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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Culture

Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage

• There is little literature on Brazilian health conditions, practices, and beliefs, although there is a lot on the objective culture such as arts, music, dance, and cuisine.
• Brazilian heritage is rich in its mixture of Portuguese, French, Dutch, German, Italian, Japanese, Chinese, African, Arab, and native Brazilian Indians.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage

• Common knowledge among Brazilians living in the United States is that many of them are escondidos (hidden) or officially referred to as undocumented aliens.
• The exact number of Brazilians living in the United States is unknown.
• Many Brazilians subsist in urban slums without privacy and hope to earn enough money to return home.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Overview/Heritage

• Brazilians in the US are underemployed, often giving up their professions to earn money as domestic workers, waiters, cab drivers, and other low-paying positions.
• Immigrants often move to large cities where many networks help find “under-the-table” wages.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Portuguese is the official language of Brazil, although dialects exist and vary.
• Many Brazilians continue to be of “proper” old-world orientation where true feelings are not divulged for fear of hurting the receiver of the communication.
• In the intimate circle of family and compatriots, sharing thoughts and feelings is common.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Young adult and adolescent Brazilians in the United States are generally more acculturated because of their desire and need to assimilate.
• Sharing thoughts and feelings is more common among intragenerational groups rather than intergenerational groups.
• Most Brazilians use touch and direct eye contact.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Women kiss each other on both cheeks when they meet and when they say good-bye.
• At times, women and men kiss in the same manner.
• Men shake each other’s hands and slap each other on the back with the other hand. This gesture frequently ends in an embrace.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Children are kissed, and there is much touching. Kissing a child frequently includes the combination of a “kiss and smell.”
• Spatial distancing is close.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Facial expressions and symbolic gestures are commonplace.
• Most Brazilians in America are future-oriented.
• In general, they are not punctual, especially for social occasions.
• However, those in professional circles are punctual.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Brazilian names are lengthy, but the modern trend is to use only the first and last names.
• Traditionally, names appear as first name, mother’s family name, and father’s family name. “Junior” is added to a name if the son has been named after the father and Neto if the son has been named after the grandfather (third generation).

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• When a woman marries, she may opt to drop her mother’s maiden name and her father’s name, or she may keep them both.
• At times de, da/do, das/dos is added to a name to denote “of” and seems to be done out of tradition. No rigid protocol is apparent.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Children who have no father are often given the mother’s maiden name to which da Silva is added, denoting that the line of paternity is unclear.
• In day-to-day relationships, people are called by their first name or Seu, Senhor (more respectful) preceding the first name of a man, or Dona preceding the first name of a woman.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Brazilian Communication

• Mothers, grandmothers, or respected strangers are referred to as A Senhora, and fathers, grandfathers, and respected men are called O Senhor.
• Doctors are addressed as Doutor or Doutora, and professors are addressed as Professor or Professora. The latter two are followed by the first name.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles and Organization

• Brazilian society is one of machismo, with the middle and upper classes being patriarchal in structure.
• As women assert their equality, more egalitarian relationships are becoming evident.
• Lower socioeconomic households tend to be more matriarchal in nature.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization

• Older people live with one of their children when self-care is a concern.
• Older people are respected, seen as family counselors, and are always addressed as O Senhor or A Senhora.
• They are included in family activities and usually accompany their children’s families on vacation.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization

• Godparents are a very important family extension.
• Poor families frequently ask their patron and patrona (employer and spouse) to be godparents to their child.
• The godmother is called comadre by the mother.
• Compadre is used in reference to the godfather.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization

• Although historically common in the lower socioeconomic classes, middle-class households with a single-female parent are becoming increasingly common among Brazilians in the United States.
• In middle-class families, the “no father” status is obscured by the child receiving the same middle and last names as the mother.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Family Roles & Organization

• Social status is very important in the Brazilian society, demonstrated in the titles that people use with each other, and the practice of listing both parents’ surnames.
• Brazilians, especially from the south and southeast of Brazil, have become more accepting of gay and lesbian relationships.
• Same-sex relationships may carry a stigma.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues

• Brazilians value diplomacy over honesty even when they promise to attend to something the next day, knowing that it will be impossible.
• Professional Brazilians show up for work on time.
• Less educated Brazilians may find it difficult to adhere to time schedules in the American workplace.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues

• Brazilians generally respect authority and are frequently more comfortable in employment situations where rules and job specifications are well defined.
• Many undocumented Brazilians find employment within the Brazilian community where they may never have to learn the new language.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Workforce Issues

• The categorization of Brazilians in the US under the general category of “Hispanics” adds to their discomfort.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Biocultural Ecology

• The “typical” Brazilian is a moreno with brown skin and eyes and black or brown hair. However, individuals particularly from the southern states of Brazil may have blond hair and blue eyes.
• Common health conditions among Brazilians include malaria, Chagas disease, dengue fever, meningitis, yellow fever, schistosomiasis, typhoid fever, Hansen’s disease, hepatitis, tuberculosis, parasitic skin infections, cholera, cardiovascular diseases, and lactose intolerance.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Biocultural Ecology

• Smoking is a high-risk behavior among Brazilians living in the United States.
• Among men, drinking hard liquor is also prevalent.
• Accessibility and use of street drugs and an individual’s desperate search for quick money are other identifiable high-risk behaviors and often involve living in crowded conditions.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition

• The mainstay of the Brazilian American’s diet continues to be rice, beans, and farina.
• Roast beef, fresh chicken, and seafood are sought when they are not too expensive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition

• Breakfast typically consists of bread with cafe com leite (half coffee and half hot milk).
• Sometimes cuscus (dry cornmeal mush) is served with milk.
• Fruit, fruit juices, and scrambled eggs, with or without sliced hot dogs, are common special breakfast fares among middle-class families.
• Sweet potatoes and yams may grace a breakfast table.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition

• Dinner is eaten at noon. This heavy meal, consisting of beans, rice, and farina, often includes mashed potatoes and pasta.
• Common desserts are custard, various cornmeal pastries, fruit, and doce (a sweet paste made by boiling sugar and fruit.
• A vegetable and or fruit salad are also common.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Nutrition

• A preference, especially among young Brazilian women, is to rely on vitamins instead of food consumption to help them remain thin.
• In the US, food limitations are imposed by expense and inaccessibility of Brazilian mainstay foods.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Common health conditions of Brazilian immigrants include

Schistosomiasis.

