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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


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.


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.”


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.


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.


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.



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.



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.



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.



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.



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.



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.



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.



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.


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.



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.



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.



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.



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.



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.



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.



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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.



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.



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.


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.


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.


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.


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.


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.


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.


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.


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.


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.



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.



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.


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


Correct Answer

Correct answer: C

A Hmong traditional healer is called a tu txiv neeb, pronounced "too tse neng”.


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.


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.

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Documents

transcultural health

competent approach

older hmong

largest hmong community

proper communication

mountainousregions of

written language untilthe

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