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appendix f Health Care and Gender Issues of Hmong in the United States I began my field research in hopes of discovering how Hmong cultural beliefs aªected women’s reception of Western health care during childbirth. A comparison of the two birth systems makes it clear why Hmong women in the early days of their migration to the United States regarded a hospital delivery as frightening and inexplicable. Socialized to be modest, they were forced to accept the ministrations of strangers, who were often males; they were not at home, where the lineage spirits oªered protection; because they had to give up the placenta and blood from the birth, instead of carefully burying it, their child was put at risk for health problems in the land of light and di‹culty in returning to the land of darkness; they were oªered fruit juice and other “cold” food, which could cause them to be ill in old age and slowed their return to balance and good health following the birth. The entire hospital experience was complicated by language di‹culties; in the absence of translators, no explanations could be given to the women who had to undergo what they perceived as invasive, humiliating, and even dangerous procedures. Conditions surrounding health care for the Hmong in the United States had improved by the time I finished my fieldwork: my first Hmong informants in the Providence clinics were working as translators and mediators in 276 the hospitals, and Hmong women had learned English. When the hospital staª understood why Hmong women would not eat hospital food, they allowed husbands to bring in the fresh rice and chicken soup with herbs that constitute the Hmong postpartum diet. In some instances women requested, and were given, the placenta to take home, but Hmong informants in the United States have told me that the Showing the Way chant has the power to guide a soul to its birth shirt, even if the soul does not know where it is. My informants also stated that it was impossible to bury the birth shirt when living in a tenement house with no garden, but most of them did not seem worried by this. Hospitals all over the country have begun to integrate issues of health care for Hmong and other Southeast Asians. In 1999, for example, while giving a talk in Wisconsin on epilepsy among the Hmong, I was invited to visit a clinic to speak with doctors and Hmong health-care workers about the Hmong concept of birth. Peter Kunstadter (1985, 1990, 1997) has conducted research in California and Thailand on comparative health issues, and hires Hmong as his research assistants in both countries; his work is valuable and helpful for understanding Hmong fears and the new illnesses they have contracted in this country, such as heart disease, strokes, and gout. Films have been made to explain Hmong fears about health care and hospitals,such as Between Two Worlds: The Hmong Shaman in America, produced by Taggart Siegel and Dwight Conquergood (1986); The Best Place to Live, produced by Peter O’Neill and Ralph Rugoª (1982); and Contraception Information for Hmong Couples, produced at the University of Minnesota (1992). Hospitals in Wisconsin and Minnesota allow shamans to come in and perform healing rituals—which are shorter and quieter than usual—at the patient’s bedside. As well, Hmong children who have grown up and been educated in this country can mediate for their families. Hmong women do not find giving birth in hospitals as terrifying as they used to; and often they come in to deliver their babies and leave the next day.1 But coming to a hospital to be treated for an illness is another story. Hmong think hospitals are places to die, and they believe that surgery or taking blood will weaken and deform the body throughout incarnations. Since decisions regarding medical treatment are considered a family matter , all family members go to the emergency room, which they tend to use as a primary care facility in terms of Western biomedicine; the actual primary care for many Hmong is still done by shamans, herbalists, and fam277 Health Care and Gender Issues ilies. Many Hmong women in the United States grow their own medicinal plants and rely on home remedies, as do many Americans, unless they are seriously ill. As Anne Fadiman has pointed out, some fears concerning health care are universal and cannot be ascribed to a particular culture. In the...

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