Guatemalan Culture

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Guatemalan Culture

Larry Purnell, PhD, RN, FAAN

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Overview/Heritage ▪ People of Guatemalan heritage comprise a

growing number of Hispanic/Latino populations in the United States.

▪ Guatemalans may share a common Spanish language with other Hispanic ethnic groups.

▪ In Guatemala, 56 percent of the population lives below the poverty level.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Overview/Heritage ▪ Guatemala is inhabited by Mestizo (mixed

Amerindian-Spanish – in local Spanish called Ladino) and European 59.4 percent, K’iche 9.1 percent, Kaqchikel 8.4 percent, Mam 7.9 percent, Q’eqchi 6.3 percent, other Mayan 8.6 percent, indigenous non- Mayan 0.2 percent, other 0.1 percent.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

▪ The major languages in Guatemala include the official language, Spanish, which is spoken by 60 percent of the population, and Amerindian languages, which are spoken by the remaining 40 percent.

▪ There are 23 officially recognized Amerindian languages.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Communication

▪ Some Mayan men do not have a formal education but are able to speak Spanish because of frequent interactions with Spanish speakers.

▪ Guatemalan people tend to value the past and live in the present, being more concerned with today than the future because the future is uncertain for many.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Communication ▪ Time is related to the natural environment,

such as sunrise, sunset, rainy season, etc. ▪ Punctuality is difficult for many because of

limited transportation and unexpected family needs.

▪ Guatemalans who have a Hispanic heritage use the Spanish format for names.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication ▪ At birth, a child is given a first name (Ovidio) followed by

the surname of his father (Garcia), and then the surname of his mother (Salvador), resulting in Ovidio Garcia Salvador.

▪ Men’s names remain the same through their lifetime. ▪ However, when a woman named Jovita Garcia Salvador

marries Francisco Vasquez Gutierrez, she then becomes Jovita Garcia de Vasquez or simply Jovita Garcia Vasquez.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

▪ To convey respect, address the Guatemalan in a formal manner unless otherwise requested by the patient.

▪ Male children and adults are referred to as Mr. (Señor). Females are referred to as Ms. (Señorita) or Mrs. (Señora).

▪ Guatemalans are customarily greeted with a handshake. In rural areas, people shake hands softly.

▪ To give a firm handshake indicates aggressive behavior. ▪ In the cities, the handshake tends to be more firm.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communication

▪ Guatemalans avoid direct eye contact with others, including health-care providers, which is a way of demonstrating respect and should not be misinterpreted as avoidance, low self-esteem, or disinterest.

▪ Guatemalans speak softly in public. ▪ Speaking loud is considered rude.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ Many Guatemala families follow traditional roles for husbands, wives, and children, although this is changing for some.

▪ Traditionally, the man has been the head of household and is the primary “breadwinner” and provider for the family.

▪ Ultimate decision-making power resides with the man of the house.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ Women’s roles have traditionally involved raising the children and caring for the home.

▪ Guatemalans place a high value on the family and extended family.

▪ Most families are nuclear. ▪ Extended family is important and may include

grandparents, aunts, uncles, and cousins.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ A young woman’s 15th birthday (quinceñera) is celebrated as her passage to womanhood.

▪ Coming of age for a young man is age 18 years. ▪ Children are a gift from God and are highly valued

in Guatemalan society. ▪ Sons are more valued than daughters. ▪ Children are taught to be obedient and

demonstrate respect for older people.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ Among Mayan communities, family members and other adults take an active part in raising a child.

▪ They believe it takes a village to raise a child to become a productive member of the community and to continue their culture.

▪ Values include being humble, content, and respectful of others, working hard, avoiding arguments, and placing the needs of the family before one’s own individual needs.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ When family members are unable to take care of themselves, the expectation is that their family will take care of them.

▪ Guatemalan families who migrate to the United States do so with the hope of a better life for themselves and their children.

▪ More opportunities are available in the United States.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ Catholic, protestant, and evangelical Guatemalans do not believe in homosexuality or sexual activity among the unmarried, or infidelity.

▪ Indigenous women dress conservatively with a woven long skirt (corte), blouse (huipil), a scarf (tzute), and shawl (rebozo) that promote modesty.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ A single woman is believed to be a prostitute if she is out in public alone.

