Vietnamese Cultural Health - Essay Example

Viet se Cultural Health History: In the middle of the '60s, half-million American troops and their allied troops were sent to South Vietnam in direct military intervention. From 5th of August 1964, they started bombarding North Vietnam. In spite of that, following president's Ho Chi Minh's teaching "Nothing is more precious than independent and freedom", the Vietnamese people bravely and firmly stood up and won numerous victories in the northern as well as southern part of the country. In 1973, Washington had to sign the Paris Agreement on the restoration of peace in Vietnam and the withdrawal of all American troops from Vietnam. In the spring of 1975, the patriotic armed forces of Vietnam swept across the country in the great general offensive and overthrew the Saigon government Southern part of Vietnam was liberated and the country was united as one. On 25th April 1976, the Democratic Republic of Vietnam was renamed into the Socialist Republic of Vietnam, which governs both northern and southern parts in its territory. In 1977, Vietnam became a member of the United Nations. The vast majority of the approximately 700,000 Vietnam-born persons living in the U.S. arrived here as refugees from 1975 to the present. While there are many shared cultural traits among all the Vietnamese-Americans, such as the Vietnamese language and strong emphasis on the extended family. The first group of refugees to come to the U.S. in 1975 was educated and urban professionals (and their families) who were airlifted directly from Saigon. They were closely associated with American interests in Vietnam, so many spoke English and were familiar with American culture. This group has for the most part gone on to resume their professional lives in the United States, including serving as staff members of social service agencies, which assist more recently arrived Vietnamese. In contrast, the second wave of Vietnamese refugees, arriving from the late 1970's through the mid 1980's, included a much higher proportion of merchants, farmers and other rural Vietnamese who escaped Communist Vietnam in small boats. These "boat people" suffered extreme hardship and loss through the refugee process, often remaining in harsh refugee camps for years. Many who came from rural origins or limited educational backgrounds have had a more difficult time adapting to urban U.S. life - while others from rural backgrounds found that intelligence and persistence are stronger than 100 generations of rural deprivation. This photograph is of a woman and children shortly after being picked up in the South China Sea in 1979. Finally, the third wave, continuing to arrive to the present, come to the U.S. under more "orderly" programs, typically on the basis of their statuses as political prisoners in Vietnam, or offspring of Vietnamese women and American fathers ("Amerasians"), two groups who faced serious discrimination in Vietnam. They come with their families, in the case of Amerasians, more often than not the father is unknown or otherwise out of the picture. Because of their experience as refugees, Vietnamese-Americans on the whole are at high risk for many communicable diseases like tuberculosis, hepatitis B and parasitism as they arrive to the U.S. Over time, as many face accessibility barriers to medical care because of such factors as limited English skills, transportation difficulties, and cultural misunderstandings, they are at risk for more chronic problems like hypertension, heart disease, cancer and diabetes. In addition, many Vietnamese refugees also suffer mental health problems like post-traumatic stress disorder (PTSD), a result not only of the horrors they experienced as refugees but also due to the adjustment difficulties in attempting to retain their traditional values in the face of the dominant American culture. Traditional Vietnamese perceptions of health Between 1975 and 1995, thousands of refugees left Vietnam to build their new life in the United States. The Vietnamese, with the Cambodians and Laotians, make up the largest group of refugees ever to immigrate to this country. Heart disease is the leading cause of death for all Americans and the second leading cause of death for the Vietnamese population. Vietnamese communities are focusing on local community action on creating heart disease prevention activities. Through the development and implementation of focused, culturally sensitive and language-appropriate heart health strategies, the development of heart disease risk factors is prevented in Vietnamese communities and help address the Healthy People 2010 goal of eliminating racial and ethnic disparities in heart disease risk. The Vietnamese needs assessment study: The Vietnamese community in Houston is comprised mostly of older people and youth. The participants in this study, however, varied greatly by age, gender, occupation, and socio economic status. A demographic description of the different target groups participating in the Vietnamese project in Houston is of the 25 community resident participants, 16 were male and 9 were female and 52 percent were 46 years and older. In general, the community residents sampled had high levels of educational attainment. 68 percent of the participants received at least 13 years of education, 75 percent of the males and 44 percent of the females interviewed received at least 13 years of education. Of the 25 community residents interviewed, 32 percent were employed as administrative support, staff, service industry, or sales and 32 percent were employed in professional/managerial or technical positions. Eight percent of those employed reported working more than two jobs. Interestingly, 36 percent reported being unemployed. The range of annual household income was $40,001 to $60,000. The average household size was 6.2 people. Of the 25 community residents, 96 percent reported that they spoke Vietnamese, and 4 percent speak Vietnamese and French. All of the community residents reported that they were born in Vietnam. Two of them are naturalized U.S. citizens. The resident's length of stay in the United States ranges from 1 to 26 years. The group described the heart as something beyond a "pump" in one's body and introduced the concepts of Tam (soul) and Tim (heart). Tam represents how the mind functions in interpersonal communication. Tim pumps the blood, provides nutrition and oxygen, and supports the body. The participants emphasized the importance of finding a balance in one's life and making the connections between Tam and Tim, explaining that they function together. In other words, having a "good soul, good values, and good morals" will enable one to be stronger mentally and physically. The community residents said the heart symbolizes the following: Love Respect Dedication to your family Soul Inner peace, mentality Happiness Perception of Health: A common saying in the Vietnamese culture is "Good health is golden." Many people believe that health is a blessing from God, something that must be cared for always. Being healthy generally means eating and sleeping well and may also mean living a happy life. Thus, one has to eat and sleep well, exercise, and take good care of his/her own health. Eating well and getting enough sleep leads to good health. In addition, health and religion go hand in hand. As a religious practice, people often meditate, practice yoga, or pray to maintain a healthy mind and body. Good health means living without pain and being emotionally stable. One must exercise to stay healthy; they said that exercise is considered "more of an image-related issue." In the Vietnamese community, people do not deliberately exercise when they are healthy because there are no apparent problems. Apart from improving one's physical appearance, the Vietnamese community views exercise as a way to restore good health, rather than to prevent disease. Prevention: There is a Vietnamese philosophy that "prevention is better than treatment." By prevention, they generally mean taking care of oneself through exercise, proper diet, and sufficient sleep. The notion of prevention relates to living a good life. There is a Vietnamese belief that "bad health or illness is a part of one's destiny". Many believe that illness foreshadows negative fortune or bad luck. Most Vietnamese people (in Vietnam and in the United States) do not want to admit that they are sick. Focus group participants added that in the United States an illness is often overlooked because people usually do not get regular checkups. Bad health or illness is caused by many different illness in the United States, compared with Vietnam, due to excessive use of chemicals in food production and preparation. Still others believe that there is a lesser rate of illness in the United States because of the abundance and affordability of food. Perceptions of High Blood Pressure: Community residents displayed limited knowledge of high blood pressure. They correctly identified the relationship between overweight and high blood pressure that people with higher body fat are more prone to high blood pressure, but they did not know that having high blood pressure could lead to stroke, heart attack, and kidney or eye problems. Because the Vietnamese tend to use more sodium-based sauces in their food, are not active everyday, and drink in excess, it is critical that heart health intervention programs address high blood pressure as a risk factor for heart disease. Before coming to the United States, the Vietnamese community was predominantly a refugee community where malnutrition and forced labor once was a way of life. After immigrating to the United States, problems adjusting to a Western lifestyle have become the community's highest priority. However, living a heart healthy lifestyle is not forgotten because cardiovascular health is a top concern for this community. As the Vietnamese population in the United States continues to grow, it is encouraging to know that the community is being supported, particularly on issues relating to refugee resettlement and adjustment. Programs to overcome language barriers, and to address transportation issues, financial planning, business development, and money management are available. These programs are ideal networks for beginning discussions about reaching the Vietnamese community to promote heart health activities. Traditional Vietnamese healing methods Spiritual (Thuoc Nam): The diagnosis of illness is frequently understood in three different kinds. The first, the least common, is what could be considered supernatural or spiritual, where illness can be brought on by a curse or sorcery, or nonobservance of a religious ethic. Traditional medical practitioners are common in Vietnamese culture. Some are specialists in the more magico-religious realm. These specialists may be called upon to exorcise a bad spirit, via chanting, a magical potion, or consultation from and recitation of ancient Chinese texts. Vietnamese commonly uses the use of amulets and other forms of spiritual protection. Babies and children commonly wear bua, an amulet of cloth containing a Buddhist verse or are blessed by a monk, worn on a string around the wrist or neck. Vietnamese traditionally do not have a concept of mental illness as discrete from somatic illness, and hence are very unlikely to utilize Western-based psychological and psychiatric services. Instead, most mental health issues such as depression or anxiety fall into this spiritual health realm and is treated accordingly. Balance (Thuoc Bac): Secondly, a very widespread belief is that the "Universe is composed of opposing