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The practice of pluralistic medicine by long-term immigrant and native-born Mexican Americans in Santa Ana, California: the persistence of traditional medicine

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The practice of pluralistic medicine by long-term immigrant and native-born Mexican Americans in Santa Ana, California: the persistence of traditional medicine

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Content THE PRACTICE OF PLURALISTIC MEDICINE BY LONG-TERM
IMMIGRANT AND NATIVE-BORN MEXICAN AMERICANS IN SANTA
ANA, CALIFORNIA: THE PERSISTENCE OF TRADITIONAL
MEDICINE

by

Frank R. Carrillo

____________________________________________________________________

A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIOLOGY)

December 2008

Copyright 2008
Frank R. Carrillo

ii
DEDICATION
For Robin, the girl with the Golden Halo, who has been (and remains)
the inspiration of my work and deserves a great deal of credit for any
success I may have achieved. Robin, you are my hero and I shall
always love you.

iii
ACKNOWLEDGEMENTS

Above all, I wish to acknowledge H. Edward Ransford, my friend and
Ph.D. committee chair, for his patient guidance and support. I have
known Professor Ransford for many years and he has been an
inspirational teacher and mentor to me, and many others. Without
him my task in completing this dissertation would have been
difficult, if not impossible.

I am extremely grateful to my other Ph.D. committee members.
Professor Lynne Casper has been very supportive in word and actions
and there is no way I can adequately thank her for everything she
has done for me. Professors Lourdes Baezconde-Garbarnati and
William E. Maxwell have served on my committee from the very
beginning of my dissertation project. They have provided thoughtful
and intellectual guidance and support that has contributed much to
the final rendering of this dissertation.

iv

TABLE OF CONTENTS

Dedication ii

Acknowledgements iii

Table of Contents iv

List of Tables vii

Abstract viii

Chapter 1: Introduction 1
Background 1
Statement of the Problem 3
Purpose of the Study 4
Research Questions 4
Research Objectives 6
Scope of the Study 7
Significance of the Study 11
Definition of Terms 12
Delimitations and Limitations 16
Organization of the Work 17

Chapter 2: Review of the Literature 22
Background of Mexican American Healthcare 22
The Dual Health Care Delivery System 23
Anti-Immigrant Sentiments and Policies 24
Mexican American Health: Health Risks 25
And Problem Diseases
The Latino Health Paradox 26
Assimilation and Acculturation 28
Straight-line Assimilation 28
Cultural and Pluralistic Models 29
Segmented Assimilation Models 31
System Barriers 35
Reliance on Public Sector Services 38
Responses to System barriers 39
Mexican American Health Care Seeking 40
Mexican Traditional Medicine 45

v
Chapter 3: The Social Action Paradigm 48
Figure 3.0 An Illustration of the Mexican American
Healthcare Seeker in Interactive Agency 54

Chapter 4: Research Methods 57
Methods 58
Sampling Design and Recruitment 59
Description of Respondents 63
Data Collection 67
Role of the Interviewer 69
Data Analysis 69
Ethical Considerations and Verification 71

Chapter 5: Community Services Providers’ Results 74
Introduction 74
Narratives on the Structural Barriers 76
Narratives on the Cultural: Traditional 81
And Pluralistic Medicine
Chapter Summary 84

Chapter 6: Study Participants’ Results 86
Medical Alternatives 86
Respondents’ Explanation of Alternative Choices 88
Respondents’ Narratives 90
Barriers 92
Conventional Medicine 97
Private Storefront Clinics 102
Trips to Mexico 107
Home and Herbal Remedies 113
Prayer 117
Botanicas 120
Curanderos 123
Moving Across the Alternatives: 127
The Practice of Medical Pluralism
Chapter Summary 132

Chapter 7: Narratives Across the Continuum of Alternatives 134
Perla: A Choice of Conventional Medicine 135
Frances: The Necessity of Trips to Mexico 142
Lupe: High Utilization of the Alternatives 148
Carlos: A Return to the Traditional 157
Chapter Summary 162

vi

Chapter 8: Summary and Discussion 163
Review of Important Findings 163
The Social Action Paradigm Revisited 169
Figure 3.0 An Illustration of the Mexican American
Healthcare Seeker in Interactive Agency 171
Study Limitations 173
Conclusions 174
Significance and Implications of this Study 178

References 182

Appendices 191
Appendix A: Spanish Interview Guide 191
Appendix B: English Interview Guide 193
Appendix C: Spanish Informed Consent Form 195
Appendix D: English Informed Consent Form 197

vii
LIST OF TABLES
Table 1.0: Percent of People Who Speak Spanish 8
At Home by City

Table 1.1: General Characteristics of the City of 9
Santa Ana, Orange County and the
State of California

Table 1.2: 2007 HHS Poverty Guidelines 10

Table 3.0: Comparison of Healthcare Seeking Models 51

Table 3.1: Factors That May Influence the Type of 53
Medicine Used

Table 4.0: General Characteristics of Respondents 64

Table 6.0: Percentage of Respondents Reporting 87
Having Used or Would Use Certain Medical
Treatments if Necessary by Immigrant Status

Table 6.1: Percentage of Respondents Mentioning 89
Their Use of Various Medical Treatments

viii
ABSTRACT

The sociological literature on Mexican American or Latino healthcare
seeking generally suggests that more assimilated Mexican American
seek conventional medicine when a health problems arises and the
less assimilated seek more traditional Mexican folk remedies.
Healthcare seekers are seen as reactive to social and cultural factors
in making healthcare decisions. More recently, literature which
documents pluralistic medical behavior among Mexican Americans
has emerged and represents an important departure from social and
cultural factors explanations. This research builds upon the
pluralistic medical model and argues that Mexican Americans are not
simply reactive to social and cultural factors but are more active
agents in making healthcare decisions. A new model, the Social
Action Paradigm is developed and used as a framework to analyze
and interpret the results of intensive interviews with 16 long-term
(ten years or more residency) Mexican immigrants and 17 native-born
Mexican Americans in Santa Ana, California. The results of the
study support the idea that agency does indeed play a part in the
healthcare seeking practices of the study participants and, to an
important degree, contributes to the persistence of the use of
Mexican traditional folk medicine among both groups.
1
CHAPTER 1: INTRODUCTION
Background
The United States (U.S.) is experiencing a significant health
care problem. Rising health care costs, decreases in employer
provided health care coverage, rationing of health care services, and
lack of access to health services all contribute to what is increasingly
viewed as a broken health care system (Jost 2006). In recent years,
this problem has begun to impact middle- and working-class
individuals who were once covered under adequate employer
sponsored medical health plans but now find themselves with partial
or no coverage and fewer choices regarding the types and adequacy of
health plans available to them. With the number of uninsured in the
U.S. rapidly approaching 50 million (Aston 2006), the problem has
reached crisis proportions with no viable solution in sight (Ayanian et
al. 2000; Donelan, Blendon et al. 2000; and Wechsler 2004).
The inclusion of many middle and working-class individuals
into the ranks of the uninsured and underinsured has helped to
highlight the problem of inadequate health care access to many in
the U.S. (Quadagno 2005) However, the majority of the uninsured
and underinsured continue to be the working poor and the poor,
particularly children, women, and minority group members
(Baezconde-Garbanati, Portillo, and Garbanati 1999; Brown, Wyn
2
and Ojeda 1999; and Guendelman and Pearl 2004). Of all
disadvantaged groups experiencing health care access problems due
to a lack of health insurance or other factors, Latinos appear to have
the most difficulties. A major explanation is the fact that,
proportionally, Latinos (along with Native Americans) have the
highest rates of being uninsured when compared to white and other
ethnic populations (Greenwald, O'Keefe, and Camillo 2005; Flores,
Abreu, and Tomany-Korman 2006; and Shah and Carrasquillo 2006).
For Mexican Americans, health care access problems only
begin with a lack of health insurance. Other factors such as system
barriers related to a lack of cultural sensitivity and competence, and
discrimination based on social class and immigration status
contribute to primary access and quality of care issues for this group
(Brown et al. 2000; Berk and Schur 2001; Bender et al. 2004;
Documet and Sharma 2004; and Holt et al. 2006). Mexican
Americans often must adapt their healthcare seeking behavior in
order to obtain the best possible health care for themselves and their
families. These adaptations can be viewed as a form of medical
pluralism described by Belliard and Ramirez-Johnson (2005) as the
simultaneous use of various medical treatments and may include the
use of: 1) Mexican or Mexican American traditional medicine which
differs from other alternative medicine because of its unique mixture
3
of Spanish and indigenous customs and beliefs (Torres and Sawyer
2006); and, 2) alternative medicine, e.g., holistic, homeopathic,
natural, or other medical treatment forms not practiced or officially
sanctioned by the American medical establishment (Eisenberg 2005)
as well as other creative methods of health care seeking in
combination with biomedical or conventional medical practices
(Hayes-Bautista 1979; Steinhauer 2000; Hsiao et al. 2006; and
Sobralske 2006).
Statement of the Problem
The central thesis of this study is that certain cultural and
social patterns related to health care behavior persist among long-
term immigrants (ten years or more of residency in the U.S.) and
second-generation Mexican Americans despite the influences of
assimilation and acculturation. I argue that Mexican Americans from
all generations utilize a wide set of adaptive adjustments and
behaviors in responding to their daily lives including their health care
needs. More specifically, an important assertion of this study is that
long-term immigrants and second-generation Mexican Americans do
not give up or abandon traditional Mexican-American medicine (e.g.,
use of herbal remedies, reliance on faith and spirituality, and the use
of alternative healers) but rather adopt a pluralistic approach to
health care with strong traditional medicine influences.
4
Purpose of the Study
This study examines the extent to which the use of traditional
medicine persists among immigrant and native-born Mexican
Americans within a broader framework of medical pluralistic
practices and behaviors that combines the use of conventional
(biomedical) health care and other alternatives. It also attempts to
illuminate important Mexican American health care issues related to
these health care practices and behaviors, especially those impacted
by nativist rhetoric and negative contexts of reception aimed at
Mexican American immigrants and native-born Mexican Americans
Research Questions
This is a study of health care seeking behaviors of immigrant
and native-born Mexican Americans which focuses more on what
Mexican American health seekers do in response to illness or injury
rather than health maintenance or preventative behaviors. More
specifically, a major focus of this research is concerned with the
situations under which Mexican Americans choose traditional
medicine, choose conventional medicine, or move from one type of
medicine to the other as part of a pluralistic approach to healthcare
seeking. The important questions that form the basis of this research
are:
5
1. Does the use of Mexican and Mexican American
traditional medicine persist among long-term
Mexican American immigrants and native-born
Mexican Americans?
2. What patterns of pluralistic medical health care
seeking behaviors do native-born Mexican
Americans and long-term Mexican immigrants
utilize and to what extent are these patterns based
upon the use of Mexican or Mexican American
traditional medicine or some other alternative
practices (e.g., seeking health care in Mexico)?
3. Overall, how do both groups regard traditional
medicine? That is, when are healthcare seeking
behaviors matters of choice or preference versus a
survival adaptation to blocked access to
mainstream care?
4. What important system barriers to obtaining
quality health care are perceived by the study
population and what mechanisms do they employ
to mitigate them?

6
Although these questions clearly delineate two groups, Mexican
immigrants and native-born Mexican Americans, the main purpose of
the research does not involve detailed comparisons between the two
groups nor does it involve the testing of hypotheses. Rather, the
main goals are to examine the behavior of the native-born and
immigrant Mexican Americans as a total group in relation to the
overall research questions and to gain insight and knowledge
regarding their healthcare seeking behavior.
Research Objectives
The major objectives of this study are to examine and attempt
to understand the dynamics of Mexican-American healthcare seeking
behavior, particularly in regards to those factors that promote
retention of the use of traditional medicine by long-term immigrants,
and second-generation and beyond Mexican Americans (Brown
2006). While most sociological studies in this area focus on
quantitative models that explain Mexican-American healthcare
seeking by examining such variables as assimilation, socioeconomic
status (SES) this study seeks to examine the topic from a qualitative
framework in which respondents describe their own world of
healthcare seeking and how they navigate the alternatives. This is
accomplished by the analysis of qualitative data gathered from 10
community organization representatives knowledgeable about Latino
7
health care issues and 33 intensive interviews with long-term
immigrant and native-born Mexican Americans in Santa Ana,
California.
Scope of the Study
This study is limited to Mexican-American respondents in the
City of Santa Ana, California. Santa Ana was chosen as the site of
the research for a number of reasons. First, I lived and worked in
Santa Ana for many years and am completely knowledgeable of its
geography, demography, and the overall nature of its residents in
general. As an employee of Orange County’s Health Care Agency,
which provided health and mental health services to the community,
I was in a unique position to work alongside an entire network of
service providers, particularly those that served the Mexican-
American community.
Second, on a national level, Santa Ana is the city with the
largest percentage of its citizens (74 percent) reporting speaking
primarily Spanish at home as shown on Table 1.0. Compared to
other cities with large Latino populations, this percentage is greater
than the cities of Miami, El Paso, and Los Angeles with percentages
reported at 69.5, 62, and 42.2 percent respectively. The significance
of this fact is that Santa Ana is clearly a city in which it can be
reasonably assumed that a significant Mexican American cultural
8
influence is maintained which may not be the case in other
communities such as Miami with its large Cuban American
population. One simply has to visit the downtown area of Santa Ana
and most of its outlying neighborhoods to gain an appreciation of the
concentration of persons of Mexican descent and the unique cultural
makeup of the community. As previously stated, the intent of this
study was to focus strictly on Mexican Americans and not on other
Latino groups.
Table 1.0: Percent of people who speak Spanish at home by city.

Rank City Percentage
1 Santa Ana, CA 74
2 El Paso, TX 70
3 Miami, FL 66
4 Anaheim, CA 43
5 Los Angeles, CA 42
6 San Antonio, TX 42
7 Houston, TX 36
8 Riverside, CA 33
9 Dallas, TX 33
10
(tie)
Tucson, AZ
Fresno, CA
29

Source: U. S. Census Bureau 2000

Perhaps more important is that Santa Ana’s population is a
relatively poor one, ironically geographically located in one of the
most affluent counties in the State. Table 1.1 shows that the per
capita income in Santa Ana is $12,152 compared to $25, 826 for the
County and $22,711 for the State. Moreover, the percentage of
9
persons below poverty level in Santa Ana (19.8 percent) is almost
twice the countywide percentage of 10.8 percent. Although these
figures are for the entire City and County populations, in Santa Ana
it can reasonably be assumed that most of the poor in the City are
Hispanics since76.1 percent of the City’s population is of Hispanic or
Latino origin. Also, there is evidence that, nearly all of the Spanish
speaking residents are of Mexican origin unlike in other communities
where there are growing and significant populations of Central
Americans and other Spanish speakers. Santa Ana is the ideal
location for this study because the concentration Mexican American
immigrant and native-born population.
Table 1.1 General Characteristics of the City of Santa Ana, Orange
County, and the State of California

Orange
Santa Ana County California
Total Population, 2003/2006 342,510 3,002,048 36,457,549
Hispanic/Latino Origin, 2000/2006 76.10% 32.90% 35.90%
Non-English Spoken at Home, 2000 79.60% 41.40% 39.50%
Foreign born, 2000 53.30% 29.90% 26.20%
Persons/Household, 2000
4.55 3.00 2.87
Median household income, 1999/2004 $43,412 $ 58,605 $ 49,894
Per capita income, 1999 $12,152 $ 25,826 $ 22,711
Persons below poverty, 1999 19.80% 10.20% 13.20%

Source: U.S. Census Bureau 2006

10
Third, the city is geographically ideal for this study because
Mexican American neighborhoods and communities are easily
identified and therefore more manageable in canvassing for
respondents. Businesses such as specialty food markets, music
stores, and clothing stores as well as health care facilities, storefront
clinics, and herbal shops (botanicas) are very visible throughout the
community. It is a major assertion of this study that the strong and
widespread presence of Mexican-American businesses and healthcare
related facilities is instrumental to the use of traditional medicine in
Santa Ana regardless of individual immigration status, and social
standing.
Table 1.2: 2007 HHS Poverty Guidelines

Number of Persons 48 Contiguous
in Family or
Household States and D.C. Alaska Hawaii
1 $ 10,210 $ 12,770 $ 11,750
2 13,690 17,120 15,750
3 17,170 21,420 19,750
4 20,650 25,820 23,750
5 24,130 30,170 27,750
6 27,610 34,520 31,750
7 31,570 38,870 35,750
8 34,570 43,220 39,750
For each
additional
person add 3,480 4,350 4,000

