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Cultural Competence Questions on the NP Certification Exam: Curanderismo

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC



Are topics pertaining to cultural competence included on the NP certification exam? If so, what types of issues might be covered?
Provision of culturally competent care is an essential part of NP practice, and content related to cultural competence is typically included on the NP certification exam. One aspect of cultural competence involves understanding the health beliefs and practices shared by cultural subgroups and being able to discuss these issues with patients. For example, NPs who treat Latino patients should be familiar with the traditional folk healing practices associated with curanderismo.

What is curanderismo?
Curanderismo is folk healing system of Mexico and other Latin American countries, including Guatemala, Nicaragua, Colombia, and Honduras. The term is derived from the Spanish word curar, meaning “to heal.” In some Latino communities in the United States, curanderismo is practiced as an alternative form of healthcare.

The practice of curanderismo historically has revolved around specially trained folk healers called curanderos (male healers) or curanderas (female healers). The techniques curanderos/as employ in folk healing are either passed down from family members or learned through apprenticeships with experienced healers. These techniques include herbal remedies, massage and manipulation of body parts, prayer, healing rituals, and spiritualism. Often these techniques involve reassurance and suggestion by the healer as well as involvement of family or social support systems, elements that can provide some benefit to those undergoing treatment.1

Curanderismo combines an ancient Latin American system of folk healing with aspects of Catholicism, and thus reflects both Spanish and indigenous influences. Curanderos/as see themselves, and are seen by the people they treat, as having a gift or innate talent for healing that is given by God. However, they see themselves as agents through which God works, not as effecting cures themselves. They frequently use religious items in their healing processes, such as candles, holy water, and crucifixes, and prayer plays a special role in treatment. Curanderos/ as also believe that illness and poor health arise from an imbalance of hot and cold within a person. When treating a person, curanderos/as sometimes classify that person’s activities, diet, drug consumption, and illnesses as hot or cold and prescribe remedies to reestablish equilibrium.

What conditions do curanderos/as treat?
People seek curanderismo remedies and treatments for social problems (eg, marital problems) as well as for a broad range of physical and psychological problems such as headaches, stomach and intestinal problems, kidney problems, back pain, diabetes mellitus, fatigue, anxiety, and depression.2 Patients typically receive treatment for these physical conditions from a curandero/a alongside treatment from a clinician. Curanderos/as are also consulted for help with folk illnesses. Examples of common folk illnesses include empacho (intestinal blockage), mal de ojo (“evil eye”), mal puesta (“bewitchment,” or illnesses caused by witchcraft), and susto (fright sickness, or loss of spirit). The folk illness susto, from the Spanish word for “scared,” is a condition in which the soul is believed to flee the body because of a traumatic or frightening event, resulting in soul loss and mental illness.3 Curanderos/as can specialize in their practice. Specialists include yerberos/as, herbalists with in-depth knowledge of botanical remedies; parteras, or midwives; and sobadors/sobadoras, who specialize in massage.

How common is curanderismo?
In a survey of 405 Hispanic patients who presented for healthcare to public health system clinics in Denver, CO, 29.1% reported they had been to a curandero/a at some point in their lives, and 91.3% knew what a curandero/a was.2 Of those who visited a curandero/a, 81.4% did not tell their healthcare provider about it and 72.9% believed they benefited from the visit. Variables that predicted use of curanderos/as were being bilingual in English and Spanish, at least some post–high school training, and a somewhat higher household income.

What are the benefits and risks?
Curanderismo is used in some Latin American communities to supplement conventional healthcare for various reasons. Folk healing offers treatment for ailments that conventional healthcare does not recognize, such as mal puesta. Patients also turn to cur an derismo when conventional methods for treating their chronic or serious conditions don’t work, or when they are dissatisfied with conventional healthcare in general. Notably, patients typically do not rely exclusively on a curandero/a for their healthcare needs, but rather receive care from conventional healthcare and a curandero/a concurrently.

Use of curanderismo can have benefits for patients. The patient’s family or community often participates in the healing practices and rituals, which gets the patient’s support system involved in addressing his or her health issue(s). Also, curanderismo recognizes the spiritual, emotional, and psychological aspects of illness as well as the physical. For patients with major health problems like cancer, this holistic approach, combined with prayer and massage, can provide patients comfort, relief, and spiritual peace of mind. Curanderos/as are not expected to cure serious medical problems, and reliable healers will refer patients to conventional healthcare when confronted with a condition that is beyond their abilities.

While the remedies and treatments used in curanderismo typically do not cause harm, problems can arise. The herbs and other substances used in folk healing have not been tested and their side effects and interactions with other substances are not known. Also, a patient’s interaction with a folk healer can delay care for serious conditions for which conventional healthcare has effective treatments. Given these risks, it is important for NPs to initiate discussions with patients about alternative forms of healthcare such as curanderismo.

References
1. Mull JD, Mull DS. A visit with a curandero. West J Med 1983;139:730–6.
2. Padilla R, Gomez V, Biggerstaff SL, Mehler PS. Use of curanderismo in a public health care system. Ann Intern Med 2001;161:1336-40.
3. Tafur MM, Crowe TK, Torres E. A review of curanderismo and healing practices among Mexicans and Mexican Americans. Occup Ther Int 2009;16:82–8.
 
Updated 4.21.14