Hmong

Background   Family Structure / Relationships   Language   Health Beliefs

Health Issues / Medication   Grandparents Raising Grandchildren   Etiquette When Working With Elders

Background
In the late 1970’s, the Hmong refugees fled to Thailand as a result of the American War (Vietnam War). These refugees settled in refugee camps in Thailand and were later given the opportunity to relocate to the United States of America.

Since the transition to the United States, the Hmong communities have developed and implemented programs to meet the needs of Hmong families. The focus of these programs consists of ways to strengthen family dynamics by implementing educational, employment, and violence prevention programs. Although these focuses were helpful to the families as they integrated and adapted into their new lives in this country, services for the Hmong Elders were nonexistent. The elders were isolated and often forgotten due to academic, cultural, and other socioeconomic changes. The present communities are implementing programs to enable Hmong elders to meet their needs and to provide access to translation and interpretation services and assistance in completing applications for programs and benefits. The Hmong communities and service providers understand that Hmong elders wish to hold on to their traditions and the comfort of their roots. These elders value the family structure and traditional healing rites. Some challenges that the elders encounter include isolation and community changes that directly impact their lives.

Family Structure / Relationships
Hmong elders encountered dramatic changes when they arrived to the United States. These changes reflect their way of life and their role within the community. Due to language barriers, it has been difficult for these elders to fully understand the mainstream society, therefore making them feel isolated.

Elders in the Hmong community are leaders. They teach traditional rituals and oral history and mediate among members within the community. Family and clan members are valued within the Hmong community system. Following their arrival to this country, the roles of the Hmong elders changed significantly. Their ability to discipline their grandchildren and teach their cultural practices was no longer effective.

The most important biological and social structure in the Hmong community is the Hmong kinship, defined by blood relationship. When a person is born into a clan, he remains with that clan for life. This clan is known as “kwv tij.” Members of a clan are expected to provide social, legal, and economic support for all members. The blood relative is identified by the surname of the person. The Hmong classifies marital relationships as the marriage among clan members, which form a new relationship within their clan known as “neeg tsa.” The Hmong clan is important because it acts as the nucleus and decision making body within the community.

The clan functions are vital to the Hmong community and especially to the elders who hold key leadership positions in mediating disputes within families and among clan members. Elders are in favor of the clan system because of the important role they play in making certain decisions about health issues, social gatherings, and death. Another reason why the clan system is crucial to the elders is that it provides the basic social and political support structures with which they are familiar.

Hmong elders honor traditional family values; therefore, they expect their children, especially their daughters-in-law, to be the primary caregivers. Long-term care facilities are of concern to elders. Many elders openly state that they do not want to move to a nursing home or other long-term care facility. These elders would prefer to have their children care for them at home.

Today, Hmong families continue to care for their elders. In fact, about 95% of Hmong elders live with their children, while the remaining 5% live on their own. Hmong elders living independently expect their children to follow the traditional value when they do require care.

Hmong elders also expect their children to follow traditions when planning their funeral proceedings. Funerals are elaborate and consist of three full days of cultural rites and rituals. One such ritual involves guiding the soul into the world of the ancestors. Showing respect for the deceased is an important component of the funeral. This respect is demonstrated by giving gifts to the deceased. These gifts consist of money, animals, or anything that the deceased may need in the after life.

Language
Today, the primary language spoken in a Hmong household in the United States is English. Many children today cannot speak Hmong fluently. This creates a communication problem between the elders and their grandchildren. Hmong elders often stay at home to provide childcare for their grandchildren. This inability to communicate with their grandchildren results in feelings of isolation and depression among elders. Elders will attempt to communicate with their grandchildren by using nonverbal expressions and gestures. They also teach their grandchildren simple Hmong words; likewise, the grandchildren use English words such as “hi”, “no”, “yes”, “please”, and “thank you” to teach their grandparents English.

