1 Folk Medicine Spanish 1130

2 Objectives 1. Understand the origins and applications of Hispanic folk medicine 2. Identify common Hispanic folk illnesses and their remedies 3. Incorporate the knowledge of Hispanic folk medicine beliefs into the development of effective patient management and counseling plans

3 We all use it... While stereotypical folk medicine is often thought to be used by only poor and/or unacculturated people, the truth is that all of us have used some form of folk medicine in the guise of home remedies. People use folk or home remedies for several reasons: treatment of minor illnesses, the retention of a locus of self control and if accessibility to medical care is limited. Treatment may be given in one's own home, one of a relative, or it could be at a curandero's (or lay healer's) home. List at least one personal health beliefs that derives from your family upbringing and the interventions practiced by your mother or other care giver when you were ill.

4 Classifying diseases All cultures have systems for classifying diseases on the basis of etiology, signs/symptoms and treatments. Many cultures-modern and ancient, have felt that when one's system is out of balance, one will become ill. Physicians have often seen patients who, when they feel well, believe they are well, leading to a denial of or delay in diagnosis and treatment of early stages of diseases such as diabetes mellitus, hypertension, and tuberculosis. The concept of disease prevention is completely alien in this belief context.

5 Origins of Hispanic Folk Medicine People tend to look for reasons why they become ill. From the ancient Greeks came the concept that disease occurs when there is an imbalance of the four humors, or, what has survived into Hispanic folk medicine today, that disease is caused by an imbalance between hot and cold principles. For health maintenance, avoidance of exposure to extreme temperatures is important. Vasoconstriction and a low metabolic rate signify one has a "cold" disease while "hot" conditions are characterized by vasodilation and a high metabolic rate.

6 Examples Examples of "hot" diseases or states are pregnancy, hypertension, diabetes, acid indigestion, susto, ojo and bílis. Some "cold" disease examples are menstrual cramps, frío de la matriz, coryza, pneumonia, empacho, and colic. Most people do not think about hot and cold principles unless they have been stressed by illness or are in another vulnerable state. The goal of treatment is to restore harmony and balance. Thus, "hot" diseases are treated with "cold" remedies, and "cold" diseases are treated with "hot" remedies.

7 Lay Healers Among Hispanics Studies have shown that 90% of folk medicine adherents do not use the services of a curandero, or lay healer, but obtain their remedies from a hierarchy of lay healers:

8 Lay Healers Neighbors and relatives are valuable sources of information. Those whose conditions cannot be treated by a señora/abuela are usually referred to a yerbero (herbalist), sobador (massage therapist), or partera (mid- wife, who also treats problems with young children). If these specialists cannot handle the problem, then the patient is referred to a curandero total (the lay healer who may use multiple modalities).

9 Curanderos Curanderos are the clearly acknowledged experts in diagnosing and treating folk illness in the barrio. Folk illness is "a syndrome in which members of a particular group claim to suffer and for which their culture provides a etiology, diagnosis, preventive measure and regimen of healing" (Rubel). Folk illnesses have a high degree of psychological and/or religious overtones. Family involvement is an intrinsic part of the healing process, and people improve because of their religion, personal faith in the remedies, and familial commitment.

10 Curanderos There is no direct remuneration for services rendered by the curanderos, but most of them do accept gifts. While the curandero has clear expertise in folk illnesses, 80% of the folk remedies are for medical problems. Most curanderos know what they cannot handle and will refer severe health problems to the medical profession, including their own.

11 Folk Treatment for Common Medical Problems (see handout of table of folk remedies) HYPERTENSION Hypertension is defined as a hot illness. In 60% of the cases the etiology is thought to be due to corajes (anger) or susto (fear); the remaining 40% are felt to be due to "thick blood". Cool remedies such as bananas and lemon juice are popular as well as teas of passion flowers (pasionara), linden (tilia), or zapote blanco.

12 Diabetes Mellitus Diabetes mellitus is also a hot illness. While the curanderos will no doubt encourage consultation with a physician, various remedies may also be used. Nopal (or cactus), aloe vera juice, or bitter gourd can be taken. In some areas in Texas and Mexico treatment is started with maturique root infusion for approximately one week if the person is extremely hyperglycemic. Subsequently for maintenance therapy, trumpet flower-herb or root infusion (tronadora), brickle bush (prodigiosa) tea, or sage tea (salvia) are used. The proven safety and efficacy of maturique, trumpet flower, or bricklebush preparations are not known. Aloe vera juice is reasonably safe but aloe vera latex is a powerful purgative. Sage tea taken chronically can lower the seizure threshold and has been reported to cause mental and physical deterioration because it contains thujones and tannins.

13 Empacho A cold illness, Empacho (or tripida) literally means an impacted stomach or surfeit. While all ages may be prone to empacho, it is much more common in young children. The etiology is felt to be adherence of soft food and difficult-to-digest substances (such as popcorn or chewing gum) to the stomach wall. Symptoms are anorexia, stomach ache, vomiting, pain with diarrhea, and generalized abdominal fullness. The diagnosis is made by the healer noting symptoms and checking for direct (but not rebound) abdominal tenderness, feeling knots in the calves, and/or rolling a fresh chicken egg over the abdomen. Empacho is confirmed if the egg appears to stick to a particular area. Remedies include rubbing the stomach or back, popping of the skin, and purgative teas of wormwood (estafiate) or camomile (manzanilla). Lead (azarcón) or mercury (greta) powders are still occasionally given. Administration of these heavy metals can cause severe illness and death, but occasionally are still used despite a widely disseminated public information program.

