the differences between western medical model vs.hmong cultural medical model

The differences between Western Medical Model and Hmong Cultural Medical Model Kalia Lee1

Kalia Lee

Health Communication

May 5, 2010

The Differences between Western Medical Model

VS.

Hmong Cultural Medical Model


During the 1900's, United State have experience many Southeastern Asian refugee

immigrants. They were the refugees from the Vietnam War who came from Laos but does not

share the same Laotian language and culture. They are the Hmong people, an Asian ethnic group

from the mountainous regions of Vietnam, Laos, Thailand and Burma. The Hmong immigrants

have difficulties understanding the life in America such as communication, functioning in a

modern world and the Western values and expectations.

Many Hmong men and women still suffer the illness from the war injuries such as

chronic non-healing bullet, shrapnel wounds that exposures to biological and chemical warfare

and psychological conditions such as post-traumatic stress disorder and major depression. This is

why Hmong people seek assistances from the Western Medical System even though they may

not understand the diagnoses or treatments. I have heard many stories about the cultural

differences between the medical professionals model and the Hmong cultural model.

There was a study that was done using the ethnographic method of participants through

observation and interviews. There were two groups that were being focused on, one group was

the Hmong men, and the other group was the Hmong women. The purpose of this was to

increase the understanding of the vague data and confirm the findings from the ethnographic

study. One thing that the researchers found interesting was that the Hmong women would

traditionally defer to men if they were present during the discussion.

In Laos, the Hmong people did not have any exposure to modern medicine or education

so the complexities of the human body were unknown to them. When they were asked about the

anatomy of the human body, they had no idea what organs were in the body or how the organs

functioned. When the heath care provider tells them that they have some sort of disease or

malfunctioning organs, they would not understand it and would have difficult time


comprehending the situation. Since most of the medical and anatomy terms were used by the

Western medicine, there were no such words within the Hmong language. Due to the lack of

understanding the terms from the Western medical model, translation of information health care

was impossible. Hmong individuals had a hard time understanding diagnoses and treatments that

they had never encountered before. One man said that in when living in Laos, if you got sick and

you either got better or you would died.

Many Hmong elders have mention opium that was grown in Laos as cash crops. The

Hmong elders said that opium was considered an acceptance treatment for the old people's

problems. The effectiveness that opium is used within the Hmong people was to alleviate the

pain and anxiety just as long it does not become an addiction. Some Hmong elders mention that

opium was their most powerful herb. Hmong patients expected the Western medicine to have a

powerful effect just like their herbs. Elderly Hmong people said that the medication prescribe by

their physician makes them feel worse. Since the Hmong patients have a strong need to present

themselves as a good person, they have the lack of compliance with treatment regimens to their

Western health care provider. The Hmong patients consider it rude behavior to tell the health

care provider that they were not taking the medication as prescribe. The Hmong people use the

word "yes" in a respectful way to say that they heard what was said but "yes" does not mean that

they understood it or would follow the recommendations.

One interesting thing I have found that Hmong people's belief was different from the

Western perspectives was the "pool of blood" in the chest that served as a life force. Within the

Hmong culture, they believe that if you were to squeeze a person's chest too hard, it can kill

them. The belief was that in the chest there is a pool of blood that is vital to life. If someone was

to lose their pool of blood, they would die. A nurse that I have interview from the emergency


told me that she was working in the emergency room one night and a Hmong family brought in a

patient who had been vomiting blood. They put in an nasogastric tube and bright red blood was

flowing from their catheter. The family members went crazy. They tried pulling the tube out and

trying to take the patient out of the hospital. The nurses and doctor called security and they took

the family members away. The family members thought the nurses were trying to kill the patient.

On the other hand, the nurses thought the family members were trying to kill the patient. If the

nurses knew about the belief in the "pool of blood" they would have been more understanding.

The Hmong people believe that soul loss can be a result of illness that is why they engage

in practices to keep the soul within the body. What they do is they would do a ritual where they

take red string cloth and tie them onto the wrists. If the illness is serious then it would be tied

around the ankle, waist and neck. Hmong people believe that for new born babies, doing the

ritual of the red cloth tying is very important. They believe that since the babies are young, it is

easier for their souls to be lost so they would need the red cloth for protection. The Hmong belief

system is very important because these protective spiritual items remain on the sick person yet in

many health care settings they are removed due to the concerns about cleanliness, safety, and

access to veins. In the Shamanism ceremonies, animal spirits are very important. It is to honor

the ancestors and treating illnesses. Shaman ceremonies are held to determine the cause of a

person's illness. The animal is selected based on their value to the spirit world and their strength

to fight in the spirit world for the soul of the ill person. Usually the sacrificed animals are as

chickens, pigs, or cows. Chickens are sometimes used for small family ceremonies. If someone

had a serious illness, the spirit world sometimes calls for a dog to be sacrificed because they are

fierce and will fight valorously in the spirit world for the sick person's soul. The Shaman

ceremonies can't be held any other places except the patient's home. There are two ceremonies


that are conducted: the first one is where the Shaman goes to the spirit world and find where the

soul is and what kind of payment or sacrifice the soul needs to be able to return back to the

patient's body. If the sacrifice was prescribed then the second ceremony will be where the animal

will be sacrifice and the shaman will take the blood from the animal and place it on the clothing

that the sick person wears.

Hmong people feel vulnerable to be harmed by spirits during the night. Being a patient in

a hospital can be scary due to the fear of harm from spirits. This can cause consternation for

nurses who perceive the presence of families intrusive and interfering with their work. Although

many hospitals have visiting restrictions, yet when one is ill, the Hmong families are mostly

anxious to be with their loved one. Honoring the Hmong elders are very important within the

Hmong culture because when they die, their spirit will become a protective spirit that can prevent

harm and bring good fortune to the family.

