Question

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 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

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 pregnancy.

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

José.

Answer 1

1. The bond of a mother and an adolescent daughter is poor .This is a stage were the adolescent girls are in a stage of identity vs confusion,.Parents has to provide special attention and care their child so that the child can grow in the right way.Here Medina's restrictions can make the girl uncomfortable by her attitude of making the girl to be home.

2.Some of the strategies for Rosa to seek prenatal care are

• Rosa has to come up with the truth by telling about her pregnancy to her mother or her grandmother for getting support and guidance
• Parents has to be friendly with their children to let them speak openly

3.The main barrier for accessing healthcare is a low financial status of the family and lack of adequate insurance coverage

4.The high risk behavior exhibited by the family are

• A act of unprotected sexual life of an adolescent
• Truancy behaviour and binge drinking of the son
• Use of alcohol and tobacco can lead to mental and physical agony
• The lack of attention of parents on the family members due to work stress