CAMBODIAN CULTURE

Formerly known as Kampuchea, Cambodia faces the gulf of Thailand and is bordered by Thailand, Laos, and Vietnam. Cambodia has a population of over 14 million. Between 1969 and 1973, Cambodia was invaded by the U.S. and Vietnam, with more than 2 million Cambodians made refugees by the war. By 1975 the country was faced with famine, and the Communist Khmer Rouge, heavily influenced by China, took power.

Prior to 1975, a limited number of Cambodians who lived in the U.S. were children of upper income families or children who had received government funded scholarships and were sent abroad to attend school. In 1979, the U.S. government settled 150,000 refugees in various towns and cities throughout the country. The 2006 American Community Survey showed the largest Cambodian-American populations were in California, Massachusetts, Washington, Texas, and Minnesota.

Social Structure

Cambodian people are also referred to as Kampuchean or Khmer. They speak Khmer, Chinese, Vietnamese, and French. Throughout history, their culture has been heavily influenced by Thailand, Laos, China, and India.

Khmer are generally respectful, polite, and speak softly, communicating carefully and indirectly. Sompeah is a gesture of greeting with both palms brought together with fingers pointed upward. The higher the sompeah, the higher the status of the person being greeted. Khmer often raise large families if financially able to do so, with extended family members living together or nearby. The spokesperson for the family may be the father, or the eldest son or eldest daughter. Men are generally recognized as head of the family with women expected to be care givers—although roles are changing as Khmer become acclimated to American society and values. Women now often work outside the home. Elders are important in decision making and often take care of their grandchildren. Men and women protect and care for the disabled in the community.

Religion

Most Cambodians are Theravada Buddhists, one of the two major branches of Buddhism. Followers of Theravada, meaning the “Doctrine of the Elders,” adhere to the earliest surviving record of Buddha’s teachings. Buddha is believed to have lived and taught in northeastern India sometime during the fifth century BC. The two largest Cambodian Buddhist temples in Minnesota are located in Hampton and Rochester. Other Cambodians practice Islam, Cham, Christianity, or animist religions.

Health Considerations

Khmer often attribute good health to equilibrium, adopting the Chinese philosophy of balancing hot and cold. Many Khmer also believe in the inherent properties of balancing hot and cold foods. Food is deemed either hot, cold, or neutral. For example, chicken is hot, vegetables are cold, and rice is neutral. Khmer people who eat a traditional Cambodian diet eat rice at all three meals and prefer warm tea or water to drink. Most Khmer do not use ice and rarely consume dairy products. Many are lactose intolerant. Khmer who subscribe to traditional beliefs attribute illness to natural or super natural powers. Illness may be considered punishment for sins committed in a past life. Many believe evil spirits or ancestors cause mental illness.

Common health problems for older refugees who came to this country 30 years ago include nutritional deficits, hepatitis B, tuberculosis, malaria, and HIV/AIDs. Older Khmer may suffer from post traumatic stress disorder as a result of war and the brutality of the Khmer Rouge in Cambodia.

Khmer may seek traditional practices before they seek Western medicine, and often hold traditional healing ceremonies in the home. They may reject or not appreciate the value of preventive care, screening, or early detection.

Khmer are known for enduring pain stoically. Rather than asking general questions about pain or symptoms, clinicians should ask very specific questions. Common treatments for pain include herbal medicines, acupuncture, acupressure, cupping, coining, moxibustion, and use of Tiger Balm. In cupping and coining, cutaneous hematomas are made on the face and trunk by pinching and pulling the skin to release excessive air, by rubbing oiled skin with a coin or spoon, or by cupping—heating air in a cup with a flame, then placing the cup onto the skin. As the air cools, it contracts and pulls on the skin, leaving a purple mark.

Moxibustion, often combined with acupuncture, is the process of making circular superficial burns on the skin with ignited incense or other material placed directly on the skin.

Health care providers should be aware of dermabrasive procedures used by patients that leave marks on the skin—and not misinterpret the marks as a sign of physical abuse.

In the hospital, many family and friends may visit patients and often like to sleep in the patient’s room. Khmer may fear surgery and giving blood due to the belief that these procedures will result in heat loss.

End of Life

Most patient’s families prefer to discuss end of life issues with the physician, protecting the patient from the knowledge of a poor prognosis. Many patients prefer to die at home with family care and community support. When a person dies at home, the body may be kept in the home for 24 hours to allow for visitation and ceremonies.

Buddhists believe they will return in another life and should prepare for death calmly and thoughtfully. The family and monks may wash and shroud the body. Monks recite prayers and burn incense. Due to belief in rebirth, Buddhists rarely allow organ donations or autopsy.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients

Source: www.stratishealth.org