Gypsies are a largely unknown
ethnic population in the United States. Lacking census data, most estimates
suggest there are between 200,000 and 500,000 members of various Gypsy
groups living in all regions of the United States. Not all Gypsies belong
to the same group or speak the same dialect or language. The data presented
here refer to the largest group, the Rom, which is the group physicians
are most likely to see and to recognize as Gypsy. The
Rom live all over the United States. The specific group this article is
based on live in the San Francisco Bay Area of California. The Rom are
originally from India, migrated through the Middle East and Europe over
the past 800 years, and arrived in the United States primarily at the end
of the 19th century. The Rom speak Romany as a first language and English
as a second language. Older Rom are generally not literate, but younger
members of the family usually have some schooling and can read important
documents to older members.
Although most Americans hardly know that Gypsies live in their cities,
the medical profession is usually aware of them. This is because Gypsies
are generally not healthy and because they are assertive in seeking medical
care. Gypsies have an unusual ability to maneuever within a complex medical
system and to get attention from medical personnel. The Gypsy "style" of
seeking help is often frustrating and confusing to health care professionals.
Gypsies often request specific "famous name" physicians and demand specific
treatment they have heard of even when the treatment or specific physician
is inappropriate. Gypsies frequently request specific colored pills that
they share with their relatives. They prefer older, "big" (well-known)
physicians over younger ones. They often do not comply with preventive
and long-term treatment. When a relative is sick, they come to the hospital
in alarmingly large numbers, sometimes camp on hospital grounds, disregard
visiting rules, and generally create chaos in the corriders of the hospital.
Hospital personnel are often at a loss in knowing how to deal with Gypsies.
Gypsies can be cooperative, interesting patients, however. They respect
authority in their own families, they are eager to learn about the best
treatment for themselves and their relatives, and they have a large support
network of relatives. All of these factors can be called on by medical
professionals to assist them in providing treatment to Gypsies while reducing
the disruption that results from a sick Gypsy's desire to have relatives
In this article I provide information about Gypsy culture that will
be useful for understanding how to interact with them in medical situations.
This article contains guidelines, but not every Gypsy follows every single
custom or rule. Families and individual members have varied practices.
Some Gypsies are more old-fashioned than others; some are more fastidious;
some, generally older ones, are more informed; and some are sicker and
have more experience with physicians. Nonetheless, these general guidelines
should ease some of the frustration between Gypsy patients and health professionals.
Gypsies live in urban areas, usually on main street, in the poorer parts
of towns. They are not always recognizable as such, especially the men
who wear American clothes; however, women, in particular older women, often
wear long colorful skirts and low-cut sleeveless blouses. Gypsies often
prefer to pass as another ethnic group and may claim to be American Indian,
Mexican, or Romanian. They are accustomed to discrimination and stereotyping
by those who often see them either romantically as free spirits or as contemptible
thieves. Neither stereotype is accurate. If a medical professional indicates
that it would help to know if a patient is Gypsy, the family may freely
admit to it.
Gypsies live in households with somewhat fluid membership because they
generally belong to large extended families. Dating back to the days when
they all shared one camp, members of extended families will eat and sleep
at each other's homes as if they were their own. The men work in groups
of relatives and friends. Their usual work involves soliciting body and
fender repair jobs, buying and selling cars, or helping women with their
fortune-telling businesses. The women (mothers, daughters, and daughter-in-law)
often share a storefront office or room at the front of a house, where
they tell fortunes. Gypsies prefer to keep to themselves and to avoid contact
with non-Gypsies. As a cultural group, they have survived hundreds of years
living by their wits.
Illness Is Social
For Gypsies, illness is not just the concern of the individual, it is
a problem of broader social importance. A serious illness always elicits
deep concern from a wide circle of relatives willing to drop everything
and rush to the bedside of the stricken. The gathering of Gypsies in the
vicinity of a seriously ill person is partly socially mandated by custom
but also is a genuine expression of concern for both the afflicted and
his or her immediate relatives. Families coming together when someone is
ill is one of the strongest values in Gypsy culture.
A knowledge of certain basic beliefs and behaviors
of Gypsies in relation to sickness and health and the sociocultural context
of health care is essential to effectively interact with Gypsies. The social
context of Gypsy medical and religious knowledge begins with Gypsy attitudes
in general toward health and illness, auspiciousness and inauspiciousness,
and cleanliness and uncleanliness. These attitudes
are reflected in certain key concepts, presented in complementary position
in Table 1.