SOURCE: U.S. Department of Health and Human Services 2007

11
The study only uses long-term Mexican American immigrants
and second-generation and beyond Mexican-Americans, and
emphasizes selection of individuals identified as poor (below the
poverty threshold) or working class (above the poverty threshold) as
defined by the 2007 U.S. Health and Human Services Department
Poverty Guidelines outlined in Table 1.2. These standards were
applied to study respondents.
Significance of the Study
This study is driven by the idea that Mexican-Americans
construct unique patterns of behavior that incorporate social and
cultural characteristics from both the American and Mexican social
systems. The idea is well supported by the works of Ann Swidler
(1986 and 2001). Swidler argues neither culture nor social structure
completely determine human action. Rather, the interaction of social
structure and culture, contributes to the formation of a repertoire of
choices (a tool kit if you will) in social action and behavior. As my
research progressed I became more impressed and influenced by
Swidler’s ideas and they became the foundation for the social action
paradigm that I describe in Chapter 4, along with the works of Hay’s
(1996) and Sewell (1992) that share similar themes to the work of
Swidler but focus primarily on structure. In brief, the paradigm
12
posits that the interaction of social structure and culture operates
among Mexican Americans by providing with a tool kit that they
utilize in the practice of medical pluralism with a strong influence of
traditional Mexican American folk medicine. This tool kit provides
them with a wide range of health care seeking behavior options that
are studied and discussed in this research.
The most important aspects of this study are: 1) that it
deviates from the general practice in sociology to study Mexican
American health care systems from a conventional medicine versus
traditional medicine dichotomy; 2) an examination of the role of
traditional medicine and medical pluralism in the lives of long-term
Mexican immigrants and native-born Mexican-Americans, and, 3) its
attempt to move away from conceptual models that focus simply on
culture and social structure as the main influences on Mexican
health care behavior. Coincidentally, the current trend of an
increased use of alternative medicine among the overall U.S.
population makes this study timely since it is important to articulate
the differences between that movement and traditional medicine by
Mexican Americans, which is a unique and distinct phenomenon.
Definition of Terms
The following is a set of definitions of the terms most widely
used in this study and which are important to the general
13
understanding of the text. All other terms, particularly those in
Spanish (Mexican folk remedies, herbs, and rituals) are defined in the
text when they first appear.
Conventional Medicine is allopathic or biomedicine whose
treatment modalities are based on scientific methods and research
typified by the U.S. and European health systems.
The Dual Health Care Delivery System is a description of the
U.S. health care system in which the wealthy and those with
adequate health insurance have access to the private health care
system typified by regular medical visits, a regularly assigned or
selected physician, and access to most medical treatments to address
both acute and chronic health conditions. In this system, the poor
have access only to the public health care system in which patients
experience long waits for care, do not have a regularly assigned
physician, and generally receive inferior care due to funding
limitations and rationing of services. (Dutton 1978)
The Dual Health Perspective describes the contrast between
conventional western European the health system and the Mexican
traditional medicine system (Lopez 2005) and should not be confused
with the concept of the dual health care delivery system defined
above. The dual health perspective describes a bi-modal model of
healthcare seeking that dominates the sociological explanations of
14
the Mexican American experience. Although discussed in this study,
it is not a major model employed here to explain the study findings.
The Latino Health Paradox is the epidemiological observation
that Mexican and Latino immigrants (and other immigrant groups) in
general have lower rates of morbidity and mortality than other social
groups in the U.S. including whites. It is also widely accepted that
the health advantage enjoyed by immigrant groups begins to erode as
the process of assimilation into American culture occurs. (Aldrich
and Jayachandran 2000; Arcia et al. 2001; Cannato 2004; Finch,
Reanne, and Vega 2004). The paradox stems from the fact that
Latinos are one of the poorest groups in the U.S., and is the group
with the largest percentage of uninsured persons within its
population. Three theories have been proposed to explain the
paradox: the healthy immigrant theory states that only the healthiest
migrants emigrate, therefore the Latino population is healthier in
general; the salmon bias theory states that older immigrants return
to Mexico to live out their final days thus leaving behind in the U.S. a
younger, healthier population to skew the health statistics of the
population; and, the Latino lifestyle theory states that Mexican
Americans and other Latinos have closer knit families and
communities, enjoy greater social support, and eat much healthier
foods than the general U.S. population. Hayes-Bautista (2007)
15
argues that the paradox continues to be present in the larger Latino
population including the native-born, especially in California.
Medical Pluralism (Belliard and Ramirez-Johnson 2005) is a
relatively new concept in the social sciences which consumers of
health services utilize a range of alternatives that may include any
combination of conventional medicine, traditional medicine,
alternative medicine, complementary alternative medicine (so-called
because it may used as a complement to conventional medical in the
treatment of patients) (Arcury et al. 2006), and visits to Mexico for
less expensive medical care and prescription drugs.
Mexican or Mexican American Traditional Folk Medicine
(herein referred to as traditional medicine) is folk medicine primarily
from Mexico but also prevalent in the southwestern U.S. which is
based on a mixture of Spanish and indigenous health, medical,
religious beliefs, and practices. It includes the strong tradition of
curanderismo (the belief, value, and practice of ritual healing) in
which healers (curanderos) are frequently consulted by Mexican
American healthcare seekers. (Trotter-II and Chavira 1997; Torres
and Sawyer 2006)
Narrative is a qualitative process by which study subjects
articulate their experiences related to an important issue of study. In
this research, the stories of respondents’ health care seeking and
16
health care behavior is crucial to understanding the overall health
care systems that Mexican Americans utilize and why. (Bell 2000)
The Social Action Paradigm is a qualitative model of behavior,
conceptualized in this study, in which the interaction of social
structure and culture contributes to the development of a set of tools
that people use to make decisions about certain actions. In this
model, social structure and culture do not directly cause action, but
rather provides actors with alternatives to maintain agency. In this
study, the paradigm is applied to the health care seeking and health
care behavior of Mexican Americans and long-term Mexican
immigrants.
Delimitations And Limitations
This study focuses only on long-term Mexican immigrants (10 or
more years of residency in the U.S.), and native-born (second-
generation and beyond) low-income or working class Mexican-
Americans. Including these two groups I will be able to examine the
extent to which alternative medicine persists into and beyond the
second generation. The study of healthcare seeking and health
behavior of middle-income and affluent Mexican Americans is not
included. I am focusing on the working class because I am interested
in the probable effects of a lack of resources due to economic
17
disadvantage and the negative contexts of reception to which this
population is likely subjected.
Organization of the Work
The balance of this dissertation contains chapters which
include a review of the literature, a detailed description of the
qualitative research paradigm which I have labeled The Social Action
Paradigm, a discussion of the research methods employed in this
study, three chapters of findings, and, finally, a review of the
significant study findings and discussion. More detailed descriptions
of the contents of the study are summarized in the following
paragraphs.
Chapter 2 is a comprehensive review of the literature in which
the factors impacting the general healthcare of Mexican Americans in
the U.S. are discussed. These include the dual health care system,
patterns of Mexican American health, the impact of assimilation and
acculturation, system barriers (in particular, the lack of health
insurance), and Mexican American health care seeking behavior. The
discussion begins with the most general topics and funnel down into
a discussion of medical pluralism and the role it plays in Mexican
American health care seeking. The chapter concludes with a
discussion about what is lacking in the literature (what we do not
know) about Mexican American healthcare seeking behavior
18
Chapter 3 presents the Social Action Paradigm that guides this
research. The paradigm is based upon the works of Swidler (1986) ,
Sewell (1992), and Hays (1994) and its main proposition is that
actors (in this case Mexican American health seekers) develop a tool
kit of alternatives and maintain agency in making healthcare choices.
The paradigm posits that social structure and culture do not totally
create or constrain social action, but rather interact in significant
ways to provide actors with the valuable “tool kits” they need in their
social behavior. The paradigm is very useful in the articulation and
understanding of healthcare seeking behavior under medical
pluralistic models, which are fairly recently developed conceptual
models in the social sciences.
Chapter 4 is a comprehensive statement of the research
methods and more fully discusses the work as a qualitative one. The
use of narratives to promote better and more detailed understanding
in medical sociology is explained and directly related to the specific
method of using open-ended interviews in this study. The study
limitations are detailed, particularly the decision to limit the study to
a nonrandom, nonscientifically small sample utilizing a qualitative
interview guide. Sample limitations include the selection of long-term
immigrants, native-born Mexican Americans, and selection of only
working class and poor individuals. Also included is a rationale and
19
justification for selecting the City of Santa Ana as the research site.
Chief among the reasons include the facts that Santa Ana has the
highest proportion of primary Spanish speakers of any other city in
the U.S, and that the City is largely influenced by Mexican American
culture in which ethnic stores and business are highly visible and
abundant. Specialty stores such as herbal shops (botanicas) that are
essential to this study. Finally, the sampling design is described as
one in which interviews were obtained by door-to-door canvassing,
finding respondents in public places such as strip mall shopping
areas, Laundromats, etc.
Chapter 5 contains narrative data from 10 health care services
providers. These providers are not part of the main sample of
respondents but, rather, are viewed as key informants who were able
to shed some light on the subject of the healthcare services available
to Mexican Americans in Santa Ana, and who were able to provide
information and observations regarding the healthcare seeking
behavior and barriers that Mexican Americans in Santa Ana
experience. The data gathered from this group were very helpful in
preparing for and conducting the interviews with the 33 study
respondents.
Chapter 6 contains a comprehensive analysis of the qualitative
data. The analysis begins with a discussion of system barriers and
20
proceeds along a continuum of alternatives available to Mexican
American healthcare seekers in Santa Ana including the exclusive
use of conventional medicine, the use of storefront clinics, trips to
Mexico for healthcare, the use of home remedies, engaging in prayer
for health, the use of botanicas, and finally, the use of curanderos.
Another section of this chapter is an analysis that specifically looks
at the ways in which many respondents moved across the
alternatives with varying degrees of frequency and fluidity. The
chapter concludes with a further articulation of the medical
pluralistic model in which healthcare seeking is viewed from four
major perspectives: the exclusive use of conventional medicine, the
use of conventional medicine with some alternatives selected, moving
across the alternatives with frequency and fluidity, and the
preference for, or the exclusive use of, traditional medicine.
Chapter 7 presents the findings from four case studies that
illustrate the four perspectives identified in the above paragraph.
Each of these case studies was selected out of the larger sample of 33
respondents because they illustrate the major healthcare seeking
perspectives. Of the five case studies, two are immigrants and two
are native born Mexican Americans. The case studies were prepared
with the intent to provide more in-depth and detailed analysis of
21
healthcare seeking behavior and preferences among the sample
respondents.
Chapter 8 contains a summary of the major study findings and
conclusions, and provides further clarification of how the Social
Action Paradigm contributed to study analyses when used in
combination with a medical pluralism perspective. Finally, the
limitations of the study are discussed and recommendations for
further research are proposed.
22
CHAPTER 2: REVIEW OF THE LITERATURE
Background of Mexican American Healthcare
Understanding the dynamics of Mexican American health care
access, usage and behavior requires examination in respect to several
broader health care issues in the U.S. The problems of the U.S.
health care system and its institutions are closely tied to the health
care issues of the Mexican American community in general. The
American health care system is one that is based on inequality and
Mexican Americans, and other Latino groups, are among the poorest
and most disadvantaged people in U.S. society (LeClere et al. 1997;
Waitzman and Smith 1998; Politzer et al. 2001; and Davidson,
Kitzinger and Hunt 2006).
Despite a health care system that is arguably the most
scientifically and technologically advanced, American citizens
experience higher rates of morbidity and mortality than all other
industrialized nations and even some so-called developing nations.
Furthermore, the per capita expenditures for health care services in
the U.S. in 2002 was $5,317 and far exceeded those of any other
nation (e.g., compared to Switzerland, the nearest western nation’s
per capita expenditures of $3,446), which makes the relative poor
health of the U.S. population more disturbing and puzzling
(Cockerham 2006). The explanation of this problem is complex but is
23
rooted in the inequality embedded in the U.S. health care delivery
system (Davidson et al. 2006). Social inequality within and across
societies has long been associated with poor health outcomes among
the lower classes and poor countries (Dutton 1986; Wilkinson 1998).
The Dual Health Care Delivery System
The U.S. health care delivery system is best described as a dual
health care system composed of a private sector utilized primarily by
the American middle-class and the rich, and a public sector utilized
by the poor (Dutton 1978). The private sector includes health care
systems accessed through health insurance while the public sector is
accessed through social welfare programs such as Medi-care and
Medi-caid. The private sector is characterized by regular care and
higher quality care compared to sporadic and poor quality care in the
public sector.
The dual health care system is inherently one of unequal
access to health care in the U.S.; but it does, in fact, provide health
care coverage to the poor who are eligible to receive services. A far
more serious problem is the 46.6 millions of Americans who lack
health insurance but do not qualify for any health care assistance
whatsoever (Aston 2006) many of whom are Mexican Americans or
Mexican immigrants. Most of these are individuals who are classified
as the working poor or individuals with limited income but who do
24
not meet the poverty level criteria established by the government for
public assistance.
Anti-immigrant Sentiments and Policies
For Mexican Americans and Mexican immigrants, the problem
of a lack of access is better understood when placed within a larger
perspective of the contexts of reception for Mexican immigrants in the
U.S. It then becomes clear that healthcare, or a lack of it, is a major
social and economic issue for these two groups. Negative political
movements and policies targeted at particular groups, such as
welfare reform and the Proposition 187 movement in California
(which targeted undocumented immigrants in an effort to deprive
them of access to social benefits including medical care) often emerge
from the misconception that undocumented immigrants are a drain
on our economic resources (Wilson 2000). There have been notable
spillover effects of these movements and policies onto the legal
Mexican immigrant and native-born Mexican American populations
(Feld 2000).
For Mexican Americans and Mexican immigrants, negative
contexts of reception (compared to the relatively positive contexts of
reception for certain middle class and wealthy Asian immigrants)
have directly affected their ability to sustain themselves economically,
and to socially reproduce their ethnic communities (Skerry 2000).
25
They have been impacted by negative governmental policies;
relegation to low paying, dead-end jobs without benefits; and
segregation in the poorest neighborhoods with the least favorable
social services such as police protection, health care availability, and
quality schools (Portes and Rumbaut 1996). As a result, Mexican
Americans and Mexican American immigrants, more often than not,
have the poorest health care access compared to any other group in
our society. It is common for them to postpone seeking medical care
because they cannot afford being absent from their low paying job
(which would mean lost wages), lack of funds, or lack of insurance.
Medical or health conditions go untreated until they become critical—
sometimes to the point that they require emergency room treatment.
On a day-to-day basis, the medical care that many Americans take
for granted is beyond the reach of many Mexican Americans and
Mexican immigrants.
Mexican American Health: Health Risks and Problem Diseases
Native-born Mexican-Americans in the United States face a
number of health problems and there is good reason to believe that
Mexican immigrants share the risks related to the specific diseases
with their native-born counterparts (Suarez 2000; De la Torre and
Estrada 2001; Quadagno 2005). Major health risks for Mexican
Americans include: diabetes, heart disease related to hypertension,
26
breast cancer in women, HIV/AIDS, and cirrhosis of the liver
(Baezconde-Garbanati, Carmen et al. 1999; Martinez-Ebers, Raga,
and Lopez 2000; Guendelman and Pearl 2004; and Frenk and
Richard 2006). Newly arrived immigrants are sometimes afflicted
with diseases contracted in their home country such as yellow fever,
plague, cholera, and strains of tuberculosis that are resistant to drug
therapies in the United States (Cookson, Waldman, and Gushulak
1998). Unfortunately, much of the concern about these diseases
remains in the shadow of the so-called “Latino health paradox” which
stems from the statistical facts that Mexican American and Latino
immigrants in general are apparently healthier and outlive both
native-born whites and African-Americans.
The Latino Health Paradox
The epidemiological evidence that Mexican Americans are
healthier and live longer than both whites and African-Americans
may be true for particular diseases (e.g., cancer, heart disease, and
strokes), but is misleading as a statement across all health problems.
Three explanations for the phenomenon have been proposed. First,
there is the hypothesis that only the healthiest Mexican immigrants
emigrate. Second is the “salmon bias” explanation that posits that
Mexican immigrants return to their home country after some
employment in the U.S. in a desire to die at home leaving a younger,
27
healthier Mexican immigrant population in the U.S. statistics
(Abraido-Lanza et al. 1999; and Palloni and Arias 2004). Third, it has
been posited that the Latino lifestyle is health-enhancing with high
levels of social capital; i.e., church attendance, community cohesion,
strong work attachments, none smoking, and low fat diets (Hayes-
Bautista and Rodriguez 1995). None of these three theories is
conclusive nor do they provide satisfactory evidence to explain the
Latino health paradox convincingly. A more plausible explanation for
the paradox may be the underutilization of health services (primarily
because of a lack of health insurance and other resources to obtain
health care) and the underreporting of disease and illness among this
population.
The acceptance of the so-called Latino health paradox may be
premature and it should be studied more rigorously to determine its
efficacy as an explanatory model. The existence of the paradox has
likely led to the downplaying of serious health issues faced by native-
born Mexican Americans and Mexican immigrants. But, the specific
illnesses and diseases that put this population at risk is only part of
the overall problem related to their health. Poor access and obstacles
to health care in the form of a lack of health insurance, language
problems, and other cultural and economic factors exacerbated by
racism and discrimination emerge as the most significant set of
28
problems affecting the overall health of the Mexican American
community.
Assimilation and Acculturation
The concepts of assimilation and acculturation are important
to the study of Mexican American health care. It is a generally
accepted notion that the health care behavior and health outcome
patterns of immigrants begin to approximate those of mainstream
Americans after living in the U.S. for about 10 years (Aldrich and
Jayachandran 2000; Arcia et al. 2001; Cannato 2004; and Finch et
al. 2004). Given the evidence that Latinos may generally be healthier
than whites and other ethnic groups, some Latino social scientists
are concerned that assimilation can lead to social and cultural
adaptations that may have negative consequences on Latino health
(Hayes-Bautista and Rodriguez 1995; and Finch et al. 2004).
Presumably, this problem occurs in cases in which immigrants are
more fully acculturated into American society; therefore, it is
important discuss Mexican-American health in relation to specific
assimilation models that can be labeled as straight-line assimilation;
cultural pluralism, and segmented assimilation.
Straight-line Assimilation Model
The term Straight-line Assimilation Model was coined by
Herbert Gans (1997) and incorporates a variety of similar
29
descriptions of the experiences of immigrant populations to American
society. Generally, the model describes the arrival of immigrants
with ethnic and national identities quite different from those of the
native-born American population. In older versions of the model,
immigrants start at the bottom of the social and economic structure
of society and eventually move up as they acculturate; i.e., learn
English and acquire the necessary educational and social skills
required to be successful in their new environment. This process is
not rapid, but occurs over the lifetime of individual immigrants and
over the lifetimes of subsequent immigrant group generations.
Ultimately, second- and third-generation children of immigrants
become more acculturated and assimilated, losing their ethnic and
cultural identities as they become Americanized (Portes and Rumbaut
1996; Waldinger and Bozorgmehr 1996; and Alba and Nee 1997).
The major critique of the Straight-line Assimilation Model is
that it best describes the immigrant experiences of white ethnics in
the immigration waves of the late 19
th
and early 20
th
centuries
(Rumbaut 1997). Further, although the model may still have some
utility in explaining the immigration experiences of some white ethnic
groups in the U.S., it is woefully inadequate in explaining the
immigrant experiences of other immigrant groups, particularly those
of racial and ethnic groups that are different than the white ethnic
30
majority in America. For example, the model clearly does not fit the
experiences of middle-class and wealthy immigrants (mostly from
Asia, South-Asia and the Middle-East) who are able to immigrate to
the U.S. and enter into occupational and spatial areas to which
earlier immigrants were able to penetrate only after generations of
assimilation. More importantly, the model is not a good fit in
explaining the experiences of poorer immigrants from Mexico, Central
America, and other Latin American countries. It is well documented
that subsequent generations from these groups do not do as well
economically as their white ethnic counterparts from earlier
immigration periods, or when compared to the Middle-eastern and
Asian immigrants of today (Foner 2000).
Cultural and Pluralistic Models
In response to this critique, many scholars have moved away
from the idea of America as a melting pot in which the ideal is that
immigrants are fully acculturated and assimilated into the social and
cultural fabric of society. What have emerged are models of
assimilation that take into account racial, ethnic, cultural, and
national traits, especially in the case of contemporary immigrant
populations. These posit that different immigrant groups will
acculturate and assimilate at different rates and in many cases, bring
about cultural changes, and contribute to, the make-up of American
31
society and culture. Generally, these models place value on the
concept of cultural pluralism and accept that total immigrant
assimilation (including subsequent generations) will not necessarily
occur, or even more importantly, may not be desirable considering
America’s history of racial and gender discrimination, educational
practices, cultural genocide, and European-based white
ethnocentrism (Skerry 2000). At the core of these models is the idea
that acculturation and assimilation do not necessarily occur at the
same levels. Individual immigrants and immigrant groups can be
more or less successful with varying degrees of assimilation (Alba and
Nee 1997). Cases where immigrants are not fully assimilated but are
economically and socially successful usually can be explained by the
value and positive application of pluralism (Romero 2004; and
Abraído-Lanza et al. 2006). On the other hand, lack of success may
be attributed to discrimination on the basis of race, ethnicity, gender
and a negative value on pluralism (Espiritu 1996; Olsen 1997; Zhou
and Bankston 1998; Livingston and Kahn 2002; and Holt et al.).
Segmented Assimilation Models
Some scholars argue that the concept of segmented
assimilation provides a basis for a more appropriate model that
explains how certain groups of immigrants become Americanized.
Since immigrant groups find themselves in different political, social,
32
and economic contexts upon their arrival to the U.S., it makes good
sense to expect them to adjust in different ways and at different
rates. In this case, assimilation is largely dependent upon the
characteristics that immigrants bring with them, and on the
opportunities and restrictions that they encounter in the U.S. (Zhou
and Bankston 1998; Skerry 2000).
There is much evidence of segmented assimilation in
contemporary U.S. society. For example, to a large extent,
immigrants from India do not migrate to specific geographic
locations, are usually fluent in English, and often move directly into
well-integrated, middle-class neighborhoods. While Indian
immigrants hold on to many of their important cultural traits, for the
most part, they usually have no plans to return to their country of
origin and acculturate well into American society (Ramiro, Matthew,
and Nielson 2004; Robert 2005; and Brown 2006).
Many Chinese immigrants come to the United States with solid
middle-class credentials; i.e., high levels of education and significant
social and economic capital. However, they differ in the respect that
many may have to plans to eventually return to their home country,
are not fluent in English, and migrate to middle-class ethnic
enclaves. Thus, in terms of employment and middle class lifestyle,
acculturation clearly occurs. However, many Chinese immigrants,
33
particularly stay-at-home mothers and the elderly, do not acculturate
fully into American society restricting their social lives to the ethnic
enclave and speaking mostly their native language (Waldinger and
Bozorgmehr 1996; and Ong 1999).
Mexican immigration to the United States is quite different
from that of Asians and East Indians. For decades, it has been
driven primarily by the need for cheap labor in the United States and
many of the immigrants have little or no education and speak very
little English. Mexican immigrants bring with them very little social
and economic capital and take low-paying unstable jobs with no
benefits. Moreover, their economic problems and lack of English
fluency, relegates them to ethnic enclaves in poor neighborhoods
where overcrowding and crime are commonplace (Portes and
Rumbaut 1996). As a result, Mexican immigrants are more isolated
from mainstream society in America than other immigrants. The
result is decreased opportunities to acculturate and a tendency to
maintain a strong Mexican American cultural identity even into the
second generation and beyond. Moreover, the sheer number of
immigrants, which includes the approximately 10 million who
immigrated to the U.S. between 1946 and 1964, and the current
estimate of over 11 million Mexican undocumented immigrant of
today makes this more likely. (Hondagneu-Sotelo 1994)
34
Overall, what segmented assimilation models illustrate is that
old notions of assimilation (such as that envisioned by Milton Gordon
in which the final stage of assimilation) including the achievement of
structural assimilation, intermarriage, and assuming the American
identity, have less utility in the study of contemporary Mexican
American immigrant population (Rumbaut 1997; Ramiro et al. 2004;
and Levine 2005). Mexican American immigrants have little choice
but to work in the lowest paying jobs and make their homes in
established ethnic enclaves in which they find acceptance and
familiarity. In summary, because of segmented assimilation and the
social forces that contribute to its existence (nativism, governmental
policies, discrimination, and labor market patterns) there is a strong
persistence of many of the social institutions, language, customs and
practices that Mexican immigrants brought with them to this
country.
In the study of immigrant assimilation in American society,
sociology has made many significant adjustments and has
contributed to the development of assimilation models that more
appropriately describe and explain U.S. immigrant assimilation.
These new models of assimilation are more relevant to contemporary
immigrants and there has been a significant decline in the use of the
Straight-line Assimilation Model and models that were more useful in
35
explaining white European immigration during the latter half of the
19
th
century and the first half of the 20
th
century. Unfortunately, the
use of these old assimilation paradigms persists in the field of
medicine (and to some extent in sociology) in regards to health issues
of native-born and Mexican immigrants. Much of the literature
focuses on the relationship between immigrant acculturation or
assimilation and health care usage or outcome (Cookson et al. 1998;
Aldrich and Jayachandran 2000; and Lauderdale et al. 2006). The
general findings of these studies is that as immigrants become more
assimilated to American mainstream lifestyles, their health patterns
and outcomes approximate those of the native-born white
population—generally to the detriment of the immigrants’ health.
This approach is extended to studies of the psychological well being
of immigrants focusing on the negative aspects of assimilation to
mental health (Zambrana et al. 1994; and Harket 2001).
System Barriers and Lack Of Health Insurance

The downplaying of the specific diseases to which Mexican-
Americans and Mexican immigrants are at risk is only part of the
overall problem related to their health. More than the risks of certain
diseases, inadequate access and obstacles to health care in the form
of a lack of health insurance, language problems, and other cultural
and economic problems exacerbated by racism and discrimination
36
emerge as the most significant set of problems (Nguyen and Brian
2000; Warren et al. 2006; Yang, Zarr, and Kass-Holt 2006). There
are many reasons for the detrimental effects of these factors on
native-born Mexican Americans and immigrants (Ku and Matani
2001; Guendelman and Pearl 2004; and Jacobs et al. 2004). The fact
that many Mexican Americans, and most Mexican immigrants, are
low-skilled workers essentially trapped in low-paying, dead-end jobs
(and that many of these immigrants are undocumented as well)
severely limits their prospects for access to quality health care, and
their willingness and ability to seek health care when they or
members of their families require it.
There is little information and few theoretical models about the
health care seeking behavior of Mexican Americans and Mexican
immigrants. An unpublished work by Ransford and Carrillo (2006)
attempts to do this by integrating Mechanic’s (1978) theory of health
seeking, Rosenstock’s (1966) Health Belief Model, and Dutton’s
(1976) discussion of system barriers. Their approach posits that
immigrant healthcare seeking and access depends upon three
important factors: belief barriers, structural barriers, and the use of
cultural alternatives. Belief barriers refer to fears, anxieties, and
concerns that individuals may hold in getting care when they need it.
Examples would be concern about deportation, not being able to
37
communicate with doctors and nurses, the cost of treatment, and
long waits for service. These concerns greatly dampen utilization
such that the person only approaches the doctors or the hospital
when extremely ill.
Structural barrier factors deal with the complexity of navigating
and negotiating the physical and bureaucratic realities of a large
complex hospital or clinic. Meeting health insurance requirements,
demonstration of ability to pay, and other red tape requirements are
examples of these barriers. Also, dealing with hostile personnel at
the front desk, distance to the hospital from home, or the lack of
Spanish- or indigenous-speaking providers or interpreters are
examples of other barriers encountered by Mexican Americans and
Mexican immigrants. The major barriers to Mexican Americans and
Mexican immigrant health seeking are the costs of medical care, lack
of health insurance, language and cultural differences, and the
negative reception at public hospitals and clinics. Costs and lack of
health insurance among Mexican Americans is extremely common
given the pervasive employment in minimum wage jobs without
health benefits. Approximately 38 percent of Latinos nationally lack
any health insurance—one of the highest rates of any ethnic group
(Cockerham 2006). Among Mexican Americans and Mexican
immigrants the rate is far higher. Lack of health insurance has an
38
extreme adverse impact on health care utilization (Hernandez 1999;
and Brown et al. 2000).
Language or the lack of interpreters to assist patients is a
serious barrier to health care seeking Mexican-Americans and
Mexican immigrants. Often, patients speak only Spanish and have
no English language skills (Reimann et al. 2004; Gregory 2005; and
Sobralske 2006). Some Mexican immigrants may be members of an
indigenous group from isolated, rural communities. These
individuals may speak only their native language and may not be
able to communicate in Spanish. In this case, even if Spanish
language translators are available, it is difficult for Mexican-
Americans to receive the services they need. What exacerbates this
situation is that health care providers are generally unaware that
there are indigenous Mexican immigrant populations that are not
Spanish speakers and who have diverse cultural backgrounds that
impact their health care needs (James and Lee 2005).
Reliance on Public Sector Services
System or structural barriers to Mexican American and
Mexican immigrant health care are embedded in institutional
discrimination and inequalities of the American health care system
(Documet and Sharma 2004; and Davidson et al. 2006). Dutton
(1978) describes a dual system of health care in the U.S in which the
39
poor obtain their medical care from public sector institutions such as
large County hospitals or clinics and the middle and upper classes
obtain their medical care from private providers in individual or
group practices. Mexican Americans and Mexican immigrants, who
are among the poorest members of our society, must rely heavily on
the public sector facilities that are typically under funded,
understaffed and unable to provide adequate medical care. Patients
in these institutions must often endure long waits, discriminatory
practices by stressed and hostile medical and administrative staff,
and lack of access to needed medical treatment or technology—some
of which is essential to the patient and may result in death if not
received. For Mexican-Americans and Mexican immigrants, these are
foreboding and fearful places. Moreover, seeking care in these
facilities may be an extreme hardship for working immigrants whose
jobs do not provide them with health insurance or sick pay benefits.
Responses to System barriers
Mexican Americans and Mexican immigrant responses to these
barriers are varied and many have deleterious effects. For example,
in response to costs, a lack of insurance, and the negative
experiences faced in public medical institutions, many choose to not
seek medical attention until their illness (or that of a child or family
member) has become so severe as to require use of an emergency
40
room. Sometimes, they do not seek medical care in the U.S. at all,
postponing visits to a doctor until they can obtain services in their
home country (Feld 2000; Zambrana and Logie 2000) It is not
uncommon for many Mexican-Americans and Mexican immigrants to
travel to Mexico for their health care needs. When Mexican-
Americans and Mexican immigrants do seek medical services in
American medical institutions, their children are often pressed into
service as interpreters with mixed results. The children become the
main communication connection between the adult immigrant and
the institutions (Menjivar 2002 and James and Lee 2005).
Mexican-American Healthcare Seeking
The literature on Mexican-American or Latino health care
seeking takes more or less a dichotomous perspective as described in
earlier definition of the dual health perspective, i.e., that segments of
the Mexican-American community either utilize culture-specific
traditional medicine to deal with their health care, or they utilize
conventional mainstream medicine (Castro 2001 and Bond et al.
2002). It is widely believed that traditional medicine is usually the
choice of the recent Mexican-American immigrant population, and
that conventional medicine is the choice of long-term immigrants or
native-born Mexican-Americans because they are more assimilated
into the American way of life. Of course, these perspectives are based
41
upon the faulty assumptions that Mexican nationals are primarily
rural folks who are largely influenced by traditional social structures
and culture, and that only through assimilation into mainstream
American society does their health care behavior change to accept
more modern medical alternatives (Martinez 1978).
This is not to say that traditional medicine does not have a
significant influence in the health care seeking behavior of many
Mexican-American immigrants and native-born Mexican-Americans
(Castellanos 2003; Lopez 2005; and Ruvinskis 2005). Mexican
traditional medicine is a mix of Spanish and indigenous health care
beliefs and practices and is well integrated into the Mexican and
Mexican-American cultures. Its approach is primarily holistic in
nature and values the use of natural remedies (remedios naturales),
various curanderos such as sanadores (healers who specialize in
physical health but not conventional health workers), brujos (literally,
witches), hueseros (bone manipulators, and espiritistas (spiritualists)
to name a few), and strong spiritual beliefs (Rojas 1996).
The basic problem with this dichotomous, narrow perspective
is that Mexico is in fact a fully modern country with much of its
population fully integrated into modern behavior and lifestyles.
(Thelen 1999) Even in the mostly rural areas populated by
indigenous groups, many accept and utilize modern medicine when it
42
is available to them. This is not to say that many Mexican people do
not value and practice traditional medicine, many do. Rather, the
point is that there are gross misperceptions of Mexican health care
practices that are not based on facts.
Most importantly, the perspective that Mexican Americans
either favor traditional medicine or conventional medicine has
contributed to the proliferation of deterministic models to explain
Mexican American health care behavior. These models usually posit
that structural, economic, or cultural factors can fully explain why
Mexican-Americans behave in certain ways regarding their
healthcare. For example, on the one hand, recent immigrants are
heavily influenced by a lack of resources (low-paying jobs, no health
insurance, or a lack of access to modern healthcare) so they turn
primarily to using traditional medicine in dealing with their health
care needs. On the other hand, more fully assimilated Mexican-
Americans will have higher educational attainment, better jobs, are
more likely to be insured, and a have greater appreciation for modern
medicine.
What is missing from the literature are studies that provide
theoretical or conceptual models that more fully explain Mexican
American healthcare seeking behavior beyond the simplistic
explanations that this behavior is driven primarily by the forces of
43
social structure and culture; which, in turn impact Mexican
American behavior when individuals within the community react to
them. From this perspective, individual Mexican Americans simply
seek the most readily available and affordable healthcare that they
can obtain. Intuitively, this does not make good sense.
The earliest example similar to mine is the work of Roeder
(Roeder 1988). Roeder conducted a qualitative study of immigrant
and second generation Chicanos (Mexican Americans) and was
concerned with the question of why second generation Chicanos
continued to use traditional medicine. She identified several factors
that contribute to the use of folk medicine including: necessity (no
access to physicians); economic factors (poverty, social class);
psychological factors (fear of hospitals, confidence in home remedies
and folk medicine); cultural factors (belief in folk healers and
conditions such as mal ojo (evil eye), susto (fright), caida de mollera
(fallen fontanelle,) etc.; dissatisfaction with conventional medicine;
parents education and attitudes (family is important in the
transmission of beliefs one way or the other; gender (women more
likely to be the possessors of folk medicine knowledge); continued
contact with exponents of folk medicine (residency in barrios and
exposure to traditional sources of medicine such as the prevalence of
botanicas (in fact, Roeder visited botanicas as I did); personal analysis
44
and reassessment of tradition (spiritual people or people prone to
alternative medicine use reassess their values when confronted with
conflicting alternatives--many chose to practice traditional medicine);
and, finally ethnic pride versus assimilation (Chicanos chose
traditional medicine as a sort of rejection of Anglo conformity).
More recently, although studies are still scarce, researchers
have begun to develop new models to explain Mexican American and
Latino healthcare seeking behavior and have placed a label on them.
These generally fall into the broad category of models of medical
pluralism which describe how Mexican Americans and other Latinos
use a wide variety of healthcare seeking strategies (as Roeder posited)
to meet their health care needs including the use of: mainstream
medicine, traditional medicine, more general types of complementary
alternative medicine, home remedies, over-the-counter drugs, trips to
Mexico to obtain less expensive treatment and prescription drugs,
and many more alternatives (Padilla et al. 2001; Belliard and
Ramirez-Johnson 2005; and Ransford and Carrillo 2006).
The problem with Roeder’s early work and the more recent
works based on the concept of medical pluralism, is that they do not
adequately explain the dynamics of Mexican American healthcare
behavior. Although they significantly improve on describing behavior
as more complex than the dual health care perspective, they still rely
45
on explanations that point to social structural and cultural variables
as primary correlates. As I have previously stated, my main objection
to this is that these approaches reduce individual actors to persons
without any agency or choice. I found no studies based on the
premise that Mexican Americans do have, and exert, significant
choice and agency in their healthcare seeking behavior, although the
work of Ransford and Carrillo (2006) begins to examine agency in
healthcare choices among a group of recent Mexican American and
Central American immigrants. However, medical pluralism models
can form the basis for the development of new conceptual models
that may be useful in developing theoretical work.
Mexican Traditional Medicine
With the increased interest in alternative medicine in the U.S.
it is reasonable to ask what makes Mexican traditional medicine
different from those traditional medical practices of other ethnicities,
or from the alternative medicine practiced by mainstream Americans.
This is a reasonable question. However, there are three things that
set Mexican traditional medicine apart from other modalities.
First, Mexican traditional medicine is a mixture of the Spanish
and indigenous traditions that emerged after the conquest of Mexico
(Castro 2001; and Torres and Sawyer 2006). Although there are
similarities to other ethnic traditional medicine, such as Chinese
46
medicine , there are several important differences in terms of the
healing herbs and the mix of Spanish and indigenous religious
symbolism. Mexican traditional religiosity and spiritualism is much
more important than in Chinese medicine (Wing 1998; and Goldstein
1999). The influence and importance of traditional medicine in the
Mexican American community is so strong, that many hospitals have
incorporated some of its practices in the treatment of Mexican
American patients .
Second, although many mainstream American turn to
alternative medicine for the same reasons that Mexican Americans
maintain value on traditional value (e.g., poor doctor/patient
relationships, the failure of conventional medicine to find cures, high
costs of medical care, etc.), the rise of alternative medicine in the U.S.
has occurred only recently within the last 50 or 60 years (Astin 1998;
and Eisenberg 2005). On the other hand, Mexican traditional
medicine has been practiced in Mexico and the southwestern U.S. for
over 400 years (Trotter and Chavira 1997). As such, many
consumers of American alternative medicine are relying on recently
educated practitioners, or on their own research, to make decisions
on what alternative medicines and treatments to use. In the Mexican
tradition, trusted curanderos, a trusted wise woman (mujercita), or
47
family knowledge past down from generations are the sources of what
is good medicine.
Third, Latinos (most of whom are of Mexican origin) in the U.S.
are the largest and one of the fasted growing ethnic populations in
the U.S. Combined with the continued influx of Mexican immigrants,
both legal and undocumented, Mexican Americans are, and will
continue to be, a significant social and political force to be reckoned
with. Their educational, occupational, and healthcare needs will
increase proportionally to the size of the population (David 2000; and
Ling 2004). If the dissatisfaction with the conventional health care
system among mainstream Americans is any indication, it is
reasonable to assume that traditional medicine will remain
significantly important in many segments of the Mexican American
community.
48

