21 Jun WHAT ARE THE MOST COMMON HEALTH PROBLEMS OF IRANIAN IMMIGRANTS?
What are the most common health problems of Iranian immigrants? What are some implications for health-care providers? 12. Identify characteristics of a healthy Iranian diet. IRANIAN CASE STUDY #2 Hamid moved his family to the United States within 5 years of the 1984 revolution.The restrictions of the Islamic government were increasingly affecting everyone’s social, economic, and private lives. With two young daughters and a third child on the way, he “didn’t want to take any chances by remaining in Iran.” He thought that leaving while he was “fairly young” would allow him and his family to adjust better and more easily. The family fled Iran with great hardship and settled in Pakistan until they could obtain their visas to enter the United States. A friend from high school was helping him. The friend had left Iran many years ago and had a successful accounting firm in a southeastern state. Hamid was promised a job and a company to sponsor him so he could get a green card. The year the family spent in Pakistan was filled with frustration, anger, and illness. Eventually, they managed to obtain tourist visas and entered the United States in 1985. By now, the two daughters were 10 and 11 years old and the baby was 9 months old. Jaleh, Hamid’s wife, was exhausted and weak. The pregnancy was problematic, and without the support of her sisters and mother, her recovery had been slow and rocky. Hamid and Jaleh began a constant stream of arguments because of her mental and physical state. She felt that their situation in the United States was no better than they had had in Pakistan. They could not afford housing in a good neighborhood; the girls and Jaleh were scared at night because Hamid had to work long hours at the accounting firm. Leaving Iran was a desire but never a priority for Jaleh, especially while she was pregnant. Hamid’s hours became longer, and the work became more involved. He had to improve his English and increase his technical skills and knowledge of U.S. tax rules and regulations. His friend told him that, to succeed in the United States, he was expected to perform. “No time to feel sorry for yourself. What better place to be than here?” Jaleh had a probable genetic predisposition to mental illness. She had always heard rumors about different aunts, uncles, and cousins who had suffered from different forms of anxiety and depressive disorders. She was always told that they had a “nervous problem.” But Jaleh had always thought that she was strong willed and would not succumb to the pressures. Unfortunately, as Hamid worked harder and longer, Jaleh became more and more depressed and nonattentive to the children. Three years passed. The only easy task was changing from their tourist visa to permanent residency. Hamid’s desire to excel had also been financially rewarding. They moved to a better house. Jaleh remained at home, didn’t try to improve her English, and felt she should keep the baby at home. Neither she nor Hamid trusted leaving the baby in day care. The two girls were adjusting a little differently; the older was active and outgoing. She was befriended by classmates and neighbors and was enjoying her teenage years. The second daughter was now 13, reclusive, and slightly overweight. Hamid constantly commented on her looks, and Jaleh attempted to protect her against his words. Jaleh thought of her as her soulmate. As the sisters drifted apart, the bond between Jaleh and her second daughter became stronger. The baby was often sick, but Jaleh was increasingly too tired to care. One night, as the baby’s fever spiked, he began to have difficulties breathing. Hamid rushed him and the family to the hospital. By this time, Jaleh’s weight had dropped to 98 pounds. Even though she was small statured, the weight loss made her appear weak and unhealthy. In the emergency department (ED), the family was assessed and evaluated by the triage nurse. She was attentive and noticed the strained family dynamics. In reporting the case to the ED physician, she stressed that the physician should consider the family’s circumstances. Study Questions 1. If you were the nurse or physician, what areas would you focus on first? 2. What initial interventions would you suggest? 3. How would you develop a relationship that would allow you to ask private and personal questions? 4. Would you talk to the family as a unit or separately? Why? 5. As a health-care provider, what might you do to help the two girls adjust in the United States? 6. Describe how Jaleh might perceive her changing behaviors and mood. Describe her perception of any effects the change might have on family dynamics. 7. How would you approach this family for mental-health counseling? 8. Describe culturally congruent dietary counseling for Jaleh. 9. Why do Hamid and Jaleh not trust leaving the baby in day care? 10. Why did the entire family accompany the baby to the ED? 11. Describe traditional Iranian health beliefs and practices. IRISH CASE STUDY The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his wife, Mary, aged 29; and two children: Bridget, aged 7, and Michael, aged 6. Both David and Mary are second-generation Irish. Before purchasing their farm 5 years ago, David sold farm equipment in Ohio. The O’Rourkes are Catholic; Mary converted to Catholicism when they married. David, who works long hours outdoors, is concerned about profitability from his corn crop because of the unpredictable size of the harvest, and thus, his income varies depending on the weather. Mary did not work outside the home because she wanted to be with their children until they started school. However, because both children are now school age, Mary has discussed with David the possibility of working part time to supplement the family income. He would prefer that she stay at home, but Mary is anxious to return to the workforce and believes the timing