Transcript Folk Medicine - University Center Rochester

Folk Medicine
Spanish 1130
1
Objectives
1.
2.
3.
Understand the origins and applications
of Hispanic folk medicine
Identify common Hispanic folk illnesses
and their remedies
Incorporate the knowledge of Hispanic
folk medicine beliefs into the
development of effective patient
management and counseling plans
2
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.
3
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.
4
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.
5
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.
6
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:
7
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 (midwife, 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).
8
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.
9
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.
10
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.

11
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.
12
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.
13
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.
14
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:
15
Mal de ojo
1.
2.
3.
4.

a fresh egg is passed over the patients' body;
it is broken into a bowl of water and covered by a cross of palm
or straw; and
put under the head of the patient's bed.
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 buckeyes 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).
16
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.
17
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.
18
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.
19
Recommendations
1.
2.
3.
4.
5.
Understand (and be sensitive) to the role folk medicine may play
in patients one encounters;
Practice delivering messages of tolerance and respect - "the art of
medicine";
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?";
When appropriate, and not contraindicated, incorporate some
benign folk medicine remedies into one's advice to the patient to
improve the compliance and trust;
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.
20