The following is a guide for healthcare
learn about the Hmong culture with emphasis on Hmong healthcare
beliefs. This site should serve only as a general reference in
relevant cases. It is the belief of the authors of this site that
every Hmong patient is an individual with individual ideas that may or
may not reflect these generalizations on traditional Hmong
culture. Furthermore, even very westernized Hmong patients may
wish to combine their physician's care with traditional
practices. More information about this page can be found under
the Sources and References
Advanced directives can be a difficult process, as many people have not
considered the various technological options that sustain life and
their significance for quality of life. Also, the meaning of
"brain death" is a new concept, as opposed to death that occurs with
the cessation of breath. Finally, some people are reluctant to
make advanced directives for fear that the predictions will cause dire
events to occur prematurely. See Decision Making and Brain Death links for more information.
Amulets are bracelets, anklets or
necklaces made from twisted cloth, metal, plants, or herbal
medications that ward off spirits that cause illnesses.
Healthcare workers should respect
religious and traditional healing rite and should avoid removal of
unless absolutely necessary and after talking with the patient or the
family. If they have been removed without permission, patients or
family members could blame adverse medical or surgical outcomes on the
Anatomy: The traditional Hmong perception of the
body is different from Western culture. The Hmong view the
as a whole, with each body part having a soul that interconnects with
the souls of the other body parts. If one part of the body is
sick, this sickness will spread throughout the body to affect the whole
Blood gives the body its strength and vitality. Some Hmong
believe that the amount of blood in their bodies is absolute and that
the body does not replace drawn blood. Therefore, these people
may be more
apt to refuse blood draws. The color of the blood
holds significance, in that dark blood may be interpreted as being
unhealthy while bright blood may be seen as a sign of vitality
and health. See Blood Draw link for
center for thoughts.
Chest: (hauv lub siab) There can
be confusion between chest ("hauv lub siab") and the liver ("daim
nplooj siab") as the word "siab" is connected with both body
parts. Pain described as "mob huav siab" can indicate pain
located in either the chest cavity or in the region next to the
liver. Due to problems in translation, a careful history and
physical exam as well as a skilled interpreter are important in
determining the distinction between chest pain and right upper quadrant
The stomach and intestines are regarded as digestive organs of equal
importance. The gallbladder and appendix are believed to be less
other organs--Some people are more apt to allow their
gallbladders or appendix to be removed than other digestive organs.
The anterior fontanel is considered sacred and Hmong parents may not
wash this area until its closure, as one of the baby's souls resides
It is customary to avoid touching the top of adult heads, as it is
considered insulting and disrespectful to do so. This idea is
related to the Buddhist belief that higher parts of the body (and
buildings) are more sacred than lower parts of the body (or
buildings). When healthcare providers need to examine the head,
it is best if the provider respectfully ask permission and inform the
patient before doing so.
heart is considered the center of the body and is responsible for
life. Some believe that
the reincarnated soul resides here and that it may serve as the focus
when a shaman quickly attempts to recover a person's soul in an effort
to heal the patient's
illness. Generally, the Hmong associate the liver, as opposed to
the heart, with emotions. For example, a "good-hearted" person in
Western culture is believed to be a "good-livered" person in Hmong
The kidneys are essential for life and for energy in the body.
Also, the kidneys are understood to filter blood and produce urine, an
idea that has crystallized since arriving in the United States.
Liver: (nplooj siab) The liver is the center of
(much like the American view of the heart as the center of
emotions). One's character is often described in terms of an
adjective followed by the word liver or "siab". Dichotomous
examples include: long liver=patient, short liver=impatient, large
liver=brave, and small liver=cowardly. The
two lobes are sometimes described as depicting a person's
personality--one side is good and the other
bad. The two lobes battle each other much like the devil and
on one's shoulder analogy used in Western culture. The goodness
a person is dependent on which lobe wins more often.
The lungs are the area where air enters and leaves, providing life to
The lungs' role in red blood cell reoxygenation may not be recognized
by more elderly Hmong while younger Hmong, who have been educated in
the United States, are more likely to be familiar with this idea.
