LIA LEE'S CULTURAGRAM

Condensed Hmong Cultural Overview by Michelle Manteuffel

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10 Critical Areas of Exploration

Garnering knowledge about your client from these 10 areas will help increase your understanding for purposes of improving advocacy and facilitation of human health services:


  1. Reasons for relocation
  2. Legal status
  3. Time in community
  4. Languages spoken in home & community
  5. Health beliefs
  6. Crises events
  7. Holidays & special events
  8. Contact with cultural & religious institutions
  9. Values about education & work
  10. Values about family - structure, power, myths, & rules

Vietnam War, Loss of Sustainable Habitat, Mass Exodus, & Refugee Camps

2. LEGAL STATUS

Born July 19, 1982 to Legally Settled Refugee Family in Merced, California 1980

3. TIME IN COMMUNITY

Approximately 2 years from time of settlement to Lia's birth

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4. LANGUAGE SPOKEN IN HOME & COMMUNITY

Parents spoke Hmong only, while children were bilingual and often use to interpret

Both parents were illiterate, creating an additional barrier in understanding and administrating Lia's medical care.

5. HEALTH BELIEFS

Protective Practices

Culture is heavily ladened with protective ceremonies and rituals for the purposes of receiving and maintaining physical wellness. Primary reliance on Shaman Medicine with very reluctant use of Western Medicine based on poor medical experiences in refugee camps, Western culture's unwillingness or reluctance to integrate with Shaman Medicine, and cultural lore. Hospitals are populated by the spirits of people who die there. Psychological issues do not exist for Hmong people as they consider them to be spiritual problems.


Surgery is taboo, repeated blood sampling is fatal, and the only type of Western Medicine acceptable is antibiotic therapy. Lia's family adhered to these beliefs.

6. CRISES EVENTS

Onset Seizures, CPS, Septic Shock, & Persistent Vegetative State

Lia's first seizure occurred at 3 months of age. On May 2, 1985, Lia was removed from her home and placed in foster care until April 30, 1986 due to medical noncompliance by her parents. At age 4, on her 16th visit to the emergency department, she experienced a septic-shock-induced 20 minute seizure causing catastrophic brain injury resulting in persistent vegetative state.

7. HOLIDAYS & SPECIAL EVENTS

Hmong New Year, Weddings, Births, and Funerals

Hmong New Year is the biggest celebration of the year, but special attention and specific rituals are conducted with respect to weddings, births, and funerals, too.


Even after Lia's catastrophic seizure, her family continued celebrating Hmong New Year and her birthdays with parties and new elaborate costumes.

8. CONTACT WITH CULTURAL & RELIGIOUS INSTITUTIONS

Clan Structure, Religion, & Cultural Identity

Strong adherence to ethnic solidarity places the needs of the group before those of self. Cultural practice to first seek advice from tribe leaders before making any major decisions. No area of their lives is untouched by the spirit world.


Lia's family fought a constant battle trying to integrate their religious practices with Western Medicine. They frequently engaged in herbal remedy applications, rituals, animal sacrifices, and Shaman-led ceremonies, often unbeknownst to Lia's medical care team.

9. EDUCATION & WORK VALUES

Strong Work Ethic & Educational Aspirations

Hmong workers have a very strong work ethic and are considered by many employers to be better workers than the average American worker. Language barriers have created difficulty securing high-end agricultural employment, and the low-end agricultural jobs have been filled by illegal Hispanic workers who are competing for the same jobs. Therefore, 79% of Merced's Hmong are on public assistance, as is Lia's family.


Education is highly valued in the Hmong culture. Hmong children rarely cause discipline problems, and are considered to be hard-working, quick learning students. Though Lia did not attend school, many of her siblings completed college educations.

10. VALUES ABOUT FAMILY - STRUCTURE, POWER, MYTHS, & RULES

Strong Family Loyalty, Strong Tribe Allegiance, & Emphasis on High Moral Character

Structure & Power: Tribal structure of Hmong culture promotes the tribal leader as the head of the family clan whose decisions then funnel down through the family hierarchy allowing parents to "back down" without loss of face in situations of ethical dilemmas, which is how Lia's family often attempted to responded to Lia's medical issues. Males rank higher than females and old people higher than young.


Myths: Some of the myths Lia's family brought into the relationship with the medical personnel were that doctors were not to be trusted, blood supply is finite, a fat baby is a sign of love and good health, a slamming door caused LIa's epilepsy, Lia's was taken from the family because the doctors were angry at them for non-compliance, doctors wanted to punish them, keeping Lia at the hospital just made her sicker, and Lia was transferred to a different hospital because Neil was going on vacation.


Rules: Every decision Lia's family made in every area of their lives, including her medical care, were based on the 'rules' of their religion. They were constantly engaged in behaviors and practices intent on preventing the evil influences of malevolent spirits on ther daily functioning and wellbeing.


Family Values: Most prized Hmong characteristic is self-sufficiency. Other valued characteristics are are related to maintaining cultural sovereignty and independence. Noted by outsiders to be very stubborn. Again, all of these characteristics are descriptive of Lia's family and their responses to her medical complications.

Resources

"The Spirit Catches You and You Fall Down: A Homng Child, Her American Doctors, and the Collisions of Two Cultures" by Anne Fadiman


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Producer

Michelle Manteuffel

March 18, 2016