CHAPER 3: THE SOCIAL ACTION PARADIGM
In this study I have constructed an explanatory model that I
call the Social Action Paradigm that is based upon the works of Ann
Swidler (1986), William Sewell (1992), and Sharon Hays (1994).
Swidler argues that there is a need to develop more theoretical work
that can explain how culture interacts with social structure to shape
or constrain action. According to Swidler, culture and social
structure do not directly and automatically lead to action, but the
interaction of the two creates a repertoire of capacities which
individuals and social groups can use to develop a set of strategies (a
tool kit if you will) of coping. Similarly Sewell (1994:4) argues that
structure cannot be seen as simply constraining human agency, but
rather that human beings as social “agents’ are capable of putting
their structurally formed capacities to work in creative or innovative
ways.” Finally, Hays (1994) dealing with the limited options of
women in lower SES conditions, presents the concept of
transformative agency. Although this is discussed mostly in macro
level terms in her work it can be applied to individual behavior as
well and is quite complementary to ideas of Swidler and Sewell.
Transformative agency actors do not merely react to social and
cultural forces but are rational in their decisions.
49
These tool kit coping strategies, as they pertain to healthcare
seeking behavior, were found in both the work of (Menjivar 2002)
with Salvadorian immigrant women and Ransford’s and Carrillo’s
(2006) work with Mexican and Central American immigrants. Each
of these works found that Latino immigrants employ an effective tool
kit in coping with health care issues. I assert that these tool kits
provide Mexican-Americans and other Latino groups with some
autonomy in making decisions about their health care, i.e., they are
able to exert agency with the interplay of cultural and structural
factors. More specifically, this research is focused on the role of
traditional medicine as a part of the Mexican-American health care
seeking tool kit. Included is an examination of any cultural and
social structure factors identified by respondents as contributing to
their ability to make decisions to utilize, or not utilize, traditional
medicine or other types of medicine.
Table 3.0 contains a comparison of the general models that I
have found in the literature and compares them to the Social Action
Paradigm. Especially the role and agency of the healthcare seeker is
emphasized from the perspectives of the models. The Social Action
Paradigm assumes that Mexican-Americans are not mindlessly
compelled to primarily utilize either traditional or mainstream
medicine by the forces of culture and social structure that impact
50
their overall and daily lives; but, rather, acquire a took kit of options
from structural and cultural influences that allows them to make
healthcare seeking choices in informed and rational ways.
There is significant evidence in the literature that the process
by which Mexican-Americans make health care choices is far more
complex than previously understood. For example, it is well
documented that Mexican-American assimilation and acculturation
does not follow the widely accepted straight-line model, but instead
their assimilation process is often segmented. Mexican-American
immigrants may assimilate into American culture in unique ways
(Portes and Rumbaut 1996 and Arcia et al. 2001). For example,
Mendez (2005) found that Mexican Americans transitioning into new
neighborhoods, are often influenced by both American and Mexican
styles in altering the structure, landscaping, and decorating of their
homes. They will often build fences, walls and building façades that
have a distinct Mexican influence while maintaining a general
American style of architecture. This phenomenon illustrates the
interaction of social structure (the value of home ownership) and
culture (landscaping and building forms heavily influenced by
Hispanic themes), and the resulting unique home settings that are
simultaneously American and Mexican.

51
Table 3.0: Comparison of Healthcare Seeking Models

Point of View

Role of the
Healthcare Seeker

Comment

Structural and
Cultural Models

The behavior of
healthcare seekers is
determined by
structural and
cultural forces; e.g.,
more assimilated
healthcare seekers
will utilize
conventional
healthcare while the
less assimilated will
utilize traditional folk
medicine.

Reactive to
structural and
cultural factors.
Limited or no agency
in behavior.

Perpetuates the idea
that Mexican
American healthcare
seekers choose either
conventional or
traditional medicine
exclusively.

Medical Pluralism
Models

The behavior of
healthcare seekers
may be influenced by
structural or cultural
forces, but
healthcare seekers
are aware of other
alternatives in
addition to
conventional or
traditional medicine.

Behavior may still be
reactive to structural
or cultural factors,
but some agency is
implied with an
increase in perceived
alternatives. Use of
alternatives may be a
pragmatic response.

Falls short of an
adequate explanation
of why healthcare
seekers utilize the
range of alternatives
available to them.
The mere existence of
the alternatives is
not a complete
explanation.

Social Action
Paradigm

Social structure and
culture interact in
ways that lead to the
development of a
“tool kit” that
healthcare seekers
utilize in making
decisions about
healthcare
alternatives. Social
structure and culture
together or alone do
not necessarily lead
to predictable
healthcare seeking
behavior.

Behavior is
interactive and
healthcare seekers
have agency.
Healthcare seeking
decisions are made
within the context of
resources, available
alternatives, and
belief systems.
Healthcare seekers
often move across
the alternatives with
some degree of ease
and fluidity.

Strong assumption of
healthcare seekers
agency. Adds
explanatory
dimension not found
in other models.

52
The process by which Mexican-Americans seek healthcare can
occur in similar ways. Social structural influences, particularly
barriers to health care, interact with cultural influences such as
strong values, beliefs, or exposure to traditional medicine to provide
Mexican-Americans with a set of social tools that allow them to seek
health care by using an array of alternatives available to them. This
process implies a rational social action effect in which Mexican-
Americans maintain significant agency in health care seeking, rather
than just reacting to social structural and cultural forces.
Table 3.1, is a variation of a conceptual table developed by
Belliard and Ramirez-Johnson (2005) to illustrate the medical
pluralism model and the complexity of some structural and cultural
factors that may influence health care behavior. For example, the
use of conventional medicine by Mexican Americans may be
negatively (indicated by a “-” sign) influenced by such factors as a
lack of health insurance, poor quality of care, discriminatory
practices, and a lack of cultural competency in health care providing
agencies. That is, even if a Mexican American individual places a
high value on conventional medical practices, his or her decisions to
use conventional medicine may be influenced by negative structural
experiences—or not.
53
On the other hand, cultural influences such as immigrant
status, living in an area of high Mexican American population
concentration may lead to higher (or positive influence indicated by
“+” sign) usage of storefront trips to Mexico for medicine or traditional
medicine practices. Because of the range of healthcare alternatives
available to some Mexican Americans, some degree of agency in
healthcare seeking is implied. However, medical pluralism models
alone do not adequately address or explain how Mexican American
can and do exercise agency in their healthcare seeking.
Table 3.1: Factors That May Influence the Type of Medicine Used

Conventional Trips to Traditional
Factors Medicine Use Mexico Medicine Use
Trust Conventional Medicine + + -
High Costs/No Insurance - + +
Quality of Care Received +/- + +
High Discrimination - + +
Cultural Competency +/- + +
Value of Trips to Mexico +/- + +
Enclave Residency +/- + +
Trust Traditional Medicine - +/- +

Culture, structural barriers, and the assimilation process do
appear to influence Mexican American behavior on a societal level,
but studies based upon deterministic models can only provide
general knowledge of Mexican American health care seeking behavior
54
and miss much of the rich data regarding the myriad of choices
available to Mexican Americans in making healthcare decisions.
The Social Action Paradigm provides a more advanced level of
explanation of Mexican American healthcare seeking than has
previously been presented. The paradigm assumes that Mexican
American healthcare seekers have agency and that their healthcare
seeking decisions are made consciously within the context of the
resources available to them, availability of various healthcare seeking
alternatives, and belief systems. Graph 3.0 illustrates this idea.
Figure 3.0: An Illustration of the Mexican American Healthcare
Seeker in Interactive Agency.

FAMILY AVAILABILITY
RESOURCES COMMUNITY OF
INFLUENCE ALTERNATIVES

THE HEALTHCARE
SEEKER AS AGENT

BELIEF OR WILLINGNESS BELIEF OR
PREFERENCE TO MOVE PREFERENCE
FOR ACROSS THE FOR
CONVENTIONAL ALTERNATIVES TRADITIONAL
MEDICINE MEDICINE

In simple terms, social structure and culture provide the basic
tools (primarily in creating belief systems) Mexican Americans need to
make healthcare seeking decisions, but agency may not occur unless
actors have resources (e.g., health insurance, social capital in the
form of community or family support) and alternatives (e.g.,
conventional healthcare facilities, storefront clinics, botanicas,
55
curanderos, and proximity to Mexico. In this regard, Santa Ana is an
ideal location for this study because of its significant Mexican
American population, availability of traditional medicine alternatives
because of a strong presence of botanicas and curanderos, and the
fact that it is situated in a relatively small California county that has
demonstrated the ability to provide at least some medical services to
many of its citizens.
The use of the Social Action Paradigm in this study allowed me
to determine, primarily in the case studies presented in Chapter 7,
whether respondents likely had agency in making healthcare
decisions. Resources (or a lack of resources), family and community
influences, availability of alternatives, beliefs systems or healthcare
preferences, and a willingness to move across the alternatives
became the criteria which I utilized in making decisions about
whether or not agency was present. For example, an immigrant who
chooses to use conventional medicine exclusively despite a cultural
background in which traditional medicine is valued and residency in
an area where traditional healthcare seeking modalities are present,
can be assumed to have made his or her choice with full awareness
and control. Another example would be a native-born individual who
has used conventional medicine for most of his or her life but has
decided to seek out traditional healthcare. Of course, other factors
56
such as the presence of traditional alternatives in the neighborhood
he or she resides in, or history of family use of traditional medicine in
Mexico may contribute to the decision, but the decision is not made
in direct response to any one factor. These examples represent real
people that were included in my sample population and their stories
are detailed further in Chapters 6 and 7.
57
CHAPTER 4: METHODS AND RESEARCH DESIGN
Many studies in medical sociology or healthcare studies rely
heavily on quantitative methods, data, and analyses.
Unquestionably, morbidity and mortality data, along with data on the
costs of health care, can help us to understand the patterns of
disease and illness among the U.S. population and the costs
associated with them. However, there is a need for qualitative
research that can provide more complete information that captures
the nuances of the human experience in obtaining health care and
healing from injury or illness. Bell (2000) argues that we can gain
knowledge of disease and illness (beyond the numbers associated
with them) by studying the experience of illness through the process
of narrative where the person experiencing the disease or illness
provides a personal account of that experience.
It is now more widely recognized that the experience of illness,
health care seeking behavior, or other social realities could be
interpreted from a framework of interactions and recollections that
participants have of their experiences. The essential justification for
qualitative methods and interviews is based upon the belief that
meanings produced by social actors are constructed through social
interaction. This can be, and often is, contrary to systematic
positivistic approaches that require repeated, objective, observations
58
in data collection. Qualitative research, on the other hand is usually
not concerned with deterministic research models and is instead
interpretative and most concerned with establishing the meaning and
understanding of social behavior (Denzin and Lincoln 1998).
Because of the unique features of Mexican-American health
care seeking in the U.S. I believe that qualitative methods,
particularly the use of the narrative as an analytical tool, is especially
well suited to their study. Therefore, my study employs the method
of analyzing the narratives of respondents to intensive interviews
conducted using open-ended questions regarding their health care
seeking and behavior practices. (Derose 2000; and Diaz 2001)
Methods
My study includes interviews conducted with 33 adult working
class and marginally poor Mexican Americans living in the city of
Santa Ana, California, and 10 professional health care providers. My
respondents were also limited to individuals who were long-term
Mexican immigrants and native-born Mexican Americans. I
purposely included both individuals who had health insurance
available to them and those who did not. My intent was to utilize
individual characteristics to be able to analyze and interpret the
impact of assimilation and possession or lack of health insurance on
health care seeking behavior.
59
My purpose for interviewing the health care professionals was
to use them as sounding board for my notion that Mexican
Americans in Santa Ana were likely to utilize traditional health care
regardless of their economic or immigrant status. These individuals
were engaged in providing health services, either directly or
indirectly, to Mexican-Americans and other Latinos in Santa Ana. As
such, they possessed an intimate, day-to-day knowledge of some
pertinent behavior patterns of my study population.
However, the providers were also a limiting factor. These
professionals served only Orange County residents, primarily in
Santa Ana so their observations and comments could be applied only
to Mexican-Americans in Santa Ana or adjoining Orange County
communities. In no way were they able to provide information about
populations outside Santa Ana or Orange County.
Sampling Design And Recruitment Techniques
This study began as an extension of a similar study conducted
in Los Angeles of Mexican-American and Central-American
immigrants (Ransford and Carrillo 2001). The studies share some
similarities in terms of the questions asked of respondents but differ
in that the study population is limited to only persons of Mexican
heritage. Perhaps the most significant difference is that this study
focuses more on the process that Mexican-Americans experience in
60
making health care decisions (i.e., to utilize traditional medicine or
engage in medical pluralism) rather than cultural and structural
factors that may contribute to health care behavior.
Recruitment of subjects began with door-to-door canvassing of
homes in a predominately working class, Mexican American
neighborhood, which also was in close proximity to several botanicas
in the area. This approach was moderately successful and I was able
to obtain eight interviews using this method.
A second approach in recruiting respondents was simply to
approach people on the streets of downtown Santa Ana and several
store front shopping areas throughout the city, most with a
supermarket nearby (usually a market catering to Hispanics). This
was the most difficult method since people out shopping were often
focused on their tasks and errand and did not want to be bothered.
Also, I had targeted both men and women to be included in my
sample. As a male, approaching Hispanic women on the street was
rarely positively received. In most cases I was simply ignored or
passed by. Using this method I was able to obtain only a few
interviews.
A third recruitment method was to visit Laundromats in several
Santa Ana neighborhoods. I was pleasantly surprised to find that I
had some success at obtaining interviews in these environments from
61
both men and women. I conclude that this was possible because
many of the respondents were just passing time in between wash and
dry loads, and may have welcomed a diversion from a boring task.
A fourth approach was to ask colleagues and other professional
health care providers if they knew of potential research subjects that
matched my selection criteria. Networking with health care
professionals was moderately successful, but often there were
concerns that referring someone to me might violate confidentiality at
some degree, or involve conflict of interest issues. Although I did
obtain a few interviews from this method, my success was limited.
A fifth approach was to ask respondents to refer friends,
relatives, or acquaintances that they felt might be good study
subjects. Eight of the interviews (approximately a quarter of the total
sample) were obtained through this method although I did not
interview subjects who were living in the same household or when
the referee specified the healthcare seeking preference of the person
referred. I merely asked if the referee knew of someone who would be
willing to talk to me without specifying a specific type of respondent.
My recruitment methods can clearly be categorized as a
convenience sample obtained through chain and snowball methods
aimed at ideal interview subjects. It was my intent to recruit
respondents so that the sample would ideally possess one-half of the
62
following characteristics for comparative purposes: long-term
immigrants, second generation or beyond respondents, working class
or marginally poor status, and male or female.
In all cases, I offered to each interview respondent a $10 gift
certificate to local stores in exchange for their time. On the one
hand, this proved not to be a significant incentive as many potential
respondents clearly did not feel that it was enough to warrant their
time and attention. On the other hand, some respondents were
surprised at being offered any incentive at all and expressed that they
would have participated in the interview in any case. All respondents
receiving a gift certificate expressed appreciation at being offered
something in return for their time so, in that sense, this was a good
recruitment strategy to employ.
Finally, recruitment of health care professionals was not
difficult to achieve. My former position as a middle manager in
Orange County’s Health Care Agency provided me with many
potential contacts with former colleagues and others that I knew in
the agency or in other County agencies. Four of the professionals I
interviewed were former colleagues who had left County employment
to take management or CEO positions in non-profit health care
organizations. Two others were persons that my former colleagues
63
referred me to, and the two remaining were managers in County
provided services programs.
Description Of Respondents
My final sample of 33 respondents included 16 long-term
Mexican immigrants, 11 second-generation, and six third-generation
Mexican Americans. This sample is not likely representative of the
overall Mexican American population because I purposely targeted
certain individuals with specific characteristics in order to insure a
good mix of respondents with some variation in background, and to
exclude recent immigrants.
Table 4.0 provides data that generally describe the sample
population in terms of immigration status, gender, marital status,
SES, and possession or lack of medical insurance. In the case of
immigrant respondents, it was a requirement that they be a long-
term U.S. resident of at least 10 years.
Seventeen respondents were native-born Mexican Americans
second-generation and above. Sixteen respondents were long-term
immigrants with two of the 16 being in the category known in the
literature as a generation-and-a-half person (often referred to as the
1.5 generation), or someone born in Mexico but who migrated to the
U.S. at a very early age (Portes and Rumbaut 1996).

64
Table 4.0: General Characteristics of Respondents

Immigrants Native-Born Totals
N=16 N=17 N=33

Gender
Male 7 8 15
Female 9 9 18
Totals 16 17 33
Marital Status
Married 14 6 20
Single 0 8 8
Divorced 0 3 3
Separated 1 0 1
Widowed 1 0 1
Totals 16 17 33
Generation
First 13 0 13
Generation and a Half 3 0 3
Second 0 14 14
Third 0 3 3
Totals 16 17 33
Income Group
Poor 11 2 13
Above Poverty 5 15 20
Totals 16 17 33
Insurance
None 9 4 13
Partial 5 1 6
Full Coverage 2 12 14
Totals 16 17 33

Average Years in the U.S. 15.5 n/a n/a

My sample was fairly well distributed along gender lines but a
bit skewed toward women with 18 female respondents and 15 male
respondents. Within each group, the distribution was very similar to
the total group with nine female and seven males among the
immigrant respondents and nine females and eight males among the
native-born group. Among the native-born respondents, 14 were
65
second generation (children born in the US of immigrant parents)
and three were third generation.
The possession or lack of insurance is also a major factor in
this study. Overall, 13 respondents had no medical insurance, six
had partial insurance (usually Medi-Cal coverage for children but not
parents or inadequate employer provided insurance), and 14 had full
coverage insurance either HMO or PPO types. Understandably, since
they represent the poorest individuals within my sample, immigrant
respondents had far less medical coverage than native-born
respondents with nine having no insurance at all, five with partial
insurance, and only two with full coverage. This compares to the
native-born group with twelve fully insured, one partially insured,
and only four with no insurance.
Finally, the overall average age of my sample was 36 years.
However, the average age of the immigrant group was a full 10 years
higher than the native-born group with ages of 42 years and 32
years, respectively.
As previously stated, my general approach in this study
employs a model that seeks to explain that Mexican American
healthcare seeking impacted by the interaction of structural and
cultural factors which leads to individual choices and agency.
Specifically, I assert that this interaction involves the development of
66
a unique choice inducing process in which Mexican Americans utilize
many options available to them including conventional medicine,
alternatives related to conventional medicine (visits to Mexican
doctors and pharmacies, sharing prescriptions, etc.), and Mexican
traditional medicine (e.g., home remedies, visits to healers, rituals).
There were striking differences between the two groups in the
ratios of working class versus marginally poor, having insurance
versus not having insurance, and marital status. Among the
immigrants, most had no health insurance, and about half were
married. Among the native-born Mexican Americans more than two-
thirds had health insurance and about two-thirds were single or
divorced.
My intent was to have as much of an equal distribution of the
various characteristics for both groups. However, it makes good
sense that immigrants will generally have fewer resources and
generally lack health insurance, while native-born Mexican
Americans will be somewhat better off in these areas. It also makes
sense that immigrant family patterns tend to be more stable than the
native-born so the higher ratios of single and divorced individuals in
the latter group is not surprising (Arcia, Skinner et al. 2001).

67
Data Collection
I utilized an open-ended interview guide that was designed to
collect data on various aspects of health care seeking behavior,
health care beliefs, experiences with health care institutions, specific
usages of various health care options in both traditional,
mainstream, or pluralistic medicine, and various other background
questions (see appendices A and B for a complete interview guides in
both Spanish and English). The open-ended interview questions
sought to elicit stories and narratives from the respondents and were
not asked in the same order with all respondents. The interviews
generally begin with the same start-up question: “When you or a
member of your family gets sick, what do you do?” The intent here
was to initiate a dialogue between me, as the interviewer, and the
respondent. In most cases, the interviews proceeded in a useful
fashion and all pertinent data sought was obtained without having to
follow a formal structure in conducting the interview.
Before the interview began, I provided each respondent with a
background of the study, its purpose, and their rights as a research
subject. Although, since the identities of all respondents were kept
confidential and no signed consent was required from respondents, I
did read them a prepared Informed Consent document and provided
them with a hard copy. I then asked each respondent for permission
68
to audio record the interview. All respondents readily agreed to this.
I also asked permission to take notes during the interview and, again,
all respondents agreed to this as well. About two-thirds of the
interviews were conducted in English, and the rest in Spanish.
Most of the respondents in this study were very open and
willing to talk extensively in response to my questions. Many
expressed a sincere appreciation that this type of study was being
conducted and commented that they thought it “could bring good
things to the Mexican American community.” About two-thirds of the
interviews were conducted in a public setting outside of stores,
restaurants, etc. The rest of the interviews were conducted in the
homes of respondents and with two exceptions only the respondent
and I were present. In the other two cases, the college aged daughter
of a female respondent was present, and in another case, a female
respondent’s two young children were present until a relative came to
fetch them a half-hour into the interview.
The interviews were intensive, lasting an average of one to one
and one-half hours in length. One interview lasted a full three hours
as the respondent had many interesting stories to relate. In his case,
I chose to not limit the interview to the standard length because as
an immigrant and a health care worker, he had many relevant
insights and opinions on the general topic of Mexican American
69
health care. All of the interviews were conducted within the limits of
the City of Santa Ana.
The Role Of The Interviewer
My role as the interviewer in the study was clear to all
respondents at all times. At no time did I represent myself in any
other role; e.g., participant-observer, health care services client, etc.
I stated to each respondent that my goal was to listen to his or her
story as completely as I possibly could. I did not approach the
interview in an overly rigid way, nor did I try to control the interview
to obtain just the data I was looking for. I felt it imperative that a
respondent feel that his or her story, opinions, and experiences were
important to the study and to me as a researcher. In most cases I
was successful at clearly indicating my role to the respondent and
having them understand the purpose and goals of the study.
Data Analysis
All of the respondents were given the opportunity to select a
pseudonym to protect their identity and confidentiality. In cases
where the respondent declined to select a pseudonym, I assigned one
for them. At no time in this dissertation is the real name or true
identity of any respondent revealed. The identifying names in the
chapters that follow are all pseudonyms. I also changed certain types
of information when it was possible without jeopardizing the integrity
70
of the data. For example, the names of the healthcare professionals
and their organizations were changed or disguised so as not to make
their identities recognized. In each case, I made the assumption that
what an individual respondent said was more important than their
title or organization. The need for these precautions among the 33
main respondents was not as great a concern because providing
them with a pseudonym was enough to conceal their identities.
The analysis of the data from the interviews incorporated the
use of three levels of files: a master file, theme files, and interpretive
files. First, a master file of all the interviews was compiled by having
each interview fully transcribed verbatim. This file contains every
audible and comprehensible word that was spoken by the respondent
and me during the interview with the exception of some audiotape
defects in which a word or phrase is garbled, corrupted, or otherwise
not audible.
Theme files contain quotations of various lengths from
interviews as they pertain to certain aspects of the interview. For
example, the difficulties in accessing health care due to a lack of
health insurance coverage. These files are the major source of data
in preparing the study results
Interpretive files contain relevant quotations but also include
my own comments, notes, observations and questions that assisted
71
me in determining how best the data fit into my analysis and
conclusions. Some of these files contain data that did not initially
clearly fit into the analysis or required more thought to interpret
them correctly.
Preserving the integrity of the data was a priority in this study.
Therefore, quotations taken from interviews conducted in English are
presented as spoken. If necessary, interpretive notes regarding body
language, interview setting and conditions, or any other necessary
documentation is presented when appropriate in order to maximize
the a true interpretation of the data. Interviews conducted in
Spanish require a bit more caution in analysis. In this case, I avoid
verbatim translation as they are usually incorrect in meaning.
Instead, careful attention is paid to possible idiomatic interpretations
that are close to the true meaning that the respondent intended.
This is important to consider when one respondent may be originally
from central Mexico and another from the southernmost areas of the
country. Fortunately, about two-thirds of the interviews were
conducted in English.
Ethical Considerations And Verification
It is imperative that the trust of respondents be maintained
and that their privacy, protection from harm, and confidentiality is
maintained. Additionally, what they have said, however they
72
intended it, must be presented in the truest form possible in any
data analysis (Punch 1998). Gaining respondents’ confianza
(confidence) was vitally important to this study. Goldstein (2002)
addresses losing a respondent’s confidence through insincerity and
misrepresentation. To this end, I took all precautions to gain
respondents’ confidence by emphasizing the importance of the
project and their participation. Moreover, as previously stated, I
utilized an unsigned Informed Consent form (a signed consent form
was not required by the University of Southern California’s
Institutional Review Board because respondents remained
anonymous and no questions were asked in the interviews that might
threaten a respondent’s well-being), protected respondents real
identities, and was committed to providing the most accurate and
true representation of the data provided by the respondents. The
latter is sometimes accomplished by allowing research subjects to
read what quotations are taken from their interview and how close
researcher interpretations match what they intended to say. In this
study, it is not practical to go back to respondents to conduct
verification in this manner. Rather, all quotations are presented
using the exact wording recorded on interview transcripts.
Translations and interpretative data are clearly indicated so as to
highlight those areas that may be susceptible to error in analysis or
73
interpretation. Every precaution has been taken to present the
words and ideas of respondents as they intended them.
74
CHAPTER 5: COMMUNITY SERVICES PROVIDERS’ RESULTS
Introduction
I interviewed 10 representatives from various non-profit health
care provider agencies in Orange County. Four of these were former
colleagues from the time I worked for the Orange County Health Care
Agency as a mid-level administrative manager in strategic planning
and health care services contracts. Three of these former colleagues,
like me, have since left County employment to pursue careers with
other agencies. One has remained a County employee. Six of the
interviewees I had never met before. I either visited their
organizations or was referred by colleagues in seeking interviews with
knowledgeable and responsible representatives of their organizations.
The public sector of health care services is comprised of limited
services provided directly by the County by one clinic, many non-
profit organizations funded by private and government sources, and
County contracted services providers. Unlike large cities or
metropolitan areas like Los Angeles City or County, the Orange
County system is a relatively small, intimate network of providers.
There is no county hospital, and while the County does provide some
safety net medical programs to the indigent, recent federal
requirements have restricted the provision of services from these
75
programs to persons who can prove citizenship or legal status.
Moreover, the County requires the 27 hospitals with operational
emergency rooms within the County to share equally in providing
emergency services to indigents. As a side note, there are currently
no free clinics in Orange County.
Because of the relatively small, intimate structure of the
County’s healthcare system, I have purposely provided only minimal
descriptions of my interviewees and information about them and
their organizations in order to ensure their privacy and
confidentiality. Otherwise, it would be likely that anyone who has
worked in, or is familiar with the County system would recognize
them.
My purpose interviewing the health care professionals was
based upon my opinion that they were in a position to directly
observe the healthcare needs of Mexican-Americans in Santa Ana,
and to provide insight regarding some of the cultural and structural
factors that impact those health care needs. I wanted to see if their
knowledge and observations of the community supported my notions
that traditional or pluralistic medical seeking behavior persisted in
both immigrant and native-born groups. The interviews with the
Santa Ana health care professionals were completely open-ended and
focused on three general questions designed to elicit data that would
76
shed light on structural and cultural factors perceived by these
professionals that impacted Mexican-American health care seeking
and utilization behavior:
1. Do Mexican immigrants and Mexican Americans in Santa
Ana face many barriers to healthcare access? If so, can you
identify these barriers and what impact you think they have
in delivering healthcare services to Mexican-Americans in
Santa Ana?
2. To your knowledge, to what extent do Mexican Americans,
both immigrant and native-born, in Santa Ana turn to
traditional medicine and other alternatives in their health
care seeking?
3. What sorts of traditional medicine or other alternatives to
healthcare seeking by Mexican-Americans in Santa Ana
have you observed or know about?

