North Carolina Latino Farmworkers’ Use of Traditional Healers: A Pilot Study

Abstract

Farmworkers in the United States experience high rates of injury and illness but have limited access to conventional health care. Farmworkers are often from countries that have active traditional healers, so understanding the use of traditional healers among farmworkers is important. This pilot study (1) describes the use of traditional healers among farmworkers and (2) compares the use of traditional healers by farmworkers to other Latino immigrants. Interviews were conducted in 2015 with 100 Mexican farmworkers (80 men, 20 women) and 100 Mexican immigrant non-farmworkers (50 men, 50 women) in North Carolina. Most farmworkers (78%) had H-2A visas. More farmworkers (64%) than non-farmworkers (41%) had ever used traditional healers. Among farmworkers, 21% (vs 11% of non-farmworkers) had used curanderos; 54% (vs 32%) sobadores, 43% (vs 21%) hueseros, 11% (vs 13%) yerberos, and 4% (vs 6%) espiritualistas. More farmworkers had used a traditional healer in the past year (16% vs 8%), but fewer had used this healer in the United States (4% vs 8%). Among all participants, males (58.5%) more than females (41.4%) (P=0.0214), and returning to Mexico annually (64.1%) more than who do not (45.1%) (P=0.0086) had ever used any traditional healer. This pilot study indicates the need for further research that documents the use of traditional healers by Latino farmworkers with diverse visa statuses, from countries in addition to Mexico, and in other regions in the United States. This research should also delineate the specific illnesses and injuries for which Latino farmworkers use traditional healers.

Introduction

Latino migrant farmworkers in the United States are a vulnerable population who experience high rates of injury and illness, but who have limited access to conventional health care.¹ These farmworkers are largely from countries such as Mexico and Guatemala² that have diverse and active traditional healers.³ The traditional healers available to Latino farmworkers include curanderos, sobadores (massage), hueseros (bonesetters), yerberos (herbalists), and espiritualistas (spiritualists).^4–8 Curanderos use a variety of approaches to healing that include physical treatments, spiritual healing and spiritualism, and psychic healing.^4,5 Sobadores use massage, mobilization, and manipulation to care for pulled muscles and injured joints, as well as moving internal organs.^6–8 Hueseros set broken bones as well as dealing with sprains and muscle pulls.^4–5 Yerberos prescribe herbal teas, baths, or poultices to cure physical and mental illnesses.⁹ Espiritualistas are faith healers who attempt to heal the soul.¹⁰

Understanding the use of traditional healers among Latino farmworkers is important. While farmworkers suffer high rates of injury,^11,12 and have limited access to conventional health care,¹ their jobs seldom provide health insurance or even Workers Compensation Insurance. They seldom have paid sick leave, which would allow them to get conventional medical care; many do not have access to health insurance through the Affordable Care Act. Often they lack the transportation needed to get to conventional medical care providers. Although requirements are in place to provide farmworkers with H-2A visas with health insurance, Workers Compensation, and transportation for health care, these requirements are often not met and farmworkers are often reluctant to ask for these benefits for fear of offending their employers.^13,14 Finally, many Latino farmworkers have health beliefs that differ from those of conventional medicine,^5,15,16 so may turn to available traditional healers to address their injuries and illness. The use of traditional healers may influence how and when farmworkers use conventional health care; the use of traditional healers is an indicator of their access to conventional medical care.¹⁶ However, the degree to which Latino farmworkers use traditional healers, and whether their use of traditional healers differs from other Latino immigrants in the United States has not been described.

Several surveys have reported on the use of traditional healers among the general United States Latino population. Results of these surveys vary greatly. Skaer and colleagues¹⁷ found that 21% of Mexican American women in Washington State acknowledged having received treatment from “curanderos, sobadores, or spiritualists” in the past 5 years; use of these traditional healers was related to fewer years living in the United States, a preference for speaking Spanish over English, and having received medical care in Mexico in the previous 5 years. Andrews and colleagues¹⁴ interviewed Latino mothers in Washington State concerning child health and found about a third used sobadores, 8% curanderos, and none used herbalists or spiritualists. Chavez¹⁵ surveyed Mexican immigrants to San Diego, California, and found that very few had used curanderos (1.3%), spiritualists (0.4%), witches (0.1%), or sobadores (5.7%) in the past. Lopez¹⁰ queried a sample of Chicano/Mexican American undergraduate women in California and found that 26% had ever used curanderos, 39% had ever used sobadores, 20% had ever used yerberos, and none had ever used espiritualistas.

