medicinal plants in the form of teas, potions, salves, or poultices. In Cuban communities, stores called botanicas sell herbs, ointments, oils, powders, incenses, and religious figurines to relieve maladies, bring luck, drive away evil spirits, or break curses. ▪ Santería necklaces and animals used for ritual sacrifice are often available at botanicas. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Health-care Practices ▪ Blood transfusions and organ donations are usually acceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cuban American Health-care Practitioners ▪ Both traditional and biomedical care are acceptable. ▪ Folk remedies may be used at home, but if the condition persists, folk practitioners such as santeros and biomedical practitioners may be used either simultaneously or successively. ▪ Santeros may prescribe treatment or perform rituals to enable ill people to recover by invoking supernatural deities to intervene to help make them well. 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 1 Chapter 30 People of Greek Heritage Irena Papadopoulos and Larry D. Purnell We wish to acknowledge Maria Athanasopoulou’s contribution in obtaining data that helped to update this chapter. Overview, Inhabited Localities, and Topography Overview This chapter presents two groups of people with Greek heritage. The first group refers to those people or their ancestors who emigrated from Greece. The second group originated in Cyprus. Both groups share the same history and have a common language and religion. The Greek and Greek Cypriot diaspora is of considerable size and is spread to all continents and numerous countries. The largest Greek community outside Greece is in America; the largest Greek Cypriot community outside Greece is in Britain. Therefore, the main focus of this chapter is on the large Greek American community, with a secondary focus on the British Cypriot community. Although geographic location and social context are important, many of the issues and principles discussed in this chapter can be applied to the broader diaspora. When the term American is used in this chapter, it refers to residents of both Canada and the United States. Greece, a small country in southern Europe with a climate similar to that of southern California, covers slightly more than 50,000 square miles (131,940 sq km) and has a population of over 10.7 million (CIA World Factbook, 2011a). The capital, Athens, has a population of 3.252 million. The population is 93 percent Greek and the rest other. Greece does not collect data on ethnicity (CIA World Factbook, 2011a). The land is very mountainous with small patches of fertile land separated by hills, mountains, and a plethora of small and medium-sized islands. The main crops are wheat, grapes, olives, cotton, and tobacco. Geopolitical boundaries have shifted dramatically over time. Greeks struggled under 400 years of Turkish rule, which ended in 1829. At that time, the Peloponnese, central Greece, and some of the Aegean Islands were freed. Later, Thessaly, Macedonia, Crete, the Ionian Islands, Epirus, Thrace, and the Dodecanese were incorporated into Greece’s boundaries. Greece joined the European Union in 1981. Cyprus, located in the most eastern part of the Mediterranean Sea, is a small mountainous island with an area of 3572 square miles (9251 sq km). The capital is Nicosia with a population of 240,000 people. The total population of Cypriots is 1,240,000 million of whom 77 percent are Greek Cypriots, 18 percent are Turkish Cypriots, and 5 percent other (CIA World Factbook, 2011b). Since the entry of Cyprus into the European Union, a significant increase of economic migrants and asylum seekers has been recorded (Cyprus Statistical Services, 2011). Cyprus has a rich history and culture, the result of many influences over 9000 years. Mycenean and Achaean Greeks settled in Cyprus around the 14th century B.C. After the Trojan War, legendary Greek heroes visited the island, where they were associated with the founding of great cities such as Salamis, Kourion, and Paphos. The Achaean Greeks had a profound and lasting influence on the culture of Cyprus, introducing their language, religion, and customs. After the death of Christ, St. Paul traveled to Cyprus, where he was joined by St. Barnabas and St. Mark. The island was the first country to have a Christian ruler when Sergius Paulus was converted. The Greek Orthodox Church stems from Cyprus. Cyprus gained its independence from Britain in 1960; however, the Constitution of the Republic of Cyprus proved unworkable, making a smooth implementation impossible. Following episodes of ethnic conflict between Greek and Turkish Cypriots, Cyprus was divided in 1974 following the invasion of Turkey. Almost half the population was displaced, with Greek Cypriots settling in the south and west of the island and Turkish Cypriots settling in the north and east. The characteristics of members of the Greek and Greek Cypriot communities vary considerably according to the time of immigration (with earlier immigrants being predominantly younger, rural males), the characteristics of the site of immigration (rural, 1 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 2 2 Aggregate Data for Cultural-Specific Groups island, or urban), the variant cultural characteristics (refer to chapter 1 in this book ), and the number of generations since initial immigration. Despite considerable temporal and geographic variation, several core themes are common to people who retain affiliation with a Greek community—emphasis on family, honor, religion, education, and Greek heritage. The core values of philotimo (honor and respect) and endropi (shame) are key when considering the experience of Greeks and Greek Cypriots. Although values of honor and shame are found in all societies, these attain immense importance among Mediterranean groups. Although philotimo is a characteristic of one’s family, community, and nation, it most centrally implies concern for other human beings. Philotimo is a Greek’s sense of honor and worth, derived from one’s selfimage, reflected image (respect), and sense of pride. Philotimo is enhanced through courage, strength, fulfilling family obligations, competition with other people, hospitality, and right behavior. Shame results REFLECTIVE EXERCISE 30.1 Mr. Marios Stavrakis is a 49-year-old Greek who arrived in New York from Crete at the age of 21. After working very hard doing different jobs for a number of years he saved enough money with which he started a business with his best friend Mr. Soteris Ioannou, who is also his son’s godfather. As the business grew the partners spent less time with each other since each one had separate responsibilities within the company. About a year ago Mr. Stavrakis developed signs of depression. His wife noticed that he was worried about something, was frequently anxious, and at the same time appeared to have less energy and vitality than usual. When he started neglecting the business he so much loved and had worked so hard to make successful, his wife insisted that he see a doctor. Mr. Stavrakis was prescribed antidepressants but took the medication infrequently and then he stopped it all together. His condition deteriorated and he began to obsessively talk about philotimo. When he eventually saw a psychiatrist he explained that he discovered that his best friend and business partner was making deals behind his back and that he was embezzling money from the company. He had suspected this some time ago but did not want to report his best friend to the police while at the same time he could not deal with his anger and disappointment as he felt totally betrayed by a man whom he trusted. 