Cultural competence

Abstract This paper explores the Hmong people’s views toward medicine within the lens of their culture. It will take into account their history and also seek to explain the natural aversion these people have to most modern techniques in medicine. The Hmong people have a large immigrant population in the United States and represent unique challenges to most medical practitioners that can be used as a model to teach new methods of treating patients who may not understand western medicine.

Understanding the Hmong is the first step in devising better techniques for nurses and other health professionals who seek to provide the best standard of care to all peoples in a safe, professional and cooperative way. Medical Views of the Hmong People: The Importance of Cross-Cultural Understanding As the United States becomes a more racially and ethnically diverse nation, health care systems and providers must adapt to be able to better care for patients’ with regard to their perspectives, values, and cultures.

Failure to understand and manage social and cultural differences may have significant health consequences to the patient and could lead to ineffectual practices in the delivery of care. This is particularly significant in the treating of patients from the Hmong ethnic group. Whose cultural beliefs and practices are often opposed to the methods of modern U. S. Medicine. The Hmong people are made up of peoples from China, Vietnam, Laos, and Thailand. Indigenous to South East Asia, many of them resided in Laos until 1975 when Pathet Lao came into power and began to persecute them for their involvement (on behalf of the United States) in Vietnam.

As a result of this political crackdown many Hmong fled Laos and have been accepted as refugees in many western countries including the United States. Although they are a largely diaspora population they have managed to hold onto their cultural traditions as well as assimilated (partially) to the culture s of their home countries. These traditions are passed down from elders to youth and are a strong pillar through which the Hmong are able to maintain their history and community.

Currently there are 245,000 Hmong people residing in the United States, most of which live in California, Minnesota and Washington. As their numbers grow so does the importance of dynamic care practices that can better suit their medical needs. The Hmong are a primarily Shamanistic culture, with a strong reverence for ancestral spirits. Their beliefs in spirits are not regulated to simply deceased family members, but in all things both animate and inanimate. These spirits reside in a mirrored Spirit realm, where the spirits of their ancestors and also that of trees dwell.

The individual is thought to have multiple spirits residing in them that regulate both the spiritual and physical health of the person. Illness is thought to come from evil spirits who attempt to harm the native spirits that reside in individual’s body. These spirits are the cause of all illness and exist in the spirit realm. It is to be noted that these spirits exist on the same plane as regular mortals, however the deity Saub made us blind to them after conflicts between the spirits and the mortals. It is only through the utilization of shamans that we may access them, and treat illness.

As the malevolent spirits descend on the body, they may cause the native spirits to leave their human host, this is thought to be manifested in the physical world as serious illness. The Hmong believe that illness is intrinsically linked with a spiritual imbalance, therefore the Shaman is called upon to conduct rituals to bring back the wayward spirit and to discern the cause of its leaving. These beliefs can be in direct opposition to the belief of modern medicine, which relies heavily on scientific and empirical evidence.

The simple diagnosis of illness can be greatly impeded when the patient believes that their rash comes from evil spirits as opposed to the contact of a poisonous material. Also this can breed a general distrust of western medication, when for centuries the answers to illness have always lied with the shaman and not with pills and elixirs. The language barrier also is challenging, but in a novel way, whole concepts in the Hmong culture are untranslatable, and the nuances in regional practices of the Hmong make each group individual in their phrasings and pronunciations.

Even with the assistance of a native translator many concepts remain completely lost in translation, especially for American nurses who are often the first line of care for these people. Traditionally when a Hmong person becomes sick they are taken to see the community Shaman. The Shaman is considered a very important member of Hmong society as they are able to communicate and travel with spirits. They serve the role of both doctor and priest in that they care for the physical and spiritual wellbeing of the person.

Because of the link between spiritual and physical illness, it is held that the main means to achieve health wellness is through ritual to appease the spirits. This can be dangerous to the person as their illness may go undiagnosed and untreated as the afflicted wait for the results of the ritual to affect them. Among the largest problems with treating the Hmong is noncompliance, as their tradition may prevent them from actually utilizing the medicine given to them from western hospitals and pharmacies. The treatment of psychological disorders in the Hmong people also poses a unique challenge to western health professionals.

