People of Greek Heritage, People of Cuban Heritage and People of Hindu Heritage.

Description

People of Greek Heritage, People of Cuban Heritage and People of Hindu Heritage.

Read chapter 11, 16 and 30 of the class textbook (

Transcultural Health Care. A Culturally Competent Approach (4th


ed.)



Purnell, L.D.


Publisher:

F.A. Davis Company; 4th edition) review the attached PowerPoint presentations. Read Content chapter 30 in Davis Plus Online Website. Once done present an 800 words essay contracting the cultural and health care beliefs of the Greek, Cuban and Hindu heritage. Please note we are studying two oriental and one occidental heritage. In the essay mention how the Greek and Hindu heritage has influenced the Cuban heritage in term of health care beliefs.

You must cite at least 4 evidence-based references no older than 5 years excluding the class textbook

. The format has to be APA format. A minimum of 800 words must be presented excluding the first and reference page.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ The Republic of Cuba is a multiracial society with
people of primarily Spanish and African origins.
▪ Other ethnocultural groups include Chinese,
Haitians, and Eastern Europeans.
▪ Spain, the United States, and the Soviet Union
significantly influence Cuba’s history and culture.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Mistrust of government has reinforced a strong
personalistic tradition and sense of national
identity evolving from family and interpersonal
relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Desire for personal freedom, hope of refuge,
political exile, and promise of economic
opportunities prompted migration.
▪ Cubans in the United States take great pride in
their heritage and tend to be conservative,
Republican, and anticommunist.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Overview/Heritage
▪ Many possess a strong ethnic identity,
speak Spanish, and adhere to traditional
Cuban values and practices..
▪ The highest concentration of Cubans is in
Florida, although significant numbers live in
New Jersey, New York, Illinois, and
California.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Many Cubans live and transact business in
Spanish-speaking enclaves.
▪ While the second generation speaks Spanish,
many converse with friends or peers in
“Spanglish,” a mixture of Spanish and English.
▪ The highly educated are more likely to speak
English at home.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Many value simpatía and personalismo in their
interactions with others.
▪ Simpatía, the need for smooth interpersonal
relationships, is characterized by courtesy, respect,
and the absence of criticism or confrontation.
▪ Personalismo, the importance of intimate
interpersonal relationships, is valued over
impersonal bureaucratic relationships.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Choteo, a lighthearted attitude with teasing,
bantering, and exaggerating is often observed
in their communications with others.
▪ Conversations are characterized by animated
facial expressions, direct eye contact, hand
gestures, and gesticulations.
▪ Voices tend to be loud, and the rate of
speech is fast.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Touching, handshakes, and hugs are
acceptable among family, friends, and
acquaintances and may be used to express
gratitude to the caregiver.
▪ Touch is common between people of the
same gender; older men and women rarely
touch in public.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Communication
▪ Most tend to emphasize current issues and
problems rather than future ones.
▪ Hora cubana (Cuban time) refers to a flexible period
that stretches 1 to 2 hours beyond designated clock
time.
▪ Most Cubans use two surnames representing the
mother and father’s family names.
▪ Married women may also add the husband’s name.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Traditional family structure is patriarchal,
characterized by a dominant and assertive male
and a passive, dependent female.
▪ Traditionally, Cuban wives stay at home, manage
the household, and care for children, whereas
husbands are expected to work, provide
financially, and make major decisions for the
family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Honor is attained by fulfilling family obligations and
treating others with respeto (respect).
▪ Vergüenza, a consciousness of public opinion and the
judgment of the entire community, is considered more
important for women than for men.
▪ Machismo dictates that men display physical strength,
bravery, and virility and be the spokesperson, even
though they might not make the decisions.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ La familia (the family, nuclear and extended,
including godparents) is the most important
source of emotional and physical support.
▪ Multigenerational (3 to 4 generations)
households are common, including a high
proportion of people 65 years and older who live
with their relatives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ According to U.S. standards, Cuban parents tend to
pamper and overprotect their children.
▪ Children are expected to study, respect their parents, and
follow el buen camino (the straight and narrow).
▪ Boys are expected to learn a trade or prepare for work
and to stay away from vices.
▪ Girls are expected “to remain honorable while single,” to
prepare for marriage, to avoid the opposite sex, and not
to go out without a chaperone.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ When a daughter reaches 15 years, a
quinceaneras, or elaborate 15th birthday party, is
typically held to celebrate this rite of passage for
the daughter.
▪ Adolescents may undergo an identity crisis and
reject their heritage causing parents to feel their
authority is being challenged.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Family Roles and
Organization
▪ Little information is available on homosexuality.
▪ Same-sex behaviors among men may be
regarded as a sign of virility and power rather
than homosexual behavior.
▪ The gay lifestyle is contradictory to the machismo
orientation of this culture. Same-sex couples may
be alienated from their families.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
A 22-year-old from Cuba comes to the prenatal
clinic for the first time. She introduces herself as
Elena Florencia Gonzalez Portillo. The
receptionist should ask what
a. Is your husband’s surname?
b. Is your husband’s last name?
c. Name do you wish to be called?
d. What is your legal name?

Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
The legal name is what should be used for recordkeeping.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Workforce Issues
▪ Cuban ethnic enclaves with a familiar language
and culture have created numerous employment
opportunities for recent Cuban immigrants.
▪ A source of tension is the tendency of Cubans to
speak Spanish with other Cuban or Hispanic
coworkers. Speaking the same language allows
them to form a common bond, relieve anxieties at
work, and feel comfortable with one another.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Workforce Issues
▪ Traditional Cubans recognize supervisors as authority
figures and treat them with respect and deference.
▪ Cubans value a structure characterized by
personalismo, one that is oriented around people rather
than around concepts or ideas.
▪ Personal relationships at work are considered an
extension of family relationships.
▪ Because of the emphasis on the job or task in the
American workplace, many Cubans view this workplace
as being too individualistic, businesslike, and detached.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Biocultural Ecology
▪ Most Cubans are white, and only 5 percent are black with
physical features similar to those of African Americans.
▪ Cuban Americans tend to have lower incidences of
diabetes mellitus, obesity, and hypertension than other
Hispanic groups or whites.
▪ Because of their diet, which is high in sugar, many exhibit
a high prevalence of tooth loss, filled teeth, gingival
inflammations, and periodontitis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Biocultural Ecology
▪ Commonly occurring health conditions of Cubans
are hypertension, coronary artery disease,
obesity, diabetes mellitus, and lung cancer.
▪ Specific information related to drug metabolism is
limited; however, in general, many require lower
doses of antidepressants and experience greater
side effects than non-Hispanic white populations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American High-risk Health
Behaviors
▪ Cuban Americans tend to exhibit a higher
incidence of smoking than other Hispanic or
European groups.
▪ Alcohol use is greater among males than females
and among younger versus older groups.
▪ Violent deaths account for high mortality rates
among adolescents and young adults.
▪ Suicide rates also exceed those of the white nonHispanic population.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
▪ The nurse is using an interpreter to interview the
parents of a 6-year-old Cuban, Leonardo, who
has stomach pain. The nurse should direct
questions to
▪ A. The father.
▪ B. The mother.
▪ C. The interpreter.
▪ D. Both parents.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: D
The nurse should address the questions to both
parents to demonstrate respect to both of them.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Nutrition
▪ Food allows families to reaffirm kinship ties,
promotes a sense of community, and
perpetuates customs and heritage.
▪ Staple foods include root crops like yams,
yuca, malanga, and boniato; plantains; and
grains.
▪ Many dishes are prepared with olive oil, garlic,
tomato sauce, vinegar, wine, lime juice
(sofrito), and spices.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Nutrition
▪ Meat is usually marinated in lemon, lime, sour
orange, or grapefruit juice before cooking.
▪ A leisurely noon meal (almuerzo) and a late
evening dinner (comida), sometimes as late as 10
or 11 PM, are often customary.
▪ Being overweight is seen as positive, healthy, and
sexually attractive.
▪ Food allows families to reaffirm kinship ties,
promotes a sense of community, and perpetuates
customs and heritage.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Cuban women’s fertility rate is lower than that of
other Hispanic American women. Cuba’s current
reproductive rate is among the lowest in the
developing world.
▪ Even before the revolution, Cuba had the lowest
birthrate in Latin America.
▪ The low fertility rate has been attributed to many
women in the workforce.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Preterm births and neonatal and post-neonatal
deaths are lower among Cuban American
women than among other Hispanic American
groups.
▪ Prenatal care is higher than among other
Hispanic and white non-Hispanics.
▪ Mothers tend to use advice about child health
given by their spouses, mothers, mothers-in-law,
and clerks and pharmacists.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Childbirth is a time for celebration with family
members and friends congregating in the
hospital.
▪ Traditionally, men have not attended the births of
their children, but younger, more acculturated,
fathers are frequently present.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ During the postpartum period, ambulation,
exposure to cold, and bare feet place the mother
at risk for infection.
▪ Family members and relatives often care for the
mother and baby for about 4 weeks postpartum.
▪ Most women consider breast-feeding better than
bottle feeding; approximately half choose to
breast-feed.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Pregnancy and
Childbearing Practices
▪ Cutting the infant’s hair or nails in the first 3
months is believed to cause blindness and
deafness.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ In death, as in life, the support of the extended
family network is paramount.
▪ Bereavement is expressed openly as loud crying
with other physical manifestations of grief.
▪ Death is often seen as a part of life and some,
especially men, may approach death stoically.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ The dying person is typically attended by a large
gathering of relatives and friends.
