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Healing by Heart

Clinical and Ethical Case Stories of Hmong Families and Western Providers

Edited by Kathleen A. Culhane-Pera, Dorothy E. Vawter, Phua Xiong, Barbara Babbitt, and Mary M. Solberg

Publication Year: 2003

"This is a 'must read' book for anyone interested in providing more culturally competent health care and addressing cross-cultural ethical conflicts. The writing is fascinating, informative, practical, and provocative. Congratulations on what I am sure will become a seminal text in the field!"-- Robert C. Like "A spectacular work of scholarship and collaboration among authors of varying backgrounds, professions, and ethnicities. It covers a very broad range of medical and ethical issues in an accessible format, based on actual medical cases in all their frustrating and fascinating complexity. The views of both health professionals and patients/families are represented, along with steps in negotiating mutually acceptable courses of action. This unique and important work will quickly become indispensable to all who teach about, study, or practice cross-cultural health care and medical ethics."--Bonnie B. O'Connor Healing by Heart is a book of stories--stories of people's search for culturally responsive health care from U.S. providers. It offers resources to providers and institutions committed to delivering culturally responsive health care, paying special attention to building successful relationships with traditional Hmong patients and families. It makes available extensive information about the health-related beliefs, practices, and values of the Hmong people, including photographs of traditional healing methods. Ranging in age from young infants to older adults, the patients in the stories present a wide range of health problems. The clinicians are from family practice, internal medicine, pediatrics, emergency medicine, surgery, obstetrics-gynecology, psychiatry/psychology, and hospice.  Each of the fourteen case stories is accompanied by discussion questions as well as two or three commentaries. The commentaries--written by patients, family members, shaman, Western clinicians (including Hmong physicians, nurses, and social workers), medical anthropologists, health care ethicists, social workers, psychologists, and clergy--are rich in personal reflections on cross-cultural health care experiences. Readers are rewarded with a combination of perspectives, including those of Hmong authors who have not previously published in English and scholars with years of professional experience working with the Hmong in Laos, Thailand, and the United States. The editors offer a model for delivering culturally responsive health care with special attention to matters of cross-cultural health care ethics. The model identifies questions health care providers can focus on as they seek to understand the health-related moral commitments and practices prevalent in the cultural groups they serve, ethical questions that arise frequently and with great poignancy in cross-cultural health care relationships, and points to consider when a patient's treatment wish challenges the provider's professional integrity.  By sharing stories of suffering, confusion, and success, Healing by Heart couples an accessible method of learning about others with concrete recommendations about how to enhance cross-cultural health care relationships. 

Published by: Vanderbilt University Press

Title Page, Copyright

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pp. iii-iv


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pp. v-viii


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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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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


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pp. 387-392

E-ISBN-13: 9780826591715
Print-ISBN-13: 9780826514301
Print-ISBN-10: 0826514308

Page Count: 368
Publication Year: 2003