Folk Medicine and EMS: The Mexican-American Experience

Men will sooner surrender their rights than their customs.
                                           — Moritz Guedemann

July 2002, MERGINET - Since its founding, the United States has been regarded throughout the world as the land of hope and opportunity. Immigrants by the millions have come to this country and integrated into American society. Today, the US has more minority groups than any other country in the world. In addition to their skills, families, and belongings, immigrants brought to this country their customs and culture. Although the United States has become a "melting pot" of humankind, many distinct cultural beliefs and practices persist, many of them related to health and illness.

Folk medicine, an alternate system of health care, is widely practiced throughout the US . Folk medicine actually means "medicine of the people" and has evolved as the layperson's way of dealing with health and illness. At the center of most folk medicine beliefs is the ability to obtain curing or healing. Prayer, chanting, or the use of various herbs or other substances typically bring about this healing. Religion, spirituality, and faith play a central role in every type of folk medicine. It also satisfies many of the physical and emotional needs of the people. And throughout recorded history, certain individuals have been thought to possess special healing powers.

Mexican-American folk medicine
Nowhere in the United States is folk medicine more common than along the 1,933 miles bordering Mexico . Mexican-Americans have immigrated to this country in large numbers for the last century and are now among the fastest growing minority groups in the United States . Texas , New Mexico , Arizona , and California all boast large Mexican-American populations. However, immigration is not limited to these border states . Many large cities, such as Atlanta , Denver , and Chicago , have burgeoning Mexican-American populations, and they have brought with them many folk medicine practices.

One of the largest and most widely used systems of Mexican-American folk medicine is called curanderismo . The word curanderismo is derived from the verb curar , which means to heal. Curanderismo is a system of “holistic” or “folk” healing typically presided over by a curandero (male healer) or curandera (female healer) who has el don de Dios , the “gift from God” to heal others.

The roots of curanderismo can be traced back to Greek humoral medicine, which believed that three “humors” (wind, bile, and phlegm) controlled organ function. It was revived during the Spanish Renaissance by consulting Latin translations of Galen and Hippocrates. Curanderismo was also influenced by medieval and European witchcraft, early Arabic medicine, and Judeo-Christian religious beliefs. These beliefs were brought to Mexico by the Spanish conquistadors. There, they blended with Mayan and Incan herbal lore and health practices. Today, curanderismo is a blend of all of these cultural beliefs, accompanied by many rituals and practices of modern Christianity.

Many types of illness cause people to seek help from a curandero . Some may be naturally occurring, and others may be attributed to witchcraft ( mal puesto ). Part of the role of the curandero is to be an adversary for good in the struggle between good and evil. In this case, evil is Satan and those who have made secret pacts with him, namely brujos or brujas (witches). This belief is strongly supported by tenets of Catholicism that still include exorcism. Exorcism is a sacrament of the Catholic church that uses spiritual authority to expel demons or demonic possession. Today, priests may only practice exorcism with permission from a bishop, thus driving many believers to seek remedies from curanderos.

Brujos, who are said to frequently take the form of lechuzas (barn owls), cats, turkeys, or coyotes, are said to use their evil powers to cause a multitude of problems ranging from prolonged, serious physical or mental illness to death, and even cause bad luck in business and love. Brujos use rituals, incantations, potions, and powders to bring on the desired illness. The agent is sometimes placed into the victim's food or drink, or it may be a powder spread across the victim's path or placed in his house or yard. Witchcraft ( brujeria ) is particularly feared, since it can penetrate the sanctity of one's home.

When deemed appropriate, believers consult a curandero . Because the ratio of curanderos to the population is very small, people must often travel some distance and wait several days to receive healing. Healing may consist of rituals, herbal remedies, potions, or counter magic, depending upon the illness being treated. Healing often occurs in a ceremony called a barrida (the sweeping) whereby eggs, lemons, and various herbs, along with prayer, are used. Typically, the egg is swept repeatedly over the victim's body while prayers are chanted. The egg is usually then placed in a glass under the victim's bed. In the morning, the egg may be either cooked or contain a small amount of blood, indicating that the healing was successful.

Curanderismo and EMS
It is important for emergency medical service personnel to understand, recognize, and respect the role of folk medicine. Knowledge about folk medicine beliefs and practices can provide prehospital personnel with valuable information about the patient. In addition, many situations being treated by folk practices have legitimate medical causes.

Folk beliefs are as real to some people as heart attacks are to the EMT. A recent survey of 405 Hispanic patients who attended a Denver medical clinic found that 91 percent knew what a curandero was, and 29 percent reported that they had been to a curandero at some time during their lives. It is important to note that folk medicine is not necessarily limited to lower socioeconomic groups. Also, some practices similar to those of curanderismo have found their way into the Anglo population.

