Filipino Americans Larry Purnell, PhD, RN, FAAN

1. Filipino Americans Larry Purnell, PhD, RN, FAAN

2. Overview/Heritage • Almost 2 million in the United States • Literally all speak English and Tagalog (Pilipino), and many speak Spanish and another language • Predominantly from Malayan ancestry with influence and mixtures from other Asian groups, Spanish, and Arab

3. Overview/Heritage Continued • Americanization of the Philippines began after the Spanish–American War • Immigrant Filipinos make up the majority of Filipinos in the United States • Unrestricted immigration in the early 1900s then very restricted in 1924 because of the Exclusionist policies of Immigration Act of 1924

4. Overview/Heritage Continued • Immigration and Nationality Act of 1965 eliminated the quota system for the Philippines resulting in large numbers of middle class and professionals coming to the United States • Included relatives of Filipinos living in the United States

5. Overview/Heritage Continued • First group were primarily single men who were brought to the United States to work in Alaskan canneries, farms in California, and plantations in Hawaii and endured much discrimination • Most were restricted from owning or leasing land and could not become US citizens

6. Overview/Heritage Continued • After WW II, many Filipino Veterans immigrated and settled on the West Coast • Now more women than men immigrate to the United States • Well educated immigrants continue to have difficulty in finding similar work in the United States unless they are in the healthcare field

7. Communications • Tagalog is the national language with English the second official language • Eight other dialects are spoken as well as Spanish • Taglish is common among immigrants and American born Filipinos • Highly contextual communication patterns

8. Communications Continued • Pakikisama—smoother interpersonal relationships and sacrifice exact meaning • External or outsider communication and internal or one-of-us communication proceeds on different levels

9. Communications Continued • Interacting level • Participating level • Conforming level • Adjusting level • Understanding and acceptance level • Getting involved level • Being one with level

10. Communications Continued • An exclusive “we” and an inclusive “we” • Eye contact varies with age, education, and acculturation • Many ways to say yes, but how do you say no?

11. Communications Continued • Respect the past, enjoy the present, and hope for the future • Filipino time for social events, clock time if really important events, business, and work usually • Many names are Spanish in origin • One of the middle names is the mother’s maiden name

12. ClickerCheck Many Filipinos speak Tag-Lish, which is a. A combination of Tagalog and English. b. The indigenous language of the Philippines. c. The official language of the Philippines. d. A combination of Spanish and English.

13. Correct Answer Correct answer: A Tag-Lish is a combination of Tagalog and English.

14. Family Roles • Matriarchal before Spanish, then Patriarchal, now more egalitarian in decision making • Gender neutral pronouns causing confusion with he and she in English • Respect is a dominant family value and older children may assume the role of parent

15. Family Roles Continued • Honor and care for parents or brings shame to the family • Nuclear family is dominant although polygamous families exist among Moslem Filipinos • Extended family members are important • Education is paramount for children and parents sacrifice so at least one child will become educated and help the others if necessary

16. Family Roles Continued • Respect is shown to elders with deferential behavior • Grandparents become surrogate parents for their grandchildren in the United States especially • Advance degree brings higher social status

17. Family Roles Continued • Filipino organizations targeted to gays and lesbians • Chastity is valued premaritally • Single parenting becoming more common in the United States

18. Biocultural Ecology • Varying skin tones of brown and tan with dark eyes, flat nose bridges, and mildly flared nostrils • Most are of smaller stature than European Americans • More difficult to determine age than in European Americans because of youthful face

19. Biocultural Ecology Continued • Endemic conditions in the Philippines include malaria, tuberculosis, gastrointestinal disorders, due to parasitosis, cardiovascular related disease, cancer, respiratory diseases, nutritional diseases, HTN, and diabetes • Sensitive to the effects of alcohol and require lower doses of neuroleptics

20. Nutrition • Fundamental form of socialization • Any occasion is an occasion for food • Wide variety of foods and prepared in a variety of ways • Outsiders are served western food • Insiders are served Filipino food • To help in the kitchen you are really an insider

21. Nutrition Continued • Rice may be served at every meal, most common meats are fish, chicken, and pork • Diet varies among urban and rural areas • Lactose intolerance among adults • Milk in cooked desserts is tolerated well • Salt and vinegar are used frequently • Moderation in food is considered important

22. Nutrition Continued • Considered polite to leave some food on your plate • Herbs are grown in many homes to be used for cooking and for medicinal purposes • Newer immigrants are at risk of nutritional deficiencies if unfamiliar with American foods

23. Childbearing Family • Catholic religion influences birth control practices —rhythm method only • Abortion is considered a sin, carries a stigma, and leads to back door abortions • Pregnancy is a time for pampering and attention from entire family • Mother of pregnant woman has a very special role

24. Childbearing Family Continued • Consult healthcare provider plus a massage therapist for advice • Reluctant to take any medicine during pregnancy, even vitamins for fear of harming the fetus • Satisfy cravings so baby will not be marked with the craving

25. Childbearing Family Continued • Should be protected from a sudden fright for fear it will harm the fetus • Mother rather than husband may be the coach during birthing • Traditional may not want to bathe but engage in sponge bath and aromatic oils • Soup increases lactation

26. Death Rituals • Three days to week for wake after death to await for family to come together—varies in United States because of work schedules • Plenty of food available and family support • Nine days of novenas in the home or church are common • Ritualistic mourning wearing black for one year

27. Death Rituals Continued • Burial is the most common but cremation is okay • Body or ashes may be returned to the Philippines • Open expression of emotions and may include fainting

28. Spirituality • 80% Christian with 90% of them Roman Catholic • 5% practices Islam • Many returning to Bathala, ancestral religion with a spiritualist guide who is usually a woman

29. Spirituality Continued • Novenas and prayers are commonly said for the sick person • Good health comes to those who are in good with God and is the “Will of God” • Many are considered fatalistic, life is up to God, there is little one can do to change life circumstances and the forces of nature, monsoons, tides, volcanoes, earthquakes, etc.

30. Healthcare Practices • Adhere to Western medicine and traditional practices simultaneously • Health is the result of balance and moderation and God’s Will • Adequate sleep, rest, nutrition, and cleanliness are important for good health • Aromatic baths restore balance

31. Healthcare Practices Continued • In the Philippines many medicines can be purchased over-the-counter • May hoard and share medicine • Many do not seek care until the illness is advanced • Many distrust the healthcare environment • In the Philippines, one pays for testing before the testing is done

32. Healthcare Practices Continued • Protect oneself from wind and cold • Avoid extremes of hot and cold—balance • Introduce changes gradually • Pain is part of life and may be atonement for immoral behavior and leads to stoicism • Mental illness carries a stigma, is hereditary and may affect one’s ability for a spouse

33. Healthcare Practices Continued • Mental illness may be severe before help is sought —take care of family member at home • Somatization of symptoms is common • Important to maintain self-esteem and self-image for self and family • Able to enter the sick role easily

34. ClickerCheck Mrs. Lino, age 38 years, has been seeing a traditional Filipino healer for her pregnancy complications. A Filipino traditional healer is • Galang. • Utangnaloob. • Hilot. • Hiya.

35. Correct Answer Correct answer: C A hilot is a traditional Filipino healer.