Hmong Cultural & Beliefs Impact Western Health Care

Social Structure  Emphasis on the clan system originating form a common ancestor  Clanship is the basic social and political organization  A Hmong at birth takes on his/her father’s c

Diversity Rx 2010 Seventh National Conference

On Quality Health Care for Culturally Diverse

Populations October 18-21, 2010

THE HMONG CULTURAL/BELIEFS IMPACT WESTERN

HEALTH CARE

By Fuechou Thao

HMONG HISTORY

1 Theoretical framework about the Origin of the Hmong

a Savina concluded that the Hmong were a subgroup of the Turanians, a

Caucasoid people, originally from Mesopotamia

b Eickstedt introduced the theory of ultimate southern origin_ either coming from India, Burma, or Tonkin

However, all researchers agreed that the Hmong were in China before the Chinese

2 The Hmong’s Migration

a From China to Southeast Asian (Laos) about 1810 and early 1900

b From Laos to the U.S.A, Australia, France, Canada, etc in 1976

DEFINITION OF TERMS

The Chinese used the following terms:

Mong-Tse Historical Chinese work compared our language to the

howling or crying of the hyena

The Lao and Thai used: Meo

U.S Government used: Highlander

We call ourselves: Hmong or Mong

DEMOGRAPHY AND GEOGRAPHY

1 Chij Tsaj, Hmoob Pa Tawg Teb ( The Hmong in Wanshan), (Guyane: Association Communaute Hmong, n.d.), 17

2 Dao Yang , Les Hmong du Laos Face au Development (Vientiane, Laos: Edition Siaosavanth, 1975), 26-28

3 W.E Garrett, “The Hmong of Laos: No Place to Run,” National Geographic, Vol 145,No 1

(Washington, D.C.: National Geographic Society, January 1974), 80

4 Xeev Nruag Xyooj, “Txooj Moob huv Nplaj Teb” (The Mong in the World), Txooj Moob, Vol 4

(Winfield, Illinois: Mong Volunteer Literacy, Inc., May 1989), 8-12

HMONG CULTURE

1 Family Life

 Basic nurturing institution, extended family

 Organized strictly on the patriarchal side

2 Religion

 Traditional animists (Kev Cai Poj Yawm)

 Animism: a belief system that combines the ancestor , supernatural power, superstition and devil worship

 No standardization in Hmong religion

 Belief in life after death

 Dealing mostly with superstition and devil worship through the notion of illness and death

3 Arts and Crafts

 The Hmong are known for their “Paj Ntaub” translated “Flower Clothes”

 Hmong observed the patterns, the cross-stitch embroidery and their applique from the design of the cowries Shell and the shape of animals and plants from China

 Those patterns were incorporated into costume design

 Paj-Ntaub became one of the most distinctive features of traditional Hmong culture

4 Social Structure

 Emphasis on the clan system originating form a common ancestor

 Clanship is the basic social and political organization

 A Hmong at birth takes on his/her father’s clan and remains a member for life

 Origin of the clan remains a mystery referring to a child of incest born from a brother and a sister dating back to the Great Flood Shaped like an egg, the couple cut their offspring into pieces that became the different Hmong Clans

 In Hmong Society, boys and girls are forbidden to date and marry within their own clan

 The traditional Hmong consisted of twelve clans that corresponded to their

rituals:

CLAN NAMES RITUALS

 The Hmong took on Mandarin Clan name during King Wu of the Chou Dynasty (1028-257 B.C.)