Autopsy: Many Hmong tend to dislike and
refuse autopsies while some accept autopsies as a way to determine the
cause of death. For many people, burying the whole body is
important for 1) respect of the dead person; 2) successful
reincarnation of a healthy body; or 3) ensuring the happiness of the
soul that stays with the body until it disintegrates.
Furthermore, burying the body with missing parts may cause one of the
dead person's souls to be unsettled, which may lead the soul to haunt
living ancestors and cast bad luck upon them.
The function of the pancreas is not understood by many people and it is
confused with the spleen as being the same organ.
The function of the spleen is not understood by many people
as they do not believe in the regeneration of blood cells (as this
function is not very apparent to the naked eye). Some
may not differentiate the spleen from the pancreas.
believe that birth control pills or injections are unsafe for
Hmong women. This belief stems from the idea that Western
medications are designed for Western women and are too strong for a
Hmong woman's body. In addition, the hormones alter the woman's
natural menstrual cycle which is thought to be important for the
woman's overall health. See individual listed birth control
below for more information.
responses to the option of surgical and medical abortions is varied
depending upon the individual. Some Hmong are more apt to never
this procedure regardless of their situation while other women request
an abortion. Women may believe that abortion may lead to chronic
abdominal pain, cancer or infertility from uterine damage. Some
believe that the offended fetus's soul may haunt the woman and her
family, causing them to suffer blindness, disfigurement, or hardship,
Draw: This procedure can cause much concern
for the some Hmong patients. Many feel that physicians draw
too much blood and that blood is nonrenewable. Some believe that
taking too much blood will cause the person to die, and they relate the
lightheadedness and weakness associated with blood draws to interrupted
blood flow. To help alleviate these concerns, physicians may
chose to use finger-sticks, give iron supplements to help people
replace their blood, and only order blood draws when critically
necessary. Other patients are eager to have providers check their
blood when they are sick, as they want physicians to diagnose their
illness and prescribe treatments.
are popular as they have few side effects.
or INTRAUTERINE DEVICES: These
devices are considered
less satisfactory by some people who worry about abdominal pain and
CONTRACEPTIVES: Birth control pills are popular with
younger Hmong patients, while others may refuse this
method as they may cause some to have irregular or missed periods that
considered bad for the woman's health. Some fear that children
conceived while on birth control pills will be born mentally
retarded. Other women have experienced infertility or have
developed cancer after using this method and attribute it to the birth
control pills. For those using hormonal contraceptives, the skin
patch is popular due to its
convenience in both use and ability to take oneself off the
medication. Others may choose to use Chinese-made monthly
estrogen-progesterone pills from Asian pharmacies.
This method usually indicates herbal contraceptives sent from Southeast
(whose active ingredients Western scientists have not yet
identified). Herbal medications are usually taken after delivery
to prevent future pregnancies or for permanent prevention of
contraception. Some Hmong believe that these herbs cause
permanent dark spots on the skin, identifying
the women who use them. Some prefer this method because they
believe it causes less harm than Western methods of birth control.
NATURAL FAMILY PLANNING:
(Caiv) This term has many different meanings. It can be
mean the natural method, "the Hmong way", abstinence (periodic or
continual), and withdrawal.
SURGICAL STERILIZATION/TUBAL LIGATION: Hmong
believe that if body parts are removed in a current life, when that
person's spirit is chosen to live another life, he/she will lack that
body part in the new life. Thus, surgical sterilization is
believed to cause the spirit to be sterile in all future lives.
In addition, children, especially sons, are considered a family's
wealth in the traditional culture, and giving up the option of
reproduction can be a hard choice to make. Sterilization has been associated with
debilitating abdominal pain by some
patients and tubal ligation may prevent a woman from being able to
Some believe that unejaculated semen may enter the man's abdomen to
form a hard painful mass that can be fatal.
Some men believe this procedure causes sexual dysfunction. The
patient may also be ridiculed for having the procedure done by other
Hmong men in his community.
Brain Death: Hmong believe that life continues
within a person until
either respiratory or cardiac arrest, and may not interpret brain death
as death. However, as the Hmong population becomes
more acquainted with Western medicine, more people understand the idea
that technology can prolong physical life and postpone cardiac death.