Several studies have documented the traditional health beliefs of farmworkers, including beliefs related to humoral medicine,¹⁹ diabetes,²⁰ tuberculosis,²¹ pesticide exposure,^6,22 and occupational skin disease and its treatment.^23,24 However, studies have not documented use of traditional healers by farmworkers. Based on in-depth interviews with six farmworkers in Michigan, McCullagh et al.²⁵ found farmworkers sought health care that was low cost, accessible, and did not interfere with their work; none had used traditional healers due to lack of such healers in their current location.

This pilot study uses survey data collected from 100 Latino farmworkers and 100 Latino non-farmworkers in North Carolina to address two aims. The first is to describe the use of traditional healers (curanderos, sobadores, hueseros, yerberos, espiritualistas) among Latino farmworkers. The second is to compare the use of traditional healers by Latino migrant farmworkers to other Latino immigrants.

Methods

This pilot study was conducted in 2015 as part of an ongoing community-based participatory research project that included North Carolina Farmworkers Project (Benson, NC), El Buen Pastor Latino Community Services (Winston-Salem, NC), and Wake Forest School of Medicine (Winston-Salem, NC) as primary partners. We included topics in this pilot project to address the needs of the different partners. The study protocol was approved by the Wake Forest School of Medicine institutional review board.

Two hundred adults ages 18 and older were recruited to the study. Inclusion criteria were age 18 and older, born in Mexico, self-identified as Latino or Hispanic, and being either a farmworker living in Johnston County, NC, or a non-farmworker living in Forsyth County (Winston-Salem), NC. Women who lived in households with individuals employed as farmworkers were considered farmworkers, regardless of their occupation. Participants had to be native Spanish-speakers. Half the participants were farmworkers; 80 were men and 20 were women; half the participants were non-farmworkers, evenly split by gender.

The NC Farmworkers Project facilitated recruitment of farmworker participants. Most farmworkers were recruited from camps, with no more than five participants recruited from each camp to minimize clustering. Farmworker camps are dwellings in which migrant farmworkers reside. Camps may be barracks, individual houses, or apartments. All male farmworkers lived in camps. Female farmworkers were more difficult than male farmworkers to locate. North Carolina Farmworker Project staff worked with local organizations that serve the population to identify and recruit females. El Buen Pastor Latino Community Services facilitated recruiting non-farmworker participants. Working directly with their own clients and those of other organizations that serve Latinos in Forsyth County, staff personally identified potential participants. Potential participants in Johnston and Forsyth counties were screened to ensure they met the inclusion criteria. The project was then explained, and written informed consent was obtained. Participants received a $20 cash incentive for completing the interview.

Interviews were administered by trained Spanish-speaking interviewers using a tablet computer with Research Electronic Data Capture (REDCap) electronic data capture tools hosted at Wake Forest School of Medicine.²⁶ Twelve interviews were conducted using paper forms due to some difficulties with the tablet. Interviews lasted an average of 30 minutes and included sections addressing participant personal characteristics, genetic knowledge, Human Papilloma virus (HPV) and HPV vaccine knowledge, cancer knowledge, knowledge about the Affordable Care Act (ACA), and use of traditional healers.

Dichotomous measures for the use of traditional healers included ever used a curandero, sobador, huesero, yerbero, espiritualista, or other traditional healer; used this traditional healer in the past year; and, if used a specific traditional healer in the past year, whether this traditional healer was used while in the United States. Additional dichotomous measures were constructed to indicate if any traditional healer had ever been used; if any traditional healer had been used in the past year; and if any traditional healer used the past year had been used while in the United States. Measures of personal characteristics included gender, age (<30 years, 30–39 years, 40–49 years, 50 + years), marital status (not currently married, married or living as married), education (0–6 grade, 7–11 grade, 12+ grade), having an H-2A visas,¹⁴ dominant language of Spanish, and years in the United States (<5 years, 5–9 years, 10–14 years, 15+ years).

