Discussing issues of my small community:
I have a special interest in wanting to learn more about health concerns in the Asian American communities. However, I think the topic is quite broad, so I wanted to narrow it down to focus on my Hmong community. I want to explore and learn more about the beliefs concerning health within my Hmong community. I would like to probe deeper into the arising problem of health and diseases that occur as well as to examine and study the factors that are causing uncommon health issues to appear within this community. I would like to see how much it differs from the American society and why is health problem among the Hmong community such a big problem today. I strongly feel that the understanding of health issues within my community is still very limited and constricted. I want to find probable solutions to tighten this gap of understanding a little bit.
What strikes me to choose this topic is because every now and then, I would hear my grandma or my mom complain about how bad their health has gotten since living in the United States. They would talk about their lives in Laos and Thailand, describing how active they used to be and how capable they were of their daily activities. They would tell stories of the days when they used to work so hard in the fields, and no one complained much about health issues. Breast cancer, diabetes, high blood pressure, and cholesterol was not common and their parents and grandparents lived to be of old age. What happened to those bright days? Today, in the United States, we have lost family members to these terrible diseases and it has deeply scarred this community. We are finding that many of our parents and grandparents are battling these diseases and refuse to seek proper care because of the misunderstanding and mistrust about the American health system.
This is an important topic to study in the Hmong community because if we don't find ways to approach the problem and propose potential solutions, we will continue to have a community that suffers in silence. I specifically want to explore this topic because as an individual studying in the health major, I have always had an interest for topics like this. As mentioned in my where I stand page, when I picked up on my volunteer position at Kaiser, I gained a whole new perspective at how different groups of people view a health care setting and how much their cultural values and beliefs play a role in their health care decisions. I hope to use my past experiences to help me gain a better understanding of this problem within my community.
What strikes me to choose this topic is because every now and then, I would hear my grandma or my mom complain about how bad their health has gotten since living in the United States. They would talk about their lives in Laos and Thailand, describing how active they used to be and how capable they were of their daily activities. They would tell stories of the days when they used to work so hard in the fields, and no one complained much about health issues. Breast cancer, diabetes, high blood pressure, and cholesterol was not common and their parents and grandparents lived to be of old age. What happened to those bright days? Today, in the United States, we have lost family members to these terrible diseases and it has deeply scarred this community. We are finding that many of our parents and grandparents are battling these diseases and refuse to seek proper care because of the misunderstanding and mistrust about the American health system.
This is an important topic to study in the Hmong community because if we don't find ways to approach the problem and propose potential solutions, we will continue to have a community that suffers in silence. I specifically want to explore this topic because as an individual studying in the health major, I have always had an interest for topics like this. As mentioned in my where I stand page, when I picked up on my volunteer position at Kaiser, I gained a whole new perspective at how different groups of people view a health care setting and how much their cultural values and beliefs play a role in their health care decisions. I hope to use my past experiences to help me gain a better understanding of this problem within my community.
Community Issue Analysis:
My community issue focuses on health concerns within the Hmong community. I am approaching this issue with emphasis on how the Hmong community views health care settings by closely examining the care exhibited by health care professionals towards this particular community. Much of my community issue mainly focuses on how Hmong people view the American health system and how this affects their health choices. Along with this analysis, I want to examine the factors and effects of emerging diseases and mental health effects on this community. My goal is to build a better understanding of how this community perceives health care and what better ways they can achieve it to help them maintain a healthy lifestyle.
In my analysis, I have come to a realization that there are several components to this problem. First of all, as mentioned in both articles that I have read, “Building Partnerships: Conversations with the Hmong about Mental Health Needs, and Community Strengths,” by the UC Davis Center for Reducing Health Disparities (CRHD) and “Providing Health Care to Hmong Patients and Families,” by Marcia Carteret, many of the Hmong people’s traditional beliefs about illness is a crucial component that strongly influences and affects their health care decisions. These two articles highlight the importance of understanding the cultural traditions, religion, and values of the Hmong people first before attempting to understand their reactions and decisions in the health care settings. Both articles also descriptively describe the Hmong's refugee status and history which is critical in the process of analyzing these effects as well.
As mentioned in both articles above, traditional beliefs in spirituality and shamanism is one of the Hmong's biggest cultural value and tradition. Their beliefs in illness and health being affected by an imbalance of these spiritual beings in one self is the contributing factor to health concerns. When an individual becomes ill, Hmong families often seek a shaman to perform spiritual callings or rituals like “ua neeb” to enter into the spiritual world in which high negotiation and animal sacrifices are done to suffice the spirits and bring back this soul to attach to the individual’s body again. As one can clearly see, these methods of approaching illness is drastically different from the American culture. It often times causes concerns because in times of really bad illness, Hmong communities tend to reach out to a variety of Shamans for help before turning to doctors and western medicine. American health care settings are not the first, but the very last resort of help for many of the Hmong communities. This is definitely problematic because often times diseases and illnesses that are presented to health care professionals are entirely curable and preventable had they seeked help from health care professionals first.
Their historical past is truly significant in the explanation for their beliefs and behaviors in today’s social setting. For instance, as mentioned by Marcia Carteret in her article, that due to the Hmong's refugee status, they tend to exhibit a strong distrust of the American government, which is a possible factor that continues to affect many of their views and beliefs about the American government and authoritative officials. This in many ways explains why Hmong people always seem hesitant in believing doctors' words about diseases and treatment methods. Because of this chaotic history with the U.S. government from the past, they are traumatized and have lost trust in believing that the American government or officials will actually put them in the government’s best care and thoughts. In the past, as a volunteer, I cannot keep count of how often I would hear a Hmong elderly speak about their distrust of American doctors when it came to illness, health preventive measures, or treatments. They assume quite a lot of negative thoughts believing that Americans will never put Hmong people in their best thoughts, and always tend to conclude that because of age and race, that American doctors never truly have positive thoughts of curing them. Instead they believed these doctors and health care providers most likely wanted to make them dead, to eliminate the numbers of Hmong so the government would not have to continue supporting most of the Hmong population through governmental assistance such as social security, disabilities, Medicare and welfare benefits. Despite any real or concrete evidence about whether this was an actual circumstance or not, they continued to view health care providers in negative perspectives.
Poverty is also another contributing component in lack of proper health care. As mentioned in the article, "Health Disparities in the Hmong American Community: Implications for Practice and Policy," the authors provides statistical analysis that demonstrates how much health related issues are linked with Hmong's poverty levels. The authors provide strong details stating that "one in four Hmong, are living below poverty." Only 48.9% have privately held health insurance and 41.6% Hmong people receive public coverage for health in comparison to the 19.% overall in Asian American communities and the 28.5% in the U.S. population. " Looking deeper into health concerns, the mortality rates among Asian Americans for cancer such as stomach and liver are known to be two times that of whites. However, in the Hmong population, reports are finding that cancer mortality rates are higher than as reported with the Asian American community. For instance, stomach cancer is 3.5 times higher in Hmong communities compared to Asian Americans and Asian Pacific Islanders. These findings have also led to the fact that Hmong people have the lowest rate of cancer screening of any racial or ethnic groups in the U.S. The reasons for this are likely due to: "access to healthcare, length of time in the United States, foreign born status, mistrust towards the western medical system, and cultural barriers."
Research and findings indicate that Hmong Americans throughout the United States have a higher instance of having cancer, diabetes, hepatitis, hypertension, and gout. In some small studies of Asian Americans, it is usually found that in the case of patients who have cancer, it is often times hard to healthcare professionals to provide them with the right care and treatment because by the time they present themselves with the disease, it is already too late for medical interventions to be successful. It is difficult to face patients from these communities who are battling such diseases for so long without seeking proper treatments. Despite the findings that such late diagnosis is due to cultural barriers, it may also be due to their limited understanding of these diseases as well. In some aspects, at least it's becoming more common among second generations to be more open to western medicine and procedures even through many foreign-born, first generation Hmong adults are still highly relying on traditional Hmong healing methods.
Learning from Mor's Perspective:
My name is Mor Vue. I was born in Thailand on November 02, 1982. I grew up with a big, loving family with both parents, four brothers, and five sisters. I am the oldest daughter in my family. My family immigrated to the United States in March of 1995 and we settled in Stockton, CA. At that time, I was 12 years old and remember starting off my education in middle school first. After middle school, I went on to high school as well. In my senior years of high school, I met my husband from Sacramento and we got married. I married quite young, however, culturally, it is considered about the right age (or actually, it was considered a little late, given that most girls married when they were 13-15). My decision to marry didn't appear as a big deal to me until several months, years into my marriage. After marriage, I continued my high school education and successfully finished my high school education. With the support of my husband and my in-laws, I quickly went on to continue my education at Sacramento City College. I was at Sacramento City College for three years before I felt confident enough in what I wanted to do, so I transferred my credits to Western Career College. There, I pursued my certification for the Medical Assistant program. Right after I finished my program, I also found out that I was pregnant with my first child. My life was changing for the better. I got a job immediately at Dr. Pira Ronchanayon's family clinic. There, I worked as a medical assistant, mostly only administrative tasks. Some of the things I did are lots of patient paperwork, health insurance billings, making phone calls, and briefing patients about their visits. After a year or two, I became more confident in my work and Dr. Ronchanayon wanted me to assist more with his work. I was soon working more and more with patients, taking vitals, giving shots,...etc. Working in this small family clinic, we come across a lot of Hmong patients, which makes the environment very easygoing and comfortable. I love being able to do something I enjoy and giving back to my Hmong community as well. Although, our clinic has not been seeing as much Hmong patients as we have in the past, I am blessed to have the opportunity to work with my Hmong people. I have the opportunity of comfortably speaking Hmong with them and explaining certain diseases or illness to them. This education process is probably the best part of my day. I love it because It issomething that I really enjoyed doing and I was making enough to support my family. Soon afterwards, I had my other three sons, following my last sweetheart, my daughter.
My husband in the youngest son in his family, so he and I have the responsibility of taking care of his mother. I am so thankful to have my mother-in-law because she is so supportive of my work and what I do. I am glad to have her to help watch my children while I'm always away at work. Although. there is a lot more responsibility that goes into play as a daughter-in-law in a Hmong family in the Hmong community, I feel that my mother-in-law is always very understanding and forgiving, so it makes life a little easier for me overall. My children and my family are my life. I love my job and what I do, but I can't imagine what life would be like if I didn't have the special people that I have today with me. My husband is the most supportive person who understands my every needs and continuously stands with me through every struggle that I've had to deal with. I am happy with my life right now, and I wish i could pause it in these moments.
My husband in the youngest son in his family, so he and I have the responsibility of taking care of his mother. I am so thankful to have my mother-in-law because she is so supportive of my work and what I do. I am glad to have her to help watch my children while I'm always away at work. Although. there is a lot more responsibility that goes into play as a daughter-in-law in a Hmong family in the Hmong community, I feel that my mother-in-law is always very understanding and forgiving, so it makes life a little easier for me overall. My children and my family are my life. I love my job and what I do, but I can't imagine what life would be like if I didn't have the special people that I have today with me. My husband is the most supportive person who understands my every needs and continuously stands with me through every struggle that I've had to deal with. I am happy with my life right now, and I wish i could pause it in these moments.
Interview with Mor:
Me: How long have you been working as a Medical Assistant for Dr. Ronchanayon?
Mor: Right after I finish my school, I immediately landed the job so uhm...I would say maybe 13 or 14 years. Well,...13.
Me: What are some of the conflicts you encounter at your work place as a Medical Assistant? How do you wish to change it?
Mor: Uhhh...well, I don't really identify any specific conflicts. Are you talking about conflicts with patients?
Me: Any kind of conflicts that you come across,..with patients? with the doctor?
Mor: Okay, so...well, I think that the...for me I see that Dr. Ronchanayon mostly has hard time dealing with patients that don't really follow through with his orders. And, it's hard because it puts a lot of stress on us. He usually asks me, he always asks me to provide translation for the patient, Hmong patient. So I'm always the one talking to them in Hmong, explaining their health condition to them...This is hard sometimes.
Me: Why is it hard for you?
Mor: Because sometimes I say something to them and they understand it, but they don't do it. Like, Like for example, Dr. Ronchanayon tells me to tell the patient that they have diabetes and that they need to watch their diet,....The patient don't want to do it. They can't follow through because they don't want to change their diet or they don't want to take the medications.
Mor: Right after I finish my school, I immediately landed the job so uhm...I would say maybe 13 or 14 years. Well,...13.
Me: What are some of the conflicts you encounter at your work place as a Medical Assistant? How do you wish to change it?
Mor: Uhhh...well, I don't really identify any specific conflicts. Are you talking about conflicts with patients?
Me: Any kind of conflicts that you come across,..with patients? with the doctor?
Mor: Okay, so...well, I think that the...for me I see that Dr. Ronchanayon mostly has hard time dealing with patients that don't really follow through with his orders. And, it's hard because it puts a lot of stress on us. He usually asks me, he always asks me to provide translation for the patient, Hmong patient. So I'm always the one talking to them in Hmong, explaining their health condition to them...This is hard sometimes.
Me: Why is it hard for you?
Mor: Because sometimes I say something to them and they understand it, but they don't do it. Like, Like for example, Dr. Ronchanayon tells me to tell the patient that they have diabetes and that they need to watch their diet,....The patient don't want to do it. They can't follow through because they don't want to change their diet or they don't want to take the medications.
Reflection:
This oral history project has been an interesting one for me. Although I've known Mor for some years, It surprises me how little I knew about her work, her joy and happiness in working with the Hmong people, and how this affects her family life. I've always only known or look up to her as my Auntie but she is so much more. In her career life, she holds a lot of responsibility and she is very hard working. She cares about the people in her life and the people she treats. She always does her best to make sure people understands. Talking to her about her career and work life is something totally new to the both of us. This is things we don't normally talk about because when we do see each other, we're having fun discussing other things besides work. I've learned so much from her.