Asymptomatic patients may refuse cancer screening of the breasts,
genitals, and colon, seeing these exams as invasive
and unnecessary. However, clinical breast exams are more accepted
than pelvic or rectal exams.
Some Hmong may view bone marrow draws as they do other invasive
procedures, as painful and potentially harmful. Deciding to have
a bone marrow biopsy will require careful consideration of the costs
and benefits. Also, people may believe that marrow is a
nonrenewable source and
that drawing too much can interfere with one's own health.
described as "mob huav siab" can indicate pain located in either the
chest cavity or in the region next to the liver. Due to problems
translation, a careful history and physical exam as well as a skilled
interpreter are important in determining the distinction between chest
pain and right upper quadrant pain.
may interpret childhood febrile illnesses as due to a variety of
causes, including: 1)
frightening or startling the child (ceeb); 2) bad spirits; 3) a
build-up of pressure within the body from excess wind exposure; or 4)
germs. Some parents or grandparents may treat the child by
wrapping the child in
warm blankets, rubbing a coin or boiled egg on the child, calling the
soul, or giving the
child medications, including herbal or over-the-counter Western
medications. A soul-calling ceremony is done to restore the
soul back into his/her body if illness is thought to be due to
Parents may resist cooling a febrile child too quickly from fear that
1) wind will enter the child's body and make the child more sick; or 2)
abrupt transitions in temperature will harm the child further.
CHICKEN POX/MEASLES: (Qoob)
Traditional Hmong concepts of illness include "qoob", which is a
general term for childhood febrile illness that are characterized by an
accompanying rash. Generally, "qoob" must be allowed to mature
and grow out of the body. Parents may try to treat the illness by
several ways. They may protect the child from becoming chilled
and limit the child's exposure to
the odor of fried foods, as chilling and strong smells can impair the
illness's maturation. Parents may also try the power of khawv
koob, a traditional ritual healing practice, before the implementation
invasive Western methods. This ritual
healing involves incense burning and chanting to spirits who can help
the illness mature and leave the body.
clan is a group of patriarchal families with common ancestral
ties. When a woman marries, she switches from her parents' clan
to her husband's. Marrying within one's own clan is
taboo. 18 patriarchal clans are recognized; however, 15-22 clans
may actually exist depending on people's interpretations. Large
clans have been
subdivided further into lineages that share a common ancestor.
Social, political, financial, and health issues are traditionally
decided by the men in the family with extended families offering much
assistance in the decision-making process. There are also societal distinctions
based upon the style of clothing, language and rituals that divide the
Hmong into White (Hmoob
divisions (Moob Leeg or Moob Ntsuab).
18 Clan Names: Chang/Cheng/Cha,
Chu, Fang, Hang, Her/Heu, Khang, Kong, Kue, Lor/Lo, Ly/Le/Lee, Moua,
Mua, Phang, Tang, Thao/Thor, Vang/Va, Vue, Xiong/Song, Yang/Ya.
Rubbing: (Kav) A Hmong healing method in which the skin
is vigorously rubbed in specific areas with medicated oil and silver coins
or a spoon. Rubbing
creates pressure on the skin to draw the wind or excess
pressure, that is believed to be causing the ailment, out of the body. This is a harmless procedure;
however, the red
marks can be mistaken as abuse.
Birth Control Link
Cupping: (Nqus) A piece of paper is lit inside a
cup and placed on top of the skin to create a vacuum. When the
fire burns out, suction is created, drawing out the "wind" or "bad
blood" causing the ailment. This is a painful procedure that is
done for its curative powers. Unfortunately, sometimes American
officials have mistaken the bruises for abuse, with dire social
For more information about Hmong healing see Coin Rubbing Link.
is the general term for spirits in the world and can cause a wide
variety of illnesses through various mechanisms. Some dab spirits
are malevolent while some dab spirits are tame and benign or even
benevolent. The malevolent dab may steal the souls of living
people and, in particular, the souls of the weak or ill, for these
souls are easier for the dab to steal. Telling Hmong patients
directly that they are dying is taboo, for a dab may overhear the
conversation, realize the patient is weak, and steal the weak patient's
soul. Other dab are not evil, but if their homes are disturbed,
they may cause people harm. Some dab are believed to live in
certain places, in particular around certain bodies of water, or rocks,
or mountains. Some Hmong take caution to avoid walking past such
areas and those affected with illnesses may blame themselves for having
wandered past an area believed to have an evil dab lurking.
is important when working with most Hmong not to directly tell the
patient or their loved ones that the person may die. For some
people, telling them directly that they will die is viewed as cursing
them to death. Words have power, and so may bring death.