Narratives On Structural Barriers
I began my interviews by asking question one: “Do Mexican
immigrants and Mexican Americans in Santa Ana face many barriers
to healthcare access? If so, can you identify these barriers and what
impact you think they have in delivering healthcare services to
Mexican-Americans in Santa Ana?”
77
Oscar Schneider pointed out that, in his opinion, the major
barrier to good health care for Mexican-Americans was not
necessarily an issue of access, but one of quality and the lack of
culturally competent services:
Most often in Santa Ana, and in Orange County in
general, Mexican-American clients and patients find
themselves receiving services from doctors and nurses
that can’t speak their language or don’t understand the
nuances of the culture. Sure, in Santa Ana, translators
are readily available because Santa Ana has a lot of
Spanish speaking workers in the County and clinic
locations, but in the end, there is a lack of good direct
communication between the provider and patient. Most
Anglo doctors and nurses, even though they may serve
primarily Spanish speaking clients really don’t know
much about them. This is a major problem that I see as
important.

I also asked the following probing question: “Do you think this is
more important than a lack of health insurance or discrimination?”
Yeah, sure. We can help a lot of people get access
through various programs like Indigent Medical Services,
and here the County has some very strong policies that
really discourage and curb blatant discrimination, but
it’s really hard to educate people to be culturally
sensitive. That’s not so easy.

Another provider, Alma Meza provided the following in response
to the main question:
The real problem here is a lack of access and resources
and most people don’t realize how bad this is. I’ll tell you
something that I experienced. Not that long ago I worked
for one of those store front clinics that are usually owned
and operated by a single doctor or sometimes a
partnership of more than one. By the way, if you don’t
78
know this, there are at least 99 places like this in Santa
Ana, maybe more. They cater mostly to poor Mexicans
and services are provided in a strictly cash basis only.

Anyway, my job was at the reception desk and
translating for the doctor. This one day, a middle-aged
woman came in complaining of stomach pains and
dizziness. In pre-screening her, I found that she had no
money and no insurance. I called the doctor hoping that
he would see her anyway. The doctor came up front and
asked me to translate what he was about to say to her.
‘Ask her if she has anything of value that can used to pay
for her medical care today,’ he said. I was really
embarrassed to ask her, but I did what the doctor told
me.

She responded that she had no money at all and asked if
she could make payments. The doctor looked at me and
said, ‘Repeat to her the question I asked about
valuables,’ so, still embarrassed I did. ‘I have some
jewelry at home, but it’s not much’, she replied. ‘Tell her
to go home and get it and bring it back,’ the doctor told
me, ‘I’ll decide if I will take it as payment if she brings it
in.’ After I told the woman what the doctor said, she left.

A few hours later she was back with the jewelry. It was
not much, but the doctor told me to tell her that he
would take it as payment for the services he would
provide her that day and no more. The jewelry was not
much, but I think it was worth more than we would
charge for the examination and consultation she would
receive. I could tell she was really upset but she agreed
and handed over the jewelry and the doctor treated her.
I was so ashamed and embarrassed to be part of what
happened that I quit my job the next day.

The biggest sin is the exploitation of these poor people by
dishonest doctors and there are plenty of people in Santa
Ana that are exploited. This would not happen as much
if there were insurance or more programs available to the
poor.

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Alma’s story is not an unusual one. Santa Ana’s storefront
clinics and their questionable operating and billing practices in
dealing with Mexican-American patients were the subject of several
well-publicized and well-documented stories in the local newspapers.
In an attempt to get more detailed information about any
health care access barriers, I routinely asked a follow-up question
regarding the current anti-immigrant sentiment among the general
U.S. populations and blaming so-called illegal immigrants for the
California budget crisis. Specifically I asked if this anti-immigrant
sentiment negatively impacted Mexican immigrant health care access
and whether this impact spilled-over into the native-born Mexican-
American community. Sarah Ortiz responded to this question as
follows:
…it is true that if you are without health insurance and
you are not white [you are a Mexican immigrant or
appear to be a Mexican immigrant], you are likely to
receive poor treatment at some health care facilities. In
fairness though, if you are white and present yourself at
a predominantly Mexican clinic, you might experience
the same treatment.

Cesar Muñoz made a similar statement, “...remember, poverty
has no face and some racist comments toward immigrants come from
the Mexican community itself even though Proposition 187 hurt all
Latinos.” In other words, despite the spillover effect on native-born
Mexicans, their emphasis was that discrimination is often present
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and all poor persons experience it--it is not always a case of whites
discriminating against minorities.
Oscar Schneider cited more structural examples of why he
believes native-born Mexican Americans use traditional or alternative
medicine:
It is not just an issue of access. I think the under-
representation of Mexican-Americans in the health care
workforce, and the ‘acceptability factor’ in the health care
Mexican-Americans receive contributes to the use of
alternatives by native-born Mexican-Americans. By
‘acceptability factor’ I mean that health care in this
country is not acceptable to Mexican-Americans when it
impinges on their integrity and self-worth. The long
waits, rude treatment and lack of quality medical
services to Latinos degrades the ‘acceptability’ of the
services so naturally Latinos turn to other alternatives.

Oscar went on to say:
…because of barriers to access, many Mexican-
Americans in Santa Ana visit curanderos and utilize
other parts of the 'gray market' by purchasing illegal
prescription drugs, visiting unlicensed persons practicing
medicine, and, of course, they use a wide variety of
traditional medicine that is prevalent in the culture.

Marilyn Sanchez’s comments differed from the previous two in
a significant way. Her response was:
Absolutely! Last year, an L.A. Times editorial reported
that the cost of public services programs attributed to
"illegal" immigrants was one third or less of the amount
generally reported by the media. Also, the contribution
that undocumented workers make to the tax base and to
social security is grossly understated. So, the idea that
Mexican immigrants drain the economy does spillover to
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the entire Mexican community and exacerbates its ability
to access health care.

Narratives on the Cultural: Use Of Traditional Medicine and other
Alternatives

A major question in this study is whether the use of traditional
medicine or other alternative that is generally attributed to Mexican
American immigrant healthcare seeking persists among long-term
immigrants or native-born Mexican-Americans. In order to try to
measure this I asked questions two and three as stated above.
Sarah Ortiz stated that from focus group interviews, her
organization determined that second-generation Mexican-Americans
in Santa Ana routinely use traditional medicine or other alternatives
at least peripherally; she stated that certain remedies such as eating
raw eggs or taking a lettuce bath are not taken seriously by this
native born Mexican Americans. They have been educated to know
that there is little evidence that these are true remedies. However,
both immigrant and native-born Mexican American use home
remedies (remedios caseros) known to have some value because they
believe they work.
Sarah, who is Anglo, also shared the following example from
her personal life:
My husband is third generation Latino. When we were
first married we were poor and could not afford dental
insurance and he and I needed dental care badly. My
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husband told me that we could go to Tijuana, Mexico to
get affordable dental care. Up to that point, I had no idea
that this was done but my husband told me that lots of
Latino people did it because it was affordable, although I
didn't think that the quality of care was as good as here,
we went several times for dental care. Going to Mexico for
dental care and other medical care is common practice in
the Latino community even among those Latinos who
were born here.

Cesar Muñoz stated that he believes that Mexican-Americans
will always consider various alternatives to conventional medicine if
they live in a predominantly Mexican-American community. He
stated,
...in a Latino community such as Santa Ana, there is an
established infrastructure... by that I mean there are
shops and 'gray markets' that cater to Mexican people,
including native-born Mexicans, providing them with
many alternatives that you don't find elsewhere. Where
you find immigrants, and immigrant owned businesses
you will find Mexican-Americans using alternative
medicine regardless of their origin.

Marilyn Sanchez pointed out her observation:
Mexican immigrants, particularly recent immigrants, do
what they did in their home country where it is common
to access medicines without prescriptions and where the
use of traditional medicines is more prevalent. Certainly,
here in this country, lack of access contributes the use of
traditional medicine in the United States but access is
not the only issue. More important, I think, is that people
turn to programs that reach out to them. We have to do
more to educate Mexican-Americans how to use the
health care system here and be successful doing it.

83
Finally, I met with Frances Smith, Director of an agency
assisting young pregnant girls and young mothers (most of who are
of Mexican-American descent). Frances and I had had previously
had several telephone conversations about the possibility of
interviewing some of her organization’s clients. Ultimately, I decided
against it because of the medical and social services the girls were
receiving and restrictive Health Insurance Portability and
Accountability Act (HIPPAA) requirements in using them as research
subjects. The HIPPAA requirements are designed to protect privacy
of individuals receiving medical services by preventing disclosure of
protected information.
I asked Frances, “What do you know about the use of
traditional medicine in the Mexican American community? What
have you observed in the work your organization does?”
She asked in response, “What are you defining as traditional?”
I responded to her question: “By traditional, I mean any
medical practices that can be identified as traditional Mexican or
Latino practices, let’s say for instance, healing rituals, herbal
medicine use, or visiting a healer.”
In turn, she responded:
Oh, here in Santa Ana it’s very prevalent. My girls often
tell me about how their moms’ do certain things with
their babies’ soft spots. I’m not sure what they call it
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(caída de mollera; fallen fontanelle), but it’s done all the
time. Sometimes the moms come in with their daughters
and I hear them telling their daughters what to be careful
of. You know, like someone eyeing the baby in an
envious way (mal de ojo).

I probed, “Are most of these girls immigrants?”
She replied:

No, not necessarily. Only a few are, but most of my girls
were born here and so were some of their mothers. Not
all that many are recent immigrants, so it what they do
really can’t be explained by that. It just seems to me that
the girls and their moms are concerned about lots of
things concerning their babies and they know a lot of folk
stuff to do. I don’t really know how well they think it
works but I also think that they do believe that it helps
them.

Chapter Summary

My purpose in interviewing health care providers in Santa Ana
was based on my assumption that they are in a unique position to be
natural observers of their client population, in this case, mostly
Mexican Americans residing in Santa Ana--these health care
providers are very well qualified to make legitimate and accurate
observations of their clients. A major criticism of this might be that
all or most of the providers are really outsiders viewing the
community from without; in particular when the health care provider
is non-Mexican American, which was true of four of the 10 providers.
However, I knew some of these providers, and all of the four Anglo
85
providers, as colleagues for many years. I know them to be persons
of integrity and commitment to service to the Mexican American
community, and not easily given to stereotyping the persons they
serve. In short, I trust their judgment and have a great deal of
respect for them and believe in the validity of their observations.
What emerges from these interviews is an overall picture of the
barriers to health care faced by Mexican Americans in Santa Ana and
what medical services and alternatives are available to them in
response to these barriers. These are summarized as follows: first,
the health care system available to Mexican Americans in Santa Ana
may include regular health care if they have health insurance;
County-operated clinics and health education programs; at least 99
store front clinics offering conventional medical services, usually on a
cash only basis; and an unspecified number of botanicas that can be
found throughout the city. Second, Mexican Americans in Santa Ana
face a number of barriers to health care access. Beyond the access
issue, Mexican Americans face “quality of care” issues that are
exacerbated by a lack of health insurance and cultural competency
when access is obtained. Finally, there is evidence that Mexican-
Americans, both immigrants and native-born, maintain a system of
traditional medicine that provides them with alternatives when they
cannot access more conventional systems of medical care.
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CHAPTER 6: STUDY PARTICIPANTS RESULTS

Medical Alternatives

Table 6.0 contains data regarding the types of medical
alternatives that my study respondents might consider in their
health care seeking behavior by immigration status. The reader is
cautioned that these data are not statistically or scientifically
analyzed here. The goal is to simply identify broad patterns
regarding the different alternatives and some of the reasons that
Mexican Americans make certain choices regarding their healthcare.
Because of its widespread availability and governmental
programs designed to assist the poor with health care, it is no
surprise that all 33 respondents reported using conventional
medicine. As for the alternatives, all respondents were specifically
asked about trips to Mexico, use of home remedies and herbs, if they
prayed for good health or a cure, and if they had ever visited a
curandero—if not, would they consider visiting one with a good
reputation. Questions regarding storefront clinics and botanicas
were not routinely asked, but whether a respondent used or would
use these alternatives emerged primarily in response to the question:
“What do you do when you or a member of your family gets sick?
What do you do, where do you go?” In other cases, the answers
emerged from probing questions.
87
Table 6.0: Percentage of Respondents Reporting Having Used or
Would Use Certain Medical Treatments If Necessary
by Immigrant Status

Immigrants Native-Born Totals
Medical Treatments N=13 N=20 N=33
Conventional Medicine 16 100.0% 17 100.0% 33 100.0%
Private Clinics 5 31.3% 4 23.5% 9 27.3%
Mexico Trips 7 43.8% 4 23.5% 11 33.3%
Home Remedies 11 68.8% 8 47.1% 19 57.6%
Prayer 8 50.0% 12 70.6% 20 60.6%
Botanicas 3 18.8% 6 35.3% 9 27.3%
Curanderos 10 62.5% 7 41.2% 17 51.5%

These data were recorded using a simple content analysis of
respondents’ narratives. I simply recorded if a respondent had ever
used one of the alternatives, and if not, would they consider doing so.
As such, these data should not, in any way, be considered scientific
or of any statistical significance or value. My intent here was to
simply provide a basis for discussion regarding the various
alternatives available to study respondents. It is important to keep in
mind the qualitative nature of this study and the fact that the
convenience sample the data were derived from is not a scientifically
or randomly selected one.
There are some notable differences between immigrants and
native-born respondents in terms of the types of alternatives they
have or would use. However, because of the small number of
respondents and the fact that these data are not statistically or
88
scientifically meaningful, only differences of approximately 20
percent or more are highlighted and discussed.
Generally immigrants were most likely to: consider trips to
Mexico to get health care, prescriptions or herbs (43.8 percent
compared to 23.5 percent of the native born), utilize home remedies
(68.8 percent compared to 47.1 percent of the native-born), and
utilize the services of a curandero (62.5 percent compared to 41.2
percent of the native-born. Although no valid interpretation of these
data can be made, one can speculate that the results may be
indicative of the higher barriers faced by immigrants, and that
immigrants have stronger cultural values and ties than do the native
born.
Respondents’ Explanations of Alternative Choices
The data reviewed in this study so far, indicate that
participants in this study employ an array of health care choices in
dealing with their medical needs. The discussion that follows is
based on data found in Table 6.1 that summarizes some of the
reasons for Mexican American health care behavior mentioned by
study respondents.
The data indicate immigrants mentioned a lack of money, a
lack of insurance, long waits for treatment, discrimination or being
treated badly (not quality of care but by staff), poor quality of care,
89
and language difficulties as reasons for choosing alternatives to a
greater extent than did the native-born. This is especially telling
because those categories are indicative of perceived and actual severe
system barriers. It should be pointed out that these results are likely
related to the fact that there were more poor persons and uninsured
in the immigrant group than in the native-born group as discussed in
Chapter 3 of this report.
Table 6.1: Percentage of Respondents’ Mentioning Reasons For
Their Use of Various Medical Treatments

Immigrants
Native-
Born Total
N=16 N=17 N=33
More Faith in Conventional Medicine 7 43.8% 5 29.4% 12 36.4%
Doctors and Medicine in Mexico 5 31.3% 3 17.6% 8 24.2%
Lack of Money 8 50.0% 6 35.3% 14 42.4%
Lack of Insurance 7 43.8% 4 23.5% 11 33.3%
Long Waits for Treatment 8 50.0% 2 11.8% 10 30.3%
Discrimination/Treated Badly (Behavior) 6 37.5% 1 5.9% 7 21.2%
Poor Quality of Treatment (Cure) 5 31.3% 1 5.9% 6 18.2%
Language Difficulties 7 43.8% 0 0.0% 7 21.2%
More Faith in Traditional Medicine 4 25.0% 4 23.5% 8 24.2%

The differences between immigrants and the native-born in
tables 6.0 and 6.1 are interesting and provide a basis for discussion,
but I argue here that the most important data provided by the tables
are those that indicate that, for both groups, there are relatively high
percentage levels of the actual or a definite willingness to pursue, the
practice of the identified alternatives. For example; 68 percent of
90
immigrants and 47.1 percent of the native-born reported using home
remedies and the percentage for the total group was 57.6 percent;
18.8 percent of immigrants and 35.3 percent of the native-born
reported using botanicas to obtain herbals or seek healing rituals and
the percentage for the total group was 27.3; and, 62.5 percent of
immigrants and 41.2 percent of the native-born reported using
curanderos and the percentage for the total group was 51.5. The
overall important conclusion is that, at least for persons in this
sample, there is a persistence and maintenance of traditional health
care seeking among these long-term immigrants and native-born
Mexican Americans.
Finally, it is important to note that the purpose of this study
was to gain detailed accounts of Mexican American healthcare
seeking, and, as a qualitative study, is more concerned about small
group internal validity, rather than the ability to generalize that is
achieved with the external validity that large representative surveys
provide. The core data sources of this study are the respondents’
narratives collected through the intensive interviews.
Respondents’ Narratives
The data collected through my interviews with Mexican
Americans in Santa Ana were useful in identifying a set of viable
alternatives that Mexican Americans, whether immigrant or native-
91
born, have available to them in making decisions about their health
care seeking. These alternatives can be viewed as a continuum
ranging from conventional medicine on the one hand, to very
traditional practices on the other. Examination of individual health
care seeking behavior will reveal that a person has taken a path
either heavily dominated by the conventional, heavily dominated by
the traditional, or a path that combines elements of all the
alternatives available to him or her.
What I have shown so far with my descriptive data is that many
of the persons in my sample are not easily categorized into groups
showing specific health care seeking propensities based upon the
structural or cultural aspects of their lives and experiences. In the
discussion and narratives that follow, I will begin by examining the
barriers faced by respondents in my sample first and then by
examining the medical alternatives available to them, moving along
the continuum of conventional medicine toward much more
traditional practices, and, finally, by discussing how both immigrants
and native born Mexican Americans move across the alternatives
with some ease. These data are presented with some, but not
comprehensive, interpretation because I wanted to illustrate the
richness and detail in the dataset to provide a foundation for more
interpretative work in the case studies found in Chapter 7, and in
92
Chapter 8 with regard to the Social Action Paradigm and analysis of
health care seeking agency. The data in this chapter indicate that
the practice of traditional medicine persist among long-term
immigrants and native-born Mexican Americans.
Barriers
Other studies have described the existence of severe barriers to
healthcare access for immigrant and Mexican Americans (Ransford &
Carrillo 2006; and Hayes-Bautista 1979). For many, a lack of health
insurance, extremely long waits for service, hostile treatment by
hospital or clinic intake staff, language and communication
problems, and a lack of cultural competency on the part of providers
create a hostile and formidable environment. In my study, the
immigrant sub-sample generally reported being more negatively
impacted by various system barriers. This makes sense and is
partially explained by the fact that over one-half of the immigrants in
my sample reported having no health insurance at all, compared to
just under one-forth of the native-born reporting the same. The
following are examples of identified and experienced by my study
respondents.
Rosa Leon (immigrant, widow, one child) reported that she has
never had health insurance as the main reason for not having good
access to adequate health care. She has often postponed going to a
93
doctor and has had to visit emergency rooms at times when an illness
in her family became serious. She also reported regular use of
storefront clinics, home remedies, and sobadoras (masseuse). She
clearly stated that she would go to a curandero with a good
reputation if she knew one. I asked Rosa what she generally does
when she or a member of her family becomes ill.
RL: Well, if it is very serious, I go to see a doctor in the
emergency room. But, if it is not an emergency I
treat myself with home remedies and teas…
manzanilla (chamomille), yerba buena
(peppermint) and things like that.

Q: Why do you use home remedies rather than go to
a doctor?

RL: Because the doctor charges much money for the
few pills that he gives you. They charge $100 for
the pills and $30 for a consultation

Q: Do you believe that home remedies are more
effective than medicine you can get from a doctor?

RL: They are not more effective for most things…they
work the same when the illness is not serious.
When the illness is very serious you should see a
doctor and get medicine from him.

Q: Have you ever been to a County clinic to get
health care?

RL: Yes, but you are there the entire day from the
early morning…then the just give you Tylenol and
nothing else…and you have been there all day.

Q: Other than the long waits, did you have any other
problems there?

94
RL: Yes, they didn’t have enough people that could
speak Spanish and understand what I was telling
them about my problems…and I don’t feel that I,
or the other people that were there, were treated
very well.

Rosa’s responses to my question indicate that a lack of health
insurance and money are the main barriers to adequate health care
for her and her family. However, she identifies long waits and poor
communication with medical staff at County clinics as problems.
Maribel Mendoza (38, immigrant, separated, insured) and
Leticia Bueno (28, married immigrant, two children) have different
stories:
Maribel Reports going to Mexico for treatment and prescription
drugs, and having much faith in traditional herbal remedies. She
does not visit doctors here because of a lack of money and health
insurance.

Q: What is the main reason you go to Mexico for
health care?

MM: Like I told you, if you have insurance it is easy to
get health care here, put if not, it is very difficult
because in this country [U.S.] everything is
money, money, money. For example, in my case, I
have no money…I hope to get a job soon for
money but even then I will not have enough for
doctors or specialists. As I have told you, a
specialist here costs $200, so even if I need to see
one I can’t because I have no money and that is
what is difficult.

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Leticia’s experiences were mainly about communication and language
problems:
Q: Do you have any problems communicating with
your doctor?

LB: Yes some, I have a Russian doctor who speaks
Spanish so generally most of the time we
understand each other when we talk.

Q: So you have no communication problems with the
doctor at all?

LB: No, not that…I am not fluent in English so I can’t
talk to him in that language…his Spanish is good,
but sometimes we don’t understand each other…I
can’t really explain to him what I think is
wrong…so sometimes it is a big problem.

I asked Lupe Contreras, a 24-year-old immigrant with two
children if she had ever received care in a County clinic for herself or
her children, and if so, how she was treated there. She replied:
Well, listen, the treatment you get depends because
there are differences when you have insurance or you
don’t. My children now have Medi-Cal but before they
didn’t. Once my daughter had severe diarrhea and I
had to wait 14 hours before the doctor saw her. We
were there from 4:00 in the afternoon until 8:00 the
next morning. After waiting so long, all they told me it
was nothing serious and gave me instructions on a diet
to keep her on. I was really angry—it was a horrible
experience.

I was curious about the treatment she received, so I probed: “So, you
were treated very badly? She responded, “Yes, I have gone twice and
the treatment was bad both times.” I probed again, “Do you think
96
they (hospital staff) discriminated against you in any way—maybe
because of being Mexican or an immigrant?
I have noticed that people who had insurance were seen
very quickly and received treatment very rapidly. If one
can’t pay they have to wait a long time because they
[hospital staff] see that they are not going to get paid
that day. You asked if I think they discriminated
against me…yes, I am sure of it…but not because I am
an immigrant…but because I had no insurance.

There is sufficient evidence that the respondents in my study do
experience, or have experienced, substantial barriers to adequate and
quality health care. This is truer for immigrants especially when they
lack health insurance. An important observation is that respondents
in my sample appear to experience barriers on more individual levels
rather than having to face extreme systemic barriers such as those
encountered by the recent Latino immigrant respondents in the
Ransford and Carrillo (2006) study. A partial explanation is that the
respondents in the Ransford and Carrillo study, as recent immigrants,
are less familiar with ways to navigate the system in their health care
seeking, while respondents in my study are long term immigrants and
native born Mexican Americans with more social and economic
capital, and, subsequently, more opportunities to obtain good health
care.
However, recall Oscar Schneider’s observation (Chapter 5) that
Orange County has up to now, been able to provide medical services
97
to many of its citizens whether they are immigrant or not; and the real
issue is one of an acceptability factor, which for Mexican Americans in
Santa Ana is degraded as a result of a lack of cultural competency.
According to Oscar, this is one of the main reasons Mexican
Americans in Santa Ana turn to other alternatives.
Conventional Medicine
All respondents in my study reported having used conventional
medical services beyond just occasional usage. There is little doubt
that access to conventional health care services is important to
mostly all of the respondents. Only a few reported that they use
other alternatives exclusively. To many, the value of conventional
medicine is clear, even if they have some belief in the value of more
traditional medicine.
The use of conventional medicine occurred in several forms.
For the native-born population there was fairly good access to both
private and public health care services since most of the respondents
in this group had either private insurance or some sort of government
insurance such as Medi-Cal. Immigrants on the other hand, had
much lower rates of insurance, but used conventional medicine
whenever they were able to access it. This was particularly true for
respondents who had children covered by Medi-Cal or some other
form of insurance.
98
A second conventional alternative for both immigrants and the
native-born was private/storefront clinics operated by a doctor or a
partnership of doctors. As previously mentioned, in 2007 there were
at least 99 of these clinics in operation in Santa Ana and catering to
clients with Medi-Cal and cash paying customers. Mexican
Americans in Santa Ana often view these clinics as low-cost
alternatives to hospitals and emergency rooms. In fact, although
these clinics may charge a low attractive fee for a consultation,
patients often pay much more than they would have at other clinics
when the costs of prescription drugs, other medicines, and medical
equipment are added to a clients visit.
In my interview of Pedro Franco, a 53-year-old immigrant from
Zacatecas, Mexico, I asked him what he and his family did when they
became ill. He replied:
Well, we go to the doctor that is the best thing to do. Let
me tell you something, if someone is really sick, he needs
to find a doctor because he is the only one that can cure
him. Doctors can provide cures--If you are really sick, go
see a doctor!

My interpretation of Pedro’s comments is that he believes that
conventional medicine has the best technology and medicine to cure
a disease once a person becomes ill. For him, and his family, there
are no other options.
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I asked Martina Amezqua, 43-year-old immigrant from
Durango, Mexico, if she thought conventional or traditional medicine
was better, she emphatically replied:
If it is not a serious illness, for example, a cold, a
temperature [but not serious], or a headache, then we
take Tylenol or drink an herb tea. But, if the illness is
serious then we go to the doctor or the hospital [not
stated but implied is that visits to doctors are postponed
until the illness is serious, and then a hospital visit,
often the emergency room, is required]

On the issue of conventional medicine, some respondents were
more conservative and adamant that they would never use any other
type of medical alternative. When I asked Fernando Nieves, 34 years
old, second-generation respondent about the comparison between
conventional and traditional medicine, his response was forcefully in
favor of conventional medicine. “I would never use anything other
than real medicine. Doing anything else is just dumb because it isn’t
real and does not really help you at all.”
I probed: “You told me that both your parents were born in
Mexico. Haven’t they ever used or given you traditional medicine
treatments?”
Fernando: “No, they never did anything like that. They always
took me to doctors. I don’t think they would have ever done it.”
I probed: “So, you’ve never had any kind of alternative or
traditional medical treatment?”
100
Fernando: “A friend recommended a chiropractor to me once
because my back hurt. It didn’t do any good so I never went back. I
think he was a quack!”
When I was conducting interviews in a Laundromat, I met
Albert Jimenez, a 39-year-old second-generation respondent. In
response to our discussion regarding the merits of conventional
versus traditional medicine, he said:
Look, the truth is that I only use modern medicine. I
don’t know much about any other type. Both my
parents came to the U.S. when they were really young so
they were Americanized by the time they had me. They
never exposed me to anything but regular medicine.
Now I have clients immigrant and not, that use medicine
that they get from someone who says they are a healer. I
don’t judge them but it is not for me, no. I think they go
to a healer to get treatment because it is what they can
afford.

In another interview, I asked Lourdes Bernal, a 29 year-old
immigrant the question about what she or her family members do
when they get sick:
LB. Well, if it is something very serious we go to the
emergency room, if my child has just a cold then I
take him to the pediatrician, and me, I use my
family doctor.

Q. When you were a child in Mexico, what did you or
your family do when you got sick?

LB. Well, my mama went to the pharmacy to buy
penicillin and then she injected me.

Q. Your mother injected you?

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LB. Yes, she alone injected me.

Q. So she didn’t need a prescription for the penicillin?

LB. In Mexico the pharmacy does not need a written
prescription from a doctor to give you the
medicine. In Mexico you go to the pharmacy and
you tell the pharmacists what you want or what
ails you. He will either give you what you ask or
recommend something he thinks will help you.

Q. Have you ever used the services of a curandero or
used home remedies either here or in Mexico?

LB. No, not ever. My parents did not believe in any of
that and my mama could always get the medicines
we needed at the pharmacy.

Finally, another native-born respondent indicating a preference
for only conventional medicine for himself and his family was
Fernando Nieves, 34-years-old. Fernando was very clear that
conventional medicine was the only viable alternative and, that even
though his parents were from Mexico, his family always had health
insurance and never used any other health care alternatives. I tried
asking several probing question to be sure of his responses:
Q. Many Mexican families use home remedies,
sometimes prepared with special herbs, instead of
going to the doctor. Have you ever used herbal
remedies?

FN. No, never.

Q. So, you haven’t used any herbal remedies at all. If
you or someone in your family becomes ill, you
always go to a doctor?

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FN. Yes, always. If it’s something minor I try to get
some over-the-counter stuff. You know, if it’s a
cold or the flu. But if it’s something serious, we go
to the doctor. We don’t take any chances.

It is important to note that each of the preceding respondents
had some form of complete health insurance. In Martina Amezqua’s
case, she and her children had Medi-Cal coverage while the other
respondents had employer provided health insurance. However,
there were several respondents who expressed a preference or high
trust of conventional medicine but lack any insurance at all, had
only partial insurance, or lacked money and resources to obtain
services from mainstream clinics and hospitals. The answer for some
of these individuals in obtaining the health care they wanted was the
privately owned storefront clinics found throughout Santa Ana. As
previously discussed, these clinics cater to persons with Medi-Cal
coverage or persons who have some ability or potential to pay in
cash.
Private Storefront Clinics
Berto Rosales, a 21-year-old native-born respondent told me
that he recently obtained health insurance (HMO) but his immigrant
parents remain uninsured. He also stated that as long as he could
remember, his family had gone to private storefront clinics for their
health care. Even now with health insurance, he prefers to go to
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these clinics because he is “used to them and knows what to expect.”
The following is a short excerpt from his interview:
Q. When you or someone in your family gets sick,
what do you do? Where do you go for health care?

BR. We usually go to this clinic in Santa Ana. We have
to pay cash. My parents have no insurance and no
credit so usually the doctor wants his money up
front. Sometimes, if the bill is not too high, they
will let us make two or three payments to pay it
off.

Q. How much does it cost you to go there?

BR. Usually about $20 or $30 for a consultation, plus
the doctor has prescription medicines there that
we can buy from him, but those are extra.

Q. Why do you continue to go there if you have
insurance.

BR. It doesn’t seem that much different to me. I have
Kaiser and I have to pay $20 every time I go there
and still have to pay for prescriptions, so I don’t
see the difference. I’m used to going to the clinic
with my parents and know what to expect when we
go there.

Marcelino Peña, a 49-year-old immigrant also had experiences
with private storefront clinics before he was able to obtain health
insurance for himself and his family.
Q. You have told me that most of the time you have
been in the US, you and your family had no health
insurance. You have it now, but what did you do
before whenever you or someone in your family got
sick?

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MP. We went to this doctor who has a clinic in
downtown Santa Ana. We had to pay about $50
for a visit and more for any medications he told us
he was selling us at reduced prices. But,
sometimes the medicine would cost 40, 50, and
even 100 dollars so sometimes we couldn’t afford it
and we went without. We went to him only when
we needed—we had to be very sick.

Q. Do you believe he was really selling you
medications at reduced prices?

MP. How is one to know? We never went anywhere else
so how could we compare? Even now, I don’t know
how much medications really cost because my
insurance pays for much of it. I don’t know the
real costs.

Teresa Palacios, a 24-year-old native-born Mexican American
had a very similar story. She is married with one child and there is
no health insurance for anyone in her family including her child who
is eligible for Medi-Cal.
Q. What worries you the most about getting health
care for you and your family?

TP. Money and that something may happen someday
and we have no health insurance at all to cover any
of us.

Q. Doesn’t your son qualify for Medi-Cal?

TP. I’ve been trying to cover him through Medi-Cal but I
haven’t had the chance to fill out all the paperwork
they want. And you have to have proof of income
and all that stuff.

Q. So, basically they require a lot of paperwork and
that’s stopped you from applying?

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TP. Yeah, basically, I work, go to school and take care
of my family. I never have the time to do stuff like
collect paperwork and fill out applications.

Q. So what do you do when you need health care?

TP. We go to this clinic on McFadden…I don’t know
what it’s called. It’s a private one not run by the
County.

Q. One of those storefront clinics?

TP. Yeah. They charge us $25 for a visit plus
whatever…

Q. Whatever?

TP. Yeah, like medicine and stuff like that.

Q. What’s the most you ever had to pay in one visit?

TP. About $100 but I never take everything they want
me to…like some medicines I skip if I think we can
get by without them.

Q. Have you ever not been able to pay?

TP. Well, yeah, sometimes but I’ve borrowed money
from my parents when that’s happened. We go
mostly for our son. My husband and I don’t go
unless we are really, really sick.

In the past few years, store front clinics have received serious
negative press about their practices and the possibility that they may
be exploiting unknowing clients who are paying above market level
prices for their health care, not to mention questionable interactions
with their patients (recall the story in Chapter 5 or the physician
taking a woman’s jewelry as payment for services). My final
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respondent example on this issue, Carlos Perez, a 20-year-old native-
born student, illustrates how serious this problem may be.
Q. When you or a member of your family gets sick,
where do you go to get health care? What do you
do?

CP. Well, we have health insurance so we go to the
doctor we have through our HMO.

Q. Has your family always had health insurance?

CP. Actually no, we only got it about a year ago
through my step-dad’s work.

Q. So where did your family go for health care when
you didn’t have insurance?

CP. We went to a couple of clinics in Santa Ana and
stuff like that…where we had to pay up front in
cash.

Q. Did you get good care there?

CP. Yes and no. I mean I got better, but I think it’s
kinda shady the way they run things. Like, even
the last time I went to the clinic because I had a
cyst on my chin…before they would do anything
they wanted money up front. We asked if they
would take payments and they were like, ‘no, you
have to pay now or we won’t do it.” It was very
money driven.

They also said I had high blood sugar and a
slightly enlarged heart for my age. They wanted to
run all kinds of tests and they wanted like $5000
for everything including the cyst surgery up front!

Q. Did you have them do the work?

CP. No, my mom and I shopped around and found
another doctor that would do the cyst surgery for
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$900 so we went with him. We still had to pay
cash upfront—it wasn’t easy.

Q. What do you think of the other doctor who wanted
$5000?

CP. Well maybe I have a slight heart problem or am
pre-diabetic, but I think he was scamming me and
my mom. He just wanted to make a lot of money
off of us.

It is impossible to determine if Carlos really needed all the tests
and health care the first doctor wanted him to have. It is also
difficult to determine if the costs were reasonable given the costs of
services in the general market. What is important here is that from
the perspective of the uninsured and low-income consumer, the costs
are insurmountable and seem very unreasonable.

Trips to Mexico
Mexican Americans in southern California have historically
made trips to Mexico, especially Tijuana, to obtain goods and services
that can be bought more cheaply there. This is true of health care as
well, as many Mexican Americans go to Mexico to receive medical and
dental care, and to purchase prescription drugs from Mexican
pharmacies with no requirement for a written prescription from a
doctor. In recent years, Anglos have also joined Mexican Americans
in journeys to Mexico for more affordable health care and drugs.
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Some who go to Mexico are seeking the services of healers,
such as curanderos, and also seek to purchase herbal remedies that
the curanderos or the many botanicas in Mexico have to offer them.
Although the services of curanderos and herbals are readily available
in the US, particularly in cities like Santa Ana with its large Mexican
American population, many believe that the curanderos are more
highly skilled and the herbs more potent in Mexico. The following is
an analysis of my study data related to the practice of trips to
Mexico. For example Antonio Gonzalez (immigrant aged 41) told me
that he sometimes goes to Mexico specifically to get antibiotics such
as tetracycline to avoid having to pay for a doctor’s visit and the high
costs of drugs here in the US. “It is more economical for me to go
there,” he said.
Maribel Mendoza, a 38-year-old single immigrant had a more
complete story of why she goes to Mexico:
Q. When you get sick or ill, what do you do?

MM. Right now, without health insurance I go to
Tijuana. I can get anything I need there for health
care. I can get a regular doctor, a specialist, a
dentist. Everything there is much cheaper than if I
tried to get services here—here I can’t afford to get
health care.

Q. Is it a lot cheaper to go to Tijuana?

MM. Yes. There's a consultation cost of 200 pesos
which is about $20, and here the same
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consultation would cost me about $50. Also, the
medicine there is much stronger and more effective
I think. I also buy herbals there which are purer
and more effective than the ones you get in Santa
Ana botanicas.

Q. Are the doctors in Tijuana better than the doctors
here?

MM. Well in some ways yes.

Q. How?

MM. In treatment that they give—it is more effective and
they resolve your problems better. Also in the
medicine they prescribe. When you have severe
and chronic problems like me, you need strong
medicine so the doctors there are able to give it to
me. Here they can’t…here the doctors tell me they
have to follow County regulations and they can’t
give medicines with higher dosages.

Q. What other differences are there between Mexican
and U.S. doctors?

MM. Well, I have more confidence in the doctors there.
I had a doctor here that tried to listen to me. I
would say to him, “Doctor this is what I feel,” but I
don’t think he really understood even though he
heard what I said. Sometimes he was able to help
me but most of the time, no. Here doctors do what
they believe is right, and they see a patient from
their point of view—that is not much help. But in
Tijuana, the doctors are very good, especially for
arthritis, cough and asthma. Here, all doctors do
is give you medicine to ease the illness but not to
cure it.

Q. Many people use herbal home remedies and visit
curanderos. Do you use them?

MM. Yes, very much. They are sometimes better for
what is wrong with you. One time I had to go to a
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psychiatrist but he did not help me much. All he
did was give me pills to sleep and to relax. The
pills made me feel like a zombie without any
positive results to help my problem. So I decided
to go to a botanica in Tijuana. There a curandero
performed a limpia (a ritual cleansing) on me and
gave me some herbs that helped me get better.

Q. There are botanicas here in Santa Ana, why didn’t
you go to one of those?

MM. Well, like doctors here, they are expensive. Here, a
bag of herbals cost $5 and in Tijuana, the same
amount and herbs costs only $3. That’s a big
difference. Also, most of the operators of botanicas
here don’t know much about herbal medicine. But
in Mexico, they do know a lot because they’ve live
in that world and have sold herbs for many years.
Their parents and grandparents used herbs so
they just have a greater knowledge of what works.

Maribel’s case is an example of a regular traveler to Mexico
seeking a wide range of services and medicines including herbal
remedies. However, some of the stories of my respondents illustrate
more situational reasons why one would go to Mexico. Dennis De
Rosa, a 34-year-old, third generation respondent had a story with
some significant differences from that of Maribel. I asked him if he
had ever gone to Mexico for health care treatment or medicine. He
replied:
Yes, several years ago before we had kids, my wife and I
didn’t have health insurance. She was never sick so it
was OK for her, but I used to get these terrible migraines
and neck aches. So my dad and my wife would take me
to Mexico to get treatment from doctors there and a
couple of times we saw a healer…an herb guy too. It was
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all we had and all we could do. I don’t know if I got
better care, but like I said, it was all we could do.

I probed: “Dennis, how was the care you got from the Mexican
doctors?” I didn’t see a doctor, we went mostly to get the headache
medicine.” I probed some more: “What about the curandero, what
were your experiences with him?” “Honestly, I think that was a
waste of time…it’s like mumbo jumbo. I don’t think it did anything
for me,” he said. Dennis told me later that he thought that the
medicines he got in Mexico helped, but that he did it because he had
no health insurance and he could afford the low cost. He was glad
he now had insurance to deal with any medical problems he or his
family might face.
Silvia Camacho, a 50-year-old immigrant also went to Tijuana
to see a doctor. I asked her why:
SC. Because here, they couldn’t find what was wrong
with me so I went there. And to be honest, it is
much cheaper to go there. What happened is that
they could not find out what was wrong with me
either. The doctor gave me some medicine and
told me to come back again for another
appointment, but I didn’t go back.

Q. Were you able to communicate better with the
doctor in Tijuana than doctors here?

SC. Yes, I was able to. But I think what is more
important is that there the doctors spend more
time with their patients and that makes a
difference. For example, the doctor that saw me
was very nice, very attentive, and he spent a lot of
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time with me. Here it is not like that. Here the
doctors just ask where it hurts and then they send
you out of the exam room. They give you whatever
medicine and that all. So, one feels bad because
you take the Tylenol that they give you. The pain
goes away for a little while, but still come back
later. There is no cure.

Q. Why didn’t you go back to the doctor in Mexico?

SC. Well, even though he was very nice and spent a lot
of time with me, he was no better than the doctors
here in curing my illness. It just wasn’t worth the
trip.

Still, others see trips to Mexico to visit a doctor as very
worthwhile and satisfying experiences. Rosa Leon, a 58-year-old
immigrant provided positives reasons for going to a Mexican doctor.
Q. I have heard that many people go to Mexico for
health care. What do you know of that?

RL. Well, it is because it is more economical and the
doctors there understand you better than doctors
here. You also have more confidence in them and
they give you a more thorough examination. What
they do is find the cause of the illness by treating
the whole person—they show compassion and that
they care about you. Doctors here just treat the
symptoms and you have to keep coming back to
them because they don’t cure you.

Q. Have you gone to Mexico for health care?

RL. Yes. I feel better going there because I can express
myself and what I think is wrong with me and they
understand me well and take their time with me. I
tell them where my pain is and they examine me
and they find the problem. Also, all of the
medicines they have given me have alleviated my
problems. I go about every six months for
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checkups, and every time I become seriously ill. I
go.

For many uninsured and low-income Mexican Americans who
place a high value on the use of conventional medicine, trips to
Mexico are very viable because they provide a low-cost option of
accessing scientific, western medicine. Some may view it as inferior
to U.S. medicine, or have some fears regarding it, but for many
Mexican Americans it is not only a low-cost option but an option that
provides a more humanitarian and holistic approach to health care
as many see Mexican doctors as willing to take more time with
patients, treat the whole person (mind, body, and soul), and, very
importantly, treat the causes of disease rather than the symptoms.
Trips to Mexico also provide valuable experiences to those Mexican
Americans who seek the services of curanderos and effective herbal
remedies.
Home and Herbal Remedies
The use of home remedies to treat or prevent illnesses is a
widespread practice within the Mexican American community.
Perhaps the most common practice is simply to have a cup of
soothing tea when one begins to feel the onset of an illness. If the
illness does not abate, then often Mexican Americans opt for some
other stronger herbal medicine or remedy.
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When I asked Felipe Sanchez, “Do you use a lot home
remedies?” he replied, “Yes, often when the illness is not serious. A
headache, a stomachache, or other minor things I think I can cure
myself with some tea or an herb like yerba buena.
I asked Mario Santos, a 41-year-old immigrant, if he or a
member of his family ever postponed seeing a doctor because of a
lack of health insurance, he answered:
MS. Yes, many times. Instead of going to a doctor we
generally use home remedies that we can get
cheaply, like herbals or something like that. Some
of them are very helpful.

Q Do you believe the herbals you use are effective in
curing your illnesses?

MS. Well, I am very aware that here doctors don’t treat
the person but instead treat the disease, so you
mostly get treatment that does not directly address
the illness. So, often you keep going back to the
doctor for the same illness and they still don’t find
a true cure for it. On the other hand, I know of
home remedies that help as well as a doctor can or
better. Many times these remedies are very good
at preventing illness before it comes.

Q. Do you believe the herbals you use are effective in
curing your illnesses?

MS. Manzanilla is good for settling the stomach and
any good ointment with eucalipto (eucalyptus)
works very well when you have congestion. My
wife gives it to the children when they are sick.
She rubs their chest with it and the wraps a towel
around their necks and chests. It works very well.

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Perla Moreno, a 51-year-old immigrant when asked if she uses
traditional medicine only when she cannot afford to go to a doctor
expressed a more deeply embedded belief:
No, I’ve always believed in traditional medicine. When I
was a child growing up, we didn’t go to a doctor because
we cured ourselves with pure herbs. What happens is
that someone comes here [to the U.S.] and gets
accustomed to getting treatment from a doctor. But
everything comes around to its beginning, because by all
means, the medicines doctors give come from natural
origins, no?

Perla’s comment is indicative a strong belief in the efficacy and
effectiveness of herbal medicines and remedies within the Mexican
American community and hints at an observation that American
mainstream society often relies too heavily on doctors even for simple
medical problems and for the early (and often unnecessary
treatment) of colds or flu.
I asked Jesus Leguizamo if he ever postponed going to a doctor
when he needed health care for any reason. His response is in line
with Perla’s comments and observations:
No, not really. If I am very sick, which is not often, I do
go to the doctor. Most of the time when I feel like I am
getting sick, I may drink some tea or take some Tylenol
at night before I go to bed. Usually this helps make me
feel better the next day, but even if it does not, I don’t go
running to the doctor over a runny nose or some simple
aches and pains; and I don’t miss work over such things
either.

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In my interview with Berto Rosales (21-year-old native-born) I
asked if he or any one in his family uses home remedies including
herbal remedies:
BR. Yes. Like my mom, she’s like when we get sick or
have a fever, she gives us tea, I don’t know how to
say it in English.

Q. Can you say it in Spanish?

BR. Manzanilla.

Q. And what does your mom say it does?

BR. She says it’s for flu and infection…but see, I don’t
know. I think they help to…how can I say
it…they…I don’t know if they cure the illness but
they help me to feel better.

Antonio’s (41-year-old immigrant) reasons for his and his
family’s use of herbals included not only the efficacy of herbal
medicines but also a basic economic reason: a lack of money and
health insurance. The following excerpt is from my interview with
him.
Q. Have you ever postponed going to a doctor or
hospital because you did not have health
insurance or money?

AG. Yes, many times. I don’t have the money to see a
doctor or go to the hospital. In any case, instead
of going to the doctor we use home remedies to
deal with the illness which I think are better at
curing whatever illnesses we have. Mostly herbs
or something that we know will help.

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Q. Are these home remedies really effective or would
you rather to a doctor instead?

AG. Well, the truth…I think that here they [doctors]
don’t treat people to heal them…they treat the
illness [symptoms] but not the person, so there is
no direct cure. So, you keep going back to the
doctor over again to have them treat the same
illness and they never really find out what the
cause of the illness is. The remedies we use
certainly cure and prevent one’s illness.

Q. What kinds of home remedies do you use?

AG. Well, it depends on the illness, no? There are
many kinds. One I use a lot is called gordolobo
(mullein)…it is a very good medicine [for many
illnesses].

Q. How often do you use home remedies?

Well, it depends on how often I feel sick. When I
do, I take medicine that I can buy at the pharmacy
(over the counter). For example, when I have a
cold, I take cold pills that they sell. Sometimes, I
go to Mexico to buy tetracycline to fight infection
and, when I am there, I buy other medicines and
herbs at botanicas there depending on what the
illness is.

Prayer
It is significant that 20 (60.6%) of the 33 respondents in my
study reported praying regularly or often and that many times
prayers were specifically to ask for good health or a cure. Mexican
American traditional medicine often includes strong religious beliefs
and rituals, and prayer is of substantial importance to many Mexican
Americans.
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I asked Pedro Franco, a 53-year-old immigrant if he prayed for
good health or to cure an illness. He replied.
Yes, I do. Part of prayer is meditation and I meditate
every day. I listen to every part of my body and I pay
attention to where there are small problems. If I feel a
small pain in my foot, I meditate on it and then the pain
goes away. Prayer to God works the same way because
God sees much more than we do [about what ails us].
This recharges me and relaxes me and heals me.

Asked the same question, Dennis DeRosa (32-year-old, native-born)
responded:

Yeah. Prayer is an important part of my life and my
family’s. We go to church regularly and we are taught
that prayer is our own direct communication line to God.
So when something is bothering me I pray…sometimes
my wife and I pray together. There’ve been lots of times
that I’ve prayed for a cure, especially with the headaches
I used to get. God doesn’t always answer our prayers
but I know that he is listening and does what is best for
me.

I had a more detailed discussion on prayer with Antonio
Gonzalez (41-year-old immigrant) in my interview with him.
Q. How important is prayer in your life?

AG. It is very important to maintain the spirit of the
mind, body and soul. It is how we communicate
with the God that we believe in. If we don’t have
that communication, then we are separated from
the living God.

Q. Have you ever prayed regarding your health?

AG. Yes, I’ve prayed many times for good health. When
I am sick I think God is testing my faith, so I don’t
actually pray for a direct cure, but instead I give
thanks to God for everything that I have. In that
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way I show respect and gratitude for the good
things God does for me. It is important to give
thanks to God for the good and not focus on the
bad. I think that is the way God gives me good
health.

Q. Do you think God answers your prayers and
brings you good health?

AG. (Antonio laughs slightly)…Clearly God answers my
prayers. Sometimes He says “no” and I must
accept that. Just because I want better health or
more money does not mean I will get it. Only God
knows what is in His plan and what is best for
me…I accept what He gives me.

It is interesting that more native-born respondents in my study
reported regularly praying for health or for other reasons (70.6%),
than did immigrant respondents (50%). The difference may well be
an anomaly in my sample, but it raises the question as to whether
religiosity of native-born Mexican Americans is somehow different
than that of Mexican immigrants, and if so, in what ways does that
difference effect how they view the role of prayer in their overall
health. Perhaps it is as simple as acknowledging the role of God in
one’s life and the belief that communicating with God through prayer
is one way to obtain what is needed. Ruben Solis (28, uninsured,
native-born) expressed this idea: “Sometimes I feel that prayer is my
only resort [for good health]. I have no money or insurance so I do
pray to God a lot to help me. What else can I do?

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Botanicas
An interesting feature of the City of Santa Ana is the number of
botanicas in neighborhoods of high Mexican American concentration.
The actual number of botanicas in Santa Ana is not determined in
this study, but there are several neighborhoods in which one can find
three or four botanicas on one street. They can be found throughout
the City and are easily recognized as one drives by.
I visited at least seven botanicas in the course of this study in
an attempt to become familiar with the services and products they
provide. One of the largest of these botanicas is located in the heart
of downtown Santa Ana. The store is separated into three main
sections. One enters the store through a main door into a room
about 12 by 20 feet in dimension. There are cases filled with
hundreds of herbs, spices, and incense. Shelving and counters in
the room have artifacts and mounted, taxidermied animals that give
the store a distinctive southwestern U.S. or desert Mexico theme.
To the right there is a door that leads into a second room, this
one about twice as large as the first. In this room there are shelves
of books on herbals, spirituality, curanderismo, and such. There are
also hundreds of religious icons and products, especially many
different kinds of candles.
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A wide opening at the rear of this room leads into the third
room. When I visited, there were several people in the room all
speaking Spanish. I could see that the room was much larger than
the other two rooms and had three small cubicles enclosed by
curtains and drapes. Somehow I knew not to enter that room
uninvited…the demeanor of the people in the room told me that
access to that room was controlled even though it was very visible
from the books and candles room. I concluded that room was where
a curandero or curandera performed rituals or held consultations,
but was unable to confirm that.
Other botanicas in Santa Ana vary in size and layout. Most are
much smaller than the one I have described and usually have only a
small space in the front where there is a cash register, and books,
candles, and herbs in glass cases that are for sale. All the botanicas I
visited had back rooms with controlled access. The visible presence
and number of botanicas in Santa Ana are evidence of the use by
members of the community and of the importance they play in the
range of health care choices available to the community.
When Vicente Rodriquez (44-year-old immigrant) reported that
he used herbal remedies, I asked him where he obtained them. He
responded, “There are several botanicas in each neighborhood in
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Santa Ana. You can easily get most any herbals, a statue of your
favorite saint, or whatever you need. They are everywhere.”
I interviewed Carlos Perez (20-year-old native-born) in a
downtown courtyard and we had the following dialogue on herbal
medicine and botanicas:
Q. Do you ever use herbal or home remedies?