1. How has the belief about the importance of philotimo influenced the behavior of Mr. Stavrakis? 2. Why was Mr. Stavrakis reluctant to report his friend to the police? What cultural values influenced his actions? 3. Why did he not seek medical help and why was he eventually persuaded by his wife to see a doctor? from any conduct that is considered deviant. The system of honor and shame in the Mediterranean countries derives from the complementary opposition of the sexes, the solidarity of the family, and the relationships of hostility and competition between unrelated or unconnected families. Heritage and Residence Today, Greeks in America are a composite of three immigrant groups: an older group who came before or just after World War I, a second group who arrived after the relaxation of immigration laws in the mid1960s and who constitute the main group in the Greek American community, and the American-born children and grandchildren of these immigrants. The earlier Greek immigrants congregated for the most part in the western states of Utah, Colorado, and Nevada, where they worked in mines and on railroad crews; in the New England states of New Hampshire, Massachusetts, and Connecticut, where they worked in shoe and textile factories; and in the large northern cities of Chicago, Detroit, Toledo, Milwaukee, Philadelphia, Buffalo, Cleveland, and New York, where they worked in factories or found jobs as shoe shiners or peddlers. The greatest proportion of Greeks in America continues to live in the Northeast and the Midwest. Most live in large urban areas such as New York and Chicago. Whereas new immigrants still tend to gravitate toward the established Greek communities in cities, many Greeks in America have relocated to the suburbs (Moskos, 1989). The Greek communities in the United States and Canada are the biggest Greek diasporic communities. It is estimated that there are 1.2 million people of Greek heritage living in the United States and around 350,000 in Canada (Kitroef, 2009). Reasons for Migration and Associated Economic Factors Significant Greek migration occurred during the late 19th and early 20th centuries. During this period, migration depleted the population of Greece by about one-fifth. Economic factors were largely responsible for this mass exodus. In the latter part of the 19th century, Greece suffered a major economic crisis resulting from a nearly complete failure of its major crop, currants; relatively heavy governmental taxation to sustain an army against hostilities with Turkey; and family pressure on fathers and brothers to supply a substantial dowry for unmarried women in the family. Before the 1880s, relatively few Greek immigrants entered the United States. It was not until the start of the 20th century that massive numbers of Greek immigrants came to America. Between 1900 and 1920, almost 350,000 Greeks came to America, 95 percent of them men (Scourby, 1984). They came with dreams of economic opportunity in 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 3 People of Greek Heritage America, hoping to make enough money to provide good dowries for their sisters and daughters and to be able to return to Greece with enough money to live comfortably in their villages. At the time, Greece was beleaguered by turbulent internal politics and was a difficult place for the average Greek peasant to earn a decent living. Most Greek migrants planned to stay in the United States for a short period of time, and one in four of them managed to achieve this. As the arrival of young Greek women—potential wives—post 1920s increased, a number of men decided to put more permanent roots in their host country. With growing communities, and the establishment of small family businesses, Greek migrants began to integrate into American society (Kitroef, 2009). Legislation passed in 1921 and 1924 transformed America’s open-door policy toward European immigrants into a closed-door policy greatly affecting the number of Greek immigrants who came into the country. While in 1921, 28,000 Greek immigrants came to America, the next year, the quota of Greeks allowed into the country was reduced to 100. This was raised to 307 in 1929, and remained at that level for three decades (Moskos, 1989). Greek immigrants who had cared little about becoming American citizens saw citizenship as the only chance to bring other family members to America or to be able to return to America after visiting Greece. In addition, because fewer people were emigrating from Greece, membership in the Greek American community consisted of increasing numbers of American-born Greeks. During most of the 1930s, the number of Greeks returning to Greece exceeded the number coming to America (Moskos, 1989). Despite the economic downturn in the United States, Greeks in America managed to invest a great deal of energy in their communities. Greek-language schools were started for their children, the Greek Orthodox Archdiocese centralized, and charitable organizations were established for the poor. When the Great Depression came, however, everyone in America was affected, including the Greek immigrants. Many businesses failed, jobs were lost, and fortunes disappeared. The Italian invasion of Greece in 1940 precipitated Greece’s entry into World War II and a great outpouring of support from the Greek American community for the home country. After America entered the war in 1941, the intermingling of Greek and American interests produced a combination of American patriotism with Greek ethnic pride, which underscored the great love that Greeks in America felt for both their home and their adopted countries. The immigration laws, however, kept the actual number of new Greek immigrants to a minimum until the 1950s (U.S. Immigration and Naturalization Service, 1993). 