Survival Spanish for Pharmacists

Presented by:

Myelita Melton, President, SpeakEasy Communications, Inc.

10:00 a.m. - 11:30 a.m., Saturday, October 7, 2006 Las Vegas, Nevada

Evaluation # 06-121

This program is approved by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit. NCPA is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Educational Objectives Presentation Title: Survival Spanish and Cultural Issues for the Community Pharmacist Name of Presenter: Myelita Melton, MA Objectives: 1. Describe the diversity found in the growing US Hispanic population 2. Identify cultural and socioeconomic differences in Hispanics as they relate to attitudes on healthcare and medication 3. Explain the importance of homeopathic and herbal remedies in Hispanic culture 4. Use the Spanish sound system to pronounce words and phrases 5. Describe the four parts of a Hispanic person’s name to start a client record

Survival Spanish Survival Spanish and Cultural Issues for the and Cultural Issues for the

Community PharmacistCommunity PharmacistMyelita Melton, MAMyelita Melton, MA

October 7, 2006October 7, 2006

•• Author of 30 industryAuthor of 30 industry--specific Spanish specific Spanish programs and CDsprograms and CDs

•• Former NBC staffer Former NBC staffer

•• Rockefeller ScholarRockefeller ScholarMyelita appearing in the SBAMyelita appearing in the SBA’’s s 5050thth anniversary videoanniversary video

Myelita Melton, MAMyelita Melton, MA

AmericaAmerica’’s Favorite Teachers Favorite Teacher

LearningLearning ObjectivesObjectives•• Describe the diversity found in the Describe the diversity found in the

growing US Hispanic populationgrowing US Hispanic population

•• Identify cultural and socioIdentify cultural and socio--economic differences in Hispanics economic differences in Hispanics as they relate to attitudes on as they relate to attitudes on healthcare and medicationhealthcare and medication

•• Explain the importance of Explain the importance of homeopathic and herbal remedies homeopathic and herbal remedies in Hispanic culturein Hispanic culture

LearningLearning ObjectivesObjectives•• Use the Spanish sound system Use the Spanish sound system

to pronounce words and to pronounce words and phrasesphrases

•• Describe the four parts of a Describe the four parts of a Hispanic patientHispanic patient’’s name to s name to start a client recordstart a client record

WhatWhat’’s a Hispanic?s a Hispanic?WhatWhat’’s a Latino?s a Latino?Which term do I use?Which term do I use?Is there a difference?Is there a difference?

WhoWho’’s Whos Who

Hispanic: Hispanic: Used by US Government Used by US Government since 1978since 1978

From the Latin word for From the Latin word for Spain Spain ““HispaniaHispania””

People who speak Spanish People who speak Spanish and trace their family origin and trace their family origin to Spain.to Spain.

WhoWho’’s Whos Who

Latino/Latina:Latino/Latina:People from 20 Latin People from 20 Latin

America countries who America countries who speak Spanish and trace speak Spanish and trace family origin to the family origin to the Western HemisphereWestern Hemisphere

WhoWho’’ss WhoWho

Gaining in usageGaining in usageRacially neutralRacially neutralPreserves national originPreserves national origin““New WorldNew World”” termterm

LatinoLatino (m)(m) LatinaLatina (f)(f)

Use either Hispanic or Latino. Use either Hispanic or Latino. Both are correct!Both are correct!

Over 43 million in the US Over 43 million in the US speak Spanishspeak Spanish

Majority minorityMajority minorityOne in every 7 people in One in every 7 people in the US is Hispanicthe US is HispanicProjected to be 25% of US Projected to be 25% of US population by 2050.population by 2050.

Numbers rise because of higher birth rate Numbers rise because of higher birth rate and immigrationand immigration

Our Majority MinorityOur Majority Minority

Our Majority MinorityOur Majority Minority

AreAre::Hard workingHard workingFamily centeredFamily centered

WantWant::Better livesBetter livesEducation for Education for childrenchildren

Startling StatisticsStartling Statistics

During the 1990s the Hispanic During the 1990s the Hispanic population grew more than 63%population grew more than 63%

18% of the nation18% of the nation’’s school s school children are Hispanicchildren are Hispanic

Is she your future customer?Is she your future customer?

EconomicEconomic PowerPower

LatinosLatinos are very loyal are very loyal customerscustomers

Many prefer cash over Many prefer cash over checks and credit checks and credit

cardscards

Spending power Spending power expected to increase to expected to increase to

926 billion in 2007926 billion in 2007

MovimientoMovimiento in the USin the USLatinos live in all 50 statesLatinos live in all 50 states

Migration from within the US Migration from within the US affects every stateaffects every state

Due to local economic conditionsDue to local economic conditionsHurricanes and natural disastersHurricanes and natural disastersImmigration primarily affects Immigration primarily affects border states and large metro border states and large metro areasareas

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9 4 Mexican

Central & SouthAmericanPuerto Rican

Cuban

USUS DemographicsDemographicsFour Primary Groups of LatinosFour Primary Groups of Latinos

10 Southern States10 Southern States……have the have the fastestfastest growing growing

Latino populationsLatino populations

1.1. GeorgiaGeorgia

2.2. North CarolinaNorth Carolina

3.3. ArkansasArkansas

4.4. TennesseeTennessee

5.5. South CarolinaSouth Carolina

6.6. VirginiaVirginia

7.7. KentuckyKentucky

8.8. AlabamaAlabama

9.9. MississippiMississippi

10.10. LouisianaLouisiana

TheThe NewNew LatinoLatino SouthSouth

HypergrowthHypergrowth DestinationsDestinations

1.1. RaleighRaleigh

2.2. GreensboroGreensboro

3.3. CharlotteCharlotte

4.4. AtlantaAtlanta

5.5. OrlandoOrlando

6.6. LasLas VegasVegas

7.7. NashvilleNashville

8.8. Ft. LauderdaleFt. Lauderdale

9.9. SarasotaSarasota

10.10.PortlandPortland

Our Southern NeighborsOur Southern Neighbors

Average Minimum WageAverage Minimum WageMexico: $1.78/hour Mexico: $1.78/hour

Cuba: $14.00/ monthCuba: $14.00/ month

Many have Many have NONO electricity or clean waterelectricity or clean water

Send Send ““homehome”” $20 billion each year$20 billion each year

OurOur SouthernSouthern NeighborsNeighbors

Leave school to get jobsLeave school to get jobsLimited healthcareLimited healthcare

Live in povertyLive in povertyHave poor nutritionHave poor nutritionHave few basic Have few basic necessitiesnecessities

In many countries education is a luxury In many countries education is a luxury notnot a necessity!a necessity!

