State Services for the Blind

Minnesota State Services for the Blind

KEY POINTS TO REMEMBER WHEN INTERVIEWING A HMONG CUSTOMER

In Hmong culture it is often considered rude to “get straight to business.” It is best to begin an interaction with inquiries about family members or other pleasantries before asking direct questions.
Hmong people do not appreciate long waits, short visits or difficulties in getting appointments with service providers.
It is essential to provide quality translation services if necessary.
Prolonged or direct/sustained eye contact is considered an invasion of privacy or a sign of disrespect
Women typically do not shake hands with men, and younger people do not shake hands with an elder. It is acceptable for a Hmong woman and a non-Hmong man to shake hands.
In general, direct physical contact (particularly between men and women) should be avoided as it is seen as disrespectful.
Touching the head is often considered threatening or offensive by many Hmong people because of the spiritual belief that the head is the most sacred part of the body.
Waving arms to elicit attention and pointing or beckoning with an index finger are considered to be signs of contempt to adults and threatening to children.
Putting one or both hands in the pockets or on the hips while talking is considered arrogant and shows a lack of respect.
In a first meeting, refrain from asking personal questions of the person too quickly, but be prepared for people to ask personal questions of you.
Removing one’s shoes before entering a house is considered appropriate for many Hmong. If you are unsure about this, ASK!
Hospitality and generosity is highly valued.
1. Expect to be offered food or drinks, and partake of the hospitality.
2. The sharing of small gifts is a common way of showing appreciation.
During an interview, it is important to get the point across. Avoid questions that need simple YES or NO answers.

Yes can mean, “Yes, I respect that you asked a question”, not yes to the content of the question.
No is considered disrespectful so the individual will often give a No answer by saying yes. For example: “Are you going to go on the job interview?” The answer might be: “Yes, I will not go to the job interview.”
Reframe the questions and give the person a way to answer without having to say Yes or No.

HMONG IMMIGRANTS IN MINNESOTA

Geographic Distribution and Population Estimates:

According to information available from the Minnesota State Demographic Center published in June of 2004, the estimated immigrant population of Hmong in Minnesota is 60,000.
St. Paul is the home of more than half of all Hmong in Minnesota with Minneapolis having the next largest population.
St. Paul is seen as the Center of Hmong institutional, commercial, educational, and cultural life in North America.
Anoka, Dakota and Washington Counties have also seen increases in the Hmong population.

Religion
1. The predominant religion is animism. Some of the tenets of this religion are:
  - a belief n the Yin/Yang theory which refers to the belief that
  - balanced forces promote health;
  - a belief in spirits and in the supernatural world which is defined as the world that cannot be seen by human eyes;
  - a belief that spirits cause illness and spiritual healing is necessary to remove their harmful influence;
  - traditional Hmong belief holds that a person has several souls, usually four, and these souls occupy the body loosely. A soul can wander off at night or when visiting unfamiliar places which results in illness.
2. The Hmong New Year is the most popular Hmong festival and is celebrated in December to thank all the gods and ancestors who had helped throughout the year.
3. Because the supernatural world cannot be seen by human eyes, contact with the spirit world can only be made through a Shaman – a religious and a medical leader in the community.
  1. The Shaman is an individual chosen by the spirits to heal the afflictions of others by achieving an altered state of consciousness (ASC) which enables his/her soul to cross over to the spirit world.
  2. This then allows the Shaman to dialogue with the spirits to either tap their power or persuade them to cease making a person ill and then cross back to the world of the living.
  3. The key point here is that shamanism is not spirit possession
Languages Spoken

Hmong is a monosyllabic tonal language.
The various dialects of Hmong are: Stripe Hmong, Green or Blue Hmong and White Hmong. The dialects are mutually intelligible but do differ considerably.
There was no written language until western missionaries devised one in the early 1950’s which meant that the Hmong language, folktales, and traditions were passed along to each generation by word of mouth for thousands of years.
Some of the mountain Hmong children were sent to live in town so they could get a formal education. As a result they learned to speak, read and write other languages such as Lao, Thai and French.
It is estimated that 55% of the seven county metropolitan area school children speak Hmong at home.

Health Care and Religious and Cultural Beliefs
1. Common diseases seen in Hmong immigrants include cancer, heart disease, Influenza/pneumonia and diabetes.
2. In fact the Hmong (and Asians in general) are two to three times more likely than Caucasians to develop diabetes.
  1. Diabetes is a new disease that did not affect the Hmong people before they came to the United States.
  2. Changes in diet and activity level since migrating to America have made them more susceptible to diabetes.
3. The most common disabilities in the Hmong population include: loss of limbs, blindness (mainly due to Diabetes), mental illness and paralysis.
4. The main causes of disability in the Hmong population include: illness and disease, war and birth defects.
5. People with disabilities are deemed vulnerable, and it is the immediate family’s responsibility to care for them.
  1. To expect an elderly person or a person with a disability to live alone and to be . independent is considered cruel by the Hmong culture.
  2. The family in such a case would be shamed and chided by Hmong society for neglecting familial duties.
  3. The traditional view of disability for the Hmong people is significantly influenced by religious beliefs and cultural values which attribute disability to bad deeds or sins committed by one’s ancestors.
  4. Within this context, disability is associated with shame, pity and public humiliation.
  5. Family members usually take extraordinary measures to keep a person with disabilities out of the public eye.
6. Mental illness is believed to represent possession by evil spirits and exorcism is considered the remedy.
7. One form of congenital disability is given special social status – people who are blind at birth are revered as psychics and fortunetellers.
8. A new, emerging perspective on disability since the Vietnam war views most people with disabilities as victims of war and particularly as victims of the herbicide Agent Orange.
9. Traditional folk medicine, including herbalism and shamanism, is often used by the Hmong in addition to, or instead of, Western medicine.
10. Important decisions concerning an individual’s health are frequently made through consensus at the family or clan level.
Family Structure
1. Hmong culture places a high value on family and clan. Allegiance to one’s family is absolute, and includes fulfilling one’s responsibilities, obligations, familial role, duties and proper conduct.
  1. Hmong family consists of not only the immediate family members but extended family members such as aunts, uncles and clan leaders.
  2. The clan leaders negotiate marriages/divorces and are also the mediators during disputes.
  3. Decision-making is from collaboration between the head of the household and the clan leaders.
2. The head of the household is the father. He makes the decisions with the clan leaders.
3. The Mother is the care-taker of the children and family. Traditionally women bow to the wishes of their husbands, their in-laws and their own parents.
4. Children live with their parents until they get married.
5. After marriage, a woman takes her husband’s name, but a woman continues to use her father’s clan name even after marriage.
6. Success is measured in numbers of family members and the satisfaction of living freely and working and participating in traditional celebrations together.
7. Sons are valued more than daughters.
8. The eldest son has a duty to perform the ancestor worship in the home.
9. Brothers and sisters never touch or kiss each other.
10. Girls are under strict supervision and sex segregation is the common social rule.
11. Daughters are referred to as “other people’s women” and are expected to marry and to belong to strangers from outside their own birth group.
12. When parents get older, it is the duty of the children to take care of them.
13. It is the duty of the parents to “educate” their children as education is valued more than material wealth and success.
14. Individuals are instilled from childhood with the values of honor, hard work and loyalty to the family. To lose face dishonors oneself and one’s family.
Occupational Background
1. The first Hmong people who came to this country were farmers. Once they arrived in America, they were employed on farms or in factories where English proficiency was not necessary.
2. Many Hmong in the United States still maintain an agrarian way of life through starting family and community gardens. Local farmers’ markets reflect the large number of Hmong families who supplement their income with weekend produce sales.
3. Today Hmong people enter all kinds of professions, notably the medical and dental fields and business support services.

RESOURCE LIST FOR HMONG IMMIGRANTS IN MINNESOTA

Brief Overview of Hmong Culture; Prepared for the MN Department of Health by Vangyee Yang (Refugee Resettlement Coordinator with Neighborhood House in St. Paul Minnesota); web site address: http://www.health.state.mn.us/divs/idepc/refugee/hmoculture.pdf.

Closing the Gap: A Public Health Report on Health Disparities; Metropolitan Minority Health Assessment Project; web site address: http://www.hennepin.us/vgn/images/portal/cit_100003616/58/16/105465850ImmRefugee20010724.pdf; June 2001.

The Cultural Context of Complementary and Alternative Healing Practices: Seeking Cooperative Healing; The Park Ridge Center for Health, Faith, and Ethics; e-Ethics; web site address: http://www.parkridgecenter.org/ethics_october02.html; October 2002.

Culture and Ethnicity; Chapter 6 in the Timby – Fundamentals of Nursing; web site address: http://connection.lww.com/products/timby-fundamentals8e/documents/ch06.pdf.

Estimates of Selected Immigrant Populations in Minnesota: 2004; Minnesota State Demographic Center; Ronningen, Barbara J.; web site address: www.demography.state.mn.us/PopNotes/EvaluatingEstimates.pdf; June, 2004.

Finding Common Understanding: An Employer’s Guide to a Cross-Cultural Workplace; International Institute of Minnesota; web site address: http://www.iimn.org/ (click on Publications); January 2001.

Hmong Culture; Hennepin County Health, Housing & Social Services; web site address: http://www.hennepin.us/vgn/portal/internet/hcdetailmaster/0,2300,1273_82134_101032465,00.html; 2004.

Hmong Culture; Lao Family Community of Minnesota Inc.; web site address: http://www.laofamily.org/culture/culture_info2.htm; 1997.

Hmong/Medicine Interactions: Improving Cross-cultural Health Care; University of Wisconsin – Madison, Department of Family Medicine; Barrett, Bruce, MD, PhD, et. al.; web site address: http://www.stfm.org/fmhub/fullpdf/march98/cc2.pdf; March 1998.

Hmong Population in Minnesota Soars; St. Paul Pioneer Press; web site address: http://www.twincities.com/mid/pioneerpress/3030999.htm (must sign up for free access to St. Paul Pioneer Press to view this article); April 9, 2002

Hmong Shamanism; Power point presentation used at Syracuse University; web site address: http://faculty.maxwell.syr.edu/burdick/encounters%202000/ppmeeting2.ppt; August 30, 2000.

Immigrants in the Twin Cities: A Snapshot – 2 nd Edition; Greater Twin Cities United Way Research and Planning Department; web site address: http://www.unitedwaytwincities.org/news/download/immigrants_report_2nd_ed.pdf; August 2001.

Immigration in Minnesota; The Minneapolis Foundation; 1999.

An Introduction to Vietnamese Culture for Rehabilitation Service Providers in the U.S.; Center for International Rehabilitation Research Information and Exchange; Hunt, Peter Cody, M.P.H.; web site address: http://cirrie.buffalo.edu/vietnam.html; 2002