▪ Despite a prevailing macho attitude with a deep- rooted homophobia, some inroads have been made for gays, lesbian, and transgendered populations in Guatemala with Lesbiradas, an organization for lesbians and bisexual women.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles and Organization

▪ Larger cities in the United States offer organizations such as Ellas, a support group for Latina lesbians; El Hotline of Hola Gay, an organization with information and referrals in Spanish; and Dignity, a gay Catholic support organization.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Workforce Issues

▪ During the civil war in Guatemala, residents were permitted to migrate to the United States and apply for political asylum.

▪ If granted, this allowed Guatemalans to stay permanently in the United States, but they were not permitted to ever return to Guatemala.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Workforce Issues

▪ Guatemalans may miss work due to an illness of a loved one, a need for transportation to an appointment, or lack of childcare.

▪ When a Guatemalan learns that a loved one in Guatemala is ill or has passed away, they feel compelled to return to Guatemala for an extended period of time, risking loss of their job if a leave of absence is not possible.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Workforce Issues

▪ Because punctuality is not valued in Guatemala, the Guatemalan employee in the United States may arrive for work late.

▪ They may not wear a timepiece, be able to tell time, or understand the importance of punctuality in the United States.

▪ Guatemalans tend to respect persons in positions of authority.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Workforce Issues

▪ Those of lower socioeconomic status and/or with formal education and English language skills usually acquire positions with responsibility but little authority.

▪ They prefer to get along well with others and not criticize or voice complaints when treated poorly.

▪ The Guatemalan is likely to remain in a position equal to his peers rather than seek a promotion.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

▪ Most Guatemalans are a mixture of Spanish and Mayan Indian heritage.

▪ There is a small population of Black Guatemalans with ancestry from the Caribbean and Africa.

▪ This accounts for variations in skin color, facial features, hair, body structure, and other biological variations.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology ▪ Guatemalans who are predominately Spanish

may have blonde or brown hair, fair complexion, and blue eyes and be of average or taller height with a medium to large build.

▪ Guatemalans with predominately Mayan Indian ancestry tend to have black hair, brown skin, and dark eye color and are of short height with a petite build.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

▪ The leading causes of mortality in Guatemala are pneumonia, diarrhea, communicable diseases, diseases of the circulatory system, perinatal conditions, and tumors.

▪ Other major health problems for Guatemalans include musculoskeletal pain, abdominal pain, upper respiratory problems, headaches, rashes and itching, and eye disorders.

 

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

High-Risk Health Behaviors

▪ Alcohol is the most misused substance. ▪ Guatemalan families readily participate in

immunization programs for their children yet do not participate themselves.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

▪ Food to Guatemalans signifies physical, spiritual, and cultural wellness.

▪ Foods vary among Guatemalans based on cultural traditions and accessibility.

▪ Corn is highly valued in the Mayan culture. Corn is the chief crop and the basis for many food products and meals. Foods bring strength, good health, and a spiritual connection to the past.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition ▪ The Mayan diet primarily consists of maize, black

beans, rice, chicken, squash, tomatoes, carrots, chilies, beets, cauliflower, lettuce, cabbage, chard, leek, onion and garlic.

▪ These foods are used to maketortillas, atole, (liquid corn drink), pinol (chicken flavored corn gruel), pepi’an (chicken stew with squash seeds, hot chilies, tomatoes, and tomatillos [small green tomato]), and caldos (soups made of chicken stock and vegetables.)

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

▪ Guatemalan food is not served spicy. A spicy hot sauce may be served alongside a meal for individuals who prefer to add it.

▪ The diet of many Guatemalans is low in protein, iron, and vitamin C.

▪ Lactose intolerance is especially prevalent among indigenous populations.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition ▪ Some Guatemalan families encourage their

children to drink coffee with sugar when they refuse the poor tasting drinking water.

▪ This practice leads to gastritis, dehydration, and dental caries.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ Guatemalans value life beginning from conception; a baby is a gift from God.

▪ Most do not believe in contraception or abortion for religious reasons.