is right. Both David and Mary are happy with just two children and do not desire more. They use the rhythm method for family planning. Eating a healthy breakfast is important to the O’Rourkes. Because eggs are readily available on the farm, they have fried eggs with potato bread and juice at least four times a week. Their main meal in the evening usually includes meat, potatoes, and a vegetable. David enjoys a glass of beer with dinner. David has been a little edgy lately because of his concerns about the corn crop. He admits to having some minor chest pain, which he attributes to indigestion. His last visit to a physician was before their marriage. Mary knows David is concerned about finances and believes it would help if she had a job. Bridget and Michael spend a lot of time outside playing and doing some minor chores for their parents. Both children enjoy school and are looking forward to returning in the fall. Bridget is starting to show concern over her appearance. She does not like her red hair and all the freckles on her face. Her teacher has noted that Bridget has trouble reading and may need glasses. Michael wants to be a farmer like his Dad but worries about his Dad being tired at night. The O’Rourkes have not taken a vacation since they were married. They go to the state fair in the summer, which is the extent of their trips away from home. They are active in the church and attend services every Sunday. Study Questions 1. Describe the O’Rourke family structure in terms of individual roles. 2. Identify two potential health problems related to the O’Rourke’s dietary practices. 3. Identify potential health-risk factors for the O’Rourkes as a family unit and for each family member. 4. Explain the relationship between risk factors and ethnicity specific to the O’Rourke family and their Irish heritage. 5. Describe culturally competent health-promotion strategies for the identified risk factors for the O’Rourke family. 6. Describe the O’Rourke family’s fertility practices. Are they congruent with their Irish background and religious beliefs? 7. Describe the O’Rourke family’s communication patterns. 8. What are the predominant health conditions among Irish immigrants? 9. Explain the significance of the Great Potato Famine for Irish Americans. 10. Name two genetic diseases common among Irish Americans. 11. Identify accepted fertility practices for Irish American Catholics. 12. Identify three sources of strength for the Irish American in times of illness. 13. Identify traditional home remedies commonly used by Irish Americans. ITALIAN CASE STUDY #1 Rosa and Mario Gianquito live on the ground floor of a three-family house in Brooklyn, New York. Although they completed only grammar school in Italy, they speak English and have little difficulty understanding most verbal communication. They have a daughter, Lucia, aged 25, and a son, Anthony, aged 28, who were born in this neighborhood but now live in Manhattan. Both children speak fluent Italian. Anthony is an attorney and does not visit with his sister very often. Lucia is a grammar school teacher, married to an Italian man, Guido Venetto, who recently immigrated from southern Italy and is 10 years older than Lucia. Guido speaks mostly Italian at home but does speak broken English. In addition to smoking two packs of cigarettes a day, Guido is emotionally abusive to Lucia. He is very jealous and does not want Lucia to go out after work with her friends or to spend much time visiting with her parents. Lucia has allergies, and the last time she visited the doctor, he told her that her blood pressure was elevated. She has noticed lately that, after standing all day at work, she often has swollen ankles and leg pain. Lucia’s husband works 12 hours a day as a construction worker and expects her to cook Old-Country–style Italian food, which requires that she use a great deal of salt. She is often depressed and feels isolated and powerless. She has been trying to have a baby for 3 years. Rosa comes to visit her daughter when she can. She often brings homemade manicotti or tortellini when she comes. She is very concerned about Guido’s behavior toward her daughter but does not feel that she can challenge Guido because he is the capo di famiglia. Rosa is concerned about Lucia’s swollen feet and suggests that she drink red wine and eat more garlic and dandelions. She tells Lucia to pray to the Virgin Mary to ask for help in conceiving a child and to make Guido treat her better. Lucia and Guido attend the neighborhood Catholic Church on Sunday. Lucia always wears the cornicelli around her neck that her mother gave her to protect her from il mal occhio. Lucia says her faith and her family help her cope with life challenges with pazienza. Study Questions 1. Identify three problems and a related plan of care for Lucia. 2. Identify two health-teaching goals for this family that are congruent with family order and rituals. 3. Identify three socioeconomic factors that influence the health of the Venetto family. 4. How might the health-care provider involve Lucia in a mutual-planning process for her holistic health-care needs, including mind, body, and spirit? 5. Knowing that many first-generation Italians generally mistrust health-care providers, how would you encourage Lucia to engage in health-promotion behaviors? 6. Discuss at least two preventive health maintenance–teaching activities that respect the folk practices used to treat illness in this family. 7. Define the Italian’s unique relationship with food and discuss implications this could have on the health of the Venetto family, particularly Lucia. 8. Discuss the status and role of elderly Italians in the extended family. 9. Identify two practices common among Italian women that might affect conception and pregnancy. 10. Name two dietary health-care risks and two dietary health-care assets for Italians.
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