Key Concepts in Gypsy Thought
|Romania (social order)
| Sastimos (good
|BaXt (good fortune)
||Prikaza (bad luck)
||Marime (impurity; exclusion)
Fortune and Health
Good fortune and good health are closely associated for Gypsies, as
expressed in their most common blessing, "May God give you luck and health."
Those who enjoy good health also have been blessed with good fortune; those
who are ill have lost their good luck. To some extent everyone can influence
their own fortunes. By their actions they either promote their own health
or cause their own illness. Illness can be caused by actions that are considered
contaminating or polluting. Returning to a state of purity and conforming
to correct social behavior are necessary to cure these conditions. For
example, a young person who exhibits rebellious behavior and may be in
danger of pollution through illicit sexual relations can be "cured" by
Perhaps the most frustrating belief physicians encounter is that the
larger a person is, the luckier, healthier, and happier that person will
be. A fat person is perceived as healthy and fortunate, and a thin person
is pitied as either ill or too poor to eat, both of which indicate a lack
of good luck. Wealth is also partly attributed to luck because although
each family develops similar economic skills, some are more fortunate than
others. Some families enjoy good health, grow to a large size, and prosper,
whereas others are plagued with illness, family troubles, and economic
failure. In such a situation persons must take action to change their fate.
Personal cleanliness, proper social attitudes, and behavior--generosity
and virtue--should bring good luck. In a more general sense, traveling
as opposed to living in one place is considered auspicious.
Marime, meaning polluted, defiled, or unclean, is used
to indicate uncleanliness or impurity of a physical as well as a ritual
or moral nature. To be "clean," the top half of the body from the waist
up ideally must be kept separate from the bottom half of the body, which
is considered polluted and is an area associated with feelings of shame.
The source of pollution of the lower body is the genitoanal area and its
emissions and secretions. Secretions from the upper half of the body are
not polluting or shameful. For example, spittle is viewed as a clean and
curative substance that may be used to clean cuts or scratches. This viewpoint
conflicts with medical practice, which sees spittle as a possible source
of contagion. Separate soap and towels are allocated for use on either
the upper or the lower part of the body, and they must not be allowed to
mix. Bathing in a hospital can be easily accommodated to Gypsy beliefs
by providing them with separate soaps and towels for the upper and lower
parts of the body.
A failure to keep the two sections of the body separate in everyday
living can result in serious illness. A large number of practical guidelines
are necessary to keep the upper half of the body separate and pure. At
the least, it is important to wash the hands after touching the lower body
and before touching the upper body. Body separation is a general cultural
ideal that comes into play more in public situations than in private ones,
and it has implications for a physician wishing to examine the lower body.
Most Gypsy women will not agree to a gynecologic examination or a Papanicolaou
smear unless the necessity of the procedure is clearly explained as essential
to a woman's well-being.
Marime can also mean rejection because to become physically or morally
impure could mean being rejected by the entire group. Rejection is a serious
punishment for a Gypsy because it means social isolation.
Marime and Non-Gypsies
The use of marime as a defining term for a whole series of social boundaries
gives it much importance for the Rom. The most important boundary is that
between Gypsy and non-Gypsy. Because they do not observe body separation,
non-Gypsies are a source of impurity and disease. Public places where non-Gypsies
predominate such as public toilets, hospitals buses, schools, offices,
jails, and non-Gypsy homes are also potential sources of disease. All these
places are less "clean" than the home of a Gypsy or open outdoor spaces
such as parks and woods. When they must be in non-Gypsy places, Gypsies
generally avoid touching as many impure surfaces as possible, but, of course,
prolonged occupation of a non-Gypsy place such as a hospital means certain
impurity. In this case the person tries to lessen the pollution risk by
using disposable paper cups, plates, and towels--that is, things not used
Concern for a person's health begins at birth and is most active during
the days or weeks of confinement (from 9 days to 6 weeks) of the mother.
In the past, infant mortality for Gypsies has been high. This may be somewhat
improved nowadays because more women give birth in hospitals; however,
the crucial period of prenatal care is still entirely neglected because
few women will accept a vaginal examination. One of the reasons Gypsies
have turned to hospital birth is the advantage to them of avoiding the
impure birth substances.
Gypsies recognize that a baby is vulnerable in the first weeks of life
and take precautions to protect the child. A new baby is immediately swaddled
tightly and handled only by his or her mother. The woman avoids certain
foods, such as green vegetables and tomatoes, so that the nursing baby
will not get colic. The child's navel is carefully cleaned and protected
with ashes, and amulets are sewn into the baby's clothing for protection.
