HMONGS

Hmong customs and culture

TheHmong peopleare anethnic groupin

several countries, believed to have come from
theYangtzeRiver basin area in southern China.
The Hmong are known in China as theMiao, a
designation that embraces several different
ethnic groups. There is debate about usage of
this term, especially amongst Hmong living in
the West, as it is believed by some to be
derogatory, although Hmong living in China
still call themselves by this name.

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Chinese scholars have recorded contact with the Miao as

early as the 3rd century BCE, and wrote of them that they
were a proud and independent people. However, after
theMing DynastyandQing Dynastyattempted to impose
several new taxation systems and continued expansion of
their empire, the Hmong are reported to have rebelled. Many
wars were randomly fought, and eventually many Hmong
were
pushed
from
China
intoBurma(Myanmar),Laos,ThailandandVietnam.
The history of the Hmong people is difficult to trace; they
have anoral tradition, but there are no written records except
where other people have encountered them. Hmong history
has been passed down through legends and ritual ceremonies
from one generation to another as well as throughHmong
textile artor story cloths sewn by the women.

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The Hmong culture usually consists of a dominant hierarchy within

the family. Males hold dominance over females and thus, a father
is considered the head in each household. Courtships takes place
during the day when a man would go visit a woman at her house
and tries to woo her with sweet-talks; during the night time, it was
also common to have talks through the thin walls of the house
where the woman's bedroom may be. When a woman isn't willing
to marry, if a man kidnaps the woman for a day, she would have to
marry him because it is not proper to spend a night with a men
that you're not married to yet. Today, the practice is not as
common; marriages can end in divorce or even suicide if the
woman does not love the man she is married to. Before a couple
can marry, the man is required to make a financial offering for
removing a daughter from the family. The money is given as
support to the family, which is the daughter's role in the family.
Most Hmong families prefer sons, as daughters cannot carry on the
family name. The daughter's last name is changed to her
husband's and she becomes "one of his people".

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Various Hmong spiritual practices run on the traditional
basis ofshamanism (a practice that involves a
practitioner reachingaltered states of consciousnessin
order to encounter and interact with the spirit world and
channel these transcendental energies into this world).
A lot of Hmong Families in Thailand, Vietnam, and Laos
live byagricultureand hunting in the forest for their own
food. Although they have chickens, pigs, and cows, some
poor families keeps them alive as long as possible for
sacrifices during a shaman ritual, because they aren't
able to always buy and raise more animals. Oftentimes,
they eat the vegetables that they grow with rice and
peppers. For more meat, they would go and hunt for
animals in the woods/forest. Such animals that they
would eat are rats, squirrels, birds, fish, etc..

Health and Illness among

Hmongs

Traditional Hmong view illness from a holistic perspective. Perfect

health is a balance between the spirit and the body. Illness is
seen as having either spiritual or physical causes. Typical physical
causes are exposure to environmental factors and unsuitable
dietary practices including hot/cold food imbalances. Physical
illness is treated with various traditional curatives and/or western
medical care. Spiritual causes of illness include:
Evil spirits that are unhappy with the ill person
Loss of ones own spirit (an ill person has lost their soul)
Unhappy ancestors (Perhaps someone has done something to
offend the familys spirits or ancestors. An example might be
forgetting to provide food to needy ancestors or forgetting to
make offerings of paper money. Those in the real world offer
paper money by burning it; it is converted to silver and gold in
the spirit world.
A curse upon the family by someone

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Hmong believe good health depends on souls living in each person.

These souls govern the body. Illness or an invasive procedure of any kind
can cause soul loss. Spiritual healing rituals are common, often
conducted in the home or even in the hospital. Spiritual healing involves
retrieving the lost soul from another plane of existence. The practice of
soul calling during ritualistic ceremonies is performed by a shaman.

Many Hmong, especially older ones, focus on treating illness when it

occurs, but do not have an understanding of preventive medicine or of
chronic disease requiring daily treatment even when symptoms are not
experienced. Similarly, these are often people who have no concept of
germs causing disease. Younger Hmong who are raised in the US will
naturally be much more familiar with these concepts and will be more
likely to value preventive medicine. They will understand that
immunizations are required when children enter schools. As crossgenerational conflicts are common in refugee communities, it is
important that healthcare professionals in the US understand the
importance of respect younger Hmong must demonstrate respect for
the opinions of Hmong elders to maintain familial harmony.

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Many Hmong continue to use traditional herbal treatments.

Others will use herbal treatments as complements to western
treatments. Traditionally, someone who is sick is required to
eat hot food and certain vegetables. Hmong prefer hot
chicken and rice. They drink hot or warm water. Within 30
days of childbirth, Hmong mothers will usually only eat warm
foods.

Sick children are often put on a strict dietary regimen, such

as eliminating vegetables and only feeding a diet of rice and
chicken. Chicken must be boiled, not fried. Herbal medicines
are added to the meal in small amounts. Other treatments for
physical illness include cupping, coining, and moxibustion.
Treatment for illness of a spiritual nature involves religious
ceremonies, wearing amulets, or food/animal sacrifices.

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Traditionally not acceptable. Hmong believe it is not a good idea

to put something into their bodies. If a person is immunized or
has surgery, he/she will be reincarnated with less than a
complete body or a body with something foreign in it. However,
most Hmong parents will have their children immunized once
they know it is required for school or other activities.

Usually not acceptable. Opening the body allows the soul to

escape; soul loss is one of the Hmongs greatest health
concerns. However, in some cases, with the support of the clan
shaman and leader, the Hmong are willing to consider surgery.

Traditionally, both are unacceptable. Younger Hmong, however,

are more accepting of these medical procedures.
Blood Tests: Hmong accept blood tests. But they may question
why they have to have blood taken more than once in one visit
or why a large volume of blood is needed.

Cont

Build trust:Building trust from the very outset is essential with the
Hmong. Providers need to be open to the familys suggestions. Show
respect for the family by listening.
Privacy Concerns:Hmong share information among certain clan
members. All staff and all interpreters in healthcare settings must honor
the privacy of patients and their families. This policy needs to be
communicated to the Hmong.
Alternative Medicines/Herbs/Healing:Ask what care, if any, is already
under way? What herbal treatments are being used? What is the source
of the herbs?
Should You Inform the Patient Directly:Before sharing information
regarding a serious diagnosis with a Hmong patient consult the family. If
may be a necessary to hold a conference if there is a major problem or
surgery is needed. A conference may need to involve all important family
decision-makers including clan leader and shaman. Consider the location.
Hold the session in a conference room, not in the patients room.
Use Hmong Interpreters:Be aware that even if the patient/parents speak
English, other important other decision-makers may not. Provide a
Hmong interpreter.

Cont

Explain Explain!The Hmong may be fearful and

distrustful at the outset. Be very clear about
details of the patients condition and intended
care (but be sure to talk to important family
decision-makers before informing a patient of bad
news).
Explain why many immunizations are needed.
Explain what a chronic disease is; asymptomatic
does not mean cured
Repeat information about medicines.
Explain purpose of blood withdrawals. Explain
what the test is and why so much blood is needed

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