In the Hmong tradition those with unexplained psychological illnesses such as bi-polar disorder, schizophrenia, multiple personality disorder, and some neurological disorders (i. e. epilepsy) are considered to be chosen to become shamans. The symptoms with these maladies are often closely associated with spiritual intervention such as: multiple personalities exhibited being the manifestation of different spirits attempting to possess the body, or epileptic seizures being a communication from spiritual forces.

This has caused these disorders to be revered in the Hmong tradition and have led to many of them going undiagnosed. The usual protocol for such episodes are for the child (as these ailments often present themselves in childhood) to be blessed and sent to learn with a shaman teacher, so that they may use their gifts for the community and become a shaman themselves. As shamans are highly respected and important members of the community any attempt to stifle or diminish their gifts can be construed as going against the wishes of ancestral spirits.

To have a shaman in ones family is considered one of the highest honors, thus creating a situation where the illness goes both undiagnosed and untreated. Interactions between American health professionals and the Hmong people have even been documented in the book The Spirit Catches You and You Fall Down by Anne Fadiman where culture clashes between ignorant parents and culturally insensitive medical staff ends very tragically for a young girl diagnosed with epilepsy.

The combination of the Hmong parents unwillingness to trust the medicines of the Merced doctors and doctors unwillingness to understand the culture of the Hmongs and to tailor the care of the daughter unfortunately end in the girl in a vegetative state. This book goes through the history of the Hmong and makes the reader understand the nature aversion they have to medicines. To them healing is their religion, and to these people the American method of medicine is entirely too invasive.

They feel we cut and defile bodies, we take too much blood and we cause dramatic personality changes with our drugs. This failure to understand these concerns is damning for Lia Lee (the little girl) and led to both noncompliance and also fear about regarding possible surgeries for the very young child. This book is assigned reading for many medical programs and is compelling read, The importance of its theme of cultural understanding cannot be stressed enough.

When Lia was brought to the emergency room for the last time, the staff at the hospital assumed that she had a big seizure because of her parent’s unwillingness to give her seizure medications that had been prescribed. They all silently agreed that it was just a matter of when. It was to the disappointment of many and a shock to Neil Ernst and his wife Peggy Philp when another neurologist who had treated Lia previously announced that it was septic shock and not under medication that had caused the “big one”.

The fact that Neil Ernst did order a septic workup on Lia indicated that he was not treating her symptoms but was had used previous experience with the parent’s noncompliance as all- purpose explanation that blinded him from seeing exploring other more obvious possibilities of Lia illness. The role of the nurse as educator is paramount in these situations. A nurse when performing her role in the health care setting always has the opportunity to bridge the gap between the patient and the physcians.

Anne Fadiman after researching the book for eight years ascertains that “We do not know if Lia would be able to walk and talk today had she been treated by Arthur Kleinman instead of by Neil Ernst and Peggy Philp. However, I have come to believe that her life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding. ” In modern medicine there has been an increased prominence put in patient education and understanding. What could have saved Lia’s life is a more tailored course of treatment that both respected her families beliefs while also allowing for the benefits of modern medicine.

When helping patients it is always important to respect their cultures and traditions, but it is more important to build understanding between their traditions and what will best allow them to get better. Nurses can play the greatest role in building cross-cultural trust, when they (as the first line of care) educate patients on their medications and dietary recommendations. In a more diverse America we will need more Nurses to be able to not only respect cultural boundaries, but foster cultural cooperation to better treat all patients. References Clapsaddle, Diane.

(2008). The Best Notes on The Spirit Catches You and You Fall Down”. TheBestNotes. com. Retrieved from http://thebestnotes. com/booknotes/Spirit_Catches_You_Fadiman/The_Spirit_Catches_You_Study_Guide10. html Cultural Orientation Resource Center. (2004). The Hmong. Center for Applied Linguistics Retrieved from http://www. cal. org/co/hmong/hlaos. html#7 Vang, S. (1998). Hmong Perception and Behaviors Regarding Shamanic Practice and Western Medicine. Hmong Studies Online Library Retrieved from www. hmongstudies. org/HmongStudiesNewsletterFebruary2003. html.