CHAPTER 17: Filipino Americans Marilyn Uvero
Overview of the Philippines
The Philippine Islands constitute an independent nation located in the Pacific Ocean approximately 450 miles off the southeastern coast of China.
Taiwan is the nearest neighbor, approximately 65 miles to the north; Indonesia is 150 miles to the south. More than 7000 islands compose the Philippine Archipelago; however, the largest islands, Luzon (40,420 square miles) and Mindanao (36,537 square miles), account for 94% of the country’s total land area.
The economy of the Philippines is based on agriculture. One of the principal crops is rice, which occupies about half the farmed land in the Philippines.
Corn and coconuts are also very important crops, and other significant crops include root crops, fruits, nuts, sugarcane, abaca, tobacco, ramie, kapok, and rubber.
Although agriculture is the principal industry, the yields per crop per acre are among the lowest in Asia (Central Intelligence Agency, 2015).
Causes of low productivity of agriculture in the Philippines include poor farm management, inadequate use of fertilizers, poor seeds, and lack of incentive on the part of the farmers because many are tenant farmers
Immigration to the United States
Three different waves of Filipino immigrants have come to the United States: the first-wave, or pioneer, group; the second-wave group; and the third-wave, or new immigrant, group (Palaniappan et al., 2010).
Although “Philipino American” is the correct spelling because there is no F in the Philipino alphabet, “Filipino American” is the accepted English spelling (Cantos & Rivera, 1996).
The first-wave Filipino immigrants were originally drafted to work on trade ships that were traveling from China to the United States (Bartlett, 1977).
From 1565 to 1815, hundreds of Filipinos escaped from the trading ships and went first to Mexico and finally to Louisiana and other regions throughout the United States.
In 1907, with the passage of the gentleman’s agreement that restricted Japanese immigration, Filipinos were recruited to work in Hawaii on sugar plantations (Van Horn & Schaffner, 2003).
The second wave of immigration began after the Philippine Islands won independence from the United States in 1946, when the annual quota was raised to 100 persons.
Many Filipinos who served in the U.S. Armed Forces immigrated to the United States with their families after World War II.
Lott (1976) noted that during this period many of the Filipino men were physically separated from their immediate kin and denied full participation in the larger American society.
The new immigration group, or the third wave of immigrants, is composed of those Filipinos who have immigrated to the United States since 1965 as a result of the liberalization of the immigration quota.
In 1974, Urban Associates reported that in the 10-year period from 1960 to 1970, the Filipino population residing in the United States doubled, from 343,000 to 774,652.
From 1965 to 2009, the population of Filipino Americans almost doubled again, to 2,475,754
More than 93 dialects were spoken in the Philippines in 1960’
The most common languages are Tagalog, Ilocano, Cebuano, Bicolano, Pampangan, and Chabacano (Cantos & Rivera, 1996).
Although 86% of Filipinos speak one of eight major languages as their mother tongue, the fact remains that many diverse languages and dialects are spoken across the country.
When a Filipino man acknowledges emotions in a verbal manner, this may be interpreted as a sign of unmanliness or weakness.
Cultural values emphasize group harmony and smooth interpersonal relationships; decision making may be shared among family members according to a patient’s needs.
A clinician could develop a family decision tree or algorithm.
Decisions may be referred to family members living outside the United States, or birth order may be used to designate decisions
Filipino Americans are “laid-back, easy-going, serene people”
Filipinos are a polite people who do not like to disagree, particularly with people in authority, and because some Filipino men experience discomfort with women as authority figures.
Nonverbal language is important for Filipino persons.
For example, direct eye contact in the Filipino culture between an older man and a younger woman may be indicative of either seduction or anger.
Little eye contact is likely to be used with superiors and authority figures.
Touching is not uncommon, although handshakes are not commonly practiced by Filipino Americans.
Elderly people are shown respect by being kissed on the hand, forehead, or cheeks
Some Filipino Americans tend to collapse their space inward and limit the amount of personal space available.
This is caused in part by the Filipinos’ strong feeling for family (Cantore, 2001). On immigration to the United States, the personal space of Filipino Americans also collapsed inward because some of the people lived in urban ghettos, or “little Manilas,” that were vastly overpopulated (Burma, 1974).
Family: Most of the first-wave immigrants who came to the United States were not allowed to immigrate with their wives. This immigration pattern was responsible for a disproportionate ratio of males to females. The male-to-female ratio in 1930 for Filipinos residing in the United States was 14 to 1, compared with 1.1 to 1 for the rest of the population (Melendy, 1977).
In 1974, 38% of all Filipino-American families had five or more members (Urban Associates, 1974). In 2009, this number decreased somewhat, and the average Filipino-American family now has 4.0 persons, compared with the national average of 3.2
Filipinos are predominantly Roman Catholic, which has been attributed to the influence of the Spanish missionaries in the Philippines as early as 1520. In 2006, chief religions included Roman Catholic, 81%, and Muslim, 5% (World Almanac, 2015).
