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Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Brazilian

This subject guide is a collaborative project with the Children's Medical Center Pediatric Palliative Care Team, the Lamar Soutter Library, and Interpreter Services.




Geography of Brazil: Brazil is the fifth largest country in the world; in terms of population (186 million in 2005) as well as land area. It is the economic leader of South America, with the ninth largest economy in the world, and a large iron and aluminum ore reserve. Brazil encompasses so much of South America that it shares borders with all South American nations except Ecuador and Chile. Brazil is divided into 26 states and a Federal District.

General Cultural Information: Brazil, officially the Federal Republic of Brazil, is the largest country in South America, and the only Portuguese speaking country in the Americas. Brazilian culture is very diverse. Brazil was a colony of Portugal for over 3 centuries. Large number of settlers from Portugal arrived during this period and brought their culture to the colony. The native inhabitants of Brazil had a strong contact with the colonist. Many were exterminated, others mixed with Portuguese. For that reason, Brazil has an Amerindian influence in its culture, food and language. Language is one of the strongest elements of Brazil's national unity. Portuguese is spoken by nearly 100 percent of the population. The only exceptions are some members of Amerindian groups and pockets of immigrants, primarily from Japan and South Korea.  There is  much difference between the Portuguese spoken in Brazil and that spoken in Portugal.  There is are strong concepts of class and social status embedded in Brazilian society.  Social identity is based on these concepts.

Brazil - Ethnic groups: Within the Brazilian nationality are blended the various aboriginal Indian cultures; the Portuguese heritage, with its diverse strains; the traditions of millions of persons of African descent; and European elements resulting from sizable immigration since 1888 from Italy, Spain, Germany, and Poland. The Portuguese settlers had few taboos against race mixture, and centuries of large-scale intermarriage have produced a tolerant and distinctly Brazilian culture. According to the most recent estimates, 55% of Brazil's population is white; 38% are mixed white and black; and 5% are black. The remaining 1% is comprised of Japanese, Arab, and Amerindian groups.

The official language of Brazil is Portuguese. Minority languages include indigenous languages, and languages of more recent European and Asian immigrants. Language is one of the strongest elements of Brazil's national unity. There are more differences between the Portuguese spoken in Brazil and that spoken in Portugal than there are between the English spoken in the United States and that spoken in the United Kingdom. The written language, which is uniform all over Brazil, follows national rules of spelling and accentuation that are revised from time to time for simplification. They are slightly different from the rules followed in Portugal.  Because of Brazil's size, self-sufficiency, and relative isolation, foreign languages are not widely spoken. English and Spanish are often studied in school and increasingly in private.

Family Structure: Family is the foundation of the Brazilian social structure. The nuclear family has strong ties to the extended family, which includes cousins, aunts, uncles, grandparents, godparents and close friends. It is quite common to find three generations living under same roof.  Family size has being diminishing in recent years.  Family, kinship and friendship play a major role in both social and business interactions. Children are indulged and welcomed. Children are brought up as an integral part of the family unit and are expected to contribute to the overall welfare of the entire family. Adult children are expected to live at home until marriage. Married children tend to live in a house or apartment near the parents. 

Communication Style: Brazilians provide many details when offering information. They are always very courteous and will stop the conversation to summarize it for those who cannot keep up. They are comfortable with verbal confrontation, although confrontation does not happen between a younger and an older person.  It is considered impolite to say ‘no’ directly to a health care provider; clinicians should not assume patients have necessarily concurred. Brazilians greet everyone with a hug. If the newcomer is a family member, friend, or acquaintance, a kiss on each cheek is included. Handshakes are appropriate when strangers are introduced or in formal situations, both for greetings and good-byes. If two men are well acquainted, a slap on the shoulder or stomach, or a sustained pat on the back, may accompany the handshake and last into the conversation. 

Religious Practice: The religion of the majority of Brazilians is Roman Catholic. Brazil has the largest Catholic population in the world. Afro-Brazilian religions, such as Candomble and Umbanda are widespread. Though a minority, they are characteristic of the country, and their influence goes well beyond their numbers. Evangelical and Protestant churches are present in Brazil. However, there are many other religious denominations in Brazil. Some of these churches are the Pentecostal, Episcopal, Methodist, Lutheran, and Baptist.  There are followers of The Church of Jesus Christ of Latter-day Saints, small minorities of Jews, Muslims, Buddhists and numerous followers of Candomble and Umbanda.

