Empacho, or blocked intestine, is believed to develop after eating when foods stick to the walls of the intestines, causing obstruction. The cause is usually a dietary indiscretion, such as eating improperly cooked foods or fatty foods, eating too fast or too slow, smoking, alcohol, or taking antibiotics or pain killers. However, it may also be attributed to changes in formula or swallowing too much saliva during teething, Symptoms include abdominal pain, vomiting, diarrhea, indigestion, dryness of the tongue and constipation. There are a variety of treatments. However, the most common is massaging the stomach or back with oils. The goal is usually to dislodge the offending agent from the intestines. Unfortunately, one form of treatment for empacho is to administer substances containing lead, such as greta and azarcon; both are readily available at botanicas or drug stores in border Mexican cities and can ultimately lead to lead toxicity. (See table of lead-containing substances at end of text.) Empacho can be avoided by avoiding foods that can cause heartburn such as chocolate, onions, tomatoes, and carbonated drinks or by going to bed at least 2 hours after eating.

Mal de ojo, or evil eye, is one of the oldest and most popular cultural beliefs. It is the belief that through a simple look, a person could cause another to get sick. It could be someone that loves you too much and wishes to protect you all the time or someone that envies you. It can be done by a relative or a complete stranger and is usually not on purpose. Hispanic families believe that strong eyes heat up the child's blood, leading to inconsolable crying, fever, diarrhea, vomiting, and gassiness. They often turn to curanderos, or "folk healers," to cure mal de ojo. Having the child wear an azabache, or seed-like charm, on a necklace or bracelet is believed to protect against this belief. The most commonly used treatment for mal de ojo entails "sweeping" the child's body with an egg. The egg is later broken into a glass of water and placed under the head of the child's bed overnight. If the egg appears solidified and milky white in the morning, the child is thought to have had mal de ojo. In some Latin cultures, the mere wishing that a child be well by saying “May God bless you,” may avoid any evil eye transfer that may have occurred.

Mollera caida, or fallen fontanelle, is believed to be caused by pulling a baby away from the breast or bottle too quickly. It is also believed to be caused by having the baby fall to the ground or by carrying the baby incorrectly. The soft palate is thought to sink in, leading to difficulty feeding and swallowing, as well as fussiness, fever, dehydration and diarrhea. Children with Caida de la Mollera are thought to be neglected children, and there is a high degree of maternal guilt (which may not be recognized by the health care professional.) Therapy is aimed at "realigning" the fontanelle, for example, by sucking on the fontanelle or pushing up against the soft palate. The most dangerous remedy for mollera caida involves hanging the infant over a basin of hot water and tapping the feet. Because of these remedies, this is the most challenging and potentially fatal pediatric folk illness. Susto, or fright, is a belief that through a frightening experience, a person (mostly women) can become ill. If a person goes through an emotion too sudden or too strong, her soul will leave her body, because the body is unable to equilibrate on it’s own. A susto can be an accident, the witnessing of a relative’s death, or a fall. Symptoms include insomnia, anorexia, nightmares, depression, fevers, and diarrhea. Treatment includes herbal teas (orange blossom), or a variety of rituals such as applying holy oil and water to the forehead and performing prayers to rid the child's body of the so-called fright.

Mal puesto is when someone uses witchcraft to place bad wishes on a person, resulting in an illness. The hex can be placed by a bruja (witch) or someone who knows about witchcraft. Symptoms can vary and the cure involves prayers, massages, herbs, making crosses on the arms with olive oil and chili powder, and medicinal enemas.

It is important to remember that with diseases caused by supernatural forces, non-supernatural cures are not believed to be helpful and often have poor compliance. Therefore, it is important to point out the natural cause of the disease and why the prescribed treatment will be beneficial.

Below are some common problems and their traditional remedies:

• Fever

• Cough

• Diarrhea

• Vomiting

It is important to understand the role of folk practitioners when interacting with Hispanic patients. Patients often share in the philosophies of the folk practitioners and share a common language. In addition, folk practitioners are validated by family and faith. Patients sometimes go to medical practitioners for relief of symptoms while simultaneously using a folk therapist to eliminate the cause of the illness. However, parents are skeptical to admit the use of any home remedies to a professional provider.

Cultural Competency Course 2004
 

Learning Module text written by Eyal Ben-Isaac

Sources:

1. Tylor 1924 [orig. 1871]

2. The culturally competent pediatrician: Respecting ethnicity in your practice. Lori Taylor, MD, and Lindia J. Willies-Jacobo, MD. Contemporary Pediatrics, June 2003

3. Mexican Cultural profile. Ethnomed, Ethnic medicine information from Harborview

4. Culture Clues: Communicating with your African American Patient. University of Washington Medical Center, Patient and Family Education Services. 2001

5. Los Angeles County Census 2000

6. Culture and Nursing Care, A Pocket Guide. Juliene G. Lipson, Suzanne L. Dibble, and Pamela A. Minarik. School of Nursing, UCSF. University of California, San Francisco, Press.

7. Rosa Linda Guadarrama, M.S., M.B.A.