Social structure
Hmong are organized into 18 clans determined by ancestral
lineage. They have large, extended families and practice traditional ceremonies
to remember their ancestors. Clan leaders are the key decision makers. Each
person has a last name that represents the clan they belong to. When a woman
marries, she keeps her maiden name. The Hmong language, Hmoob (Hmong in
English), has many dialects, although most Hmong speak either White Hmong or
Green Hmong. Hmong was not a written language until the late 1960s and has few
medical terms.
Diet
Traditional staples of the Hmong diet are rice, noodles,
fish, meat, and green vegetables with hot chili sauces. Hmong tend to eat the
same types of food at each meal, with very little fruit or dairy products.
Hmong people often prefer hot dishes and drink hot or warm water.
Traditionally, a sick person must eat hot food with certain vegetables. Within
30 days of childbirth, Hmong mothers usually eat only warm foods.
Religion
The Hmong shaman is a religious leader who makes all
decisions related to spiritual healing and conducts religious ceremonies. The
shaman acts as a medium between the visible world and an invisible spirit
world, and practices rituals for healing, divination, and control over natural
events. Since coming to the US, a number of Hmong have become Christian.
Medical care
Chronic diseases common among the Hmong population include
chronic obstructive pulmonary disease, diabetes, congestive heart failure, and
hypertension. The adoption of a Western diet and sedentary life style has lead
to a dramatic increase in the prevalence of diabetes. A lack of roughage in the
diet has resulted in chronic constipation and diarrhea among many Hmong.
Refugees 30 years of age or older may have long-term effects from malnutrition
and exposure to yellow rain and other war zone chemicals. Many refugees have
intestinal parasites, tuberculosis, anemia, depression, and post traumatic
stress syndrome. Although Hmong have been exposed to Western medicine since the
1950s, they traditionally view illness from a holistic perspective, with
perfect health being a balance between the spirit and the body. Good health
comes from the souls living within each person. When a person is ill, they seek
the help of a shaman to determine if the cause of the illness is within the
realm of the spirit. Spiritual causes require religious remedies. Traditional
spiritual causes of illness may include evil spirits or because one’s own
spirit has left the body. A person may be ill because an ancestor or evil
spirit is unhappy with them or their family or because someone cursed the
family or offended the family’s ancestors or spirits. The sick person may accept
either the appropriate Hmong medicine or treatment, or the Western approach.
Some Hmong people will not communicate dissatisfaction with the quality of
health care they receive. If they are dissatisfied with their care, they may
refuse care and turn to traditional treatments. Older Hmong may listen
attentively to health professionals, but avoid direct eye contact, which is
considered to be rude.
Many Hmong practice spiritual healing, which involves
retrieving the lost soul from another plane of existence. They may consider an
illness or an invasive surgical procedure to be the cause of soul loss. Hmong
may conduct healing ceremonies in the hospital or in the home. Herbal medicine
and traditional healing practices are often widely used before a person seeks
Western medical remedies. A person also may use traditional herbal treatments
as complements to Western treatments and practices. Surgery is usually not
acceptable to older Hmong people unless laboratory or other tests identify a
disease. Blood transfusions and organ donation also are considered
unacceptable.
Recent immigrants are unaccustomed to doing things at
specific times. In their native lands, farmers organized their activities
around sun up and sun down. Appointment times need to be written down and fully
explained. Take advantage of the following tips to help you provide the most
appropriate, culturally competent care for your Hmong patients:
• Demonstrate
respect to Hmong patients by asking how they would like to be addressed. Hmong
do not call each other by their first name. They address one another by their
title, such as aunt, uncle, brother, etc. (The medical record is filed under
first and last name.)
• Maintain
physical distance during an initial encounter. As trust develops, Hmong
patients become comfortable shaking hands. Not using direct eye contact with
the opposite sex demonstrates respect. Saying “no” to a Hmong patient
demonstrates disrespect.
• Involve
the patient and family in the care plan and in obtaining consent signatures.
Ask the patient, “In what language do you prefer to discuss your health with
us?” Use trained medical interpreters rather than family members. Never use
children as interpreters.
• Ask
patients what they believe is causing their illness. Be aware that Hmong health
beliefs are intermingled with spirituality. Schedule longer appointments for
Hmong patients, and take the time to explain care options. Explain the long
term consequences of not taking care of chronic illnesses, and the need to take
medications even when they are feeling well.
• Ask
elderly patients, “Who in your family can help you do this?” Solicit support
from adult children in caring for their elderly parents.
• Educate
patients about the safety of non FDA-approved foreign medications. Ask if they
use herbs or medications from Thailand, China, Laos, or France.
• Provide
the patient and family with current knowledge about an incurable disease.
Explain that a cure has not yet been discovered for this disease. Hmong people
sometimes feel they do not receive the same treatments others receive that
could cure them.
• Review
instructions orally and ask patients to repeat them back to you. Hmong may say
“yes,” but still do not understand. Explain by comparing a condition or disease
to a familiar household process such as using heat to control room temperature.
• Explain
your telephone triage system. You may need to make appointments for some
patients and to call them before their next scheduled appointment.
• Provide
educational materials in Hmong and English. The patient, family member, or
someone else at home may be able to read at least one of the languages.
Death and dying
Traditional Hmong view life as a continuous journey, rather
than the Western perspective of life as a journey with a beginning and an end.
They believe that death is merely a phase people go through when passing from
this plane of existence to the next. They believe people are destined to live
to a certain age. When that age is reached, it is time for the person to
depart. Hmong believe the spirit will reincarnate. Religious ceremonies
conducted on behalf of a dying person are intended to make the person happier.
The deceased is dressed in fine Hmong clothes to demonstrate to the community
and family that the person has lived a good life, will be missed, and will make
a proper entrance into the next world.
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
Source: www.stratishealth.org
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