Transcultural Health Care: Groups with Greek Heritage

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Greek Culture

Larry Purnell, PhD, RN, FAAN

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

Overview/Heritage

This show presents two groups of people with Greek heritage.
The first group refers to those or their ancestors who emigrated from Greece, the second group originated in Cyprus.
Both groups have a common history, language, and religion.Transcultural Health Care: Groups with Greek Heritage

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

Overview/Heritage

The largest Greek community outside Greece is in the United States.
The largest Greek Cypriot community outside Greece is in Britain.
The core values of philotimo (honor and respect) and endropi (shame) are key when considering the experience of Greeks and Greek Cypriots.

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

Overview/Heritage

Philotimo is a Greek’s sense of honor and worth that is derived from one’s self-image, one’s reflected image (respect), and one’s sense of pride.
Philotimo is enhanced through courage, strength, fulfilling family obligations, competition with other people, hospitality, and appropriate behavior.
Shame results from deviant conduct.

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

Communication

All Greeks, whether in Greece, Cyprus, or the diasporas, use the same form of written language, although there are regional and country variations in spoken Greek.
Diasporic Greek communities regard the retention of the Greek language as an essential part of their identity.

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

Communication

Greek and Greek Cypriot people tend to be expressive in both speech and gesturing.
They use their hands frequently while talking.
They embrace family, friends, and others to indicate solidarity.
Whereas inner-most feelings, such as anxiety or depression, are often shielded from outsiders, anger is expressed freely.

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

Communication

Eye contact is generally direct, and speaking and sitting distance is closer than that of other European Americans.
Patients often appear to be compliant in the presence of the health-care worker, but this may be only superficial to ensure a smooth relationship.

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

Communication

Greeks are oriented to the past as they are highly conscious of the glories of ancient Greece.
They are present-oriented with regard to philotimo, family life, and situations involving family members.
However, they tend to be future-oriented with regard to educational and occupational achievements.

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

Communication

Greek Americans differentiate between “Greek time,” which is used in family and social situations, and “American/clock time,” which is used in business situations.
Greek time emphasizes participating in activities until they reach a natural breaking point, whereas American/clock time emphasizes punctuality.

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

Communication

For Greeks and Greek Cypriots, having a Greek name is an important sign of their heritage.
Honorific titles might be given to members of the community who are elders or otherwise respected.
Terms such as Thia (aunt), Kyria (Mrs.), or giagia (grandma) may be used.

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

Communication

First names come either from the Bible or from ancient Greek mythology and history.
Ideally, first daughters are named for the mother’s mother and first sons for the father’s father.
Following tradition, middle names are the first name of the father.

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

Family Roles and Organization

The father is considered the head of the household in Greek and Greek Cypriot families.
The complexity of household dynamics is noted in the well-known folk saying, “The man is the head, but the wife is the neck that decides which way the head will turn.” This acknowledges the primacy of fathers in the public sphere and the strong influence of women in the private sphere.

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

Family Roles and Organization

The roles of husband and wife are characterized by mutual respect (a partnership). However, their relationship is less significant than that of the family as a unit.
Fathers are responsible for providing for the family, whereas women are responsible for the management of the home and children.

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

Family Roles and Organization

Greeks are often friendly but somewhat superficial and distant with those considered “outsiders.”
Traditionally, the cleanliness and order of the home reflect the moral character of the woman.
Children are included in most family social activities and tend not to be left with babysitters.

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

Family Roles and Organization

The child is the recipient of intense affection, helpful interventions, and strong admiration.
The child may be disciplined through teasing, which is thought to “toughen” children and make them highly conscious of public opinion.
Adolescents, particularly young women, tend to reside with their parents until they get married.
Transcultural Health Care: Groups with Greek Heritage

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

Family Roles and Organization

Girls have considerably less freedom in dating than their brothers, and it is common for girls to be prohibited from dating until they are in the upper grades of high school.
Suppression of personal freedom by parents is a major risk factor for suicidal attempts in Greek and Greek Cypriot adolescent girls.

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

Family Roles and Organization

Additional areas identified as high-stress for Greek adolescents include extreme dependence on the family, intense pressure for school achievement, and a lack of sexual education in the home.
Families feel responsible to care for their parents in old age, and children are expected to take in widowed parents.

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

Family Roles and Organization

Failure to do so results in a sense of dishonor for the son and guilt for the daughter.
Treatment of the giagia (grandmother) and the pappou (grandfather) reflects the themes of closeness and respect emphasized in the family.
Grandparents tend to participate fully in family activities.

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

Family Roles and Organization

If the older person is ill, living with the family is the first preference, followed by placement in a residential care facility.
The basis of social status and prestige is family philotimo and cohesiveness.
Social status is also received from attributes such as wealth, educational achievement, and achievements of its members.