Thalassemia.

Glucose-6-dehydrogenous deficiency.

Hemophilia.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: A

Schistosomiasis is a common health condition of immigrant Brazilians, especially those coming from rural areas.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices

• Although Brazil is predominantly a Catholic country, birth control is taught and used.
• Women are encouraged by their physicians or clinic personnel to have tubal ligations to prevent unwanted pregnancies.
• Frequently, unwanted pregnancies and abortions are, in the end, left in God’s hands.
• Immigrants in the United States generally practice birth control.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices

• Herbal teas are used for bringing on late menstrual periods and for stimulating natural abortions.
• Single women may try to become pregnant to facilitate their chance of remaining permanently in the US.
• Pregnant women are encouraged not to do heavy work and not to swim.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices

• Taboos also warn against having sexual relations during pregnancy.
• Taboos generally vary according to geographic region, socioeconomic status, and ethnic background.
• Many Brazilian mothers prefer to give their babies powdered dry milk in place of breastfeeding.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices

• Some women often feel that their milk is fraca (weak).
• Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Pregnancy &
Childbearing Practices

• A postpartum woman eats chicken soup to help her body return to normal.
• She is also advised not to eat spicy foods or repadura (a molasses candy) and not to drink garapa (sugar water) or caldo de cana (sugar cane juice) if she breastfeeds her infant.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals

• The death of a baby or an infant, historically, has been and continues to be treated joyfully and without much sadness, for the child has died pure and is regarded as an angel.
• If financially possible, the families of Brazilians who die in the United States personally accompany the body to Brazil for burial in the family vault.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals

• The fatalistic expression, “It was God’s will,” helps the grieving process among the rich and the poor.
• Older people wear black for various amounts of time depending on their relationship with the family member.
• Frequently, the final portrait is hung in the family chaper or near the family altar, and prayers are recited. An eternal light burns.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Death Rituals

• Relatives are honored on the anniversaries of their death, both at home and at Masses.
• Often, the family places an obituary of remembrance with or without a picture of the deceased in the local newspaper on the anniversary of the death.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Maria Miranda de Silva is reluctant to breastfeed. A common belief about breast feeding among Brazilians is that breastfeeding

Breastfeeding causes diarrhea in the infant.

Breastfeeding Is linked to a social stigma.

Breast milk is weak.

Breast milk is contaminated with iron.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: B

Breastfeeding is linked to a social stigma that a mother who breastfeeds may often be thought of as abandoned or sexually unattractive.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Spirituality

• 90 percent of Brazilians are Catholic, various Protestant sects are making inroads into the Brazilian culture.
• A few, including Catholics, incorporate traditions of Indian animism, African cults, Afro-Catholic syncretism, and Kardecism, a spiritualist religion embracing Eastern mysticism.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Spirituality

• Saints are asked for help, and people wear medals or little pouches of special powders around their necks.
• The meaning of life is found in religion, economy, fatalism, and reality. For some, life is uma luta (a battle). For others, life has an almost hedonistic attitude.
• The greatest source of strength for Brazilians is their immediate and extended families.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Most Brazilians do not talk about their illnesses unless the illnesses are very serious.
• Generally, illness is discussed only within the family.
• Many Brazilians feel that talking about an illness, such as cancer, negatively influences their condition.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Because many Brazilians tend to shun hospitals, their families accompany them and stay around the clock.
• The patient is often brought food from home.
• The family is the nucleus of responsibility for health care and is eager to participate in care.
• Brazilians are known for their self-medication practices.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Antibiotic, neuroleptic, antiemetic, and most other prescription drugs are easily obtained over the counter in Brazilian pharmacies.
• Once in the US, incoming Brazilians bring medicines requested by their friends and, thus, maintain the circulation of medications not available to Brazilians living in the US.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Traditional and homeopathic pharmacies are supplemented by remedios populares (folk medicines) and remedios caseiros (home medicines).
• Folk remedies and traditional health-care practices are intermeshed when a serious illness may be best treated by traditional caretakers.
• Some take homeopathic bolinhas (little white balls) prepared specifically for certain ailments.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Brazilians generally do not like to talk about pain. However, once the emotional barrier is removed, they feel relieved to be able to discuss their discomfort.
• Many pain-relieving medicines are available without a prescription in Brazil.
• Sickness is a neutral role and is considered socially exempt.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practices

• Nervios is the ever-present folk diagnosis that identifies weakness, craziness, and anger as principally associated with hunger.
• Better-educated Brazilians accept blood transfusions, organ donation, and organ transplantation.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practitioners

The folk-health field has many health-care practitioners:

• Curandeiros are divinely gifted.
• Rezadeiras (praying women) help exorcise illnesses.
• Card readers can predict fortunes.
• Espiritualistas are able to summon souls and spirits
• Conselheiros are counselors or advisors.
• Catimbozeiros are sorcerers.
• Additionally, head priestesses or priests from the African-Brazilian Umbanda or Xango religion, all have the power to heal their believers.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Brazilian Health-care Practitioners

• Brazilians in the United States tend to respect physicians and nurses.
• Medical education is prestigious and highly sought by aspiring university students.

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