Some believe that a dab or evil spirit may overhear the conversation,
recognize the person as weak, and steal the weak person's spirit,
causing death. For others, speaking directly about death may take
away the patient's hope for a cure. Rather, speaking indirectly,
or metaphorically, is more acceptable. For example, phrases such
as "we cannot help you anymore," and "I fear the sky is getting darker
and darker for you," are more accepted ways of conveying the patient's
prognosis. For animists, it is important for people to die in
their own house, or the house of their family or clan members, where
the ancestral spirits reside, rather than in other people's houses
where other people's ancestral spirits reside. Failure to do so
may result in angering the ancestral spirits, causing
the spirits to lash out on familial lineage or punish the deceased to a
lower level of reincarnation. See End-of-Life
Link Issues for more information.
Decision Making: Many Hmong
regard "the family group" as more important than "the
for making health care decisions. Extended
male family members and clan leaders are often involved in difficult
making processes. Usually, the husband's or father's side of the
responsible for medical decision making, however the wife's or mother's
side of the
family may participate in discussions about health matters. In
some families, younger and educated patients may play a larger role in
decision making and, oftentimes, serve as interpreters to others that
do not speak English. See Family
Decision Making Link for more specific information.
Devil: Ntxwv Nyoog
is an evil god who guards the gates of hell. Christian Hmong consider
Htxwv Nyoog to be the devil.
Diagnostic Procedures: Individual patients and families usually
evaluate the pros and cons before accepting diagnostic
procedures. Generally, as with most patients, the more invasive
the procedure, the more likely it is to draw resistance from the
patient. Blood draws and pelvic exams may be met with some
resistance (see Blood Draw Link and Pelvic Exam Link for more information) while
CT, MRIs, nuclear scans, and X-rays are generally accepted.
Digestive System: See
Historically, divorce was an uncommon occurrence, while now it
is more accepted. Marital couples with conflicts often seek help
from their family members, including sage male elders, who often
counsel the couple to patch up their differences and love one
another. Oftentimes, couples are given many chances to learn from
their mistakes, make-up, and continue trying to be a loving couple and
effective parents. Divorce is often considered a last
Disrobing: Some Hmong women are reluctant to expose
their bodies to anyone, even their husbands, and may perceive the
request as being for the physician's pleasure rather than for
Elders: The elders of the Hmong community are
treated with respect and serve a vital part in Hmong
decision-making processes. The word "elders" does not always
refer to advanced age; successful and middle-aged men and women can be
considered elders whose advise and counsel are worthy. Elders are
included many important decisions made concerning family members,
with the older men in the family playing the dominant role in culture,
finance, and political decisions. In today's society, there is a
struggle within the Hmong community to keep this tradition as the
younger generation continues to gain power in the family hierarchy due
to their education, English-skills, literacy, and experience.
decisions for patients at the end of the patient's life varies from
patient to patient and from family to family. Most Hmong adults
have not created living wills, as it has been taboo to make plans for
future adverse events. Some families will want everything done
for their loved ones, while others will carefully accept some
interventions while rejecting others. Some families embrace
hospice and palliative care while others continue to pursue multiple
therapies in the hopes of a cure. See Decision
Making and Death Discussion links
for more information.
family decision-making, decisions are generally made as a concerted
effort between members of
the family. Often, the men in the family and the members of the
husband/father's side of the family carry more weight in their opinions
then do the women in the family, or the people on the wife/mother's
side. Usually, no one person makes a
decision; rather, the group discusses the options with certain members
holding more respect or weight in the conversation. The group
then comes to an agreement such that the group is then responsible for
outcome of the decision. Some people believe that it
is better to do nothing then to interfere with fate and be responsible
for the result of interfering. It is important for physicians to
realize that decision-making in the traditional Hmong community can be
a timely process, but the time is important for in creating a trusting
and therapeutic relationship. See Decision
Making Link for more information.
Childhood Illness Link
Fontanel (anterior): See
Funerals: Following death, the entire family will
gather to see the deceased, and some will dress
the body in either traditional Hmong clothing or in formal Western
clothing of 3 to 4 layers to ensure better preparation for the body's
return to heaven or to the land of the ancestors. Funerals
for animists and Christians are different.
is important that no plastic
or metal be buried with the body as these impair the body's complete
disintegration. The body will
be buried (not cremated) after what might be several days due to the
Hmong belief that only one funeral may occur at a funeral home at a
time. The Hmong believe that the souls remain close to the body
after death and do not want dead persons' souls coinciding with one
another. Many animists funerals begin with a Showing the Way
ritual and chanting on Friday morning and ending with burial on Monday
afternoon. Playing the drum and windpipe, socializing, chanting,
and eating are part of the funeral. It is important that all
family members attend and view the body to ensure
the deceased has died and to help the mourning process. Due to
the belief that only 1 funeral
occur at a time at a funeral parlor and the length at which funerals
occur, the wait for a funeral to occur may last up to four weeks,
depending on the resources available to hold such funeral processions
Traditionally, Hmong men are more powerful than Hmong women. Men
able to perform ancestral and spirit rituals, arrange marriage
contracts, conduct funerals, and settle disputes between clans or
within one's family. Middle-aged men held the most power with
their power decreasing as they got older. Women tended to hold
power within the household and gained power with age. A newly
bride often faced much criticism from elders of her husband's
and worked hard to please her new family. Middle-aged women were
able to make or contribute to decisions about money, household
chores, animals, family relations, and the health of a family
member. As couples entered old age, they depended on their sons
for financial support.
funerals vary by denomination, with Catholic rituals building upon
traditional animist practices and Evangelical denominations eschewing
all references to traditional practices.
Religion Link. The Hmong believe that
Huab Tais Ntuj is the creator and supreme ruler of the world and
heaven. Saub is a lesser god who created the original 12 Hmong
clans that originated after the great flood on Earth. The Hmong
also believe in a number of lesser gods and in spirits that
reside in the spiritual world.
Herbalist: See Medicine Doctor Link for more information.
Hmong were a migratory people who, due to their physical
characteristics, are thought to have originated in Europe and moved to
Asia around 5000 years ago. Scarce resources, a growing
confrontations with the Chinese drove most of the Hmong clans to new
locations in Southeast Asia, including areas in Thailand, Burma,
Vietnam, and Laos, sometime in the 1800's. In 1893, the French
began to colonize Laos. Failure to profit from the land drove the
French to raise revenue through taxation and forced labor, with the
Hmong population in Laos suffering from the heaviest taxation.
This led to the "Madman's War" from 1918-1921. Following the war,
relations improved between the French and Hmong, with the Hmong gaining
much autonomy and self government. The Hmong learned to raise
opium for a cash crop and sold some of the opium to the French.
After WWII, the confrontation between the French and Laotians renewed,
eventually arriving at the Paris Peace Accords, which required the
French to stop assisting the Royalist government against the communist
Laotians. In the 1960's, the
United State's CIA employed many of the Hmong men and boys, some as
10 years old, to help fight the
communist Northern Vietnamese and Pathet Laos soldiers in Laos.
The Hmong leader General Vang Pao was instrumental in the recruitment
and leadership of Hmong fighters. In 1973, the US withdrew
from the war and in 1975, the communists took over Vietnam and
Laos. When the Americans pulled out of the Vietnam War, many
Hmong were left behind without supplies and protection against the
victorious communist leader Pathet Lao. Fearing persecution,
thousands of Hmong fled Laos to Thailand, where refugee camps were
This refugee flight was dangerous as the communist soldiers continued
to fight, killing many Hmong who left Laos for Thailand. In 1976,
as well as France, Germany, Australia, Argentina, French Guyana, and
Canada agreed to accept these refugees into their countries.
