Running head: CULTURAL INTERVIEW OF A BRAZILIAN IMMIGRANT Cultural Interview of a Brazilian Immigrant Olga V. Moreira Florida International University Abstract The purpose of this interview is to obtain ideas and opinions of a Brazilian immigrant to the United States of America on various aspects of the Brazilian culture and its relation to healthcare. Purnell’s Model of Cultural Competence, which uses both primary and secondary characteristics of culture, will be used to guide the interview format and questions in relation to (a) high risk behaviors, (b) spirituality and (c) health care practices.
Overview and Topography Brazil is a vast country rich in natural resources and beauty in the continent of South America. Located in the east-central coast of South America, it is the largest country in South America occupying nearly half the continent. Brazil’s topography is vast with its most priceless treasures inarguably being the Amazon Rain Forest. The Amazon River and its components attribute to two fifths of the country with the Amazon Basin making up 40% of the continent of South America (“Brazil”, n. d. ).
The Portuguese settlers were the first to arrive in Brazil and quickly found they were not alone, discovering the many tribes of natives that called Brazil their home for hundreds and maybe even thousands of years. These Portuguese settlers were not determined to conquer as the Spaniards, but were poor sailors who were seeking items for trade. This made it easy for the settlers to intermarry with the natives as well as the slaves they had brought from Africa, creating the mix of races known in Brazil today (Geographia, 2006).
The Portuguese were not the only ones to seek Brazil to escape their situation and they were quickly joined by many immigrants such as French, Dutch, German, Italian, Japanese, Chinese, African and Arab, with Portuguese remaining the dominant and official language of Brazil. These cultures have blended into one to form the colorful Brazil that many of us know and love today. Despite their multiple ancestries, Brazilians share many of the same traditions and qualities amongst themselves with some variations existing according to socio-economic status (Coler, 2008).
The cultural interview was conducted on a 40 year old man, L. C. Passos. , who migrated to the United States of America from Rio de Janeiro, Brazil, in 1992. His purpose was not to stay, but to study and return to his country once his studies were over. But fate dealt him a new set of cards when he met his future wife during his internship at the United Nations in New York City. As a young man in his early 20’s, he wandered back and forth between the two countries until he decided to call the United States home once and for all in 1996. He has kept many of his traditions and customs as his family has for many years.
He is the youngest child of five, from an upper- middle class family; his mother a school principle and father a high ranking official in the Brazilian Army. He describes Rio de Janeiro as a place full of natural beauty that is unfortunately inundated with social inequities. He has completed graduate school and places high importance on education, which he learned from both his parents and is evidenced by his siblings, all being professionals, one that completed graduate school and three having doctorate degrees (L. C. Passos, personal communication, October 15, 2009). . Literature Review High Risk Behaviors
Many cultures share alcohol consumption as a high risk behavior, but some new research is showing that Brazilians’ use of alcohol is rising quickly. In 2001, Carlini-Marlatt stated, “A study based on data from the Global Status Report on Alcohol suggests that per capita alcohol consumption in Brazil had a 74. 5% increase over the period between 1970 and 1996, a situation quite the opposite to many other countries worldwide” (Pinsky & Laranjeira, 2003, p. 17). As the marketing industry noticed this trend in Brazil, it spent millions on advertising with approximately 80% of these being applied to beer advertising (Pinsky & Laranjeira, 2003).
When questioning who is consuming, a study conducted in Salvador, Bahia, Brazil titled, “Alcohol Drinking Patterns by Gender, Ethnicity and Social Class in Bahia, Brazil”, studied a total of 2,302 adults (1,250 females and 1,052 males) from 1,258 families demonstrated that “overall alcohol consumption was significantly associated with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper-middle)” (Almeida-Filho et al. , 2004, p. 53).
This same study concluded that beer was the most popular alcoholic beverage of choice as reported by 54% of the participants, with wine coming in second at 32% followed by cachaca at 12. 8% and other distilled beverages at 10% (Almeida-Filho et al. , 2004). As the Brazilian government noticed this cycle, increased in consumption, increase in advertising dollars, increase in purchasing, it decided to implement stronger regulations on the companies such as only being allowed to advertise alcohol containing beverages between the hours of 9pm thru 6am, when most minors are not watching television (Pinsky & Laranjeira, 2003).