Latinos and HealthcareLatinos and HealthcareAttitudes Shaped ByAttitudes Shaped By

English ProficiencyEnglish Proficiency

EducationEducation

AcculturationAcculturation

Limited Access to Limited Access to ServicesServices

Legal statusLegal status

Lack of preventive healthcareLack of preventive healthcare

Misconceptions about nutrition Misconceptions about nutrition and weightand weight

Seek care only in a crisisSeek care only in a crisis

Fatalistic view of illnessFatalistic view of illness

Many symptoms are selfMany symptoms are self--treatedtreated

Culture andCulture and Medical IssuesMedical Issues

Dangerous Dangerous TiendaTienda DrugsDrugsDipyroneDipyrone ((MetamizolMetamizol))Taken off the US market Taken off the US market in 1977in 1977

Uses:Uses: Alleviating pain or feverAlleviating pain or fever

Risks:Risks: Depletion of white blood Depletion of white blood cells leading to extreme cells leading to extreme infectioninfection

Dangerous Dangerous TiendaTienda DrugsDrugs

LincomycinLincomycin ((LincocinLincocin))

Uses:Uses: Severe bacterial Severe bacterial infections infections

Risks:Risks:Required to carry Required to carry warnings for severe warnings for severe side effectsside effects

Dangerous Dangerous TiendaTienda DrugsDrugsPhenylbutazonePhenylbutazone ((ButazolidinButazolidin))

Uses: Uses: AntiAnti--inflammatoryinflammatory

Regulation: Regulation: Allowed for use in Allowed for use in horses & dogs in horses & dogs in the US but not peoplethe US but not people

Risks: Risks: Ulcers, liver and Ulcers, liver and blood blood disordersdisorders

Dangerous Dangerous TiendaTienda DrugsDrugsBetween 1998 and 2001 almost Between 1998 and 2001 almost 1/3 of 79 1/3 of 79 ““tiendastiendas”” in NC were in NC were selling pills, syrup for infants selling pills, syrup for infants and the and the injectableinjectable form of form of ““AspirinaAspirina MexicanaMexicana””

ItIt’’s estimated that 2/3s estimated that 2/3’’s of s of US US tiendastiendas sell prescription sell prescription medicines under the countermedicines under the counter

LatinosLatinos and Heart Diseaseand Heart DiseaseHeart disease is the leading Heart disease is the leading

cause of deathcause of death

29% of Mexican29% of Mexican--American adults American adults have cardiovascular diseasehave cardiovascular disease

MexicanMexican--American men more American men more likely to have high cholesterollikely to have high cholesterol

LatinosLatinos and Cancerand CancerAnnually 20% of Hispanic deaths Annually 20% of Hispanic deaths

attributed to cancerattributed to cancer

Cancer risk is different for:Cancer risk is different for:

Foreign born vs. US bornForeign born vs. US bornCountry of originCountry of originDegree of acculturationDegree of acculturationSocioeconomic statusSocioeconomic status

LatinosLatinos and Diabetesand Diabetes

Diabetes is the 6Diabetes is the 6thth leading cause of deathleading cause of death

2 Million or more Latinos age 20+2 Million or more Latinos age 20+

Twice as likely to develop Twice as likely to develop serious complicationsserious complications

2525--30% of Latinos over age 50 30% of Latinos over age 50 have diabeteshave diabetes

““EpidemicEpidemic”” proportionsproportions

EducationEducation and Trainingand Training

Hispanics have Hispanics have the highest rate of the highest rate of illiteracy of any illiteracy of any minority in the minority in the USUS

27% of Hispanics over the age of 25 27% of Hispanics over the age of 25 have only a 9th grade educationhave only a 9th grade education

53% speak English fluently53% speak English fluently

43% have Limited English 43% have Limited English Proficiency (LEP)Proficiency (LEP)

Need understanding, Need understanding, help,help, and our and our patiencepatience

LearningLearning EnglishEnglish

As an adult, As an adult, 7 Years+ to full fluency7 Years+ to full fluency

ThereThere’’s s AlwaysAlways an Exception!an Exception!

English Is Full of SlangEnglish Is Full of Slang

EnglishEnglish is Harder!is Harder!

No SlangNo Slang

Speak SlowlySpeak Slowly

Get to the PointGet to the Point

DonDon’’t Yell!t Yell!

Eye Contact Eye Contact –– Body LanguageBody Language

TipsTips & Techniques& Techniques

Share the same five vowelsShare the same five vowels

Many words are the same Many words are the same in both languagesin both languages

You donYou don’’t have to speak t have to speak perfectly to communicate!perfectly to communicate!

““PocoPoco espaespaññolol”” goes a long way!goes a long way!

EspaEspaññol and ol and inglinglééss……KeepKeep in Mindin Mind

SpanishSpanish vowels make essentially vowels make essentially the same soundsthe same sounds

In English, vowels can be said In English, vowels can be said 27 different ways!27 different ways!

Spanish vowels are Spanish vowels are nevernever silent.silent.The consonants sound about the The consonants sound about the

same as in Englishsame as in English

AlsoAlso Keep in MindKeep in Mind

VowelsVowels

A = A = AHAHE = E = EHEHI = I = O = O = OOU = U = OOOO

EE——

AspirinaAspirinaSalsaSalsaSeSeññoraoraGraciasGraciasTabletaTabletaFormulaFormula

CasaCasaTacoTacoNachoNachoAdiAdióóssDrogaDrogaRecetaReceta

A =A =AHAH

E =E =EHEH

JosJoséé

EspaEspaññolol

BuenoBueno

OlOléé

FiestaFiesta

MedicinaMedicina

SeSeññoror

TequilaTequila

GrandeGrande

InglInglééssSiestaSiestaTortillaTortillaPacientePacienteIdentificaciIdentificacióónnInformaciInformacióónn

I =I =EE——

O =O =OhOh

LocoLocoNombreNombreCompletoCompletoPorPor favorfavorCinco de mayoCinco de mayo

U =U =OOOOUnoUno UrgenteUrgente JulioJulio

NNúúmeromero MuchoMucho

CH CH –– Nacho, MachoNacho, Macho

ÑÑ –– NiNiñño, Espao, Españñolol

LL LL –– Tortilla, QuesadillaTortilla, Quesadilla

RR RR –– Burrito, ZorroBurrito, Zorro

4 Extra Letters4 Extra Letters

H H = Always silent= Always silent

J J = The Sound of H= The Sound of H

GE GE = H = H AgenteAgente

GI GI = G = G EnergEnergííaa

OtherOther TipsTips

PharmacyPharmacy FarmaciaFarmacia

CreamCream CreamaCreama

SteroidSteroid EsteroideEsteroide

VitaminVitamin VitaminaVitamina

RemedyRemedy RemedioRemedio

HospitalHospital HospitalHospital

AmigosAmigos SimilaresSimilares

What is a What is a ““mala mala reaccireaccióónn””??

