Hmong Cultural & Beliefs Impact Western Health Care

Diversity Rx 2010 Seventh National Conference On Quality Health Care for Culturally Diverse Populations October 18-21, 2010 THE HMONG CULTURAL/BELIEFS IMPACT WESTERN HEALTH CARE By Fuechou Thao HMONG HISTORY Theoretical framework about the Origin of the Hmong a Savina concluded that the Hmong were a subgroup of the Turanians, a Caucasoid people, originally from Mesopotamia b Eickstedt introduced the theory of ultimate southern origin_ either coming from India, Burma, or Tonkin However, all researchers agreed that the Hmong were in China before the Chinese The Hmong’s Migration a From China to Southeast Asian (Laos) about 1810 and early 1900 b From Laos to the U.S.A, Australia, France, Canada, etc in 1976 DEFINITION OF TERMS The Chinese used the following terms: Miao Mong-Tse Meau Meau-Tse The Lao and Thai used: U.S Government used: We call ourselves: loosely translated “barbarian” Historical Chinese work compared our language to the howling or crying of the hyena Transliterating a cat’s head or all the non-Chinese Son of the soils, the farmers Meo Highlander Hmong or Mong DEMOGRAPHY AND GEOGRAPHY Country Hmong Population China Vietnam Laos Thailand Burma U.S France French Guyana Canada Australia Germany 7,393,037 250,000 350,000 125,000 4,000 300,000 15,000 1,100 700 350 130 Total 8,439,317 Chij Tsaj, Hmoob Pa Tawg Teb ( The Hmong in Wanshan), (Guyane: Association Communaute Hmong, n.d.), 17 Dao Yang , Les Hmong du Laos Face au Development (Vientiane, Laos: Edition Siaosavanth, 1975), 26-28 W.E Garrett, “The Hmong of Laos: No Place to Run,” National Geographic, Vol 145,No (Washington, D.C.: National Geographic Society, January 1974), 80 Xeev Nruag Xyooj, “Txooj Moob huv Nplaj Teb” (The Mong in the World), Txooj Moob, Vol (Winfield, Illinois: Mong Volunteer Literacy, Inc., May 1989), 8-12 HMONG CULTURE Family Life   Basic nurturing institution, extended family Organized strictly on the patriarchal side Religion      Traditional animists (Kev Cai Poj Yawm) Animism: a belief system that combines the ancestor , supernatural power, superstition and devil worship No standardization in Hmong religion Belief in life after death Dealing mostly with superstition and devil worship through the notion of illness and death Arts and Crafts     The Hmong are known for their “Paj Ntaub” translated “Flower Clothes” Hmong observed the patterns, the cross-stitch embroidery and their applique from the design of the cowries Shell and the shape of animals and plants from China Those patterns were incorporated into costume design Paj-Ntaub became one of the most distinctive features of traditional Hmong culture Social Structure       Emphasis on the clan system originating form a common ancestor Clanship is the basic social and political organization A Hmong at birth takes on his/her father’s clan and remains a member for life Origin of the clan remains a mystery referring to a child of incest born from a brother and a sister dating back to the Great Flood Shaped like an egg, the couple cut their offspring into pieces that became the different Hmong Clans In Hmong Society, boys and girls are forbidden to date and marry within their own clan The traditional Hmong consisted of twelve clans that corresponded to their rituals: CLAN NAMES RITUALS Chang (Chun) Hang Her Kue Khang, Phang Lee (Li, Ly), Lor Moua (Mua) Song Thao (Thor) 10 Vang, Cheng, Fang, Vue 11 Xiong 12 Yang Nrig Tag Dluag Nkug Pluag Cai Zag Koo (Kong) Dub Vug Mob Yawg   The Hmong took on Mandarin Clan name during King Wu of the Chou Dynasty (1028-257 B.C.) And the branching out of the clans from twelve to eighteen occurred during the Ming Dynasty (1368-1644); Political Organization           A complex hierarchical political system; Reflected the former political system of the Hmong kingdom between 400-900 A.D.; “A loose federation of tribal heredity Monarchy” Power was decentralized to the localities; The full scope of the traditional Hmong political system has not been welldeveloped; In the 19th century, some alterations in the Hmong political structure were made under the auspices of the territorial organization of the Royal Laotian government:  Nai Ban (headman or village chief)  Tasseng (district chief)  Nai Kong (a higher layer of civil tribal administrative officials)  Chao Muong (Mayor)  Chao Khoueng ( Provincial Chief) The strongest basic unit of the Hmong political system remains with the patrilineal clan system with its household at the local level; Members of the same clan refer to clan-brother or clan-sister; Grouping the members of a clan of the same and common ancestors in one particular area is typical_ Hmong enclave; Place a high value and offer much respect to elders;      Tus Tsaws –Ntug (the clan Leader/householder)-final authority in familial matters; Role is to maintain peace and harmony within his family, clan members, and other clan members; A Hmong is responsible to answer to his family, to the clan, and to the householder; As mountain dwellers, the Hmong survived on small scale agricultural economy “Ua Teb” (Farming) at a subsistent level; The notion of division of labor is very important within the family, between members of the villages, and between villages; The Hmong believe in the spirit of collective teamwork and the notion of free labor exchange existing within the traditional and cultural realm of Hmong life; HMONG LANGUAGE General Characteristics    Has always been an oral language until the end of World War II Is a subgroup in the Sino-Tibetan language family of Asia (considered a preSinitic language in the Miao-Yao family) Is a monosyllabic and tonal language e.g Kuv hlub koj ‘I‘ ‘love’ ‘you’ The ending in each word, kuv, hlub, and koj, are tone-markers The Hmong not pronounce them Therefore, pronouncing the –s or the ending sounds is difficult for Hmong  Orthography was based on the Romanized Practical Alphabet (RPA) system developed by missionaries of the Christian and Missionary Alliance (CMA) in the 1950’s Morphology: Words   Words in Hmong consist of monosyllables and not change their forms Hmong words not have suffixes so English morphology is difficult for Hmong speakers A) No –s ending in plurals e.g English: Hmong: Pen Cwj-mem B) No –ed in past tenses e.g English: Hmong: I love you (present) I loved you (past) Hmong: Kuv hlub koj (present) Kuv hlub koj (past) Pens Cwj-mem C) No –ing in participles e.g English: Hmong: Love  Loving Hlub  Hlub D) No Noun Declensions e.g English: government, nervousness, assistance, subtraction, criticism, casualty E) No Verb Conjugations like French or Spanish e.g French: Je chante une chanson J’ai chante’ une chanson Je chanterai une chanson Hmong: Kuv hu nkauj (for three) F) No Grammatical Gender (no masculine or feminine like English and French) e.g English: Hmong: Waiter  Waitress txais-tos  txais-tos EDUCATION History, legend and Hmong elders all maintain that the Hmong in China once had a writing system before the invasion of the Han Chinese Due to heavy and continued suppression by the Han Chinese, the Hmong were unable to keep their books; they threw them into the Yellow River and hid their writing by only using the characters as designs for the women’s skirts and collar So sometime in their past the Hmong lost their writing system According to Dao Yang, PhD, the first school began operating in the Hmong homelands at Xiengkhoung Province, Laos in 1939 and there were only nine Hmong students who attended Once more elementary schools were set up throughout other highland areas of Laos, Hmong children were able to attend school to learn the Lao language The Laotian school system was divided into two grade school levels The first level was called Primary Grade school which included grades 1-3, and the second level was called the Upper Grade School which included grades 4-6 Secondary School also was divided into two levels as Junior High which was grades 7-10, and High School which included grades 11-13 In 1971, there were 340 Hmong students enrolled in public and private secondary schools in Vientiane and 37 Hmong students enrolled to study at the universities in various countries abroad In 1972, Dao Yang, PhD was the first Hmong in Laos to earn a doctorate degree in economics and social development from the University of Paris, in France Education is the most important driving force in the development of the Hmong Community in the United States In the short period of 35 years ( 1975-2010) of their residence in the United States, more than 10,000 Hmong students have earned bachelor degrees, more than 1,000 earned master degrees and