It was also able to “restrict the use of sexual content and cartoons, both regularly employed in advertisements, to promote alcohol beverages. In addition, models featured in the advertisements should be and appear to be older than twenty-five and people should not be portrayed drinking” (Pinsky & Laranjeira, 2003, p. 19). Another high risk behavior prominent in Brazil is the lack barrier protection when having sex.
Coler states that Brazilian society is one of machismo (Coler, 2008). We can justify this statement by reviewing a study done in Belo Horizonte, Brazil in which special attention was given to condom use and issues with masculinity and feminity and explored the concept of condom use and its impacts from a psychological view as well as a cultural view (Levinson, Sadigursky, & Erchak, 2004).
Seventy six teenagers participated in the study from 3 different high schools and were asked various questions on expectations, in relation to sex, of men and women. When assessing the number of partners as well as risk for STDs, the investigator states, “The boys readily and unanimously agreed that boys should expect to and do have numerous sexual partners” (Levinson, Sadigursky, & Erchak, 2004, p. 211).
The study continues on and discusses several reasons for not using condoms, such as not wanting to stop being “in the moment” to put on a condom, that putting on condoms ruins their sexual pleasure and can be difficult to place and they don’t want to risk looking like they do not know what they are doing and also that if they did not have a condom they would not stop for fear of being called a “faggot” by the girl (Levinson et al. , 2004). Yet the girls’ answers did not justify the boys concerns.
They felt that the man is in control and therefore should take the time to place the condom, even if the arousal is compromised for a few moments, and that they could “artfully begin the sexual dance again and get back to a previous level of arousal” (Levinson et al. , p. 220). The study concluded by stating: Despite knowing the dangers, they continue to have unprotected sex, and often in the most risky situations, such as in a fica (one-night stand). The reasons for this are complex, but include cultural definitions of gender roles and expectations, along with difficulties in cross-gender communication.
In addition, alcohol often is involved, which may cloud their judgment (Levinson et al. , 2004, p. 222). Spirituality As diverse as Brazil’s population are its views on spirituality, religions and its followers. The most current statistics are as follows and were obtained from the 2000 census with the most prominent religion being Roman Catholic at 73. 6%, followed by Protestant at 15. 4%, Spiritualist at 1. 3%, Bantu/voodoo at 0. 3%, other at 2% and none at 7. 4% (Nation Master, 2005).
The Roman Catholic religion was brought to Brazil by the Spaniards and Portuguese about five centuries ago and has continued to dominate mainstream religion in Brazil. Despite the enormous influence of the Catholic Church in many countries, in Brazil it has recently not had a grasp on controlling new religious movements from surging (Carpenter, 2004). Religions such as Kardecist Spiritism, the Temple of Good Will and Union Vegetal and are just some of the most widely growing “new” religions in Brazil today (Carpenter, 2004).
Allan Kardec, who real name was Hypolyte Leon Denizard Rivail, is the father of today’s spiritist movement. Born in France in 1804, he was formally educated in the field of law but when the phenomenon of “table turning” was exciting Europe, he took interest. “Foreseeing the vast importance, to science and to religion, of such an extension of the field of human observation, he entered at once upon a careful investigation of the new phenomena” in the unification of the visible and invisible world (Spirit writings, n. d. . His most known works are, The Spirits’ Book and The Mediums’ Book, which are the foundation for the Spiritist movement (Spirit writings, n. d. ). The Temple of Good Will also follows the basic spiritualist movement and originated in Rio de Janeiro (Carpenter). Union Vegetal is based on the use of Ayahuasca tea, a hallucinogenic, and a mix of shamanism and Christianity (Carpenter, 2004). With just a glimpse of these dynamic belief systems, Brazil truly fits the phrase “alternative spirituality” (Carpenter, 2004).
Despite these new religions, Brazil is the largest Roman Catholic country in the world with their patron saint being Our Lady of Aparecida, which literally means, one who appeared. Her statue was pulled from the sea after a night of unsuccessful fishing by three fishermen, but once they started praying to her, they caught many fish (Marypages, 2007-2009). Ever since, Brazilians have been diligently praying to her for health, protection and miracles; her niche is visited by over 5 million pilgrims yearly (Marypages).
Health Care Practices The Brazilian culture is rich in health care practices. It has a variety of home and folk remedies that many people try prior to seeking allopathic care (Roberts, 2007). Folk remedies can be delivered from a variety of care providers such as shamans, exorcists, card readers, advisors and sorcerers among others (Coler, 2008). Home remedies include different teas and meals for specific ailments, as Roberts (2007) concur and cites: Brazil is known for its natural botanical pharmacopoeia.
Anthropologically speaking, Brazil is not only rich in biodiversity, its people are particularly knowledgeable about ways to use local plants to heal. There are innumerable examples of home remedies, or remedios caseiros, that participants mentioned to me during this research, including propolis, ginger, mint, garlic, and also many herbs (p. 195). Self medication does not only apply to natural medicine but to prescription drugs as well. Many drugs such as strong pain relievers (non-narcotic), birth control and antibiotics are readily available without a prescription in local pharmacies in Brazil.
Many ask family members and friends, which frequently travel between both countries, to bring or mail medications for them (Roberts, 2007). Another aspect of health care discussed in the article “Health Practices and Expectations of Brazilians in the Unites States” is the topic of American physicians prescribing medications without what the Brazilians thought was “thorough testing” such as lab work; an example given was prescribing and anti-acid based only on description of signs and symptoms and not performing an endoscopy (Roberts, 2007).
The Brazilians interviewed felt that this was not adequate care and many resorted on returning to Brazil for “adequate” care (Roberts, 2007). Client Interview Data High-Risk Behaviors When questioned about involvement in high-risk behavior, Passos simply stated he had none. He is married and truthfully stated he only has one sexual partner. He does however state that as a young man in Brazil, had many sexual partners but used condoms readily. Prior to his marriage, he did have yearly physicals which included testing for HIV as well as other STDs.
When he did have a steady girlfriend and felt it was acceptable to have unprotected sex, he did so but always used a method of birth control. To this date, he does continue with routine physical exams, with an Eastern medicine practitioner, but does admit to not testing for STDs because he does not find it necessary at this time of his life. Alcohol is not a part of Passos life as he states that it does not make for a balanced individual and therefore has no desire for it. He states perhaps he has champagne once a year to toast the oncoming year.
When questioned about physical safety, Passos did state that he must improve on the use of seat belts; he states they are “restricting. ” When questioned about high risk behaviors in his family, he admitted that his family as well as himself had a higher than normal caloric intake, nightly deserts and not getting around to enough exercise. To decrease this behavior, Passos has already started on a lower caloric intake diet that incorporates more fruits and vegetables than before (L. C. Passos, 2009). Spirituality
When asked about what religion Passos identifies with he states he was raised Catholic but diverted to Kardecism (Spiritist) in his 20s, which correlates with Carpenter’s research stated earlier in this document, about the “alternative spirituality” movement in Brazil. He still considers himself Christian as many Kardec followers do, but states he has a different view of heaven than the “norm. ” He strongly believes in the spirit world versus a “heaven” in which we return to earth for a different life and another chance to learn what our spirit needs to learn to become an elevated pirit. Passos also states that he has attended a few meetings of Santo Daime, which is very similar to Union Vegetal and was part of the ritual of the drinking of the Ayahuasca tea; he did say that this was one of the best experiences of his life. He claims not to be a devout follower of Our Lady of Aparecida but does state that his parents are and pray to her on a daily basis. Pertaining to religiosity versus spirituality Passos stated religiosity is “how you practice your beliefs and attendance of a ceremony whereas spirituality is how you act based on the values that you learned. When asked about prayer, Passos stated he prays daily and needs nothing to pray but concentration and an open heart and mind that is ready to receive the day with all it may bring. He trusts in the Highest Beings’ knowledge and decisions and knows that all matters in life have purpose. When asked about what gives meaning to his life he stated daily interactions, the impact he has on others and the way his actions and thoughts define who he is (L. C. Passos, 2009). Health care practices L. Passos was asked multiple questions on his healthcare practices as well as his family’s practices and how they are similar or how they differentiate.