In the first weeks at night, no member of the family is allowed to go in
and out, and all windows and doors are kept shut lest a spirit of death,
called "the night," enters to harm the baby. Crying and fear are prevented
in a child by placing a small piece of johai ("ghost vomit," a curative
substance) on their tongue. Visitors are carefully watched lest they give
the baby the evil eye. If the baby fusses or becomes ill, the giver of
the evil eye must make a cross with spittle on the forehead of the baby.
If despite these precautions a baby dies, this is bad luck for the parents.
They must avoid the baby's body, which is buried in a secret place by the
grandparents. Another way to avoid the bad luck of the death of a baby
is to leave the funeral and burial to the hospital authorities.
After the period of pollution of birth has passed (more or less 6 weeks),
children are considered basically pure in body and action. They can enjoy
freedom from most social restraints and are not expected to understand
or demonstrate "shame" in their actions. Physical contacts defiling to
adults are not necessarily defiling to children, who need not take many
of the precautions that adults do to ensure cleanliness in their daily
lives. Children, for example, may eat food handled and prepared by non-Gypsies
that postpuberty juveniles would reject.
At puberty, boys and girls are introduced to the idea of personal shame.
Now both their bodies and their actions will be judged in terms of control
of their own polluting secretions (menstrual blood, semen) and of "shameful"
and polluting actions (sexual contact). The control of sexual relations
and body cleanliness is modified by marriage and childbirth, but basically
such controls last throughout married life until old age.
Women have a particular need to keep clean. Menstruation, for example,
is surrounded by a number of rules to control the ill effects of this potentially
polluting bodily function. When a girl first menstruates she is introduced
to shame and must observe the washing, dressing, cooking, eating, and behavioral
rules of adult women, partly for her own protection and partly for the
protection of men. Her clothes must be washed separately from those of
men and children, and she cannot cook food for others during menstruation.
She must show respect to men by not passing in front of them, stepping
over their clothes, or allowing her skirts to touch them.
At old age, after menopause and when sexual relations are assumed to
have ceased, many of these regulations are relaxed. The aged are venerated
and respected persons, both because they are politically powerful (political
authority is vested in the aged) and because they now enjoy a "clean" status.
When in contact with a group of Gypsies, it is always wise to seek out
older authority figures and to communicate problems in their presence because
they have authority and exert influence over younger Gypsies. Also, without
the approval of older relatives, many young Gypsies will not agree to medical
procedures considered risky.
Food and Health
Gypsies try to eat only food that is known to be pure and clean. Consequently,
there are many regulations regarding the preparation and handling of food.
There are no foods that are always prohibited, although some adult Gypsies
fast on Fridays. Some foods--pepper, salt, vinegar, garlic, and onions--are
considered lucky. To eat them encourages good health.
Eating together is imbued with great social significance. To share food
with someone demonstrates respect, friendship, and acknowledgment of their
cleanliness. Refusing to share food is a serious affront, implying a person
is not pure and clean. The most serious punishment Gypsies as a group can
impose on anyone is to refuse to eat with the person. To be prohibited
commensality is social death. All rituals at which the Gypsies express
important unifying social values involve the sharing of food at a feast.
All food must be carefully prepared to avoid any marime contacts. Cooking
and eating utensils are always washed in a special separate basin reserved
only for that purpose. In many households, a separate soap is reserved
for food-related items, and even the hands are washed only with that soap
before handling food. Women in birth confinement and menstruating women
do not handle food. Food prepared by non-Gypsies is marime and is avoided.
This avoidance is not always possible, such as when in a hospital, but
it can be aided by eating wrapped take-away foods, drinking from cartons
or bottles, and using disposable eating implements. Gypsies may simply
eat with their hands rather than use utensils that may not have been properly
Causes of Illness
Gypsies make a distinction between illnesses that originate from the
non-Gypsies (gaje) and illnesses that are exclusively part of their
own world. The former can be cured by non-Gypsy doctors, but the latter
can only be tackled by the drabarni, their own medical practitioners. A
knowledge of Gypsy medicine is the prerogative almost exclusively of the
oldest women. They are both respected and feared because of this knowledge.
Gypsies do not have a scientific understanding of how the body functions.
To them American physicians simply have a special knowledge of (gaje)
illnesses and cures, a store of lore on medicines, and diagnostic and curing
techniques. Not all physicians have the same knowledge or ability. To a
Gypsy, a "big" doctor is one who cures, and a bad doctor is one whose medicine
does not work.
