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222 11 DomesticViolence A Case Story 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 he might hurt the baby, she called the police. The police referred Mrs. Thao to a local clinic, where she began working with a counselor experienced in domestic violence among Southeast Asians. She told neither her husband nor her family of her visits with the counselor. Mrs. Thao’s and her husband’s families were aware the couple was having difficulty . The two families met with the couple to counsel them and asked that they be patient and try different ways to work out their problems. They disapproved of Mr. Thao’s kicking his wife and of Mrs. Thao’s calling the police. They suggested methods for them to talk to each other and to improve their relationship but gave no timeline for the resolution of the problems; nor did they give Mrs. Thao the option to leave. Two weeks after the family meeting, there was another argument and Mr. Thao kicked his wife again. This time she was hospitalized. She contacted her family and told them about her work with the counselor. Her family called the counselor to find out what role she was playing and what help was being recommended to their daughter . The counselor was trying to arrange a shelter placement for Mrs. Thao. Her family was opposed to this solution and wanted her to stop meeting with the counselor . The counselor explained the importance of keeping Mrs. Thao safe and not forcing her to go back to her husband. Her family promised to intervene to help her before allowing her to return home to him. Family leaders from both families, including uncles, brothers, fathers, and others who understood the situation, met at the home of a member of Mr.Thao’s family.Mr. Thao and his family accused Mrs. Thao of having a lover and of carrying another man’s child. Mr. Thao was upset and kept saying he did not trust his wife and was afraid she would leave him. He took no responsibility for their problems. His family begged her family to stop the involvement of outsiders.After a long discussion, everyone agreed that if Mr. Thao abused Mrs. Thao again, her family would “open the door” and permit her to leave the marriage. They would also support her should she wish to take additional steps, such as seek a restraining order. 11. Domestic Violence 223 Questions for Consideration Questions about Culture How is domestic violence understood and addressed in traditional Hmong families ? How is it understood and addressed in mainstream U.S. families? What are the most important stressors in the Hmong community related to domestic violence? How has the understanding and incidence of domestic violence changed since the Hmong have immigrated to the United States? What incentives or disincentives are there to report domestic violence to the police? How might Mr. Thao’s accusation of his wife’s extramarital sexual activity influence the families’ reactions to the violence? What would the families’ attitudes likely be if the baby were not his? Why might Mrs. Thao’s family have been opposed to their daughter’s seeking the help of a counselor? How do these reasons compare with attitudes prevalent in mainstream U.S. families? What risks does a Hmong victim of domestic abuse take when she seeks help outside of the family? Questions about Cross-Cultural Health Care Ethics What are the most important differences between the counselor’s and the family’s perception of best interests in this case? What are the largest barriers to Hmong families’ trust of Western-trained counselors , police, and U.S. courts? What differences are there in family and professional roles and responsibilities in Hmong and American families struggling with domestic abuse? Questions about Culturally Responsive Health Care How can health care professionals and institutions be more culturally responsive to reports of injuries due to domestic violence in Hmong families? From whose perspective is this case successful? What might health care professionals and institutions do to encourage Hmong families...

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