W6: Cultural competence: A slow, but necessary transition

The Hmong people have been through a lot in their past, and there are obvious reasons as to why the Lee family may not have completely trusted the “American way” of doing things, specifically medicine. When the Vietnam War was occurring, the United States recruited Hmong people, living in Laos, to help fight against the communist forces. The United States eventually withdrew their support, leaving hundreds of thousands of Hmong people, who were originally helping our country, to be forced to out of their own homes. The Lee family was one of the Hmong families that was forced out of their homes to escape persecution and when many of the Hmong people arrived in the United States, they were not welcomed as well as they should have been, and many had to deal with unemployment and mistreatment from the Americans. This backstory is incredibly important to reference, especially with relation to the Lee family, because it gives logical reasoning as to why they were not fully trusting of the United States and our style of doing things. Through the visualization activity in our second lecture this week, I was able to better feel exactly how the Lee family must have felt throughout Lia’s health issues. Because of their background and the visualization, I understand the caution that the Lee family took and why they took it, but I do think there are better ways to go about a situation such as this one, with regard to both our doctors of Western medicine and the Lee family.

The United States is a country unlike any other, what with our whole population being a mix of different immigrants from around the world. This is how we began as a country, and this is how we continue to grow. In order for this growth to continue positively, with regard to immigrants’ and refugees’ transitions into the United States, some changes need to be made. One huge transition for refugees to make deals with health, illness, and treatment. We all know that there are many different belief systems in other countries that base their feelings towards medicine upon religion or spirits. This is something that we, as in medical professionals within the United States, need to be more open to. This has to do with the idea of “cultural competence” and trying to better understand the cultures and beliefs of different people coming to our western medical system for help. Anne Fadiman, the author of The Spirit Catches You and You Fall Down, makes note as to what approaches to cultural competence could be helpful to improve healthcare experiences for refugees. Some of these suggestions include first, acknowledging the other belief systems that refugees and immigrants bring into the United States (Fadiman, 1997). Fadiman also suggests including cross-cultural programs into the medicinal practices here, which would include shamans working alongside western health care providers (Fadiman, 1997).  This would help to intertwine the two different types of healing and to make the refugees feel that they are being understood and listened to from two trusting sources. Cultural competence and cross-cultural programs within medicine and healing would greatly help to improve the experiences of refugees coming into the United States. This improvement is necessary because in a study done surrounding healthcare barriers of refugees, it was found that “the majority of refugees do not regularly access health services” (Morris et al., 2009). Refugees ran into problems like language barriers, and cultural beliefs about health care affecting refugees’ expectation of care (Morris et al., 2009). Again, these are things that can be fixed, or at least tried to be fixed with simple actions, as aforementioned.

Fadiman, Anne. The Spirit Catches You and You Fall Down. Farrar, Straus, and Giroux, 1997.

Morris, Meghan D., Steve T. Popper, Timothy C. Rodwell, Stephanie K. Brodine, and Kimberly C. Brouwer. “Healthcare Barriers of Refugees Post-resettlement.” Journal of Community Health, December 2009.

4 thoughts on “W6: Cultural competence: A slow, but necessary transition

  1. The recent history of the Hmong is very harsh, and you demonstrated that very well in your description. I think it important to point out that while the Hmong do have a historic resistance to power, that alone isn’t the reason for the poor relationship between the Hmong patients and physicians. The physicians were very
    unaccommodating for their treatments and this had significant consequence. In the book, you see this consequence in play. The physicians at MCMC over-prescribe anti-seizure medications, which may have led to an infection, which in turn lead to the loss of cognitive functioning in Lia. Had the physicians actually compromised with Lia’s family and prescribed a lesser dose, this result may have never happened. So the historic background of Lia’s family, the physician’s poor understanding of their patients, and the lack of empathy to the viewpoints of their patients all contributed to overall poor healthcare.

    I have a tiny disagreement with one of your statements. I do believe this problem can be fixed. While we can’t educate every single physician on every single culture, the “fix” in my opinion is more flexible and open-minded physicians. What we need is open-minded physicians plus a course or something we can use to increase cultural competence of them, as you pointed out. Because the real problem is not just culturally ignorant physicians, its physicians who become arrogant with their beliefs and lose their cultural empathy for patients.

  2. Hello!
    I completely agree that there are many reasons that the Hmong people do not trust the American culture, especially with medicine. I feel like medicine is such a new thing compared to everything else and the American people themselves do not know how to handle medicine, I can only imagine how I would feel if I was a refugee. There is so much history intertwined with the Hmong people. I am amazed that none of the history classes I have taken mentioned these people and the sacrifices they made to fight for what they believe in. My grandparents and parents immigrated to the United States, and to this day, when I am sick they try to use methods that they used back home. It is amazing to see the different ways of treatment each country has. Although my family’s belief in these ways isn’t as strong as the Hmong’s were with there, I feel like it is hard to get rid of tradition. I agree with what you said about improving refugee experience. I feel that one of the biggest problems is cultural incompetence. I feel like I have more of a cultural grasp because of my background, but for people who are not exposed to different cultures, I feel that it is harder for them to imagine a different way of life.

  3. I think you did a great job of discussing the history that the Hmong people have had with the United States as a means of providing some cultural context behind the Lee’s actions. I think that so often people have a tendency to look at just one reason and say that is why someone does something. In the case of the Lee’s it would be very easy to say ok well they believe in spirits so this is why they are acting differently than what we are used to in the United States, however it is more than just that. While their spiritual beliefs did play a role in their behavior, and helped to make up how they understood the world, their history is also a major part of their world view. I think it is especially important that you noted this because most Americans don’t know that the Hmong people fought in the Vietnam war, or would probably think that they fought against us . However, we know from the book that they did in fact make that sacrifice, and they did so to help the United States. So those predispositions can actually be very harmful to the way that we understand people and their motivations, and I think it is great that you spent part of your blog explaining the background.

  4. Hello, I think you did a great job answering the questions for this assignment. I also think it is incredible arrogant of the doctors to just completely ignore the way the Hmong men and women were used to living, and just go ahead with their way of actions. I understand the doctors believed they were doing the right thing, and they think their ways are the best ways, but I really think they could have spent a little bit more time trying to understand the Hmong culture. As we learned from the reading, the Hmongs were much more open to trying to accept and listen to the Americans, yet the doctors did not return the favor. As someone mentioned above, the doctors can not be expected to know and understand every culture, but they should do their best to understand and work with the families of their patients. I like the way that you said that you do not think we can “fix” this issue, and I completely agree with you; there are so many cultures out there, and it would almost be impossible to educate every single doctor about every single culture system. As Americans, we need to accept and understand that the United States is extremely diverse and not everyone has the same opinions as we do, or the same values and rituals.

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