Coming to the United States brought big social cultural changes with their traditional health care, beliefs and practices versus western medicine health care. The Hmong in America “adapting to enormous changes in their sociocultural environment has resulted in some enduring misunderstandings, including those that emerged between traditional health care and beliefs and practices and those of biomedical health care” (Helsel, 934). With health care, “physicians want to overcome barriers with providing health care to Hmong Americans and share strategies of how to respect the Hmong culture while providing quality health care (Cobb, 79). Having shamanism as their religion, it gets quite hard at times to get a patient to cooperate well with doctors.

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In the article, “Hmong Shamanism Animist Spiritual Healing in Minnesota”, it gives the readers more explanations on Shamanism and biomedicine. The authors, Gregory A. Plotnikoff, Charles Numrich, Deu Yang, and Phua Xiong spent two years interviewing 11 shamans and 32 Hmong patients. The traditional Hmong religious beliefs are considered animistic. As the authors stated, “Life is seen as a continuous circle of birth and rebirth, and the Hmong believe that there are two worlds – physical and spiritual – that coexist side by side” (Numrich 29). The Hmong believed that a person is “chosen” to become a shaman. Once they are chosen, the person shows signs of unusual serious illness. A shaman is then asked to look into the person’s illness. Then the shaman will tell the person if he or she is going to become a shaman or if it’s just because the person’s spirit is not with their body. Shamans are required to make a lifelong commitment to being a healer. As one of the shamans that got interviewed explained, “We are there to rescue the victim. Our purpose is to have a good understanding of each other and a mutual respect of one another. Also, we are there to make peace between good and evil” (Numrich, 31). 

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The authors collected statistics of the patients, which contains tables that showed how widely shamanism is used in the Hmong community, and how often they seek to see a physician. From the results, it shows that: “22 of the 32 subjects reported using both shamans and physicians” (Numrich 31). Of the 22 patients that used both shamans and physicians, they identified using shaman for spiritual illnesses and physicians for physical illness. To develop a relationship with the Hmong patients, physicians will need to be aware of their patients’ religious and spiritual concerns. By asking patients questions, it would enhance cross-cultural care for physicians and other health professionals. The answers from the patients will help physicians understand if the patients see their religious/spiritual beliefs as resources, or if they are using any herbs as medicine. Hmong Christians tend to not practice this religious belief. A small minority of them use a shaman and a physician.

 

To enumerate the barriers to providing health care to Hmong American, the article, “Strategies for Providing Cultural Competent Health care for Hmong Americans”, will explain the barriers and strategies in working with Hmong patients. Torry Grantham Cobb, the author, list that the barriers are languages, medical and religious beliefs, medical practices, cultural beliefs and social organization.

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The largest obstacle is language barriers. According to the U.S. Census Bureau (2000), majority of the Hmong households (58.6%) do not have family members who speak English well. Only 4.4% reported English as the only language spoken in their homes. Also, the language does not include many medical terms (Johnson, 2002). There are certain internal organs that there are no words for it at all. For example, the words for stomach and pancreas have no translation into Hmong (T. Shong, personal communication, 2008). Some meaning can be lost in translation when translating medical and sometimes medical practices terms.

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In a traditional Hmong family, there are variety of home remedies and feeding practices. Traditionally, those who are sick can eat only hot food and drink hot or warm water. For example, the first 30 days after giving birth, women generally eat warm food. When a child is ill, parents restrict their diet to boiled chicken, and sometimes, herbal medications may be added to the meal (Cobb, 80). Medical practices such as spooning, cupping or pinching or wearing religious symbols, amulets or strings may be employed in the care of sick individuals as well (Koltyk, 1998; Waters, Rao & Petrachi, 1992). Traditional Hmong believe that birth defects are a form of punishment for past or present offenses. They fear surgery because it could result in their soul leaving the body through surgical opening. Hmong also don’t believe in autopsies because they believe that it will leave the body unwhole and endanger reincarnation.

Hmong live in clan societies which include extended family members. Clan serve as “basic unit of both social and political organization in Hmong culture” (McInnis, 1991). They are a patriarchal clan system where males are dominant and make all major decisions. The men are more respected than women, but the elderly are most respected. Women are responsible for domestic duties and care of children (Sperstad & Werner, 2005). Families in Laos are generally larger for farming communities. Hmong Americans here struggles to raise large families with low wage jobs or public assistance (Cobb, 81).

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With the struggles and culture differences, many express lack of confidence or mistrust of the health care system (Cobb, 81). Reasoning to that is because of historical distrust and differences in health beliefs and practices. The best way to communicate with patients is through their own language. A strategy recommended by Viste (2007), suggest engaging patients in development of educational materials. The strategy was documented by Chu, Lawton, Martinson & McNaughton (2000). At the end, the strategy came up with these preferences by the Hmong people: use of bright colors with bold type, providing information in Hmong and English, providing lists or bulleted points rather than paragraphs of information, the use of simple diagrams and drawings and artwork that is culturally appropriate (Cobb, 82).

Out of all, the most recommended remains in the use of medical interpreters. Flores (2005) conducted literature review on impact of medical interpreter services on health care. Flores found that patients with limited English proficiency (LEP) who were not provided interpreters had poorer quality of care (Cobb, 82).  LEP patients with trained interpreters experienced greater patient satisfaction. Also, such media as the telephone interpreter services has been proven successful.

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Torry Cobb provided a list of recommendations for providers from people who have already constructed them. Barret (1998) conducted semistructured interviews with patients and providers to identify possible solutions in Hmong health care interaction (Cobb, 82). There, Barret recommended: “be kind and have a positive attitude, learn about each other’s cultures, use culturally appropriate concepts, terminology and explicit visual aids, be respectful of patients’ choices, avoid making negative predictions and avoid stereotyping” (Cobb, 82). Parker and Kiatoukaysy (1999) made recommendations for health care professionals to: “use trained interpreters, use same gender providers, be neutral or supportive of patients working with a shaman, allow families to bring Hmong foods into the hospital for the patient, don’t remove strings or charms… designed to ward off evil spirits, do not undermine a father’s authority and promote the practice of combining Western medicine with traditional Hmong medical practices” (Cobbs, 82).