Hmong elders depend on their children to help them access benefits and complete necessary paperwork. It can be difficult for the elders to receive benefits because their children are often busy and communication with their grandchildren is limited. Many elders feel isolated and often lonely because they feel as though no one understands them or can have a meaningful conversation with them. They often express this isolation as “kho siab” which means loneliness of the heart. Many elders rely on Hmong social service providers to help them access social activities with other elders.

Elders express their emotions very differently, depending on the situation. Women tend to be social and openly discuss domestic matters. Men, on the other hand, do not discuss personal matters. They focus their discussions on traditional rituals, disputes among clan members, and concerns within the Hmong community. Hmong men tend to be more reserved, withhold their emotions, and appear to be more in control than women.

Health Beliefs
Hmong elders believe that an individual’s fate is predetermined. For example, how long he will live, what illnesses he will have, and how his live is shaped are determined at birth. Therefore, when an elder becomes sick, he does not seek out modern medicine or go to the hospital as a first option. Elders believed that only a spiritual healer can help them by conducting a ritual to satisfy the spirits.

When a Hmong elder is critically ill and unable to get out of bed, he will seek traditional healing because he believes that an evil or bad spirit caused the illness. When an illness is not curable, it is believed that it is the individual’s fate to have contracted the illness. Most elders believe in traditional healing such as herbal, shamanistic (txiv neeb), and black magic (khawv koob).

Hmong elders usually live with one of their sons and daughters-in-law; usually the youngest son. In the Hmong culture, it is expected that the son will seek out traditional healing rituals for the elder. These healings consist of a combination of herbal medicine and spiritual healing. Spiritual healing consists of obtaining the proper shaman with the ability to heal the illness. Either the son or a clan member determines the proper shaman by a ritual called “khaws qe” (stacking two eggs) or “tsawv neeb” (selecting). In this ritual, the individual will try to summon a shaman (txiv neeb) by (khaws qe) stacking two eggs on top of each other in a small bowl with rice and lighting incense (xyab). The individual summoned to carry out the ritual proceeds to call each shaman’s name. When he lets go of the eggs and they still stack on top of each other, then that shaman will be the one to cure the illness. The son will contact the shaman to perform the healing. The shaman in turn will tell the individual what he needs to do as part of the healing process.

If all of the traditional healing is performed and the elder continues to be ill, the family will then consider modern medicine. It is very important to understand that if any elder seeks these modern alternatives, this does not mean that the traditional medicine failed. After the elder has recovered from the illness, the family will hold a ceremony called “hu plig” (calling the spirit) to bless the elder.

Health Issues/ Medication
Health, nutrition, and medication have become important issues among Hmong elders. Hmong service providers and health professionals are concerned about the elders’ health and misuse of prescribed medications. Two primary diseases from which Hmong elders suffer include hypertension and diabetes. Elders do not understand that these diseases are often influenced by lifestyle choices including nutrition and exercise. The following are some examples of ways in which elders mismanage their medications:

When it comes to medication, elders expect to be healed right away. The elders would explain that they would take the medication and if their blood sugar is lower they would stop taking the medication because they believe that they were cured. Others explained that they would break a pill in half because they have difficulty swallowing it and would take the other half before their bed time. Some expressed that they shared their medicines with other elders, who have the same symptoms as they do.

Most elders believed that herbal medicine is better than a pill because they know all the contents of the brew and no one knows what is in the pill and it could even be poisonous.

Most of the elders stressed that these two diseases are cause by the additives and fertilizers in this country because back in Laos no one has ever had hypertension or diabetes.

These are only some of the major themes that Hmong elders discuss about health related issues. These elders are concerned with these health issues in particular, because they believe that no one has a cure for them.

Grandparents Raising Grandchildren
One trend that has dramatically impacted the lives of some Hmong elders is raising their grandchildren. This is a new role for them. Many of them have previously helped with childcare responsibilities, but some Hmong grandparents are parenting their grandchildren because of the absence of the parent in the home. These situations cause stress for the elders who must now raise their grandchildren in a new country with little or no knowledge of the language, laws, school system, or culture. Furthermore, they do not know how to access support or help in navigating these complex systems.