StartStart Here!Here!The Most Important Words AreThe Most Important Words Are thethe

OnesOnes YouYou AlreadyAlready Know!Know!

Please Please PorPor favorfavorThank youThank you GraciasGraciasSirSir SeSeññororMaMa’’amam SeSeññoraoraMissMiss SeSeññoritaorita

Building trust is the key to successful Building trust is the key to successful tratamientotratamiento!!

SpanishSpanish SoundsSounds RRáápidopidoLearn These Emergency Phrases FirstLearn These Emergency Phrases First

No No comprendocomprendo..

HabloHablo pocopoco espaespaññol.ol.

¿¿HablaHabla inglingléés?s?

RepitaRepita, , porpor favor.favor.

HablaHabla mmááss despaciodespacio..

Gracias.Gracias.

I donI don’’t understand.t understand.

I speak a little Spanish.I speak a little Spanish.

Do you speak English?Do you speak English?

Repeat, please.Repeat, please.

Speak more slowly.Speak more slowly.

Thank you.Thank you.

¡¡Hola! Soy + (your name)Hola! Soy + (your name)Soy Soy farmacfarmacééuticoutico. (. (aa f.f.))

oror Soy Soy droguistadroguista ((ttéécnicocnico) (a ) (a f.f.). ). HabloHablo pocopoco espaespaññol.ol.

¿¿ HablaHabla inglingléés?s?HablaHabla mmááss despaciodespacio..

Gracias.Gracias.¿¿PuedoPuedo servirleservirle??

IntroducingIntroducing YourselfYourself

UnderstandingUnderstanding NamesNames

Spanish Names Have 4 PartsSpanish Names Have 4 Parts

PrimerPrimer nombrenombreFirst nameFirst name

SegundoSegundo nombrenombreMiddle nameMiddle name

ApellidoApellido paternopaterno ––FatherFather’’s surnames surname

ApellidoApellido maternomaternoMotherMother’’s surnames surname

CarlosCarlos

JuanJuan

SantanaSantana

RodriguezRodriguez

A A SeSeññoritaorita Has 4 NamesHas 4 Names

PrimerPrimer nombrenombreFirst nameFirst name

SegundoSegundo nombrenombreMiddle nameMiddle name

ApellidoApellido paternopaterno ––

FatherFather’’s surnames surname

ApellidoApellido maternomaternoMotherMother’’s surnames surname

CarmenCarmen

JuanitaJuanita

MirandaMiranda

RiveraRivera

Tying the KnotTying the KnotIs she Is she SeSeññoraora

Miranda Miranda -- SantanaSantana

oror

MirandaMiranda -- RodriguezRodriguez??

Carmen Juanita Miranda Carmen Juanita Miranda -- SantanaSantana

EsposoEsposo y y EsposaEsposaCarmenCarmen

DropsDropsher her apellidoapellido maternomaterno

AddsAddshis his apellidoapellido paternopaterno

WhenWhen éél nil niñño arriveso arrives……..

Primer Primer nombrenombre:: JosJoséé

Segundo Segundo nombrenombre:: CarlosCarlos

ApellidoApellido paternopaterno:: ??????

ApellidoApellido maternomaterno:: ??????

JosJoséé Carlos Carlos

Santana MirandaSantana Miranda

NaciNacióó el 3 de el 3 de juliojulio 20022002

WhenWhen éél nil niñño arriveso arrives……..

CuCuááll eses susu nombrenombre completocompleto??

••A name canA name can’’t be t be ““fullfull””

••ItIt’’s information sos information so……

••ItIt’’s complete or incomplete!s complete or incomplete!

••ItIt’’s a better match to ingls a better match to ingléés!s!

There are at least two ways to ask a There are at least two ways to ask a personperson’’s names name

¿¿CuCuááll eses susu nombrenombre completocompleto??¿¿CCóómomo se llama?se llama?

¿¿

Learn the Learn the ““emergencyemergency””phrases firstphrases firstMake notesMake notesCarry Carry ““cheatcheat”” sheetssheetsPractice each dayPractice each dayLaugh at your mistakesLaugh at your mistakesDonDon’’t laugh at othert laugh at other’’s s mistakesmistakes

Set Sail and Explore!Set Sail and Explore!Keep talking!Keep talking!

Keep talking!Keep talking!

Work on your accent, Work on your accent, but donbut don’’t worry about itt worry about it

Learn the words you Learn the words you use the most firstuse the most first

Review oftenReview often

Set Sail and Explore!Set Sail and Explore!

Keep talking!Keep talking!Say what you knowSay what you know——even if iteven if it’’s not a s not a complete sentencecomplete sentence

Have fun and go at Have fun and go at your own speed!your own speed!

NeverNever give up!!give up!!

Set Sail and Explore!Set Sail and Explore!

AdAdííosos¡¡MuchasMuchas Gracias!Gracias!

C h a n g i n g C h a n g i n g A t t i t u d e s & A b i l i t i e s

A t t i t u d e s & A b i l i t i e s

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Survival Spanish and Cultural Issues for the Community Pharmacist

Using This Material… Throughout this handout you will find study tips and pronunciation guides to help you learn practical Spanish words and phrases. In the guides we have broken down the Spanish words by syllables, choosing English words that closely approximate the Spanish sound needed. This method makes learning Spanish easier because it doesn’t seem so foreign. When you see letters that are BOLD in the guide, say that part of the word the loudest. The bold capital letters are there to show you where the emphasis falls in that particular word. Learning Objectives:

1. Describe the diversity found in the growing US Hispanic population. 2. Identify cultural and socioeconomic differences in Hispanics as they relate

to attitudes on healthcare and medication. 3. Explain the importance of homeopathic and herbal remedies in Hispanic

culture. 4. Use the Spanish sound system to pronounce words and phrases. 5. Describe the four parts of a Hispanic person’s name to start a client record.