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

Family Roles and Organization

Greek and Greek Cypriot communities tend to be relatively conservative.
As a consequence, alternative lifestyles encompassing premarital sex, divorce, and same-sex relationships are considered sources of concern for family members and the community.

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

Workforce Issues

In the United States, the high achievement orientation and work ethic have resulted in Greeks’ serving as a “model” ethnic group.
Greeks stress self-reliance is sometimes seen as reluctance to be told what to do.
Eye contact is generally direct, and speaking and sitting distance is closer than that of other European Americans.

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

Biocultural Ecology

Greeks and Greek Cypriots are most commonly of medium stature, shorter than northern Europeans, but taller than other populations of southern Europe.
Although some Greeks have blue eyes and blond hair, usually from the northern provinces of Greece, most Greeks have dark hair and dark skin.

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

Biocultural Ecology

Common health conditions of Greeks and Greek Cypriots include cardiovascular disorders, cerebrovascular disorders, thyphoid, hepatitis A and B, glucose-6-phosphate dehydrogenase, thalassemia, lactose intolerance, Tay-Sachs disease, malaria, and tuberculosis.
Most women choose to have an abortion if they are found to carry a fetus with thalassemia.

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

High-Risk Health Behaviors

Alcohol is most often considered a food item and is consumed with meals.
However, losing control by being “under the influence” engenders considerable gossip and social disgrace, focused not only on the individual but also on the family.
Obesity among both sexes and smoking among men are high among Greeks.

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

High-Risk Health Behaviors

Greeks and Greek Cypriots tend to disregard standard health promotion behaviors.
Safety measures for adults, such as seat belts and helmets, are often viewed as infringements on personal freedom and are frequently ignored, particularly by the older generation.

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

Nutrition

Greeks describe their culture as an “eating culture.” Food is a centerpiece of everyday life as well as of social and ritual events.
Fasting is an integral part of the Greek Orthodox religion.
During fasts, it is forbidden to eat meat, fish, and animal products such as eggs, cheese, and milk. General fast days are Wednesdays and Fridays.

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

Nutrition

Greeks and Greek Cypriots base their diet on cereals, pulses, lentils, vegetables, fruits, olive oil, cheese, and milk.
They are also relatively high consumers of sweets and snacks.
For adults, dairy products are consumed in the form of yogurt or cheeses such as feta, kopanisti, kefaloteri, kasseri, and halloumi.

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

Nutrition

Fats are consumed in the form of olive oil, butter, and olives.
Meats include chicken and lamb or, in the United States and Britain, beef adaptations.
Eggs; lentils; and fish such as shrimp and other shellfish, whitefish, and anchovies are additional sources of protein.

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

Nutrition

Vegetables such as potatoes, eggplant, courgettes (zucchini), spinach, garlic, onions, peas, artichokes, cucumbers, asparagus, cabbage, and cauliflower are common Greek food choices.
Bread choices include pita, crescent rolls, and egg breads. Other foods include rice, tabouli, macaroni, and cracked wheat (bourgouri).
Fruit preferences include grapes and currants, figs, prunes, oranges, lemons, melons, watermelons, peaches, and apricots.

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

Pregnancy and
Childbearing Practices

In North America, Greeks have deliberately limited family size so children can be adequately cared for and educated.
A wide variety of birth control measures, such as intrauterine devices, birth control pills, and condoms are preferred.
The strong pro-life Greek Orthodox church condemns birth control while silently accepting the reality.

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

Pregnancy and
Childbearing Practices

Abortion is condemned as an act of murder except in circumstances that threaten the life of the mother or when a young woman becomes pregnant as a result of rape.
In practice, a number of women, particularly those who are unmarried, have legal abortions because of the negative consequences of having a baby out of wedlock.

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

Pregnancy and
Childbearing Practices

Pregnancy is a time of great respect for women and a time when women are given special considerations.
Proscriptions include not attending funerals or viewing a corpse, refraining from sinful activity as a precaution against infant deformity, and praying to St. Simeon.

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

Pregnancy and
Childbearing Practices

Pregnant women are encouraged to eat large quantities; foods high in iron and protein are particularly important.
If a pregnant woman remarks that a food smells good or if she has a craving for a particular food, it should be offered to her; otherwise the child may be “marked.”
This is the usual explanation for birthmarks.

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

Pregnancy and
Childbearing Practices

After delivery, most traditional Greeks consider the mother ritually impure and particularly susceptible to illness for 40 days.
During this time, she is admonished to stay at home and not attend church.
At the end of the 40 days, the mother and child attend church and receive a ritual blessing.

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

Pregnancy and
Childbearing Practices

For breast-feeding mothers, early showering is sometimes thought to result in the infant developing diarrhea and becoming allergic to milk.
Newborns are generally breast-fed, and solids are not introduced early.
When relatives visit an infant in the hospital, silver objects or coins may be placed in the crib for good luck.

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

Death Rituals

A klama (wake) is held in the family home or, more commonly in North America today, in a funeral home.
All relatives and friends are expected to attend.
The wake ends when the priest arrives and offers prayers.
Pictures and mirrors may be turned over. During the wake, women may sing dirges or chant. In some regions, people practice “screaming the dead,” in which they cry a lament, the miroloyi.

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

Death Rituals

In Greece and Cyprus, the kidia (funeral) is held the following day at the Orthodox church, with internment in a cemetery.
After internment, family and friends gather for a meal of fish, symbolizing Christianity; wine, cheese, and olives in the family home or a restaurant.

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

Death Rituals

On the basis of the Orthodox belief in the physical resurrection of the body, Greeks and Greek Cypriots reject cremation.
The extent of adherence to this precept varies in North America, but Greeks and Greek Cypriots in Britain do not practice cremation.
Black is the color of mourning dress and is often worn by family members throughout the 40 days of mourning; for widows it may be worn longer.

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

Death Rituals

While black armbands are still worn in Greece and Cyprus, that custom is virtually nonexistent in immigrant communities.
After death, family and close relatives, who may stay at home, mourn for 40 days.
Close male relatives do not shave as a mark of respect.
Transcultural Health Care: Groups with Greek Heritage

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

Death Rituals

A memorial service follows 40 days after burial and at 3 months, 6 months, and yearly thereafter.
At the end of this service, koliva (boiled wheat with powdered sugar) is served to participants, and mourning is conducted with joyful reverence.

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

Spirituality

Most Greeks in America are affiliated with the Greek Orthodox church, whereas Greeks and Greek Cypriots in Britain are affiliated with the Archdiocese of Thyateria and Great Britain.
The central religious experience is the Sunday morning liturgy, which is a high church service with icons, incense, and singing or chanting by the choir.

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

Spirituality

The Greek Orthodox religion emphasizes faith rather than specific tenets.
The Greek faith does not emphasize Bible reading and study.
Some parishioners attend church services weekly; others attend only a few times a year.

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

Spirituality

Easter is considered the most important of holy days, and nearly all Greeks and Greek Cypriots in America and Britain attempt to honor the day.
There is a strong belief in miracles, even among second and subsequent generations of Greeks and Greek Cypriots in America and Britain.
Daily prayers may be offered to the saints.

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

Spirituality

Family members may make “bargains” with saints, such as promises to fast, be faithful, or make church donations if the saint acts on behalf of the ill family member.
They may call on an individual’s namesake or a saint believed to have special affinity with healing.

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

Spirituality

A distinctive feature of the Greek Orthodox religion is the place it assigns to icons, such as paintings of saints, the Virgin Mary, and Christ.
These icons have sacred significance as sources of connection to the spiritual world.
In the homes, holy vigil candles are often kept burning.
To ensure safety and health, many begin each day by kissing the blessed icons and making the sign of the Greek cross.

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

Spirituality

When a person is ill, the icon of the family saint or the Virgin Mary may be placed above the bed.
Many Greeks and Greek Cypriots also may sprinkle their homes with holy water from Epiphany Day church services to protect the members of their household from evil.

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

Health-care Practices

The amount of acceptance and use of biomedicine is highly related to one’s level of education and generation of immigration.
Greek immigrants tend to be anxious about health, to lack trust in health professionals, and to rely on family and community for advice and remedies.

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

Health-care Practices

To be healthy means to feel strong, joyful, and content; to be able to take care of oneself; and to be free from pain.
Threats to health result from a lack of balance in life; departure from family; neglect of education or work; and failure to demonstrate right behaviors, such as respect toward parents, sharing with family, upholding religious precepts, and staying out too late.

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

Health-care Practices

Problems are considered originating outside the individual’s control and are attributed to God, the devil, spirits, and envy or malice of others.
The family generally assumes responsibility and care for a sick member and works to control interactions with health professionals.

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

Health-care Practices

Three traditional folk healing practices are particularly notable: those related to matiasma (bad eye or evil eye), practika (herbal remedies), and vendousas (cupping).
Matiasma results from the envy or admiration of others. While the eye is able to harm a wide variety of things including inanimate objects, children are particularly susceptible to attack. Common symptoms include headache, chills, irritability, restlessness, and lethargy; in extreme cases, matiasma has resulted in death.

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

Health-care Practices

Greeks employ a variety of preventive mechanisms to thwart the effects of envy or evil eye, including protective charms in the form of phylactos, amulets consisting of blessed wood or incense, or blue “eye” beads, which “reflect” the eye.
In particularly severe cases, the Orthodox priest may recite special prayers of exorcism and use incense to fumigate the afflicted person.
Transcultural Health Care: Groups with Greek Heritage

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

Health-care Practices

Practika are herbal and humoral treatments used for initial self-treatment.
Chamomile, the most popular herb, is generally used in teas for gastric distress or abdominal pain, including infant colic and menstrual cramps.
It is also used as an expectorant to treat colds.

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

Health-care Practices

Liquors, such as anisette, ouzo, and mestika, are used primarily for colds, sore throats, and coughs and are consumed alone or in combination with tea, lemon, honey, or sugar, either alone or in some combination.
Occasionally, liquors are used for treatment of nevra (nerves).
Raw garlic is used as prevention for colds, and cooked garlic is used for blood pressure and heart disease.

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

Health-care Practices

Vendousas, a healing practice, is used as a treatment for colds, high blood pressure, and backache.
It consists of lighting a swab of cotton held on a fork, then placing the swab in an inverted glass, thereby creating a vacuum in the glass, which is then placed on the back of the ill person.
The skin on the back is drawn into the glass. This procedure is repeated 8 to 12 times.

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

Health-care Practices

Self-medicating behaviors are common, with herbal remedies and over-the-counter medications used widely for specific symptoms.
Mental illness is accompanied by social stigma, with negative consequences for the afflicted person as well as the family and relatives.
Shame originates in the notion that mental illness is hereditary; afflicted people are viewed as having lifelong conditions that “pollute” the bloodline.

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

Health-care Practices

Individuals with mental illness often present with somatic complaints such as dizziness and paresthesias on initial visits to health-care practitioners.
Recent immigrants tend to have higher rates of mental disorders, which perhaps result from the stress of culture change.
A folk model for nevra is a socially acceptable and culturally condoned medium for the expression of otherwise unacceptable emotions.

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

Health-care Practices

Ponos (pain) is the cardinal symptom of ill health and an evil that needs eradication.
The person in pain is not expected to suffer quietly or stoically in the presence of family.
The family is relied on to find resources to relieve the pain or, failing that, to share in the experience of suffering.
In the presence of outsiders, the lack of restraint in pain expression suggests lack of self-control, and therefore it is considered endropi.

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

Health-care Practices

The key aspect of the sick role is for the sick to fully rely on the family for sustenance.
When an individual is ill, it is particularly important that he or she not be left alone.
When hospitalization occurs, family members expect to stay with the individual, even during examinations and therapeutic procedures.
Protection includes shielding the sick from a serious diagnosis.

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

Health-care Practices

On the basis of the Christian Orthodox belief in the physical resurrection of the body, some Greeks and Greek Cypriots may reject the concept of autopsy and do not readily accept organ donation.
However, the Greek Orthodox church is strongly pro-life and more recently has been encouraging organ donation as an act of love.
Blood transfusions are wholly acceptable and are common for people with thalassemia.

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

Health-care Practitioners

A woman who cures, particularly one who cures the evil eye, is known as a magissa, which is usually translated as “witch” but means “magician”; she may also be called doctor.
In the US and Britain, “wise women” from one’s own family conduct most lay healing.
The priest may also be called on for advice, blessings, exorcisms, and direct healing.

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

Health-care Practitioners

Many Greeks and Greek Cypriots display a general distrust of all professionals and le shopping around for physicians and other professionals to obtain additional opinions is relatively common.
The use of several physicians simultaneously may result in untoward drug interactions from conflicting interventions or overdoses.
There is also a fear that the sick person may be used as a subject for experimentation.

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

Health-care Practitioners

Hospitals are a particular source of mistrust both for Greeks and Greek Cypriots.
When hospitalizations occur, the family may be perceived by staff as demanding or “interfering” as they enact their protective advocacy roles.
Mothers may demand to sleep with their children and fear that the children may not receive appropriate care.

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

ClickerCheck

The parents bring their 14 month old baby to the clinic because herbs have not adequately treated matiasma which is

Evil eye.

Colic.

Teething.

Sunken fontanelle.

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

Correct Answer

Correct answer: A

Matiasma is evil eye.

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

ClickerCheck

The family has been treating their teenage son with vendouses, cupping which is traditionally used to treat

Infertility.

Nervous disorders.

Pneumonia.

Acne.

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

Correct Answer

Correct answer: C

Vendouses, cupping, is used to treat colds, high blood pressure, and backache. Transcultural Health Care: Groups with Greek Heritage