Study data were managed using REDCap electronic data capture tools hosted at Wake Forest School of Medicine.²⁶ REDCap is a secure, web-based application designed to support data capture for research studies. Descriptive statistics (count, percent) were calculated within farmworker status for participant personal characteristics of interest as well as the use of traditional healers. Chi-square tests were used to examine differences between farmworker status for the participant personal characteristics and types of traditional healers. Chi-square tests were also used to examine the association between participant characteristics and the use of any traditional healer, for the entire sample and for the farmworker group alone. All analyses were performed using SAS v. 9.4 (SAS Institute, Cary, NC) and p-values of less than 0.05 were considered statistically significant.

Results

Participants

As dictated by the sample design, 80 of the farmworkers were male, and 50 of the non-farmworkers were male (Table 1). Farmworkers were somewhat younger than non-farmworkers; 27% of the farmworkers were under age 30 and 13% were aged 50 or older, while 16% of the non-farmworkers were under age 30 and 26% were aged 50 or older. Significantly more of the farmworkers (91.8% versus 71%) were married. Farmworkers had significantly less formal education than non-farmworkers, 11% versus 36% having completed 12^th grade or more. Three-quarters of the farmworkers had H-2A visas, which required them to return to Mexico each year. Spanish was the dominant language of all participants. Farmworkers had lived in the United States for significantly fewer years than non-farmworkers (24% of farmworkers versus 9% of non-farmworkers had lived in the United States for fewer than 5 years; 29% of farmworkers versus 64% of non-farmworkers had lived in the United States for 15 or more years).

Table 1.

Participant Characteristics n=200

Participant Characteristics	Farmworkers n=100		Non-farmworkers n=100		p-value
	n	%	n	%
Gender					<0.0001
Male	80	80	50	50
Female	20	20	50	50
Age					0.0516
< 30 years	27	27	16	16
30–39 years	30	30	33	33
40–49 years	30	30	25	25
50+ years	13	13	26	26
Marital Status*					0.0002
Not currently married	8	8.2	29	29
Married/living as married	90	91.8	71	71
Education					0.0001
0–6 grade	45	45	37	37
7–11 grade	44	44	27	27
12+ grade	11	11	36	36
H2A visa					NA
Yes	78	78
No	22	22
Dominant language-Spanish	100	100	100	100	NA
Years lived in United States					<0.0001
< 5 years	24	24	9	9
5–9 years	22	22	7	7
10–14 years	25	25	20	20
15+ years	29	29	64	64

^*Data for 2 farmworkers are missing.

Use of traditional healers

Farmworkers (64%) had made substantial use of specific types of traditional healers, particularly curanderos, sobadores, hueseros, and yerberos (Table 2). A smaller group (16%) had used these traditional healers in the past year. Of those who used traditional healers in the past year, few (25%; 4% of total sample) saw these healers in the United States. Fewer non-farmworkers than farmworkers had ever used a curandero (11% vs. 21%, P=0.0538), sobador (32% vs. 54%, P=0.0017), or huesero (21% vs. 43%, p=0.0014), but about equal percentages had used a yerbero (13% vs. 11%), or espiritualistas (6% vs. 4%).

Table 2.

Use of Traditional Healers by Farmworkers and Non-Farmworkers

Type of Traditional Healer	Ever Used			Used in the Past Year		Used in the United States
	FW*	Non- FW*	p-value+	FW	Non- FW	FW	Non- FW
	n=100	n=100		n=100	n=100	n=100	n=100
Curandero	21	11	0.0538	4	0	0	0
Sobador	54	32	0.0017	10	6	3	6
Huesero	43	21	0.0014	7	2	1	2
Yerbero	11	13	0.6634	1	2	0	2
Espiritualista	4	6	0.5164	0	2	0	2
Other (Brujo)	0	1	0.4975	0	0	0	0
Any Traditional Healer	64	41	0.0011	16	8	4	8

^*FW = farmworker, non-FW = non-farmworker

⁺Chi-Square or Fisher’s Exact test as appropriate

More farmworkers (64%) than non-farmworkers (41%) had ever used any traditional healer P=0.0011). More farmworkers had also used any traditional healer in the past year (16% versus 8%). If the non-farmworkers used a traditional healer in the past year, they used this traditional healer in the Unites States. More farmworkers than non-farmworker had ever used multiple type of traditional healers; 42% of farmworkers had used two or more types of traditional healers, while only 25% of non-farmworkers had used two or more types of traditional healers.

