Citation:
Date Presented:
February 7, 2013Abstract:
This thesis springs from the question, how do Hmong-American young adults make healthcare decisions? Although most Hmong-American young adults have grown up in the US, their parents—first-generation refugees from the Vietnam War—grew up in the mountains of Laos without access to biomedical care. Instead, they obtained care for illness and disease from shamans, magical healers, and herbalists. While this thesis’s central question could be framed in terms of the degree to which the Hmong have acculturated, the synthesis of interviewees’ compelling statements leads this thesis to challenge the concept of acculturation and the concept of culture itself, especially in the context of cultural competency programs. This work draws upon two months of ethnographic data collection, demographic and acculturation survey (SL-ASIA) data, and sixty-six in-depth interviews of Hmong-American patients, family members, physicians, interpreters, shamans, and herbalists in Hmong-American communities in St. Paul, Minnesota. One principal finding is that the traditions and past experiences of the Hmong who came as first-generation refugees have a modest to strong influence on the perspectives and decisions of the second generation. Another principal finding is that Hmong-American young adults integrate and adapt distinct spiritual and physical views and practices to accord with their local moral worlds. I argue that this thoughtful and creative process is far better understood as adaptation than as acculturation. Similarly, the concept of the local moral world promotes understanding of Hmong-American young adults’ decision-making processes better than does the concept of culture. Building from recommendations provided elsewhere, this thesis concludes by outlining and recommending a clinical approach that is deeply patient-centered and that applies for all types of patients, not just those singled out as embodying culture.