more than 500 earned doctorate degrees at American Colleges and Universities HMONG BELIEFS Hmong traditional beliefs regarding the cause of illness, and their descriptions of symptoms are very different from commonly used Western medical concepts Western health practitioners may become confused, frustrated and may conclude that the Hmong patient is answering inappropriately by presenting a traditional belief in relating his or her symptoms However, health practitioners can learn to correctly diagnose the patient’s ultimate health concern and respond accordingly to the patient’s needs through an appropriately trained interpreter or a cultural broker Common traditional Hmong concepts regarding causes of illness are as follows: FOOD AND DRINK Many illnesses, especially those which manifest themselves as stomach aches or digestive problems are thought to be caused by eating or drinking something that does not agree with the body This does not necessarily mean that the food and drink was contaminated, rotten, or poisonous This idea is not dissimilar from the symptoms caused by a Western “allergy.” However, the Hmong perceive bad food and drink to cause different symptoms than allergies in Western medicine For example, a chronic feeling of bloating in the abdominal area may be described as “ having a lump in the stomach,” or “kem plab” A common folk practice for differentiating between “bad food” and “bad drink” as the cause for a stomach ache is for a second party to massage the stomach of the sick person in a upwards motion towards the throat, and outwards along the arms to the fingers A finger is then pricked and a drop of blood is allowed to drop into a bowl of water If the blood floats, the illness is thought to be cause by drinking, and if it sinks then it is thought to be cause by food Other symptoms believed to be caused by food and drink: ANIMISM & ANCESTOR WORSHIPERS Hmong Community Leaders in the United States estimate that at least 70 percent of Hmong refugees have chosen to retain their traditional beliefs Ancestor Worshippers/Animists view most major illnesses as spiritual or traditional belief problems Each Hmong family has a group of ancestor spirits, which belong to the father’s or husband’s side From time to time the ancestor spirits are in great need of certain things from the descendents’ family to be used or spent in the spiritual world by causing illness in a member of the family To make an appropriate diagnosis a shaman or diagnostician must be called in and ritual of animal sacrifice will be offer to the ancestor spirits NATURE SPIRITS The Nature Spirits own and control their properties such as the hills, mountains, trees, rivers, caves, animals and its kingdom In general, nature spirits are not malevolent towards humans However, if a person offends, they may cause illness to the Offender, the Family members of the offender and the Immediate Families Tossing a rock into the river may offend the river spirit However, health usually returns to the sick person once an appropriate ritual is conducted If an offense has transpired a Hmong Shaman, Diagnostician and Tamed Good Spirit Master will be called in to make an appropriate diagnosis EVIL SPIRITS The evil spirits are believed to live everywhere, especially in uninhabited areas such as forests and jungles If offended, they necessarily attack the perpetrator by causing acute pain, violent pain, sickness and death The powerful Hmong Shaman, Tamed Spirit Master, or Evil-Spirit Master can deal with problems of this sort, and treatment usually entails fighting off the evil spirits, rather than appeasing it with ritual and sacrifice TAMED EVIL SPIRITS Throughout Southeast Asia there is a common belief that a person, by joining a religious cult or by studying under the established masters, can learn to control evil spirits The only two tamed evil spirits are “Nyuj Ciab, and Zeb Ntais.” They can be controlled under a specialty Master who are thought to be able to magically insert the “Nyuj Ciab, and Zeb Ntais” into anyone whom they target People may also seek out and hire them to inflict sickness and death upon an enemy Common symptoms of an attack by the evilspirits include acute pain, violent pain, and sickness and death It is believed that the only way to escape from such a tamed evil-spirit