Etiquette when working with Hmong Elders – adapted from Hmong Cultural Center

• Traditionally, direct eye contact within the Hmong culture is considered to be rude and inappropriate. Therefore, when talking to a Hmong elder, one must understand that lack of eye contact is actually a sign of respect.
• In the Hmong culture, the head is the most sacred part of the body. Thus, most Hmong elders will not allow a stranger to touch their head.  
• The handshake is a new concept to a traditional Hmong person, especially among women. Many Hmong women will become embarrassed when shaking the hand of a male. Thus, handshakes are deemed not necessary and rarely occur. Greet a Hmong person verbally and avoid offering a handshake.  
• Displaying a smile is indicative of a warm welcome and is a sign of friendship in the Hmong culture. On the other hand, laughing or making rough comments in the presence of a Hmong person may be considered to be a sign of insincerity and rudeness.
• When entering the home of a Hmong person, it is courteous to ask not only for permission, but also if it is spiritually well for one to enter (nej puas caiv os). Upon arrival, the guest will be offered a seat or chair. It the visitor declines to sit on the family's furniture, it may be assumed that he believes the furniture to be messy or contagious with disease or that he considers himself to be of a higher status.  
• Most traditional Hmong men assume an adult surname once they are married and following the birth of their first child. This is a sign of maturity and status. After the naming, it is believed that the recipient will be blessed with good fortune. Most Hmong men prefer to be called by their adult name. It is common for Hmong men and women to have the same names.
• Hmong people are humble in nature. They typically avoid expressing their true emotions in front of others. Often they will say: "maybe" or "I will try" instead of giving a definite positive or negative reply. Sometimes they might say "okay" or "yes" which actually means "no", when they feel pressured. When talking to less assimilated Hmong persons, always repeat questions and allow them some time to think and process before they respond.
• When it comes to decision making, it might take a Hmong person a while to come up with a response to a particular situation. Usually the father or leading male figure in any given household makes most of the decisions for the family. Sometimes, the decision making process may even involve immediate as well as extended relatives including uncles, cousins, or even clan leaders. Before making a decision, most Hmong elders like to receive several opinions. This is because they do not want to be held solely accountable for what might turn out to be a wrong decision.
• When dealing with a Hmong family, confidentiality is considered to be very important. However, within the family itself, confidentiality may not be thought of as being very important. Family members openly share their experiences and seek support from one another.
• When a Hmong person offers you a drink one should not simply decline it, as this is considered to be impolite or rude. In an effort not to offend the host, accept the drink. It is acceptable to hold it for awhile before placing it back on the table or a nearby surface. The same goes for offered gifts. Refrain from quickly saying "no". Explain why the gifts cannot be accepted at a later time.
• When entering a Hmong home during mealtime, guests will be invited to join the family at the table. Whether the guest wants to eat or not, he should take part in the meal. He does not have to eat much; taking just a bite or two will make the family happy. Otherwise, the family will stop eating and will talk to the guest until he has left.
• It is considered quite embarrassing and rude when outsiders assumingly label the members of a Hmong family as man or wife. If one does not know the family or the relationships between family members, one should ask.
• Most traditional Hmong families do not enjoy hearing direct comments about their children, especially infants and babies. A comment such as "your child is so cute" is not looked upon favorably. Hmong believe that if a bad spirit hears such comments, it might come and take the child's soul away.
• There are many unusual physical marks which might be found on the body of a Hmong person. These are commonly a result of a home remedial treatment for traditional healing and health problems such as colds and headaches. These marks may involve bruises or redness from cupping, spooning, or coining on the neck, shoulder, back, chest, forearms, and forehead. Hmong elders may also wear unusual accessories such as red necklaces made from silver and brass, white cloths around their wrists, red or white strings on their wrists, necks, or ankles. These accessories are worn for health and religious purposes.