Hospitals are feared and avoided whenever possible. Most Gypsies will
go to a hospital only if they are in serious danger of dying or if they
view the situation as a crisis. Furthermore, a hospital is a hostile place
for the Gypsies, full of non-Gypsies, unclean, and completely removed from
Gypsy society. Too few visitors are allowed, so for the Gypsies, who want
to be with their kin when ill, a hospital is close to a state of exile
from their own society. For these reasons, many Gypsies suffer great pain
rather than go to a hospital. If they have to be admitted, the one thing
they know for certain is that they do not want to be alone, to be without
their relatives. [Tabular data omitted.]
Gypsy and non-Gypsy diseases overlap, but their causes are different.
Most Gypsies prefer to try several different cures for any single illness
to combat the different causes. A person who has convulsions, for example,
may be rushed to a hospital where a physician can attend but will also
be given asafetida by relatives. Physicians, therefore, are not
in competition with Gypsy drabarni.
Health Status of Gypsies
Many Gypsies claim that they are sicker now than they used to be. They
believe it is because they travel less and live in houses instead of separate
from non-Gypsies in camps. They think that the closer contact with non-Gypsies
is having a deleterious effect on their health. Recent work on the medical
condition of Gypsies would indicate that their medical problems are in
fact serious. In a study of 58 Gypsies in the Boston
area, Thomas found that 41 of 56 (73%) had hypertension, 24 of 52 (46%)
diabetes mellitus, 32 of 40 (80%) hypertriglyceridemia, 26 of 39 (67%)
hypercholesterolemia, 20 of 51 (39%) occlusive vascular disease, and 8
of 40 (20%) chronic renal insufficiency. A combination of diet, which is
extremely high in fat, and genetics could be leading to the high cholesterol
levels and hypertension. In this group, 50 (86%) smoked cigarettes and
49 (84%) were obese. The life expectancy of a Gypsy in the United States
is between 48 and 55 years.
To combat non-Gypsy diseases, the Gypsies logically turn to non-Gypsy
physicians and hospitals. Although they are eager to try any cure that
they think might work, they are suspicious of physicians and tend to "shop
around." A physician who acquires the reputation of being effective will
find Gypsy patients flocking to the office. Physicians whose Gypsy patients
die under their care will probably never see another in their practice.
Surgery is feared, especially when general anesthesia is required, as
Gypsies believe a person under anesthesia undergoes a "little death." Thus,
Gypsies will gather around the bedside to muster support and help the patient
come out of the anesthesia.
Despite their fear of hospitals, Gypsies are in general
extremely knowledgeable of hospital procedure. They know what services
are available and who are the best physicians for specific problems. They
learn of famous clinics and learn the complicated hospital regulations,
how to get around them, and how to get what they want. One study concluded
that Gypsies receive better medical care than other urban minorities because
they have figured out effective ways to use medical services.
In the same way that they are willing to try physicians and hospitals to
cure them, they will also try cures and medicines advertised by Mexican
curanderos, faith healers, and patented miracle cures. These are all gaje
remedies. Nothing that might work is to be scorned.
Gypsy diseases have no connection with non-Gypsies or with germs and
therefore cannot be cured by non-Gypsy physicians. For these diseases the
Gypsies must turn to their own knowledge and their own medical practitioners,
the drabarni (literally, "women who have knowledge of medicines").
The knowledge of spirits and medicines that old women have is a great source
of power for them.
Serious Gypsy diseases are caused either by a spirit
called Mamioro or the Devil. Mamioro, a specific spirit who has
become a disease carrier, causes illness simply by visiting the homes of
Gypsies. Fortunately, she only visits dirty houses, so by keeping a clean
house, the Gypsy can keep her away. Johai, her vomit, is found most
frequently in garbage dumps, and it is the most powerful and valuable cure
the Gypsies have.(*)
Several important diseases are caused by the Devil. Tosca is
a disease that the Gypsies translate as "nerves." People who are nervous,
fidgety, and worry excessively have tosca. A lot of Gypsies get
especially the less aggressive and more sensitive ones who find it hard
to keep up with the demanding, noisy, fast pace of Gypsy social life. Khantino
drab will cure tosca. Khantino drab is also said to be
found near the place where a person has been seized with a convulsion or
epileptic seizure. It is believed that convulsions occur when a person
is possessed by the Devil and that usually the Devil defecates during the
convulsion. Locating the Khantino drab and giving it to the convulsed
person will make the devil marime and drive him away.
Gypsies can never be sure that they have done everything possible to
keep pure, to promote auspiciousness, and in general to live up to the
ideals of correct behavior; therefore, it is not surprising when someone
becomes ill or suffers misfortune. For the Gypsies, illness and death are
not only a personal crisis, they introduce a social crisis as well. Reporters,
physicians, hospital staff, social workers, and police are all aware of
a great happening when a Gypsy becomes seriously ill and dies. When they
ask what is going on, they may be told, "a Gypsy king (queen, prince) has
died." This reply is a way of satisfying reporters and providing a reasonable
explanation to hospital staff and police of why the Gypsies are flocking
into town in large numbers, camping on hospital grounds, and in general
breaking rules and creating havoc. Although there are no kings and queens,
only leaders of the large Gypsy extended family, death is a major crisis
in a Gypsy family that must be dealt with in ritual.
When a young person dies unexpectedly, the relatives are so grief-stricken
that their behavior can become extremely wild. In one case, after the accidental
death of a young man, the relatives were so distraught that they threatened
physicians for "letting him die." The relatives scratched their faces,
drawing blood, beat themselves on the chest and head, wailed and screamed.
This behavior was an expression of extreme grief. Even in the case of a
death that has been anticipated, however, it is culturally acceptable for
relatives to moan and shout out to the deceased, scratch their faces, or
pull out their own hair.
Death at an old age is generally perceived as part
of the natural and acceptable course of events, and the attitudes and feelings
toward the death of an old person are very different from those toward
early death. The main preoccupation of the relatives of an old person,
as well as the dying person, is to see that all preparations for the person's
eventual demise have been arranged. For the Lowara Gypsies, Yoors said,
"the Gypsies yearned for what they called 'a great death' for which they
could prepare and which they could share with their households, relatives
and friends. They feared most that kind of death which came when one was
John Davis, also known as Rattlesnake Pete, had a "great" death. His
funeral was the greatest spectacle since Big George Adams hired an entire
movie studio to provide props for his funeral in Los Angeles. John Davis
had a brass band playing Dixieland in the funeral cortege, a horse-drawn
hearse complete with black enameled scrollwork and silver lanterns and
drawn by two grey Appaloosas. His grave was a red-carpeted crypt with a
chandelier inside in a grave site surrounded by full-sized statues of the
Apostles. In front of the casket was a flower arbor with the words "Welcome
to Heaven, John Davis," in gold letters. He also had flowers in the shape
of his favorite fishing chair with a pole and line dangling into a flower-edged
pool, the American flag, a clock with the time of his death, a car, an
airplane, and a ship (because he liked to travel), a barrel of beer and
beer mugs (he liked a drink), and a little white house (he was a property
owner). The newspaper the next day ran a picture of the funeral cortege
with the caption, "Death of a Gypsy King" (Janet Tompkins, Contra Costa
County Social Service, written communication, July 1976).
To help physicians and hospital personnel interact effectively with
Gypsies, I have some specific suggestions.
Older relatives have an important role in the decision making process of
a patient. Try to include them and treat them with the respect they are
due as elders in the community. Older relatives can be of great help in
ensuring the cooperation of younger ones.
Gypsies can alternate rapidly between moods or styles of interpersonal
interaction from extreme assertion to plaintive begging. Medical personnel
should appeal to the strong desire of Gypsies to obtain the best medical
treatment and assure them that cooperation will work best for them.
English is a second language. Explain clearly without resorting to too
many technical terms the procedures the patient will undergo. Then ask
if there is anything that is against the patient's religion. If there is
something they do not want done, explain why it is necessary for their
health or allow them to forego it.
Many Gypsies cannot read, but it would be a mistake to assume that they
are therefore less intelligent. Read important instructions (particularly
at intake) to a patient or ask a translator to read out loud to the patient.
They are accustomed to dealing with complex bureaucracies and policies.
Gypsies accept emergency measures more readily than they accept proscriptions
to undertake changes in diet or lifestyle; however, instruction in long-term
health goals is crucial. They need education on the connection between
diets high in animal fats, heavy smoking, drinking, and no exercise and
the health problems they cause.
A Gypsy patient does not want to be alone and will be fearful and agitated
if forced to be without family. Allowing some relatives in the room with
the patient on a rotation basis will keep the chaos to a minimum. Allow
someone to stay overnight with the patient. If the patient is dying, it
is essential that relatives be allowed to be present at the moment of death.
(*) Rena Gropper, PhD, Professor of Anthropology at Hunter
College and a gypsiologist, discovered " ghost vomit" on some wood chips
in her garden in New York City. Thomas H. Delendick, PhD, associate taxonomist
at the Brooklyn Botanic Garden, identified it as a slime mold, Fuligo septica.
A literature search showed that heretofore there had been no known economic
or folklore uses of this slime mold (written communication, July 1983).