Ethnic Minorities: Caregiving Team Ministry in Hispanic Culture

Each of us is unique because of our individual culture and experience. These shape our understanding and values, influence our decisions. The differences, in cultural norms between mainstream American culture and Hispanic cultures, do not mean that they are good/bad, right/wrong. It means that cultural differences will influence perceptions, attitudes, and responses. In the area of giving and receiving care, cultural norms influence how a person responds to someone who is in need, whether s/he will ask for help, how asking for and accepting help is perceived and understood. Important Differences Here are some important differences of how caregiving is perceived and offered in the Hispanic culture. Mental illnesses carry a great deal of shame, embarrassment, and stigma for the patient and the family. This stigma may cause family members to minimize, deny, and hide the behaviors to outsiders. This sense of shame further discourages caregivers from seeking professional or informal support from others. A female in the family is usually the designated caregiver. This may be a daughter, daughter-in-law, or granddaughter. Generally, when no female caregivers are available, men and extended family are enlisted as caregivers. Typically, the Hispanic family will not place the parent, spouse, or child in a longterm care institution. Decisions and arrangements will be made among family members about who will provide care. The two primary reasons for this is the Hispanics concept of family and low income. Family is very important in the Hispanic community and intergenerational reciprocity is valued. A sense of obligation, responsibility and high expectations towards parents is instilled in children from an early age and passed on to the next generation. Instances of a female caregiver leaving her job to care for an elderly parent are not uncommon. Many Hispanic families are low income. To meet the needs of a person who is suffering from a chronic illness, resources will be pulled by combining incomes or

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two families living in one house. A person suffering from a chronic illness will either be moved to the house of the caregiver or the caregiver will move into the home of the patient. A Care Team member ought not be surprised if s/he finds three generations living in the same house. Living, sharing space in close quarters is culturally quite acceptable. Issues of personal privacy are set aside for the sake of helping the family member who is in need. Caring for an aged parent, who is chronically ill, has dementia, Alzheimers, or impairment will be perceived and described by many family caregivers as a blessing, something they are happy to give. Caregivers may deny their own needs and suffer from depression, experience guilt, shame, and feelings of failure if s/he fails to provide care. Reliance on people or services outside of the family is viewed as shirking ones familial responsibility and putting undue burden on outsiders. Not only is it perceived as a burden on others, but the cultural norm is to avoid sharing family secrets or embarrassing information with strangers. The cultural norm of not sharing family matters will be more ingrained as it pertains to mainstream American culture which is perceived as being too individualistic and uncaring, particularly towards the elderly.

Suggestions to overcome barriers These cultural norms create barriers that may seem insurmountable to care team members, but as more and more Hispanic women are working outside the home requests for assistance have risen. Any ministry or educational program that aims to assist a Hispanic caregiver to improve his or her quality of life and that of his/her loved one must have three key components. The first one is to identify a well-known, respected and trusted person in the church, i.e., priest, deacon, long time member, etc. This person may have a key role in communicating and disseminating the information about support services. This person will also be the one to introduce the Team member to the family. Before the Hispanic family accepts care from a stranger, an element of trust and understanding must be established.
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Provide materials to educate the community that chronic illnesses, dementia, Alzheimers disease or related illnesses are becoming more prevalent among Latinos. If these materials are in Spanish, they should be reviewed for clarity. This will help raise awareness. Raising awareness will create interest. In creating interest, a more receptive attitude may be fostered and the Caregiving Team concept of ministry may be easier to implement. Any assistance, such as respite-care, ought to be presented as a benefit for the impaired loved one, explaining that breaks from caregiving are important to the care partner and the caregiver. They must be convinced that taking time to rest and recharge does not mean they have abandoned their loved one or that they are bad caregivers.

Establishing a relationship with Hispanics Hispanics are typically outgoing, expressive in their speech and mannerisms, colorful, earthy and realistic. They feel their emotions - love, hate, joy - deeply and intensely. Most will be Roman Catholic and will have a tendency to be submissive to authority, as represented by the Pope and/or head of family. For this reason, few Hispanics will ask a lot of questions from someone in a position of authority. However, the prevalent attitude toward civil authorities is one of high suspicion. To establish a relationship, one must be patient. Visits will take time. One does not just pop in, get right to business, and leave. A Team member should be prepared to spend time chatting and have a social conversation before s/he can ever ask about offering assistance. (Please note that it is preferable that women visit women and the opposite is true for men.) Hispanics who have just immigrated (legally or illegally) to the U.S. may speak some very basic English phrases. Young children may be enlisted as translators for the parents. In this instance, one has to be very careful because the child may inadvertently translate a concept or word incorrectly and alienate the adult. Many Hispanics will blend mystical beliefs and superstitions with their Roman Catholic faith. Do not be surprised if the person mentions mal de ojo (evil eye), susto (fright), or empachado (a stomach ailment) as the cause of an illness. These will typically be cured by a curandera or a practitioner of folk medicine. Even when a person does not hold these beliefs, he or she will know about them.

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It is very important that these beliefs not be dismissed as a bunch of superstitious nonsense or that the person visiting attempt to enlighten or educate. These attempts will be viewed as condescending and will be resented. The blending of mystical beliefs with primarily Roman Catholic faith has produced a variety of folk religions that may seem similar. In both, there are practitioners who use their knowledge to heal like, curanderas or shamans, and there are those who use it to hurt or control other people by putting hexes or spells. The following are very brief and generalized explanations. Brujeria is the form found mainly in Mexico and Central America. This is a mix of Roman Catholic faith intermingled with the beliefs of indigenous culture. Santeria is the form found mainly in Cuba and the Caribbean islands. This is a mix of Roman Catholic faith intermingled with the beliefs of African slaves that were brought to the islands. If a caregiver or care partner uses any of these terms then they hold some of these beliefs. The most prudent thing to do is to respond with comments similar to the ones below. The most important thing is to listen, to let the person talk about their anxieties and worries. Oh, tell me more about that. How does it make you feel? How do you deal/cope with this?

Written by Nora Gonzalez

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