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Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Culture
Larry Purnell, PhD, RN, FAAN
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Overview/Heritage
Hmong began to immigrate to the United States and other countries in 1975 after the Viet Nam war.
These refugees came from the mountainous regions of Laos where they had fought on the side of the CIA during the war.
They were targeted for genocide because they fought against the communist Pathet Lao, and because of this, they fled their county.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Overview/Heritage Hmong escaped to Thailand through the jungles
and across the Mekong River. Many died because of the war, genocide, or while
attempting to flee. Many immigrants in the US bear the scars of war,
bullet and shrapnel wounds, and the lasting effects of exposure to biological warfare, something which they called “yellow rain.”
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Overview/Heritage Almost 200,000 Hmong have immigrated to the
US. Hmong rapidly sought their families starting a
second migration, which resulted in larger groups living together and moving to areas deemed more accommodating.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Overview/Heritage No Hmong initially settled in California, but now
hosts the largest Hmong community, followed by Minnesota and Wisconsin, respectively.
Currently, the Hmong are dispersing to many other states as economic opportunities arise.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Overview/Heritage Hmong in Laos generally did not have formal or
informal education. They were primarily illiterate, lived in very
primitive circumstances, and had no access to the modern world or modern medicine.
When immigrating to the US, many Hmong experienced shock in a world that was completely foreign to them.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication Hmong in the US speak either White or Green
Hmong, sometimes called blue. These languages may not be understandable
to those who speak the other Hmong language, and the same word can have totally different meanings between the languages.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication Hmong did not have a written language until
the 1950s when missionaries began to develop a written form of their language.
Hmong is uses the Roman alphabet rather than characters or script that are used in other regional Southeast Asian languages.
Many older Hmong are not literate in their own language.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication In Laos, the Hmong had no calendars or clocks so these
concepts were foreign to them. For Hmong born in Laos, their ages are often not known. An age is assigned to them by immigrant officials prior to
them immigrating to the US; thus, Hmong may appear older or younger than the age on official documents.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication Many Hmong believe that Americans are
rude because they look directly in the eyes when speaking, and they are too direct with their questions.
Proper communication when speaking to a Hmong person is to use fleeting glances without staring.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication
Making light conversation prior to asking questions about health is proper and important.
Appointment times are a difficult concept, and Hmong may sometimes arrive early in the morning when they had an afternoon appointment.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication Hmong also use the word “yes” to indicate that
they hear what you are saying. Saying “yes” does not mean that they
understand what you are asking or that they will do what you are asking them to do.
Hmong, in general, have a strong desire to be seen positively by people in authority.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication In the Hmong culture, the male head of the family or clan
makes decisions for family members. Individuals do not have the right to make decisions for
themselves. Hmong believe that it is inappropriate to say negative things
in front of sick people. Words have great power and Hmong believe that if you say
negative words in front of an ill person, speaking the words can make those things happen.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Hmong Communication In Western culture, the achievement of
education and position engenders respect and authority.
In the Hmong culture, patients may not feel the same difference toward Hmong health-care providers and may treat them according to their position within the Hmong family/community hierarchy.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Hmong are organized into 18 clans; each clan has a surname that all men and children have.
Although wives and mothers usually retain the clan name with which they were born, they are still considered a member of their husband’s clan.
Hmong have no single leader; each clan has leaders who are older males.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Older males are the leaders in each family. If a husband dies, the oldest son is expected to
make decisions for the family. The youngest son is expected to marry and bring
his wife home to live with his parents.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Older sons and their families leave the family home when the family increases in size.
Daughters are expected to marry and to live with their husbands and in-laws.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Plural marriages were common in Laos, and they persist today.
Men may marry as many women as they can afford to support. This is becoming less common.
Single Hmong may find mates at the annual Hmong New Year celebrations held between Christmas and New Year.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Marriages are advantageous if they are between first cousins, but not those who retain the same last name.
Young women are still victims of “capture bride,” a process where a young girl is taken to her future husband’s home over night where they are then pronounced married.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Boys are not considered adults until they marry. Young girls are thought to be marriageable when
they become “plump” or enter puberty. The young family lives with their in-laws so multi-
generations assist in child rearing. Girls who go to college are sometimes thought to
be “too old” to marry.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Great social pressure exists for very young Hmong girls to marry in their early teens.
These marriages are not legal marriages but traditional Hmong ceremonies.
Family “disgraces” are widely known even among Hmong who may live in different parts of the US.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Family Roles and Organization
Disgraces might be birth defects, opium addiction of a family member, or a divorce in the family.
Any of these “disgraces” are considered to reflect on every member of a family and, as a result, decrease their chances of making a good marriage.
Same sex relationship are not condoned.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Workforce Issues
Hmong have the lowest socioeconomic level of all Asians in the US.
Employment for first generation immigrants is difficult due to poor English language skills and few workplace skills.
Large family size results in low employment for women.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Workforce Issues
Their desire for social acceptance may result in them saying “yes” to questions regarding knowing how to perform something when they actually do not understand.
Hmong are now in many professional roles and government service.
They are hard workers and are loyal to their employers.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Biocultural Ecology Men average 5’3 and women about 5’ tall. Men may
weigh 100-120 pounds and women 85-100 pounds. Since immigration, obesity is very common in children
and adults. Skin color is light brown; faces are round with almond
shaped eyes. A few Hmong have blond hair, light skin, and hazel eyes.