▪ In Catholic families, individual and group prayers
are held for the dying to provide a peaceful
passage to the hereafter.
▪ Religious artifacts such as rosary beads,
crucifixes, or estampitas (little statues of saints)
are placed in the dying person’s room.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ For adherents of Santería, death rites may
include animal sacrifice, chants, and ceremonial
gestures.
▪ Candles are lighted after death to illuminate the
path of the spirit to the afterlife.
▪ A velorio (wake) lasts 2 to 3 days and is usually
held at a funeral parlor or in the home where
friends and relatives gather to support the
bereaved family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Death Rituals
▪ Burial in a cemetery is common practice,
although some may choose cremation.
▪ The deceased are customarily remembered and
honored on their birthdays or death anniversaries
by lighting candles, offering prayers or masses,
bringing flowers to the grave, or gathering with
family members at the grave site.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Approximately 85 percent of Cuban Americans
are Roman Catholic; the remaining 15 percent
are Protestants, Jews, and believers in African
Cuban Santería.
▪ Roman Catholicism is personalistic and
characterized by devotion and intimate,
confiding relationships with the Virgin Mary,
Jesus, and the saints.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Significant religious holidays include Noche
Buena (Christmas Eve), Christmas, Los Tres
Reyes Magos (Three Kings Day), and the
festivals of the La Caridad del Cobre and Santa
Barbara.
▪ Santería is a 300-year-old African Cuban
religious system that combines Roman Catholic
elements with ancient Yoruba tribal beliefs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Followers of Santería believe in the magical and
medicinal properties of flowers, herbs, weeds, twigs,
and leaves.
▪ Sweet herbs such as manzanilla, verbena, and
mejorana are used for attracting good luck, love,
money, and prosperity.
▪ Bitter herbs such as apasote, zarzaparilla, and yerba
bruja are used to banish evil and negative energies.
Santería is viewed as a link to the past and is used to
cope with physical and emotional problems.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Physical complaints may be diagnosed and
treated by a physician, whereas the santero may
assist in balancing and neutralizing the various
aspects of the illness.
▪ Deeply held religious beliefs provide guidance
and strength during the long and difficult process
of migration and adaptation and continue to play
an important role in their day-to-day lives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Spirituality
▪ Belief in a higher power is evident in practices
used to maintain health and well-being or cure
illness, such as using magical herbs, special
prayers or chants, ritual cleansing, and
sacrificial offerings.
▪ Many tend to be fatalistic, believing that they
lack control over circumstances influencing
their lives.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ African Cubans may seek biomedical care for
organic diseases but consult a santero for
spiritual or emotional crises.
▪ Conditions such as decensos (fainting spells) or
barrenillos (obsessions) may be treated solely by
a santero or simultaneously with a physician.
▪ Many tend to seek help only in response to crisis
situations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Many Cuban Americans rely on the family as the
primary source of health advice.
▪ Older women provide traditional home remedies
such as herbal teas or mixtures to relieve mild or
moderate symptoms or cure common ailments.
▪ Older Cuban Americans were socialized into a
strong health ideology and successful primary
care system while still in Cuba.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Use of preventive services in the US is generally
determined more by access to care than by acculturation.
▪ Many Cuban Americans use traditional medicinal plants
in the form of teas, potions, salves, or poultices. In Cuban
communities, stores called botanicas sell herbs,
ointments, oils, powders, incenses, and religious figurines
to relieve maladies, bring luck, drive away evil spirits, or
break curses.
▪ Santería necklaces and animals used for ritual sacrifice
are often available at botanicas.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care Practices
▪ Blood transfusions and organ donations
are usually acceptable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Cuban American Health-care
Practitioners
▪ Both traditional and biomedical care are acceptable.
▪ Folk remedies may be used at home, but if the condition
persists, folk practitioners such as santeros and biomedical
practitioners may be used either simultaneously or
successively.
▪ Santeros may prescribe treatment or perform rituals to
enable ill people to recover by invoking supernatural deities
to intervene to help make them well.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ More than a billion people inhabit India.
▪ Eighty percent of the population are Hindus,
followers of Hinduism.
▪ Other significant religious groups include Sikhs,
Moslems, and Christians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ Different religious sectors share many common
cultural beliefs and practices.
▪ Immigrants to the United States come
predominantly from urban areas, including all
major Indian states.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Overview/Heritage
▪ Most recent immigrants are highly educated.
▪ More than 1,600,000 Asian Indians are living in
the United States.
▪ Most come to the United States to attain a higher
standard of living, better working conditions, and
job opportunities.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Asian Indian languages fall into two main
groups: Indo-Aryan in the north and
Dravidian in the south.
▪ Hindi, with 1,652 dialectical variations, is the
national language along with English.
▪ Women often speak in a soft voice, making it
harder to understand what they say.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Men may become intense and loud when
they converse with other family members.
▪ Women avoid direct eye contact with men.
▪ Direct eye contact with older people and
authority figures may be considered a sign of
disrespect.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Touching and embracing are not acceptable
for displaying affection.
▪ Even between spouses, a public display of
affection such as hugging or kissing is
frowned upon, being considered strictly a
private matter.
▪ Temporality is past-, present-, and future–
oriented.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ Punctuality in keeping scheduled appointments
may not be considered important.
▪ Older family members are usually not
addressed by name but as elder brother, sister,
aunt, or uncle.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Communication
▪ A woman never addresses a man by name
because the woman is not considered an
equal or superior.
▪ Strangers are greeted with folded hands and a
head bow that respects their personal
territory
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ No institution in India is more important than the
family.
▪ The hierarchical structure of authority is the
patriarchal joint family based on the principle of
superiority of men over women.
▪ The male head of the family is legitimized and
considered sacred by caste and religion, which
delineate relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Central relationships are based on continuation
and expansion of the male lineage through
inheritance and ancestor worship, related to the
father-son and brother-brother relationships.
▪ A matrilineal system exists in a few areas in the
southwestern and northeastern regions of the
country; however, power rests with the men in
the woman’s family.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ A submissive and acquiescent role is expected of
women in the first few years of married life with
little or no participation in decision-making.
▪ Strict norms govern contact and communication
with the men of the family, including a woman’s
husband.
▪ Parents strongly encourage and emphasize
scholastic achievement in fields that promise
good employment and a high social status.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Although many parents expect and accept the
Westernization of their children, the question of
marriage is still a concern for parents who have
opinions about how their children should be
married, whether “arranged” or partly arranged.
▪ Hindu parents or Indians from all religious
traditions want their children to marry other
Indians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Arranged marriages at a young age are
considered most desirable for women.
▪ The practice of an arranged marriage continues
in the United States in order to minimize the
stress associated with differences in castes,
lifestyles, and expectations between the male
and female hierarchy.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ The two major types of transfer of material wealth
accompanying marriage are bride price and a
dowry.
▪ Bride price is payment in cash and other
materials to the bride’s father in exchange for
authority over the woman, which passes from her
kin group to the bridegroom’s kin group.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ In the joint family structure, Hindu women are
considered “outsiders” and are socialized and
incorporated in such a way that “jointness” and
residence are not broken up.
▪ A close relationship between the husband and
wife is disapproved because it induces favoring
the nuclear family and dissolving the joint family.
▪ A marriage is regarded as indissoluble.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Family Roles & Organization
▪ Older family members are held in reverence and
cared for by their children when self-care
becomes a concern.
▪ Single-parent, blended, and communal families
are not well accepted by Hindus.
▪ Homosexuality may cause a social stigma.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
A male nurse is giving dietary discharge
instructions to Mrs. Mukhopadhya. She she does
not maintain eye contact with the nurse. This
means she is
a. Embarrassed.
b. Does not understand.
c. Demonstrating respect.
d. Does not care.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
Out of respect, traditional Hindus do not maintain
eye contact with authority figures, nor do females
maintain eye content with men.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Workforce Issues
▪ At work, Hindus adopt American practices and
cultural habits.
▪ Hierarchies of age, gender, and caste prescribe
transactions among Hindus.
▪ At work, relationships are a reproduction of the
authority-dependence characteristic of family and
social relationships.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Workforce Issues
▪ In seeking to establish a personal and
benevolent relationship, Hindus may be seen
as too eager to please, ingratiating, or docile, all
antithetical to the task of assertion and
independence.
▪ Women avoid direct eye contact with men.
▪ Direct eye contact with older people and
authority figures is a sign of disrespect.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Indian diversity of physical types and can be
divided into three general groups according to
the color of their skin:
▪ White in the north and northwest,
▪ Yellow in areas bordering Tibet and Assam, and
▪ Black in the south.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Indids (whites) have a light-brown skin color,
wavy black hair, dark or light brown eyes, are tall
or of medium height, and are either
dolichocephalic (long-headed) or brachycephalic
(short-headed).
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Melanids, often referred to as the Dravidians and
are the population of southern India, have dark
skin ranging from light brown to black, elongated
heads, broad noses, thick lips, and black, wavy
hair.
▪ They are usually shorter than 5 feet 6 inches tall.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Common health conditions of Asian Indians
include malaria, filiariasis, tubersulosis,
pneumonia, cardiovascular diseases, rheumatic
heart disease, sickle cell anemia, dental disease,
lactose intolerance, cancer of the cheek, nose,
and mouth, breast and stomach cancer,
ichthyosis vulgaris, beriberi, thiamine deficiency,
goiter, osteomalacia, dropsy, and flurosis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Biocultural Ecology
▪ Many individuals require lower doses of lithium,
antidepressants, and neuroleptics, and they may
experience side effects even with the lower
doses.