Factors associated with the use of traditional healers

Farmworkers did not differ in their use of traditional healers in terms of gender, age, educational attainment, years coming to the United States, or annual return to Mexico (H-2A visas). Significant differences were present in the use of traditional healers for the entire sample (farmworkers and non-farmworkers) by gender and annual return to Mexico. Males (76, 58.5%) more than females (29, 41.4%) ever used any traditional healer (P=0.0214). Those returning to Mexico annually (50, 64.1%) more than who did not (55, 45.1%) ever used any traditional healer (P=0.0086). However, these factors were related. More males were farmworkers and most farmworkers had H-2A visas, which required them to return to Mexico annually.

Discussion

The results of this pilot study indicate that about half of Mexican immigrants have used a traditional healer, with more farmworkers than non-farmworkers having used traditional healers. Use in the last year is more limited, with little more than one-in-ten having used any traditional healer; again twice as many farmworkers as non-farmworkers used traditional healers in the last year. Most farmworkers have used traditional healers outside of the United States when used in the past year, while most non-farmworkers have used traditional healers in the United States.

These results are similar to some of the other research on the use of traditional healers by Latinos in the United States. These results are most comparable to those reported by Lopez,¹⁰ with our participants making substantial but somewhat greater use of curanderos and sobadores, and somewhat less use of yerberos. Like results reported by Andrews and colleagues¹⁸ and Lopez,¹⁰ both Latino farmworkers and non-farmworkers had made greater use of sobadores compared to other types of traditional healers. These results show greater numbers using traditional healers than reported by Skaer and colleagues.¹⁷ However, both Skaer and colleagues¹⁷ and Lopez¹⁰ included only women in their studies; our results show greater use of traditional healers by men in comparison to women. These results also contradict other research on the use of traditional healers. Chavez¹⁵ found very little use of traditional healers, including curanderos, spiritualists, witches and sobadores, in a survey of Mexican immigrants to San Diego, California. Leclere and López²⁷ found virtually no use of traditional healers in a study of Latino immigrant day laborers.

Farmworkers may have more recent use of traditional healers because they return to Mexico every year where such healers may be more accessible. The greater use of traditional healers by the farmworkers in this study is in contrast to the results reported by McCullagh and colleagues,²⁵ who reported no use of traditional healers. However, as McCullagh and colleagues note, the farmworkers reported no use of traditional healers because none were available in the area where they lived. Many of the farmworkers in this study return to Mexico each year where traditional healers are available.

These results reinforce the conclusions presented by Ransford and colleagues¹⁶ and underscore the medical pluralism of Latino immigrants. These immigrants will use those resources available to them. Health care policy must provide access to affordable health care to all, even those immigrants not covered by the Affordable Care Act. Farmworkers have very limited access to health care.¹ Health care services for farmworkers need to be culturally and linguistically appropriate, including an understanding of the use of traditional healers and medical pluralism.^1,16 It is interesting that most of the farmworkers in this study held H-2A visas. Unlike other farmworkers, farmworkers with H-2A visas do have access to health insurance through the Affordable Care Act.

The results of this pilot study must be evaluated in light of its limitations. Participants were not randomly selected, and they were from two locations in a single state. These factors limit the generalizability of the results. The large number of farmworkers with H-2A visas, requiring them to return to Mexico each year, limits generalization to other farmworker populations. The survey only asked whether a traditional healer was used, but not why the traditional healer was used.

This pilot study indicates the need for further research that documents the use of traditional healers by Latino farmworkers in other regions. This research should include Latino farmworkers who do not have H-2A visas and who are not from Mexico. This research should also delineate the specific injuries and illnesses for which Latino farmworkers use traditional healers.