El Salvador

Cultural Competence Brochure

Introduction:
El Salvador is the smallest and one of the most densely populated countries in
all of Central America.1 Politics, religion, food practices, social views, and
language are some of the factors that shape the cultural identity of
Salvadorans, and largely impact health outcomes. The purpose of this
brochure, is to develop the readers cultural competence by examining the
constructs that make the Salvadoran culture unique. By providing this
information, health professionals can equip themselves with the knowledge to
provide services to Salvador-Americans in a meaningful and culturally
sensitive way.
Communication Guidelines:
The primary language in El Salvador is Spanish, but other language
variations exist region including Lenca, Nawat, and Qeqchl.2
Use a translator when counseling and which language variation is
used; at times Salvadorans.2
Refer to Salvadorans by the appropriate title Senor (Sir) Senora (Ms.)
Food and and their last name until invited to move to a first name basis.2
While shaking hands, use the appropriate greeting for the time of
language are day: "buenos dias"(good morning), "buenas tardes" (good afternoon),
the cultural or "buenas noches" (good evening).2
Failure to greet a person is considered offensive.2
habits humans Keep a reasonable distance when speaking. it is not proper if you
approach too much.9
learn first and Do not be afraid if somebody touches your arm or tries to shake your
the ones they hand during a conversation. 9
In addition, eye contact is considered very important. Excessive eye
change with contact could be offensive.9
the greatest Salvadorans often make facial gestures, a common one is to purse the
lips in the direction of the person or object one is referring to. This is
reluctance. considered more polite than pointing.9
-Donna Gabaccia It is impolite to raise your voice to someone and doing so would be
interpreted as a sign of anger.9

Traditional Dishes4:
Plato Tipico: fried sweet plantains, refried beans, scrambled or fried eggs, Salvadoran cream, corn tortilla
and coffee.
Papusas- Thick corn or rice tortillas stuffed with cheese, potato, beans, or pork.
Tamales- Cornmeal wrapped around chicken, pork, beans, vegetables and cooked in a banana leaf.
Yucca Frita- Deep fried cassava root served with a garlic sauce
 Significant Health Problems5:
Liver Disease Ischemic Heart Disease Diabetes
Meal Patterns:
The diet of those living in Central America, most noticeably in El Salvador and Guatemala, is generally low
in fat, protein, and in many other micronutrients.3 Salvadorans typically consume three meals per day
(desayuno, almuerzo, and cena).4 Meals usually consist of tortillas, beans, rice, and an animal source of
protein such as eggs, pork, fish, or chicken when available. At meal times, men are the first to eat their fill,
then the mothers, and children eat last; Many times, children are left with only tortillas. Plantains, and beans
are reliable crops grown in El Salvador, and are a staple in Salvadoran cultural cuisines. Fresh produce is
usually grown or purchased at a market where farmers sell their crops or a grocery store (depending on
geography). Common beverages are blended fruits, hot chocolate, or coffee with breakfast.
Salvadoran Perception of Healthcare
Salvadorans, in general, believe that God controls their status of their health even with professional
treatments.6 They believe that treatments work or dont work based on the will of God.6

Despite the prevalence of the Catholic religion and other mainstream Christian denominations in
the lives of most Salvadorans, indigenous healthcare options are often utilized. A common home cure for a
headache used by Salvadoran people is to drink a mixture of egg whites and coffee beans.6 Traditional
healers called curanderos may be called upon when a person is sick rather than going to a Western doctor.6

Barriers to Good Nutrition: Nutrition Counseling Considerations:

Education- For those raised in El Salvador,
consider that 79% of men and 73% of women
are literate; 82% make it to grade 9.7
Culture- Salvadorans are reluctant to seek out
treatment with western medicine.6
Lower Income- The majority of Salvadoran
immigrants to the U.S. have a household
income below that of the average American.8
Fear of Services For those in the US with
questionable legal status, many fear coming to
food banks for fear they will be turned in to INS
and deported.8
Aramark Dietetic Internship 2016-2017
Brochure By:
Dakkota Deem, Alisha Mukadam, Bobbi Nelson
Provide education on breast feeding and/or
importance of assisting the child at meal times..
Choose lean sources of protein (i.e. chicken and
fish vs. other seafood options)
Cook with vegetable or cahoon oil, not lard
Increase consumption including mango, papaya,
tamarind, oranges, bananas, watermelon,
cucumber, pacayao, lettuce, tomatoes, and
radish.
Emphasis on drinking water instead of sugary
beverages like coke
Use a translator when counseling and which
language variation is used; at times Salvadorans
may nod, without understanding.
Citations:
1. Annex 11: El Salvador. The World Health Organization Website. http://www.who.int/
workforcealliance/knowledge/resources/MLHWCountryCaseStudies_annex11_ElSalvador.pdf.
Accessed November 28, 2016.
2. Cultural difference and medical care: The case of the Spanish-Speaking people of the southwest.
Journal of the American Medical Association. 1955;157(13):1170. doi:10.1001/jama.
1955.02950300098033.
3. Malnutrition and Stunting in Central America. Academy of Nutrition and Dietetics Website. http://
www.eatrightpro.org/resource/practice/practice-resources/international-nutrition-pilot-project/
malnutrition-and-stunting-in-central-america.2016. Accessed on December 2, 2016.
4. El Salvador: A Taste of El Salvador. Progressio Website. http://www.progressio.org.uk/blog/ics-blog/
el-salvador-taste-el-salvador. 2016. Accessed on December 4, 2016.
5. CDC in El Salvador. The Center of Disease Control and Prevention Website. https://www.cdc.gov/
globalhealth/countries/el_salvador/pdf/el-salvador_factsheet.pdf. 2013. Accessed November 28,
2016.
6. Paz Amor: El Salvador. Health Beliefs. World Press. https://pazamorelsalvador.wordpress.com/
traditional-beliefs-on-health-disease-and-disability/. Accessed October 22, 2016.
7. Whats Education Like In El Salvador?.Stanford University website. https://web.stanford.edu/
~hakuta/www/archives/syllabi/E_CLAD/sfusd_cult_03/nancy/new/educ.html. Accessed December
5, 2016.
8. Migration Policy Institute. RAD Diaspora Profile. The Salvadoran Diaspora in the United States.
Revised June 2015.
9. Government of Canada. Global affairs Canada. Cultural Information: El Salvador. https://
www.international.gc.ca/cil-cai/country_insights-apercus_pays/ci-ic_sv.aspx?lang=eng. Accessed
1/21/2017.