Healing Traditions: Alternative Medicine and the Health Professions

3. Hmong Cultural Values, Biomedicine, and Chronic Liver Disease

Chapter 3 Hmong Cultural Values, Biomedicine, and Chronic Liver Disease In the past decade, scholars of many disciplines concerned with health care in complex societies have paid increasing attention to the importance of matters of culture and worldviewin health care delivery. The education and training of health professionals in the United States, however, does not yet incorporate much of this information or routinely teach the skills for evaluating and responding to significant differences in worldviewbetween patients and providers. As a result, many providers remain unaware of the extent to which such differences can affect clinicalinteraction and outcomes, and are badly hampered in cross-cultural encounters. The case history recounted in this chapter illustrates the possible extent of the complexities of this meeting of very different views of health and illness.It highlights the great variety of values, beliefs, and cultural considerations—not merely those directly related to health and illness—which may have bearing on both patients' and providers' responses to illnessand to care. Mr. L., the patient in the case, is a young Hmong refugee who was resettled in Philadelphia in1979. Historical Background The Hmong are an ethnically distinct southeast Asian group whose origins are generally traced to central China, during the second millennium , B.C. (Chindarsi 1976; Geddes 1976).l In the middle of the eighteenth century large numbers of Hmong were forced out of China and began a decades-long peregrination that resettled the majority in Laos and Vietnam by the early to mid-nineteenth century, with smaller numbers migrating into northern Thailand. In these adoptive homelands the Hmong were mountain dwellers, as they had been forcenturies in China, inhabiting the forested ridges at altitudes several thou- Hmong Values, Blomedlclne, and Liver Disease 81 sand feet above sea level. The Hmong have traditionally been an agrarian people. In promising mountain sites, they established settlements , typically of some thirty to forty households, and practiced swidden agriculture. Villages generally remained stable for the duration of land fertility. When land became unproductive, or if infectious sickness or other misfortune overcame a village, the houses would be abandoned and the village moved to a fresh site. Throughout their historyof continual resettlement the Hmong have remained culturallyseparate and ethnicallydistinctfrom other southeast Asian peoples. A powerful sense of cultural identity has led throughout their history to a quite deliberate maintenance of ethnic unity within Hmong society, and of separateness from surrounding peoples. Although engaging in trade and other economic relationswith them, Hmong seldom socializesignificantly with other groups in their countries of residence, and very rarely marry non-Hmong (Chindarsi 1976; Geddes 1976; Lemoine 1986). The strength of the Hmong sense of ethnic identity and solidarity has been undiluted by hundreds of years of migration and a wide diaspora. Those Hmong who resided in Laos in the mid-twentieth century became entangled, by virtue of their location,in the politicalmachinations of the Indochinese wars that began in about 1945, with resistance to French domination in Indochina led first by the Japanese and later by the Viet Minh and Pathet Lao (Dao 1982). Laotian Hmong villages tended to be located in places well suited, and thus susceptible, to guerrilla warfare. The Hmong began to be displaced, often with violence , by local opposition forces. In consequence they alliedthemselves for protection with the French arid the Royal Government of Laos. This alliance in turn made them targets of Viet Minh and Pathet Lao eradication efforts. Followingthe withdrawalof the French from Indochina in the mid-1950s, many Hmong continued to fight in the ongoing Laotian battle against North Vietnamese occupation forces in the northeastern parts of the country. The United States government began in the early 1960s to support the Royal Laotian government and itsallies(which included the Hmong) in the fight against North Vietnamese forcesin Laos during the American military engagement in Vietnam. This alliance helped to set the stage for the later exodus and relocation of the Hmong as the Western effort in Vietnam began to collapse. A mass exodus of Hmong from Laos to Thailand began in 1975. Enormous refugee camps were established in Thailand to receive the influx, and resettlement efforts were handled out of these camps. Countries of relocation included the United States, France, Australia,Canada, Argentina, and China (Dao 1982). The first Hmong refugees began arriving in the United States in the 82 Chapter 3 spring of 1976 (Dunnigan 1986). Some 100,000 Hmong had been relocated abroad by 1982...