▪ They are also more sensitive to the adverse
effects of alcohol consumption, resulting in
marked facial flushing, palpitations, and
tachycardia.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu High-risk health Behaviors
▪ Alcoholism and cigarette smoking among Hindu
Americans, especially among men, cause
significant health problems.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Dietary habits are complex and regionally varied. Most
believe that food was created by the Supreme Being for
the benefit of man.
▪ The influence of religion is pervasive in food selection,
customs, and preparation methods.
▪ Classification of regional food habits can be two-fold
based on the types of cereals and fresh foods
consumed.
▪ In the first category are rice and bread eaters; in the
second category are vegetarians and non-vegetarians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Vegetarianism is firmly rooted in culture.
▪ The term non-vegetarian is used to describe anyone
who eats meat, eggs, poultry, fish, and sometimes
cheese.
▪ Many Brahmins in North India consider eating meat to
be religiously sanctioned.
▪ In some parts of India, eating fish is acceptable to
Brahmins, whereas in other parts eating meat is
sacrilegious.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Dietary staples include rice, wheat, jowar, bajra,
jute, oilseeds, peanuts, millet, maize, peas,
sugarcane, coconut, and mustard.
▪ Cereals supply 70 to 90 percent of the total
caloric requirements.
▪ A variety of pulses or lentils, cooked
vegetables, meat, fish, eggs, and dairy products
are also consumed.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Heavily spiced (curry) dishes with vegetables,
meat, fish, or eggs are favored, and hot pickles
and condiments are common.
▪ Spice choices include garlic, ginger, turmeric,
tamarind, cumin, coriander, and mustard seed.
▪ Vegetable choices include onions, tomatoes,
potatoes, green leaves, okra, green beans, and
root vegetables.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ In North India, wheat is the staple food. Other
cereals are jowar, bajra, and ragi, consumed in
porridges, gruels, and rotis (baked pancakes).
▪ People from Punjab do not favor fish, and people
from the south generally dislike the idea of meat
of any kind.
▪ In Saurashtra in the south, fish, fowl, flesh, and
eggs are taboo practically everywhere.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Women generally serve the food but may eat
separately from men.
▪ Women are not allowed to cook during their
menstrual periods or have contact with other
members of the family.
▪ Foremost among the perceptions of Hindus is
the belief that certain foods are “hot” and others
are “cold,” and therefore, they should only be
eaten during certain seasons and not in
combination.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Nutrition
▪ Geographic differences in the hot and cold
perceptions are dramatic.
▪ Many foods considered hot in the north are
considered cold in the south. Such perceptions
and distinctions are based on how specific
foods are thought to affect body functions.
▪ Failure to observe rules related to the hot and
cold theory of diseases results in illness.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ Birth control methods include intrauterine devices,
condoms, and rhythm and withdrawal methods.
▪ Grandmothers, mothers, and mothers-in-law are
considered to have expert knowledge in the use of home
remedies during pregnancy and the postpartum period.
▪ Many older women frequently travel to the United States
to assist new mothers in antenatal and postnatal care that
is consistent with traditional customs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ The birth of a son is a blessing because the son
carries the family name and takes care of the
parents in their old age.
▪ The birth of a daughter is cause for worry and
concern because of the traditions associated with
dowry, a ritual that can impoverish the lives of
those who are less affluent.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy and Childbearing
Practices
▪ No taboo against the father being in the delivery
room exists, but men are usually not present
during birthing.
▪ Because self-control is valued, women suppress
their feelings and emotions during labor and
delivery.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Certain “hot” foods like eggs, jaggery, coconut,
groundnut, maize, mango, papaya, fruit, and meat are
avoided during pregnancy because of a fear of abortion
caused by heating the body or inducing uterine
hemorrhage.
▪ Pregnancy is a time of increased body heat; hence, “cold”
foods, such as milk, yogurt, and fruits, are considered
good. Buttermilk and green leafy vegetables are avoided
because of the belief that these foods cause joint pain,
body aches, and flatulence.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Burning sensations during urination, scanty urine,
or a white vaginal discharge are considered
serious signs of significant overheating.
▪ Overeating and consumption of high-protein
foods, including milk, are avoided because such
foods result in an exaggerated growth of the
baby that may lead to a difficult delivery.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Pregnancy & Childbearing Practices
▪ Morning sickness is caused by an increase in
body heat.
▪ Anemia caused by iron deficiency is one of the
nutritional disorders affecting women of
childbearing age. This condition may be
aggravated because of the practice of reducing
the consumption of leafy vegetables to avoid
producing a dark-skinned baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Childbearing Practices
▪ After the birth, both the mother and the baby
undergo purification rites leading to the 11th day.
▪ The baby is officially named on the 11th day
during the “cradle ceremony,” and several rituals
are performed to protect the baby from evil spirits
and to ensure longevity.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Childbearing Practices
▪ The postpartum mother is considered to be impure and is
confined to a warm room and often keeps the windows
closed to protect her against cold drafts. Exposure to air
conditioners and fans, even in warm weather, may be
considered dangerous.
▪ The pollution lasts for 10 days. This period of
necessitated and mandatory confinement assists in
bonding between the mother and the newborn. It provides
the mother with adequate rest and time to tend to the
baby’s needs.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ A sponge bath for the newborn is recommended
until the umbilical cord falls off.
▪ Soft massage to the extremities is recommended
before bathing the infant.
▪ Washing the infant’s hair daily is believed to
improve the quality of the hair.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ During the postpartum period, hot foods, such as
brinjals, drumsticks, dried fish, dhal, and greens,
are good for lactation.
▪ Cold foods, such as buttermilk and curds,
gourds, squashes, tomatoes, and potatoes, are
restricted because they produce gas. Cold foods
are thought to produce diarrhea and indigestion
in the infant.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ Abstentions are primarily practiced for the baby’s
health; harmful influences might be transmitted
through the mother’s breast milk. Some believe
that colostrum is unsuited for infants. Most
women think that the milk does not “descend to
the breast” until their ritual bath on the third day
and, as a result, newborns are fed sugar water or
milk expressed from a lactating woman.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ Breast milk is commonly supplemented with
cow’s milk and diluted with sugar water. A
child’s stomach is considered weak as a result
of diarrhea; therefore, the child is given diluted
milk.
▪ Sources of protein, such as eggs, curds, and
meat are avoided because they might adversely
affect the baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Practices
▪ The mother’s diet the first few days is restricted
to liquids, rice, gruel, and bread.
▪ Boiled rice, eggplant, curry, and tamarind juice
are added to the diet between 6 months and a
year after the birth of the baby.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ A tenet of Hinduism is that the soul survives the
death; death is a rebirth.
▪ The death rite is called antyesti, or last rites.
▪ The priest pours water into the mouth of the
deceased and blesses the body by tying a thread
around the neck or wrist.
▪ The eldest son completes prayers for ancestral
souls, but all male descendants perform the rites;
each offers balls of rice on behalf of the
deceased ancestor.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ The body is usually cremated rather than
interred.
▪ The ashes are immersed or sprinkled in the holy
rivers. Such immersions are of great benefit to
the souls of the dead.
▪ Hindus may save their family’s ashes to later
scatter them in holy rivers when they return to
their homeland.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Death Rituals
▪ Women may respond to the death of a loved one
with loud wailing, moaning, and beating their
chests in front of the corpse, attesting their
inability to bear the thought of being left behind to
handle situations by themselves.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Hinduism, the largest religion and oldest tradition
practiced in India, represents a set of beliefs and a
definite social organization.
▪ Hinduism denotes belief in the authority of Vedas and
other sacred writings of the ancient sages, immortality
of the soul and a future life, existence of a Supreme
God, the theory of karma and rebirth, theory of the four
stages of life, and the theory of four Purusarthas, or
ends of human endeavor.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Orthodox Hindus view society as divinely
ordained on the basis of the four castes: (a)
Brahmin, the highest caste, priests and
scholars, emerged from the head of God; (b)
Kshtriya, warriors, from the arms; (c) Vaisya,
merchants, from the waist; and (d) Sudra,
menials, from the feet of God.
▪ Hindu legal codes are based on the caste
system.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Spirituality
▪ Women often fast one day a week or for a lunar month
to fulfill a vow made to a deity in supplication for a
particular blessing.
▪ Wives frequently fast to secure the continued health of
their husbands and families.
▪ Shrines may be set up in the living room, dining room,
or in a back room or in a closet.
▪ The shrine typically contains representations or
symbols of one or more deities.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
The wife of Mr. Ganganna ask the nurse to arrange
antyesti for her critically ill husband. The nurse
recognizes that antyesti is
a. Last rights.
b. A Hindu religious leader.
c. A traditional Hindu healer.
d. A strength enhancing special drink.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Antyesti is last rights among Hindus.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Physical examinations are especially traumatic to
women who may not have experienced or heard
about Pap tests and mammography exams.
▪ Most individuals believe that illnesses attack an
individual through the mind, body, and soul.
▪ Some believe that too much sexual activity and
worry are associated with tuberculosis.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Suffering of any kind produces hope, which is essential to
life.
▪ To maintain harmony between self and the supernatural
world, the belief that one can do little to restore health by
oneself provides a basis for ceremonies and rituals.
▪ Worshiping goddesses, pilgrimages to holy places, and
pouring water at the roots of sacred trees have medicinal
effects in healing the sick person and in appeasing the
planets to help prevent illnesses and misfortunes.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ In Ayurveda, the traditional system of medicine in India,
the primary emphasis is on the prevention of illnesses.