▪ A Guatemalan woman may bear 10 or more children in her lifetime. In Guatemala, of these, many die before the age of 5 years.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ Mayan midwives (comadronas) deliver 80 percent of all children born in Guatemala in the home. It is unknown how widespread this practice is in the United States.

▪ If the baby dies during delivery, the family accept it as God’s will.

▪ On the day a Guatemalan woman becomes pregnant, she and her husband share the news with respected elders of the village. Godparents are also selected at this time.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ In the 7th month of pregnancy, the woman introduces her fetus to the environment.

▪ She goes through her daily activities showing and telling her fetus about the life she leads. The mother tells the fetus to be honest and never abuse nature.

▪ If someone eats in front of the pregnant woman without offering her food, she will have a miscarriage.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ Children are permitted at the delivery. ▪ The woman’s husband, village leaders, and

parents of the couple may be present. ▪ A single woman must not observe the birth of

the baby. ▪ Mayan women do not believe in lying down to

give birth or delivering in a hospital.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ A midwife and witch (brujo) may both attend the birth.

▪ The midwife helps with delivery. ▪ The brujo prays for long life, good health, and

protection from the evil eye (mal ojo). ▪ A breech delivery or one in which the baby’s cord

is around the neck are considered good luck.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ Following delivery, the placenta has to be burned, not buried, because it is disrespectful to the earth to do so.

▪ The placenta can be burned on a log and then the ashes used for a steam bath, temascal.

▪ To celebrate the birth of a baby, the villagers slaughter a sheep.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ The mother and baby are kept separated from others for 8 days.

▪ When the baby is born, the hands and feet are bound for 8 days. This signifies that they are meant for hard work, not for stealing.

▪ Guatemalan women may continue breastfeeding until the child reaches the age of 5 years.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ During the first 8 postpartum days, friends and extended family bring food, clothing, small animals, or wood as gifts for the newborn’s family.

▪ They also offer their services, like carrying water or chopping wood.

▪ The family of the newborn does nothing for these 8 days; their needs are taken care of by others.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Pregnancy and Childbearing Practices

▪ A bag with garlic, lime, salt, and tobacco is hung around the baby’s neck and a red thread is used to tie the umbilical cord to protect the baby, provide strength, and denote respect for the ancestors.

▪ If the baby is a female, the midwife pierces her ears at birth.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Juanita Juarez, is pregnant with her second child. The nurse recommended that she increase her milk consumption, which she has not done. He has been compliant with other dietary recommendations. The most likely reason for not increasing her milk consumption is that she

a. Does not like milk. b. Cannot afford milk. c. Has lactose intolerance. d. Has fructose intolerance.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C Many Guatemalans have lactose intolerance and

cannot drink milk or milk products because it caused bloating and indigestion.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals ▪ Many Guatemalans grow up experiencing far more death than

most North Americans. ▪ They see babies and children die of malnutrition and disease,

parents and grandparents die from violence, and loved ones die because the health care they needed was too far away or was too expensive.

▪ The family may decide the cost for treatment of one family member is too much and decide against it because of the financial strain on the entire family.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

▪ When death occurs in Guatemala, it is customary to place the deceased in a simple wooden coffin/casket and conduct a funeral.

▪ Graves are decorated with flowers on All Saint’s Day in memory of the deceased.

▪ Some Guatemalans relate their illness to “punishment” or impending death to “God’s will”.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

▪ When a Guatemalan dies in the United States, the family may request repatriation because it is important for the final resting place to be the home country.

▪ Guatemalans believe in burial; they do not practice cremation.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

▪ Yellow is the color of mourning. ▪ Yellow flowers are placed at the grave. ▪ Food is placed at the head for the spirit of the

departed. ▪ Church bells are rung to gain favor with the gods. ▪ Ladinos mourn the dead by wearing black.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

▪ Approximately 65-80 percent of Guatemalans are Roman Catholic.

▪ Others continued to practice their Mayan religion.

▪ Still other Guatemalans combined beliefs and practices of the two.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

▪ Two practices influenced by the Spanish are guachibal and cofradia.

▪ Guachibal involves the practice of keeping an image of a Christian saint in the home and celebrating on the particular saint’s day.

