HMONGS

HMONGSHmong customs and cultureTheHmong peopleare anethnic groupin several countries, believed to have come from theYangtzeRiver basin area in southern China. The Hmong are known in China as theMiao, a designation that embraces several different ethnic groups. There is debate about usage of this term, especially amongst Hmong living in the West, as it is believed by some to be derogatory, although Hmong living in China still call themselves by this name. ContChinese scholars have recorded contact with the Miao as early as the 3rd century BCE, and wrote of them that they were a proud and independent people. However, after theMing DynastyandQing Dynastyattempted to impose several new taxation systems and continued expansion of their empire, the Hmong are reported to have rebelled. Many wars were randomly fought, and eventually many Hmong were pushed from China intoBurma(Myanmar),Laos,ThailandandVietnam. The history of the Hmong people is difficult to trace; they have anoral tradition, but there are no written records except where other people have encountered them. Hmong history has been passed down through legends and ritual ceremonies from one generation to another as well as throughHmong textile artor story cloths sewn by the women.ContThe Hmong culture usually consists of a dominant hierarchy within the family. Males hold dominance over females and thus, a father is considered the head in each household. Courtships takes place during the day when a man would go visit a woman at her house and tries to woo her with sweet-talks; during the night time, it was also common to have talks through the thin walls of the house where the woman's bedroom may be. When a woman isn't willing to marry, if a man kidnaps the woman for a day, she would have to marry him because it is not proper to spend a night with a men that you're not married to yet. Today, the practice is not as common; marriages can end in divorce or even suicide if the woman does not love the man she is married to. Before a couple can marry, the man is required to make a financial offering for removing a daughter from the family. The money is given as support to the family, which is the daughter's role in the family. Most Hmong families prefer sons, as daughters cannot carry on the family name. The daughter's last name is changed to her husband's and she becomes "one of his people".contVarious Hmong spiritual practices run on the traditional basis ofshamanism (a practice that involves a practitioner reachingaltered states of consciousnessin order to encounter and interact with the spirit world and channel these transcendental energies into this world).A lot of Hmong Families in Thailand, Vietnam, and Laos live byagricultureand hunting in the forest for their own food. Although they have chickens, pigs, and cows, some poor families keeps them alive as long as possible for sacrifices during a shaman ritual, because they aren't able to always buy and raise more animals. Oftentimes, they eat the vegetables that they grow with rice and peppers. For more meat, they would go and hunt for animals in the woods/forest. Such animals that they would eat are rats, squirrels, birds, fish, etc..

Health and Illness among HmongsTraditional Hmong view illness from a holistic perspective. Perfect health is a balance between the spirit and the body. Illness is seen as having either spiritual or physical causes. Typical physical causes are exposure to environmental factors and unsuitable dietary practices including hot/cold food imbalances. Physical illness is treated with various traditional curatives and/or western medical care. Spiritual causes of illness include: Evil spirits that are unhappy with the ill person Loss of ones own spirit (an ill person has lost their soul) Unhappy ancestors (Perhaps someone has done something to offend the familys spirits or ancestors. An example might be forgetting to provide food to needy ancestors or forgetting to make offerings of paper money. Those in the real world offer paper money by burning it; it is converted to silver and gold in the spirit world. A curse upon the family by someoneContHmong believe good health depends on souls living in each person. These souls govern the body. Illness or an invasive procedure of any kind can cause soul loss. Spiritual healing rituals are common, often conducted in the home or even in the hospital. Spiritual healing involves retrieving the lost soul from another plane of existence. The practice of soul calling during ritualistic ceremonies is performed by a shaman.

Many Hmong, especially older ones, focus on treating illness when it occurs, but do not have an understanding of preventive medicine or of chronic disease requiring daily treatment even when symptoms are not experienced. Similarly, these are often people who have no concept of germs causing disease. Younger Hmong who are raised in the US will naturally be much more familiar with these concepts and will be more likely to value preventive medicine. They will understand that immunizations are required when children enter schools. As cross-generational conflicts are common in refugee communities, it is important that healthcare professionals in the US understand the importance of respect younger Hmong must demonstrate respect for the opinions of Hmong elders to maintain familial harmony.ContMany Hmong continue to use traditional herbal treatments. Others will use herbal treatments as complements to western treatments. Traditionally, someone who is sick is required to eat hot food and certain vegetables. Hmong prefer hot chicken and rice. They drink hot or warm water. Within 30 days of childbirth, Hmong mothers will usually only eat warm foods.

Sick children are often put on a strict dietary regimen, such as eliminating vegetables and only feeding a diet of rice and chicken. Chicken must be boiled, not fried. Herbal medicines are added to the meal in small amounts. Other treatments for physical illness include cupping, coining, and moxibustion. Treatment for illness of a spiritual nature involves religious ceremonies, wearing amulets, or food/animal sacrifices.

ContTraditionally not acceptable. Hmong believe it is not a good idea to put something into their bodies. If a person is immunized or has surgery, he/she will be reincarnated with less than a complete body or a body with something foreign in it. However, most Hmong parents will have their children immunized once they know it is required for school or other activities.

Usually not acceptable. Opening the body allows the soul to escape; soul loss is one of the Hmongs greatest health concerns. However, in some cases, with the support of the clan shaman and leader, the Hmong are willing to consider surgery.

Traditionally, both are unacceptable. Younger Hmong, however, are more accepting of these medical procedures.Blood Tests: Hmong accept blood tests. But they may question why they have to have blood taken more than once in one visit or why a large volume of blood is needed.ContBuild trust:Building trust from the very outset is essential with the Hmong. Providers need to be open to the familys suggestions. Show respect for the family by listening.Privacy Concerns:Hmong share information among certain clan members. All staff and all interpreters in healthcare settings must honor the privacy of patients and their families. This policy needs to be communicated to the Hmong.Alternative Medicines/Herbs/Healing:Ask what care, if any, is already under way? What herbal treatments are being used? What is the source of the herbs?Should You Inform the Patient Directly:Before sharing information regarding a serious diagnosis with a Hmong patient consult the family. If may be a necessary to hold a conference if there is a major problem or surgery is needed. A conference may need to involve all important family decision-makers including clan leader and shaman. Consider the location. Hold the session in a conference room, not in the patients room.Use Hmong Interpreters:Be aware that even if the patient/parents speak English, other important other decision-makers may not. Provide a Hmong interpreter.

ContExplain Explain!The Hmong may be fearful and distrustful at the outset. Be very clear about details of the patients condition and intended care (but be sure to talk to important family decision-makers before informing a patient of bad news). Explain why many immunizations are needed. Explain what a chronic disease is; asymptomatic does not mean cured Repeat information about medicines. Explain purpose of blood withdrawals. Explain what the test is and why so much blood is needed

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