CP. Yes. I’m just getting to know more about them and
want to learn more. I think that they are more like
the medicine of the people and I’m thinking that
they are better for me than regular medicine—
more natural for sure.

Q. How are you learning about them now?

CP. My mom knows a lot about them and so does my
aunt, they tell me about them…and I go to that
botanica down a couple of blocks (points in the
direction of the botanica I have described above).
They have a lot of stuff and there’s a guy I talk to
there. He tells me things.

In my sample only nine respondents, three immigrants and six
native-born, reported using botanicas in Santa Ana. Other
respondents reporting the use of herbals obtained them on trips to
Mexico. This is difficult to explain given the number of botanicas in
the city. It is also difficult to explain why more native-born than
immigrant respondents reported visiting botanicas. One possible
explanation is that many of the products sold in botanicas, especially
some of the herbs, can be expensive and therefore access to them
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may be limited to persons with the financial resources to purchase
them.
Curanderos
In traditional Mexican American and Mexican medicine the
curandero (male) or curandera (female) often holds a position or
respect and trust within the community. The term curandero(a) is a
general term meaning healer. Within the framework of curanderismo
are various types of curanderos. For example, a curandero total
(complete curandero) is a person who is highly trained and skilled in
all aspects of Mexican folk medicine including the use of herbs,
spirituality, rituals, etc. Although the term curandero generally holds
a positive meaning, some curanderos prefer to use the term sanador
or sanadora which for some people connotes distance from the
occult.
Other curanderos are specialists and are called by titles that
indicate their specialties. Some of these are espiritistas (spiritualists
that deal with aspects of the supernatural or the spirit world),
sobador (massage practitioner), huesero (bone setter or manipulator),
or brujo (literally a witch) who dabbles in the occult and in both white
and black magic. It is the brujos that some Mexican Americans think
of when the term curandero is used, and that evokes distaste or fear.
Most curanderos are not brujos, but holistic practitioners that utilize
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an array of traditional modalities in helping Mexican Americans with
health issues.
In my interviews, I asked respondents if they have ever seen a
curandero. If not, I asked if they heard of a curandero with a good
reputation whom they would go see. About half (51.5 percent) of my
respondents stated that they had seen a curandero or would go see
one of good reputation. When asked this question Silvia Camacho
(50-year-old immigrant) responded:
SC. Yes, clearly. Right now I am seeing a sanadora
that treats me with herbal medicine. I very much
believe in this type of medicine and the sanadora
is helping me a lot with my problems.

Q. What does the sanadora do for you?

SC. She’s done some limpias on me to get rid of
negative energy and I know that works. She also
gives me some herbal medicine…I don’t know what
kind…but that works too.

Q. Do you go to her because your doctors can’t find
what is wrong with you? Is the sanador your only
option?

SC. Yes, that is the truth. As I told you before the
doctors here or in Tijuana haven’t cured me. Also,
you should know that the sanadora does not
charge me as much doctors do.

Rosa Leon (58 years old immigrant) went to a curandero when
she believed her son was the victim of mal ojo (the evil eye) which was
the topic that she and I were discussing in the interview.
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Q. Have you ever heard of mal ojo?

RL. Yes, I have heard of it and believe it is true
because one time when my son was a baby
someone did that to him. He got sick with a high
temperature, he cried a lot, and one of his eyes
went shut. I had to take him to a curandero to be
cured.

Q. What did the curandero do to cure him?

RL. Well, the truth is that I don’t know exactly
everything he did. I know my son was massage
with garlic and I think that cured him. The
curandero did other things but I can’t tell you what
they were. I didn’t understand completely what
was going on.

When I asked Berto Rosales (21-year-old native born) if he had
ever seen a curandero he said:
BR. Uh, huh…like I play a lot of sports and every time
you like…like when we play sports and we get an
injury or body pain, we go to a curandero. The one
I’ve seen…like when an arm goes out of place he
does this massage thing and the bones go ‘whack!’
and then they are all right.

Q. Was that a curandero or a sobador?

BR. Yeah, that’s right. He’s a sobador.

Q. Have you heard of other kinds of curanderos like
an espiritista or a brujo?

BR. From my mom. Once when she lived in Mexico
she found a doll in front of her house. I don’t
know what it had but my mom said it was a lot of
bad stuff...that a brujo put a spell on her. That
was, like, really bad.

Q. What did your mom do?
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BR. She went to see another brujo to get the spell taken
away.

Marie Madrid’s (50-year-old, native-born) experiences with
curanderos as a child were more dramatic. I asked her:
Q. If you knew of a reputable curandero would you
visit him for your health care?

MM. Yes, for sure! I haven’t gone in years but when I
was a kid I had a muscular disorder that was
getting worse to the point where I couldn’t walk.
The doctors told my parents I would never walk
again. My dad looked at me and said, “Oh yes you
are!” So, he took me to Tijuana several times to
see a curandero. The last time he took me to
CHOC (Children’s Hospital of Orange County) it
was to show the doctors. When we got there my
dad said to me to get out of the car and walk, and I
said, “No, I can’t, carry me,” and I was arguing
with him the whole time. He finally said, “No, you
are going to get up and walk!” I got up and I
walked.

Q. Was it the curandero that cured you?

MM. Yes, definitely.

Q. Do you go to curanderos now?

MM. No.

Q. Why not?

MM. Basically, because I don’t know who to go to. My
parents always knew the right curanderos but I
don’t have a clue on how to find a good one I can
trust. I really believe a good curandero can help
you but there are a lot of fake ones and I really
don’t know how to find a good one. That’s the only
reason I don’t go to one now.
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In a final example regarding curanderos, I asked Vicente
Rodriguez, if he would see a curandero with a good reputation. His
answer was very interesting:
VR. Actually, right now I am studying to be a
curandero…no, actually I have to say a
shaman…yes, not a curandero but a shaman.

Q. Really, that is so interesting! Where are you
studying? Where does one go to learn to be a
curandero?

VR. I know a couple of guys in Santa Ana that are
training me. But I recognize that what I can learn
from them is limited. Thank God my wife, Emelda,
understands what I want to do and she supports
me. She’s from Peru and we are moving there…to
the Amazon area where I will apprentice to a
Shaman. I’ve already quit my job and she will be
quitting hers soon, and then we are gone.

A more detailed account of Vicente’s story and his ambition to
become a shaman is presented in the next chapter of this report.

Moving Across the Alternatives: The Practice of Medical Pluralism
A primary thesis of this study is that many immigrant and
native-born Mexican Americans engage in the practice of medical
pluralism. There were several examples medical pluralistic practices
among the respondents in my sample and there were only five cases
in which respondents reported using conventional medicine
exclusively, and no cases in which the exclusive use of traditional
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medicine was reported; although within the total sample, 12
respondents reported having “more faith in conventional medicine”,
and eight reported having “more faith in traditional medicine.” The
following are examples of respondents who engaged in medical
pluralistic behavior to some degree or another.
Michael Quintero, is a 29-year-old, married, second generation
Mexican American, and is currently insured. He reports that he and
his wife, Hope have made trips to Mexico to seek health care and
medications, have used various home remedies (both teas and
herbals), and have utilized the services of a curandera. Generally,
Michael and his wife have more faith in conventional medicine, but
during a period where they had no health insurance, they made use
of several alternatives. Now that they are insured, they continue to
use some alternatives because of family influences and cost
considerations.
Currently, Michael and Hope have one child, hers from a
previous relationship. They would like to have a child of their own
but Hope is experiencing some fertility problems. Fertility problems
are not covered under their insurance plan, so, at the urging of family
members, they are visiting a curandera until they can save money for
conventional services. The following excerpt is from my interview
with Michael:
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Q. Michael, you mentioned earlier that you have seen
a curandero in Mexico, is that the only time?

MQ: For me, yeah, but my wife has a problem, you
know, like we are trying to get a child. Because
we don’t have one with me. We have one from her
previous relationship and she has, um what’s it
called, polycystic ovaries. So we are seeing a lady-
-a curandera. And she, you know for a fee they
massage you, certain body parts that are going to
help you. And we believe that, a lot of my wife’s
mother’s sisters [aunts], have gone with her and I
guess its called massaging the diaphragm. I think
that’s what it is. Kind of helps it put it in place to
be able to make it easier to make a child, I believe.
Anyway, it can’t hurt to see her while we’re saving
the money to see a doctor.
Q: How did you find this curandera? Is she around
here?

MQ: Yeah, she’s actually in [the City of] Orange. My
wife’s mom knows her so that’s how we got to
know her.

Q: Do you go over to her house or does she come to
you?

MQ: We…actually, my wife and her sisters go to her
house…my wife is supposed to go two more times.
My wife told her about the problems she has and
she gave her some teas to drink to help clean the
ovaries.

Q: So, she’s taking teas and going for the massages.

MQ: Yeah, she’s doing that right now.

Michael and his wife are not completely convinced that the
curandera’s treatment will help them have a baby, but they are
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willing to try this option until they can afford to see a conventional
doctor about their problem.
Teresa Palacios is a 24-year-old, second generation Mexican
American. She works part-time, attends school part-time, is married
and has one child. Although her child is eligible for Medi-Cal, Teresa
stated that she has not had the time to complete the necessary
paperwork so the entire family remains uninsured. She reports that
her family utilizes storefront clinics primarily, and has made
occasional trips to Mexico to obtain medical care. She states that,
overall, she has much more faith in traditional medicine and
regularly uses teas and herbal remedies at home.
Q: You’ve told me that you use teas and herbals at
home rather than got to a doctor? Why is that?

TP: Going to the doctor can be very expensive and we
cannot afford that now, especially with no health
insurance.

Q: So, if you had health insurance would you use
home remedies as much or would you go to the
doctor?
TP: I’ve tried the stuff doctors give you. I don’t really
have much faith in them cause I don’t think they
work.

Q: You don’t think that regular medicine works as
good as teas and home remedies? You think
herbal remedies or home remedies are better or
more effective?

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TP: Yeah, they’re more natural and don’t have a lot of
chemicals and stuff.

Teresa was clear that she does not lack complete faith in
conventional medicine and clarified that she and her family do see
doctors when they have to, and would certainly do so in case of a
very serious illness or condition.
Lupe Contreras, is a 24-years-old immigrant who is married
and has two children—both of whom have medical coverage through
Medi-Cal. Lupe and her husband are uninsured. They believe
strongly that conventional medicine is often the better option, but
when I asked her if she thought that conventional medicine was
better than traditional medicine she stated:
It is not that one is better or worse than the other. They
both are valuable. The first thing we do when we get
sick is take a tea or some other remedy that we think
may help. But if the illness gets serious, we go to a
doctor right away. You cannot cure an illness with teas
and herbals—for a cure you must go to a doctor.
Herbals are for prevention and for illnesses that are not
serious, like a cold or the flu.

Lupe reported that neither she nor her husband would consider
using a curandero because they do not believe that they have any
healing powers beyond some knowledge of the kinds of herbals to use
for certain illness—something that Lupe felt she and her husband
already knew.
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Many of the respondents in my study had similar stories in
which they related the many ways that they navigated between
conventional medicine, traditional medicine, and other medical
alternatives available to them. These stories are indicative of the
flexible and creative ways that Mexican Americans utilize medical
pluralistic alternative in their health seeking behavior. It is not
always a matter of how much one believes in the various alternatives,
but is more a matter of the resources, family or community
influences, and the availability of the alternatives.
Chapter Summary
This chapter presented a general discussion of the health care
seeking alternatives practiced by study respondents, and some
reasons they chose certain alternatives. The major alternatives
identified and discussed were: use of conventional medicine; use of
private storefront clinics; trips to Mexico for health care, prescription
drugs, and traditional healing and herbs; the use of home or herbal
remedies; the practice of prayer for good health and cures; use of
botanicas; and the use of curanderos.
The data analyzed in this chapter indicate there are some
differences between the immigrant and native-born groups in the
alternatives practiced. The persons in the immigrant group were
more likely to take trips to Mexico, use home remedies, and use
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curanderos; while members of the native-born group were more likely
to use prayer and visit botanicas. However, more important than the
differences between the two groups are the overall percentages among
the entire sample that are indicative of a notable persistence and
maintenance of alternative health care practices to conventional
medicine among Mexican Americans in Santa Ana. This assertion is
then supported by the respondents’ narratives that are illustrative of
the diverse range of health care seeking and health care behavior
practiced by individuals within the sample.
What emerges from the analysis of the data for the overall
sample is general model of medical pluralistic healthcare seeking
among many of my study respondents. The following healthcare
seeking categories identified in this study are crucial to the
examination of the model: the exclusive use of conventional
medicine; the primary use of conventional medicine with partial
utilization of the alternatives; moving across the alternatives
(conventional and traditional) with frequency and fluidity; and the
exclusive use of traditional medicine. The case studies presented in
Chapter 7 are offered as examples of individuals who more or less are
representative of these categories.

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CHAPTER 7: CASE STUDIES, NARRATIVES ACROSS THE
CONTINUUM OF ALTERNATIVES

In this dissertation, I have argued that long term immigrants
and native-born Mexican Americans in Santa Ana have available to
them a continuum of choices regarding their health care seeking and
health care behavior. To review, the main categories along this
continuum include the exclusive use of conventional medicine; the
primary use of conventional medicine with partial use of the
alternatives; moving between conventional medicine and the
alternatives with some degree of frequency and fluidity; and the
exclusive use of traditional Mexican folk medicine including the use
of home remedies or herbal treatments, prayer, visits to botanicas,
and the use of various types of curanderos. I also argue Mexican
Americans in Santa Ana may engage in behavior that is best
described as pluralistic medical behavior. Further, both immigrants
and the native born maintain a reverence for (and high a value)
traditional medicine which is at the core of their pluralistic health
care seeking behavior as evidenced by the findings discussed in
Chapter 6.
The results of my study so far indicate that most, but not all,
Mexican Americans in my sample engage in more than one
alternative available to them. However, in order to more fully
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describe the health care experiences and preferences of respondents
in my sample, I have selected four case studies that illustrate the
choices available to them along the continuum that I have described
here. To my mind, each of the case studies that follow are significant
and compelling stories and narratives that tell what healthcare
choices Mexican Americans in my sample have made and why they
have made those choices.
Perla Moreno: A Choice of Conventional Medicine
I interviewed Perla Moreno in her Santa Ana apartment. She is
a 48-year-old immigrant who was born in Mexicali, Mexico. I was
referred to her by an acquaintance, her daughter’s college friend.
Although in all of my interviews I made it a point not to ask about
immigrant status, Perla freely revealed in the course of the interview
that she and her husband immigrated to the US illegally 26 years
ago. They have lived in the same apartment in the southeast area of
Santa Ana for the past 19 years. They have a 24-year-old daughter
and a 21-year-old son. Their daughter recently graduated from a
nearby California State University, and their son is attending a local
community college.
Twelve years ago Perla and her husband were able to obtain
legal residency. Soon after, Perla’s husband was able to find
employment with a local school district as a custodian and Perla also
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found employment at a local community center. Their new jobs came
with good benefits and now the Moreno family is fully covered by
health insurance. Before that time, the family had no health
insurance at all and experienced access and financial hardships
when they needed medical attention.
Despite the fact that they have steady jobs with the City, Perla
and her husband speak very little English on the job and speak
Spanish exclusively in their home. Perla interacts exclusively with
Spanish speakers so there has been no demand on her to speak
English. Her husband is also not required to speak English on the
job.
The Morenos live on a quiet street lined with older, but well
kept, wood framed houses. The property where the Moreno’s
apartment is located has a small house in front with a wide driveway
to the right side of the house. At the rear of the property, there is a
bank of three garages with two apartments built over them. There is
a stairway to the left of the building that leads to a railed walkway
that provides access to the apartments. The Moreno’s live in the first
apartment.
The apartment was very large. The front entrance led directly
into the living room area and directly ahead was a raised (about the
height of a standard stair riser) dining area of about eight by eight
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feet. To the left of the dining area was a long, narrow kitchen. These
were the only rooms of the apartment that I saw. A hallway to the
right just before the dining area obviously led to the bedrooms and
bath.
The home was modestly furnished and immaculately
maintained. There were wall decorations and family photos hung on
the walls and there were several attractive and tasteful rugs that
accented the living room carpet and furniture. The dining area
flooring was linoleum. The dining table was rectangular and of
medium size with two chairs on either side facing each other. Perla
offered me a seat on one chair and she took a seat on the opposite
side facing me.
Perla is an attractive, petite woman about five feet tall and
average weight. Her long dark hair was braided with a single braid in
a style that many Mexican women wear. Her demeanor was quietly
respectful and she seemed a bit shy, but I also perceived that she
was a strong, capable woman.
I began the interview with the question of what she, or a family
member, does when they get sick or need medical attention. She
answered simply,

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PM. We go to the doctor.

Q. How do you pay for your health care when you go
to the doctor?

PM. My husband and I both get health insurance from
our work.

Q. Does the insurance cover all your health care
expenses?

PM. Well, it is BlueCross…HMO… and each time we go
there we have to pay $15 for a visit and if the
doctor gives us a prescription we pay $5 more, but
that is all.

Q. Is everyone in your family insured?

PM. Yes, everyone is covered.

It was clear at this point of the interview that the family was fully
covered by health insurance and was not experiencing any health
care access problems or issues. I decided to take another direction
and ask Perla about her family’s health care before they were
insured.
Q. Perla, your family has health insurance now, but
what did you do about getting medical care before
you had medical insurance?

PM. I’ll tell you the truth, in those times we didn’t have
papers so I did what I could to get medical care for
us when we got sick. We went to some clinics that
were there to help people like us.

Q. Didn’t you ever go to the County for help?

PM. NO! We had no papers and we didn’t want anyone
to know. Like I said, we went to the free clinics or
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sometimes to a clinic where they didn’t ask…but
there we had to pay.

Q. Your children were born here in the US?

PM. Yes.

Q. Did you know they were eligible to Medi-Cal or the
Healthy Families Program?

PM. No, I didn’t then, but the truth, we would not have
gone to try to get those programs because they ask
too many questions and we didn’t want to take
chances. Thank God, nothing serious ever
happened and we were able to finally get papers
and not worry.

I saw an opportunity to move from questions about health
insurance to questions about traditional medicine.
Q. Many people in the community often use home
remedies or herbals when they can’t go to a doctor.
Do you do that now, or did you when your family
had no health insurance?

PM. No, no…I would never do that. I only take my
family to doctors when they are sick.

Q. Did you ever use home remedies or herbals when
you were younger and lived in Mexicali?

PM. No, never. Lots of people think that all Mexicans
use herbs or go to brujos or curanderos to get
treated, but my family always went to doctors.

Q. So in Mexicali people don’t use herbals or go to
curanderos?

PM. No, that is not true…they are there if you want
them or believe in them, but my parents did not
believe in that and taught me not to trust it. It is
not real medicine.

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Q. So no one in your family in Mexicali ever used
traditional medicine?

PM. Well, I have aunts and uncles, and cousins that
do. One of my cousins lives two houses from here
on this street. She and her husband believe in
this kind of medicine and they do it.

Q. But Perla, if you were in a situation again with no
health insurance for you or your family, would you
consider using herbals or seeing a curandero if he
had a good reputation?

PM. I tell you the truth, no. I did not do it before and I
would not do it now. That is not really medicine, it
is something other people believe but for me, no.

I then decided to ask Perla about the treatment and services
she receives at the HMO:
Q: Do you get good, quality care from BlueCross?

PM: Yes, I think so…most of the time I see the same
doctor and nurses and they know me. They do a
good job most of the time.

Q: Most of the time? Why not all of the time?

PM: First, then the actual doctor comes in, but she’s
kind of in and out and says, ‘okay, what’s the
matter with you, what’s going on, okay I got to go’.
She doesn’t actually say that, but that’s the way I
feel it is. Then the nurse practitioner comes in
and takes over.

Q: Do you have any trouble communicating with the
doctor where you go for care because you don’t
speak fluent English?

PM: The doctors are hard to talk to sometimes. They’re
Chinese, and they speak some Spanish. I don’t
think it is a language problem. It is that we are of
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different cultures and sometimes we don’t really
understand each other.

Q: Do you feel intimidated by the doctors or other
medical staff?

PM: The nurses are fine to deal with; they have more
time to answer your questions. Sometimes when I
see the actual practitioner I think she is really
short with me.

Q. And how do you interpret that behavior? Is that
the way she treats everybody or she treats you
differently than she might treat everybody else?

PM. She’s a busy woman, so that’s how I interpret it. I
don’t think she’s discriminating against me
because of how I am.

Q. What is your reaction to her, how do you
personally deal with it when she is short with you?

PM: I go in there with a list of questions I want to ask
her. I ask her all my questions right after another
really quickly, and that’s how I get my answers.
But if I go in there thinking about ‘oh, what was
the matter with me the other day’, but I can’t
remember, then I never get any answers.

Perla’s experiences as a Mexican immigrant tell a story of
determination and resiliency. Although she is a modest woman with
a tendency towards shyness, she has always been resourceful in
getting health care for her family even when the family was without
health insurance. Because of her personal beliefs and upbringing by
her parents in Mexico she prefers and seeks out conventional
medicine only. She is steadfast in her resolve that she would never
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use any traditional medicine options because she does not believe
that they are effective because “they are not real medicine.” As for
the use of teas when one is not feeling well, or praying for good
health, her opinion is, “those have little to do with medicine, one is
just something good to do, and the other is faith in God.”
Frances Morales: The Necessity of Trips to Mexico
Frances Morales is a 29-year-old second generation Mexican
American. Carlos, her husband of nine years is a third generation
Mexican American. They have two small children, a boy aged nine
and a girl aged eight. Frances’ story is one of extreme hardship in
accessing health care and getting adequate healthcare when she or
her family required it. In the past, her family has had to utilize
emergency rooms and private cash only clinics frequently which has
put them thousands of dollars in debt and has ruined their credit.
The family survives on a total income of $24,000.
Frances lives in an apartment in a large low-income housing
complex. The landscaping is sparse and the buildings are fairly well
maintained but the complex and surrounding community are easily
identifiable as low-income. The apartment itself was small, modestly
furnished, but neat and clean. Frances offered me a side chair and
she sat opposite me on the sofa as we began the interview.
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As a child, Frances’ family always had health insurance from
her father’s employment. Before her marriage, she was accustomed
to having adequate healthcare when she needed it. Her children have
also been without health insurance for most of their lives. At the
time of our interview her children had finally covered by Medi-Cal
just a few days before. When I asked her how she felt about growing
up having health insurance and then suddenly not having it, she
replied:
It was hard to accept, especially with kids. I had severe
asthma growing up as a child. I was in the ER four
times a week, so I couldn’t imagine being without health
insurance as a child because I had asthma. I can’t even
think about it now because it makes me upset that I
can’t get care when I need or want it.

Then I asked her how important it was that her children were
receiving health care under Medi-Cal:
It’s very important. Now that the kids have Medi-Cal,
great. My son, he has migraine headaches. The thing is I
never knew for sure that they were migraine. I read
about them myself. A friend told me “yeah, they’re
migraines.” And he gets in severe pain. And now that we
have insurance we went to the doctor. I got insurance,
on Wednesday I got the letter. On Thursday I had
appointments made for doctors…The doctor was worried
about the migraines. He’d get dizziness. He’d have like
his vision would be lost…Last month he got a really bad
migraine. I didn’t know what to do. What I did was he
ended up staying here at home. He just suffered until he
went to sleep and when he woke up he felt better. Now,
that’s he’s seen the doctor. The doctor is like no, he
needs to see a neurologist. The neurologist wants to do a

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CAT scan. And he has more appointments to get more
done. Now he is getting the care he needs.

Prior to insurance coverage, Frances often withheld taking her
children to the doctor even when they had severe symptoms. She
recalls one of her son’s migraines. She reported sitting up late at
night with him until he finally went to sleep and that in the morning
he felt better. “I didn’t know what to do,” she said, “we had no
money.
In another incident her youngest son had a fever that reached
105 degrees. She told me the story:
Once he had a fever and it hit 105. At first it got to 102
and we waited. At 103 we tried to cool it down let it go
down. Once it got to 104 we took him the emergency
room... And we took him to the least expensive
emergency room and they wanted $250 up front, just to
walk in.

I probed, why didn’t you take him to the County hospital?

It was too far away and I would have to go wait at County.
And going and waiting at County, which I’ve done before…it’s
insane because unless you’re dying right there they don’t do
anything.

I then asked her about how she paid for the emergency room visit:
I borrowed it. It was $250 to walk in. To go and sit in the
waiting room it was another $6. The bed was like
another $60 dollars. There was a doctor’s fee and then
there were prescriptions. I think that visit was probably
like $500…I borrowed it from my parents…I have an
outstanding debt to my parents for thousands of dollars
for stuff like this.

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In another story, Frances told me an account of an accident
she had driving her children to their first day of school. The children
were in the back seat squabbling so Frances turned around to scold
them. She drove over the curb and lost control of the car as it went
down an embankment. The children were wearing seat belts so they
were not injured, but Frances was not and she hit her head on the
windshield when the car stopped at the bottom of the embankment.
I hit my head. I got glass in my head. I was pretty much
all bruised. It was near a Ranger station. The Rangers
came out. My kids had nothing. They had no scratches
on them. My son had a little scratch, he says he had one
scratch. The car seat and the seat belt saved them cause
everything was thrown out. The ambulance came. I was
still kind of out of it. I just remember I said I have two
kids. Check them. They seen them and they said we are
going to take you to the hospital. They put us on the
stretcher. Me and my daughter shared an ambulance.
My son went on a second one. But there they were
walking around like oh they’re fine we just want to make
sure. I was like, okay. They drove us. That was $800 for
each one of us for the ambulance rides. And they said
my kids were fine, but they wanted to be safe, cause my
son was walking back and forth. He had to go to the
bathroom. The Ranger took him to the bathroom. They
still put him on the stretcher. That was $800. My
daughter shared one with me, but they still charged us
$800 each. And when we got there, there was another fee
to get into the emergency room. And they charged us. In
fact, my kids got off the stretchers. They put them on one
bed. The doctor spent 15 minutes with them and said
they’re fine.

Frances’ total expenses for this one incident were over $5,000 which
she has not been able to pay to this day. She tried to make
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arrangements of payments of $10 or $15 but the hospital would not
agree to payments less than $150 which Frances could not afford.
She is still hounded by bill collectors and said that being unable to
pay that bill has ruined her family’s credit.
Frances also told me now that her children have insurance
coverage she expects that her family’s medical expenses will decrease
significantly. I asked her why. She replied:
I’ve found lots of ways to avoid going to the doctor. Like,
I know I shouldn’t do it, but if someone offers me an
inhaler they don’t want and I can use it for my asthma, I
take it. Also, my neighbor is from Mexico and she got me
going to TJ [Tijuana, Mexico] for medicine you can get
without a prescription. So now me and my husband go
when we need medicine or we need to see a doctor
because down there we can afford it. I just recently went
and got a lot of dental work done for only $50! I’ll keep
going too until I get health insurance.

I responded and probed:

That’s interesting. Some people I’ve talked to have told
me that they do that too. Do you get good care there and
do you think the doctors in Mexico are the same, better,
or not as good as American doctors?