14 Caída de la mollera Caida de la mollera means "fallen fontanel". The actual etiology may be any severe illness resulting in a 10% loss of body weight in an infant such as bacterial or viral dysentery, meningitis, or sepsis. Children with caída are commonly felt to be neglected and there is a high degree of maternal guilt (which may not be recognized by the health care professionals). The etiology is felt to be mechanical in origin--the fontanel being pulled down by the soft palate when the nipple is pulled too suddenly out of the infant's mouth or by a sudden jolt, bump or fall. Symptoms are dehydration, crying, inability to achieve sufficient suction while nursing, fever and diarrhea. Remedies include: pressing upward on the soft palate with thumbs or fingers, sucking the anterior fontanel, holding the baby upside down over water with or without shaking or hitting the feet. Poultices are applied to the fontanel with raw egg, oil, or liniment and the hair is pulled up (so that the roots will raise the skin back up). This is the most challenging and potentially fatal pediatric folk illness.

15 Mal de ojo Mal de ojo means "strong glance" or "evil eye". Young children are most susceptible but all ages may suffer from ojo. The etiology of ojo is when a person with a "powerful" gaze glances or looks admiringly at someone without touching them. The symptoms include sudden onset of high fever, vomiting, headache, coryza, fainting, and sometimes convulsions. The diagnosis of "Ojo" is made by consideration of the patient's symptoms and an examination of a fresh egg broken after being passed over the patient's body. A positive diagnosis is made when the egg appears cooked, or the yolk appears to have the image of an eye. The most effective remedy is to have the perpetrator touch the patient as soon as possible. When that is not an option, an alternative treatment is as follows:

16 Mal de ojo 1. a fresh egg is passed over the patients' body; 2. it is broken into a bowl of water and covered by a cross of palm or straw; and 3. put under the head of the patient's bed. 4. The patient is then put to bed for the night and in the morning the egg is examined; if it is curdled then that indicates that the Ojo is cured and the egg is then disposed of. For prevention, children or susceptible individuals wear buck- eyes as amulets or necklaces, or pink coral bracelets. In this Hispanic folk tradition if a child is complimented, the care giver should make every effort to touch him or her. (This contrasts sharply with an Asian belief that a child should never be touched on the top of his head).

17 Susto Susto is a folk illness with strong psychological overtones defined as a "fright sickness" and (literally) a loss of soul from the body. A more severe and potentially fatal form is called espanto. Studies have confirmed that those individuals suffering from espanto do indeed have a higher index of morbidity and mortality when followed for five years or more. Diagnoses at the time of death have included diabetes mellitus, carcinoma, or liver disease. Those most likely to suffer from "susto" are culturally stressed adults--women more than men. Occasionally children suffer susto as well. The cause is a sudden frightening experience such as an accident, a fall, witnessing a relative's sudden death, or any other potentially dangerous event.

18 Susto Symptoms include nervousness, anorexia, insomnia, listlessness, despondency, involuntary muscle tics, and diarrhea. A diagnosis is made by the symptom complex and the associated history of a traumatic event. Oral remedies can be attempted such as teas of orange blossom, brazil wood or marijuana. An oral solution of figs boiled in vinegar is also felt to be advantageous. However the most effective treatment for susto is a ceremony known as the barrida or "Sweeping". The barrida should be done immediately after the traumatic event occurs and is optimally conducted by a curandero in his/her home. During the barrida, the patient recounts the details of the frightening event then lies down on the floor on the axis of a crucifix; the curandero may or may not have the crucifix outlined with aluminum foil or other shiny material. The patient's body is then swept with fresh herbs such as basil, purple sage, rosemary, or rue; an egg may also be used. While the sweeping is occurring, the curandero and other participants say ritual prayers in groups of three. The curandero exerts the frightened soul to return to the body. A single barrida is not enough; this ceremony is usually repeated every third day until the patient is healed. Wednesday and Friday are felt to be optimal days for barridas. In some areas, the curandero may also jump over the patient's body during the ceremony. Since an individual may be more susceptible to susto when away from home, a preventive measure is to carry a whole nutmeg during journeys.

19 Frío de la matriz Frio de la matriz is an illness suffered by post-partum women. Literally it means "coldness of the womb or the uterus" and is caused by insufficient rest after the delivery. Symptoms include pelvic congestion, menstrual irregularities and loss of libido-these may persist up to several years after delivery if the conditions is not treated. In traditional Hispanic folk beliefs, the pregnant women is attended by a partera or mid-wife at the time of delivery and afterwards. After delivery, the new mother is put to bed for 40 days. All household duties are assumed by her family or extended family. Her only responsibility is to feed her baby. One can quickly surmise that the incidence of frío de la matriz is quite wide-spread in this era of hospital deliveries and rapid mobilization of new mothers after birth. The traditional methods provide the opportunity for more intense bonding with the infant as well as the interaction with the rest of the family without additional responsibilities. The treatment of choice for frío is té de damiana; while it is not known if damiana has actual physical properties, the herb is widely used across the world as an aphrodisiac; it has no known toxicity.

20 Recommendations 1. Understand (and be sensitive) to the role folk medicine may play in patients one encounters; 2. Practice delivering messages of tolerance and respect - "the art of medicine"; 3. During the interview, ask "What do you think caused your illness?", and "We all have favorite remedies that we use when we are sick. What have you done to treat this condition?"; 4. When appropriate, and not contraindicated, incorporate some benign folk medicine remedies into one's advice to the patient to improve the compliance and trust; 5. As an example, when encouraging liquid intake for colds and flu, considering suggesting té de manzanilla (chamomile tea) with other electrolyte replacement as part of the therapeutic regimen.