Southeast Asian Culture: An Introduction

Presented by:Ammala Douangsavanh

October 9, 2012

Presented by:Ammala Douangsavanh

October 9, 2012

Southeast Asians at a Glance• 2.5 million SEAs living in U.S. • 30,000+ Asian & Pacific Islanders in RI•18,000 – 20,000 Southeast Asians living in RI •Major SEA ethnic groups in RI:

•Cambodian/Khmer•Laotian/Lao•Hmong•Vietnamese

• Higher populations of SEAs can be found in Providence and Woonsocket

How Did SEAs Get Here?

Wars in Southeast Asia

• 1955 – 1975: Wars in Vietnam, Laos, and Cambodia

• 1975: Fall of Saigon & rise of Communist rule• Millions of Vietnamese, Lao, Khmer, Hmong

people and American soldiers perished as a result of armed conflict, bombings, starvation, forced labor, or while attempting to escape by land and by sea

• 1975 – 1985: 700,000 SEAs were admitted to the U.S. as a result of refugee resettlement programs

SEA Refugee Arrivals in US

Challenges faced by SEA Refugees• Poverty, racial tension, gangs• PTSD, physical trauma• Linguistic isolation, cultural barriers• Refugee resettlement program loss/dissolution• Lack of access to/availability of culturally appropriate resources, education and care• Poor mental health awareness and education• Tenuous relationship with law enforcement, and other governmental agencies

The Model Minority Myth

The stereotype suggests that Asian Americans are more academically,

economically, and socially successful than any other racial minority

groups.

The Importance of Disaggregation of Data

Population Percentage

Cambodian Americans

9.1

Hmong Americans

7.4

Lao Americans 7.6

Population Percentage

Overall US population

25.9

African Americans

14.2

Latino Americans

10.3

White Americans

25.9

Asian Americans

42.7

People 25> with a bachelor’s degree People 25> with a bachelor’s degree

The Model Minority Myth

Socioeconomic Characteristics by Racial/Ethnic and Asian Ethnic Groups

  Not Proficient

in EnglishLess Than High

SchoolCollege Degree High Skill

OccupationMedian Family

IncomeLiving in Poverty Public

Assistance

Whites 0.7 15.3 25.3 21.4 $48,500 9.4 1.3

Blacks 0.8 29.1 13.6 12.3 $33,300 24.9 4.5

Latinos/Hispanics 30.3 48.5 9.9 9.6 $36,000 21.4 3.5

Indians 8.4 12.6 64.4 51.6 $69,470 8.2 0.9Cambodian, Hmong, or

Laotian 44.3 52.7 9.2 9.8 $43,850 22.5 9.9

Japanese 10 9.5 40.8 32 $61,630 8.6 0.9

Koreans 32.9 13.8 43.6 27 $48,500 15.5 1.6

Chinese 31.3 23.6 46.3 41.9 $58,300 13.1 1.8

Numbers are in percentages, except for income

SEAs in RI: Socio-economic status, education, health

• The percentage of Asians and Pacific Islanders in RI living below poverty is almost two times that of the overall state population and almost three times that of the White population.

• Southeast Asian youth have the highest HS drop out rate/ lowest rates of post-secondary education achievement

•Nearly twice as many Asian Pacific Islanders report they could not afford to see a doctor in the past year compared to the White and the overall state populations

• The percentage of Asian/Pacific Islander women who received delayed prenatal care is about two times greater than the White and the overall state populations.

Common health problems in SEA population

• Hepatitis B – Prevalent in SEA refugees• Type II Diabetes – American standards of normal BMI inaccurately predicts risk among SEAs• Cervical Cancer – low rates of screening, highest rates of invasive stage• PTSD, Depression – Social stigma and lack of education/awareness prevent help-seeking behaviors• Cancer, Heart Disease, stroke

Background of Culture• Patriarchal• Multigenerational households• Reverence of elders• Deference to authority / Fear of authority• Limited English Proficient parents vs. English-only children• Holistic vs. Symptomatic

Common Cultural Themes

• Collectivism• Prioritize needs of

others/community• Value harmony

• “Face”• Prestige, honor, social

standing, reputation

• Families and communities are insular; prefer to resolves problems alone or within the family unit

• Apprehensive of seeking outside help

Spiritual Beliefs: Buddhism, Animism, Ancestor Worship

•Celestial beings & spirits of ancestors are believed to move amongst the living • In times of sickness, or hard times, people have blessing ceremonies in the home or bring offerings to temple• Physical ailments are sometimes attributed to spiritual reasons: bad karma, the work of spirits

Case Study9 year-old Lao patient diagnosed with bi-polar disorder

• Mom refuses to sign release to administer anti-psychotic meds. Because it will “turn him into a vegetable”•Those voices he hears makes him special; that he may be “destined for greatness” because maybe “the spirits are communicating with him”

Tips

• Engage spiritual guides/elders• Unless absolutely necessary to carry out

treatment, do not remove artifacts • Discuss a balanced approach to care plan that

acknowledges patient’s spiritual or religious beliefs

Differing Perspectives of Health and Healing

Case Study

Undocumented Lao woman seen at a free clinic complaining of an upper respiratory issue

•When asked if she is taking any medication to alleviate her symptoms, she pulls out several medications (among them penicillin), mostly imported from Thailand, as well as a nasal spray with a label indicated for another’s person’s use.

Tips

• Ask about any herbal medicines, teas, ointments or any other healing methods patient is using

• Educate patient about med adherence and not sharing prescriptions

CLAS Standards“The clinical impact of inadequate interpreter

services extends directly to thedoctor-patient relationship. With very fewcertified interpreters, many patients rely

on friends and family members to interpret.Due to the lack of specific vocabularywords in SEA languages to describe

symptoms and signs, many important clinicaldetails frequently get lost in translation.”

Case Study

Male patient is making his third visit in 3 months to ER complaining of dizziness

• Patient’s son, who was interpreting, described his symptoms as dizziness. Besides a slightly low potassium level, multiple tests yielded no discernible cause for dizziness. When patient’s daughter visited him, she clarified he was experiencing vertigo, not general dizziness

Tips• When going on home visits, wear clean socks!• On a home visit, you will always be offered food and/or drink• Never point at anything with your feet•Never touch an adult’s head•Be mindful of your speaking volume• Regardless of whether there is an interpreter present, it is important that you address the client, and not the interpreter

Organizations Serving SEA Population

– SEDC-SEA : Social services, family support, youth programs, VOCA, adult education, ESL, GED, elderly services, interpreting services, and more

– Mutual Assistance Associations: Cambodian Society of RI, Laotian Community Center of RI, Hmong United Association of RI

– SEA Youth & LGBTQQ: Providence Youth-Student Movement (PrYSM)

– Home Healthcare: Independence Health Services

Places of Worship

Khmer Buddhist Temples– Wat Thormikaram – Providence– Buddhist Center of New England - Providence– Wat Dhamagosnaram – Cranston

Lao Buddhist Temples- Wat Lao Buddhovath of RI – Smithfield

Hmong Church Services- St. Michaels/ St. Martin de Porres – Providence

Vietnamese Church Services- Sacred Heart - Woonsocket

Resources

WebsitesAsian Pacific Islander Health Forum: www.apiahf.orgSEA Resource Action Center: www.searac.orgKhmer Health Advocates: www.cambodianhealth.orgFilmNew Year BabyNerakhoon: The BetrayalBooksThe Spirit Catches You, And You Fall Down

Ammala DouangsavanhNeighborhood Health Plan of RI

299 Promenade St., Providence, RI 02908

adouangsavanh@nhpri.org401-459-6632