Hmong health beliefs and experiences in Western healthcare systems

Introduction The Hmong are an ethnic group from Laos. During the Vietnam War, the Hmong aided the United States in its war against the communists in Vietnam. When the Americans withdrew from Vietnam, the communists severely persecuted the Hmong hill tribes. The United States then welcomes Hmong immigrants for humanitarian purposes from the 1980s onwards. Almost 100,000 Hmong live in the United States (Johnson, 2002). The reason why I chose the Hmong population for this cross-cultural nursing paper is that this group exemplifies many of the challenges nurses face when working with people from different backgrounds. Culture, religion, language, and tradition all impact attitudes towards health and healing, attitudes towards a healthcare system and its bureaucratic modalities, and expectations of the entire healthcare experience. Summary of Article In “Hmong Health Beliefs and Experiences in the Western Health Care System,” Johnson (2002) uses ethnographic methods including focus groups, interviews, and participant observation to better explicate Hmong attitudes and beliefs towards healthcare. The introduction to the article provides background information about the Hmong, their history, and how they have experienced general struggles assimilating into American society. Therefore, Johnson (2002) outlines the main reasons why the ethnographic research was conducted, and how the results of the study can be used to better inform nursing practice. The research was conducted over the period of two years, with data collected primarily from a primary care clinic in an area of central California with a large Hmong population. During this two year period, the author collected field notes from the formal observations. The author also conducted systematic interviews with willing participants to clarify and confirm the participant observation. All the informants used for the research were first-generation immigrants, meaning they were born in Laos. When necessary, the researcher used a translator or interpreter. In fact, the researcher notes that none of the participants in the focus group spoke English fluently. Johnson (2002) also points out that she focused on the specific linguistic group of Hmong that lives in Central California (White Hmong). In addition to the participant observation and the interviews, the author also used a focus group technique to verify and illuminate the results. Partly because of Hmong beliefs about gender roles and norms, the researcher separated the focus groups by gender to facilitate communication. Thus, even the methods of the study reflect cultural sensitivity just as Almutiari, McCarthy & Gardner (2014) use in their research in Saudi Arabia. Johnson (2002) describes the ethical procedures used to acquire informed consent, too. The results are presented thematically, starting with Hmong perspectives regarding the human body. For example the author points out that Hmong people did not learn about anatomy and there were no Hmong terms for body parts and functions. The lack of knowledge of medicine and the body made it difficult to interpret healthcare issues, concerns, and medical procedures. In fact, Johnson (2002) claims that translations to Hmong language were “lengthy and at times impossible,” (p. 128). Remarkably, the Hmong did not have a concept of a chronic illness that could be cured, such was their lack of exposure to Western/modern medicine. Another theme in the results was related to superstitions related to health including spirits, ghosts, and the “pool of blood” that is the “life force” dwelling in the human chest (Johnson, 2002, p. 128). For the Hmong, illness is related to the loss of the soul. To prevent the soul from getting lost, the Hmong use specific ritual practices. Johnson (2002) details many of the practices that the Hmong use to make sure the soul stays in the body to prevent illness. For example, the wrists are tied with strong or cord. Animal sacrifices are also used in the Hmong culture. Johnson (2002) also points out that Hmong shamanic ceremonies must take place within the patient’s home because the soul needs to be called back to the home and not to a medical institution like a hospital. Being in a hospital is traumatic for Hmong people for several reasons. For one, the financial burden is tremendous, given their mutual belief in the shamanic practices that are also expensive. Second, the Hmong feel that the soul is especially vulnerable overnight. Staying overnight in a hospital can cause deep anxiety, particularly if the patient is not allowed overnight visitors. Decision making in healthcare is another theme that Johnson (2002) found in the research. The Hmong culture is patriarchal, but it is also a communitarian society. Thus, the patient may have totally different views of patient autonomy than the nurse might have. Johnson (2002) also shows how Hmong patients have experienced the American health care system. Many report positive experiences, but some report the distress of being misunderstood or belittled. Miscommunications were problematic, and the author calls upon nurses to serve as patient advocates for the Hmong and similar populations. Application to Practice Although Johnson’s (2002) research focuses on the Hmong, the implications can be extended to other patient populations. It is important to take into account patient background and culture. The background, culture and traditions may also be related to the patient’s knowledge of the human body and is processes. Similarly, patients may not be aware of healthcare issues like how their nutrition or lifestyle impacts their health. Some patients may not understand how drugs work, or how to conceptualize side effects. Many patients will have superstitious beliefs like the Hmong do. Rather than make fun of these types of beliefs, nurses and other healthcare workers can learn how to unify patient cultural beliefs with modern medicine. Just as nurses welcome their patients to pray, nurses can also welcome their patients from other backgrounds to do whatever makes them confortable. Superstitions are not harmful, and nor are most shamanic practices, so long as those practices coincide with ideal medical care for the patient’s condition. The implications of this research would be to encourage patients to honor their traditions, while also learning about modern medical care and how they can improve health outcomes.