There are many cases where Hmong patient have terrible experiences in an American

Health Care setting. There was this elderly Hmong woman who went to the emergency room

because of terrible pain. She said that the American doctor was very nice to his patients but when

it came to her, he was mocking her distress and mimicking her facial expressions. She felt

humiliated and asked why the doctor treated her so badly when he was nice to his other patients.

There was another incident where there were Hmong parents whose daughter was diagnosed

with metastatic terminal ovarian cancer. The doctor told the parents that she had appendicitis

and that she would be fine after the surgery. After the terrible diagnosis, the physicians asked the

parents to give consent for their daughter to receive palliative chemotherapy. They told the

parents that chemotherapy would not save their daughter's life but may help prolong the illness.

The physician also said that with chemotherapy the side effects include nausea, vomiting, weight


loss, hair loss, and maybe even death. The parents were asked to give consent for the procedure

and the physicians assume that the parents would make the right choice. The parents refused the

chemotherapy. If their daughter was going to die, they didn't want her to suffer more due to the

treatment. The physicians became angry and told them that if they were not going to corporate

with the doctor then they can take their daughter home. The parents took their daughter home

and the next morning the police showed up and forcibly took their daughter to the hospital where

she was given chemotherapy against her parents' wishes. The physicians had a court order saying

that the parents had removed their daughter from the hospital against medical advice. The court

order the parents to give them permission to return the child to the hospital and force the child to

have treatment. The parents were scared and heartbroken. The parents did not understand why

they had been asked to give consent for the chemotherapy treatment when, in fact, they had no

choice. They could not understand why their daughter was being forced to have the treatment

that they perceived as torture.

Since the experiences in the Western medical system were shared within the Hmong

community, it has caused the Hmong people to be afraid of hospitals and have lost trust in the

Western medical providers. The Hmong people fear surgery and Western medicine because they

have heard rumors that "doctors experience on Hmong people". They perceive that the "student

doctors" are there to learn and that Hmong people are used for practices. They feel that the

treatment the doctors gives them are not for their benefits but for the doctor who just needs to

learn and gain practice skills. The beliefs in soul loss, spirits, and ghosts are common in many

cultures. The biomedical model, however is based that "based on scientific rationality where all

assumptions and hypotheses must be capable of being tested and verified under objective,

empirical and controlled conditions. Health care providers often disparage subjective diseases


etiologies which can't be confirmed using the scientific model. Nurses needs to understand that

beliefs in spirits and ghosts are prevalent among some Hmong individuals and that actions taken

by family members are not intended to cause harm to their patients but to bring them help from

their traditional perspectives. Hmong family members who believe that their loved one's illness

is caused by spirits will refuse Western medical treatments and will take their family member

home to do proper Shaman ceremonies.

The Hmong individuals were interviewed and said that they have been treated

disrespectfully. They may not understand fully on what was being said, but they did understand

the body language, facial expressions and tone of voice from the health care providers.

Communications have many forms but the only possible one was language. Hmong people who

doesn't speak English are even more sensitive to the nonverbal manner in which they are treated.

It is very important to know that Hmong individuals have had little experiences with Western

health care systems due to emigration. The Hmong language have lack of words such as

anatomy, physiology, various symptoms and illnesses. When Hmong people come face to face

with American medical system, it is important that sufficient time and effort be given to fully

explain what is needed to be done and why using terms and concepts that can understood.

Western health care providers needs to understand that although Hmong individuals may not

have the benefits of education, literacy, or knowledge of the English language, they are not

ignorant. If the health care provider wants to assist their patient, they need to acknowledge them

as human being who are intelligent and have great capacity for understanding and will help

choose the treatment that is right for them. With the increasing education and exposure to

Western life ways, the Hmong are changing many of the perspectives. Younger individuals being

educated in United States are adapting both American and Hmong cultural perspectives. As with


all patients, each must be assessed on an individual basis to determine his/her own beliefs and

culture practices.

Myself, being born within two culture and understanding the Western medical model and

the cultural model is very difficult. There are certain things that when using the Western medical

model, it just doesn't cure the sickness as well as the cultural model. Maybe that is just how my

body was raised but I do question myself about how does these things work. There is always that

say that if you believe it, it will work and if you don't believe then it doesn't work. I still question

myself after all these years to see why it works this way and not that way.

On Communication Day we had a guess speaker who came and shared with the class

about her cultural medical model. I thought it was pretty interesting how she says that everything

she does her ceremony, it gives her the strength and energy. She was also sharing with us that in

their culture they believe that there is an "evil wind". I remember her telling us about one of her

experiences with one of her patient. Her patient had an evil wind instead of her and as the

speaker felt her patient's shoulder, she can feel the evil wind enter into her body. I can really

relate that to the Hmong culture. The Hmong people believe in the "evil wind" as well. The "evil

wind" is where it causes sickness for one person and so certain people can use the wind to

predict what is wrong. During a Hmong funeral, the elders say that if it is raining, the dead

person is sad and doesn't want to leave. If it is very windy, it means that the dead person is angry

at something/someone. Going back to Communication Day, the presenter talked about the egg

and what the egg signifies itself as. For the Hmong culture, Hmong people uses the egg as an

healer. They use it during their alter ceremony and as well as healing sickness such as fever, a

cold, and sore muscles.


Over all Hmong people have a difficult time understanding the Western medical model

and trying to apply it to their lives. If the Western providers takes a little more time explaining to

the Hmong people for their understanding, it will help the Hmong patients to open up and

explain to the providers what they use for healing and as well as what their culture medical

model is.


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