3 Although the quota system was maintained, special legislation in 1953 allowed those who had been displaced by the war and those who wished to reunite with their families to enter America. In addition, countries were allowed to “borrow” on quotas for future years. As a result, approximately 70,000 Greeks entered the United States between World War II and 1965. During this time, the immigration laws dating from the 1920s were liberalized. This large influx rejuvenated the Greek American community’s ties to Greece and changed the composition of the Greek community from Greeks with American citizenship to Americans of Greek descent. By this time, the third generation of Greek Americans was being born. The Immigration Act of 1965 lifted the earlier restrictive quotas, allowing more Greeks to immigrate to America. Whereas the U.S. Census 2000 reported that 1,153,307 people of Greek descent lived in America, in 2006, 12,723 Greeks emigrated to the United States (Statistical Yearbook, 2006). The decline in Greek immigration to the United States is attributed to several factors that are largely economic. Improvement of economic conditions in Greece has lessened the impetus to emigrate. Canada and Australia have more lenient visa requirements than the United States. Finally, with the entry of Greece into the European Union (EU) in 1981, Greeks were able to freely move within the EU, thus reducing the number of people emigrating to the United States to an estimated 2000 per year. Greece in the 21st century is changing from a country of outward emigration to one of inward immigration. Immigration for Greek Cypriots is a very old phenomenon (Panayides, 1988). This is exemplified by the figures from a survey published by the Ministry of Education in Cyprus and cited by the Cyprus High Commission in Britain (1986), which numbered the Cypriot population in London as 208 in 1911; 1059 in 1931; 10,208 in 1941; 41,898 in 1961; and 78,476 in 1964. The first major group of Greek Cypriots who emigrated to Britain arrived in the 1930s. Because Cyprus was a British colony, young men seeking employment made their way to Britain and primarily settled in the Camden Town and Soho areas of London but later spread to Islington, Hackney, and northward to Haringey. The second wave of emigration occurred in 1960 to 1961 when 25,000 Cypriots left for Britain when Cyprus became a republic. This number was reduced to less than 2000 a year after the Commonwealth Immigrants Act of 1962. The last wave of emigration occurred in 1974 following the troubles between the Turkish and the Greek Cypriots, when an estimated 50 percent of Cypriot people became refugees in their own country. By 1974, an estimated 120,000 Cypriots were in Britain, of whom five out of six were of Greek origin and the remainder of Turkish origin. 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 4 4 Aggregate Data for Cultural-Specific Groups In 1986, the Cyprus High Commission reported that some 200,000 Cypriot-born people and descendants of Cypriots (Greek and Turkish) were living in Britain. In 1996, the Greek Orthodox Archdiocese in Great Britain reported that London alone was home to more than 250,000 Greek and Greek Cypriot people. These figures were derived from church attendance, numbers of weddings, baptisms, and funerals performed, as well as by the number of children attending the church-run and independent Greek schools. In addition to the Londonbased Greek Cypriot population, large communities are found in many other British cities, particularly Birmingham, Bristol, Manchester, Great Yarmouth, and Glasgow. The Greek and Greek Cypriot communities in Great Britain continue to increase, and in 2011 they are estimated to be in excess of 300,000. Educational Status and Occupations Most early Greek and Greek Cypriot immigrants were poor men who had limited education. However, they had a very strong work ethic, determination, and ethnic pride. Their achievements are evident in the schooling patterns of Greek immigrants and fostered by the competitive dimension of the Greek character. Greek children are expected to succeed in school. This attitude is fostered by an achievement orientation, high educational and occupational aspirations, a cohesive family unit that exhorts children to succeed, nationalistic identification with the cultural glories of ancient Greece, and private schools that teach the Greek language and culture (Marjoribanks, 1994). Typically, this pattern of achievement continues into adulthood and is reflected in career success. Most third-generation Greeks in America have attended college. During the 1965 immigration, Greeks coming to America included educated professionals and students in professional fields such as engineering, medicine and surgery, and other academic areas (Moskos, 1989). A common theme (repeated so often it has become an archetype) is that of Greek parents who came from an impoverished land with no money or education. Lacking English language skills, most of these immigrants had no recourse except to accept low-paying jobs as peddlers pushing carts and shoe shiners. Greek and Greek Cypriot men disliked working for others and considered it a violation of pride (philotimo). They were industrious and frugal and eventually saved enough money to start their own businesses, such as restaurants and cigar and candy stores (Lovell-Troy, 1990). In Britain, a number of Greek Cypriots established small clothing factories, and some opened food shops specializing in foods imported from Cyprus. Greek and Greek Cypriot people take pride in controlling their own businesses and have done very well economically. Initially, they sought these opportunities to save money to return to their homeland, but the more successful they became, the more likely they were to remain in America and Britain. In America, Greek immigrants who earned only marginal wages were more likely to return to Greece. This description represents the typical pattern in the eastern and northern parts of America. In the west, men worked on railroads and in mines and exhibited greater rates of marriage outside the Greek community because of their smaller numbers in these more-remote communities. Often, once they had settled, worked hard, and acquired some capital, these Greeks too became entrepreneurs, opening shops and small businesses and eventually acquiring American citizenship. In the United States, Greek immigrants attained middle-class status more rapidly than most of their fellow immigrants. As America grew more affluent in the 1920s, so did the Greek immigrants. During the 1950s, even more Greeks in America ascended into the middle class. American-born Greeks held mostly white-collar jobs, and many Greek immigrants owned small businesses. Professions such as engineering, medicine, pharmacy, scientific research, and teaching are favored by Greek Americans (Kunkelman, 