The remaining religious groups include Evangelical, Aglipayan, Iglesia ni Kristo, other Christian, and other (Central Intelligence Agency, 2015).
Rituals Related to Death and Dying
If a client has a diagnosis of terminal disease, the client should not be told before the family is consulted.
The family will usually want to disclose the prognosis to the client and in some cases will prefer to protect the client from knowing the diagnosis (Geissler, 1998).
The health care professional should generally continue to communicate with the head of the family outside of the patient’s presence regarding the health status.
If the family is Catholic, the family will usually want the Catholic priest to give the sacrament of the sick, in which the client is anointed with holy oil
Filipinos and Filipino Americans support at least two, often competing, medical systems.
A Filipino individual who becomes ill might consult both a folk healer and a Western-trained physician.
Filipino Americans are like other ethnic groups in that they continue to practice folk medicine simply because it works (McKenzie & Chrisman, 1977).
In the Filipino culture, certain illnesses may be assigned to natural causes, such as overeating, poor diet, or excessive drinking. These illnesses would normally be treated with home remedies, including herbal preparations, decoctions, massage, sleep, and exercise.
Illness and Wellness Behaviors
Three concepts underlie Filipino health beliefs and practices: flushing, heating, and protection.
Flushing is believed to keep the body free from debris, heating is believed to maintain a balanced internal temperature, and protection is believed to guard the body from outside influences.
Flushing is based on the premise that the body is a container that can collect impurities.
Heating involves the belief that hot and cold qualities must be in balance in the body.
Protection involves safeguarding the natural boundaries of the body from supernatural as well as natural forces.
Body Size and Structure
Filipinos are short and tend to have very small frames.
Some Filipinos have short limbs in comparison with the trunk size. At 3 years of age, the mean standing height is 85.7 cm (33.7 inches) for Filipino boys and 84.8 cm (33.4 inches) for Filipino girls.
Thus Filipino children are considerably shorter than White children, for whom the mean standing height is 95 cm (37.4 inches) for boys and 93.9 cm (37 inches) for girls
Mongolian spots are commonly found at birth on Filipino infants.
Normal pigmentation among Filipinos ranges from brown to peach brown, and it is extremely difficult to detect conditions such as cyanosis in darker-pigmented skin.
Cardiovascular Disease: The researchers concluded that Filipino Americans have a higher prevalence of hypertension and diabetes and a lower prevalence of smoking and obesity than Caucasians.
Diabetes Mellitus: There is an increased incidence of diabetes mellitus among Filipino Americans (Araneta & Barrett-Connor, 2005; National Center for Health Statistics, Health, United States, 2014). Sloan (1963) concluded that diabetes mellitus occurs three times more often among Filipino Americans than it does among White Americans
Susceptibility to Disease
Increased incidence of STD
Increased risk of amyotrophic lateral sclerosis (ALS)
Filipino Americans subscribe to a theory of hot and cold, foods with these properties are incorporated into their dietary regimen. For example, it is customary to include both “hot” and “cold” foods in cooking, such as mixing beans, which are considered hot foods, with green vegetables, which are considered cold foods, regardless of how they are prepared.
In addition, Filipino Americans who practice imitative magic may incorporate the concept of magic into the preparation and consumption of foods. For example, a pregnant Filipino woman may believe that eating dark foods such as prunes will produce a dark-complected baby (Affonso, 1978; Pimentel, 1968).
The traditional foods for Filipinos include rice, fish, and vegetables.
For Filipino Americans, typical dishes include adobo, pancit, and lupia.
Adobo is a method of preparation that includes cooking certain meats, such as pork, chicken, or beef, that have been marinated in vinegar, garlic, and other typical Filipino condiments.
The meat is simmered slowly until it becomes tender and brown
Because Filipino Americans tend to have darker-pigmented skin than White Americans, the nurse must be able to distinguish between the norm and carotenemia, jaundice, or cyanosis.
When the nurse is inspecting the skin of a Filipino American, it is important to inspect the buccal mucosa for petechiae. When looking for evidence of carotenemia, the nurse can substantiate this finding if a yellow tint is absent in the palate when the sclerae are yellow (Roach, 1977).
Implications for Nursing Care
Implications for Nursing Care
Because some Filipino Americans have a prevalence for enzymatic conditions, such as G-6-PD deficiency, lactose intolerance, or thalassemia, it is important for the nurse to encourage the client to eat meals that are high in protein and to replace whole milk with high-calcium substitutes such as buttermilk, yogurt, and sharp cheese or to add lactic aids to foods or other dairy products.
The nurse should be cognizant that some Filipino foods are high in purine, such as dinuguan (from dugu, “blood”), which is a food prepared from the small intestines, liver, heart, kidney, and blood of pork.