attack is to bribe the attacker with more money or hire a more powerful master to fight off the evil spirits LOST SOULS A prevalent concept throughout many Southeast Asian cultures is that good health is the union of one’s souls always with the body The Hmong believe that each person has twelve souls - there are three major souls and nine shadow souls-united in the body The more souls lost and the longer they are lost, the sicker the person will be The souls can be lost in numerable ways such as being frightened, depression, trauma, kidnapped by evil spirits, on a long trip, and simply get lost There are many different types of ceremonies to call the souls back to their bodies Ceremonies range greatly in complexity from a basic calling ceremony to the most elaborate, enlisting specialty soul callers CURSES In the Hmong society it was believed that elders, particularly those of the same clan, had the right to curse their descendants if the descendants did not carry out the filial duties A person who is morally right could curse anyone who has done him a serious wrong Curses could cause a wide range of illness, economic disaster, and even death The only way to remove these effects was for the person who originated the curse to take it back through appropriate ritual and ceremony WEATHER Traditionally Hmong elders believe that chronic illness, old injuries, etc, will reoccur as various forms of pains or aches in the body when the weather changes sudden It also believed that changing weather can bring on colds, influenza, and muscle aches which western people might call arthritis or rheumatism Heat exhaustion and sunstroke are also recognized by the Hmong as being caused by overexposure to the sun and heat OLD AGE Hmong understand that as the human body ages, it degenerates, and various ailments occur Long term hard work and having borne many children are often cited by the elderly for body aches and pains and respiratory and digestive problems In Hmong culture and society old age begins at age 30 The lifespan was shorter than the American average Being considered old in Hmong society was perceived as something desirable, even though illnesses were anticipated with advancing age EXPIRATION OF BIRTH VISA The Hmong believe that each person receives or carries a visa from God to be born as human being God determines the length of stay on earth and the expiration date of the visa Life-threatening illnesses and unexpected or unexplained sudden death are thought to be cause by that person’s visa being expired The Hmong Shaman is the only one who has the power to extend, renew, or restore the expiration date For routine preventive care a shaman is called in to perform ritual of trance or incantation, make negotiations to extend or renew the visa, offer animal sacrifices, restore supplies and goods by the family members such as the younger brothers, daughters, and son in-law, son and daughter in-law at a ritual ceremony HOUSE SPIRITS There are six house spirits who play an important roll in the house in guarding the individual person’s souls and spirits and while fending off any outside spirits The spirits of the ritual hearth or large stove and the spirit of the cooking hearth, which is in the middle of the floor, help to protect every member of the entire family from harm or misfortune The spirits of the ancestors live in the central pillar and protect everyone in the household against devils The spirit of the door helps to protect the house and everyone’s souls in the entire family against devils The spirit of wealth and prosperity lives against the middle of the back wall and protects the entire household and every member of the family The spirit of the marital bedroom lives in a gourd in the bedroom and the gourd needs to be kept clean, to protects and produce the animal of the family KARMA The concept of Karma is a common belief throughout Asia Karma is not directly a part of Animism or Ancestor Worship, the Hmong believe that souls return to earth time after time, and life on earth is designated by luck, and by karma Thus, people born with birth defects, mental retardation, handicaps, and chronic illnesses are often regarded as paying for sins committed in past lives DEPRESSION OR STRESS Depression or stress is not perceiving by the Hmong in the same way that