1990). Second and subsequent generations of Greeks and Greek Cypriots continue to establish their own or run family businesses (Kapa Research, 2007), although more of them are currently entering professions such as medicine, accounting, and law. Communication Dominant Languages and Dialects Although all Greeks, whether in Greece, Cyprus, or the diaspora, use the same form of written Greek, regional and country variations in spoken Greek do exist. Diasporic Greek communities regard the retention of the Greek language as an essential part of their Greek identity, so numerous efforts are continually being made to encourage second and subsequent generations to speak Greek. Papadopoulos and Papadopoulos (2000) surveyed young British-born Greeks and Greek Cypriots living in Britain to determine how they defined themselves in terms of ethnic identity. Of the 94 people who responded, 87 defined themselves as British Greek/Greek Cypriots or just Greek/Greek Cypriots. Forty-six reported that they spoke Greek fluently, 35 spoke enough to “get by,” and 10 spoke “basic” Greek. Only three respondents reported not being able to speak any Greek. The spread of the Greek language is achieved by attending Greek-language schools, using Greek in the home, and regularly visiting Greece or Cyprus. Robins and Askoy (2001) argued that people of second and subsequent generations of any migrant community who are able to speak their mother tongue are more successful as they achieve greater cultural mobility. Knowledge of both Greek and English (or any other 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 5 People of Greek Heritage language, depending on the country of residence) enables people of Greek heritage to move through the cultural spaces both of their ancestors and of their adopted country. This is a helpful and nourishing process for both the individual and the collective. Cultural Communication Patterns Because Greeks and Greek Cypriots value warmth, expressiveness, and spontaneity, northern Europeans are often viewed as “cold” and lacking compassion. Protection of family members and maintenance of family solidarity tend to be foremost among their values. As a consequence, they are often friendly but somewhat superficial and distant with those considered “outsiders.” Greek and Greek Cypriot people tend to be expressive in both speech and gestures. They embrace family, friends, and others to indicate solidarity. Eye contact is generally direct, and speaking and sitting distances are closer than those of other European Americans. They gesture frequently with their hands while talking. Whereas innermost feelings such as anxiety or depression are often shielded from outsiders, anger is expressed freely, sometimes to the discomfort of those from less-expressive groups. In health-care situations, patients often appear to be compliant in the presence of the health-care worker, but this may be only a superficial compliance, employed to ensure a smooth relationship. Greeks consider deeds to be much more important than what one says. Temporal Relationships Greeks and Greek Cypriots demonstrate a variety of temporal orientations. First, they are oriented to the past because they are highly conscious of the glories of ancient Greece. They are present oriented with regard to philotimo, family life, and situations involving family members. Finally, they tend to be future oriented with regard to educational and occupational achievements. Greek Americans differentiate between “Greek time,” which is used in family and social situations, and “American time,” which is used in business situations. Greek time emphasizes participating in activities until they reach a natural breaking point, whereas American time emphasizes punctuality. 5 such as Eleni (Helen) and Alexandros (Alexander). Ideally, first daughters are named for the mother’s mother, and first sons after the father’s father. Following tradition, middle names are the first name of the father; thus, all children of Stavros might carry his first name as their middle name. In health-care situations, it is not appropriate to call older women or men by their first names. The prefix “Kyria” (Mrs) or “Kyrie” (Mr) should be used with the first name, for example, Kyria Maria or Kyrie Alexandre; the preferred mode of address is to use their surname preceded by Mr., Mrs., or Miss. Family Roles and Organization Head of Household and Gender Roles The father is considered the head of the household in Greek and Greek Cypriot families. However, the complexity of household dynamics is noted in the wellknown folk phrase “the man is the head, but the wife is the neck that decides which way the head will turn.” This saying acknowledges the primacy of fathers in the public sphere and the strong influence of women in the private sphere. In recent years, increased recognition of a trend toward more equality in decision making has occurred. Most important, however, in consideration of gender roles are the complementary values of honor (philotimo) and shame (endropi). These core values tend to set the pattern for the family and for the enactment of gender roles. Although the educational levels of women have often matched those of their brothers in the past, women usually did not work outside the home, particularly after they married. A woman may, however, have worked in her husband’s store or restaurant. Women of later generations who obtained professional degrees tended to work after their children were in school. The roles of husband and wife are characterized by mutual respect (a partnership). However, their relationship is less significant than that of the family as a unit. Fathers are responsible for providing for the family, whereas women are responsible for management of the home and children. Traditionally, the cleanliness and order of the home reflect the moral character of the woman. Format for Names Prescriptive, Restrictive, and Taboo Behaviors for Children and Adolescents It is customary for honorific titles to be given to members of the community who are older people or otherwise respected. Terms such as Thia (aunt), Kyria (Mrs.), or Giagia (grandma) may be used. For Greeks and Greek Cypriots everywhere, having a Greek name is an important sign of their heritage. First names come either from the Bible, such as Maria and Petros (Peter), or from ancient Greek mythology and history, Children are included in most family social activities and tend not to be left with babysitters. The child is the recipient of intense affection, helpful interventions, and strong admiration. The child may be disciplined through teasing, which is believed to “toughen” children and make them highly conscious of public opinion. The family environment has been identified as strongly pressuring for dependence and achievement. 