Case 3: Alejandro Flores

This case focuses on a low-income, non-English speaking Latino patient and family. As you read through this story, pay special attention to issues involved in medical decision-making such as gender roles and values, and interest in treatments outside of traditional western medicine based on culturally constructed folk illness beliefs.

When Alejandro Flores was born, his parents were ecstatic and very proud. Alejandro was their first child born in the Continental United States, in a world far away from their tradition and family in Puerto Rico. The Flores had worked very hard to move to the Northeast a year before Alejandro’s birth, and they felt that his arrival helped connect them with their new home.

It is four years after Alejandro’s birth, and the Flores family has grown even larger. There are now 5 children (3 older than Alejandro and one 20-month-old) and Alejandro’s grandmother living in the same apartment. Alejandro’s mother, Señora Flores, takes care of her family as best she can, and she feels lucky to have her mother there to give her advice and a helping hand. Señor Flores works very hard as a custodian at a local school to provide his family with enough income. He has picked up a little English at work, but only Spanish is spoken at home.

Serious asthma problems run in the Flores family, and Alejandro is no exception. Although he looks healthy, Alejandro has had severe asthma for several years. When he was 2, a series of awful wheezing episodes sent him to the hospital multiple times. Sr. and Sra. Flores do their best to care for him, but they are both spread pretty thin.

To help with all the Alejandro's asthma problems, the Flores recently relocated to a new apartment that has air-conditioning, and Sr. Flores has limited his smoking to outside on the patio. The family has two dogs, which could be a problem, but they just couldn’t see getting rid of two loved members of their family.

Alejandro also takes a lot of medications for his asthma symptoms. His parents have been taught about asthma and have been given an asthma action plan—all in Spanish. They were told to call the clinic if at any time Alejandro’s symptoms worsened. Despite these actions, Alejandro still continues to have heavy wheezing and a tight cough, especially at night.

With Alejandro continuing to have asthma problems, Sra. Flores became skeptical that the medications weren't working. Under the guidance of her mother, she took Alejandro to an espiritista. At the espiritista's advice, Sra. Flores stopped giving Alejandro all of the prescribed medications, and began giving him an herbal tea that she believed, along with prayer, would take Alejandro's asthma symptoms completely away.

Alejandro and his parents have come for a regularly scheduled visit to the clinic today to see if the new medications were helping to control Alejandro’s symptoms. This is the second visit since Alejandro’s last hospitalization 6 months ago. Sra. Flores has not contacted anyone at the clinic about Alejandro’s asthma getting worse, so the clinic assumes the best.

Later, in learning Activity 1: The Big Picture, you will find out what happens during this visit.

There are several issues to consider about this case. You will explore these issues more fully in the learning activities.

Why might Sra. Flores have chosen to consult an espiritista rather than call the clinic when Alejandro was not getting better?
Do you think that traditional Latino gender roles might have some effect on this child and family’s experience with the health care system
How might it be possible to incorporate alternative folk remedies with mainstream western medicine in developing a treatment plan for Alejandro?