The importance of understanding not just Hmong culture, but their unique history, especially recent history in Laos can’t be overstated. The fought in a secret war, where their population size dwindled because their lives were seen as less valuable than the American soldiers. Throughout their history, the Hmong fought and won against all forms of assimilation and persecution. But during the Vietnam wars and the secret war in Laos, their people sustained such heavy losses that returning to their high altitude lifestyle was all but impossible. When a group is known to be so tenacious and resistant to change, the answer will never be how it was for the Lee’s family in America, where their customs and traditions were typically seen as medieval hurdles for the doctors of the west to overcome. When Lia’s doctors thought he parents were abusing her to the point or removing her from their care, they did it out of ignorance. They didn’t accurately explain why and how the medicine would help Lia which, albeit difficult through a language barrier, is vital. The idea of informed consent is very ingrained into our medical and legal culture that even if a procedure saved a patient’s life, they can sue the doctor for failing to get consent. Beyond the language barrier, they could’ve seen that many of the Lee family’s resistance to follow directions was because every step eroded their traditions and culture, which is usually all refugees have of their homeland. If one doubts the importance of this, ask why people decades out of college still have shirts and sweaters from their alma mater. Tradition, and loyalty to those traditions is something that seems to only be respected in medicine when the doctors understand and relate to the traditions, which is highly ethnocentric. Ethnocentric is just a fancy way to say that they view their way as the only right way, and all others are confused and misguided.
As for improving healthcare, the two best ways, highlighted in Dr. Clea McNeely and Lyn Morland’s article, are identifying barriers to care at all levels, and ‘cultural brokers,’ as they said, to bridge the cultural gap between themselves as the west. Meeting with every group that will be involved in a refugees settlement, from health care to jobs, transportation to schools, and seeing what barrier will exisit for them, and brainstorming (hopefully with individuals who have gone through the refugee pathway before) solutions for these barriers. No one can accurately fix a problem unless it is identified, and you don’t want to realize there is problem, like say a hole in a tire, when it’s too late, say when you are going 70mph down a highway. Cultural brokers help both the refugees and the current residents see where the other is coming from, and find ways to bridge any gaps between the two. For example, the shamans chanting can be easily understood by the west as a priest leading in prayer for a patient. Something that, if it occurred, would be very easy for western doctors understand.
McNeely, Clea, PhD. M.A., and Lyn Morland, MSW, M.A. “The Health of the Newest Americans: How US Public Health Systems Can Support Syrian Refugees.” American Journal of Public Health 106, no. 1 (January 2016). Accessed August 10, 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695930/.