Individuals have to be aware of their own health needs.
▪ One of the principles of Ayurveda includes the art of living
and proper health care, advocating that one’s health is a
personal responsibility.
▪ The key to health is an orderly daily life in which personal
hygiene, diet, work, and sleep and rest patterns are
regulated.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ A common health problem is self-medication.
▪ Those migrating to America are accustomed to
self-medicating and may bring medications with
them or obtain medications through relatives and
friends.
▪ The traditional healers use Ayurvedic, Siddha,
and Unani medical systems all of which are
based on the Tridosha theory.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ The Ayurvedic system uses herbs and roots; the
Siddha system, practiced mainly in the southern
part of India, uses medicines; and the Unani
system, similar to the Siddha, is practiced by
Muslims.
▪ According to the Tridosha theory, the body is
made up of modifications of the five elements:
air, space, fire, water, and earth.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Because of their religious beliefs of karma,
Hindus may attempt to be stoic and may not
exhibit symptoms of pain.
▪ Pain is attributed to God’s will, the wrath of God,
or a punishment from God and is to be borne
with courage.
▪ Family may not want to disclose the gravity of an
illness to the patient or discuss impending
disability or death for fear of the patient’s
vulnerability and loss of hope, resulting in death.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ The sick role is assumed without any feeling of
guilt or ineptness in doing one’s tasks.
▪ The individual is cared for and relieved of
responsibilities for that time.
▪ Psychological distress may be demonstrated
through somatization, which is common,
especially in women.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practices
▪ Because of the stigma attached to seeking
professional psychiatric help, many do not
access the health-care system for mental health
problems.
▪ Mental illness is considered to be God’s will.
▪ No Hindu policy exists that prevents receiving
blood or blood products.
▪ Donating and receiving organs are acceptable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ Although Hindus in general have a favorable attitude
toward American physicians and the quality of medical
care received in the United States, relatives and friends
are usually consulted before health-care professionals.
▪ Physicians are considered omnipotent because God
grants cures through physicians.
▪ Clients tend to be subservient and may not openly
question physicians’ behavior or treatment.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Hindu Health-care Practitioners
▪ Physician is also viewed like an older person in the
family; a protective, authoritative, and responsible
relationship; and a parent-child relationship.
▪ Mental health traditional healers such as Vaids, practice
an empirical system of indigenous medicine; mantarwadis
cure through astrology and charms; and patris act as
mediums for spirits and demons.
▪ Women are especially modest, generally seeking female
health-care providers for gynecologic examinations.
2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 1
Chapter 30
People of Greek Heritage
Irena Papadopoulos and Larry D. Purnell
We wish to acknowledge Maria Athanasopoulou’s contribution in obtaining data that helped to update this chapter.
Overview, Inhabited Localities,
and Topography
Overview
This chapter presents two groups of people with
Greek heritage. The first group refers to those people
or their ancestors who emigrated from Greece. The
second group originated in Cyprus. Both groups share
the same history and have a common language and religion. The Greek and Greek Cypriot diaspora is of
considerable size and is spread to all continents and
numerous countries. The largest Greek community
outside Greece is in America; the largest Greek
Cypriot community outside Greece is in Britain.
Therefore, the main focus of this chapter is on the
large Greek American community, with a secondary
focus on the British Cypriot community. Although geographic location and social context are important,
many of the issues and principles discussed in this
chapter can be applied to the broader diaspora. When
the term American is used in this chapter, it refers to
residents of both Canada and the United States.
Greece, a small country in southern Europe with a
climate similar to that of southern California, covers
slightly more than 50,000 square miles (131,940 sq km)
and has a population of over 10.7 million (CIA World
Factbook, 2011a). The capital, Athens, has a population of 3.252 million. The population is 93 percent
Greek and the rest other. Greece does not collect data
on ethnicity (CIA World Factbook, 2011a). The land
is very mountainous with small patches of fertile land
separated by hills, mountains, and a plethora of small
and medium-sized islands. The main crops are wheat,
grapes, olives, cotton, and tobacco. Geopolitical
boundaries have shifted dramatically over time.
Greeks struggled under 400 years of Turkish rule,
which ended in 1829. At that time, the Peloponnese,
central Greece, and some of the Aegean Islands were
freed. Later, Thessaly, Macedonia, Crete, the Ionian
Islands, Epirus, Thrace, and the Dodecanese were
incorporated into Greece’s boundaries. Greece joined
the European Union in 1981.
Cyprus, located in the most eastern part of the
Mediterranean Sea, is a small mountainous island
with an area of 3572 square miles (9251 sq km). The
capital is Nicosia with a population of 240,000 people.
The total population of Cypriots is 1,240,000 million
of whom 77 percent are Greek Cypriots, 18 percent
are Turkish Cypriots, and 5 percent other (CIA World
Factbook, 2011b). Since the entry of Cyprus into the
European Union, a significant increase of economic
migrants and asylum seekers has been recorded
(Cyprus Statistical Services, 2011). Cyprus has a rich
history and culture, the result of many influences over
9000 years. Mycenean and Achaean Greeks settled in
Cyprus around the 14th century B.C. After the Trojan
War, legendary Greek heroes visited the island, where
they were associated with the founding of great cities
such as Salamis, Kourion, and Paphos. The Achaean
Greeks had a profound and lasting influence on the
culture of Cyprus, introducing their language, religion,
and customs. After the death of Christ, St. Paul traveled to Cyprus, where he was joined by St. Barnabas
and St. Mark. The island was the first country to have
a Christian ruler when Sergius Paulus was converted.
The Greek Orthodox Church stems from Cyprus.
Cyprus gained its independence from Britain in
1960; however, the Constitution of the Republic of
Cyprus proved unworkable, making a smooth implementation impossible. Following episodes of ethnic
conflict between Greek and Turkish Cypriots, Cyprus
was divided in 1974 following the invasion of Turkey.
Almost half the population was displaced, with Greek
Cypriots settling in the south and west of the island
and Turkish Cypriots settling in the north and east.
The characteristics of members of the Greek and
Greek Cypriot communities vary considerably according to the time of immigration (with earlier immigrants being predominantly younger, rural males), the
characteristics of the site of immigration (rural,
1
2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 2
2
Aggregate Data for Cultural-Specific Groups
island, or urban), the variant cultural characteristics
(refer to chapter 1 in this book ), and the number of
generations since initial immigration. Despite considerable temporal and geographic variation, several core
themes are common to people who retain affiliation
with a Greek community—emphasis on family, honor,
religion, education, and Greek heritage.
The core values of philotimo (honor and respect) and
endropi (shame) are key when considering the experience
of Greeks and Greek Cypriots. Although values of
honor and shame are found in all societies, these attain
immense importance among Mediterranean groups.
Although philotimo is a characteristic of one’s family,
community, and nation, it most centrally implies concern for other human beings. Philotimo is a Greek’s
sense of honor and worth, derived from one’s selfimage, reflected image (respect), and sense of pride.
Philotimo is enhanced through courage, strength,
fulfilling family obligations, competition with other
people, hospitality, and right behavior. Shame results
REFLECTIVE EXERCISE 30.1
Mr. Marios Stavrakis is a 49-year-old Greek who arrived in
New York from Crete at the age of 21. After working very hard
doing different jobs for a number of years he saved enough
money with which he started a business with his best friend
Mr. Soteris Ioannou, who is also his son’s godfather. As the business grew the partners spent less time with each other since
each one had separate responsibilities within the company.
About a year ago Mr. Stavrakis developed signs of depression. His wife noticed that he was worried about something,
was frequently anxious, and at the same time appeared to
have less energy and vitality than usual. When he started neglecting the business he so much loved and had worked so
hard to make successful, his wife insisted that he see a doctor.
Mr. Stavrakis was prescribed antidepressants but took the
medication infrequently and then he stopped it all together.
His condition deteriorated and he began to obsessively
talk about philotimo. When he eventually saw a psychiatrist he
explained that he discovered that his best friend and business
partner was making deals behind his back and that he was
embezzling money from the company. He had suspected this
some time ago but did not want to report his best friend to
the police while at the same time he could not deal with his
anger and disappointment as he felt totally betrayed by a man
whom he trusted.
1. How has the belief about the importance of philotimo
influenced the behavior of Mr. Stavrakis?
2. Why was Mr. Stavrakis reluctant to report his friend to the
police? What cultural values influenced his actions?
3. Why did he not seek medical help and why was he
eventually persuaded by his wife to see a doctor?
from any conduct that is considered deviant. The system of honor and shame in the Mediterranean countries derives from the complementary opposition of
the sexes, the solidarity of the family, and the relationships of hostility and competition between unrelated
or unconnected families.
Heritage and Residence
Today, Greeks in America are a composite of three
immigrant groups: an older group who came before
or just after World War I, a second group who arrived
after the relaxation of immigration laws in the mid1960s and who constitute the main group in the Greek
American community, and the American-born children and grandchildren of these immigrants.
The earlier Greek immigrants congregated for the
most part in the western states of Utah, Colorado, and
Nevada, where they worked in mines and on railroad
crews; in the New England states of New Hampshire,
Massachusetts, and Connecticut, where they worked in
shoe and textile factories; and in the large northern cities
of Chicago, Detroit, Toledo, Milwaukee, Philadelphia,
Buffalo, Cleveland, and New York, where they worked
in factories or found jobs as shoe shiners or peddlers.
The greatest proportion of Greeks in America continues to live in the Northeast and the Midwest. Most
live in large urban areas such as New York and
Chicago. Whereas new immigrants still tend to gravitate toward the established Greek communities in
cities, many Greeks in America have relocated to
the suburbs (Moskos, 1989). The Greek communities
in the United States and Canada are the biggest
Greek diasporic communities. It is estimated that
there are 1.2 million people of Greek heritage living
in the United States and around 350,000 in Canada
(Kitroef, 2009).
Reasons for Migration and Associated
Economic Factors
Significant Greek migration occurred during the late
19th and early 20th centuries. During this period, migration depleted the population of Greece by about
one-fifth. Economic factors were largely responsible for
this mass exodus. In the latter part of the 19th century,
Greece suffered a major economic crisis resulting from
a nearly complete failure of its major crop, currants;
relatively heavy governmental taxation to sustain an
army against hostilities with Turkey; and family pressure on fathers and brothers to supply a substantial
dowry for unmarried women in the family. Before
the 1880s, relatively few Greek immigrants entered
the United States. It was not until the start of the
20th century that massive numbers of Greek immigrants came to America.
Between 1900 and 1920, almost 350,000 Greeks came
to America, 95 percent of them men (Scourby, 1984).
They came with dreams of economic opportunity in
2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 3
People of Greek Heritage
America, hoping to make enough money to provide
good dowries for their sisters and daughters and to be
able to return to Greece with enough money to live
comfortably in their villages. At the time, Greece was
beleaguered by turbulent internal politics and was a
difficult place for the average Greek peasant to earn a
decent living.
Most Greek migrants planned to stay in the
United States for a short period of time, and one in
four of them managed to achieve this. As the arrival
of young Greek women—potential wives—post
1920s increased, a number of men decided to put
more permanent roots in their host country. With
growing communities, and the establishment of small
family businesses, Greek migrants began to integrate
into American society (Kitroef, 2009).
Legislation passed in 1921 and 1924 transformed
America’s open-door policy toward European immigrants into a closed-door policy greatly affecting the
number of Greek immigrants who came into the
country. While in 1921, 28,000 Greek immigrants
came to America, the next year, the quota of Greeks
allowed into the country was reduced to 100. This was
raised to 307 in 1929, and remained at that level for
three decades (Moskos, 1989). Greek immigrants who
had cared little about becoming American citizens
saw citizenship as the only chance to bring other
family members to America or to be able to return to
America after visiting Greece. In addition, because
fewer people were emigrating from Greece, membership in the Greek American community consisted of
increasing numbers of American-born Greeks.
During most of the 1930s, the number of Greeks
returning to Greece exceeded the number coming to
America (Moskos, 1989). Despite the economic downturn in the United States, Greeks in America managed
to invest a great deal of energy in their communities.
Greek-language schools were started for their children, the Greek Orthodox Archdiocese centralized,
and charitable organizations were established for the
poor. When the Great Depression came, however,
everyone in America was affected, including the Greek
immigrants. Many businesses failed, jobs were lost,
and fortunes disappeared.
The Italian invasion of Greece in 1940 precipitated Greece’s entry into World War II and a great
outpouring of support from the Greek American
community for the home country. After America entered the war in 1941, the intermingling of Greek
and American interests produced a combination of
American patriotism with Greek ethnic pride, which
underscored the great love that Greeks in America
felt for both their home and their adopted countries.
The immigration laws, however, kept the actual
number of new Greek immigrants to a minimum
until the 1950s (U.S. Immigration and Naturalization Service, 1993).
3
Although the quota system was maintained, special
legislation in 1953 allowed those who had been displaced by the war and those who wished to reunite with
their families to enter America. In addition, countries
were allowed to “borrow” on quotas for future years. As
a result, approximately 70,000 Greeks entered the
United States between World War II and 1965. During
this time, the immigration laws dating from the 1920s
were liberalized. This large influx rejuvenated the Greek
American community’s ties to Greece and changed the
composition of the Greek community from Greeks with
American citizenship to Americans of Greek descent.
By this time, the third generation of Greek Americans
was being born. The Immigration Act of 1965 lifted
the earlier restrictive quotas, allowing more Greeks to
immigrate to America.
Whereas the U.S. Census 2000 reported that
1,153,307 people of Greek descent lived in America,
in 2006, 12,723 Greeks emigrated to the United States
(Statistical Yearbook, 2006). The decline in Greek immigration to the United States is attributed to several
factors that are largely economic. Improvement of
economic conditions in Greece has lessened the impetus to emigrate. Canada and Australia have more
lenient visa requirements than the United States.
Finally, with the entry of Greece into the European
Union (EU) in 1981, Greeks were able to freely move
within the EU, thus reducing the number of people
emigrating to the United States to an estimated
2000 per year. Greece in the 21st century is changing
from a country of outward emigration to one of
inward immigration.
Immigration for Greek Cypriots is a very old phenomenon (Panayides, 1988). This is exemplified by
the figures from a survey published by the Ministry
of Education in Cyprus and cited by the Cyprus High
Commission in Britain (1986), which numbered the
Cypriot population in London as 208 in 1911; 1059
in 1931; 10,208 in 1941; 41,898 in 1961; and 78,476 in
1964. The first major group of Greek Cypriots who
emigrated to Britain arrived in the 1930s. Because
Cyprus was a British colony, young men seeking
employment made their way to Britain and primarily
settled in the Camden Town and Soho areas of
London but later spread to Islington, Hackney, and
northward to Haringey.
The second wave of emigration occurred in 1960 to
1961 when 25,000 Cypriots left for Britain when
Cyprus became a republic. This number was reduced
to less than 2000 a year after the Commonwealth
Immigrants Act of 1962. The last wave of emigration
occurred in 1974 following the troubles between the
Turkish and the Greek Cypriots, when an estimated
50 percent of Cypriot people became refugees in their
own country. By 1974, an estimated 120,000 Cypriots
were in Britain, of whom five out of six were of Greek
origin and the remainder of Turkish origin.
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4
Aggregate Data for Cultural-Specific Groups
In 1986, the Cyprus High Commission reported that
some 200,000 Cypriot-born people and descendants of
Cypriots (Greek and Turkish) were living in Britain. In
1996, the Greek Orthodox Archdiocese in Great Britain
reported that London alone was home to more than
250,000 Greek and Greek Cypriot people. These figures
were derived from church attendance, numbers of weddings, baptisms, and funerals performed, as well as by
the number of children attending the church-run and
independent Greek schools. In addition to the Londonbased Greek Cypriot population, large communities
are found in many other British cities, particularly
Birmingham, Bristol, Manchester, Great Yarmouth,
and Glasgow. The Greek and Greek Cypriot communities in Great Britain continue to increase, and in 2011
they are estimated to be in excess of 300,000.
Educational Status and Occupations
Most early Greek and Greek Cypriot immigrants were
poor men who had limited education. However, they
had a very strong work ethic, determination, and ethnic pride. Their achievements are evident in the
schooling patterns of Greek immigrants and fostered
by the competitive dimension of the Greek character.
Greek children are expected to succeed in school. This
attitude is fostered by an achievement orientation,
high educational and occupational aspirations, a
cohesive family unit that exhorts children to succeed,
nationalistic identification with the cultural glories of
ancient Greece, and private schools that teach the
Greek language and culture (Marjoribanks, 1994).
Typically, this pattern of achievement continues
into adulthood and is reflected in career success.
Most third-generation Greeks in America have attended college. During the 1965 immigration, Greeks
coming to America included educated professionals
and students in professional fields such as engineering, medicine and surgery, and other academic areas
(Moskos, 1989).
A common theme (repeated so often it has become
an archetype) is that of Greek parents who came from
an impoverished land with no money or education.
Lacking English language skills, most of these immigrants had no recourse except to accept low-paying
jobs as peddlers pushing carts and shoe shiners. Greek
and Greek Cypriot men disliked working for others
and considered it a violation of pride (philotimo).
They were industrious and frugal and eventually saved
enough money to start their own businesses, such as
restaurants and cigar and candy stores (Lovell-Troy,
1990). In Britain, a number of Greek Cypriots established small clothing factories, and some opened food
shops specializing in foods imported from Cyprus.
Greek and Greek Cypriot people take pride in controlling their own businesses and have done very well
economically. Initially, they sought these opportunities to save money to return to their homeland, but the
more successful they became, the more likely they
were to remain in America and Britain.
In America, Greek immigrants who earned only marginal wages were more likely to return to Greece. This
description represents the typical pattern in the eastern
and northern parts of America. In the west, men
worked on railroads and in mines and exhibited greater
rates of marriage outside the Greek community because
of their smaller numbers in these more-remote communities. Often, once they had settled, worked hard, and
acquired some capital, these Greeks too became entrepreneurs, opening shops and small businesses and eventually acquiring American citizenship.
In the United States, Greek immigrants attained
middle-class status more rapidly than most of their
fellow immigrants. As America grew more affluent in
the 1920s, so did the Greek immigrants. During the
1950s, even more Greeks in America ascended into the
middle class. American-born Greeks held mostly
white-collar jobs, and many Greek immigrants owned
small businesses. Professions such as engineering,
medicine, pharmacy, scientific research, and teaching
are favored by Greek Americans (Kunkelman, 1990).
Second and subsequent generations of Greeks and
Greek Cypriots continue to establish their own or run
family businesses (Kapa Research, 2007), although
more of them are currently entering professions such
as medicine, accounting, and law.
