Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers

Hmong Culture:Tradition and Change [Contains Image Plates]

11 1 HmongCulture: TraditionandChange KathleenA.Culhane-PeraM.D.,M.A., andPhuaXiong,M.D. 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 ground Hmong health-related beliefs, values, and practices. This historical and cultural information is crucial for U.S. health professionals and institutions committed to providing culturally responsive health care to Hmong patients and their families. A note of caution: while general statements about culture are useful as starting points, they can become dangerous stereotypes if applied unconditionally. Also, general statements will not hold for all Hmong people because of significant variations in Hmong culture influenced by differences in Laos (such as animistic rituals, geographic locations, political affiliation, the war, and refugee experiences) and differences in the United States (such as formal education,employment,and religion).Health Information for this chapter is based on texts cited, the authors’ clinical experiences and interviews with Hmong patients in health care settings from 1983 through 2002, and the authors’ research projects from 1986 through 2002. Kathleen A. Culhane-Pera has conducted qualitative research on Hmong people’s reactions to operations, blood draws, and septic work-ups in St. Paul, Minnesota; on providers’responses to Hmong refusal of treatment in St.Paul; on Hmong concepts of health,causes of disease,traditional healing practices,preventive care,children’s illnesses, and decision making for children’s illnesses in Thailand; on the role of hemp fiber in life-cycle rituals; on the effect of changing village socioeconomic conditions and household decision making on children’s health status in Thailand; on adult health status in Thailand; and traditional healing, concepts of childhood illnesses, childhood immunizations, childhood anemia, medical decision making for children’s illnesses, and childhood home safety in St. Paul. She is currently researching the effects of group visits on Hmong patients with type 2 diabetes mellitus. Phua Xiong has conducted qualitative research on Hmong people’s reactions to Western medicine and immunizations; traditional and changing shamanic healing practices and how these influence health care utilization and decision making; Hmong cultural and religious practices; traditional Hmong health concepts and beliefs; the construction and use of storycloths; the design, method, and meaning of White Hmong paj ntaub (embroidered cloth); Hmong cultural and social adjustment to American society; and trust and distrust of Western health care. Map 1.1. Southeast Asia in the Late 1970s 1. Hmong Culture: Traditions and Changes 13 care providers should consider this general information as a resource from which to learn more and to generate questions for individual patients and their families. Traditional Life in Southeast Asia According to ancient Chinese texts, the Hmong lived in northern central Asia, approximately the area of present-day Mongolia, in 2300 B.C.E. (Ruey Yih-Fu, 1962; cited in Tapp, 1989). Over the centuries, people migrated south into Tibet and China and finally into Southeast Asia in the 1800s as a result of warfare with the Han Chinese and a decrease in fertility of mountaintop soil (Cooper,1984; Savina,1930; Tapp, 1989). Despite their conflicts, the Hmong and the Han Chinese have many cultural and linguistic similarities,including their social structures,their practices of geomancy, their beliefs in the importance of ancestors, and their metaphysical concepts of the yin/yang balance (see Schein,2000).Many Hmong migrated to Laos,where for almost two hundred years they lived separate from the native Lao people geographically, socially, and culturally. After the 1975 communist takeover in Laos, Hmong soldiers and their families fled to Thailand. In the ensuing two decades, they were resettled from refugee camps in Thailand to countries around the world. The Hmong diaspora numbers about five million Hmong people in China and almost one million in other countries, including Argentina,Australia, Canada, France, French Guyana, Laos, New Zealand, Thailand, the United States, and Vietnam. Agriculture On the shallow but fertile mountaintop soil in Southeast Asia, Hmong people practice subsistence, slash-and-burn agriculture (Cooper, 1984; Kunstadter, Chapman & Sabhasri, 1978; Lemoine, 1972b; Geddes, 1976; Tapp, 1989; Yang, 1975, 1993). Before clearing the land and after harvesting the crops, men perform rituals to honor, thank, and appease the land spirits. Life is physically demanding; with no...