Southeast Asian Culture: An Introduction

Presented by:Ammala Douangsavanh

September 12, 2013

Presented by:Ammala Douangsavanh

September 12, 2013

About MeEducational Background:

• BA, Communication Studies, Sociology – URI • AS, Nursing – CCRI (2015)

Professional Background: social services, health education, community outreach • Center for Southeast Asians (formerly SEDC)• Rhode Island Women’s Cancer Screening Program• Neighborhood Health Plan of Rhode Island

Diversity/Cultural Competency Training Experience:• Woonsocket Substance Abuse Prevention Coalition• Lifespan Health Advocates• Diversity in-service for staff at Neighborhood Health Plan of RI

Volunteer Service:• Center for Southeast Asians, Board of Directors, Secretary (2010-2013)• Mayor’s Southeast Asian Work Group, Chair (2012-2013)

What’s in a Name?

1) Pick a partner (Someone you don’t already know!)

2) Explain to your partner what your name means, where it comes from, etc.

3) Be ready to share with the group the meaning behind your partner’s name

Ammala Douangsavanh“Am” – Hidden“Mala” – Flower

“Douang” – Fortune, Destiny“Savanh” – Heaven

“Hidden flower, Heaven’s fortune”

What’s in a Name?

Cultural Competence

• A set of behaviors, attitudes and policies that enables an individual or system to communicate effectively across different cultures and languages

CLAS Standards

Culturally and Linguistically Appropriate Services: A framework of standards for providing healthcare services that effectively responds to cultural and linguistic differences

Themes: Culturally competent care, language access, organizational support for cultural competence

Play video link

http://youtu.be/E1MI_h0HIcw

Cambodian/ Khmer

Population in RI: 5,536 (2010 Census)Language: Khmer

• Largest SEA community in RI• Providence, Cranston

Laotian/ Lao

Population in RI: 3,114 (2010 Census)Language: Lao

• 2nd largest SEA community in RI• Providence, Woonsocket

Vietnamese

Population in RI: 1,442 (2010 Census)Language: Vietnamese

•Substantial community in RI•Woonsocket

Xin Chao

Hmong

Population in RI: 972 (2010 Census)Language: Hmong

• Substantial community in RI • Providence

Nyob zoo

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• 1975 – 1995: Approximately 1.4 million SEAs

were admitted to the U.S. as a result of refugee resettlement programs

The Killing Fields• The Killing Fields, where large numbers of

Khmer people were killed and buried by the Khmer Rouge regime, during its rule of the country from 1975 to 1979.

• Estimates of the total number of deaths resulting from Khmer Rouge policies, including disease and starvation, range from 1.7 to 2.5 million out of a 1975 population of roughly 8 million.

Legacies of War

Approximately 30% of these cluster munitions that litter Laos never exploded

Laos holds the unfortunate distinction of being one of the most bombed countries in the world

From 1964 to 1973, the U.S. dropped more than two million tons of ordinance over Laos during 580,000 bombing missions

That equals to a planeload of bombs every 8 minutes, 24 hours a day, for 9 years

Play video link

http://www.youtube.com/watch?v=tQBM9We3pjU&feature=share&lis

t=PLsY51tE8yNk0_4nS7ZQkWVM-D0oDC0ex2

Secret War in Laos• The Geneva Accords of 1954 established Lao independence from France and

neutrality regarding the Vietnam conflict

• This neutrality prevented overt military operations, so the CIA was sent in to recruit and train more than 30,000 hill tribesmen (mostly Hmong), to aid the Royal Lao Army and American/Allied troops elsewhere in its efforts to subdue

the North Vietnamese.

•Of particular interest was the “Ho Chi Minh Trail” which was developed by the North Vietnamese to run supplies and troops into South Vietnam. This trail ran

through parts of eastern Laos.

•Air strikes were the preferred method of disrupting activity on the “Ho Chi Minh Trail”

•These clandestine operations are referred to as the “ The Secret War”

Aftermath

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

Cambodia: 2.7 million deathsLaos: 200,000 deathsVietnam: 2-3 million deathsHmong: Over 100,000 deathsAmerican servicemen and women: 58,000+

SEA Refugee Arrivals in US

Play video link

http://youtu.be/nVqDLLQlOC4

Play video link

Group Exercise

A StereotypeStereotype is a an exaggerated or distorted generalization about an entire category of people that does not acknowledge individual variation.

Stereotypes form the basis for prejudice and discrimination.

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

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

Challenges faced by SEA Refugees

Poverty, racial tension, and gangs• Poor acculturation, poverty, and lack of education and/or employment opportunities affect community

Mistrust of institutions •Tenuous relationship with law enforcement, and other governmental agencies

Common Cultural Themes

• Collectivistic , but…• Private - Issues should be resolved within the

family• “Face” “Honor” “Family Name”• View health as holistic vs. symptomatic• Practice alternative healing methods

Family Structure

• Multigenerational Households• Extended family members residing in the

home• Limited English-Proficient Parents or Grand-

parents• English-only children• Deference to/ Reverence of elders

Gender Roles

• Patriarchal• Male elders are seen as decision-makers for

the family

• Women are generally not allowed to touch Buddhist monks

Spiritual/ Religious Beliefs

Lao – Predominantly Buddhist, some Christian (Protestant)

Khmer – Predominantly Buddhist, some Christian (Mormon)

Hmong – Christian

Vietnamese – Catholic, Buddhist, Taoist

Religious and spiritual beliefs can overlap with ancestor worship and/or animism

Spiritual Beliefs and Health• Celestial beings & spirits of ancestors are sometimes 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

Health Access for SEAs

•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.

• Nationally, the rate of insurance coverage for SEAs ranges 46% - 59%, compared to 72% of Caucasians

Barriers to Care

Linguistic isolation, cultural barriers• Lack of access to/availability of culturally

appropriate resources, education and care

Poor mental health awareness and education• Social stigma, lack of vocabulary

Lack of personal info./ incorrect ID• Some SEAs may not have accurate info. on ID

Barriers to Care

Lack of data• Few studies that focus on SEA health issues

that could provide resources info. About interventions or prevention

Low health literacy, low screening rates• Shyness, embarrassment

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

Traditional Health Practices

• Health practices and beliefs different from the biomedical or Western approaches practiced by most health professionals in the US

Play video link

http://youtu.be/dG3FY12E1Kw

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

• Utilize qualified interpreters whenever possible

• Ask about any healing practices used at home – herbal medicines, teas, ointments, etc.

• Educate patient about: • Med adherence• Prescription sharing• Imported drugs

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

Accurate Interpreting Services“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.”

Eastern Practices in the U.S.

• Yoga• Meditation• Reiki• Acupuncture• Herbal medicine and teas

Play video link

http://youtu.be/fVUMa-ToozI

Tips• When going on home visits, you may be asked to take your shoes off• On a home visit, you will always be offered food and/or drink• Never point at any object or person 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

– CSEA : 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 Douangsavanh

Neighborhood Health Plan of RI299 Promenade St., Providence, RI

02908adouangsavanh@nhpri.org

401-459-6632

Find me on Facebook and LinkedIn!

Extra Slides

Cambodian/ KhmerMutual Assistance Association: Cambodian Society of RI

Buddhist Temples:Wat Thormikaram - ProvidenceWat Dhamagosnaram – CranstonBuddhist Center of New England – Providence

Churches:International Alliance Church

Laotian/ LaoMutual Assistance Association: Laotian Association of RIOther: Laotian Community Center, Lao Women’s Association, Lao Family of Woonsocket

Buddhist Temples:Wat Lao Buddhovath of RI – SmithfieldWat Sokesai - Woonsocket

Churches:Laotian Evangelical Church

Vietnamese

Mutual Assistance Association: Vietnamese Society of RI

Churches:Sacred Heart Church - Woonsocket

Hmong

Mutual Assistance Association: Hmong United Association of RI

Churches:St. Michael the Archangel - ProvidenceSt. Martin de Porres Center - Providence

Center for Southeast Asians

Social service agency addressing the needs of SEA and surrounding communities

Classes: Citizenship, ESL, EDP, Youth LiteracySocial Services: Family Support, FCCPElder Services: Meals on Wheels MealsiteDomestic Violence Support Services: VOCAQualifed SEA interpreting services and translation: International Language Bank

Providence Youth-Student Movement (PrYSM)

Youth organization supporting the needs of Southeast Asian and allied youth

SOUL: Leadership development through community organizing training and mentorship

SeaQuel: Support services, leadership development, and mentorship for LGBTQ and allied youth