Dietary Practices: The Brazilian cuisine has been strongly influenced by Portuguese colonization and Italian, German, Syrian and Lebanese immigrants, who came at the end of the nineteenth century. Brazilian culinary build into a rich variety of flavors and colors adapted to local ingredients which is unique and delicious.
Because the country is so vast, each region has its specialties. In the Northeast, especially in Bahia, African influence is prominent with the spiciest food such as: Acarajé (a mashed bean small cake stuffed with peppers, dried shrimp, onions and ginger), Vatapá (a puree of fish or shrimp), Moqueca (seafood broth eaten with rice) and Dende Oil (orange palm oil). The Amazon is better known for the Indian influence and has a diet rich of fish (Pirarucu), root vegetables, yams and peanuts or tropical fruits. In São Paulo and Rio de Janeiro, the two most cosmopolitan cities of Brazil, there is a great concentration of national and international restaurants with contemporary food. Minas Gerais regional dishes are short ribs, beans and local soft ripened cheese. Churrasco or beef barbecue is a contribution from the South, it is among Brazilian favorites and widely found in the steakhouses all over the country. In this " All you can Eat" steakhouses, pieces of beef are skewered into a metal sword and roasted over hot coals.

Feijoada is considered the national dish, a heritage from African slaves during Brazil's colonization. They used pork leftovers that their Portuguese masters wouldn't eat, such as ears and tail cooked with black beans. Nowadays it is elaborated with many different smoked and sun-dried meats, smoked sausage and served with a number of side dishes, including sliced oranges, cold cuts, farofa (stir-fried manioc flour), couve mineira (thinly sliced kale) and white rice. Feijoada is commonly served on Wednesdays and Saturdays. Delicious tropical fruits are found all year round. Some rare examples are açaí, cajú, cupuaçu, graviola, mangostim, carambola, pitanga, romã, cajá, umbú, tamarindo, saputi, jaboticaba, acerola, mangaba, among others.
Among the popular drinks are chopp (draft beer), cachaça (alcoholic beverage distilled from sugar cane) and caipirinha, Brazilian's favorite. At breakfast, coffee is served with hot milk and after meals in tiny cups, really strong. Because of the tropical fruit variety, juices are divine.

Concepts of Health and Wellness: Concepts of health and wellness are considered to be an absence of pain, suffering, or disease and sometimes a divine blessing. Brazilians seek medical care for treatment of illness rather than to prevent disease. Many illnesses may be attributed to divine intervention or fate. A common belief is that infants and children can become ill if exposed to fresh air or wind. When someone is sick, they are not expected to make decisions about their own health issues. Families handle these decisions. A mainstay of folk medicine is herbal and medicinal teas. Family members often share prescription drugs and self medication with antibiotics is common. Immigrants to the US frequently bring drugs with them or have them sent from Brazil. For procedure, they tend to accept surgery, blood transfusions and organ transplants. Patient and family may monitor duration and quantity of IV infusions as an indication of severity or prognosis of patient’s condition.

Causes of/attitudes about illness: May be attributed to divine intervention or fate. Acute illness often attributed to activity, change in temperature, food ingestion, or strong emotio0n before onset. A common belief is that infants and young children can become ill if exposed to bursts of fresh air or wind. Brazilians may attribute some childhood illness to a spiritual origin, such as the evil eye or a spell, or to jealousy or revenge. Attribute folk syndromes known as NERVOS, ATTAQUE DE NERVOS, and SUSTO to suppression of strong negative emotions such as anger, envy, worry, sadness, or grief. Stigma attached to institutionalization for mental problems. A common fatalistic explanation is God’s will. May also be attributed to events during pregnancy (e.g., accidents, emotional shocks), to defective sperm, or to excessive alcohol use. Some parents accept child’s genetic or congenital defects, other harbor strong feelings of guilt and shame.

Home and folk remedies: Use a variety of herbal baths and teas as household remedies, sometimes along with special prayers and blessings. A mainstay of Brazilian folk medicine is drinking herbal and medicinal teas, especially for gastric symptoms such as indigestion, heartburn, and diarrhea. Medicinal teas include lemon grass(cidreira) and orange rind (casca de laranja) for indigestion, guava flower (flor de goiaba) for diarrhea, and garlic (alho) and ginger (gengibre) for colds.

Home vs. hospital: In cases of acute illness, usually prefer hospital. In chronic or terminal cases, may prefer home. Might be reluctant to accept terms of hospice care (e.g., no therapeutic measures) because they do not want to give hope.

Use of Interpreters: Clinician should not use Spanish speakers as interpreters; key words will not be understood. Family or friends can translate, but their knowledge or understanding of medical terminology will be limited.

