Pablo Gaborra, aged 32, lives in a migrant worker camp in Maryland with his wife Olga, aged 24, and their two children. Pablo and Olga were born in Mexico and have lived in the US for 13 years, working as farm laborers. They have limited education and speak only Spanish at home. The family picks vegetables during harvesting seasons and struggles with poor living conditions, low income, lack of healthcare access, and health issues like Pablo's tuberculosis and Olga's anemia.

1. MEXICAN CASE STUDY #2
Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a
migrant-worker camp on the eastern shore of Maryland. They
have two children: Roberto, aged 7, and Linda, aged 18 months.
Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged
12, live with them. Another distant relative, Rodolpho, aged 28,
comes and goes several times each year and seems to have no
fixed address. Pablo and Olga, born in Mexico, have lived in the
United States for 13 years, first in Texas for 6 years and then in
Delaware for 1 year, before moving to the eastern shore of
Maryland 5 years ago. Neither of them have U.S. citizenship,
but both children were born in the United States. Pablo
completed the sixth grade and Olga the third grade in Mexico.
Pablo can read and write enough English to function at a
satisfactory level. Olga knows a few English words but sees no
reason for learning English, even though free classes are
available in the community. Olga’s sisters have attended school
in the United States and can speak English with varying degrees
of fluency. Roberto attends school in the local community but is
having great difficulty with his educational endeavors. The
family speaks only Spanish at home. Not much is known about
the distant relative, Rodolpho, except that he is from Mexico,
speaks minimal English, drinks beer heavily, and occasionally
works picking vegetables. The Gaborra family lives in a trailer
on a large vegetable farm. The house has cold running water but
no hot water, has an indoor bathroom without a shower or
bathtub, and is heated with a wood-burning stove. The trailer
park has an outside shower, which the family uses in the
summer. The entire family picks asparagus, squash, peppers,
cabbage, and spinach at various times during the year. Olga
takes the infant, Linda, with her to the field, where her sisters
take turns watching the baby and picking vegetables. When the
vegetable picking season is over, Pablo helps the farmer to
maintain machinery and make repairs on the property. Their

2. income last year was $30,000. From the middle of April until
the end of May, the children attend school sporadically because
they are needed to help pick vegetables. During December and
January, the entire Gaborra family travels to Texas to visit
relatives and friends, taking them many presents. They return
home in early February with numerous pills and herbal
medicines. Olga was diagnosed with anemia when she had an
obscure health problem with her last pregnancy. Because she
frequently complains of feeling tired and weak, the farmer gave
her the job of handing out “chits” to the vegetable pickers so
that she did not have to do the more-strenuous work of picking
vegetables. Pablo has had tuberculosis for years and
sporadically takes medication from a local clinic. When he is
not traveling or is too busy picking vegetables to make the trip
to the clinic for refills, he generally takes his medicine. Twice
last year, the family had to take Linda to the local emergency
room because she had diarrhea and was listless and unable to
take liquids. The Gaborra family subscribes to the hot and cold
theory of disease and health-prevention maintenance.
Study Questions 1. Identify three socioeconomic factors that
influence the health of the Gaborra family.
2. Name three health-teaching interventions the health-care
provider might use to encourage Olga to seek treatment for her
anemia.
3. Identify strategies to help improve communications in
English for the Gaborra family.
4. Identify three health-teaching goals for the Gaborra family.
5. Name three interventions Olga must learn regarding fluid
balance for the infant, Linda.
6. Discuss three preventive maintenance–teaching activities that

3. respect the Gaborra family’s belief in the hot and cold theory of
disease management.
7. Identify strategies for obtaining health data for the Gaborra
family.
8. Identify four major health problems of Mexican Americans
that affect the Gaborra family.
9. If Olga were to see a folk practitioner, which one(s) would
she seek?
10. Explain the concept of familism as exhibited in this family.
11. Distinguish between the two culture-bound syndromes el
ataque and susto.
12. Discuss culturally conscious health-care advice consistent
with the healthbelief practices of the pregnant Mexican
American woman.
13. Discuss two interventions to encourage Mexican American
clients with tuberculosis to keep clinic appointments and to
comply with the prescribed medication regimen.
14. Identify where the majority of Mexican Americans have
settled in the United States.
PUERTO RICAN CASE STUDY #2
Carmen Medina, aged 39, lives with her husband, Raúl, aged 43,
who works as a mechanic in a small auto shop. Mr. Medina has
worked in the same place since he and his wife came to the
United States from Puerto Rico 15 years ago. The Medinas have
a 4- year-old son, José; a 16-year-old daughter, Rosa; and an
18-year-old son, Miguel. The Medinas both attended vocational

4. school after completing high school. Mrs. Medina is employed 4
hours a day at a garden shop. She stopped working her full-time
job to care for her ill mother and aged father, who do not speak
English and depend on government assistance. The family
income last year was $28,500. The family has health insurance
through Mr. Medina’s job. They live in a threebedroom
apartment in a low-income Illinois community. Miguel works in
a fast-food store a few hours a week. Because Rosa has
responsibilities at home, the Medina’s do not allow her to work
outside the home. She is very close to her grandmother but
avoids talking with her parents. Both Rosa and Miguel are
having difficulties in school. Rosa is pregnant and the family
does not know. She is planning to drop out of school, get a job
in a beauty shop, and leave home without telling the family.
Miguel frequently comes home late and, on occasion, sleeps out
of the home. He is beginning college next semester and has
plans to move out of the house during the summer. The family
is having difficulty dealing with Rosa’s and Miguel’s
developmental and behavioral challenges. Although Mrs.
Medina is outspoken about these concerns, Mr. Medina is quiet
and not actively involved in the discussion. He is more
preoccupied with the family’s financial situation. Mrs. Medina’s
parents are encouraging them to return to Puerto Rico. Mr.
Medina was diagnosed with hypertension 2 months ago, when
he went to the emergency room for a respiratory infection. He
smokes cigarettes and drinks two to three beers every evening
after work. He has not followed up on his blood pressure
treatment. Miguel is beginning to smoke, but not at home. José
has had frequent colds and sinus allergies. He has been to the
emergency room three times during the past year for respiratory
infections. Mrs. Medina’s last physical examination was after
she had José. She is experiencing insomnia, tiredness,
headaches, and gastrointestinal problems. She is very concerned
about Rosa and Miguel, her parents, and the family’s finances.
Mrs. Medina is Catholic and recently has been visiting her
church more often. Study Questions

5. 1. Explain Mrs. Medina’s attitude in her relationship with her
adolescent daughter.
2. Identify strategies to ensure that Rosa seeks prenatal care.
3. Identify barriers to accessing health care for the Medina
family.
4. What are the high-risk behaviors exhibited by this family?
5. What communication barriers exist in this family that affect
care delivery?
6. Discuss gender and family roles in the context of traditional
Puerto Rican culture.
7. Identify sociodemographic factors affecting the physical- and
mentalhealth well-being for this family.
8. Identify Puerto Rican folk practices appropriate for this
family.
9. If the Medina family chose to visit a folk healer, which
one(s) do you think they might visit? Why?
10. If Mrs. Medina’s parents visit a health-care provider, what
might they expect?
11. Identify culturally congruent interventions to ensure
compliance with Western health prescriptions for Mr. Medina.
12. Discuss the importance of respeto and familism in the
Medina family.
13. Identify culturally congruent interventions for Rosa’s

6. pregnancy.
14. Identify health-promotion and disease-prevention
interventions needed for José.