Most folk remedies are harmless. However, there are some remedies that are potentially fatal. Some of the herbal preparations used to treat many Mexican-American folk ailments may contain potentially toxic levels of lead. Another potential problem is that traditional medical care may be delayed while families wait for folk remedies to work. EMS personnel may be summoned to care for people who have become seriously ill after it becomes apparent to the family that folk practices are not working.

Curanderismo has a wide spectrum of illnesses and conditions. One of the most common folk illnesses seen is empacho (“locked" intestines). This is thought to occur due to an inflammation and blockage of the intestines with undigested food. The patient with empacho complains of abdominal pain, constipation, belching, or bloating. The curandero 's treatment may include administration of a tea made of various herbal substances. Some remedies ( azarcon or greta ) have been known to contain large quantities of lead and may prove toxic to the patient.

Another common folk illness in the Mexican-American community is mal de ojo (the evil eye). Mal de ojo is said to cause many symptoms and can occur accidentally by admiring and not touching a child. To prevent a child from getting mal de ojo , a person admiring a child might go to great lengths to touch the youngster. If a person has mal de ojo , a curandero may be called to heal the person. A barrida is often employed to treat mal de ojo.

A common infant folk illness is caida de la mollera (sunken fontanel). This is thought to occur when the nipple is pulled suddenly from the infant's mouth, causing the soft palate to be pulled down, in turn drawing down the anterior fontanel. Treatment is often initiated by the mother or grandmother and involves sucking vigorously on the anterior fontanel. This treatment may result in bruising on the head, which may be mistaken as a sign of child abuse. If a curandero is summoned, he may push up on the soft palate during a healing ceremony, effectively curing the illness. An alternate treatment is to turn the baby upside down for approximately one minute, then tap on the baby's feet three times. This reportedly elevates the fontanel to its normal position. The sunken anterior fontanel seen with caida de la mollera may actually be a symptom of dehydration. EMS personnel should look for other symptoms of dehydration including tachycardia, dry mucous membranes, and decreased urine production.

Another condition is aire de oido (air in the ear). This is believed to occur when a person, especially a child, is exposed to cold air or a strong wind. Air enters the ear and causes the condition. The patient will complain of earache, altered hearing, and headache. The folk treatment for aire de oido is to roll a piece of paper into a cone, place the small end of the cone into the ear canal, and light the large end with a match. The flame will create a vacuum that will evacuate the offending air from the ear. Aire de oido may be mistaken for a legitimate ear infection (otitis media), which requires antibiotics.

In addition to the "illnesses" described above, many signs and symptoms of traditional illnesses cause increased concern in many members of the Mexican-American population. Fever ( calentura or fiebre ) is worrisome. Many see fever as a discrete disease, not as a symptom of broader processes such as infection. Also, increased sputum ( flema ) is a cause for concern and may also be thought to be an illness in and of itself. This belief can be traced back to one of the three “humors” of Greek medicine.

EMS personnel may often hear complaints that, on the surface, appear trivial. The presence of a fever in a young child may be a real emergency in the mind of the mother. Although the child may have other symptoms, such as diarrhea, she will be most concerned with the fever. Respect this concern. Do not ever be condescending. When assessing a patient, always consider the possibility that belief in folk medicine is part of the scenario, especially if the history or chief complaint fits any of the folk concerns described here. Not all Mexican-Americans practice folk medicine. However, to those who do believe, it is as real as any traditional medical illness.

References
Mangos, J.A., “Folk Medicine in Texas ,” Texas Medicine, 1986. 82(10): p.5.
Hentges, K.; Shields, C.E., and Cantu, C., “Folk medicine and medical practice,” Texas Medicine, 1986. 82(10): p. 27-29.
Ripley, G.D., “Mexican-American folk remedies: their place in health care,” Texas Medicine, 1986, 82(11): p. 41-44.
Leads from the MMWR, “Lead poisoning from Mexican folk remedies - California ,” JAMA 1993, 250(23): p. 3149.
Marsh, W.W. and Eberle, M., “ Curanderismo associated with fatal outcome in a child with leukemia,” Texas Medicine, 1987, 83(2): p. 38-40.
Padilla, R.; Gomez, V.; Biggerstaff, S.L.; Mehler, P.S., “Use of curanderismo in a public health care system,” Archives of Internal Medicine , 2001, 28;161(10): p. 1336-40.
Catechism of the Catholic Church . 1994, Citta del Vaticano: Libreria Editrice Vaticana; 1673:445.
Curanderismo: The Handbook of Texas Online . (accessed March 6, 2002 )

Bryan Bledsoe lives in the Dallas/Fort Worth, Texas area. He is a former EMT and paramedic and is the author of numerous EMS texts including Paramedic Emergency Care , Atlas of Paramedic Skills , Prehospital Emergency Pharmacology and Paramedic Pocket Reference . Dr. Bledsoe is a frequent speaker at EMS conferences and seminars, and serves on the MERGINET.com editorial advisory board.