The Hmong People in Healing by Heart by Kathleen Culhane-Pera, Dorothy Vawter, and Phua Xiong - Essay Example

?Healing by Heart Part One The Hmong People The Hmong can be defined as an Asian ethnic group, who originate from mountainous areas of China, Thailand and Vietnam. After the Vietnam War, the Hmong people began immigrating in large numbers to the United States, and they now number over a quarter of a million. The Hmong people generally have integrated well into American society, and many of the younger generations speak English fluently and generally use this to communicate. However, Hmong language and customs are still alive in these small communities, which can cause problems, particularly in healthcare. Like many Asian communities, herbal medicine is still very important, and many of the Hmong people prefer traditional medicines to the conventional options. This can cause conflict between those working in the American healthcare industry and the patients who wish to retain their traditions, not least because traditional medicine could cause problems that would lead to healthcare providers breaking the Hippocratic Oath. Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers gives details of the issues facing both healthcare providers and the Hmong patients in society and how these may be explained and discussed from a clinical and ethical perspective. Young Woman with Kidney Failure and Transplant The story of Mai Neng Moua is an excellent example of how the Hmong people struggle to come to terms with aspects of the American healthcare system. Moua suffered from end-stage kidney disease and thus was forced to deal with the consequences of this debilitating illness at a very young age. Moua was forced to wait for a kidney transplant for a long time as her family refused to get tested to see if they were a match; her mother suggesting that it was better to have one person sick than two. Moua also struggled with explaining her choice to use dialysis (an example of conventional medicine) rather than the traditional Hmong remedies for her condition to her family and friends, as this was seen as breaking with traditional culture. It is clear from Moua’s writing that she suffered greatly from the consequences of her end-stage renal failure and her choice of conventional medicine was a sensible one; it is quite likely she would have died without it. Her choice to undergo a transplant was not supported by her family, although the decision was supported by her church. One of the most interesting things about this case is that Moua’s final kidney donor was a Caucasian friend, rather than any member of her community. This could be considered an example of direct diffusion as her choice reflects an adoption of the American culture she was interacting with. Moua also notes that her choice to accept the donation of a kidney from a Caucasian friend surprised the Hmong community, and helped break down some of the stereotypes of white people, because it showed generosity. It could also be seen as an example of ethnocide, particularly from the perspective of the Hmong people, as it is an example of how American culture has perhaps predominated over the traditional, particularly amongst the younger generations. Reflections The case of Mai Neng Moua is interesting from a medical anthropology perspective because it shows how traditional medicine and conventional medicine can often be at odds. It also illustrates how members of the community can ostracize those who choose the American health system over their own culture, as shown by the fact that Moua describes herself as a ‘loss to the family, to society in general’. Her mother seems to be the character in this story that is most confused and hurt by Moua’s decision to undergo dialysis and the eventual transplant, and is also against many other Western ideas that Moua has, such as moving in with her college roommate. Again, this shows how those among the Hmong communities in the United States may feel that their culture is being lost or destroyed (ethnocide) or becoming amalgamated into the American culture (indigenization). These pose a threat to a community who have a great pride in their language, their traditions and their Church, as it does to any community that places great value on culture. One of the most interesting aspects of the story is how the American healthcare system is built to deal with this kind of issue. If Moua had decided to go with traditional medicine, it may have caused an ethical problem for the doctors who diagnosed the end-stage kidney failure, as they may have felt it their duty to try and treat the disease to their best advantage. The United States is an example of a country with a great range of cultures, and learning how to deal with the wishes of immigrants is one of the most taxing and challenging aspects for nurses and physicians working in this area. There is an eternal conflict between wanting to improve the health of the patient and working to fulfill their wishes about their own healthcare. In this case, it is lucky perhaps that Moua decided that she wished for dialysis and a transplant, as it removed some of these issues for the healthcare providers. Something else that stands out about this case is the strength of Moua. Her lively descriptions of how her condition developed are almost heartbreaking because of the pain she suffered. It must have been difficult to stick by the decision to use conventional medicine when her condition worsened, as her family would suggest that the traditional herbal medicines may have done a better job. Moua herself suggested that she wished her mother would have forbade her to undergo one of her operations and suggest a better way, indicating that there must have been a significant amount of doubt at some times. It is evident from this that there are many aspects to balancing traditional cultural ideas and what is best for the individual in healthcare, as there is in other areas of globalization and indigenization. Conclusion Young Woman with Kidney Failure and Transplant is a thought-provoking example of how important it is to respect and investigate culture in the medical profession to ensure that the standards of care meet the expectations of all the stakeholders. This means to ensure that the individual themselves are happy to continue with their choice of treatment, whether it be based on their personal cultural ideas or not. Moua’s story is also interesting because it suggests that there may be a need for a support network or counseling for those undergoing this type of life-threatening treatment against their family’s wishes, because there is a significant amount of mental anguish involved with the choice. Moua’s choice to eventually get the kidney transplant shows a lot of courage, although it was supported by some members of the Hmong community in the United States. Part Two What is My Point of View? The story of Mr. Lee is an interesting one because his condition is shared by many Americans who also fought in the Vietnam War. Mr. Lee suffered from post-traumatic stress disorder (PTSD) and depression associated with fighting in the Vietnam War, and suffers from many different complications. The depression could also be associated with Mr. Lee’s refugee status, as being a refugee has several financial consequences and upheaval problems that can cause severe depression and mental anguish. Mr. Lee also has a preoccupation with Sudden Unexpected Nocturnal Death Syndrome (SUNDS), which is a disease that primarily affects young males from the Hmong community and has a strong hereditary component. Mr. Lee also does not speak English and therefore finds it difficult to communicate with his healthcare providers about his condition, which makes the situation more difficult. Additionally, he is dependent on his children for his finances, which again makes his situation more difficult and may be contributing to his depression. Many among the Hmong community believe that mental illness is karmic payback of some sort, and should be cured with traditional medicine, which makes Mr. Lee’s choice of treatment more difficult. This is an interesting case because it illustrates again how difficult it can be for healthcare providers trying to establish a good healthcare regiment for a patient whose culture may be at odds with the use of conventional medicine. When this concerns mental illness, the choice becomes more difficult as many treatments for mental illness affect different patients in different ways, and in many cases the traditional medicine may be equally effective. It is easy to feel quite strongly for the individuals in question when they are suffering from such debilitating mental illnesses and they need a translator to communicate with their healthcare provider, which again must add to the distress of the patient. Linguistic barriers may occur when the words cannot be found in the appropriate language to correctly describe the ailment of the person, which is quite an interesting thought and should be considered by those working in the medical profession, even if there is a translator available. Personally, the complex nature of Mr. Lee’s problem seems to add more depth to the situation, as there are so many elements involved (depression, PTSD, nightmares and a legitimate fear of illness) which make decisions on treatment much harder. It seems fair to hire a translator to explain to Mr. Lee the types of treatment option available within the American healthcare system and allow him a personal choice as to whether he would prefer this or a traditional Hmong remedy, as well as taking family perspectives into account. My perspective is that there should always be a choice for refugees when it comes to healthcare, and that cultural medical traditions should always be respected. How is That Perspective Affecting My View of These Events? As a firm believer in respecting cultural traditions, I feel that it is fair that Mr. Lee should be treated with respect and dignity in his treatment. It also is a concern that so many of the Hmong community suffer from PTSD and depression, and this could be linked with the high numbers of the community suffering from SUNDS. It seems sad yet inevitable that so many of these refugees are suffering from PTSD from the Vietnam War and depression associated with the upheaval of culture that any refugee must face. There is a certain amount of sympathy for the Hmong people, who do not seem to have it easy with respect to their health, particularly their mental health. However, as an anthropologist one must take care to remain objective, even when the case studies are particularly distressing and do not have an obvious solution, as they are in this case. Mr. Lee also has an added dimension to his problems, which stem from his son. His son appears to have adjusted to American society a little too well, and indulges in risky sexual behaviors as well as being associated with a gang. The Hmong people place great value on their children and it is upsetting for Mr. Lee that his son did not do well in school and has not achieved what he could have achieved. There must be an added element of self-blame for this because Mr. Lee could feel that it is his fault for becoming a refugee and exposing his son to this aspect of American culture. My perspective on this is that this is an incredibly complex element, because some amount of indigenization must occur for a community to become successful in their new home, but this does seem to be a particularly upsetting outcome. It is hard to remain neutral on the matter, because part of me wants to defend the way that children are brought up in America, and another part of me feels sorry that this has affected Mr. Lee so distinctly and that he now must try and communicate this disappointment in a country that does not necessarily understand his perspective on the matter. How is this Inquiry Changing my Understanding of Myself and my Culture? One of the most interesting things about the case of Mr. Lee is that it has brought me to question my own culture and how it affects both refugees and Americans. It is particularly interesting to see how the change in culture has affected Mr. Lee’s son, although it is impossible to know what would have happened if they had stayed in Asia. It seems that American culture may have caused or at least worsened Mr. Lee’s mental condition, which causes me to question what aspects of American culture are actually beneficial to us as a group of people and which may be to our detriment. It is also interesting to consider how I view mental illness, which is as a mental condition, compared with how the Hmong people view it. Comparisons of the type of medication I would choose for a mental illness are at stark contrast to those explained in the chapters in the mental illness section, and perhaps some of these could help Americans if they chose to accept these. It also induces feelings of sadness about how the Hmong people are affected by their refugee status and how many of them are affected by this type of mental illness, and changes my understanding of the position of refugees immensely. How Well Tuned is my Instrument? As previously mentioned, an anthropologist must strive to remain neutral as much as possible, because personal views on some matters may cloud true knowledge about the situation. In this case, I have quite strong views about upholding cultural values and the importance of respecting refugees in America, and thus many of the things considered in the case of Mr. Lee may be more distressing for me than they are for others. It is hard to say how well-tuned I am into the situation, because there will always be an element of subjectivity in the field, but it could be said that as a sympathetic individual then my views on these case studies are good because it allows me to see how tough the lives of the Hmong people are in the United States, without being clouded by prejudices. Part Three Many of the Hmong people are skeptical about American conventional healthcare, and as Mrs. Xiong believed that her cancer was caused by nurses, this could be the reason why Mrs. Xiong and her family initially refused treatment for gallbladder cancer. There were many fears and concerns for Mrs. Xiong about the invasive procedure that she would have to undergo, and this again contributed to the delay in treatment for her gallbladder cancer. An ill Hmong patient may refuse treatment for any reason, particularly if they feel that their illness was caused by the American healthcare system in the first place, as Mrs. Xiong did. The family agreed to hospice care because it included a Do Not Resuscitate clause, and it was in the same hospital within which she received treatment. For the first three to four days, Mrs. Xiong felt better, but after her condition deteriorated her husband decided to take her home. The skepticism of the American healthcare system again is problematic here, because in some sense it may have been felt that the hospice was causing Mrs. Xiong to deteriorate. A ‘good’ death for the Hmong people is one where the individual can die surrounded by their family and friends, and can impart wisdom as they leave this world. A ‘good’ death from the hospice workers perspective is simply the most painless death possible for that patient. These two perspectives are at odds, and again may have contributed to the fact that the family wanted to take Mrs. Xiong home. The purpose of Mrs. Xiong dying in the clothes she was buried in are central to the Hmong beliefs that the soul is reincarnated after death. The hemp shoes that are worn are to help the Hmong individual back to the placental jacket through which they can be reborn, and the rest of the clothes are there to help on this journey. This is an aspect of Hmong death that may be at odds with the traditional American views, and may not be possible as part of hospice care. Additionally, hospices also often have limited visiting hours and the patient may die alone, which would count as a ‘bad death’ amongst the Hmong people. These elements would have contributed to the family’s decision to move Mrs. Xiong from the hospice back to her home. The surgical staples are also at odds with the traditional death favored by the Hmong people, and therefore these were removed before the funeral. This is a fairly simple way of respecting the Hmong culture, but it shows that hospital staff were willing to accept and respect individual cultures; and is an example of a good cross-cultural relationship within the American healthcare system. The treatment for cancer is an interesting one among the Hmong people. In this case, Mrs. Xiong refused treatment initially, and this is because many of the Hmong believe that it is a bad thing to induce further suffering before death, as well as to be skeptical of American healthcare. For a healthcare provider in the United States, this might be an ethical issue, because it is their duty to prolong life, something that is offered by provision of chemotherapy. Ultimately, it is the patient’s decision and this must be respected, despite the fact that this might cause conflict. It should be dealt with respectfully and it should be ensured that an apt translator is available to convey the consequences of this decision. From this Hmong family, there are many lessons that can be learnt. Firstly, it must be noted that there are different cultural beliefs among many people in the United States and the case of Mrs. Xiong shows how important it is to the family and the patient that these beliefs are respected. The case of Mrs. Xiong also shows how traditional beliefs can be against what might be seen as moral for the American healthcare provider, but these wishes must be respected at all times so that no legal action can be taken. It is interesting to see how these issues are dealt with by the system, and the case of Mrs. Xiong is an important example of end-of-life care and how it differs from American beliefs. Read More