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Cultural Diversity Información

What’s The Proper Term? Both!

Latino/Latina: Anyone from Latin America who speaks Spanish as his or her native language. (Preferred) Hispanic: Anyone who speaks Spanish as his or her native language and traces family origin to Spain. Note: Don't assume that because a person speaks Spanish that they are Mexican. They could be from anywhere in Latin America.

Hispanics in the US come mainly from the following three

areas:

1. Mexico 2. Central & South America

3. Puerto Rico 4. Cuba

According to US Census:

2. Over 43 million in the US speak Spanish.

3. Hispanics are the majority minority in America.

4. By 2050, Hispanics will make up 25% of the US population.

5. Georgia & NC have the fastest growing Hispanic populations.

6. Over 17% of the nation’s school-aged children are Latino.

7. In 2007, Latino buying power will surge to over 900 billion dollars.

8. 47% are limited in English proficiency.

Central America

Each year Latinos come to America because of natural disasters such as hurricanes or drought. High unemployment in Latin America is also a factor in immigration.

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Factors Shaping Hispanic Attitudes on Healthcare

Hispanic attitudes on healthcare and medical treatment are as complex as Hispanics are themselves. By far, the largest obstacle to providing excellent healthcare services to Latinos in the US is overcoming the language barrier. In addition to the limited English proficiency found in many first-generation Hispanics, many other factors shape their overall attitudes on our healthcare system. The following issues must be considered in any discussion of Hispanics and healthcare:

1. Language barriers a. Lack of bilingual healthcare providers b. Lack of interpreters in the healthcare setting c. A patient’s inability to read Spanish language information

or brochures d. Brochures which are badly translated or translated into a grade-

level format that is inappropriate e. Cultural conflicts between Latinos from different countries

i. Use of language ii. Level of education

iii. Cultural attitudes f. Many Latinos understand there are laws which require interpreters

in healthcare settings but feel that providers do not always follow the law

g. Telephone translators are impersonal and have no knowledge of the individual

i. It is difficult to discuss issues of a personal nature with a stranger by telephone

ii. Particular problem for older, female patients 2. Status discrimination: Legal or Illegal 3. Lack of education

a. 27% of Hispanics over the age of 25 only reach the 9th grade b. Many first-generation Hispanics are functionally illiterate in

Spanish 4. Acculturation

a. First Generation: Tends to integrate into US society more slowly

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i. Hangs on to traditional values ii. Retains native language

iii. Always limited in English proficiency because of the difficulty in learning a second language in adulthood

b. One and a Half Generation: Born in a Latin American country but immigrated into the US with parents at an early age.

i. Becomes bilingual ii. Learns and retains core values from first generation parents

c. Second Generation: Completely bilingual and bicultural 5. Limited access to services

a. Limited knowledge about services b. Lack of trust in the medical system

6. Perception of treatment a. Experience longer waits b. Denied services due to language barriers c. Lack insurance d. Possible discrimination e. Lack of cultural understanding on the part of providers

Cultural Values and Healthcare For many US healthcare providers it is hard to realize how poverty in Latin America affects Hispanic attitudes with regards to healthcare. The lack of healthcare facilities throughout the region has a serious impact on the overall health and nutrition of the citizens who live there—especially the children. In many areas, public clinics or missionary hospitals are the only avenues of care available. Often these facilities lack basic supplies and are not open on a regular basis. Many small towns in Latin America do not have pharmacies. It is not unusual for patients to take buses to larger towns to purchase their prescription medication. The extreme poverty in Latin America contributes to the following pervasive cultural values in regards to good health and healthcare.

1. Lack of preventive healthcare a. Seek care only in a crisis b. Machismo

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2. Misconceptions about nutrition and weight a. Being overweight in males shows affluence b. Overweight babies and children are considered to be healthy

3. Fatalistic view of illness (Particularly chronic diseases like asthma, obesity, and diabetes)

4. Many symptoms are self-treated 5. Use of folk practitioners and alternative medicine

a. Mexico: “curanderos” b. Cuba: “santeros” c. Puerto Rico: “espiritistas”

6. Rely heavily on the advice of family and friends a. Feel that following a special treatment regimen or diet is selfish

because everyone in the family is affected by it 7. Prefer to visit healthcare facilities or deal with healthcare professions who

are bilingual. a. They feel they are “treated better” b. The cultural sensitivity displayed in a bilingual setting makes the

patient feel “more at ease” c. Bilingual healthcare providers are better able to establish a trusting

relationship with the patient

Dangerous “Tienda” Drugs and Home Remedies Latino convenience stores called “tiendas” (t-N-das) provide an important slice of life for immigrants living in the US. “Tiendas” are a hub of social life, where people go to discuss the events of the day and to purchase familiar brands. In most Latin American countries it is common to buy antibiotics and other medications at the “tienda” without a prescription. The practice of buying prescription medication at the “tienda” is becoming more commonplace in the US, especially in areas with high immigrant populations. An estimated two-thirds of US “tiendas” sell prescription medicines to their customers “under the counter.” Because the medication is readily available in their country of origin, many Latinos don’t understand why they can’t purchase the same thing here without seeing a doctor. Many Hispanics don’t have health insurance, and some feel going to the “tienda” for medicine is a much less-expensive course of

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treatment. Going to the “tienda” is also faster because it eliminates the need to call the doctor’s office and wait for an appointment. It also eliminates an absence from work. Since the possibility of job loss is frightening to most Latinos, many of them will avoid absences of any kind, especially for illness. As the Hispanic population continues to grow in the US, each healthcare provider should learn to ask the following question: Are you taking medicine without a prescription? ¿Toma medicina sin receta médica? (TOE-ma may-d-SEEN-na seen ray-SAY-ta MAY-d-ca) Listed below are the most dangerous and prevalent “tienda” drugs sold without prescription in the US:

1. Dipyrone (Metamizol) banned in US in 1977. a. Still marketed in Mexico, Central America and some European

countries b. Believed to be simply a stronger form of “aspirin” c. Pyrazolone class of analgesics d. Generic Names: Neo-Melubrina, Magnopyrol and Prodolina e. Uses: Alleviating pain or fever f. Risks: Depletion of white blood cells leading to fatal infection

i. Known to induce agranulocytosis by inducing an antibody response

ii. Expectant mothers exposed to “Mexican aspirin” were five times more likely to have a child suffering from leukemia

g. Between 1998 and 2001 almost 1/3 of 79 “tiendas” in North Carolina were selling Dipyrone pills, syrup for infants, along with an injectable form

2. Lincomycin (Lincocin)

a. Uses: Antibiotic for treatment of serious blood, lung, skin tissue or pelvic infections caused by bacteria.

b. Risks: Required to carry warnings for severe side effects c. Side effects: Difficulty breathing, diarrhea, pain on swallowing,

stomach pain and skin rash

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3. Phenylbutazone (Butazolidin) a. Uses: Anti-inflammatory b. Regulation: Allowed for use in horses & dogs in the US but not

for people c. Risks: Anemia and hemorrhaging in addition to ulcers, liver

problems, and blood disorders

4. Antibiotics and Birth Control Medications a. Gentamicin (Bactrim)

i. Risks: Hearing loss, kidney and nerve damage b. Penicillin

i. Often expired c. Pentrexyl (Ampicillin) d. Depo-Provera

Hispanics and Home Remedies Home remedies are very important aspects of Latino healthcare. Recipes are passed down from one generation to the next. These remedies often involve teas infused with a variety of herbs. Individuals with knowledge of herbs and how to use them are highly regarded. In Hispanic culture, balance is considered to be important in having good health and in the treatment of illness. Good health is being balanced in mind, spirit and body. When one’s body is out of balance, the following ailments can occur:

Empacho: Upset stomach caused by being psychologically distressed before, during or after eating.

Ataque de nervios: Attack of nerves caused when a person needs an outlet for grief, anger and discontent with family.

Susto: Fright or “loss of soul” that occurs due to a prolonged or chronic condition or when a person has been exposed to a traumatic experience.

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Caída de mollera: Occurs primarily in infants when the fontanelle is not properly positioned at the top of an infant’s head causing a serious blockage of oral passages that potentially can lead to death.

o In adults a significant disruption of life’s balance Mal de ojo: (Evil eye) A tremendous imbalance within social

relationships that cause high fever, headaches and sleeplessness.

Common Hispanic Home Remedies

Spanish English Use

Ajo Garlic Hypertension, antibiotic, cough syrup

Azarcón/Greta Lead/mercury oxides Empacho, teething

Damiana Damiana Aphrodisiac, chickenpox

Estafiate Wormwood Worms, colic, diarrhea, cramps, empacho

Eucalipto Eucalyptus Asthma, bronchitis, tuberculosis

Gobernadora Chaparral Arthritis (poultice); tea for cancer, venereal disease, tuberculosis, cramps, analgesic

Gordolobo Mullein Cough suppressant, asthma, tuberculosis

Manzanilla Chamomile Nausea, flatus, colic, anxiety; eyewash

Orégano Oregano Expectorant, menstrual difficulties, worms

Pasionara Passion Flower Anxiety, hypertension

Rodigiosa Bricklebush Adult onset diabetes, gallbladder disease

Ruda Rue Antispasmodic, empacho, insect repellent

Saliva Sage Prevent hair loss, diabetes

Tilia Linden Flowers Sedative, hypertension, diaphoretic

Tronadora Trumpet Flowers Adult onset diabetes, gastric symptoms, chickenpox

Yerba buena Peppermint Dyspepsia, flatus colic, susto

Zábila Aloe Vera External - cuts, burns Internal - purgative, immune stimulant

Zapote blanco Sapodilla Insomnia, hypertension, malaria

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Becoming a Culturally Competent Pharmacist It’s important to recognize the wide diversity in the Hispanic community as you become a culturally competent pharmacist. Latinos come from all races and ethnicities. Latinos from Mexico are quite different from those who come from Central, South America, or the Caribbean islands. Some Latinos are bilingual and well-educated, while others speak only Spanish and have had limited educational opportunities. The one thing they have in common is that they call themselves “Latinos,” they speak Spanish, and they possess several core cultural values which affect how they view healthcare. These core values are: Personalismo, Respecto, Espiritismo, Fatalismo and Presentismo.

Personalismo—trust and rapport established by developing warm, friendly relationships

o Expect healthcare professionals to take a personal interest in their diagnosis and treatment

o Trust can be built on even an elementary use of Spanish and more formal terms of address like Señor, Señora and Señorita

o Latinos can be offended by our efficiency. Interpreted as not caring about the health of the individual

or the effectiveness of the treatment o Latinos are uncomfortable with conflict

Saving face is important.

Respecto—self-respect and respect for those involved in the healthcare professions

o Revere healthcare professionals and others who have achieved a high degree of education

o High degree of respect for elders, whose opinions are valued because of their “life” experience

Espiritismo—a belief that the world is inhabited by good and evil

spiritual beings who can affect humans particularly in regards to their health and well-being

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o Beliefs about disease derive from a combination of sources: medieval Spanish traditions, indigenous Indian traditions, and modern, scientific knowledge

o Health is considered to be a temporary condition o Illness is caused by extremes of hot, cold, wet or dry conditions

that upset the body’s balance o The strength of traditional health beliefs varies by the degree of

acculturation, education, and socioeconomic level

Fatalismo—a lack of free-will o Often seen in patients with chronic illnesses like diabetes, cancer

or asthma o This illness is “my cross to bear.” Since it can’t be cured, it doesn’t

matter what choices I make.

Presentismo—living in the present o One cannot change the past or the future o Living in the present is more important than thinking about the

future Now that you are on the road to becoming a culturally competent community pharmacist, here are things you can do to help your patients and your staff:

1. Study your community carefully. Research articles about the ethnic groups represented in your area.

2. Attend ethnic festivals in your area. You will certainly see some of your customers. They will appreciate your interest

3. Ask your customers where they are from and to discuss life “back home.” 4. Hire bilingual staff members 5. Cultural competence also means cultural acceptance! Often a person’s

cultural tradition isn’t right or wrong. It will just be different. 6. Know your own cultural biases 7. Encourage your Hispanic patients to discuss their problems and ask

questions. Conversation is very important in Hispanic culture. 8. Use the Spanish you already know, even if it’s only “Buenos días.” This

goes a long way towards establishing a trusting relationship. 9. Be extremely polite. Courtesy titles help to build rapport.

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SpeakEasy’s Secrets to Speaking Spanish

The key to speaking Spanish is having a great sense of humor along with a desire to view customer service in a new light. Speaking another language is going to “feel funny” to you as an adult. That’s natural. It happens to everybody. It’s going to require some courage and commitment on your part to take this bold step. Por favor, please take comfort in the fact that nobody speaks perfect English or perfect Spanish! The goal is always to communicate. So, learn to laugh at your mistakes, relax, and move on. Also, keep these tidbits in mind.

Thousands of words are similar in our languages. Grammar and pronunciation don’t have to be “perfecto” to be understood.

Some very important concepts can be said in Spanish with a few simple words or phrases.

You may never have a conversation that is totally in español. It’s OK to use both inglés and español together. In

fact that’s a great way to get started speaking Spanish. Even poco español goes a long way!

You know more español that you realize!

Amigos Similares

Farmacia Hospital Paciente Medicina Tableta Droga Droguista Enferma Crema Doctor Problema Diabetes Remedio Nausea Vitamina Suplemento Cápsula Solución Depresión Causa Aspirina Inflamación Inhalador Emergencia

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The Spanish Sound

¡No se preocupe! Don’t worry. One of your biggest concerns about learning Spanish will be speaking well enough so that others understand you. Spanish is close enough to inglés that some errores won't hamper comunicación. Our languages share a common Latin heritage. Because our languages share this heritage, both have a common sound pool and grammatical structure. English and Spanish are great matches for each other. Here are the basics. The five vowel sounds are essential in speaking Spanish. Spanish vowels are importante because:

Spanish vowels are NEVER silent. Spanish vowels are consistent in how they sound. Break down large words by syllables using the vowels.

A (ah) Mama E (eh) or (a) Hay

(eh) Met I (ee) Meet O (oh) Open U (oo) Spoon

Spanish has four more letters in its alphabeto than English.

CH (che) Charlie, Chuck or chocolate LL (y) Tortilla. Ñ (ny) Canyon or onion RR (rrrr) Burrito or Zorro

Here are a few more tips for successful survival Spanish. For the most part, Spanish consonants make the same sounds as English ones; however, there are a few excepciones

The letter H is always silent. J takes on the sound of the H like it does in José, Jorge and Jesús G will also sound like an H when it is followed by an E or an I

Emergencia (a-mare-HEN-see-ah) Energía (n-air-HE-ah)

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The Spanish Accent In Spanish you will see two accent marks. Both are important and do different things. One of the diacritical marks you will see is called a “tilde.” It is only found over the letter “N.” But, don’t get the Ñ confused with N. The accent mark over Ñ makes it into a different letter entirely. In fact, it’s one of four letters in the Spanish alphabet that the English alphabet doesn’t have. The Ñ changes the sound of the letter to a combination of “ny.” You’ll hear the sound that this important letter makes in the English words “canyon” and “onion.” Occasionally you will see another accent mark over a letter in a Spanish word. The accent mark or “slash” mark shows you where to place vocal emphasis. So, when you see an accent mark over a letter in a Spanish word, just say that part of the word louder. For example: José (ho-SAY). These accented syllables are indicated in our pronunciation guides with bold, capital letters.

Pronouncing Spanish Words The pronunciation of Spanish words follows more regular rules than most other languages. That makes it easier to learn. Here are some tips to remember.

1. Most Spanish words that end with vowels are stressed or emphasized on the next to the last syllable. Medicine: medicina (may-d-SEE-nah)

2. Look for an accent mark. If the Spanish word has an accent in it, that’s the emphasized syllable. Capsule: Cápsula (CAP-soo-la)

3. Words that end in consonants are stressed on the final syllable. Doctor: Doctor (doc-TOR)

Spanish Punctuation Marks

You will see two different punctuation marks in Spanish. First there’s the upside down question mark (¿). You will see it at the beginning of all questions. It’s there to simply let you know that what follows is a question and you will need to give your voice an upward inflection. It’s the same inflection we use in English. Then, there’s the upside down exclamation mark (¡). It’s there to let you know that what follows should be vocally emphasized.

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Even More Amigos

Using what you’ve learned about the sounds of Spanish, practice with the words listed below. After you pronounce each word, go back

through them again and mark the ones you will use on the job with a highlighter. Practice these words often to help you remember the basic sounds of español.

Más Amigos Similares y Familiares

Agua Asma Agite Aplicación Cortisona Antiácido Artritis Crema Apetito Caución Diarrea Aspirina Codeína Frío Cápsula Depresión Hospital Cliente Doctor Importante Diabetes Especialista Insomnio Forma Esteroide Insulina Identificación Fantástico Leche Infección Farmacia Minuto Inflamación Fiebre Narcótico Inhalador Loción Náusea Número Refrigerador Nervioso Oficina Remedios Protección Problema Repetición Servicio Solución Tableta Temperatura Suplemento Úlcera Vitaminas Teléfono

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Tips and Techniques for Comunicación Remember: When you’re trying to communicate with anyone who doesn’t speak English as a native language, patience is a virtue! Here are a few easy things you can to do which will make the conversation easier and more productive for both of you.

Speak slowly and distinctly.

Do not use slang expressions or meaningless words.

Get to the point! Unnecessary words cloud your meaning.

Speak in a normal tone. Speaking loudly doesn’t help anyone understand you any better!

Look for cues to meaning in body language and facial expressions. Use gestures of your own to get your point across.

Don’t expect good eye contact or a firm handshake.

Never forget that the person you are speaking with is translating what you are saying in English back into their native language. After they understand what you’ve said, they must retranslate back into English. This process takes time! It isn’t automatic.

If you aren’t understood the first time, try to find a different, simpler way to say the same thing.

When you are speaking Spanish, don’t hesitate to ask the person you are talking with to speak slower or to repeat what has been said. This is especially true with memorized items like telephone numbers. They tend to be said extremely fast! Remember even in English, we sometimes have trouble understanding a telephone number from a voice mail or answering machine when it is said too quickly.

Latinos tend to stand closer to each other than North Americans do when they talk to each other, so your personal space could feel crowded. Stand your ground!

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Spanish Sounds Rápido – What Do I Do Now?

Be honest! One of the reasons you are hesitant to speak Spanish is that it sounds so fast! Naturally you’re afraid you won’t understand. Search for clues to what the person is saying. If necessary, use body language to help you convey meanings. Always ask your customer to speak more slowly. These phrases will help. Make learning them your priority. ¿Comprende, amigo?

English Español Guide I don't understand. No comprendo. no com-PREN-doe Do you understand ¿Comprende? com-PREN-day I speak a little Spanish. Hablo poco español. AH-blow POE-co

es-pan-NYOL Do you speak English?

¿Habla inglés? AH-bla POE-co eng-LACE

Repeat, please. Repita, por favor. ray-PETE-ah, pour fa-VOR

Write it, please Escribe, por favor es-SCREE-bay pour fa-VOR

Speak more slowly, please.

Habla más despacio, por favor.

AH-bla mas des-PA-see-oh pour fa-VOR

Thanks for your patience.

Gracias por su paciencia.

GRA-see-ahs pour sue pa-see-N-see-ah

How do you say it in Spanish?

¿Como se dice en español?

CO-mo say DEE-say n es-pan-NYOL

Where are you from? ¿De dónde es? day DON-day es

May I help you? ¿Puedo servirle? pooh-A-doe seer-VEER-lay

The key here is not to pánico. Your Spanish-speaking customer is having as much trouble understanding you, as you are in understanding them! Make an effort, and between the two of you, comunicación will take place.

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The Key to Getting Started The key to getting started with your Spanish is simple. Be prepared! Read from a script like the one below. Having something in hand will boost your confidence, and it will demonstrate your commitment to providing excellent customer service. First, it’s important to have a greeting. Next, introduce yourself and give your job title. The third step in this process is to express your skill level in Spanish. This is very important information! People who have studied Spanish in high school or college can sound almost like native speakers with basic “meet and greet” Spanish. Because you sound so proficient with these few phrases, you are going to send a signal of fluency that you don’t process! As a result, Latinos will believe you speak Spanish fluently and will treat you like you do. This means that the Spanish will be “muy rápido”! At this point, both of you will be very embarrassed. Follow step three by asking your patient about his or her skill in English. That’s important information for you! Don’t hesitate to ask the individual to speak slowly. This will give you a better chance at understanding. Step four is a smile with a polite “thank you.” Now, you are beginning to build a trusting relationship. Lastly, ask how you can be of service.

Hi! I’m (your name).

I’m the pharmacist. I speak a little Spanish. Do you speak English?

Speak more slowly, please. Thank you.

May I help you?

¡Hola! Soy (your name).

Soy el/la farmacéutico. (a) Hablo poco español.

¿Habla inglés? Habla más despacio, por favor.

Gracias. ¿Puedo servirle?

Making a script is a great practice technique—especially if you need to handle customer service calls over the telephone. This type of conversation is more difficult

than “in-person” because there are no visual cues from body language to help you!

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¿Cuál Es Su Nombre Completo? What is Your Complete Name?

Hispanic Names Have 4 Parts

First Name

Middle Name

Father’s Surname

Mother’s Surname

Primer Nombre

Segundo Nombre

Apellido Paterno

Apellido Materno

Carlos Juan Santana Rodríguez José Pedro Cuervo Álvarez

Poncho Luis Villa García Carmen Juanita Miranda Rivera

Always start with: Señor, Señora, or Señorita

Use Both Names or the Paternal/Father’s Surname

Señor Santana Señor Cuervo

Señor Villa Señora. Miranda-Santana

When A Woman Marries:

She Keeps Her Father’s Apellido Paterno She Drops Her Apellido Materno

Children Have The Apellido Paterno of

Both the Father and Mother

If Carlos Santana married Carmen Miranda, what would the Nombre Completo of the bebé be?

José Carlos ???? ?????

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Remedies and Medicines—Remedios y Medicinas You are going to be pleasantly surprised when you see all the English Spanish matches or cognates in this list of remedies and medicines. These really are your amigos! If you have trouble remembering the Spanish word for a particular medication, try using its brand name. Brand names, especially for products that are sold world wide, aren’t translated. A good example of this is El Tylenol.

English Español Guide Tablet Tableta ta-BLAY-taCapsule Cápsula CAP-soo-laPill Píldora PEEL-door-rah Lozenge Pastilla pahs-TEE-yaAnalgesic Analgésico ah-nal-HEY-see-co Anesthetic Anestésico ah-nay-STAY-see-co Antacid Antiácido ahn-tee-AH-see-doe Antibiotic Antibiótico ahn-tee-bee-OH-tee-co Anticoagulant Anticoagulante ahn-tee-co-ah-goo-LAN-tayAntidote Antídoto ahn-TEE-doe-toe Antihistamine Antihistamínico ahn-t-ees-ta-MEAN-knee-

coAnti-inflammatory Anti-inflamatorio ahn-tee-een-fla-ma-TOR-

ree-ohAntiseptic Antiséptico ahn-tee-SEP-tee-co Aspirin Aspirina ahs-pee-REE-na Astringent Astringente ah-streen-HEN-tay Barbiturate Barbitúrico bar-bee-TOO-ree-co Chemotherapy Quimioterapia key-mee-oh-ter-RA-pee-ahCodeine Codeína co-day-EE-naContraceptive Contraceptivo con-tra-cep-TEE-vo Cough drop Pastillas para la tos pas-TEE-yas PA-ra la toesCough syrup Jarabe para la

tosha-RA-bay PA-ra la toes

Cortisone Cortisona core-tee-SO-na Cream Crema CRAY-maDiuretic Diurético dee-oo-RAY-tee-co

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E n g l i s h E s p a ñ o l G u i d e

D i s i n f e c t a n t D e s i n f e c t a n t e d i s - e e n - f e c -T A N - t a y D r o p s G o t a sG O- t a sE a r d r o p s

G o t a s p a r a l a s

o r e j a s G O- t a s p a r a l a s

o r -R A Y- h a s

E y e d r o p s G o t a s p a r a l o s o j o sG O- t a s p a r a l o s O H- h o s I n h a l e r I n h a l a d o r n - a h - l a -D O O R I n s u l i n I n s u l i n a n - s o o -L E A N - a h L a x a t i v e L a x a n t e l a x -A N- t a yL i n i m e n t L i n i m e n t o l e a n - k n e e -M E N- t o e L o t i o n L o c i ó n l o - s e e - O NM o r p h i n e M o r f i n a m o r e - F E E- n a N a r c o t i c N a r c ó t i c o n a r -C O- t e e - c o N i t r o

g l y c e r i n e N i t r ogl i c e r i n a k n e e - t r o -g l e e - s e r -R E E- n a

N u t r i t i o n a l s u p p l e m e n t S u p l e m e n t o n u t r i c i o n a l

s o u - p l a y - M E N- t o e n e w - t r e e - s e e - o n -N A L

P e n i c i l l i n P e n i c i l i n a p a y - k n e e - s e e -L E E- n a S e d a t i v e S e d a n t e s a

y-D A N - t ay

S o l u t i o n S o l u c i ó n s o - l o u - s e e -O N S t e r o i d E s t e r o i d e e s - s t a i r -R O

Y - d ay

S u p p o s i t o r y S u p o s i t o r i o s u e - p o - s e e -T O R- r e e - o hT r a nqu i l i z e r s T r a nq u i l i z a n t e s t r a n - k ey- l e e -S A N- t ay s S a l v e U n

gü e n t o o o n - G W E N - t o e

V a c c i n e V a c u n a

va -C O O - n a

V i t a m i n s V i t a m i n a s

ve e - t a -M E- n a s

T i p s & T i d b i t s M a n y p h a r m a c i s t s a n d p h a r m a c y t e c h n ic i a n s t r a v e l a n d w o r k i n d i f f e r e n t n e i g h b o r h o o d s . B e c a u s e e a c h c o m m u n i t y i s d i f f e r e n t , t h e c u s t o m e r b a s e o f e a c h p h a r m a c y c a n v a r y w i d e l y . T h i n k c r i t i c a l l y a b o u t t h e c u s t o m e r s i n y o u r s t o r e • s c o m mu n i t y . T h e m a k e - u p o f t h e c o m m u n i t y o f t e n

d e t e r m i n e s t h e m o s t f r e q u e n t k i n d s o f m e d i c a t i o n s t h a t d o c t o r s p r e s c r i b e . L o o k a t t h e m o s t c o m m o n l y p r e s c r i b e d d r u g s a s t h e v o c a b u l a r y y o u s h o u l d l e a r n f i r s t .

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Learning Assessment Questions

Presentation Title: Spanish and Cultural Issues for the Community Pharmacist Name of Presenter: Myelita Melton Q True or False: Hispanics are an ethnic group made up of many races. Q Name two factors which impact Hispanic attitudes on healthcare?

1.

2.

Q What are “tienda drugs” and what are their dangers to Hispanics? Q Name the five Spanish vowels.

1.

2.

3.

4.

5.

Q Between the Hispanic surnames “apellido paterno” and “appelido materno” which is considered to be the “last” name?

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Selected Bibliography Chong, Nilda and Baez, Francia. Latino Culture. Yarmouth, ME: Intercultural Press, Inc., 2005. Cimino Karen and Coto Danica. “Prescription for Danger.” The Charlotte Observer 20 March 2005: A1. “Diabetes Facts and Figures among Latinos.” August 2006. National Council of La Raza. URL: http://www.nclr.org/section/diabetes_statistics “Diabetes in the Latino Population: A Case-based Approach to Optimal Management.” Aug. 2005. American Diabetes Association. URL: http://www. diabetes.org/for-health-professionals-and-scientists/latino-presentation.jsp Dorr, VJ and Cook, J. “Agranulocytosis and Near Fatal Sepsis Due to ‘Mexican Aspirin’.” The Southern Medical Journal June 1996: 612-614. Elba Arroyo, Liany. The Health of Latino Communities in the South: Challenges and Opportunities.” National Council of La Raza: 2004. “Heart Facts: Latino/Hispanic Americans.” August 2006. The American Heart Association. URL:http://www.americanheart.org/presenter.jhtml?identifier=3000994 Gutierrez, Nichole. “Latino Health Beliefs.” Fall 1998. University of California at Davis. URL: http://www.public.asu.edu/~squiroga/gutierre.HTM Jones, Jessica. “Tienda Drugs.” WUNC Public Radio: 5 July 2005. Karliner, Shelley MSW and Crewe, Sandra PhD. “Latino Health Beliefs: A Guide for Health Care Professionals.” September 1998. “National Eye Health Education Program Latino/Hispanic Communication Plan: Reaching Latinos/Hispanics at Risk.” June 1994. National Eye Institute. URL: http://www.nei.nih.gov/nehp/plans/latinplan.htm.

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Neff, Nancy, MD. “Folk Medicine in Hispanics in the Southwestern US.” Baylor College of Medicine. URL: http://www.rice.edu/projects/HispanicHealth/Courses/mod7/mod7.html Peterkin, Tom. “Scientists Link Pesticides to Child Leukemia.” URL: http://www.ochealthinfo.com/press/2002/0613nr.htm “The Hispanic Population: Census 2000 Brief.” May 2001. US Census Bureau. URL: http://www.census.gov/prod/2001pubs/c2kbr3sp.pdf. “Twenty Most Frequently Asked Questions About the Latino Community.” March 2006. National Council of La Raza. URL: http://nclr.org/content/faqs/detail/396 Ragan, Dan. “NCDA & CS Program Aims to Inform Hispanic families about Dangers of Illegal Prescription Drugs.” May 2006. NC Department of Agriculture and Consumer Services. URL: http://www.ncagr.com/paffairs/release/2006/5-06tiendas.htm. Sandoval, Annette. “Homegrown Healing: Traditional Home Remedies from Mexico.” Berkley: Berkley Publishing Group, 1998. Sleath, Betsy PhD. “Becoming a Culturally Competent Pharmacist.” March 2003. Pharmacy Times. URL: http://www.pharmacytimes.com/article.cfm?ID=33 Vargas, Joe. “Painkiller Poses Risks for Hispanics.” Orange County Public Health Services. 13 June 2002. URL: http://www.ochealthinfo.com/press/2002/0613nr.htm

1

Learning Assessment Questions

Presentation Title: Survival Spanish and Cultural Issues for the Community Pharmacist Name of Presenter: Myelita Melton 1. True or False: Hispanics are an ethnic group made up of many races. 2. Name two factors which impact Hispanic attitudes on healthcare? 3. What are “tienda drugs” and what are their dangers to Hispanics? 5. Name the five Spanish vowels. 6. Between the Hispanic surnames apellido paterno and appelido materno which is considered to be the “last” name?

2

Learning Assessment Answers

Presentation Title: Spanish and Cultural Issues for the Community Pharmacist Name of Presenter: Myelita Melton 1. True: Hispanics are considered to be an ethnic group made up of many races. Most Hispanics have some degree of indigenous heritage. 2. Factors which impact Hispanic attitudes on healthcare are: education, acculturation and limited access to services. 3. Many Hispanics are able to purchase medications at Hispanic owned and operated stores which have been taken off the market for safety reasons by the FDA. Even though these medications are still available in Mexico and other Latin American countries, they pose a significant risk to a patient’s health because of the possibility of drug interaction. 4. The Spanish vowels are the same as the five primary vowels in English: A, E, I, O, and U. 5. The apellido paterno or “paternal surname” is considered to be the “last” name.