 And the branching out of the clans from twelve to eighteen occurred during the Ming Dynasty (1368-1644);

5 Political Organization

 A complex hierarchical political system;

 Reflected the former political system of the Hmong kingdom between 400-900 A.D.;

 “A loose federation of tribal heredity Monarchy”

 Power was decentralized to the localities;

 The full scope of the traditional Hmong political system has not been well-developed;

 In the 19th century, some alterations in the Hmong political structure were made under the auspices of the territorial organization of the Royal Laotian

government:

 Nai Ban (headman or village chief)

 Tasseng (district chief)

 Nai Kong (a higher layer of civil tribal administrative officials)

 Chao Muong (Mayor)

 Chao Khoueng ( Provincial Chief)

 The strongest basic unit of the Hmong political system remains with the

patrilineal clan system with its household at the local level;

 Members of the same clan refer to clan-brother or clan-sister;

 Grouping the members of a clan of the same and common ancestors in one particular area is typical_ Hmong enclave;

 Place a high value and offer much respect to elders;

 Tus Tsaws –Ntug (the clan Leader/householder)-final authority in familial matters; Role is to maintain peace and harmony within his family, clan members, and other clan members;

 A Hmong is responsible to answer to his family, to the clan, and to the

householder;

 As mountain dwellers, the Hmong survived on small scale agricultural economy

“Ua Teb” (Farming) at a subsistent level;

 The notion of division of labor is very important within the family, between

members of the villages, and between villages;

 The Hmong believe in the spirit of collective teamwork and the notion of free labor exchange existing within the traditional and cultural realm of Hmong life;

HMONG LANGUAGE

1 General Characteristics

 Has always been an oral language until the end of World War II

 Is a subgroup in the Sino-Tibetan language family of Asia (considered a pre-Sinitic language in the Miao-Yao family)

 Is a monosyllabic and tonal language

The ending in each word, kuv, hlub, and koj, are tone-markers The Hmong do not pronounce them

Therefore, pronouncing the –s or the ending sounds is difficult for Hmong

 Orthography was based on the Romanized Practical Alphabet (RPA) system developed by missionaries of the Christian and Missionary Alliance (CMA) in the 1950’s

2 Morphology: Words

 Words in Hmong consist of monosyllables and do not change their forms

 Hmong words do not have suffixes so English morphology is difficult for Hmong speakers

A) No –s ending in plurals

B) No –ed in past tenses

Kuv hlub koj (past)

C) No –ing in participles

D) No Noun Declensions

E) No Verb Conjugations like French or Spanish

J’ai chante’ une chanson

Je chanterai une chanson

F) No Grammatical Gender (no masculine or feminine like English and French)

EDUCATION

History, legend and Hmong elders all maintain that the Hmong in China once had a writing system before the invasion of the Han Chinese Due to heavy and continued suppression by the Han Chinese, the Hmong were unable to keep their books; they threw them into the Yellow River and hid their writing by only using the characters as designs for the women’s skirts and collar So sometime in their past the Hmong lost their writing system

According to Dao Yang, PhD, the first school began operating in the Hmong homelands

at Xiengkhoung Province, Laos in 1939 and there were only nine Hmong students who attended Once more elementary schools were set up throughout other highland areas

of Laos, Hmong children were able to attend school to learn the Lao language The Laotian school system was divided into two grade school levels The first level was called Primary Grade school which included grades 1-3, and the second level was called the Upper Grade School which included grades 4-6 Secondary School also was divided into two levels as Junior High which was grades 7-10, and High School which included grades 11-13 In 1971, there were 340 Hmong students enrolled in public and private secondary schools in Vientiane and 37 Hmong students enrolled to study at the universities in various countries abroad In 1972, Dao Yang, PhD was the first Hmong

in Laos to earn a doctorate degree in economics and social development from the University of Paris, in France

Education is the most important driving force in the development of the Hmong

Community in the United States In the short period of 35 years ( 1975-2010) of their residence in the United States, more than 10,000 Hmong students have earned

bachelor degrees, more than 1,000 earned master degrees and more than 500 earned doctorate degrees at American Colleges and Universities

HMONG BELIEFS

Hmong traditional beliefs regarding the cause of illness, and their descriptions of

symptoms are very different from commonly used Western medical concepts Western health practitioners may become confused, frustrated and may conclude that the

Hmong patient is answering inappropriately by presenting a traditional belief in relating his or her symptoms However, health practitioners can learn to correctly diagnose the patient’s ultimate health concern and respond accordingly to the patient’s needs through

an appropriately trained interpreter or a cultural broker Common traditional Hmong concepts regarding causes of illness are as follows:

FOOD AND DRINK

Many illnesses, especially those which manifest themselves as stomach aches or digestive problems are thought to be caused by eating or drinking something that does not agree with the body This does not necessarily mean that the food and drink was contaminated, rotten, or poisonous This idea is not dissimilar from the symptoms caused by a Western “allergy.” However, the Hmong perceive bad food and drink to cause different symptoms than do allergies in Western medicine For example, a

chronic feeling of bloating in the abdominal area may be described as “ having a lump

in the stomach,” or “kem plab”

A common folk practice for differentiating between “bad food” and “bad drink” as the cause for a stomach ache is for a second party to massage the stomach of the sick person in a upwards motion towards the throat, and outwards along the arms to the fingers A finger is then pricked and a drop of blood is allowed to drop into a bowl of water If the blood floats, the illness is thought to be cause by drinking, and if it sinks then it is thought to be cause by food Other symptoms believed to be caused by food and drink:

ANIMISM & ANCESTOR WORSHIPERS

Hmong Community Leaders in the United States estimate that at least 70 percent of Hmong refugees have chosen to retain their traditional beliefs Ancestor

Worshippers/Animists view most major illnesses as spiritual or traditional belief

problems

Each Hmong family has a group of ancestor spirits, which belong to the father’s or husband’s side From time to time the ancestor spirits are in great need of certain things from the descendents’ family to be used or spent in the spiritual world by causing illness

in a member of the family To make an appropriate diagnosis a shaman or diagnostician must be called in and ritual of animal sacrifice will be offer to the ancestor spirits

NATURE SPIRITS

The Nature Spirits own and control their properties such as the hills, mountains, trees, rivers, caves, animals and its kingdom In general, nature spirits are not malevolent towards humans However, if a person offends, they may cause illness to the Offender, the Family members of the offender and the Immediate Families

Tossing a rock into the river may offend the river spirit However, health usually returns

to the sick person once an appropriate ritual is conducted If an offense has transpired a Hmong Shaman, Diagnostician and Tamed Good Spirit Master will be called in to make

an appropriate diagnosis

EVIL SPIRITS

The evil spirits are believed to live everywhere, especially in uninhabited areas such as forests and jungles If offended, they necessarily attack the perpetrator by causing acute pain, violent pain, sickness and death

The powerful Hmong Shaman, Tamed Spirit Master, or Evil-Spirit Master can deal with problems of this sort, and treatment usually entails fighting off the evil spirits, rather than appeasing it with ritual and sacrifice

TAMED EVIL SPIRITS

Throughout Southeast Asia there is a common belief that a person, by joining a religious cult or by studying under the established masters, can learn to control evil spirits The only two tamed evil spirits are “Nyuj Ciab, and Zeb Ntais.” They can be controlled under

a specialty Master who are thought to be able to magically insert the “Nyuj Ciab, and Zeb Ntais” into anyone whom they target People may also seek out and hire them to inflict sickness and death upon an enemy Common symptoms of an attack by the evil-spirits include acute pain, violent pain, and sickness and death

It is believed that the only way to escape from such a tamed evil-spirit attack is to bribe the attacker with more money or hire a more powerful master to fight off the evil spirits

LOST SOULS

A prevalent concept throughout many Southeast Asian cultures is that good health is the union of one’s souls always with the body The Hmong believe that each person has twelve souls - there are three major souls and nine shadow souls-united in the body The more souls lost and the longer they are lost, the sicker the person will be The souls can be lost in numerable ways such as being frightened, depression, trauma, kidnapped

by evil spirits, on a long trip, and simply get lost

There are many different types of ceremonies to call the souls back to their bodies Ceremonies range greatly in complexity from a basic calling ceremony to the most elaborate, enlisting specialty soul callers

In the Hmong society it was believed that elders, particularly those of the same clan, had the right to curse their descendants if the descendants did not carry out the filial duties A person who is morally right could curse anyone who has done him a serious wrong Curses could cause a wide range of illness, economic disaster, and even death The only way to remove these effects was for the person who originated the curse to take it back through appropriate ritual and ceremony