Westerners perceive it However, they recognize that stressful situations can result in various health problems, especially that which we in the Western would call mental illness Some examples include family financial problems, aggressiveness, depression, insomnia, sadness, and loss of appetite The Hmong refer to those who exhibit changes in personality as “having something wrong with their liver.” This does not mean that they think there is something pathologically wrong with his or her liver; rather, the Hmong language uses “liver” as a term to describe anyone exhibiting various sets of symptoms For example, a common Hmong term for someone who becomes destructive and begins to verbally abuse others after some kind of emotional trauma or loss is “siab phem, tsiv siab, kho siab” which translated having an “ugly liver, angry liver, rigid liver” HMONG TRADITIONAL HEALERS Western health practitioners may wonder why they lack credibility with some of their Hmong clients Part of the reason is that differences between Western and Hmong health practitioners are so great that some Hmong clients wonder if the American doctor or nurse is competent Hmong traditional healers provide health care to their patients in a completely different and unique way, and just as Western countries have different types of healers such as MDs, DOs, and chiropractors, the Hmong also have healers from different schools of practice It is quite common for individuals to study and master more than one healing art Although being a traditional healer does not usually bring a person wealth in Hmong society, it does bring status and peer admiration Common Hmong traditional healers and practitioners are as follow: ACUPUNCTURISTS It is thought that the skill of acupuncture was adapted by the Hmong from the Chinese Most Hmong acupuncturists not use the hundreds of points used by their Chinese counterparts, but rather concentrate on several key points Although, the practice of Hmong acupuncture is not very common it is utilized on occasion by both Christian and Non-Christian Hmong Hmong acupuncturists practice the following skills:    Message on arms and legs with herbs Massage on body, arms, legs, fingers and toes then use needle to prick on the areas Both Christian and Non-Christian Hmong occasionally approach the acupuncturist for certain medical problem HERBALISTS The Hmong have experiences in using herbal medicine for treatments as well as healing art techniques, they prefer self-care for sickness at home before seeking Western health care unless an emergency takes priority When someone is sick, a member of the family seeks the advice of the herbalist who is knowledgeable in herbal medicines and practices that could cure the sick person More commonly, Hmong women are responsible for growing herbal plants and hence almost every Hmong family grows herbal plants It is logical then that Hmong women are more specialized than men in the knowledge of herbal medicines and in preparing and prescribing the use of herbal medicines In the Hmong community throughout the United States, almost every family grows and keeps gardens of herbs on their back and front yard For the common practice of the Hmong herbalists, they need to:       Keep gardens of herbs on back and front yards Search for natural herbs in the forests Dry and preserve herbs Harvest fresh herbs Believed to impart some spiritual power to the herbs which give more healing strength Both Christian and Non-Christian Hmong approach the herbalists for any type of medical problems HMONG SHAMAN (TXIV NEEB) The Hmong shaman is the most commonly known traditional healer existing for many thousand years The shaman can be either male or female and shamanism is the only Hmong traditional healing art that can not be studied or passed on to another The healing spirits call “Dab Neeb” chooses their host by causing prolong illnesses such as intolerable foods, fatigue, weakness etc The shaman master is able to store the appropriate and good spirits “Dab Neeb” to the individual to teach him or her how to heal others through incantation with the spirit world Each shaman is thought to have a different level of healing powers and some specialize in certain fields of illness However, Hmong shamans are capable of dealing with almost any kind of sickness Moreover, they