She responded:

I wouldn’t say they are better, but I think I got good care.
They have taken care of what I need done and I don’t
have to wait a long time there to get treated like I do at
County. To be honest, I don’t see a lot of difference but if
I could I would go to a doctor here first if I could afford it.
I go to Mexico because it’s cheap but I wouldn’t say I get
bad treatment…no way.

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I asked her if she ever took her children to Mexico for health care
treatment. She replied, “No, I’m not that comfortable with it. It’s OK
for me and my husband but a different story for the kids.”
Frances’ personal outlook regarding accessing health care for
her family improved dramatically as a result of the Medi-Cal coverage
for her children. She felt that now the children could see the doctor
whenever they needed and her and her husband’s healthcare needs
could be managed by trips to Mexico to see a doctor there.
With the horrific stories Frances was telling me, I wondered if
she was also using traditional medicine such home remedies or
herbal treatments. She told me that she never used them but some
aunts and uncles had. She stated.
For me, its not something I would do, especially not with
the kids. My parents never tried to give me any of that
stuff, but my aunt would bring things she got from a
little botanica near where she lived. I know she would
sometimes see a curandero, but not me…I won’t do it.

Frances is a good example of how an individual or families can
be ravaged emotionally and financially by a lack of health insurance.
She has faced many extremely stressful situations including having
to put off taking her son to a doctor for his severe migraine
headaches because she could not afford the treatment. At the end of
the interview, Frances told me she felt hopeful. She had just
completed the requirements for an Associate of Arts degree and
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would be transferring to the University to pursue a Bachelor’s degree.
She also stated that her husband was actively looking for a job with
benefits so that he and she could have health insurance. Her
positive outlook was greatly bolstered by the insurance coverage that
her children had recently received.
Lupe Valdez: High Utilization of the Alternatives
Lupe Valdez is 29-years-old, married, with one child—an 18-
month-old boy. She is a trained medical assistant but is currently a
housewife and stay-at-home mother. She and her husband are both
second generation Mexican Americans and they live in a Mexican
American neighborhood in Santa Ana. Lupe’s parents migrated to
the United States approximately 50 years ago.
Lupe’s home is a two-bedroom, one-bath. The interior of the
home was dark, primarily due to the dark colored painted walls and
heavy draperies and curtains on the window. The front door led
directly into a large living and dining room, and there was a large
tiled counter that separated this room from the kitchen. The
furnishings were sparse and there was much evidence that an 18-
month-old child lived in the house. Lupe later told me that the
sparse furnishing were intentional in order to minimize bumps and
bruises to her son.
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When I first arrived, Lupe’s mother and niece were there to
pick up Lupe’s son so that she could participate in the interview
without interruption. The good-byes took some time but eventually I
was able to start the interview. We sat on some stools at the kitchen
counter. After several questions designed to get some information on
Lupe’s background I asked her:
Q: When you or a member of your family gets sick,
what’s the first thing that you do?

LV: I’ll try to take care of it on my own, just over the
counter stuff, go to the pharmacy. I’ll try that first.
I think it all depends. If he [son] has a real high
fever I will call the doctor and let them know
what’s going on. I’m not one to rush to the doctor.
I will try to take care of it on my own.

Q: And why is that?

LV: Because I notice a lot of the times I go to the
doctor and they’re like “It’s a fever give him
Tylenol”. I hate driving back and forth wasting my
time. I’d rather call, talk to the doctor. Let him
know these are the symptoms and let them tell me
what I should do.

Q: Is that something you learned on your own or
learned from your mom?

LV: I think I developed it on my own. Well, I went to
medical assisting school so I kind of learned not to
freak out, panic right away and ok run to the
doctor. Cause they’re just going to send me home
and tell me to take cough syrup. Or if it’s
something that I remember how my mom treats it,
like an earache I do that. If I have an earache or
my husband, she would warm up a garlic clove,
just one piece, warm it up in a comal (bowl), then
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put it in the ear and a cotton ball. And it would
make the pain go away. It helped and I think it
works. Stuff like that, if it’s been three days and
your ear is still hurting, it’s oozing, and okay, let’s
go to the doctor and antibiotics.

Q: So, you use home remedies as well as going to the
doctor?

LV: Sure. Not too long ago my knees, my knees were
hurting really bad. My Mom and sister have bad
knees and I thought, its just a family thing. My
mother-in-law, tell me “Ponga ruda, calientelo en
una holla chiquita (put rue in a little pot and heat it
up)…warm it up and rub it on your knees.” I did
that, but it’s just temporary stuff. I don’t think it’s
something that going to totally heal it. I get lots of
stuff like that from my mom and mother-in-law.

I wanted to know more about the influence of herbals and home
remedies in Lupe’s health care behavior so I asked more questions on
the subject:
Q: So your mom taught you about herbal remedies?

LV: Yeah, growing up. Weird stuff.

Q: Like what?

LV: I know there was one that was alcohol with ruda,
which is like a herbal plant. Alcohol, ruda, I don’t
know what else they would put in it. Alvaca
(unknown ingredient) or something like that. I don’t
know, but it was just rubbing alcohol but with
herbs in it. If I bumped my head or hit my knee
somewhere, you know I would rub with this stuff
and it would make it feel better, stuff like that.

Q: So she would actually use it rubbing …?

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LV: Yeah, or stuff like that. I remember if you got really
a bad scare they would tell you have a little bit of
sugar or candy or even alcohol.

Q: Are you talking about susto (malady from being
frightened)?

LV: Uh, huh.

Q: Do you believe susto?

LV: Yeah, and it could be bad. For you or the baby
because then they are born asustado (afraid). And
then they cry a lot, stuff like that. For a child when
they get scared…I had an incident not too long ago
when I was playing with my son and he was playing
with the cabinets right here (points to the place).
And I was over here and I was coming around and I
was like ‘Ah, el cucuy (boogyman)’. He didn’t see
that I was on this side and I tossed my head over
and he got really scared. Shaking from head to toe.
He really got scared and I felt really, really bad. I
felt bad for him, after I told my mother-in-law about
it and she was like ‘O, dale un poquito azucar o algo
dulce (give him some sugar or something sweet) or
he will have nightmares.’ And he did, he did have a
nightmare that night. He woke up crying and I had
to go in there comfort him and he had to sleep in
my room. So, I remembered that I scared him really
badly.

This was a good opportunity to ask Lupe about other maladies,
so I asked her if she had ever heard of mal ojo (evil eye). She
responded:
From what I get it, it is, there is a lot of evil mean people
that can wish bad upon someone else. I think it is bad
that there are people like that. It would be for the
simplest …

I probed: And they have the power to cause injury or illness?
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I think they can, yeah. I do believe that there is that. I
don’t know if they have the power to actually make it
happen, but I don’t want to play with it. So I’ll do
something like, I used to wear a red string, you know.
And that’s to protect you from the bad vibes or whatever.

I probed again: One of the types of mal ojo that I’ve heard about is
when someone admires your child too much you want to avoid that,
what do you think about that? She responded:
It’s true cause you don’t know what they’re really doing.
It’s trust. If they are maybe a friend or relative, like my
mom, that’s fine she can admire him all she wants. But if
I’m at a store and I just run into someone and they are
like ‘O, que chula la niña (what a cute baby)’ they keep on,
keep on. It is kind of like, stop already, I don’t know what
your intentions are or what you are doing. I’ve seen little
babies out there with little beaded bracelets, red beads, a
little bit of gold in there. I’ve seen that, but I’ve never did
it with my son. Let me tell you a story… two brujas from
Spain, they came to our home.

‘Really?’, I reacted.

Yeah, they came to our home. Well actually my Dad
stopped at a yard sale around here and he was looking at
some stuff. And the two ladies were there. They told my
Dad ‘hola’ and my Dad was like, ‘Oh hi, who are you?’
He didn’t recognize them or know them, right? He didn’t
know them. One of them told my Dad ‘Su esposa esta
enferma de las rodillas (your wife suffers from bad
knees)’. My Dad was wow, exactly, he was like what? My
Dad thought, maybe I don’t recognize who they
are…maybe they are someone from there, you know, the
neighborhood. They were like, “oh we’re brujas and we do
limpia de huevo (egg cleansing) and all that stuff.’ And
my Dad doesn’t believe in that, but because they told
him your wife has bad knees…So, he brought them to
our home…when they came it just felt like, it just didn’t
feel right. And when he said, ‘Oh, these are some brujas
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que hacen limpias (that do cleansings).’ They did a limpia
on my Dad with the huevo (egg). And my Dad said that
when they cracked the egg that it was like a blue-blue
like that cobalt blue, like that blue glass…supposedly
there was a couple that was wishing bad on our family
and that’s why we were having trouble in the family.

I asked Lupe: Do you remember exactly what they did with the egg?
Can you describe it?
No. We weren’t in there. My dad said they put the egg all
around his head and body several times and then they
cracked it open, then they were able to identify the
couple that wanted to do bad to our family. My dad
thought it might be a trick…that they put something in
the egg to make it blue, but he didn’t see them do it.

Lupe’s experience with the brujas provides insight into the role that
healers play in the Mexican American community. It is important to
note here that the brujas in Lupe’s story were a specific type of
curandero—one that dabbles in spells and often in black magic. Lupe
finished her story by telling me that the brujas asked her for a photo
of her and her husband (then her boyfriend) because “they wanted to
use it to discover any spells that might be on the couple”. Lupe was
afraid of them so she let them have the photo. When she told her
boyfriend what had happened, he too was upset and said, “They can
use the picture to hurt us! So I asked Lupe: “Do you believe
curanderos and brujas, like the ones in your story, can cure or
prevent illness and disease?”
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A part of me believes no. But those brujas really scared
me so…I don’t know. I think that for less serious
illnesses these people can be helpful, but people should
go to the doctor for serious problems. It is the same
thing with herbals even though for me, using the
herbals is comforting because they remind me of my
culture.

Lupe certainly demonstrated a fairly strong belief and practice of
traditional medicine and I wondered about the source of this. I asked
her if she, or members of her family, had a stronger faith in
traditional medicine than in conventional medicine. Her response
was a bit surprising and led to an important discussion about
doctors and health care in Mexico:
No, I won’t say any of us have more faith in traditional
medicine. It’s that we are more comfortable in our
culture. I tell you, I think for a long time my mom had
more faith in the doctors in Mexico. Even when she was
living here, she had an issue with her periods, her
menstrual cycle, was always really bad. She got really
sick. My Dad would take her to the doctors here and my
Mom would always say, ‘No, los doctores no valen para
nada (the doctors are good for nothing). Mejor que me
llevan a Tijuana (better that you take me to Tijuana)’. You
know “Take me to TJ”. Her sister, my Aunt at the time
said “You know I know of a good doctor” and she took
her. And right away they found what the problem was, so
my Mom I guess she always had more faith in the
doctors in Mexico rather than here. I don’t know if maybe
she felt uncomfortable seeing American doctors here,
someone that didn’t speak Spanish. And maybe that’s a
part. I don’t know maybe tradition. Since then, my
parents go see Dr. Garcia in TJ…he’s their doctor now.

I probed, “Why do you think your mom would rather go to Mexico
and why does she feel that way about American doctors?

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My mom, you know, she speaks Spanish. She doesn’t
speak English. She probably couldn’t let them know
what was going on and let them know, you know. With
doctors you have to be real clear and you have to push it
and tell them ‘I’m feeling this. You gave me this already,
it didn’t work. Let’s take this to another step, you know. I
think my mom probably had that problem. She got sick
of it and went, you know I’m going to see doctor in
Tijuana where I can be comfortable and he can
understand me.

I asked Lupe, “Would you ever consider going to Tijuana for health
care?”

I went once when my husband, he transferred
companies…no…he got laid off. He got laid off and then
he started working for this new company and in that
break we didn’t have insurance. I ended up having my
wisdom tooth removed in Tijuana because we didn’t have
insurance. I was in so much pain and my mom, you
know, told me, ‘I know of a good dentist, go and have
them take it out’. And I went. I was a little scared a first,
because I thought you know, is it clean, sanitized? The
doctor was nice, neat, clean, you know. He had his
certificate up on the wall. So I kind of felt like okay, this
is okay. They numbed it up and yanked it out.

At this point in the interview it was very clear that Lupe had
significant first-hand experiences with many health care alternatives.
In an effort to better understand a more accurate picture of her
health care orientation I asked her:
Q: Lupe, you seem to be willing to try many
alternatives to health care, especially those related
to Mexican culture. Do you lean more toward
using conventional medicine, traditional medicine
or a combination of both?

LV: Mostly I go to regular doctors more. As I told you I
am a trained nursing assistant and I know that
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medicine is good. But Mexican medicine is good
too for lots of things. Mostly to prevent getting
sick. And I know now that going to Mexico to the
doctors there is not bad. I am thinking of going to
the dentist in Tijuana again.

I probed, “Why?”

I have dental insurance, but the dentist that I went to [in
Mexico] last time charged me only $25 dollars to remove
wisdom teeth. And everyone I’ve heard that’s gotten
them removed here its expensive. I think its $300 dollars
a tooth, with insurance. And even though it’s a PPO
plan, they say it covers all of it. Then they mailed me a
list of prices for procedures. Every little thing they
charged for.

I continued with more questions about trips to Mexico, “Have you
gone to Tijuana to get prescription stuff or to get herbs?” She replied:
My knees were hurting and my mother-in-law told me
that there was this pomada, an ointment. I was telling
her my knees were still hurting me and I’m probably
going to be like my Mom and blah, blah, blah. And she
said, ‘Oh I have this pomada. Pongela and se quita dolor
(put it on and it the pain goes away).’ Its just temporary,
but its an actual prescription. I tried it and it worked.
And then my father-in-law went to Tijuana and brought
me back a little tube of it. Yeah, I was like, ‘That
pomada was really good, bring me a tube’.

Lupe’s story illustrates an almost perfect blending of the
alternatives available to Mexican Americans in their health care
seeking. She places a strong value on conventional medicine and is
herself trained as a healthcare worker, but she also has a very close-
knit family with strong traditional roots so she is very comfortable
using traditional healthcare practitioners and remedies. Finally, she
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is very accepting of trips to Mexico for health care and medicine and
has done so herself and is considering doing it again.
Carlos Perez: A Return to the Traditional

Carlos Perez is 20 years old, native born, and single without
children. Carlos tells a story of a lifetime without health insurance
and the struggles he and his family have experienced in accessing
healthcare. He reports that his family has utilized storefront clinics
almost exclusively for as long as he can remember. He describes how
his family has always had to pay cash for their healthcare. His story
concerning the removal of a cyst from his chin in which the doctor at
the storefront clinic wanted $5,000 for the procedures and other tests
is documented in Chapter 6.
What is important about Carlos’ story is that he and his family
now have health insurance, but because he has experienced so much
difficulty in the past accessing health care, his mindset is that
conventional medicine is not that effective, and costs too much
money. He reports that he has come to have more faith in traditional
medicine and now has a strong desire to learn more about it and use
it exclusively for his own healthcare. The following are excerpts from
my interview with Carlos.
Q: What’s your overall experience with doctors? Have
you been treated pretty well? Do they take the
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time to find out what’s going on with you or do
they rush you through? What do they do?

CP: I think they take their time to see what’s wrong
with me. But after I feel like instead of letting me
know what I really have they want to give me
medication already, they want to give me pills and
all this stuff. When they don’t really know what’s
going on. They say, oh we think it’s this, but we
are going to give you a prescription to see if it goes
away. If it doesn’t then you come back and we’ll
figure it out.

Q: What do you think about that? What’s going on
there?

CP: I think it’s wrong…because honestly I’m more…I
believe in herbs. Natural remedies.

Q: Oh, you do?

CP: I don’t really like taking prescription drugs. I don’t
believe we should take a drug when I believe
someone could be cured through a herb or
something.

Q: Why do you believe in herbs and other medicines?

CP: I think it’s from my family legacy. From my dad’s
side, my grandma was a sobadora. And she used
to cure caida de mollera. When a child’s, you
know, soft spot, like if it fell (fallen fontanel). She
would push it up, I guess.

Q: How would she do that?

CP: I guess she would put her finger in there and prop
it. And then, she could do, she could also undo un
bachado (unknown word). Like she would rub
somebody and she would pull the spine and pop
it.

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Q: Kind of like a chiropractor?

CP: Kind of. She could fix anything pretty much. But
if it was a broken bone she would say, ‘go see a
doctor and she wouldn’t touch it.’ But if they
were feeling pain or sickness she would massage
them and everything. I guess she would use herbs
like ruda and yerba buena.

Q: Where did she practice being a sobadora?

CP: I guess out of her house. Because I don’t really
know because when I was born she already
passed away…one time I watching this movie of
my family and you see this lady doing that whole,
I guess its praying over the baby, and then my
sister goes, “oh grandma used to do that.’ And
when she said that it kind of like sparked my
interest. I got really interested in learning about
that. I asked my mom and she told me all these
things about my grandma. And her dad was born
in Mexico and had a cure for everything, pretty
much. He knew what trees to use, what leaves to
use for any sickness.

Q: Who is that?

CP: My mom’s dad. One time he was in his 80’s and
they told him he could get diabetes, you know.
Watch your health. He took cactus, he started
eating cactus and drinking the juice. And he went
back later and they said oh like it’s gone. You
don’t have diabetes anymore. He always said that
there was cure for everything. He didn’t really
trust doctors and used his own home remedies.

Q: A lot of people in your family believed in
traditional medicine. And when you became aware
of that you became interested in it. How long ago
was that?

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CP: Maybe I was 11 or 12.

Q: Do you ever go to botanicas to get herbs?

CP: Yeah the one up the street from here.

Q: Did you buy anything or just go and look?

CP: I bought stuff. Because actually I wrote a paper
about curanderismo. So, I did a presentation to
the class and I had to show visual aides. I bought
some herbs that I could use for my presentation.
Q: What did you think of that place?

CP: I think it was pretty interesting…like the guy that
was there. He seemed very friendly and very
knowledgeable of the herbs and everything. I was
thinking that if I go back for future reference I
would be able to go to him and ask him specific
things and he could help me out in getting herbs.

Q: Is he a curandero?

CP: I don’t know if I asked him. I don’t know. I’m
pretty sure.

Q: You think that your interest in traditional
medicine is more because you don’t have health
insurance and health care is expensive? Or is it
more about your heritage?

CP: Yes [heritage]. Even with health insurance I still
believe in herbal remedies instead. I mean, I’m
pretty sure that a lot of Mexicans that don’t have
health insurance go to botanicas because they
don’t have health insurance. But, I think its part
of our culture. It’s a part of our culture because
back then you had to know what to use for
illnesses. So in a way we might go to the doctors
but we have our home remedies. I think most of
its part of culture, but it could be because we
don’t have health insurance.
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Q: And you know about curanderismo?

CP: Yes, I believe in curanderismo. When I talk to
people about it, even Mexican people, they go, ‘oh
isn’t that witchcraft?’ And I was like, ‘no I think it
is very spiritual because they pray.’ And I’m
pretty sure that if its involves witchcraft they are
not curanderos. I’ve never been to one, but I
guess I have belief in them.

Q: So, if you knew of a curandero that had a good
reputation would you go that person [for
treatment]?

CP: Yes, definitely.

In addition to his growing interest and commitment to traditional
medicine, Carlos expressed a strong belief in susto and mal ojo as
real causes of disease and illness. He gave an example of how his
mother was once cursed by an unknown person, and he provided a
very accurate common definition of mal ojo as the inappropriate
admiration of a baby that could cause the baby harm. There is no
way to know if Carlos’ movement toward the traditional will continue
as he matures, but he has the family background and history to
make it a possibility, along with negative experiences with the
conventional medical system (both in term of lack of resources and
cultural competency in services) to bolster his chances of doing so.
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Chapter Summary
This chapter presented five case studies that can be viewed as
examples of the various choice sets that immigrant and native-born
Mexican Americans may incorporate into their healthcare seeking
behavior. Perla Moreno is representative of someone who is
committed to utilizing conventional medicine exclusively; Frances
Morales is a good example of someone who values conventional
medicine but turns to alternatives such as making trips to Mexico for
doctors visits and prescription drugs because they are more
affordable; Lupe Valdez represents someone who moves across the
alternatives frequently and with fluidity and sees value in all the
alternatives; and Carlos Perez is a young man who because of a
family history of traditional medicine use and negative experiences
with the conventional healthcare system is gravitating toward using
traditional medicine exclusively.
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CHAPTER 8: SUMMARY AND DISCUSSION
Summary of Findings
One of the main purposes of this study qualitative study was to
illuminate the degree to which immigrant and native-born Mexican
Americans in Santa Ana, California maintained the value and utility
of traditional medicine modalities within a framework of medical
pluralistic practices. As is the case with qualitative studies and field
observations, the goal here was to obtain internal validity in the
observations of the study population (Denzin and Lincoln 1998)
rather than to make generalizations to a larger population. Overall, a
significant outcome of this research is the accumulation of a large
body of rich and detailed data which have been utilized to tell the
stories of respondents in the City of Santa Ana. The study was
guided by four important related questions.
The first question, “Does the use of traditional medicine persist
among long-term Mexican American immigrants and native-born
Mexican Americans?” The interview data from my sample indicate
that the use of traditional medicine does persist. Relatively high
percentages of both groups reported having used or indicated that
they would use: home remedies (68.8% of immigrants versus 47.1%
of the native born); a curandero or curandera (62.5% of immigrants
versus 41.2% of the native-born); praying for good health or for a
164
health cure (50% of immigrants versus 70.6% of the native born); and
botanicas (18.8% of immigrants versus 35.3% for the native born).
Chapter 6 of this report provided many examples of
respondents who regularly used home remedies or herbals, like
Felipe Sanchez who reported that he often used them to treat
headaches, stomachaches, or minor illnesses or injuries that he
could cure himself. More significantly several respondents such as
Silvia Camacho (immigrant), Berto Rosales (young native born),
Carlos Perez (young native born), and Marie Madrid (native born)
expressed trust in curanderos and their willingness to utilize their
services.
Question two asked: “What patterns of pluralistic medical
health care seeking behaviors do native-born Mexican Americans and
long-term Mexican immigrants utilize and to what extent are these
patterns based upon the use of traditional medicine, alternative
medicine, or some other practices, e.g., seeking health care in
Mexico?” What emerged from the data is the fact that respondents in
my sample were almost all inclined to utilize some mix of
conventional medicine and, at the very least, partial use of the
alternatives. In some cases, those that preferred conventional
medicine but lack resources, utilized the services of storefront clinics,
or, in the case of Frances Morales (case study) who made extensive
165
use of trips to Mexico to get modern medical care and prescription
drugs. Finally, respondents in this study reported the widespread
use of herbal home remedies and teas.
Another level of data provided an answer to this question is
represented by case study Lupe Valdez (native born) from Chapter 7.
Lupe made extensive use of conventional medicine, trips to Mexico,
use of herbals and teas, and use of curanderos. She, and members of
her family, were able to easily move back and forth among the
alternatives with fluidity according to their needs and circumstances.
Although Lupe’s story was an ideal example of this practice, several
other respondents in my sample had similar experiences. There were
only a few individuals who expressed healthcare seeking behavior at
the extremes; i.e., exclusive utilization of conventional medicine or
exclusive utilization of traditional medicine, and every respondent
reported having utilized conventional medicine to some degree. As
illustrated in Chapter 6, many expressed using a combination of
alternatives in a depending on their individual needs and
circumstances. Michael Quintero and his wife, Hope, were very
willing to use the services of a curandera hoping for a fertility cure,
although Michael expressed a greater faith in conventional medicine.
Lupe Contreras reported that her family used conventional medicine
for serious illnesses but took teas and herbs to help cure minor
166
illness and as preventative measures. They, like Lupe Valdez, moved
across the alternatives with ease.
Question 3 asked, “Overall how do both groups regard
traditional medicine? That is, when are healthcare seeking behaviors
matters of choice or preference versus a survival adaptation to
blocked access to mainstream care?
There were several respondents whose stories provided
interesting answers to this question. Case studies Perla Moreno
(immigrant) and Carlos Perez (young native born) each had unique
and somewhat opposite experiences. At one time Perla and her
husband were undocumented immigrants with no health insurance.
Although their native born children were eligible for Medi-Cal she
chose not to apply for coverage for them for fear of discovery of her
and her husband’s immigration status. Perla, a firm believer in the
efficacy of conventional medicine, never turned to any alternatives
regardless of her family’s lack of health insurance or economic
status. When her children needed healthcare, she took them to free
or low cost clinics. Fortunately, Perla and her husband have
obtained legal papers and now both have jobs that provide healthcare
benefits to the family.
Carlos Perez’s family also did not have health insurance most
of his life and when anyone in the family needed healthcare, they
167
usually went to a storefront clinic and paid cash for treatment of
their most serious illnesses. Because Carlos feels that the
conventional medical system failed him and his family, and also
because his family has some history of strong attachment to
traditional medicine, Carlos emphatically stated that he intends to
primarily utilize traditional medicine and forgo conventional medical
treatment as much as possible even though he is now fully insured
by an HMO. To a large extent, Carlos’ early life experiences with the
storefront clinics and his family’s inability to get good access to
adequate healthcare have alienated him from conventional medicine.
So Perla and Carlos have both made somewhat unusual but
rational decisions about their healthcare preferences. More typical
experiences among the study respondents, more often than not,
illustrated that they do not automatically and blindly respond to
structural factors or cultural influences in their healthcare seeking
behavior. For example, some chose to make trips to Mexico because
they believed that they could obtain better, holistic health care from
the doctors there and more powerful prescription drugs without
having to obtain a doctor’s order.
Finally, Question 4 asked, “What important system barriers to
obtaining quality health care are perceived by the study population
168
and what mechanisms do they employ to mitigate them?”
Respondents in this study identified the following barriers to
healthcare through the interviews: lack of money, lack of insurance,
long waits for treatment, perceived discrimination, being treated
badly by medical and support staff, poor quality of care and language
difficulties. In my sample, immigrants were far more likely to identify
these barriers than were the native born. Responses to these barriers
included the use of storefront clinics, trips to Mexico for medical care,
prescription drugs and herbals, use of home remedies and herbals,
use of botanicas, prayer for health and cures, and use of curanderos.
In comparison to recent immigrants studied by Ransford and
Carrillo (2006) in Los Angeles, who experienced pervasive and
powerful systemic barriers, the respondents in this study seemed to
experience more individual discrimination with a lessened negative
systemic impact. Two possible explanations are presented. First,
Orange County may be better than Los Angeles County at providing
health care access to Mexican Americans because it is a much
smaller county with a more manageable public health care system.
Second, many of the respondents in the Ransford and Carrillo study
were recent immigrants most of whom had little resources and lacked
health insurance. As new immigrants, they would be less familiar
with the healthcare system and less equipped to navigate it to obtain
169
the services they needed. On the other hand, the respondents in this
study were either long-term immigrants (some with steady jobs and
health insurance), or native born Mexican Americans with working
class wages and most covered by health insurance.
Overall, the data from my sample indicate that, at least for my
sample respondents, there is a definite persistence in maintaining a
value and utilization of traditional medicine. Other studies have
similar findings. For example, Lopez (2005) found a strong
persistence of belief and practice of traditional folk medicine among a
convenience sample of 70 Mexican American female students in a
Southern California social work program. Seventy-seven percent of
her sample was native born and the balance of the sample was born
in Mexico. Much like the results in this study, Lopez’s respondents
reported trips to Mexico for health care, use of herbal remedies, and
the use of curandero services.
The Social Action Paradigm Revisited
This study breaks new ground in the examination of the
persistence of traditional medicine within the Mexican American
population by overlaying the Social Action Paradigm over a model of
medical pluralism that describes the behaviors and practices of
individuals in the study sample. For some time now, the concepts of
the dual health care perspective and of medical pluralism have been
170
applied to describe the healthcare seeking behavior of Mexican
Americans and other Latino groups. The work of Belliard and
Ramirez-Johnson (2005) specifically uses the concept of medical
pluralism to describe the behavior of a single case (a Mexican woman
who is described as using an array of medical options including
conventional and traditional medicine). However, the weakness of
the study is that it describes the behavior or a single case without
adequately explaining the behavior. The strength of the study is the
articulation of an elegant medical pluralism model.
Lopez (2005), using a convenience sample of 70 Mexican female
students at a Southern California state university found the
persistence of the use of traditional medicine and use of other
alternatives such as trips to Mexico. However, her work is based
upon a dual healthcare perspective that compares conventional
medicine versus traditional medicine as its primary focus. Although
her findings regarding the array of alternatives to conventional
medicine were similar to those in this study, she failed to articulate
the behavior as medical pluralism or to fully explain it. As in the
Belliard and Ramirez-Johnson study, her findings were mainly
descriptive.
What the Social Action Paradigm and medical pluralistic
models provide is a means to adequately explain that healthcare
171
seeking of Mexican Americans is not driven by the forces of social
structure and culture alone and that healthcare seekers utilize
agency in their healthcare decisions. To specifically illustrate this I
am presenting Graph 3.0 from Chapter 3 here again in this
discussion.
Figure 3.0: An Illustration of the Mexican American Healthcare
Seeker in Interactive Agency.