▪ Cofradia refers to a “religious brotherhood” that serves to maintain the “cult” of a particular saint.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality ▪ Family provides Guatemalans with meaning in

their lives. ▪ Spirituality helps to explain life and the

circumstances faced by Guatemalans. ▪ When illness occurs, many Guatemalans turn to

their faith for strength, wisdom, and hope.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices ▪ The preferred mode of treatment among Ladinos

is medication administered by hypodermic injection. For example, if an infant has a cold, Ladinos believe an injection is necessary to treat it effectively.

▪ If someone has the flu, they like an intravenous infusion. Intramuscular medications are preferred to those taken orally.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices ▪ Health-care seeking among Guatemalans

generally occurs by first seeking advice from a mother, grandmother, or other respected elder.

▪ If this approach is unsuccessful, then the family usually seeks health care from folk healers.

▪ Modern medical care may be the last resort.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

▪ Many are fearful of hospitals. ▪ In Guatemala, when hospital care is necessary,

patients are often seriously ill, resulting in death, which perpetuates the belief that “hospitals are places where patients go to die.”

▪ Guatemalans often delay seeking health care until they are incapacitated by illness, disease, or injury.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

▪ Many times, they are unaware of the dangers associated with working in agriculture in the United States.

▪ They may be exposed to pesticides and dangerous equipment without proper training.

▪ Some Guatemalans fear venipuncture because taking blood leaves the body without enough blood to keep them strong and healthy.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

▪ Guatemalans tend to view health and illness in relation to their ability to perform duties associated with their roles.

▪ As long as women are functioning in their role of caring for the home and family and men are functioning in their job, then they feel “healthy”.

▪ Aches, pains, and minor illnesses that do not prevent functioning are tolerated.

▪ When an illness prevents normal functioning required for their roles, then Guatemalans view it seriously.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

▪ The cause of debilitating illness or disease may be viewed as punishment from God rather than lack of prevention or early detection.

▪ Sometimes, early warning signs of illness or disease are ignored in hopes they will go away on their own.

▪ Family members would rather care for their loved one at home if at all possible.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practices

▪ Questions related to organ donation will be puzzling and elicit fear and anxiety.

▪ The Guatemalan patient may think the health- care provider is asking them to consent to organ donation because they are going to die rather than understanding the context to which the question applies.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Maria and Pedro bring their 3 day old male newborn baby to the pediatric clinic because he is not nursing and they are sure he is losing weight. The baby has his hands and feet bound. The nurse recognizes this Mayan custom is so that the baby will

a.Grow up to work and not steal. b.Not get colic. c. Be a religious person in adulthood. d.Be safe from evil spirits.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: A Traditional Guatemalans bind the baby’s hands and

feet for the first 8 days of life so it will grow up to be a good worker and not steal.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

Three distinct health care systems exist in Guatemala:

1. Modern medicine 2. Ladino folk medicine 3. Indian folk medicine

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

▪ Modern medicine refers to health care provided by educated physicians and nurses.

▪ Ladino folk medicine is provided by Ladino pharmacists, spiritualists, and lay healers (curanderos).

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners ▪ Mayan Indians seek medical care from Mayan

shaman, herbalists, and comadronas. ▪ When Ladinos and Mayan Indians have access

to modern medicine, the utilization increases. ▪ Guatemalans have great respect and admiration

for health-care providers. They are viewed as authority figures with clinical expertise.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

▪ Guatemalans expect their health-care provider to have the appearance and manners of a professional.

▪ When this is not the case, Guatemalans lose confidence in the provider.

▪ Guatemalans are very private and are not accustomed to discussing issues and concerns openly. It may take a while to develop the trust and rapport.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

▪ They fear disclosure may result in deportation or rejection.

▪ Patients also fear confidentiality will not be maintained in the health-care setting.

▪ Guatemalan women are usually very modest. ▪ They may refuse to discuss personal issues or

receive an examination by a male health-care provider.

 

 

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Health-care Practitioners

▪ A male Guatemalan patient may refuse a female health-care provider.

▪ Because Guatemalans dislike conflict, they may not actually refuse care instead they may withhold personal information due to discomfort with the health-care provider.

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