In Laos, this variation was considered an aberration.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Biocultural Ecology
Commonly occurring health conditions for Hmong include cervical cancer, depression, anxiety, suicidal ideation, post-traumatic stress syndrome, tuberculosis, hepatitis, malaria, parasitosis, thalassemia, liver cancer, trichinosis, nasopharyngeal cancer, lactase deficiency, diabetes, hypertension, and asthma.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Biocultural Ecology Many Hmong continue to have nightmares and flash
backs to the terrors they experienced in Laos. Unemployment and reversal of family roles create
additional cultural stressors. Some older Hmong may have paragonimiasis, a
parasite contracted in Southeast Asia. The parasites settle in the lungs causing a diffuse
infection.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong High-risk Health Behaviors
Opium was grown in Laos as a cash crop and was used for pain and by many older Hmong for their aging pains.
In the US, opium addiction persists but it is rare and is considered disgraceful in the Hmong community.
Many individuals do not know that cigarette smoking can cause cancer.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong High-risk Health Behaviors
Many women have never heard of or had a Pap test.
Many have never performed a breast self-examination or had a mammogram.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Nutrition Rice is the primary staple of the Hmong
diet. Vegetables, fish, chicken, and pork are
consumed with the rice. Very hot peppers are made into a
condiment that accompanies the meal.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Nutrition Occasionally, a special dish called “laub” is
made with raw pork and vegetables and spices. This increases risk for trichinosis.
American diets have become preferred by many younger Hmong who prefer hamburgers and other fast foods.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Pregnancy and Childbearing Practices
Children are highly valued in Hmong families, and large families are considered an asset.
Most Hmong live with extended families, if not in the same household then in the same apartment complex or neighborhood.
Older adults often help to take care of their grandchildren children.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Pregnancy and Childbearing Practices
Most women marry early and have pregnancies until menopause.
Men tend to marry first when in their early 20s and 30s. Women are prohibited from drinking cold beverages and
spicy foods during pregnancy. Post-partum, white rice and chicken are the traditional
diet for one month, and the mother may not drink cold drinks.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Pregnancy and Childbearing Practices
New mothers are expected to rest after delivery. The mother-in law and husband help the new
mother. Hmong women consider regular menstruation to
be a sign of health and may not wish to use birth control that interferes with the regular menstrual cycle.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Death Rituals
Hmong funerals are may last many days. The older or more revered the person, the longer
the funeral may be. Family members are expected to attend and stay
the duration of the funeral.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Death Rituals
Specific rites are required along with animal sacrifice to honor the deceased.
These animals are used to provide food for the people present.
A proper burial enables the deceased to enter the spirit world in a positive way, a world leading to reincarnation.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Death Rituals
Most Hmong believe in multiple souls that reincarnate, one that stays in the area of the body and another stays in the present world, overlooking and caring for the family.
Rituals are conducted so that deceased ancestors are honored.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Mai Kong, age 6 years, is being seen in the urgent care clinic because of two days of nausea, vomiting and that started after eating laub which is
a. Hmong dish made with raw pork, vegetables and spices.
b. A drink made with milk and raw eggs.
c. A drink made with milk and special spices.
d. Fried rice with fish.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Laub is a Hmong dish made with raw pork, vegetables and spices and can cause trichinosis if the pork is infected.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Spirituality Most older and more recent Hmong hold
traditional animist beliefs where ancestors are revered; sprits are widely distributed in the world, residing in many inanimate objects or places such as trees, rivers, and houses.
Many believe that spirits can cause harm, misfortune, illness or death, or can be helpful to protect or prevent bad events form occurring.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Spirituality
Christian Hmong have beliefs and practices appropriate to their religion.
Some may denounce animist beliefs and traditional Hmong beliefs, such as soul loss and soul calling ceremonies by Shamen.
Good spirits are thought to be ancestors who watch over and protect them.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practices
Hmong seek western medical care often. They may also a use traditional healer or shaman
(tu txiv neeb) who perform rituals. They may seek herbalists and take multiple
treatments for the same condition. Some practice home remedies, such as coining
or cupping.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practices One cause of illness is thought to be soul loss.
Some individuals, such as babies and children, are thought to have souls that have difficulty staying in the body.
If the soul(s) leave for too long, the baby can become ill or die. For this reason, parents may tie a string around the baby’s neck or wrist soon after birth.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practices
Older children and adults may have strings tied around wrists, waists, or ankles.
These must remain on until they fall off naturally, removing them too soon can result in soul loss and illness or death.
Since immigrating to the US, the strings have been replaced with gold necklaces and bracelets.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practices
The traditional herbs found in Laos and Thailand are difficult or impossible to obtain in the US.
Traditional herbalists have sometimes used plants found in the US only because the plant looked similar to a plant they had used in Laos.
Efficacy of these herbs is unknown and may be harmful.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Ka Ying Yang has been seeing a Hmong shaman for her asthma and hypertension. A Hmong shaman is called
a. Curandero.
b. Hilot.
c. Tu txiv neeb.
d. Paj ntaub
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
A Hmong traditional healer is called a tu txiv neeb, pronounced "too tse neng”.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practitioners
Shamen ceremonies are used for serious illnesses that have not responded to other treatments.
Shamen do not choose to become shamen; the occupation is a calling.
Shamen train for many years and learn as apprentices.
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Hmong Health-care Practitioners Shaman ceremonies are conducted within the
home with all the family present; they go into the spirit world to find out why the soul was lost or was taken to the spirit world.
On a second ritual, the shamen may call the persons’ spirit home, thereby restoring harmony.
A shaman may sacrifice an animal to pay the spirit world to release the soul so it can come home.