L. Passos, despite his admitting to needing to decrease his total caloric intake as stated earlier, does believe that he consumes healthy nutrients that help him evade illness. He claims to have a diet with mostly organic foods, low in preservatives, no fried foods and no animal fat, as he is currently in transition of becoming a vegetarian for health and spiritual reasons. He wants to have a lifestyle as natural as possible therefore does not participate in Western medicinal practice of what he calls “pill popping” or vaccinations other than the ones he had as a child.
As Roberts stated in the literature, Passos habits correlates with it as he first attempts to treat his aliment using teas, herbal supplements or foods. He has excellent health insurance which covers alternative medicine such as acupuncture, which he uses as a primary care practitioner for routine assessments as well as an acute care facility. When asked about how he uses this as an acute care facility, he stated the time when his herniated disk was bothering him; he went to the acupuncturist on a daily basis for 10 days with notable improvement and was happy that he did not need conventional medicine.
Passos is very much work and responsibility oriented as when asked about working during illness he stated he would only miss work if he was hospitalized or absolutely could not move from his bed. When assessed on barriers to health care he states that there are not enough alternative medicine health care centers legitimately recognized by Western standards. When asked about his perceptions of the physically and mentally ill, Passos stated that they are in as much need as the rest of us of love, happiness, health and overall well being (L. C. Passos, 2009). Recommendations for Research
The research question proposed is post implementation of findings of the study, “Health Practices and Expectations of Brazilians in the United States” by Roberts (2007). Did the implementation of the findings have an impact on how Brazilians in the United States perceive and obtain healthcare? Or does it go beyond meeting basic needs and extend into a sort of saudade or a “longing” for communication of such personal information to be done in their native language in which they are able to fully express their symptomatology directly to the healthcare provider so that it does not get lost in interpretation?
This study would need to be conducted as qualitative research because the data collected will be a compilation of subjective data and not objective; it will develop theory and not test it. The research method I would use in obtaining this information would be the Giger and Davidhizar Transcultural Assessment Model. This model incorporates (a) communication, (b) space, (c) social organization, (d) time, (e) environmental control and (f) biological variations (Giger & Davidhizar, 2002) and can be tailored to meet the specific needs of this research without obtaining information that may not be pertinent to this specific research.
The next research question proposed would be do Brazilians that are now in the United States have different sexual practices in terms of protection, than they did when they were in Brazil and if so why did that stay the same or change? This would be of value to learn what triggers assisted in this decision making and how it has impacted their lives. This research is best collected using a qualitative study due to the need for opinions and assessments of body language, facial expressions and other non verbal hints but can also be collected as a quantitative study to gather and report data and statistics.
Again, I would use Giger and Davidhizar’s Transcultural Assessment Model for this research and as it can be molded down to be very specific, as is this topic. Applications to Practice Applying this exercise to my current practice as a nurse is one of my essential job functions. As an outpatient nurse working along side oncology physicians, I assess the cultural needs of my patients daily and how they pertain to oncology treatments. The importance of food in family rituals, appearances in social gatherings and spirituality being tested during these trying times, among others are issues addressed with my patients continuously.
This exercise has assisted me in building my confidence in accessing and reporting research materials and data, which is invaluable to the practice of nurse practitioners. As I further my education, I would take the experience of this exercise into practice by mentoring fellow nurses and other hospital staff to be open minded about our patients’ cultural needs and not expect them to just assimilate to the “American” culture. We must value each of them as an individual and treat them with utmost respect and dignity.
In conclusion, it is evident that in many ways Brazilian and American cultures are quite different, but I am assured that they are also similar other ways. Our cultures may vary in many aspects but most are composed of the same parts; human behavior and communication, spirituality, traditions, and values among others. We as nurses are fortunate to break through these differences and learn from them to better our practice as well as ourselves. I would like to thank Mr. Passos for graciously agreeing to this interview. His answers were insightful and educational. His frankness and humility were greatly valued.
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