WEATHER

Traditionally Hmong elders believe that chronic illness, old injuries, etc, will reoccur as various forms of pains or aches in the body when the weather changes sudden It also believed that changing weather can bring on colds, influenza, and muscle aches which western people might call arthritis or rheumatism Heat exhaustion and sunstroke are also recognized by the Hmong as being caused by overexposure to the sun and heat

OLD AGE

Hmong understand that as the human body ages, it degenerates, and various ailments occur Long term hard work and having borne many children are often cited by the elderly for body aches and pains and respiratory and digestive problems In Hmong culture and society old age begins at age 30 The lifespan was shorter than the

American average Being considered old in Hmong society was perceived as something desirable, even though illnesses were anticipated with advancing age

EXPIRATION OF BIRTH VISA

The Hmong believe that each person receives or carries a visa from God to be born as human being God determines the length of stay on earth and the expiration date of the visa Life-threatening illnesses and unexpected or unexplained sudden death are

thought to be cause by that person’s visa being expired The Hmong Shaman is the only one who has the power to extend, renew, or restore the expiration date For routine preventive care a shaman is called in to perform ritual of trance or incantation, make negotiations to extend or renew the visa, offer animal sacrifices, restore supplies and goods by the family members such as the younger brothers, daughters, and son in-law, son and daughter in-law at a ritual ceremony

HOUSE SPIRITS

There are six house spirits who play an important roll in the house in guarding the individual person’s souls and spirits and while fending off any outside spirits The spirits

of the ritual hearth or large stove and the spirit of the cooking hearth, which is in the middle of the floor, help to protect every member of the entire family from harm or misfortune The spirits of the ancestors live in the central pillar and protect everyone in the household against devils The spirit of the door helps to protect the house and everyone’s souls in the entire family against devils The spirit of wealth and prosperity lives against the middle of the back wall and protects the entire household and every

member of the family The spirit of the marital bedroom lives in a gourd in the bedroom and the gourd needs to be kept clean, to protects and produce the animal of the family

KARMA

The concept of Karma is a common belief throughout Asia Karma is not directly a part

of Animism or Ancestor Worship, the Hmong believe that souls return to earth time after time, and life on earth is designated by luck, and by karma Thus, people born with birth defects, mental retardation, handicaps, and chronic illnesses are often regarded as paying for sins committed in past lives

DEPRESSION OR STRESS

Depression or stress is not perceiving by the Hmong in the same way that Westerners perceive it However, they recognize that stressful situations can result in various health problems, especially that which we in the Western would call mental illness Some examples include family financial problems, aggressiveness, depression, insomnia, sadness, and loss of appetite The Hmong refer to those who exhibit changes in

personality as “having something wrong with their liver.” This does not mean that they think there is something pathologically wrong with his or her liver; rather, the Hmong language uses “liver” as a term to describe anyone exhibiting various sets of symptoms For example, a common Hmong term for someone who becomes destructive and begins to verbally abuse others after some kind of emotional trauma or loss is “siab phem, tsiv siab, kho siab” which translated having an “ugly liver, angry liver, rigid liver”

HMONG TRADITIONAL HEALERS

Western health practitioners may wonder why they lack credibility with some of their Hmong clients Part of the reason is that differences between Western and Hmong health practitioners are so great that some Hmong clients wonder if the American doctor

or nurse is competent Hmong traditional healers provide health care to their patients in

a completely different and unique way, and just as Western countries have different types of healers such as MDs, DOs, and chiropractors, the Hmong also have healers from different schools of practice It is quite common for individuals to study and master more than one healing art Although being a traditional healer does not usually bring a person wealth in Hmong society, it does bring status and peer admiration Common Hmong traditional healers and practitioners are as follow:

ACUPUNCTURISTS

It is thought that the skill of acupuncture was adapted by the Hmong from the Chinese Most Hmong acupuncturists do not use the hundreds of points used by their Chinese counterparts, but rather concentrate on several key points Although, the practice of Hmong acupuncture is not very common it is utilized on occasion by both Christian and Non-Christian Hmong Hmong acupuncturists practice the following skills: