PUERTO RICAN CASE STUDY #2
Carmen Medina, aged 39, lives with her husband, Raúl, aged 43, who works as a
mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his
wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4-
year-old son, José; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The
Medinas both attended vocational school after completing high school. Mrs. Medina is
employed 4 hours a day at a garden shop. She stopped working her full-time job to care
for her ill mother and aged father, who do not speak English and depend on government
assistance. The family income last year was $28,500.
The family has health insurance through Mr. Medina’s job. They live in a threebedroom
apartment in a low-income Illinois community. Miguel works in a fast-food
store a few hours a week. Because Rosa has responsibilities at home, the Medina’s do not
allow her to work outside the home. She is very close to her grandmother but avoids
talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is
pregnant and the family does not know. She is planning to drop out of school, get a job in
a beauty shop, and leave home without telling the family. Miguel frequently comes home
late and, on occasion, sleeps out of the home. He is beginning college next semester and
has plans to move out of the house during the summer.
The family is having difficulty dealing with Rosa’s and Miguel’s developmental
and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr.
Medina is quiet and not actively involved in the discussion. He is more preoccupied with
the family’s financial situation. Mrs. Medina’s parents are encouraging them to return to
Puerto Rico.
Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the
emergency room for a respiratory infection. He smokes cigarettes and drinks two to three
beers every evening after work. He has not followed up on his blood pressure treatment.
Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus
allergies. He has been to the emergency room three times during the past year for
respiratory infections. Mrs. Medina’s last physical examination was after she had José.
She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is
very concerned about Rosa and Miguel, her parents, and the family’s finances. Mrs.
Medina is Catholic and recently has been visiting her church more often.
Study Questions
1. Explain Mrs. Medina’s attitude in her relationship with her adolescent
daughter.
2. Identify strategies to ensure that Rosa seeks prenatal care.
3. Identify barriers to accessing health care for the Medina family.
4. What are the high-risk behaviors exhibited by this family?
5. What communication barriers exist in this family that affect care delivery?
6. Discuss gender and family roles in the context of traditional Puerto Rican
culture.
7. Identify sociodemographic factors affecting the physical- and mentalhealth
well-being for this family.
8. Identify Puerto Rican folk practices appropriate for this family.
9. If the Medina family chose to visit a folk healer, which one(s) do you
think they might visit? Why?
10. If Mrs. Medina’s parents visit a health-care provider, what might they
expect?
11. Identify culturally congruent interventions to ensure compliance with
Western health prescriptions for Mr. Medina.
12. Discuss the importance of respeto and familism in the Medina family.
13. Identify culturally congruent interventions for Rosa’s pregnancy.
14. Identify health-promotion and disease-prevention interventions needed for
José.

MEXICAN CASE STUDY #2
Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on
the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged
18 months. Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with
them. Another distant relative, Rodolpho, aged 28, comes and goes several times each
year and seems to have no fixed address.
Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first
in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore
of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were
born in the United States.
Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can
read and write enough English to function at a satisfactory level. Olga knows a few
English words but sees no reason for learning English, even though free classes are
available in the community. Olga’s sisters have attended school in the United States and
can speak English with varying degrees of fluency. Roberto attends school in the local
community but is having great difficulty with his educational endeavors. The family
speaks only Spanish at home. Not much is known about the distant relative, Rodolpho,
except that he is from Mexico, speaks minimal English, drinks beer heavily, and
occasionally works picking vegetables. The Gaborra family lives in a trailer on a large
vegetable farm. The house has cold running water but no hot water, has an indoor
bathroom without a shower or bathtub, and is heated with a wood-burning stove. The
trailer park has an outside shower, which the family uses in the summer.
The entire family picks asparagus, squash, peppers, cabbage, and spinach at
various times during the year. Olga takes the infant, Linda, with her to the field, where
her sisters take turns watching the baby and picking vegetables. When the vegetablepicking
season is over, Pablo helps the farmer to maintain machinery and make repairs on
the property. Their income last year was $30,000.
From the middle of April until the end of May, the children attend school
sporadically because they are needed to help pick vegetables. During December and
January, the entire Gaborra family travels to Texas to visit relatives and friends, taking
them many presents. They return home in early February with numerous pills and herbal
medicines.
Olga was diagnosed with anemia when she had an obscure health problem with
her last pregnancy. Because she frequently complains of feeling tired and weak, the
farmer gave her the job of handing out “chits” to the vegetable pickers so that she did not
have to do the more-strenuous work of picking vegetables.
Pablo has had tuberculosis for years and sporadically takes medication from a
local clinic. When he is not traveling or is too busy picking vegetables to make the trip to
the clinic for refills, he generally takes his medicine. Twice last year, the family had to
take Linda to the local emergency room because she had diarrhea and was listless and
unable to take liquids. The Gaborra family subscribes to the hot and cold theory of
disease and health-prevention maintenance.
Study Questions
1. Identify three socioeconomic factors that influence the health of the
Gaborra family.
2. Name three health-teaching interventions the health-care provider might
use to encourage Olga to seek treatment for her anemia.
3. Identify strategies to help improve communications in English for the
Gaborra family.
4. Identify three health-teaching goals for the Gaborra family.
5. Name three interventions Olga must learn regarding fluid balance for the
infant, Linda.
6. Discuss three preventive maintenance–teaching activities that respect the
Gaborra family’s belief in the hot and cold theory of disease management.
7. Identify strategies for obtaining health data for the Gaborra family.
8. Identify four major health problems of Mexican Americans that affect the
Gaborra family.
9. If Olga were to see a folk practitioner, which one(s) would she seek?
10. Explain the concept of familism as exhibited in this family.
11. Distinguish between the two culture-bound syndromes el ataque and
susto.
12. Discuss culturally conscious health-care advice consistent with the healthbelief
practices of the pregnant Mexican American woman.
13. Discuss two interventions to encourage Mexican American clients with
tuberculosis to keep clinic appointments and to comply with the prescribed
medication regimen.
14. Identify where the majority of Mexican Americans have settled in the
United States.

The assignment should be one cohesive paper. It should not be a question and answer assignment. This means that you should have an introduction and a conclusion and level headings. I think the easiest way to make sure that you are answering each question, organize your paper so that each heading eludes to the topic of the question. For example, you may want to organize your paper like this:

African American and Appalachian Cultures (this is the title and should be centered and not bold on page 2 and the introduction paragraphs should follow)

Organizational Structure,Family Values, Education

Child Rearing, Spirituality, Religious practices to treat illness,Mental Health

Medication,Environmental Hazards, Organ Donation,Dietary Risks, Skin Assessment, Beliefs about Pregnancy

Now after this section you would write a transition paragraph and then move into the next case study and do same

At the end of the assignment, you will include a conclusion.