Communication
Dominant Languages and Dialects
Although all Greeks, whether in Greece, Cyprus, or
the diaspora, use the same form of written Greek,
regional and country variations in spoken Greek do
exist. Diasporic Greek communities regard the retention of the Greek language as an essential part of their
Greek identity, so numerous efforts are continually
being made to encourage second and subsequent
generations to speak Greek. Papadopoulos and Papadopoulos (2000) surveyed young British-born
Greeks and Greek Cypriots living in Britain to determine how they defined themselves in terms of ethnic
identity. Of the 94 people who responded, 87 defined
themselves as British Greek/Greek Cypriots or just
Greek/Greek Cypriots. Forty-six reported that they
spoke Greek fluently, 35 spoke enough to “get by,”
and 10 spoke “basic” Greek. Only three respondents
reported not being able to speak any Greek. The
spread of the Greek language is achieved by attending
Greek-language schools, using Greek in the home,
and regularly visiting Greece or Cyprus. Robins and
Askoy (2001) argued that people of second and subsequent generations of any migrant community who
are able to speak their mother tongue are more successful as they achieve greater cultural mobility.
Knowledge of both Greek and English (or any other
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language, depending on the country of residence) enables people of Greek heritage to move through the
cultural spaces both of their ancestors and of their
adopted country. This is a helpful and nourishing
process for both the individual and the collective.
Cultural Communication Patterns
Because Greeks and Greek Cypriots value warmth,
expressiveness, and spontaneity, northern Europeans
are often viewed as “cold” and lacking compassion.
Protection of family members and maintenance of
family solidarity tend to be foremost among their
values. As a consequence, they are often friendly
but somewhat superficial and distant with those
considered “outsiders.”
Greek and Greek Cypriot people tend to be expressive in both speech and gestures. They embrace family,
friends, and others to indicate solidarity. Eye contact
is generally direct, and speaking and sitting distances
are closer than those of other European Americans.
They gesture frequently with their hands while talking. Whereas innermost feelings such as anxiety or depression are often shielded from outsiders, anger is
expressed freely, sometimes to the discomfort of those
from less-expressive groups.
In health-care situations, patients often appear to
be compliant in the presence of the health-care
worker, but this may be only a superficial compliance,
employed to ensure a smooth relationship. Greeks
consider deeds to be much more important than what
one says.
Temporal Relationships
Greeks and Greek Cypriots demonstrate a variety of
temporal orientations. First, they are oriented to the
past because they are highly conscious of the glories
of ancient Greece. They are present oriented with regard to philotimo, family life, and situations involving
family members. Finally, they tend to be future oriented with regard to educational and occupational
achievements.
Greek Americans differentiate between “Greek
time,” which is used in family and social situations,
and “American time,” which is used in business situations. Greek time emphasizes participating in activities
until they reach a natural breaking point, whereas
American time emphasizes punctuality.
5
such as Eleni (Helen) and Alexandros (Alexander).
Ideally, first daughters are named for the mother’s
mother, and first sons after the father’s father. Following tradition, middle names are the first name of the
father; thus, all children of Stavros might carry his first
name as their middle name.
In health-care situations, it is not appropriate to call
older women or men by their first names. The prefix
“Kyria” (Mrs) or “Kyrie” (Mr) should be used with
the first name, for example, Kyria Maria or Kyrie
Alexandre; the preferred mode of address is to use
their surname preceded by Mr., Mrs., or Miss.
Family Roles and Organization
Head of Household and Gender Roles
The father is considered the head of the household in
Greek and Greek Cypriot families. However, the complexity of household dynamics is noted in the wellknown folk phrase “the man is the head, but the wife
is the neck that decides which way the head will turn.”
This saying acknowledges the primacy of fathers in
the public sphere and the strong influence of women
in the private sphere. In recent years, increased recognition of a trend toward more equality in decision
making has occurred.
Most important, however, in consideration of gender roles are the complementary values of honor
(philotimo) and shame (endropi). These core values
tend to set the pattern for the family and for the
enactment of gender roles. Although the educational
levels of women have often matched those of their
brothers in the past, women usually did not work outside the home, particularly after they married. A
woman may, however, have worked in her husband’s
store or restaurant. Women of later generations who
obtained professional degrees tended to work after
their children were in school. The roles of husband
and wife are characterized by mutual respect (a partnership). However, their relationship is less significant than that of the family as a unit. Fathers are
responsible for providing for the family, whereas
women are responsible for management of the
home and children. Traditionally, the cleanliness
and order of the home reflect the moral character
of the woman.
Format for Names
Prescriptive, Restrictive, and Taboo Behaviors
for Children and Adolescents
It is customary for honorific titles to be given to members of the community who are older people or otherwise respected. Terms such as Thia (aunt), Kyria
(Mrs.), or Giagia (grandma) may be used. For Greeks
and Greek Cypriots everywhere, having a Greek name
is an important sign of their heritage. First names
come either from the Bible, such as Maria and Petros
(Peter), or from ancient Greek mythology and history,
Children are included in most family social activities
and tend not to be left with babysitters. The child is the
recipient of intense affection, helpful interventions,
and strong admiration. The child may be disciplined
through teasing, which is believed to “toughen” children and make them highly conscious of public opinion. The family environment has been identified as
strongly pressuring for dependence and achievement.
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REFLECTIVE EXERCISE 30.2
Mr. Andreas Georgiou was born in the United States in 1955.
His parents had left Greece in 1952 to join his father’s brother,
who had migrated a few years earlier. They both worked in his
uncle’s small restaurant until they were able to open their own
in partnership with his uncle. Andreas has two younger sisters.
His parents spent whatever little time they had helping at the
local Greek Orthodox Church and insisted that he and his sisters attend the Saturday Greek school. Andreas remembers
his father saying, “We must never forget where we come
from.” He also remembers how protective his parents were,
particularly toward his sisters who, in his view, did not have the
freedoms he had. “My parents always said that young women
with sexual freedom have bad reputations and decent men do
not want to marry them.” Both his sisters did well at school
and were able to find good jobs and good husbands. He studied art at the university and has his own printing business. Ten
years ago, Andreas suffered from depression. “This started
when I found out that my second child was severely disabled.
I could not cope with it. We consulted numerous specialists
searching for a cure. We prayed and prayed. At first, I could
not speak about my son to anyone other than my closest
family. I never shared my emotional turmoil with my work colleagues, and this was a major stress for me. When I eventually
had to share my ‘secret,’ they were all very understanding.”
Today, Andreas was visiting his therapist for the last time. The
therapist had helped him work through his self-blame, anxiety,
and sadness. He has come to love his son for who he is.
1. What cultural values drove Andreas’ parents after their
migration to the United States?
2. Why were his parents so protective toward their
daughters?
3. What cultural values might have led Andreas to feel so
devastated that he tried to hide his son’s disabilities?
The family goals of achievement are directed toward
and internalized by the children.
Greek American and British Greek Cypriot families stay intact longer than other American or British
families because adolescents, particularly young
women, tend to reside with their parents until they
get married. Formerly, men did not marry until their
sisters’ prika (dowry) was established and they
had married. Among first-generation immigrants,
single men often returned to Greece or Cyprus for a
bride. A proxenistra (matchmaker) and the families,
pending the approval of the young person involved,
usually arranged these marriages. Today, spouse
selection is left to the young person, with parental
approval.
Girls have considerably less freedom than their
brothers in dating, and it is common for them to be
prohibited from dating until they are in the upper
grades in high school. Adolescents in more-traditional
families may experience stress as the differences in
family and peer values precipitate family conflict. In
fact, suppression of personal freedom by parents is a
major risk factor for suicidal attempts among Greek
and Greek Cypriot adolescent girls (Beratis, 1990).
Additional areas of high stress for Greek adolescents
include extreme dependence on the family, intense
pressure for school achievement, and a lack of sexual
education in the home.
Family Goals and Priorities
Greek and Greek Cypriot families tend to be very close.
Within the family, members are expected to express
unlimited respect, concern, and loyalty. Sym-betheri
(in-laws) are considered first-degree relatives. Family
solidarity is the context in which the values of honor
and shame are measured. Prestige is connected to
the idea that honor is not individualistic but collective.
Because a person loses honor if kin act improperly, the
honor of each family member is a matter of concern for
all family members.
Older people hold positions of respect within the
Greek and Greek Cypriot communities. Their stories,
whether as pioneers, veterans, or hard-working businessmen, are well known throughout the community.
Their notable deeds are heralded and documented in
community histories, which are usually maintained by
the Greek Orthodox churches in each local community. Treatment of the giagia (grandmother) and the
pappou (grandfather) reflects the themes of closeness
and respect emphasized in the family. Grandparents
tend to participate fully in family activities. Families
feel responsible for caring for their parents in old age,
and children are expected to take in widowed parents.
Failure to do so results in a sense of dishonor for the
son and guilt for the daughter. If the older person is
ill, living with the family is the first preference, followed by residential-care facilities. Although living
alone is often the least-preferred residential pattern,
many older people are choosing to live alone in their
own home, supported by family, friends, and healthcare providers. Older Greek and Greek Cypriot widows and widowers, particularly those who speak little
or no English, may experience social isolation if they
do not have close contact with their children.
An important role is that of fictive kin, termed
koumbari (coparents), who serve as sponsors in either
(or both) of two religious ceremonies: baptism and
marriage. Ideally, the baptismal sponsor also serves as
the sponsor of the child’s marriage. The relationship
of sponsor is so important that families who are
joined by this bond of fictive kinship are prohibited
from intermarrying, although this is not always adhered to nowadays.