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 6 6 Aggregate Data for Cultural-Specific Groups REFLECTIVE EXERCISE 30.2 Mr. Andreas Georgiou was born in the United States in 1955. His parents had left Greece in 1952 to join his father’s brother, who had migrated a few years earlier. They both worked in his uncle’s small restaurant until they were able to open their own in partnership with his uncle. Andreas has two younger sisters. His parents spent whatever little time they had helping at the local Greek Orthodox Church and insisted that he and his sisters attend the Saturday Greek school. Andreas remembers his father saying, “We must never forget where we come from.” He also remembers how protective his parents were, particularly toward his sisters who, in his view, did not have the freedoms he had. “My parents always said that young women with sexual freedom have bad reputations and decent men do not want to marry them.” Both his sisters did well at school and were able to find good jobs and good husbands. He studied art at the university and has his own printing business. Ten years ago, Andreas suffered from depression. “This started when I found out that my second child was severely disabled. I could not cope with it. We consulted numerous specialists searching for a cure. We prayed and prayed. At first, I could not speak about my son to anyone other than my closest family. I never shared my emotional turmoil with my work colleagues, and this was a major stress for me. When I eventually had to share my ‘secret,’ they were all very understanding.” Today, Andreas was visiting his therapist for the last time. The therapist had helped him work through his self-blame, anxiety, and sadness. He has come to love his son for who he is. 1. What cultural values drove Andreas’ parents after their migration to the United States? 2. Why were his parents so protective toward their daughters? 3. What cultural values might have led Andreas to feel so devastated that he tried to hide his son’s disabilities? The family goals of achievement are directed toward and internalized by the children. Greek American and British Greek Cypriot families stay intact longer than other American or British families because adolescents, particularly young women, tend to reside with their parents until they get married. Formerly, men did not marry until their sisters’ prika (dowry) was established and they had married. Among first-generation immigrants, single men often returned to Greece or Cyprus for a bride. A proxenistra (matchmaker) and the families, pending the approval of the young person involved, usually arranged these marriages. Today, spouse selection is left to the young person, with parental approval. Girls have considerably less freedom than their brothers in dating, and it is common for them to be prohibited from dating until they are in the upper grades in high school. Adolescents in more-traditional families may experience stress as the differences in family and peer values precipitate family conflict. In fact, suppression of personal freedom by parents is a major risk factor for suicidal attempts among Greek and Greek Cypriot adolescent girls (Beratis, 1990). Additional areas of high stress for Greek adolescents include extreme dependence on the family, intense pressure for school achievement, and a lack of sexual education in the home. Family Goals and Priorities Greek and Greek Cypriot families tend to be very close. Within the family, members are expected to express unlimited respect, concern, and loyalty. Sym-betheri (in-laws) are considered first-degree relatives. Family solidarity is the context in which the values of honor and shame are measured. Prestige is connected to the idea that honor is not individualistic but collective. Because a person loses honor if kin act improperly, the honor of each family member is a matter of concern for all family members. Older people hold positions of respect within the Greek and Greek Cypriot communities. Their stories, whether as pioneers, veterans, or hard-working businessmen, are well known throughout the community. Their notable deeds are heralded and documented in community histories, which are usually maintained by the Greek Orthodox churches in each local community. Treatment of the giagia (grandmother) and the pappou (grandfather) reflects the themes of closeness and respect emphasized in the family. Grandparents tend to participate fully in family activities. Families feel responsible for caring for their parents in old age, and children are expected to take in widowed parents. Failure to do so results in a sense of dishonor for the son and guilt for the daughter. If the older person is ill, living with the family is the first preference, followed by residential-care facilities. Although living alone is often the least-preferred residential pattern, many older people are choosing to live alone in their own home, supported by family, friends, and healthcare providers. Older Greek and Greek Cypriot widows and widowers, particularly those who speak little or no English, may experience social isolation if they do not have close contact with their children. An important role is that of fictive kin, termed koumbari (coparents), who serve as sponsors in either (or both) of two religious ceremonies: baptism and marriage. Ideally, the baptismal sponsor also serves as the sponsor of the child’s marriage. The relationship of sponsor is so important that families who are joined by this bond of fictive kinship are prohibited from intermarrying, although this is not always adhered to nowadays. The basis of social status and prestige is family philotimo and cohesiveness. However, social status is also 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 7 People of Greek Heritage received from attributes such as wealth, educational achievement, and achievements of its members. Honor is the social worth of the family as judged by the community. A family’s status and integrity are validated when they support one another during times of misfortune such as poverty or dishonor. Alternative Lifestyles Greek and Greek Cypriot communities tend to be relatively conservative. As a consequence, alternative lifestyles encompassing premarital sex, same-sex relationships, and to a lesser extent divorce, are considered sources of concern for family members and the community. A number of religious and community support organizations in the United States and elsewhere provide support (See Resources on DavisPlus). No specific information or resources specific to Greek gay, lesbian, and transgendered people in the United States could be located. The only resources in Greece and Cyprus were travel sites that provided little information on cultural beliefs and values. Workforce Issues