FAMILY AVAILABILITY
RESOURCES COMMUNITY OF
INFLUENCE ALTERNATIVES

THE HEALTHCARE
SEEKER AS AGENT

BELIEF OR WILLINGNESS BELIEF OR
PREFERENCE TO MOVE PREFERENCE
FOR ACROSS THE FOR
CONVENTIONAL ALTERNATIVES TRADITIONAL
MEDICINE MEDICINE

In Chapter 3, I identified resources (or a lack of resources),
family and community influences, availability of alternatives, beliefs
systems or healthcare preferences, and a willingness to move across
the alternatives as the criteria I utilized in making decisions about
whether or not agency was present. From my case studies, I believe
that the stories of Perla Moreno, Lupe Valdez, and Carlos Perez all
illustrate agency.
Perla Moreno, an immigrant from Mexicali, Mexico, was raised
in an area where traditional medicine was widely practiced. She lived
in a Santa Ana neighborhood in which some of her friends and
172
relatives practiced traditional medicine and where many botanicas
were located. More importantly, she and her family lacked health
insurance and money for conventional medical care for many years.
Still, Perla consistently preferred conventional medicine and refused
to ever use any traditional medicine modalities for herself and her
family. If she could not afford the services of a doctor or a clinic, her
family simply went without treatment. She was steadfast in this
belief and practice.
Lupe Valdez, a native-born Mexican American utilized a variety
of healthcare modalities, both conventional and traditional, without
bias or prejudice. Raised in a family that was open to traditional
medicine but which mostly utilized conventional medicine, Lupe
valued both equally (even though she was a certified medical office
technician). She was very comfortable using conventional medicine,
home and herbal remedies, and, although she expressed some fear
and distrust of brujos or brujas, she was also open to using the
services of curanderos. Moreover, it was clear from her interview
responses that she was fully aware of the choices she made and that
the choices were made based on her knowledge of the alternatives
available to her.
Finally, Carlos Perez, a young native-born Mexican American
reported a strong desire to move toward an exclusive use of
173
traditional medicine because he believes that it is more effective and
natural, and that he identifies with it more as a Mexican American.
For most of his life, Carlos and his parents utilized conventional
medicine primarily visiting storefront clinics in Santa Ana in which
he and his family had many negative experiences. In earlier years, he
and his family were not covered by health insurance but Carlos had
recently obtained coverage through his employment. He also
reported having relatives in Mexico who were practitioners of
traditional medicine (an uncle that was a sanador and a grandmother
that was a sobadora). Although Carlos was definitely influenced by
his negative experiences with conventional medicine and by a family
history of traditional medicine practices, he was fully aware of the
alternatives available. At the time of the interview, Carlos was certain
that he would continue to use traditional medicine as his primary
source of care even given that he had insurance coverage.
Study Limitations
My study was limited to respondents from the city of Santa
Ana. That city’s population is predominantly Hispanic with more
than 75 percent of all households reporting Spanish as the primary
language spoken at home. Santa Ana also presented an opportunity
to study the Mexican American population in an environment which
is heavily influenced by Mexican and Mexican American culture, and
174
which has an abundance of businesses, including botanicas and
store-front medical clinics that cater primarily to Mexican-Americans
and other Latinos in that City.
Another limitation of the study was the small sample size of 33
respondents who were selected using nonrandom sampling methods.
However, it was not the intent of this study to produce data and
results that could be generalized to larger Mexican American
populations, but simply to collect detailed and rich qualitative data
related to the research objectives. Moreover, as is often the case
with qualitative studies such as this one, its limitations are also it
strengths because the study was able to capture detailed narratives
from the respondents. These data were important in the development
of the Social Action Paradigm and in piecing together the complex
puzzle of Mexican American healthcare seeking within a medical
pluralism perspective in the city of Santa Ana.
Conclusions
The analysis of the narrative data was guided by the four
research questions presented in this study in chapter 1. Therefore
the major conclusions of this study also relate back to these
questions.
First, there was significant evidence that the use of traditional
medicine does persist among long-term and native-born Mexican
175
Americans in my study. As previously reported, only five of the 33
respondents reported exclusive use of conventional medicine with
absolutely no value placed on traditional medicine or alternatives.
Although immigrants more often reported using traditional medicine,
particularly herbal home remedies, many of the native-born reported
doing so as well. It is also significant, that Lupe Valdez, who reported
moving across the alternatives with frequency and ease, and Carlos
Perez, who reported that his intent is to move away from conventional
medicine to utilize traditional medicine more completely, were both
native-born respondents.
Second, respondents in my sample demonstrated great
resiliency in their healthcare seeking and practiced medical pluralism
by using many combinations of the alternatives available to them
serially or simultaneously. For example, Frances Morales who
adapted to using trips to Mexico for her health care seeking
conventional treatments; Maribel Mendoza who also went to Mexico
for conventional health care but incorporated using traditional herbal
remedies and visits to curanderos in her trips; and Michael Quintero
and his wife Hope, who visited Mexico for health care and utilized the
services of a curandera because of Hope’s fertility problems. Many
respondents, both immigrant and native-born, had similar stories of
using more than one of the alternatives with regularity.
176
Third, in general, there was evidence that many of the
respondents, both immigrant and native-born, held traditional
medicine in high regard and chose it over conventional medicine not
in response to survival issues but out of a higher value and belief in
its effectiveness to treat illnesses and produce cures. Teresa
Palacios, a native-born young woman, was representative of this
group and expressed that she had much more confidence and belief
that traditional medicine was better than conventional medicine,
citing that was familiar and from the community—a sentiment
echoed by Lupe Valdez when she stated that using traditional
medicine gave her comfort because, “…it is from my culture.”
Finally, many system barriers were identified by respondents
and included a lack of health insurance (mostly respondents from the
immigrant group), a lack of money, long waits for treatment poor
quality of care, language problems, and discrimination. As expected,
a lack of health insurance was a major barrier as illustrated by Rosa
Leon’s (immigrant) situation in which she and her family have never
had health insurance. She and her family frequently postponed
getting medical care when they needed it and often, if a illness
became serious, they used storefront clinics, or worse, emergency
room services. She also reported problems communication with her
doctor because she was not fluent in English. When asked about
177
possible discrimination, Lupe Contreras (immigrant) stated that, yes,
she had experienced discrimination but not because of her status as
a Mexican immigrant. She felt that the discrimination was a result of
the fact that she did not have health insurance.
Part of the last question concerned what the study population
did to mitigate the barriers. What emerged from the data were
reports of utilization of the alternatives, i.e., using storefront clinics,
trips to Mexico, use of home remedies, praying for good health and
cures, shopping at botanicas, and visiting curanderos. However, it is
important to stress here that many of the respondents did not turn to
these alternatives out of desperation or for sheer survival (in reaction
to the barriers) but did so with forethought and apparent agency as
in the cases of Perla Moreno, Lupe Valdez, Carlos Perez, and Vincente
Rodriguez. It was quite evident in this study that respondents were
not merely mindless automatons responding to outside forces
compelling them to certain behaviors, but, rather, often made choices
that would not be expected given their circumstances because they
preferred certain alternatives. There is no question that social
structure and culture influenced these choices but they did not
directly create or constrain behavior. As the Social Action Model
proposes, the interaction of social structure and culture provided
178
them with a tool kit that they utilized to make real choices about
their healthcare seeking behavior.
Significance and Implications of this Research
There are three areas that I believe make this research
particularly significant. First, the results of this study have
implications in the areas of the delivery of health services to Mexican
Americans and Latinos in general and the provision of health
education programs to healthcare providers. There is little doubt
that many of the healthcare providers do not meet the standards of
cultural competency that requires much more than just
understanding and communicating in Spanish when treating
patients. (Huff and Kline 1999) Providers need to be educated in the
most important health needs of the Mexican American population
(Green) and the nuances of Mexican American culture as they apply
to healthcare delivery now and in the future. (Aguirre-Molina et al.
2001) Too often, non-successful contacts between health providers
and Mexican American patients are explained superficially by doctors
as a case of non-assimilation or poor compliance to doctor’s orders.
Pre-med student need to be presented with Latino centric models
such as the Social Action Paradigm presented in this dissertation,
models that describe the spaces, tool kits, and social agency involved
in Latino healthcare seeking. (Carrillo et al. 2001)
179
Second the recent inclusion of the concept of medical pluralism
into the study of Mexican American healthcare seeking behavior
represents a much needed move away from studying this behavior
from a conventional medicine versus traditional medicine perspective.
However, this represents only a first step and more studies are
needed in order to begin to develop theoretical work that will help us
to better understand this issue. At best, even recent studies based
upon medical pluralistic conceptual models produce only descriptive
work, thus, more explanatory models are needed.
This study has made a major contribution to the knowledge
base of Mexican American healthcare seeking through the
development of the Social Action Paradigm. For example, Hayes-
Bautista (2004) is critical of the research conducted by social and
medical sciences regarding Latino healthcare. He argues that the
research community has focused on the dysfunctional minority
model in which Mexican American and other Latino health issues are
studied. He points to the existence of the Latino Health Paradox as
evidence that this model is not appropriate for Mexican Americans
and Latinos in general, at least not in the state of California. The
Social Action Paradigm represents a significant research and study
alternative to the dysfunctional minority model, the dual health care
perspective model, or other models that blame the “inadequate
180
assimilation” of Mexican Americans for their health and healthcare
problems.
Finally, it is quite clear that this is only a beginning and one
that certainly does not address the issue completely. Therefore, if I
believe that more research efforts and studies would go far to mitigate
the limited theoretical work now available to study the issue of
Mexican American healthcare seeking adequately particularly if they
employ models that deviate from the standard.
More comprehensive surveys of Mexican American health and
health issues need to be completed. These surveys should not
include Mexican Americans as a subpopulation but should be
focused on the Mexican American (or Latino population) exclusively.
Survey questions regarding health insurance status, SES, degrees of
assimilation and acculturation, and specific questions regarding the
use of various health care alternatives, both conventional and
traditional, should be asked to provide quality data from which
broad-based datasets can be created and can be utilized in the study
of Mexican American healthcare seeking more broadly.
More qualitative studies, or studies that combine qualitative
and quantitative research methods, should be conducted to provide
more detailed data regarding Mexican American healthcare seeking
(Cresswell 1998; and Denzin and Lincoln 1998). These studies can
181
be based on ethnographic methods, involve comprehensive
observations or be based on intensive interviews as is this study.
Data collected in qualitative studies often contribute to a better
understanding of the study issue and to theoretical development
because of the detailed information gathered on populations of
interest.
182
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APPENDICES

Appendix A: Spanish Interview Guide

Frank R. Carrillo, Estudio de Disertación:
El Uso mexicano americano de Medica Tradicional y Alternativa
Guía de Entrevista

1. ¿Qué es su edad?

2. ¿Dónde nacio usted?

3. ¿Si nacio en los EE.UU., qué generación es usted?

4. ¿Si no nacio en los EE.UU., en qué edad vino usted a los EE.UU.?

5. ¿Qué idioma habla usted principalmente?

6. ¿Esta casado(a) usted?

7. ¿Qué es su ocupación y qué es la ocupación de su esposa(o)?

8. ¿Cuántas personas en su familia o en la casa?

9. ¿Cuántos de estas personas son niños?

10. ¿Qué es sus ingresos totales antes de impuestos?

11. ¿Cuál importante es la oración en su vida cotidiana, especialmente con
respecto a su salud?

12. ¿Que hace cuando usted o una persona in su familia se enferma? A donde va
para obtenar ayuda medica?

13. ¿Qué le preocupa el la mayoría acerca de obtener asistencia médica adecuada
para usted y para su familia?

14. ¿Tiene usted seguro médico? ¿Es completo o sólo parcial?

15. ¿Habla usted inglés bastante bien para obtener el cuidado médico adecuado
para su familia? Si no: ¿Cuánto de no hablando inglés le previene de obtener
el cuidado que usted necesita?

192
16. ¿Generalmente, cuando usted está enfermo, se toma tiempo libre usted del
trabajo para buscar el tratamiento médico?

17. ¿Generalmente, es usted cómodo en cualquier interacción que usted tiene con
el personal médico tal como médicos o enfermeros? ¿Si no, qué son algunos
de su conciernes cuando usted trata con estas personas?

18. ¿Ha aplazado jamás usted el cuidado médico que obtiene cuando usted o un
miembro de usted la familia lo necesitó? ¿Si eso es el caso, qué era las
razones para aplazarlo?

19. ¿Ha ido jamás usted a México o a su patria para el cuidado médico o para
fármacos y remedios de hierbas? ¿Si eso es el caso, por qué?

20. ¿Utiliza usted remedios de casa (de hierbas o una medicina familiar) para
alguna enfermedad? ¿Si eso es el caso, dígame por favor acerca de algunos
de éstos? ¿Obtiene usted estos remedios de casa de la familia, de un amigo, o
de un curador?

21. ¿Si usted supo de un curandero con una reputación excelente, utilizaría usted
sus servicios para tratar, curar o prevenir la enfermedad? ¿Si eso es el caso,
ha utilizado usted a tal curandero? ¿Con qué frecuencia?
193
APPENDIX B: English Interview Guide

Frank R. Carrillo, Dissertation Study: Mexican-American Use of Traditional and
Alternative Medicine Interview Guide

1. What is your age?

2. Where were you born (country/state/city)?

3. If born in the U.S., what generation are you?

4. If not born in the U.S., at what age did you come to the U.S.?

5. What language do you speak primarily?

6. Are you married?

7. What is your occupation and what is the occupation of your spouse?

8. How many persons in your family or household?

9. How many of these persons are children?

10. What is your total income before taxes?

11. How important is prayer in your everyday life, particularly regarding your
health?

12. When you, or a member of you family, gets sick, what do you do? For
example, where do you go to get health care?

13. What worries you the most about getting adequate health care for you and
your family?

14. Do you currently have health insurance? Is it complete coverage or only
partial?

15. Do you speak English well enough to get adequate medical care for your
family? If not: How much doe not speaking English prevent you from
getting the care you need?

16. Generally, when you are ill, do you take time off of work to seek medical
treatment?
194

17. Generally, are you comfortable in any interactions that you have with
medical personnel such as doctors or nurses? If not, what are some of your
concerns when you deal with these people?

18. Have you ever postponed getting medical care when you or a member of you
family needed it? If so, what were the reasons for postponing it?

19. Have you ever gone to Mexico or back to your home country for medical
care or for prescription drugs and herbal remedies? If so, why?

20. Do you use home remedies (herbal or a family medicine) for any illnesses?
If so, can you tell me about some of these? Do you get these home remedies
from family, a friend, or a healer?

21. If you knew of a healer with an excellent reputation, would you use his/her
services to treat, cure or prevent illness and disease? If so, have you used
such a healer? How often?
195
APPENDIX C: SPANISH INFORMED CONSENT

La universidad de California Meridional
Departamento de Sociología

La HOJA de la INFORMACION PARA la INVESTIGACION NO-MEDICO

El uso de la medicina tradicional y alternativa entre mexicano-Americanos de bajo-ingresos
en Santa Ana

Pidamos que usted toma parte en un estudio de investigación de disertación realizado por
Frank R. Carrillo, M.A. y H. Edward Ransford, Ph.D., del Departamento de la Sociología en
la Universidad de California Meridional. Usted fue escogido como un participante potencial
en este estudio porque usted es representante de la comunidad mexicano Americano en Santa
Ana, California. Un suma de 40 sujetos se escogerá de mexicano Americanos e inmigrantees
de nacimiento del origen mexicano con 10 o más años de la residencia para participar. Su
participación es voluntaria.

El PROPOSITO DEL ESTUDIO
Pidamos que usted tome la parte en un estudio de investigación porque tratamos de aprender
más acerca del acceso de asistencia médica y asistencia médica que buscan la conducta de
mexicano Americanos con y sin seguro de enfermedad. La participación en la entrevista y la
respuesta a las preguntas de la entrevista constituirá el consentimiento para tomar parte en
este proyecto de investigación.

Los PROCEDIMIENTOS
Usted será pedido tomar parte en una entrevista de aproximadamente una hora o de una hora
y media. Usted será preguntado un número mínimo de preguntas de fondo. La mayoría de las
preguntas estarán acerca de sus experiencias en el acceso de asistencia médica, las barreras
potenciales que usted ha encontrado a buscar asistencia médica, y a lo que usted hace cuando
usted encuentra dificultades a obtener adecuado, asistencia médica de calidad.

El POTENCIAL se ARRIESGA Y MOLESTA
No hay los riesgos anticipados a su participación; usted no debe experimentar ninguna
molestia por siendo entrevistado pero usted puede ser molestado de tomar el intermedio de
su día para participar. Cualquiera pregunta preguntado durante la entrevista que hace usted
incómodo se saltará en su pedido.

El POTENCIAL BENEFICIA A SUJETOS Y/O A la SOCIEDAD
Usted no puede beneficiar directamente de su participación en este estudio de investigación,
pero su participación puede proporcionar información valiosa que puede beneficiar a la
comunidad mexicano Americano más grande con respecto al acceso importante de asistencia
médica y asuntos de calidad que mexicano Americanos ahora experimentan.

La PAGO/COMPENSACION PARA la PARTICIPACION
Usted no recibirá ningún pago para su participación en este estudio de investigación.

196
La CONFIDENCIALIDAD
No habrá información obtenida con respecto a este estudio y eso se puede identificar con
usted. Su nombre, la dirección u otra información que pueden identificar usted no se
reunirán durante este estudio de investigación. Aunque las entrevistas se grabadas y serán
transcritas, usted será dado un nombre de falsificación (seudónimo) y su identidad verdadera
no se revelará en tiempo. Usted tiene el derecho de revisar y redactar su entrevista y
transcripción grabadas si usted tan desea. Sólo miembros del equipo de investigación, FranK
R. Carrillo y H. Edward Ransford, tendrán acceso a los datos asociados con este estudio. Los
datos se almacenarán en la oficina de investigador en una contraseña cerrada de archivador
protegió la computadora. Los datos se almacenarán durante tres años después que el estudio
se ha completado y entonces ha sido destruido. Cuándo los resultados de la investigación se
publican o son discutidos en conferencias, no habrá información que se incluirá eso puede
revelar su identidad desde que ningunas identificaciones se reúnen de usted.

La PARTICIPACION Y la RETIRADA
Usted puede escoger si estar en este estudio o no. Si usted se ofrece a estar en este estudio,
usted puede retirar en tiempo sin consecuencias de cualquier tipo. Usted puede negarse
también contestar que cualquiera le pregunta no quiere contestar y quedarse todavía en el
estudio. El investigador le puede retirar de esta investigación si las circunstancias surgen
cuál autorización que haciendo así.

Los DERECHOS DE los SUJETOS de INVESTIGACION
Usted puede retirar su consentimiento en tiempo y discontinuar la participación sin pena.
Usted no renuncia ningún reclamo legal, los derechos ni los remedios a causa de su
participación en este estudio de investigación. Si usted tiene las preguntas con respecto a sus
derechos como un sujeto de investigación, contacta el Parque de la Universidad IRB, la
Oficina del Alcalde del Vicio para el Adelantamiento de Investigación, el Vestíbulo de la
Gracia Ford Salvatori, el Espacio 306, Los Angeles, CA 90089-1695, (213) 821-5272 o
upirb@usc.edu.

IDENTIFICACION DE INVESTIGADORES
Si usted tiene cualquiera pregunta o concierne acerca de la investigación, se siente por favor
libre contactar Frank R. Carrillo, M.A. o H. Edward Ransford, Ph.D. en la Universidad de
California Meridional, el Departamento de la Sociología, 3620 Avenida de Vermont, el
Vestíbulo de Kaprielian 352, Los Angeles, CA 90089-2539 o nos contacta por teléfono en
(213) 740-3533.
197
APPENDIX D: ENGLISH INFORMED CONSENT

University of Southern California
Department of Sociology

INFORMATION SHEET FOR NON-MEDICAL RESEARCH

The Use of Traditional and Alternative Medicine among Low-Income Mexican-Americans in
Santa Ana

You are asked to participate in a dissertation research study conducted by Frank R. Carrillo,
M.A. and H. Edward Ransford, Ph.D., from the Sociology Department at the University of
Southern California. You were selected as a potential participant in this study because you
are representative of the Mexican-American community in Santa Ana, California. A total of
40 subjects will be selected from native-born Mexican-Americans and immigrants of
Mexican origin with 10 or more years of residency to participate. Your participation is
voluntary.

PURPOSE OF THE STUDY
We are asking you to take part in a research study because we are trying to learn more about
the health care access and health care seeking behavior of Mexican-Americans with and
without health insurance. Participation in the interview and response to the interview
questions will constitute consent to participate in this research project.

PROCEDURES
You will be asked to participate in an interview of approximately one to one and one-half
hour in length. You will be asked a minimum number of background questions. Most
questions will be about your experiences in health care access, potential barriers you have
encountered in seeking health care, and what you do when you encounter difficulties in
obtaining adequate, quality health care.

POTENTIAL RISKS AND DISCOMFORTS
There are no anticipated risks to your participation; you should not experience any
discomfort by being interviewed but you may be inconvenienced from taking time out of
your day to participate. Any questions asked during the interview that make you
uncomfortable will be skipped at your request.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
You may not directly benefit from your participation in this research study, but your
participation may provide valuable information that may benefit to the larger Mexican-
American community in regards to important health care access and quality issues that
Mexican-Americans now experience.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will not receive any payment for your participation in this research study.

198
CONFIDENTIALITY
There will be no information obtained in connection with this study and that can be
identified with you. Your name, address or other information that may identify you will not
be collected during this research study. Although the interviews will be audiotaped and
transcribed, you will be given a fake name (pseudonym) and your true identity will not be
revealed at any time. You have the right to review and edit your taped interview and
transcription if you so desire. Only members of the research team, Frank R. Carrillo and H.
Edward Ransford, will have access to the data associated with this study. The data will be
stored in the investigator’s office in a locked file cabinet/password protected computer. The
data will be stored for three years after the study has been completed and then destroyed.
When the results of the research are published or discussed in conferences, there will be no
information that will be included that may reveal your identity since no identifiers are being
collected from you.

PARTICIPATION AND WITHDRAWAL
You can choose whether to be in this study or not. If you volunteer to be in this study, you
may withdraw at any time without consequences of any kind. You may also refuse to
answer any questions you don’t want to answer and still remain in the study. The
investigator may withdraw you from this research if circumstances arise which warrant
doing so.

RIGHTS OF RESEARCH SUBJECTS
You may withdraw your consent at any time and discontinue participation without penalty.
You are not waiving any legal claims, rights or remedies because of your participation in this
research study. If you have questions regarding your rights as a research subject, contact the
University Park IRB, Office of the Vice Provost for Research Advancement, Grace Ford
Salvatori Hall, Room 306, Los Angeles, CA 90089-1695, (213) 821-5272 or upirb@usc.edu.

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please feel free to contact Frank R.
Carrillo, M.A. or H. Edward Ransford, Ph.D. at the University of Southern California,
Sociology Department, 3620 Vermont Avenue, Kaprielian Hall 352, Los Angeles, CA
90089-2539 or contact us by phone at (213) 740-3533.

Abstract (if available)

Abstract The sociological literature on Mexican American or Latino healthcare seeking generally suggests that more assimilated Mexican American seek conventional medicine when a health problems arises and the less assimilated seek more traditional Mexican folk remedies. Healthcare seekers are seen as reactive to social and cultural factors in making healthcare decisions. More recently, literature which documents pluralistic medical behavior among Mexican Americans has emerged and represents an important departure from social and cultural factors explanations. This research builds upon the pluralistic medical model and argues that Mexican Americans are not simply reactive to social and cultural factors but are more active agents in making healthcare decisions. A new model, the Social Action Paradigm is developed and used as a framework to analyze and interpret the results of intensive interviews with 16 long-term (ten years or more residency) Mexican immigrants and 17 native-born Mexican Americans in Santa Ana, California. The results of the study support the idea that agency does indeed play a part in the healthcare seeking practices of the study participants and, to an important degree, contributes to the persistence of the use of Mexican traditional folk medicine among both groups.

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Asset Metadata

Creator Carrillo, Frank R. (author)

Core Title The practice of pluralistic medicine by long-term immigrant and native-born Mexican Americans in Santa Ana, California: the persistence of traditional medicine

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program Sociology

Publication Date 12/05/2008

Defense Date 07/15/2008

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag immigrant health,latino health,Mexican folk medicine,Mexican-American health,OAI-PMH Harvest,pluralistic medicine

Place Name California (states), Santa Ana (city or populated place)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Ransford, H. Edward (committee chair), Baezconde-Garbanati, Lourdes (committee member), Casper, Lynne M. (committee member), Maxwell, William (committee member)

Creator Email fcarrill@usc.edu,frankcarrillo1946@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m1875

Unique identifier UC1291406

Identifier etd-Carrillo-2491 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-132886 (legacy record id),usctheses-m1875 (legacy record id)

Legacy Identifier etd-Carrillo-2491.pdf

Dmrecord 132886

Document Type Dissertation

Rights Carrillo, Frank R.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu