Among the challenges health care personnel in California's central valley face has been finding ways to help Hmong Americans manage chronic illness. Interviews were conducted with 11 Hmong shamans diagnosed with diabetes or hypertension and were qualitatively analyzed to ascertain respondents' understanding and management of their illnesses. Hmong shamans are influential individuals within their communities and are often the resource persons to whom patients turn for information on health. Understanding the shamans' perspective on chronic illness was seen as a gateway to understanding how the broader Hmong American community perceived these conditions. The concept of chronic illness was not well understood, resulting in sporadic medication and dietary regimens, limited awareness of potential complications, and a persistent impression that these illnesses could be cured rather than managed. Suggestions for patient educators include family and community involvement in care regimens and the use of descriptive terminology to identify the disease.
The data suggest the persistence of the need for the spiritual healing provided by the shamans within this immigrant community. Shamans' rituals affirmed and strengthened connections to family, culture, and community.
OBJECTIVES. The influx of Southeast Asians into the United States allows for the study of this special population and contributes to a broader understanding of reproductive health. METHODS. We used information on birth certificates to identify 1937 Hmong children born 1985 through 1988 in California, and we compared birthweight and reproductive factors as related to these children with the same factors as related to 3776 White, non-Hispanic children born in the same period. RESULTS. Mean birthweight among Hmong children (3311 g) was significantly lower (P less than .05) than among White children (3452 g), but the proportion of births under 1500 g was higher for Whites. Hmong women were of much higher parity and were more likely to deliver at both a young (less than 18 years) and an old (greater than 40 years) maternal age. At every age and every parity, however, Hmong women had cesarean sections at one-half to one-tenth the rate of White women. CONCLUSIONS. Despite a high proportion of births at high parity and advanced maternal age, Hmong women gave birth to very low-birthweight babies at essentially the same rates as White women. Their lower cesarean section rates, however, deserve further attention.
Interviews were conducted with 94 Hmong Americans in California's Central Valley to explore attitudes regarding placental disposition and the cultural values that affect those attitudes. Research indicated a persistence of the traditional belief that placentas should be buried at home. The placenta is perceived to be essential for travel by the soul of the deceased into the spirit world to rejoin ancestors. Older respondents (older than age 35) and those who self-identified as animists were most likely to believe in the importance of home placental burial. Comments by respondents indicated some reluctance on the part of Hmong patients to ask health care providers for permission to take placentas home. Incorporating non-Western patients' traditional health care practices into Western health care delivery may be facilitated by an awareness of the reluctance of some patients to verbalize their wishes.
Nurses' awareness that the availability of biomedicine does not preclude the continuing or recurring utilization of traditional healers can facilitate understanding of culturally defined health care needs.
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