elements held in balance". Consequently, health is a state of balance between these forces, known as "Am" and "Duong" in Vietnamese, based on the more familiar concepts of "yin"and "yang" in China. Specific to health, these forces are frequently translated as "hot" and "cold"" although it is important to understand that these concepts are not necessarily referring to temperature. Illness results when there is an imbalance of these "vital" forces. The imbalance can be a result of physiological state, such as pregnancy or fatigue, or it can be brought on by extrinsic factors like diet or over-exposure to "wind", one of the body forces or "humors". Balance can be restored by a number of means, including diet changes to compensate for the excess of "hot" or "cold", western medicines and injections, and traditional medicines, herbs and medical practices. These practices and medications include: Coining (Cao gio). "Catch the wind". A coin dipped in mentholated oil is vigorously rubbed across the skin in a prescribed manner, causing a mild dermabrasion. This practice is believed to release the excess force "wind" from the body and hence restore balance. Cupping (Giac). A series of small, heated glasses are placed on the skin, forming a suction that leaves a red circular mark, drawing out the bad force. Pinching (Bat gio). Similar to coining and cupping, the dermabrasion formed by pinching the skin allows the force to leave the body. Many of these practices are performed on young children, even infants, and the temporary dermabrasions they produce should not be confused with abuse or injury. Steaming (Xong). A mixture of medicinal herbs is boiled, the steam is inhaled, and the body bathed. Balm. Various medicated oils or balms, like Tiger balm, are rubbed over the skin. Acupuncture. Specialized practitioners insert thin steel needles into specific locations known as vital-energy points. Each of these points has specific therapeutic effects on the corresponding organs. Acupressure or Massage. Fingers are pressed at the same points as with acupuncture, and together with massage, stimulate these points to maximize their therapeutic effects. Herbs. Various medicinal herbs are boiled in water in specific proportions or mixed with "wine" and consumed, for example, in the postpartum, to restore balance. Patent Medicines. These powdered medicines come packaged usually from Thailand or China and are mixed or boiled with water and taken for prescribed ailments. Western (Thuoc Tay): Thirdly, most Vietnamese-Americans also recognize the more "western" concepts of disease causation, like the germ theory. There is widespread understanding, that disease can come from contaminants in the environment, even if full concepts of microbiology or virology are not grasped. Concomitantly, through decades of French occupation and more recently the American influence, even the most rural Vietnamese has come to know the life-saving power of antibiotics. Vietnamese frequently discontinue medicines after their symptoms disappear. Hence preventive, long-term medications like anti-hypertensives must be prescribed with culturally sensitive education. It is quite common for Vietnamese patients to amass large quantities of half-used prescription drugs, even antibiotics, many of which are shared with friends and even make their way back to family in Vietnam. Western medicines, especially oral medications, are held in general to be "hot" medicines, in their effect on the balance of the body. When medicines are prescribed for a condition like skin irritation, which is understood traditionally as a hot illness, the excess force erupting through the skin, a compliance issue may result. In this case, alternatives like a balm or poultice may better meet the patient's understanding of balance. Similarly, Vietnamese commonly believe that Western pharmaceuticals are developed for Americans and Europeans, and hence dosages are too strong for more slightly built Vietnamese, resulting in self-adjustment of dosages. Commonly, laboratory procedures involving the drawing of blood are feared and even resisted by Vietnamese, who believe the blood loss will make them sicker and that the body cannot replace what was lost. Surgery is particularly feared for this reason. Overall, as health is believed to be a function of balance, surgery would be considered an option only of last resort, as the removal of an organ would irreparably alter the internal balance. Vietnamese view health and illness from a variety of different perspectives. It is not uncommon for a sick person to interpret their illness as an interaction of spiritual factors, internal balance inequities, and even an infective process. Accordingly, Vietnamese will combine diagnostic and treatment elements from all three models in order to get the maximum health benefits. This broad perspective suggests an understanding of mind-body interactions and predisposing factors to illness that Western medicine is only beginning to fully appreciate. Vietnamese identifies with home self-care and traditional remedies as the most common initial treatments for illness. People usually first visit alternative medicine caregivers (herbalists, massage therapists, and acupuncturists) or purchase over-the-counter medications. Coining, tubing, steam baths, and medicinal herbs are common home remedies. Many people also carry an ointment, which serves as an antibiotic for "bad wind." In addition to alternative care, spiritual support from churches and temples, meditation, vegetarian diet, and Tai Chi are other practices that are routinely used to maintain health and well-being. Western medicine is considered only when one desires immediate recovery, or when traditional care does not alleviate the problem. At this point, only about half of the people utilize Western