A. Differences Affecting Cuban-American Patients Who Immigrated at Different Times

The Cuban-American community is diverse, and the experience of immigration profoundly shapes their cultural values, healthcare beliefs, and interactions with the healthcare system. Key differences emerge based on the wave of immigration:

1. First Wave (Early 1960s: “Golden Exiles” / “Marielitos”):

   • Context: These were often wealthier, educated, and predominantly white Cubans who fled shortly after the 1959 revolution. The “Mariel Boatlift” (1980) also brought a significant wave, often with a different socioeconomic background and a perception of being less educated or more marginalized upon arrival.
   • Cultural Differences:
     • Strong Anti-Communist Stance: Deep-seated distrust of government and institutions, which might extend to large healthcare systems or governmental programs like Medicare/Medicaid if not framed carefully.
     • Loss and Trauma: Experienced significant loss of property, status, and family separation. This can lead to underlying trauma, grief, and a stoic approach to hardship, potentially underreporting symptoms.
     • Family Structure: Often maintained traditional, patriarchal family structures with strong emphasis on family loyalty (familismo) and respect for elders (respeto). Healthcare decisions are often made collectively by the family, with the male head or eldest member having significant authority.
     • Language: More likely to be monolingual Spanish speakers, or to prefer Spanish, even if they have some English proficiency.
     • Healthcare Beliefs: May hold traditional beliefs alongside Western medicine. Trust in established medical authority is generally high, but they may be less accustomed to patient-centered, shared decision-making models common in the US.
     • Financial & Access Issues: While initial waves may have had more resources, later waves like Marielitos often faced significant economic hardship, leading to challenges in accessing consistent care.

2. Second Wave (Late 1980s – 1990s: “Balseros” / Rafters):

   • Context: Immigrated primarily by raft, facing extreme dangers. Often younger, less educated, and more diverse socioeconomically than the “Golden Exiles.”
   • Cultural Differences:
     • Trauma and Resilience: High levels of trauma from the journey itself and the harsh conditions in Cuba. This group often exhibits immense resilience but may have unaddressed PTSD or depression.
     • Distrust of Authority: May carry a stronger ingrained distrust of governmental authority due to prolonged exposure to the Cuban regime and their perilous journey. This might make them hesitant to fully trust healthcare providers or disclose sensitive information.
     • Acculturation Challenges: Faced significant challenges with acculturation, often struggling to find employment and integrate into US society. This can lead to chronic stress, impacting health.
     • Language: Predominantly Spanish speakers upon arrival, with varying degrees of English acquisition.
     • Healthcare Beliefs: Similar to earlier waves regarding family importance and traditional beliefs, but perhaps more pragmatic due to their experiences. May have significant distrust of the Cuban healthcare system, making them both eager for US care and wary of any perceived control.

3. Third Wave (2000s – Present: More Mixed Motives, Increased Travel):

   • Context: With more relaxed travel policies (though fluctuating) and family reunification efforts, this group is more diverse in age, education, and socioeconomic status. Many may have spent time in other Latin American countries before arriving in the U.S.
   • Cultural Differences:
     • Higher Acculturation/Biculturalism: Younger generations, in particular, are more likely to be bilingual and bicultural, navigating both Cuban and American norms.
     • Internet/Information Access: More exposed to global information, potentially leading to a more informed or even skeptical view of healthcare.
     • Diverse Political Views: May hold more varied political views about Cuba and the US, impacting trust in different institutions.
     • Healthcare Expectations: May have higher expectations for patient autonomy and shared decision-making, closer to mainstream American healthcare culture, but still value family input.
     • Economic Integration: May have more diverse economic integration, from established professionals to those in lower-wage jobs, impacting access to private insurance vs. public programs.

Implications for Nurses: Nurses should avoid making assumptions based solely on Cuban heritage. Instead, they should conduct a thorough cultural assessment, asking about:

• Their country of origin and when they immigrated.
• Their experiences with previous healthcare systems.
• Their preferred language.
• The role of family in decision-making.
• Any traditional health beliefs or practices.
• Their comfort level with discussing sensitive topics.