Spirit Lifts Us
As a cultural anthropologist, this author has become very familiar with the Lao Hmong. They are a very small minority southeast Asian minority group that has lived in the United States since the close of the Vietnam War. They immigrated to the United States from northern Laos. They also live in China, Burma and Thailand. However, the Hmong in the United States come primarily from Laos. In that country, they were self-sufficient on farms where they had a very labor intensive lifestyle.
They encountered American culture first during their involvement in the Vietnam War. Throughout the 1960s, the American Central Intelligence Agency recruited the Hmong and trained and armed their soldiers to help patrol the Ho Chi Min Trail and to prevent North Vietnamese incursions into Laos and South Vietnam in the areas that the Hmong lived in. Their American protection came to an abrupt end at the conclusion of the war in 1975. This left the Hmong people at the mercy of retribution from the Vietnamese and the now communist Pathet Lao central government who sought revenge for suffering caused by the American led Vietnam War (Fadden 124-9).
This situation became very desperate for the Hmong. Hundreds of thousands of them crossed the Laotian border into Thailand to escape this persecution. Of course, many died during this exodus. After their arrival in Thailand, they settled down in very large refugee camps where they began learning new languages and about Western society, in particular in the United States. By the 1980s, the United States had given them preferential refugee status. This prompted a sizable amount to immigrate to the United States. Their population is growing in the United States (ibid 5).
The Hmong have their own language, although it exhibits many dialects. The main dialects which most of the United States Hmong speak is called red or green. To complicate matters, the Hmong language did not exist in written form until the late 1960’s. It has very few medical terms. To deal with this, the Hmong (especially the older ones) speak in metaphors about medical issues. For this reason and to interpret the language, non-Hmong need some knowledge of the Hmong culture to understand what the Hmong are saying.
The Hmong have a very structured culture of clans. Much is determined by ancestral lineage and which traditional ceremonies are practiced. If two different families practice the same ceremony, they are probably descended from the same ancestor. Hmong families tend to be large and extended. This large family, extensions and all is considered to be one whole. Each of the clans has a leader who is usually the father. The mother has less respect. However, in the living arrangements that the Hmong are finding themselves in now, mothers are making more and more leadership decisions. This is especially so in younger Hmong families (ibid 227).
The elderly among the Hmong are the most respected members of the family. These elderly Hmong are consulted when decisions need to be made. They make discipline decisions with regard to younger children. The elderly stay with the families their entire lives. Primary clan decisions are made by the shamans or other clan leaders. In any case, the other shaman will help the clan leader make decisions. The Hmong have a number of religious beliefs that are native to their land. In addition, a large number have decided to become Christians.
Amongst the older Hmong (30 years of age or older), many have long-term effects from United States delivered chemicals such as “yellow rain” or other poisons or problems with internal parasitic worms and other diseases including tuberculosis, anemia, depression or some post traumatic stress syndrome (ibid 133). They have only been exposed to western medicine for the last few decades. Traditional Hmong see illness from a holistic perspective and perfect health is achieved by balancing the body and the spirit. These older Hmong may wee the causes as being spiritual, to include evil spirits or as they call them, dabs (ibid 4).
An ancestor may be unhappy. They may require animal sacrifices to appease them. In other words someone may have done something to offend the family’s spirits or ancestors who may have cursed the family (ibid 96). Preventative treatment of disease was unknown in the old country and the older Hmong treat illness when it comes. The Hmong have traditional treatment types such as acupuncture. Many times they will not allow antibiotics because of the belief that it is not good to bring foreign material into the body (ibid 34). Surgery is rarely acceptable unless laboratory or other tests identify it. Immunization is not acceptable due to the idea that it is not good to put something in the body. Herbal medicine is widely practiced. Given the lack of verbal language and the description of disease in traditional Hmong descriptions, the BaFa game is helpful (ibid 271).
We will be discussing here between a particular encounter between a Hmong family and medical officials here in Merced as an example. The Lee’s had a daughter with epileptic seizures. Due to their lack of English, they had trouble communicating with the doctors. As their daughter’s condition worsened, they began to doubt the effectiveness of the treatment that their daughter was receiving, especially since Lia Lee has become brain damaged due to her illnesses. Their trip to the county hospital medical emergency room in Merced caused the chain of events that led to a cultural confrontation. The unfortunate illnesses, caused by the lack of communication between the parents and the medical officials caused the foster placement of Lia, causing great pain to the parents. The child’s treatment regimen caused a cultural clash with the family’s traditional beliefs about epilepsy. In their belief system, only the Shaman can deliver their child (ibid 93).
Unlike European immigrants who came to the United States to assimilate and become a part of American culture, the Hmong left Laos to escape the destruction of their culture and the decimation of it at the hand of the other Laos peoples and the Vietnamese.
The account of the Lees is one of the more extreme cases of course but not unique. How many times has the public heard of deeply religious individuals such as Jehovah’s witnesses who refuse life saving blood transfusions. Such families are insular (ibid 80). The Hmong have their cultural issues like many other American families. They also have their share of conformists with the outside majority culture. Many of the younger Hmong accept the dictates of Western medicine as a matter of course, including modern views on birth control. The story of Mrs. Lee having 12 children by herself in Laos is not known here amongst the younger Hmong families with no immediate knowledge of Laos physically and whose cultural and other ties to the old country are tenuous.
While we can be empathetic with the Lees and can take into consideration their cultural wishes, there is a limit to this. There has to be a middle ground between cultural understanding and the saving of human life. Since the child is brain damaged and her ability to reach certain milestones in life are limited as a developmentally challenged patient, the medical community needs to be patient with the family. We know that Lia is a favorite child and is receiving the best and most loving care from the family. However, when it comes to the immediate threats to the child’s life and health, there is only a certain amount that can be tolerated (ibid 55, 90, 110).
However, we can treat many of the medical issues that children and adults such as Lia have in a more holistic fashion, especially since many types of Oriental medicine such as acupuncture have now become widely accepted in Western medicine (ibid 34). We know that we do not know everything in the West. However, many aspects of the Hmong are also just coming out of the Middle Ages and there is only so much that can be tolerated and there must be a demand for a middle ground in the way that western medicine and culture deals with medical issues when the science and the treatment regimen is clear. For instance, Sudden Unexpected Death Syndrome needs to be studied (ibid 188n).
As stated in the book, “Although the Hmong believe that illness can be caused by a variety of sources – […] by far the most common cause of illness is soul loss” (ibid 10). To bring these souls back into the body and to bring bodily health, soul calling ceremonies are seen to be important to the Hmong. There is no reason that such cultural flourishes can be tolerated and incorporated into the treatment regimen. After all, in any hospital, we tolerate and encourage pastors of Christian religions to come in and minister to their patients and pray. Should we be so intolerant when the Hmong bring their shamans into the medical treatment facilities. In the present day, we know so much about psychosomatic causes of illnesses. If such traditional ceremonies bring peace and joy to the practitioners, they may be willing to give ground and compromise on some certain other issues.
Fadiman, . The Spirit Catches You and You Fall Down. New York: Ferrar, Straus Giroux,