medicine. The group agreed, however, that because the United States has more treatment methods and medical equipment than Vietnam, Western medicine might provide a more accurate diagnosis of illness. Health Risks in Refugees: Cardiovascular disease Hypertension Diabetes Parasites (roundworm, hookworm, filaria, flukes, amoebae, giardia) Malaria HIV Hansen's disease PTSD Nutritional deficits Views on death: The Vietnamese attach great importance to two traditional family obligations to care for their parents in their old age and to mourn them in death. These duties are felt so strongly, they are considered sacred. The traditional time of mourning for parents is three years. Mourning begins even before death is imminent. When death is about to take place, the entire family assembles around the dying relative. A strict silence is observed. The eldest son or daughter bends close to record the last words of advice or counsel. At this time, the eldest child suggests a name for the dying person for it is considered unfortunate to continue the same name used in life after the relative has died. Men usually take the name "Trung" which means faithfulness or "True" which means loyalty. Women are usually called "Trinh" which means devotion or "Thuan" which means harmony. Saigon (MF) According to ritual, when the parent has died, the children do not, as yet, accept the idea of death. They place a chopstick between the teeth of the deceased and place the body on a mat on the floor in an effort to "bring it back to life". The next rite in this tradition is for the eldest son or daughter to take a shirt the deceased has worn in life and to wave it in the air and call upon the soul of the dead to return to the body. After this rite has been completed, the descendants then perform the ceremonial cleansing of the body. The corpse is bathed which symbolizes washing off the dust of the terrestrial world, hair is combed and nails clipped. Money, gold and rice are placed in the mouth of the dead to indicate that the deceased has left this world without want or hunger. The corpse is then wrapped in white cloth and placed in a coffin. Members of the family form an honor guard around the clock until a propitious time for burial is selected. A funeral procession During the period of mourning, descendants wear special mourning clothing. These garments are made of crepe of ample cut with a seam in the middle of the back. All are required to cover their heads. In times gone by when Confucianism was still a dominant influence in life, mourning the dead was considered more important than the affairs of the living. A mandarin had to resign his position and retire to his home. He was expected to erect a tomb where the parent was buried and there conduct memorial ceremonies. Mourners could not marry, comb their hair or have a haircut. They were not permitted to eat good food or enjoy any form of entertainment whatsoever. However, now the severity of the mourning period has been abolished to a large extent. After the funeral the descendants return to work and are no longer required to interrupt their business affairs. Clothing for the mourning period has been modified to only a piece of black cloth worn around the arm, lapel or the head. Wedding ceremonies during the mourning period are still banned, but if the families have already approved of the engagement, special dispensation may be obtained through the proper rural or urban authorities. The Vietnamese writer Le Van Sieu explained the importance of traditional funeral ceremonies by saying "Funeral rites represent a traditional way of life to the Vietnamese people which are based on the concept of the indestructible soul and the close relationship between members of the same blood-line". 2000 U.S. Census State Population Data states that Vietnamese Population United States of America is 1,122,528.The estimated number 13.1 million of U.S. residents who say they are Asian or Asian in combination with one or more other races. This group comprises 5 percent of the total population. Since Census 2000, the number of people who are part of this group has increased 9 percent, the highest growth rate of any race group. The bar graph above shows how survey responders rate their own health and the health of their family members. After age-adjustment, 17.2% of Vietnamese responders considered their health "fair" or "poor" compared to only 9.2% of the API population as a whole and 8.9% of the non-Hispanic white population. Less Vietnamese considered their health "excellent" or "very good" (22.7% and 25.1%, respectively) compared to the API population (34.5% and 29.7%) and the white population References: Crozier, R (1968) Traditional Medicine in Modern China: Science. Nationalism, and the Tension of Cultural Change. Cambridge: Harvard University Press. http://www3.baylor.edu/Charles_Kemp/vietnamese_health.html http://www.nhlbi.nih.gov/health/prof/heart/other/vietnamese.pdf. http://www.asiarecipe.com/images/vietnamese%20funeral.jpg http:/www.asiarecipe.com/vietfuneral.html http://www.census.gov/Press-release/www/releases/archives/hispanic_origin_population/001130.html Kuo, J., and Porter, K (1997) Health Status of Asian Americans: United States, 1992-94. Advance data from vital and health statistics; no.298. Hyattsville , MD : National Center for Health Statistics. Scott, J.(1986) Vietnamese Healing. Connecticut: Yale Southeast Asia Studies. The Healthy People 2010 report. The NHLBI Health Information Center is a service of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Web: http://www.nhlbi.nih.gov Thuy, V (1980) Getting to Know the Vietnamese and Their culture. New York Frederick Ungar Publishing Company. Tran, M T. (1978) Health and Disease: The Indo-Chinese Perspective in Working with Indo-Chinese Refugees. Chicago: Travelers d. Read More