are able to diagnose and refer patients to other sources if they are unable to cure the patients All shaman maintain an altar and many tools:      The Gong “Nruas” The Rattle “Txiab Neeb” The Buffalo Horn “Kuam” The Rattle Rings “Tswb Neeb” The Sword “Riam Neeb”      A Hat of red or black clothes A Bowl of holy water A Bowl of uncooked rice for incense base A few dozen incense (sticks) A Bowl of uncooked rice with eggs The common practice of the shaman       Performing a ritual of trance or incantation Making negotiations Offering animal sacrifices Renew or restore the appropriate spirits, and souls Ritual ceremony Diagnosis of patient sickness TAMED GOOD SPIRITS MASTER (Txiv Khawv Koob) Healers of this type are the counterparts of the Tamed Evil-Spirit Masters They are thought to have similar powers in removing foreign objects from the body that cause illness, stopping blood flow from a fresh cut or wound or nose bleeding, healing broken bones, fire burn, speeding up labor and delivery, and removing various aches and pains However, they not have the power to fight off attacks by Tamed Evil-Spirits, to insert foreign objects into victims, nor they possess the power to cause illness in others with the spirits The Tamed Good-Spirit Masters have only the power to cure and, consequently, are more well-accepted in Hmong society TAMED EVIL-SPIRIT MASTER (Txiv Khawv Koob) This person is thought to be capable of causing illness as well as curing those under attack by another Tamed Evil-Spirit Master This type of healer also has the added skill of being able to magically insert into or remove foreign objects from a person’s body The foreign objects cause various types of acute pains and illnesses and eventually death The Tamed Evil-Spirit Masters are viewed with fear by the Hmong society, so they keep their skills a secret DIAGNOSTICIAN There are several types of Hmong Diagnosticians who are capable of diagnosing what is wrong They will refer to other healers for cure, but not themselves provide cures for clients They have learned the art of fortune telling; reading various omens, using the first day that the client got sick, lost, or disappeared to find out what’s wrong Other diagnosticians specialize in using one or more “tools” to ask the spirits what is causing the patient to get sick In the ritual of diagnosis they use been seeds, rice grains, coins, wood or baboon sticks, or chicken eggs Diagnosticians are able to negotiate and offer animal sacrifices while conducting the ritual of diagnosis In general, the majority of diagnosticians must refer their clients to other healers or a shaman for treatment or cure SOUL CALLERS Almost every male head-of-household and some female in Hmong society knows how to perform simple soul-calling ceremonies In difficult cases, more complex ceremonies must be held by skilled practitioners Soul-calling ceremonies are the most common practice by non-Christian Hmong Soul calling involves the sacrifice of two chickens, two or more eggs, a pig, a cow, or buffalo HERBAL MEDICINES Name of Med: Scientific Name: Part used: Indication: Preparation: Method of use: Tshuaj Rog Ntsuab Name of Med: Scientific name: Part use: Indications: Preparation: Kuab Tub Sab Mirabilis Jalapal Stem and Leaves Weak and loss of appetite Used as a tonic in combination Leaves Weak or tired Boiled with chicken Orally-eat the chicken and drink the broth BIBLIOGRAPHY HUGO ADOLF BERNATZIK, AKHA AND MIAO HUMAN RELATIONS AREA FILES, NEW YORK, 1970 ANNE FADIMAN, THE SPIRIT CATCHES YOU AND YOU FALL DOWN FARRAR, STRANS AND GIROUX , NEW YORK, 1997 JAMES LUE MOUA, THE UESES OF HERBAL MEDICINE IN HEALTH CARE PRACTICE OF HMONG REFUGEES AND POLICY IMPLICATIONS IN MERCED COUNTY, CA 1996 PAUL AND ELAINE LEWIS, PEOPLE OF THE GOLDEN TRIANGLE THAMES AND HUDSON, NEW YORK, 1984 BARNEY, G L THE MEO OF XIENG KHOUANG PROVINCE, LAOS IN SOUTHEAST ASIAN TRIBES, MINORITIES AND NATIONS VOLUME II KINSTADLER(ED.) NEW JERSEY: PRINCETON UNIVERSITY PRESS, 1967 BLIATOUT, BRUCE HMONG SUDDEN UNEXPECTED NOCTURNAL DEATH SYNDROME: A CULTURAL STUDY OREGON: SPARKLE PUBLISHING ENTERPRISES, 1982 HMONG ATTIDUDES TOWARDS SURGERY: HOW IT AFFECTS PATIENT PROGNOSIS MIGRATION WORLD VOL XVI (1): 25-28 BLIATOUT, BRUCE THOWPAOU, BRUCE DOWNING, JUDY LEWIS, AND DAO YANG HANDBOOK FOR TEACHING HMONG-SPEAKING