Transcript Hmong Presentation #2x

Literature Search and Terms
Shaman in America
A literature search was conducted using the
following databases: CINAHL PubMed, and
Google using the following terms; culture, culture
shock, cultural competence, culture and
healthcare, South East Asian and culture, Hmong
and culture, Mien and culture, culture and
disparities, and shaman. Several selected articles
are discussed and the following terms are
provided as important concepts that are related to
our topic on the South East Asian culture.
Culture
Culture is defined as the totality of socially
transmitted behavioral patterns, beliefs, values,
customs, lifeway, arts, and all other products of
human work and thought characteristics of a
population of people that guide their world view
and decision-making (Prunell, 2009, p. 1).
Culture Shock
Culture shock refers to feelings of
bewilderment, confusion, disorganization,
frustration, and stupidity, and the inability to
adapt to the differences in language and word
meaning, activities, time, and customs, that are a
part of the new culture (Murray, Zentner &
Yakimo, 2009 p. 135).
Cultural Competence
Cultural competence is the ability of the health
care provider, agency, or system to acknowledge
the importance of culture on all levels (client,
provider, administration, and policy) for
incorporation into health care (Murray et al., 2009
p. 140).
Conceptual Framework
The Roy Adaption Model (RAM) has been selected to
guide our presentation. The RAM views the individual
as a adaptive system in constant interaction with an
internal and external environment. The environment
exposes the individual to a variety of stimuli that
threaten or promote one’s unique wholeness
(Alligood, 2010, p. 310). For example, healthcare
professionals that take the opportunity to consider
there own, as well as their patients’, cultural beliefs,
practices and communication styles can positively
impact their patients’ ability to adapt.
Background:
South East Asians Uprooted to America
In the early 1980’s the Hmong and Mien
began to immigrate to the United States with
preferred refugee status after the Vietnam war
where they fought along side the CIA blocking
arms importation into Vietnam . Many of the
older adults, who fled Laos after the war, lived
much of their lives in refugee camps in Thailand
separated from their community and social
supports (Cobb, 2010) .
Although they brought with them their
language, social structure, customs, religious
and health beliefs, young and old, arrived in
the United States where the culture, language
and socioeconomics were very different (Cobb,
2010) . One could easily conclude the myth that
adversity came to a miraculous end once
refugees of the South East Asian conflict
arrived in the United States. However, the sense
of loneliness, loss, and shame became
magnified amongst refugees relocated to the
United States (Sheng-Mei Ma, 2005).
Hmong shown here playing the Qeej , a
bamboo pipe instrument known worldwide as the
cultural identifier for Hmong people. Hundreds of
years old, it plays a pivotal role at Hmong
funerals, as the sound of its chords are thought by
Hmong to call the soul out of the body and into
the afterworld.
In keeping with Roy’s Adaption
Model we will explore cultural
disparities and venture into a
variety of South East Asian
cultures to gain understanding of
the population that entered the
“great American melting pot” with
a unique story. The culture shock
that is often experienced by
immigrants entering the United
States will be analyzed with the
focus on the elderly population.
Cultural barriers that exist in
providing care to Mien and Hmong
Americans will be reviewed, and
strategies to provide cultural
competent care specific to this
population will be shared.
The Big Transition
As the Southeast Asians entered the United States,
they entered a world that was starkly different from their
previous home. They lived in mountainous areas and were
an agrarian society (Prunell, 2009).
Both Mien and Hmong have experienced a series of
traumatic events: the war in Laos, the Pathet Lao takeover
and subsequent Hmong persecution (including the threat
of genocide), the harrowing nighttime escapes through
jungles and across the Mekong River, the hardships of
refugee camps in Thailand, and finally resettlement in the
United States, with not only housing, income, language,
and employment concerns, but also the separation of
families and clans, inability to practice traditional religion,
hasty conversion to Christianity, and the breakdown of the
gender hierarchy, among many others (Sheng-mei Ma,
2005).
Many lacked formal education; were predominantly
illiterate, lived in primitive circumstances, and had no
contact with the modern world. One journalist has
facetiously characterized Hmong refugees’ transition from
Southeast Asia to the West as moving "from the Stone Age
to the Space Age“(Sheng-mei Ma, 2005).
Acclimating to
America
The documentary movie “The Split Horn”
depicts a Hmong shaman, Paja Thao, as he
struggles to maintain ancient traditions while
his children embrace the American culture.
Paja sees his children adapting to American
society more willingly than his generation.
His children are learning the English
language, achieving an education, and
marrying Americans outside their culture.
Paja’s children talk about the guilt and
distress of living in two worlds. They enjoy
the America they have come to know while
attempting to please older generations by
honoring the culture and tradition of the
homeland (Taggart, 2001).
Cause and Effect Conceptual Inventory on Cultural Shock
Causes
Language and
Word
Meaning
Differences
Differences in
Cultural
Practices
Differences in
Health
Practices
Differences in
Social
Structure
Culture Shock
Loneliness
Depression
Confusion
Isolation
Frustration
Effects
Virginia Carrier-Kohlman, V., Lindsey, A.M., West, C., (2003)
Phases of Culture
Shock
Unpleasant feelings often associated with culture shock
occur in stages and can be magnified when one moves to a
culture that is very different from their own. Brink and
Sanders, as cited by, Murray et al., 2009, describe four
phases associated with culture shock.
Honeymoon phase: This stage is characterized by
excitement, exploration, and pleasure. This phase may be
experienced by a short-term visitor to a new area, by a
geographic move to a different location, or during initial
employment in a different health care area.
Disenchanted phase: Person feels stuck, depressed,
irritated, and that the environment is unpredictable and no
longer exotic. The normal cues for social intercourse are
absent and the person is cut adrift. The person may become
physically ill.
Beginning resolution phase: New cultural behavior patterns
are adopted. Friends are found. Life becomes easier and
more predictable.
Effective function phase: The person has become almost
bicultural and may experience reverse culture shock on
return home after living abroad or when transferring to a
different health care agency.
(Murray, et al., 2009, p.135-136).
Shaman
Societal Perfectives on the Elderly South East Asians
Cultural implication of the southeast Asian culture, ethnicity, and socioeconomic level
influence the role of the older adult in family relationships and determine health practices.
Elderly Southeast Asians often state the most stressful of all adaptations to the American
culture is “role loss” which may be the most corrosive to the ego. Southeast elderly Asians who
were well respected and held jobs of honor such as colonels and military communications
specialist are now janitors and chicken processors. Many southeast Asians state, “We have
become children in this country” ( Fadiman, 1997, p. 206).
In addition, Southeast elderly Asians feel that their children have assumed some of the power
that once to belong to them. The elders have taken this especially hard as the their identity has
always hinged on tradition. “We have lost all control. Our children do not respect us. One of the
hardest things for me is when I tell my children things and they say, “I already know that”
(Fadiman, 1997, p. 207).
Although the Hmong elders state Americanization may bring certain benefits such as job
opportunities, more money and less cultural dislocation; Hmong parents are likely to view any
earmarks of assimilation as an insult and a threat ( Fadiman, 1997, p. 207).
Religious Beliefs and Healthcare
Traditional Hmong believe in animism, the belief in the spirit world and it’s link to all
living things. They believe that illness can be the effect of physical and spiritual factors.
Hmong believe in order to maintain good health a balance between the body and the spirit
must be maintained. They also believe if their ancestors are offended illness or disease
may ensue.
A phenomenon called Sudden Unexpected Nocturnal Death Syndrome (SUNDS)
which in the 1970s and 80s mysteriously struck Hmong and other Southeast Asian male
refugees in their sleep. Some survivors claimed the attack of a Kingstonian "Sitting Ghost"
(The Woman Warrior 81) on their chests, pressing air out of their lungs. Western doctors
could do no more than attributing the cases to cardiac arrest in otherwise perfectly healthy
men, a great number of whom reported depression
and ill-adjustment to the U.S. (Munger, 1987).
Health conditions common to Hmong include depression, anxiety, suicide and
post traumatic stress disorder. As a result
of experiences during the Vietnamese war,
there flight to safety and culture stressors
many Hmong continue to have nightmares
and flashbacks related to the terrors they
experienced in Laos. Unemployment and
reversal of family roles have created
additional cultural stressors.
This You Tube video illustrated the culture shock encountered by Hmong males
and the stress they encounter while attempting to adapt to American life.
South East Asian
Culture and Healthcare
The diversity of the United States population
has resulted in the “great American melting
pot”, which has brought about a need for
culturally competent healthcare. Because
culture has a powerful influence on health and
illness, health-care providers must recognize,
respect, and integrate patients’ cultural beliefs
in their practice (Prunell, 2009 p.1).
Literature suggests that disparities in
healthcare among ethnic, social, and
economic groups show that healthcare
providers need to be attentive to cultural
diversity. In a 2010 study, several barriers to
providing healthcare to Hmong were
enumerated. This study revealed barriers that
resulted in misunderstanding and
misinterpretation between the healthcare
provider and South East Asian Americans
stemmed from differences in language,
religion, culture and social organizations
(Cobb, 2010, p. 82).
Research Bridging Cultural Barriers
In 2008 study, joint endeavors between researchers and the Hmong community
came together to develop and test the quality of a hypertension care survey
instrument. In-depth interviews were undertaken with Hmong community leaders
and hypertensive patients to enrich the understanding of quality of care from the
Hmong socio-cultural perspective. The goal of this study was to develop a quality care
survey that would assist in yielding information to help provide culturally appropriate
care to the Hmong American population. The collaborative effort at all levels within
the community helped researchers and the community members to test survey
instruments that was more culturally, linguistically, and socially appropriate. In
addition this study, provided the means through which the Hmong population could
voice their own health care needs that could be used in future research (Wong,
Mouanoutoua, Chen, 2008).
In the book titled, “The Challenge of Cross-Cultural Competency in Social Work “,
written by Dr. Jean Schuldberg , a study conducted in 1993 refers to the
recommendations of the participants of the research study concluding that, “when
teaching cultural competency it is important for the teachers to name the injustices
the Southeast Asians experienced and highlight our rapidly changing global
community” (Schuldberg, 2005).
Cause and Effect Inventory for Cultural Competence
Cause
Overcome Language Barriers
Use of Interpreter
Cultural Awareness
Integrations of Cultural
Practices
Cultural
Competence
Establishment of Support
System
Reversal of Culture
Shock Symptoms
New Cultural Behavior
Patterns Adopted
Effect
Carrier-Kohlman et al. (2003)
Cultural Competent Care
•
Cultural competent healthcare practices include the consideration of others tradition,
magicoreligious or biomedical beliefs and practices, individual responsibility for health,
self-medicating practices and views on mental illness.
•
Hmong may seek westernized medical care, traditional healers or Shamans who
perform rituals for healing. They may seek herbalists and take multiple treatments for
the same condition. Some practice home remedies such as coining or cupping. Health
care workers should not confuse the patterns of coining or cupping for abuse.
•
Bruising may be seen along with coining and pricking the center of the bruise may be
done to release bad spirits; unsterilized sewing needles are generally used for this
purpose. Healthcare workers should always encourage education regarding the use of
sterilization of needles (Prunell, 2009, p. 213-214).
Cultural Competent Care Continued
•
Parents may tie strings around baby’s necks and older children and adults
may have strings tied around wrists, waists, or ankles
•
Necklaces and strings must remain on until they fall off naturally, removing
them too soon may result in soul loss
•
Healthcare worker should never remove strings, necklaces, or bracelets
without the parents’ or patient’s permission
•
Some Southeast Asians utilize herbs prescribed by a herbalist Studies have
indicated that these herbs may have pharmaceutical properties. Healthcare
workers must always ask patients about their use of herbs
(Prunell, 2009, p. 213-214)
Mey Chao-Lee
Mey Chao-Lee is a cultural competency coordinator for the
Shasta County Health and Human Services Agency. Mey ChaoLee fled Laos with her family as a young girl and later
immigrated to America. Recently she became the first Mien to
earn a master’s degree in social work from Chico State
University, and has dedicated her life to helping those who
share her culture. We are honored to have her here with us
today to learn more about her journey to America and her
Mein culture.
Video with Mey can be viewed on first power point submitted
using the instructions provided.
Sophia Questions
• If you were to be uprooted from America to
Laos what health practices would you want
to hold on to and why?
• Would you ask for a traditional American
doctor to treat you or would you be willing to
have a Shaman treat you?
• Would you be willing to take the South East
Asian traditional medications and
treatments?
• What could Shamans do to gain your trust?
• What do you think could help break through
the language barrier?
• Would you want to practice your religious
beliefs?
References
Alligood, M. R. (2010). Nursing Theory: Utilization & Application (4 ed.). Maryland Heights,
Missouri: Mosby Elsevier.1
Carrier-Kohlman, V., Lindsey, A. M., & West, C.M. (2003). Pathophysiological phenomena in
nursing: human responses to illness (3 ed.). St. Louis, Missouri: Elsevier.
Cobb, T. (2010). Strategies for providing cultural competent health care for Hmong Americans.
Journal of Cultural Diversity, 17(3), 79-83. Retrieved February 10, 2011 from CINAHL
Fadiman, A. (1997). The spirit catches you and you fall down. New York, New York: Farrar,
Straus & Giroux.
Munger, R. (1987). Sudden death in sleep of Laotian-Hmong refugees in Thailand: A casecontrol study. American Journal of Public Health, 77, 1187-1190.
Murray, R. B., Proctor-Zentner, J., & Yakimo, R. (2009). Health promotions strategies through
the life span (8 ed.). Upper Saddle River, New Jersey: Pearson Prentice Hall.
Prunell, L. D. (2009). Guide to culturally competent health care (2 ed.). Philadelphia,
Pennsylvania: F.A. Davis Company.
Regan, K. (2009, November). Uniting cultures: May Chao-Lee culture competency coordinator.
Enjoy Magazine, 53-56.
Schuldberg, J. (2005). The challenge of cross-cultural competency in social work. New York,
New York: The Edwin Mellen Press.
Sheng-Mei, M. (2005). Hmong Refugee Death Fugue. Hmong Studies Journal, 6, 1-36.
Sudden Death Syndrome (2008), Retrieved February 8, 2011, from
http://www:youtube.com/with?v=8rAn2Tjlv4
Taggart, S. (2001). Split horn of a Hmong shaman in America [Motion Picture]. United States
Vimeo Mae Interview (2011), Retrieved February 8, 2011, from
http://.vimeo.com/20350433
Wong, C., Mouanoutoua, V., & Chen, M-J (2008). Engaging community in the quality of
hypertension care project with Hmong Americans. Journal of Cultural Diversity, 15(1),
30-36.