Building Relationships Through Understanding
Walnut Grove is Site of Hmong Culture Workshop

With Focus on Health Care

Picture yourself in the office of a health care professional – a nurse, doctor or dentist. You’re seeking help for a health problem for you or a family member sitting with you. You know this visit will involve answering questions, sharing information, listening to information, taking directions, considering choices and making decisions. Few issues are as deeply personal and vital as health care. You want your concern to be understood and eventually resolved. You can assume that your nurse, doctor or dentist wants the same.

Now picture that the health care consumer in the office is Hmong. The scenario, needs and desires of both patient and professional are the same, but the situation becomes much more complex. Language can pose a barrier to both parties’ understanding of each other’s needs and expectations. Cultural differences involving medical practices and how individuals and families make decisions can also increase the complexity of the health care interaction. And religious and spiritual beliefs enter in, as well.

Recognizing that a growing number of their hospital patients and clinic customers are Hmong, practitioners and staff of Tracy Area Medical Services (TAMS) arranged a Hmong Community Cultural Awareness Workshop this summer. With support from United Way of Lyon County, organizers from TAMS, which includes the Westbrook Health Center in Westbrook and Murray County Memorial Hospital in Slayton, hosted a July 12 Community Cultural Diversity Workshop at the Walnut Grove School in Walnut Grove. Lilian Vang from the Center for Cross-Cultural Health in Minneapolis provided the cultural competency training. Representatives from youth organizations, educational institutions, social service, employment and counseling agencies from Lyon, Redwood, Cottonwood, Murray and other counties throughout southwest Minnesota attended along with TAMS medical staff.

Vang provided information on background and history of Hmong people, family structure and migration to the United States, Minnesota and Lyon County. Among some of the highlights:

The Hmong people originated in central China, and have migrated throughout Southeast Asia, including the countries of Vietnam, Laos, Burma and Thailand.
Hmong society is largely agrarian. Families are typically large, with 5-7 people per family unit.
The Hmong population is also relatively young; 60% is under 18 years of age. Vang mentioned that in the current immigration of 5,000 refugees from the Wat Tham Krabok camp north of Bangkok the population trends even younger than this, with only two refugees over 60 years old.
United States CIA recruited Hmong soldiers from Laos to fight with American troops against Communism during the Vietnam War in the 1960’s and early 1970’s. Following U.S. departure from Southeast Asia, these Hmong sought refuge in camps in Thailand across the Mekong River.
Eighty percent (80%) of the Hmong people who have come to the U.S. have been able to do so with the help of churches, nonprofit organizations and individuals.
Minnesota is home to the largest Hmong population in the U.S. Most live in Ramsey and Hennepin Counties. According to the 2000 Census, 41,800 Hmong live in the Twin Cities area.
Two Hundred Fifty (250) Hmong individuals are estimated to live in the Marshall/Tracy/Walnut Grove area, with most working at Schwan Food Company in manufacturing jobs.
Hmong families’ ability to purchase affordable homes in Walnut Grove and Tracy is an attraction and provides a source of pride and security in raising their families.

The Southwest Minnesota Hmong Culture-History Center located at the Walnut Grove School provided an additional experience for workshop attendees with its display of information, pictures, artifacts, books, and embroideries on Hmong culture. (For more information on the Center, contact culture advisor, Harry Yang at the Walnut Grove School 507-859-2141.)

Vang also shared information on family language, communication styles, decision-making models, and religious beliefs and practices:

Hmong is predominately an oral culture. An “A-Z” system of writing is used. Values are primarily passed on through stories and ceremonies.
Hmong culture is distinguished by an extended family involvement clan system. The father’s side of the family predominates the extended family involvement, and provides the leadership in the clan system.
Children are valued. In the Hmong culture, it is customary to go right from childhood into adulthood which is defined by marriage. Hmong people marry at young ages; there is often no concept of being a teenager.
Traditional Hmong healing methods include use of shamanism for spiritual healing, and herbal medicines for physical healing.
Hmong spiritual belief is that life and death is a continuum with no beginning and no end. Belief in reincarnation has important implications for Hmong families’ decisions surrounding health care.

Implications for Health Care

Community leaders and service providers need to think about what our communities and health care settings can put in place to serve as “cultural brokers” or “cultural liaisons” to assist service providers and immigrant consumers. These liaisons need to be not only bilingual, but also bicultural in order to bridge the language and cultural barriers that challenge effective delivery of services.

Hmong families and individuals will need to understand their rights and responsibilities involving health care.

Many Western concepts will present challenges for Hmong people, for example, the concept of living with a chronic condition such as diabetes can lead to dissatisfaction with a health care provider, seeking out cures from other providers, and general frustration with the system.

When providing medical care, practitioners should ask Hmong consumers whether they use alternative medicines and remedies, whether they practice “old” ways (Hmong traditions) or “new” ways (Western medicine).

Health care practitioners and all types of service providers are encouraged to be aware of the Hmong extended family social structure as they work with Hmong community members. They are further encouraged to know that the culture’s family decision - making model is that information is brought back to the family. That is, the extended family is very much involved in the ultimate health care decisions and choices.

Health care practitioners, service providers and all community members must be willing to continue to learn about Hmong ceremonies, culture and values, and especially to deal with Hmong people respectfully in the health care setting. Says Vang, “The negotiation piece is the hardest part. Sometimes it’s humbling to get to know people – the missing pieces. As providers, it is especially difficult. We feel we know what’s causing an illness, and we know we have the answer or treatment. (But) we need to remember that the patient and family have responsibility for the decision.”

The Center for Cross-Cultural Health is an independent nonprofit organization whose mission is to “integrate cultural competency into health and human services through information, training, research, and consulting.” The vision is better health for all through cross-cultural understanding. Website: www.crosshealth.com

Tracy Area Medical Services has also received a grant from the Blue Cross Blue Shield Foundation “to assist in providing better awareness of health care through TAMS and the communities of Tracy and Walnut Grove.” For more information on TAMS and its initiatives and programs in cultural competence, contact Community Relations Coordinator, Carol Cooreman at: cooremac@siouxvalley.org Marketing & Community Relations Coordinator,Robin Madson at: madsonr@siouxvalley.org or Licensed Social Worker, Angela Nelson, at: nelsonag@siouxvalley.org

Article prepared by Lois Schmidt, SW MN Private Industry Council Workforce/ABE Collaborative
Photos by Carol Cooreman, Tracy Area Medical Center

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