STUDENTS FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT, 125 E BIDWELL ST FOLSOM, CA 1988 CAMPBELL, M FROM THE HANDS OF THE HILLS 2ND ED HONG KONG: MEDIA TRANASIA, 1981 CHAN, ANTHONY HMONG TEXTILE DESIGNS OWING MILLS, MD: STEMEIRE HOUSE, 1990 DAO YANG HMONG AT THE TURNING POINT MINNEAPOLIS: WORLDBRIDGE ASSOCIATES, LTD, 1993 DEINARD AMOS, BRUCE DOWNING, AND GLENN HENDRICKS (EDS.) THE HMONG IN TRANSITION NEW YORK: THE CENTER FOR MIGRATION STUDIES, 1986 DEVINE, JOAN, ET AL (EDS.) RESEARCH IN READING IN ENGLISH AS A SECOND LANGUAGE ALEXANDRIA, VA: TESOL, 1987 DOWNING, BRUCE T AND DOUGLAS P OLNEY (EDS.) THE HMONG IN THE WEST,OBSERVATIONS AND REPORTS UNIVERSITY OF MINNESOTA: 1986 GLIMPSES OF HMONG HISTORY AND CULTURE WASHINGTON, D.C.: NATIONAL INDOCHINESE CLEARINGHOUSE, CENTER FOR APPLIED LINGUISTICS, 1984 ERICKSON, R AND G HOANG HEALTH PROBLEMS AMONG INDOCHINESE REFUGEES AMERICAN JOURNAL OF PUBLIC HEALTH, 1980 EVERINGHAM, JOHN ONE FAMILY’S ODYSSEY TO AMERICA NATIONAL GEOGRAPHIC 157, NO (MAY 1980.) FOLK REMEDY-ASSOCIATED LEAD POISONING IN HMONG CHILDRENMINNESOTA MMWR, 1983 GARRETT, W.E THE HMONG OF LAOS-NO PLACE TO RUN NATIONAL GEOGRAPHIC 145 NO (JAN 1974.) THAILAND: REFUGE FROM TERROR NATIONAL GEOGRAPHIC 157, NO (MAY 1980.) GEDDLES, W.R MIGRANTS OF THE MOUNTAINS OXFORD, ENGLAND: CLARENDON PRESS CASTLE, TIMOTHY AT WAR IN THE SHADOW OF VIETNAM: UNITED STATES MILITARY AID TO THE ROYAL LAO GOVERNMENT, 1955-1975 NEW YORK: COLUMBIA UNIVERSITY PRESS, 1993 KNOLL, TRICIA BECOMING AMERICAN: ASIAN SOJOURNERS, IMMIGRANTS AND REFUGEES IN THE WESTERN UNITED STATES, 1982 LANDO, GAIL AND GRACE SADNESS (EDS.) PEARLS OF GREAT PRICE: SOUTHEAST ASIAN WRITINGS MINI WORLD PUBLICATIONS, 1975 LEVINE, KEN AND IVORY WATERWORTH-LEVINE EDITED BY RICHARD GENTER BECOMING AMERICAN VIDEO PRODUCED BY WNET NEW YORK IRIS FILM AND VIDEO, 1983 LIVO, NORMA J AND DIA CHA FOLK STORIES OF THE HMONG PEOPLE OF LAOS, THAILAND, AND VIETNAM ENGLEWOOD, CO: LIBRARIES UNLIMITED, 1991 MACDOWELL, MARSHA (ED.) HMONG FOLK ARTS: A GUIDE FOR TEACHERS EAST LANSING, MI: MICHIGAN STATE UNIVERISITY, 1988 MAHER, JAN AND DOUGLAS SELWYN SOUTHEAST ASIAN AMERICANS TURMAN PUBLISHING, 1319 DEXTER AVE N SEATLE, WA, 1988 MCINNIS, KATHLEEN, HELEN PETRACCHI AND MEL MORGENBESSER THE HMONG IN AMERICA: PROVIDING ETHNIC-SENSITIVE HEALTH, EDUCATION, AND HUMAN SERVICES KENDALL HUNT PUBLISHING , 2460 KERPER BOULEVARD, P.O.BOX 539, DUBUQUE, IA: 1990 MOORE, DAVID L DARK SKY, DARK LAND; STORIES OF THE HMONG BOY SCOUTS OF TROOP 100 EDEN PRAIRIE, MN: TESSERA PUBLISHING, 9561 WOODRIDGE CIRLE, 1989 MOORE-HOWARD, PATRICIA THE HMONG – YESTERDAY AND TODAY SACRAMENTO, CA: 1987 MUECKE, M CARING FOR SOUTHEAST ASIAN REFUGEE PATIENTS IN THE USA AMERICAN JOURNAL OF PUBLIC HEALTH, 1983 NUMRICH, CHARLES H LIVING TAPESTRIES LIMA OH: FAIRWAY PRESS, 1985 OLSON, DAVID R ET AL.(EDS.) LITERACY, LANGUAGE, AND LEARNING LONDON: CAMBRIDGE, 1985 ONG, WALTER ORALITY AND LITERACY: THE TECHNOLOGIZING OF THE WORD LONDON: METHUEN, 1982 PODESCHI, RONALD AND VICTOR XIONG THE HMONG AND AMERICAN EDUCATION THE 1990’S EDUCATION POLICY AND COMMUNITIES STUDIES LOIS LEE, PO.BOX 413, MILWAUKEE, WI QUINCY, KEITH HMONG: HISTORY OF A PEOPLE CHENEY, WA: EASTERN WASHINGTON UNIVERSITY PRESS, 1988 WILLCOX, DON HMONG FOLKLIFE; A GENERAL OVERVIEW OF HMONG LIFE AND CULTURE P.O.BOX 1, PENLAND, NORTH CAROLINA, 1986 WILLIAMS, JAMES D AND GRACE C SINPPER LITERACY AND BILINGUALISM WHITE PLAINS: LONGMAN, 1990 WISCONSIN DHSS, DIVISION OF HEALTH, REFUGEE AND IMMIGRANT HEALTH PROGRAM SCREENING RECOMMENDATIONS FOR SOUTEAST ASIAN REFUGEES WISCONSIN EPIDEMIOLOGY BULLETIN, DEC 1990 PAOZE THAO, Ph.D KEV CAI SIV LUG MOOB ( FOUNDATION OF MONG LANGUAGE) CALIFORNIA STATE UNIVERSITY MONTEREY BAY, 1997  ... HMONG TRADITIONAL HEALERS Western health practitioners may wonder why they lack credibility with some of their Hmong clients Part of the reason is that differences between Western and Hmong health. .. some Hmong clients wonder if the American doctor or nurse is competent Hmong traditional healers provide health care to their patients in a completely different and unique way, and just as Western. .. Words in Hmong consist of monosyllables and not change their forms Hmong words not have suffixes so English morphology is difficult for Hmong speakers A) No –s ending in plurals e.g English: Hmong: