I see many Hispanic patients, and they may be more difficult to return to work for several important, and often overlooked, reasons:
1. Whether they were skilled or even professional workers in their native countries, with the absence of English skills, they have been reduced to manual labor (and repetitive motion) jobs in the U.S. If they now have restrictions that preclude such work, they have no back up options.
2. Many are used to living in poverty and in crowded conditions; essentially living with little hope or optimism. They can too readily accept an injury as just one more discouraging example of how difficult their lives are, and they do not struggle against their limitations.
3. They understandably cluster with their countrymen where their lack of American culture and English language is expected. One patient moved here from Los Angeles and was shocked that in Atlanta _some English was expected._ He had lived two years in Los Angeles and had never needed to learn any English.
4. They are prey to others who know that they are frightened. They dependently allow such people to make decisions for them. They remain passive; the same way they behave in the workplace.
5. While they are quite often depressed (even before the injury), their culture has a less meaningful way of dealing with the depression _ they are told by family and friends that _everything will be okay_don_t worry about it._ They then wonder why everything feels so difficult.
With regards to treatment, they need to accept that the future belongs to them and that current passivity will not provide them with a meaningful/fulfilling future. They need to accept that new skill (and language) development will be necessary and is quite available in their community.