The basis of social status and prestige is family philotimo and cohesiveness. However, social status is also
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received from attributes such as wealth, educational
achievement, and achievements of its members. Honor
is the social worth of the family as judged by the community. A family’s status and integrity are validated
when they support one another during times of misfortune such as poverty or dishonor.
Alternative Lifestyles
Greek and Greek Cypriot communities tend to be
relatively conservative. As a consequence, alternative
lifestyles encompassing premarital sex, same-sex
relationships, and to a lesser extent divorce, are considered sources of concern for family members and
the community. A number of religious and community support organizations in the United States
and elsewhere provide support (See Resources on
DavisPlus). No specific information or resources
specific to Greek gay, lesbian, and transgendered
people in the United States could be located. The
only resources in Greece and Cyprus were travel
sites that provided little information on cultural
beliefs and values.
Workforce Issues
Culture in the Workplace
In the United States, the high achievement orientation and work ethic have resulted in Greeks serving
as a “model” ethnic group. However, more-recent
immigrants with little education have not been as
upwardly mobile. Workforce issues in which the interplay between gender and poverty are at work have
been well described. Although incidents of discrimination and segregation, including acts of physical
violence and murder directed at Greek immigrants,
were common early in the 20th century, less discrimination occurs in the workplace today. The Greeks’
and Greek Cypriots’ rapid, selective acculturation
has been addressed in earlier sections on migration,
occupation, and education.
Issues Related to Autonomy
Probably no single characteristic applies so completely
to members of the Greek and Greek Cypriot communities as the emphasis on self-reliance within a family
context. Greeks and Greek Cypriots in North America, Britain, Australia, and Sweden stress this trait. It
is seen as reluctance to be told what to do and is given
as a major reason for their pattern of establishing their
own businesses as soon as possible.
Biocultural Ecology
Skin Color and Other Biological Variations
Greeks and Greek Cypriots are most commonly of
medium stature, shorter than northern Europeans
but taller than other populations of southern Europe.
Although some Greeks are blue eyed and blond, usually
7
those from the northern provinces of Greece, most
Greeks have dark hair and dark skin.
Diseases and Health Conditions
Current causes of death among Greeks and Greek
Cypriots are those of developed countries and include
cancer and cardiovascular and cerebrovascular diseases (World Health Organization, 1994).
Since the early 1970s, an increase in diabetes and
heart disease has occurred in both Greece and Cyprus.
Tokas (1995) reported that in Cyprus, 2000 people
die each year from heart disease, whereas each year
600 Greek Cypriots are sent abroad for cardiac surgery. In a study of the health needs of Greek Cypriots
living in London, Papadopoulos (1998) found that
96 percent of the respondents ate red meat; of
these, 35 percent did so on most days of the week.
Nearly 50 percent of the women and 36 percent of the
men in the study were overweight. Allender and colleagues (2008) reported that cardiovascular diseases
continue to be the main reason for deaths in Greece
and Cyprus and that this is due to bad dietary habits,
smoking, and lack of exercise. In Cyprus 37 percent
of the deaths in men and 40 percent of those in
women are due to cardiovascular conditions. In
Greece the corresponding figures are 45 percent and
52.2 percent (Allender et al., 2008).
Two important genetic conditions, thalassemia and
glucose-6-phosphate dehydrogenase (G-6-PD), are
seen in relatively high proportions among Greek populations. They likely result from the selective advantage against malaria that these diseases confer on
hemizygotic carriers. In the red blood cell, G-6-PD is
a key enzyme in the hexose monophosphate shunt,
which prevents oxidation of hemoglobin to methemoglobin. This pathway is essential to maintaining the
integrity of the red blood cell and to preventing hemolysis. G-6-PD is important in the metabolism of
glutation, an antioxidant agent. G-6-PD deficiency
leads to hemolysis, which is generally well tolerated
except under specific circumstances, including exercise, infections, and the presence of oxidant drugs. The
genetic locus for the deficiency is on the X chromosome, making it more common among males than females. The possibility of G-6-PD deficiency should be
considered in Greek patients with unconjugated jaundice (Todd, Samaratunga, & Pembroke, 1994).
Thalassemia is an inherited genetic disorder manifested by a slow production of or failure to synthesize
hemoglobin A or B chains. Two main types are commonly known: thalassemia major (sometimes known
as Cooley’s anemia, homozygous, or beta thalassemia
major) and thalassemia minor (referred to as thalassemia trait, or beta thalassemia minor). Thalassemia
major is a serious condition that, if untreated, will result in death owing to very low levels of hemoglobin
and the fragility of the abnormal red blood cells.
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Undiagnosed infants become pale and irritable, do not
eat, suffer from recurrent fever, and fail to thrive.
Eventually, the liver, spleen, and heart are damaged as
a result of the accumulation of iron contained in the
red blood cells. However, if the child is correctly diagnosed, treatment with regular blood transfusions (usually monthly) and prevention of iron overload with
deferoxamine (Desferal) will provide an average life
expectancy. Various other treatments such as bone
marrow transplants have recently become available.
Conversely, most individuals with thalassemia
minor are not aware of it unless they are tested for it.
The UK Thalassemia Society reports that 1 in 7
Cypriots (including Turkish Cypriots) and 1 in 12
Greeks are thalassemia carriers (Todd et al., 1994). In
recent years, prenatal screening programs in Greece
and Cyprus, as well as other countries such as Britain,
America, Canada, and Australia, where most of the
diaspora resides, have drastically reduced the number
of babies being born with thalassemia major. Most
Greek and Greek Cypriot women choose to have an
abortion if they are found to carry an affected fetus.
Variations in Drug Metabolism
G-6-PD deficiency can result in a life-threatening
hemolytic crisis after oxidating drugs (including
primaquine, quinidine, thiazolsulfone, dapsone, furzolidone, nitrofural, naphthalene, toluidine blue,
phenylhydrazine, and chloramphenicol) are taken.
Even common medications such as aspirin can induce a hemolytic crisis. This threat is sufficiently severe that the World Health Organization (WHO)
recommends that all hospital populations in areas
with high proportions of Greeks and Greek Cypriots
be screened for G-6-PD deficiency before drug therapy is instituted (Todd et al., 1994).
High-Risk Behaviors
Greeks in Greece, the United States, Canada, and
Australia demonstrate lower rates of nontherapeutic
drug use, alcoholism, and high-risk sexual behaviors
than other groups in European or North American
countries (Rosenthal, Moore, & Buzwell, 1994). These
patterns are not due to an emphasis on health promotion, but rather to a hyperawareness of the social consequences of these behaviors for the family. For
example, alcohol is most often considered a food item
and is consumed with meals. However, losing control
by being “under the influence” engenders considerable
gossip and social disgrace, focused not only on the
individual but also on the family (Tripp-Reimer &
Sorofman, 1994).
Concern for the reputation and standing of the
family is a prime deterrent to many high-risk behaviors. Conversely, high-risk behaviors such as obesity
among both sexes and smoking among men are higher
among Greeks (Wilson, Bakiaris, Gleeson, Papasavva,
Wise, & Hawe, 1993). Despite the concern for the family reputation, many of the Greek Cypriots who took
part in Papadopoulos’ (1999) study described themselves as “risk takers” or “living dangerously.” This
may be due to a mixture of cultural and religious beliefs and the experiences of migration. The narratives
of first-generation migrants describe the risks they had
to take to survive in a foreign and often hostile land.
Whereas a high level of risk taking appeared to be part
of survival, it was perpetuated by the belief that “God
will look after me”—that God will prevent anything untoward happening, but if anything should happen, God
will heal and sustain the person. Knowing these behavioral characteristics can assist health-care providers in
planning culturally sensitive interventions.
REFLECTIVE EXERCISE 30.3
Mr. and Mrs. Christou have a 17-year-old daughter, Helen, and
a 15-year-old son, George. Mr. Christou is a second-generation
British-born Greek Cypriot, while Mrs. Christou moved to
England from Cyprus at the age of 18. Both children are
attending the same school that is located in a predominantly
middle-class area of London. The couple and the children’s
grandparents, who also live in London, are very proud of the
children.
Helen and George are given a generous allowance each
week, but lately George has been borrowing money from his
sister. At first she did not mind, but when this became more
frequent she began to wonder what George did with the extra
money. She also saw him asking his grandmother for money.
George frequently told his parents that he was going to the
snooker club with his friends after school and on Saturdays.
One day, while waiting to catch the bus home after school,
she saw George with a group of boys smoking behind the
bus shelter. That evening she confronted her brother who
admitted that he occasionally used cannabis. She told him that
unless he gives this up within 2 weeks she will tell their parents. He promised to do so, but after 2 weeks he was still
using cannabis. Helen informed their parents. Their first reaction was one of surprise; they could not believe that their
“perfect and clever” son whom they brought up to know
right from wrong, whom they trusted and had a loving relationship with, could get into “bad company” and take drugs.
Following their disbelief, they had a very angry argument
with their son who told them that he realized how hurt
they would be if they found out. The parents told him that
although they were concerned about his health they were
also concerned about the effect that his behavior might have
on family and friends if they found out about his drug taking.
When the parents calmed down, they told George that they
still loved him and that they would do whatever they could to
help him stop using cannabis. They also told him and Helen
that this incident must stay within their home and they should
not discuss this with anyone else.
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People of Greek Heritage
1. What cultural value is guiding and influencing the parents’
decision to keep their son’s problem within the confines of
the nuclear family and not seek help from their extended
family and friends?