Medications: Biomedicine well accepted, but so are herbal and home remedies; often take both simultaneously. Some persons helped by a folk remedy or pharmaceutical treatment suggest or recommended to others. Immigrants frequently bring supplies of drugs with them or have them sent from Brazil, aware that such drug require a prescription in U.S.

Serious or Terminal Illness: Family members should be consulted before patient is informed, as some families do not want patient to know or want diagnosis/prognosis presented to him/her in an indirect manner. Patient not expected to make decisions about their own health issues. Families, when present, handle decisions and details regarding patient care. Patients are likely to be totally passive and to prefer complete care by others.

Unexpected death may be perceived as God’s will. Hold Catholic/Christian beliefs about life after death. Clinician should inform family members as soon as death is certain and offer to call a priest or chaplain. Family members may feel need to say final good-byes to begin grieving. Delayed funeral services must be explained to new immigrants; in Brazil, health department mandates burial within 24 hours of death. Family may want to arrange for extended visitation to be with the body before it goes to morgue. Clinician may need to explain American hospital and mortuary procedures to recent immigrants.

Care of the body: Final good-byes may involve kissing and caressing the body. No specific rituals, but family chooses clothing for the deceased. In Brazil there is no embalming and the body is prepared at the hospital. Some want the body sent to Brazil for burial.

Attitudes about organ donation: Donation uncommon. Immigrants may not be amenable because of fear, distrust, or desire to send body to Brazil for burial.

Local Community Information: The 2000 U.S. Census counted 212,636 Brazilian-born people living in the United States, 17% living in Massachusetts.

CENTRO DO IMIGRANTE BRASILEIRO. Diretor Executivo: Fausto Rocha
Serviços Prestados: Orientações em causas trabalhistas e assuntos de imigração, saúde, seguros e aluguel; está envolvido nas Campanhas da Carteira de Motorista sem Social Security e Anistia Geral para os imigrantes. Endereço: 139, Brighton Ave, #7, Allston, MA 02134
Telefone: 1(617) 783 - 8001 Fax: 1 (617) 564-1404

Diretor Executivo: Paulo Sardinha. Serviços prestados: Orientações trabalhistas, imigração, saúde, educação, entre outros. . Endereço: 63, Moore St, East Boston-MA
Telefone: (617) 569-3048                                                                                                              

Contato: Sr. Manoel de Souza
Patrocinado pela igraja católica local.
129, Concord St, 1 andar, sala 27, Framingham/MA 01702
Telefone: 1(508) 628 3721  

Diretor Executivo: Paulo Pinto

Serviços Prestados: Programa de Assistência ao Imigrante, Serviços intensivos para Adolescentes e terceira idade; Programa de prevenção e da educação em violência doméstica; Programa de Assistência no Processo de Orientação de Cidadania Americana; ESL(Inglês como segunda língua) e Orientação e Assistência para a compra da Casa Própria.
Endereço da sede: 1046, Cambridge St, em Cambridge - MA
Telefone: 1(617) 7870557  

EBECC (East Boston Ecumenical Community Council)
Providencia serviços de imigração, direitos trabalhistas, programa de moradia e assistência à família
50 Meridian St. Suite B-1 - East Boston/MA - 02128

tel: (617) 567-2750
FEDERAÇÃO PARA CRIANÇAS COM NECESSIDADES ESPECIAIS. 1135, Tremont St. Suite 420 - Boston/MA 02109. (617) 236-7210 ramal 114  

FUNDAÇÃO ICLA DA SILVA. Responsável por cadastramento de doadores latinos para o Banco Nacional na Medula Óssea e apoio às famílas de portadores de câncer.

H.O.P.E .Projeto Educacional de Benefícios Médicos para Pessoas com Baixa Renda na Região do Cape Cod115, Enterprise Rd, Hyannis, MA - 02601Telefone: 1508 7711727  

CONSULADO GERAL DO BRASIL, EM BOSTON. Consulate General of Brazil. 20 Park Plaza, Suite 810, Boston, MA 02116. Tel.: 617-542-4000 / Fax: 617-542-4318


Geography of Brazil: Fifth Largest Country in the World.  Retrieved from

Encyclopedia of the nations.  Retrieved from   

Wikipedia:  Languages of Brazil.  Retrieved from

Waldo's Travels:  Brazilian Food.  Retrieved from

Maps of World.  Retrieved from

Lipson, J. G., & Dibble, S. L.,. (2005). Culture & clinical care. San Francisco, CA: UCSF Nursing Press.