Culture in the Workplace In the United States, the high achievement orientation and work ethic have resulted in Greeks serving as a “model” ethnic group. However, more-recent immigrants with little education have not been as upwardly mobile. Workforce issues in which the interplay between gender and poverty are at work have been well described. Although incidents of discrimination and segregation, including acts of physical violence and murder directed at Greek immigrants, were common early in the 20th century, less discrimination occurs in the workplace today. The Greeks’ and Greek Cypriots’ rapid, selective acculturation has been addressed in earlier sections on migration, occupation, and education. Issues Related to Autonomy Probably no single characteristic applies so completely to members of the Greek and Greek Cypriot communities as the emphasis on self-reliance within a family context. Greeks and Greek Cypriots in North America, Britain, Australia, and Sweden stress this trait. It is seen as reluctance to be told what to do and is given as a major reason for their pattern of establishing their own businesses as soon as possible. Biocultural Ecology Skin Color and Other Biological Variations Greeks and Greek Cypriots are most commonly of medium stature, shorter than northern Europeans but taller than other populations of southern Europe. Although some Greeks are blue eyed and blond, usually 7 those from the northern provinces of Greece, most Greeks have dark hair and dark skin. Diseases and Health Conditions Current causes of death among Greeks and Greek Cypriots are those of developed countries and include cancer and cardiovascular and cerebrovascular diseases (World Health Organization, 1994). Since the early 1970s, an increase in diabetes and heart disease has occurred in both Greece and Cyprus. Tokas (1995) reported that in Cyprus, 2000 people die each year from heart disease, whereas each year 600 Greek Cypriots are sent abroad for cardiac surgery. In a study of the health needs of Greek Cypriots living in London, Papadopoulos (1998) found that 96 percent of the respondents ate red meat; of these, 35 percent did so on most days of the week. Nearly 50 percent of the women and 36 percent of the men in the study were overweight. Allender and colleagues (2008) reported that cardiovascular diseases continue to be the main reason for deaths in Greece and Cyprus and that this is due to bad dietary habits, smoking, and lack of exercise. In Cyprus 37 percent of the deaths in men and 40 percent of those in women are due to cardiovascular conditions. In Greece the corresponding figures are 45 percent and 52.2 percent (Allender et al., 2008). Two important genetic conditions, thalassemia and glucose-6-phosphate dehydrogenase (G-6-PD), are seen in relatively high proportions among Greek populations. They likely result from the selective advantage against malaria that these diseases confer on hemizygotic carriers. In the red blood cell, G-6-PD is a key enzyme in the hexose monophosphate shunt, which prevents oxidation of hemoglobin to methemoglobin. This pathway is essential to maintaining the integrity of the red blood cell and to preventing hemolysis. G-6-PD is important in the metabolism of glutation, an antioxidant agent. G-6-PD deficiency leads to hemolysis, which is generally well tolerated except under specific circumstances, including exercise, infections, and the presence of oxidant drugs. The genetic locus for the deficiency is on the X chromosome, making it more common among males than females. The possibility of G-6-PD deficiency should be considered in Greek patients with unconjugated jaundice (Todd, Samaratunga, & Pembroke, 1994). Thalassemia is an inherited genetic disorder manifested by a slow production of or failure to synthesize hemoglobin A or B chains. Two main types are commonly known: thalassemia major (sometimes known as Cooley’s anemia, homozygous, or beta thalassemia major) and thalassemia minor (referred to as thalassemia trait, or beta thalassemia minor). Thalassemia major is a serious condition that, if untreated, will result in death owing to very low levels of hemoglobin and the fragility of the abnormal red blood cells. 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 8 8 Aggregate Data for Cultural-Specific Groups Undiagnosed infants become pale and irritable, do not eat, suffer from recurrent fever, and fail to thrive. Eventually, the liver, spleen, and heart are damaged as a result of the accumulation of iron contained in the red blood cells. However, if the child is correctly diagnosed, treatment with regular blood transfusions (usually monthly) and prevention of iron overload with deferoxamine (Desferal) will provide an average life expectancy. Various other treatments such as bone marrow transplants have recently become available. Conversely, most individuals with thalassemia minor are not aware of it unless they are tested for it. The UK Thalassemia Society reports that 1 in 7 Cypriots (including Turkish Cypriots) and 1 in 12 Greeks are thalassemia carriers (Todd et al., 1994). In recent years, prenatal screening programs in Greece and Cyprus, as well as other countries such as Britain, America, Canada, and Australia, where most of the diaspora resides, have drastically reduced the number of babies being born with thalassemia major. Most Greek and Greek Cypriot women choose to have an abortion if they are found to carry an affected fetus. Variations in Drug Metabolism G-6-PD deficiency can result in a life-threatening hemolytic crisis after oxidating drugs (including primaquine, quinidine, thiazolsulfone, dapsone, furzolidone, nitrofural, naphthalene, toluidine blue, phenylhydrazine, and chloramphenicol) are taken. Even common medications such as aspirin can induce a hemolytic crisis. This threat is sufficiently severe that the World Health Organization (WHO) recommends that all hospital populations in areas with high proportions of Greeks and Greek Cypriots be screened for G-6-PD deficiency before drug therapy is instituted (Todd et al., 1994). High-Risk Behaviors Greeks in Greece, the United States, Canada, and Australia demonstrate lower rates of nontherapeutic drug use, alcoholism, and high-risk sexual behaviors than other groups in European or North American countries (Rosenthal, Moore, & Buzwell, 1994). These patterns are not due to an emphasis on health promotion, but rather to a hyperawareness of the social consequences of these behaviors for the family. For example, alcohol is most often considered a food item and is consumed with meals. However, losing control by being “under the influence” engenders considerable gossip and social disgrace, focused not only on the individual but also on the family (Tripp-Reimer & Sorofman, 1994). Concern for the reputation and standing of the family is a prime deterrent to many high-risk behaviors. Conversely, high-risk behaviors such as obesity among both sexes and smoking among men are higher among Greeks (Wilson, Bakiaris, Gleeson, Papasavva, Wise, & Hawe, 1993). Despite the concern for the family reputation, many of the Greek Cypriots who took part in Papadopoulos’ (1999) study described themselves as “risk takers” or “living dangerously.” This may be due to a mixture of cultural and religious beliefs and the experiences of migration. The narratives of first-generation migrants describe the risks they had to take to survive in a foreign and often hostile land. Whereas a high level of risk taking appeared to be part of survival, it was perpetuated by the belief that “God will look after me”—that God will prevent anything untoward happening, but if anything should happen, God will heal and sustain the person. Knowing these behavioral characteristics can assist health-care providers in planning culturally sensitive interventions. REFLECTIVE EXERCISE 30.3 Mr. and Mrs. Christou have a 17-year-old daughter, Helen, and a 15-year-old son, George. Mr. Christou is a second-generation British-born Greek Cypriot, while Mrs. Christou moved to England from Cyprus at the age of 18. Both children are attending the same school that is located in a predominantly middle-class area of London. The couple and the children’s grandparents, who also live in London, are very proud of the children. Helen and George are given a generous allowance each week, but lately George has been borrowing money from his sister. At first she did not mind, but when this became more frequent she began to wonder what George did with the extra money. She also saw him asking his grandmother for money. George frequently told his parents that he was going to the snooker club with his friends after school and on Saturdays. One day, while waiting to catch the bus home after school, she saw George with a group of boys smoking behind the bus shelter. That evening she confronted her brother who admitted that he occasionally used cannabis. She told him that unless he gives this up within 2 weeks she will tell their parents. He promised to do so, but after 2 weeks he was still using cannabis. Helen informed their parents. Their first reaction was one of surprise; they could not believe that their “perfect and clever” son whom they brought up to know right from wrong, whom they trusted and had a loving relationship with, could get into “bad company” and take drugs. Following their disbelief, they had a very angry argument with their son who told them that he realized how hurt they would be if they found out. The parents told him that although they were concerned about his health they were also concerned about the effect that his behavior might have on family and friends if they found out about his drug taking. When the parents calmed down, they told George that they still loved him and that they would do whatever they could to help him stop using cannabis. They also told him and Helen that this incident must stay within their home and they should not discuss this with anyone else. 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 9 People of Greek Heritage 1. What cultural value is guiding and influencing the parents’ decision to keep their son’s problem within the confines of the nuclear family and not seek help from their extended family and friends? 2. What cultural values underpin the parent’s decision to support their son even though they are angry with him? 3. Should the grandmother be informed of the situation and told not to give George any money? 4. At this time with the conflict, would you recommend professional counseling? 9 from fasting. Some first-generation Greeks and Greek Cypriots observe the three major fasting periods, including The Great Fast, Lent, for 7 weeks before Easter The Assumption fast, from August 1 to August 14 The Christmas fast, 40 days before Christmas Many second and subsequent generations of Greeks and Greek Cypriots usually fast only the last week before Easter, when most will also take Holy Communion. Common Foods and Food Rituals Health-Care Practices Greeks and Greek Cypriots have tended to disregard standard health-promotion behaviors. Safety measures for adults, such as seat belts and helmets, are often viewed as infringements on personal freedom and are frequently ignored, particularly by the older generation. The first most common cause of deaths in Greece and the second in Cyprus for those aged 15 to 44 are road traffic accidents. However, relevant legislation and severe penalties are having a positive effect, and a reduction in these deaths was recently recorded (Kouta, Papadopoulos, & Sourtzi, 2010). However, the gap between health-related knowledge and appropriate health action remains. Papadopoulos et al. (1998) found that Greek Cypriot people had a good knowledge of health-promotion practices. However, good knowledge did not correlate with positive health behaviors. For example, people who know what a balanced diet is often do not eat a balanced diet. Worryingly, the new generations of Greek and Greek Cypriots, while not abandoning the traditional Mediterranian diet that is characterized by low levels of meat and fat intakes and high levels of fresh fruit and vegetables, are regularly consuming fast foods, a phenomenon that is now global. Encouragingly, Papadopoulos (1999) found that the use of screening for problems such as blood pressure, cervical cytology, and breast cancer was high. Nutrition Meaning of Food Greeks describe their culture as an “eating culture.” By this they mean that food is a centerpiece of everyday life as well as of social and ritual events. Greek hospitality nearly always includes a ritual of food and drink. Fasting is an integral part of the Greek Orthodox religion. General fast days are Wednesdays and Fridays; nowadays, these are observed only by some older people. During fasts, it is forbidden to eat meat, fish, and animal products such as eggs, cheese, and milk. Greek Orthodox wishing to take Holy Communion will observe at least 3 days of fasting. However, people with health conditions and small children are exempt Greeks and Greek Cypriots have based their diet on cereals, pulses (such as lentils, peas, and beans), vegetables, fruits, olive oil, cheese, milk, and some fish and meat. They are also relatively high consumers of sweets and snacks. In both Greece and Cyprus, consumption of pulses has decreased, and consumption of meats has increased. The consequences of this trend are not yet fully known. For adults, dairy products are consumed in the form of yogurt or cheeses such as feta, kopanisti, kefaloteri, kasseri, and halloumi. Fats are consumed in the form of olive oil, butter, and olives. Meats