Distinguish between the two culture-bound syndromes el ataque and susto

Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olga’s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables. The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetable picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines. Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out “chits” to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance.

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