Southeast Asian - Vietnamese, Camobodian, Laotian

The Southeast Asian population is heterogeneous, comprising of people from a large diverse cultural background including Vietnam, Cambodia, and Laos. Refugees from these three countries differ in religious belief, language, and certain cultural practices and traditions. Laotian refugees are themselves diverse, with three main ethnic groups: lowlanders, or "Lao Lum"; highlanders, or "Lao Theung"; and the mountain people, or "Hmong." The Hmong are often viewed as quite distinct from other Southeast Asians because they have strongly animistic beliefs and what many consider a "primitive" culture. Despite the differences among refugees from Laos, Vietnam, and Cambodia, they do share many interpersonal behaviors, health beliefs and practices, and perceptions of Western medical care.

Cultural values. According to Southeast Asian culture, the head is a sacred part of the body; casually touching or patting the head may actually be considered offensive. When examining the fontanelle of a Cambodian infant, therefore, you would want to proceed slowly and deliberately, explaining to the parent what you are doing. In contrast, the feet are considered the lowliest part of the body, and pointing them at another individual is perceived as insulting. As much as possible, it is important to remember this and adjust body posture accordingly when sitting and interviewing parents.

A Southeast Asian tries to avoid direct eye contact with a "superior" (such as a physician); averting one's gaze is a sign of respect. Therefore, parents may not be directly looking at the physician who is speaking even though they are indeed listening. Finally, many Southeast Asian parents, particularly the Hmong, believe it is bad luck to admire a baby excessively because "spirits" may hear the praise and come to take the baby away.

Traditional values include a strong family identity, respect for ancestors and the past, and a desire for smooth interpersonal relationships. The roles of both males and females are respected.

Health-related belief systems. A person is thought to fall ill because of metaphysical, naturalistic, or supernatural causes. Metaphysical causes of illness include any disruption in balance or harmony of the person or his surroundings. This imbalance is described in terms of "hot or cold" (which has nothing to do with the actual temperature of the food). Foods or experiences that are "hot" are considered energizing, while those that are "cold" are perceived as calming. Examples of hot illnesses are fever and joint pain, while cold illnesses include dysmenorrhea and diarrhea. If a child becomes ill with diarrhea, for instance, the parent presumes that he or she is imbalanced, with too much "cold" in the body.

Many Southeast Asians believe that illness can be caused by a shift in the balance of natural "forces" or "winds." At times, this description refers to actual changes in weather, such as heavy rains or high winds. Other times, the concept is more nebulous, relating to changes in energy flow in the environment. Southeast Asians believe that, at certain times, a person is more vulnerable to having these "winds" enter the body (such as during surgery or in the neonatal period). For this reason, many Southeast Asian parents heavily swaddle their babies when the weather is very hot to protect them from natural forces. Illnesses commonly thought to be caused by "winds" are rheumatism, headache, and respiratory diseases.

Many Southeast Asians, especially the Hmong, think that supernatural forces are important causes of disease. A person's spirit is considered the guardian of his or her well being. This spiritual harmony can be disrupted if a person suffers a great fright, experiences extreme grief, is the recipient of unkindly words, or fails to pay proper homage to ancestors. A disruption in spiritual harmony is believed to cause illness. In addition, because many Southeast Asians, including the Hmong, believe that malicious spirits can enter the body and cause harm, they take many measures to protect themselves and their children. To guard against loss of soul or evil spirits, many Hmong parents tie white yarn around the wrist of a newborn baby or a sick person. Older children may wear copper or silver bracelets, necklaces, or anklets to "lock" the soul and prevent it from leaving the child.

Traditional remedies. Many Southeast Asians try folk medicine before seeking Western medical care. However, they rarely volunteer that they have been using such traditional remedies (either because they do not want to show disrespect or because they fear meeting disapproval).

Illnesses with a metaphysical cause are treated by the principal of opposition: hot illnesses are treated with cold foods, such as fruits and vegetables, whereas cold illnesses are treated with hot foods, such as meats, wine, and foods that are spicy, greasy, or salty.

Physical treatments such as rubbing the skin with eggs or coins (cao gio, or "coining"), pinching the skin, or applying warm cups ("cupping") to the skin are often used to treat illnesses caused by winds. It is believed that these treatments "draw the bad wind to the surface" so that it can be eliminated. In cao gio, for example, a balm or ointment, such as eucalyptus balm, is spread over the chest or back; a coin is then pressed on the skin and drawn a short distance in one direction without breaking the skin. This procedure is repeated several times until blood appears under the skin.

Many Southeast Asians grow their own herbs to use during times of illness. Herbs are used to treat virtually all physical ailments. Many communities have "medicine men" (or women) who dispense herbs, teas, and other compounds. Most of these substances are either innocuous or, possibly, helpful. However, "pay-loo-ah" is a powder that contains lead and when used to treat a variety of ailments such as headache, muscle ache, and abdominal pain, can lead to lead poisoning.

Many Southeast Asians, especially Hmong, turn to spiritual healers to cure illnesses thought to be caused by an offense to the patient's spirit. Traditional spiritual healers, known as shamans, perform ceremonies at which they call to the spirits of ancestors or to those of sick people. Hmong families offer sacrifices to evil spirits in exchange for the soul of an ill relative. They offer food, money, and even live animals, such as cows, goats, pigs, ducks, and chickens.

Beliefs about Western medicine. Many Southeast Asian refugees, especially the Hmong, were not exposed to Western medicine before arriving in the US; they are often reluctant to seek medical care and do so only after exhausting traditional remedies.