include chicken, lamb, pork, and beef. Eggs, lentils, fish such as shrimp and other shellfish, and white fish are additional sources of protein. Vegetables such as potatoes, eggplant, courgettes (zucchini), spinach, garlic, onions, peas, artichokes, cucumbers, asparagus, cabbage, and cauliflower are common Greek food choices. Bread choices include pita, crescent rolls, and egg breads. Other foods include rice, tabouli, macaroni, and cracked wheat (bourgouri). Papadopoulos et al. (1998) found that the level of vegetable consumption of Greek Cypriots was almost twice that of their meat and poultry consumption. Common seasonings used by Greeks are aniseed, basil, lemon, mint, cumin, cinnamon, citron, cloves, coriander, dill, fennel, ginger, garlic, marjoram, mustard, REFLECTIVE EXERCISE 30.4 Mrs. Glitnatsis, age 82, has diabetes mellitus and takes insulin. She is quite underweight and does not follow her recommended diet because she is Orthodox and follows the fasting schedule of the Orthodox Church. During fasting, she does not take her insulin. She is currently seeing the diabetic nurse specialist because of her uncontrolled diabetes. 1. What are the required fast days for the Orthodox Greek religion? 2. What foods are forbidden to eat during fast days? 3. If Mrs. Glitnatsis insists on fasting, what is your recommendation for food intake and insulin administration? 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 10 10 Aggregate Data for Cultural-Specific Groups nutmeg, oregano, parsley, rosemary, sage, sesame, thyme, vinegar, bay leaf, and honey. Fruit preferences include grapes and currants, figs, prunes, oranges, lemons, melons, watermelons, peaches, and apricots. Beverages such as coffee, tea, chocolate milk, and wine are common choices. Common food items are listed in Table 30-1. Specific foods are linked with holidays or ceremonies throughout the year. For example, several different special breads, pastries, and cakes are served at traditional ceremonies: New Year’s bread, vasilopita; Easter pastries, tsoureki and flaouna; Christmas bread, chistosomo; prosfora, a traditional bread for funerals and remembrance ceremonies, which is served with koliva, a ❙❙◗ Table 30-1 Common Greek Foods Name Avgholemono Description Soup Hummus Thick sauce for dipping bread Maroulousalata Salad Tsatziki Dip Spanakopita Cheese tarts Dolmathes Stuffed grape leaves Meatballs Keftedes Souvlaki Moussaka Pastichio Psiti kota Loukomades Kourambiethes Baklava Greek coffee Ingredients Chicken stock, eggs, lemon, rice Chick peas (mashed), tahini sauce (sesame and olive oil), garlic, lemon Lettuce, onions, cucumbers, radishes, parsley, tomatoes, feta cheese, olives, olive oil Cucumbers, yogurt, vinegar, mint, garlic, salt Spinach and feta cheese in phyllo dough pastry Meat, rice, grape leaves Ground beef/pork, grated potatoes, onions, bread, parsley, oregano, eggs, garlic Meat Marinated pork or lamb on skewer Casserole Eggplant, potatoes, ground lamb, onions, tomato, garlic, parsley, white sauce Casserole Ground beef, macaroni, cinnamon, white sauce, cheese, parsley, tomato sauce, butter Lemon chicken Chicken, lemon, oil Pastry Flour, water, honey, oil, sugar, cinnamon Wedding cookie Flour, almonds, cloves, powdered sugar, egg, brandy Sweet dessert Phyllo dough, pistachio nuts, honey, sugar, cinnamon, cloves, butter Coffee Ground coffee, sugar mixture of boiled wheat, almonds, pomegranate seeds, sesame seeds, and raisins; and traditional, small, individual wedding cakes called kourapiedes. Dietary Practices for Health Promotion Although no specific classification exists of foods for health or illness, a general consensus is that people will naturally choose foods that are healthy. Therefore, an effort is made to provide ill people with the food they request. This pattern is most pronounced for pregnant women. In fact, numerous folk prescriptions exist regarding the provision of food for pregnant women, even if they are not close family or friends. Nutritional Deficiencies and Food Limitations Although nutritional deficiencies per se are rare among Greeks and Greek Cypriots, two important enzymatic conditions merit attention. First, for people with G-6-PD deficiency, broad beans (fava beans) can induce hemolysis and an acute anemic crisis (Riepl, Schreiner, Muller, Hildemann, & Loeschke, 1993). Second, the prevalence of lactose maldigestion in Greek adults is about 75 percent; however, milk intolerance is rarely seen in children (Ladas & Katsiyiannaki-Latoufi, 1991). Health-care providers should use this knowledge when counseling patients with these conditions. Virtually all food items used in the traditional Greek diet are available in the United States, Britain, Australia, and Canada. Even specialty items such as phyllo dough for pastries and appetizers, grape leaves in brine, and olives can be found in specialty areas of major supermarkets. A trend has moved away from lamb to beef for many dishes among the U.S. population. The popularity of Greek food is evidenced by the success of Greek restaurants wherever there is a Greek community. Pregnancy and Childbearing Practices Fertility Practices and Views Toward Pregnancy The trend for smaller families in Greece has been noted at least since the turn of the 21st century, whereas in Cyprus, this is a more recent phenomenon. In large part, this decreased fertility has resulted from the desire of parents to provide adequately for their children and to have them educated so they can achieve professional status. In North America, family size has been deliberately limited in order to adequately care for and educate children. In Britain, early immigrants had small families primarily because of housing problems. Many families lived in very cramped conditions, and many landlords did not rent to those with children. The method of limiting pregnancies has changed from control of gestation to control of conception. In 2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 11 People of Greek Heritage North America, a wide variety of birth control measures, such as intrauterine devices, birth control pills, and condoms, are preferred. The strong pro-life Greek Orthodox Church condemns birth control, while at the same time silently accepting the reality. However, abortion is absolutely condemned as an act of murder except in certain circumstances such as when the life of the mother is in grave danger or a young woman becomes pregnant as a result of rape. In practice, a number of women, particularly those who are unmarried, have legal abortions because of the negative consequences of having a baby out of wedlock. Inflicting endropi on the family is believed to be more severe than the consequences of abortion. Although adoption is rare among Greeks and Gre…
Purchase answer to see full attachment