Caution: These are broad generalizations and should not be used to stereotype any individuals. They are most applicable to the least acculturated members. People from Cambodia, Laos, and Vietnam are included in this group.
Values, World View and Communication
Keep in mind that many Southeast Asians are refugees who fled to the United States to save their lives rather than simply to improve them.
Many Southeast Asians are Buddhist and believe in reincarnation. Many traditionalists are animists, believing that spirits inhabit objects and places, and that ancestors must be worshipped so their spirits do not harm their descendants. It is not unusual for members of this cultural group to practice Christianity, however.
Modesty is highly valued, and this value may interfere with some screening procedures, such as pap smears and colonoscopies. Clinicians may need to take extra time to explain procedures and to accommodate modesty concerns as best as possible.
Giggling at “inappropriate” times usually indicates nervousness or discomfort.
It may be difficult to obtain an accurate health history from older individuals, as patients were rarely told the name of illnesses, medicines given, or procedures performed.
Time Orientation
A present-time orientation is common, though emphasis on remembering ancestors reflects a past-time orientation as well.
Older, less acculturated members may not be oriented to “clock” time and may thus arrive early or late for appointments.
Pain
This group is generally stoic. Pay attention to nonverbal indications, such as a clenched jaw. Anticipate the need for pain medication, even if a patient does not ask for it, and explain that the doctor ordered it.
Family & Gender Issues
Great respect for elders is common. Adult children are expected to care for their parents.
Among older generations, men are the decision-makers, and either the husband or eldest son (if his father is deceased) may take on the role. Note that the family spokesperson may not be the decision-maker, but merely the one who speaks English.
When a patient is accompanied by relatives, address the eldest person present first—especially if male.
Pregnancy & Birth
Either the mother or the husband may be the preferred labor partner. When asked, they may not give an accurate count of pregnancies because many count only live births.
Some Hmong new mothers may want to take home the placenta for burial.
Pediatric
A baby may not be seen as “human” until several days old—a tradition that probably developed to discourage mothers from bonding too closely in an environment with high infant mortality rates.
The head is the seat of life and is thus considered very personal, vulnerable, honorable, and untouchable (except by close intimates), so avoid putting intravenous lines in an infant’s scalp unless necessary, and then only with explanation.
Some Vietnamese mothers may appear to have difficulty bonding; this is an illusion. If they pay little attention to their newborn, it is probably out of fear that if they call attention to how attractive their infant is, spirits may want to steal the child, which could result in the child’s death.
Children may wear “spirit-strings” around their wrists or “neck rings.” Neither should be cut or removed as some consider these to carry the children’s life-souls.
End of Life
When a patient is diagnosed as terminal, family members may wish to shield him or her from that fact. On admission (or before the need arises, if possible) ask patients to identify how much information they want to be given regarding their condition, or to whom the information should be provided. Be aware that in most parts of Southeast Asia, diagnoses are usually given to the family, who decide whether or not to tell the patient.
Some may believe that at death parents and grandparents become ancestors who should be worshipped and obeyed. Since these ancestors shape the well-being of living descendants, a child (regardless of age) may have trouble agreeing to terminate the care of a parent.
Family may want to wash the body at death and some may want to place a coin in the deceased’s mouth, according to custom.
Hmong may refuse autopsies and organ donations because they believe that whatever is removed from the body will be missing when they are reincarnated.
Health Related Practices
Patients (especially rural non-Christians) may fear surgery because many believe that souls are attached to different parts of the body. They may feel that a surgical procedure might sever this connection, thus causing illness or death. Some may believe that if the body is cut or disfigured or parts are amputated, the patient will remain in a state of imbalance for life. This may be thought to trigger frequent illnesses and render the person physically incomplete in his or her next incarnation.
Some Hmong believe that when people are unconscious their souls can wander, so anesthesia is dangerous.
Some believe that verbal statements in and of themselves can cause illness or death, and for this reason may not want to discuss potential risks and dangers. Less acculturated patients may want to consult a shaman.
Therapies like cupping and coining (or “coin rubbing”) are traditional remedies, not forms of abuse. So ascertain how and why any observed markings on a patient’s body were made before reporting them.
Some patients may have concerns about blood being drawn. They may fear it will sap their strength, cause illness, force their souls to leave their bodies, or that it will not be replenished. If a patient is anxious, ask about his or her concerns so they can be addressed.
Note: Information for this profile was adapted from several sources, including Kulig, J.S. and S. Prak (2005) Cambodians (Khmer), in J. G. Lipson and S. L. Dibble, eds, Culture & Clinical Care, 63-84. San Francisco: UCSF Nursing Press; Johnson, S. K. and A.L. Hang (2005) Hmong, in J. G. Lipson and S. L. Dibble, eds, Culture & Clinical Care, 250-263. San Francisco: UCSF Nursing Press; and Muecke, M. A. (1983) In search of healers: Southeast Asian refugees in the American health care system. WJM 129: 835-40. Additional information on Hmong beliefs was taken from Fadiman, A. (1997) The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux.