Cover

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Title Page, Copyright

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pp. iii-iv

Contents

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pp. v-viii

Illustrations

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pp. ix-x

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Preface and Acknowledgments

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pp. xi-xiii

This is a book of stories—stories of Hmong people’s anguish, suffering, desire, struggles, and successes as they have sought compassionate health care. Refugees from the Vietnam War in Laos, the Hmong came to the United States believing they would receive excellent health care from doctors and nurses. Sometimes they did. But often they encountered disagreement, conflict,...

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Introduction

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pp. 1-8

Members of minority communities who have lived in the United States for generations— Asians, Africans, Latinos, and American Indians—have long complained about being treated as second-class citizens by a health care system that does not understand or meet their needs. The dramatic influx of recent immigrants and refugees, including, among others, Mexicans, Somalis,...

PART I Health-Related Cultural Beliefs, Practices, and Values

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pp. 9-10

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Hmong Culture:Tradition and Change [Contains Image Plates]

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pp. 11-84

This chapter provides an overview of the central elements of traditional Hmong culture in Southeast Asia and the changes that have occurred since large numbers of refugees resettled in the United States in the mid 1970s. It reviews the history of the relationship between Hmong and Americans and describes those aspects of Hmong traditional and changing culture that....

PART II Women’s Health Case Stories and Commentaries

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pp. 85-86

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Controlling Fertility A Case Story

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pp. 87-103

Mrs. Pader Moua came to the United States when she was eight years old. She married when she was sixteen and her husband was twenty-eight. They have been married for eight years, have four children (two boys and two girls), and do not want any more children because of the high cost of raising children in this country. During the month after the birth of their....

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3 Woman with Pregnancy Complications A Case Story

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pp. 104-119

In her fourth month of pregnancy, Mrs. Thor sought prenatal care at the midwifery clinic for the first pregnancy of her second marriage. A twenty-five-year-old woman, Mrs. Thor had lived in a Thai refugee camp for twelve years before coming to the United States with her family when she was...

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4Woman with Vaginal Bleeding A Case Story

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pp. 120-130

Mrs. Foua Yang is a forty-two-year-old woman who is the single parent of four children, aged fourteen to twenty-four years old. Four years ago she had an abnormal Pap smear (strong class III) and was advised to undergo a colposcopic exam and possible biopsy of the cervix. She refused, insisting that she was having no pain and no problems. She wondered how she could suddenly have...

PART III Children’s Health Case Stories and Commentaries

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pp. 131-132

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Children with High Fevers Case Stories

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pp. 133-156

Daisy Fang was a six-month-old girl who was brought by her young parents to their primary care physician with a fever of 103

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Bottle-Fed Toddler with Anemia

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pp. 157-171

Xong Mary Hang was a one-year-old girl whose mother brought her to the community clinic for a well-child check. She lived with her sixteen-year-old mother, who attended high school; her eighteen-year-old father, who worked; and her paternal grandparents, who took care of her during the day. Her mother’s primary concern was that Xong’s skin was yellow. In response to...

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Infant with Down Syndrome and a Heart Defect

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pp. 172-186

Pam Yang, a ten-month-old girl, was brought by her parents for a routine well-child check. Since the physician who had been caring for Pam was no longer with the clinic, this was her family’s first visit with her new pediatrician. Through the interpreter, they indicated that she was happy, healthy, and growing without difficulties in eating, sleeping, or activities of daily living and that they had no other concerns. They appeared to be very caring and concerned about her...

PART IV Chronic Disease Case Stories and Commentaries

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pp. 187-188

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Man with Diabetes and Hypertension

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pp. 189-201

Blia Vang was a fifty-two-year-old man who had lived in the United States with his wife and ten children for about fifteen years. He and his wife lived with three of their children and he helped care for his grandchildren while his married children worked and attended school. Concerned about his...

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9Young Woman with Kidney Failure and Transplant

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pp. 202-220

Twenty-one-year-old Mai Neng Moua was in her junior year of college when she went to see a doctor for a physical examination in anticipation of going abroad for the summer. She had been living in the United States for thirteen years with her mother and two older brothers. Her father had died when...

PART V Mental Illness Case Stories and Commentaries

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pp. 221-222

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War Veteran with Depression and Post traumatic Stress Disorder [Contains Image Plates]

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pp. 223-245

Cha Va Lee, a middle-aged veteran of the war in Laos, has lived in the United States for the past twelve years. He does not speak English. His daughters have all married and left home. His thirteen-year-old son, who speaks very little Hmong, is in a gang and has been in trouble with the law....

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11Domestic Violence

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pp. 246-262

Mai Pa Thao was two years old when she and her family came to the United States from a refugee camp in Thailand. She has a large, close family and is highly acculturated. She and her husband, Nhia Ger Thao, have been married for six years and have two children, aged two and five. She is now pregnant with her third child. Recently, she and her husband began having arguments, and during one especially heated episode, her husband kicked her. Fearing that...

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12Woman with Psychosis

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pp. 263-276

Bao Ly, a sixty-one-year-old widow with a history of psychosis, was brought by her stepson to see her psychiatrist because she was much worse. For several weeks she had talked about demons incessantly, stating that the spirits were living in her body, eating her liver, and telling her to kill people. She...

PART VI End-of-Life Care Case Stories and Commentaries

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pp. 277-278

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13Hospice Patient with Gallbladder Cancer

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pp. 279-292

Cher Xiong was a fifty-four-year-old woman with ten children ranging from eight to twenty-two years of age. She and her family had been living in the United States for fifteen years. Ever since she had delivered her last child eight years ago, she had had intermittent pain in her upper right side. Her doctors...

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14Pregnant Woman with a Brain Hemorrhage

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pp. 293-307

Mao Her, a forty-year-old woman who was thirteen weeks pregnant with her eleventh child, developed a severe headache after attending a funeral. Her husband, Toua Lee Her, massaged her head and did khawv koob, a healing ritual, which did not relieve her headache. Recognizing the seriousness of her condition, he prepared to do fiv yeem, a spiritual healing ritual that promised...

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15A Widowed Mother’s Search for a Good Place to Die

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pp. 308-318

Mrs. Chang was a sixty-two-year-old widowed animist Hmong woman with five married daughters and one married son who, after her husband died, moved between her son’s house and her daughters’ houses so she could be with all of her children and grandchildren. She was in good health, never having seen a doctor or having had periodical prevention exams, when....

PART VII Culturally Responsive Health Care

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pp. 319-320

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16A Model for Culturally Responsive Health Care

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pp. 321-380

The goal of culturally responsive health care is for patients and providers to feel respected and satisfied with both the healing methods used and the health outcomes (Jecker, Carrese, & Pearlman, 1995). This chapter presents a model of the knowledge, skills, and attitudes that support the delivery...

Editors and Contributors

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pp. 381-386

Index

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pp. 387-392