2. What cultural values underpin the parent’s decision to
support their son even though they are angry with him?
3. Should the grandmother be informed of the situation and
told not to give George any money?
4. At this time with the conflict, would you recommend
professional counseling?
9
from fasting. Some first-generation Greeks and Greek
Cypriots observe the three major fasting periods,
including
The Great Fast, Lent, for 7 weeks before Easter
The Assumption fast, from August 1 to August 14
The Christmas fast, 40 days before Christmas
Many second and subsequent generations of
Greeks and Greek Cypriots usually fast only the last
week before Easter, when most will also take Holy
Communion.
Common Foods and Food Rituals
Health-Care Practices
Greeks and Greek Cypriots have tended to disregard
standard health-promotion behaviors. Safety measures for adults, such as seat belts and helmets, are
often viewed as infringements on personal freedom
and are frequently ignored, particularly by the older
generation. The first most common cause of deaths in
Greece and the second in Cyprus for those aged 15 to
44 are road traffic accidents. However, relevant legislation and severe penalties are having a positive effect,
and a reduction in these deaths was recently recorded
(Kouta, Papadopoulos, & Sourtzi, 2010).
However, the gap between health-related knowledge and appropriate health action remains. Papadopoulos et al. (1998) found that Greek Cypriot
people had a good knowledge of health-promotion
practices. However, good knowledge did not correlate
with positive health behaviors. For example, people
who know what a balanced diet is often do not eat a
balanced diet. Worryingly, the new generations of
Greek and Greek Cypriots, while not abandoning the
traditional Mediterranian diet that is characterized by
low levels of meat and fat intakes and high levels of
fresh fruit and vegetables, are regularly consuming fast
foods, a phenomenon that is now global. Encouragingly, Papadopoulos (1999) found that the use of
screening for problems such as blood pressure, cervical
cytology, and breast cancer was high.
Nutrition
Meaning of Food
Greeks describe their culture as an “eating culture.” By
this they mean that food is a centerpiece of everyday
life as well as of social and ritual events. Greek hospitality nearly always includes a ritual of food and drink.
Fasting is an integral part of the Greek Orthodox
religion. General fast days are Wednesdays and Fridays; nowadays, these are observed only by some older
people. During fasts, it is forbidden to eat meat, fish,
and animal products such as eggs, cheese, and milk.
Greek Orthodox wishing to take Holy Communion
will observe at least 3 days of fasting. However, people
with health conditions and small children are exempt
Greeks and Greek Cypriots have based their diet on
cereals, pulses (such as lentils, peas, and beans), vegetables, fruits, olive oil, cheese, milk, and some fish and
meat. They are also relatively high consumers of
sweets and snacks. In both Greece and Cyprus, consumption of pulses has decreased, and consumption
of meats has increased. The consequences of this
trend are not yet fully known.
For adults, dairy products are consumed in the
form of yogurt or cheeses such as feta, kopanisti, kefaloteri, kasseri, and halloumi. Fats are consumed in
the form of olive oil, butter, and olives. Meats include
chicken, lamb, pork, and beef. Eggs, lentils, fish such
as shrimp and other shellfish, and white fish are additional sources of protein.
Vegetables such as potatoes, eggplant, courgettes
(zucchini), spinach, garlic, onions, peas, artichokes,
cucumbers, asparagus, cabbage, and cauliflower are
common Greek food choices. Bread choices include
pita, crescent rolls, and egg breads. Other foods include
rice, tabouli, macaroni, and cracked wheat (bourgouri).
Papadopoulos et al. (1998) found that the level of vegetable consumption of Greek Cypriots was almost twice
that of their meat and poultry consumption.
Common seasonings used by Greeks are aniseed,
basil, lemon, mint, cumin, cinnamon, citron, cloves,
coriander, dill, fennel, ginger, garlic, marjoram, mustard,
REFLECTIVE EXERCISE 30.4
Mrs. Glitnatsis, age 82, has diabetes mellitus and takes insulin.
She is quite underweight and does not follow her recommended diet because she is Orthodox and follows the fasting
schedule of the Orthodox Church. During fasting, she does
not take her insulin. She is currently seeing the diabetic nurse
specialist because of her uncontrolled diabetes.
1. What are the required fast days for the Orthodox Greek
religion?
2. What foods are forbidden to eat during fast days?
3. If Mrs. Glitnatsis insists on fasting, what is your recommendation for food intake and insulin administration?
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nutmeg, oregano, parsley, rosemary, sage, sesame,
thyme, vinegar, bay leaf, and honey. Fruit preferences
include grapes and currants, figs, prunes, oranges,
lemons, melons, watermelons, peaches, and apricots.
Beverages such as coffee, tea, chocolate milk, and wine
are common choices. Common food items are listed in
Table 30-1.
Specific foods are linked with holidays or ceremonies
throughout the year. For example, several different special breads, pastries, and cakes are served at traditional
ceremonies: New Year’s bread, vasilopita; Easter pastries, tsoureki and flaouna; Christmas bread, chistosomo;
prosfora, a traditional bread for funerals and remembrance ceremonies, which is served with koliva, a
❙❙◗ Table 30-1 Common Greek Foods
Name
Avgholemono
Description
Soup
Hummus
Thick sauce for
dipping bread
Maroulousalata
Salad
Tsatziki
Dip
Spanakopita
Cheese tarts
Dolmathes
Stuffed grape
leaves
Meatballs
Keftedes
Souvlaki
Moussaka
Pastichio
Psiti kota
Loukomades
Kourambiethes
Baklava
Greek coffee
Ingredients
Chicken stock, eggs,
lemon, rice
Chick peas (mashed),
tahini sauce (sesame and
olive oil), garlic, lemon
Lettuce, onions, cucumbers, radishes, parsley,
tomatoes, feta cheese,
olives, olive oil
Cucumbers, yogurt, vinegar, mint, garlic, salt
Spinach and feta cheese
in phyllo dough pastry
Meat, rice, grape leaves
Ground beef/pork,
grated potatoes, onions,
bread, parsley, oregano,
eggs, garlic
Meat
Marinated pork or lamb
on skewer
Casserole
Eggplant, potatoes,
ground lamb, onions,
tomato, garlic, parsley,
white sauce
Casserole
Ground beef, macaroni,
cinnamon, white sauce,
cheese, parsley, tomato
sauce, butter
Lemon chicken Chicken, lemon, oil
Pastry
Flour, water, honey, oil,
sugar, cinnamon
Wedding cookie Flour, almonds, cloves,
powdered sugar, egg,
brandy
Sweet dessert
Phyllo dough, pistachio
nuts, honey, sugar, cinnamon, cloves, butter
Coffee
Ground coffee, sugar
mixture of boiled wheat, almonds, pomegranate seeds,
sesame seeds, and raisins; and traditional, small, individual wedding cakes called kourapiedes.
Dietary Practices for Health Promotion
Although no specific classification exists of foods for
health or illness, a general consensus is that people will
naturally choose foods that are healthy. Therefore, an
effort is made to provide ill people with the food they
request. This pattern is most pronounced for pregnant
women. In fact, numerous folk prescriptions exist regarding the provision of food for pregnant women,
even if they are not close family or friends.
Nutritional Deficiencies and Food Limitations
Although nutritional deficiencies per se are rare
among Greeks and Greek Cypriots, two important
enzymatic conditions merit attention. First, for people
with G-6-PD deficiency, broad beans (fava beans)
can induce hemolysis and an acute anemic crisis
(Riepl, Schreiner, Muller, Hildemann, & Loeschke,
1993). Second, the prevalence of lactose maldigestion in Greek adults is about 75 percent; however,
milk intolerance is rarely seen in children (Ladas &
Katsiyiannaki-Latoufi, 1991). Health-care providers
should use this knowledge when counseling patients
with these conditions.
Virtually all food items used in the traditional
Greek diet are available in the United States, Britain,
Australia, and Canada. Even specialty items such as
phyllo dough for pastries and appetizers, grape leaves
in brine, and olives can be found in specialty areas of
major supermarkets. A trend has moved away from
lamb to beef for many dishes among the U.S. population. The popularity of Greek food is evidenced by the
success of Greek restaurants wherever there is a Greek
community.
Pregnancy and Childbearing
Practices
Fertility Practices and Views Toward Pregnancy
The trend for smaller families in Greece has been
noted at least since the turn of the 21st century,
whereas in Cyprus, this is a more recent phenomenon.
In large part, this decreased fertility has resulted from
the desire of parents to provide adequately for their
children and to have them educated so they can
achieve professional status.
In North America, family size has been deliberately
limited in order to adequately care for and educate
children. In Britain, early immigrants had small families primarily because of housing problems. Many
families lived in very cramped conditions, and many
landlords did not rent to those with children. The
method of limiting pregnancies has changed from
control of gestation to control of conception. In
2780_BC_Ch30_001-017 03/07/12 9:55 AM Page 11
People of Greek Heritage
North America, a wide variety of birth control measures, such as intrauterine devices, birth control pills,
and condoms, are preferred. The strong pro-life Greek
Orthodox Church condemns birth control, while at
the same time silently accepting the reality. However,
abortion is absolutely condemned as an act of murder
except in certain circumstances such as when the life
of the mother is in grave danger or a young woman
becomes pregnant as a result of rape. In practice, a
number of women, particularly those who are unmarried, have legal abortions because of the negative consequences of having a baby out of wedlock. Inflicting
endropi on the family is believed to be more severe
than the consequences of abortion. Although adoption is rare among Greeks and Gre…
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