Today, California, Wisconsin, and Minnesota have the highest Hmong
populations in the U.S. In 2004-2006, the U.S. received
approximately 15,000 refugee Hmong from the forced closing of the
illegal sanctuary at the Thai Buddhist temple of Wat Tham Krabok.
The current U.S. population of Hmong is estimated at
280,000 according to the Hmong National Development Inc.
Doctor: See Medicine Doctor Link for more information.
Many patients and patients' family
members have taken advantage of hospice services and have been
receptive to the comfort care they have received, although the
patients' and families' philosophy of end of life care has not always
fit exactly with the hospice philosophy. It is imperative that
the hospice staff understand
that the Hmong may agree to supportive care while also hoping
for a cure, and that saying a person will die may not be acceptable to
the family. See Religion Link for more
Hmong view the body as a whole, with each body part having a soul that
interconnects with the souls of the other body parts. If one part
of the body is sick, this sickness may spread throughout the body to
affect the whole body. Illnesses may be caused by natural
phenomena (such as germs, changes in weather, accidents, or emotions)
or supernatural forces (such as fate, soul loss, tame spirits,
ancestral spirits, or evil
Hmong adults accept immunizations for their children to keep them
healthy or to allow them to attend school, while others reject
vaccinating young children because they believe that immunizations can
make their children sick.
Hmong language is complex, leading to problems with
interpretation. Certified interpreters have also been noted to be
inaccurate and may not be fluent in English or may not be fluent in the
some Hmong of the patient. Problems may also arise when parents
use their children as interpreters--parents may have a distorted
perception of their children's knowledge of English, and parents may be
providing more medical information to the child interpreter than they
Necklaces, bracelets, or anklets made of metal, copper, and/or silver
that may be worn for beauty or after a healing ritual. A Shaman
may make and place these items to fend off bad spirits and alleviate
Tying strings around one's wrist to keep the soul in the body.
See Pregnancy Link for more information.
Hmong language is a tonal language. Each word has a beginning
consonant, a middle vowel, and a final tone, with eight tones imparting
as much meaning as the consonant and vowel. So, two words with
the same consonant and the same vowel but different tones have
different meanings. Common phrases include:
Hello: Nyob zoo
Traditionally, Hmong is an illiterate language, although they may have
developed a written language years ago when they lived in China.
Since then, many have developed writing using Chinese, Laotian, Thai,
and Roman systems. Today, the younger
generation is more literate in English
than in Hmong.
My name is...: Kuv lub npe hu ua
How are you?: Koj nyob li cas
I am fine: Kuv nyob zoo
Goodbye: Mus zoo
Traditional Hmong believe that the physical world (World of Light)
co-exists with and is connected to the spiritual world (World of
and death are joined in a circle in which the person rotates with
reincarnation bringing the soul back to life. The person fate,
whether born as an animal or person, and how much one suffers, depends
on the type of life they lead in a previous life, as energy (kharma or
dharma in Buddhism) is carried further into future lives. See Religion
Link for more information.
As with other invasive procedures, many have concerns about this
procedure, perhaps, because it was associated with paralysis and death
stories originating back in the Thailand refugee camps.
magical healer, or ritual healer, is a person who
performs healing rituals to cure various illnesses. The healer,
usually a man, learns his gift and receives his connection with healing
spirits from other healers. The healer calls spirits with incense
and then directs spirits to help the patient by using a bowl of water
and silver coins, a metal knife, or
his own breath. Healers are consulted for specific problems and
are thought to solve physical problems (particularly burns, eye
problems, broken bones, and childhood fevers with rashes), emotional
problems (such as fright or startle), and spiritual
problems (frightened by spirits).
Historically, marriages occurred through multiple ways: 1) through
parental arrangement; 2) individual choice with
parental approval; 3) elopement; 4) force (i.e., the woman is
pregnant); and 5) bride
capture (the woman is captured by the husband and his relatives and
forced to physically sleep with him in his house.) Currently,
most marriages occur by the man and woman's mutual desire and decision,
with or without family approval. In
traditional Hmong marriage ceremonies, the male family members
take vows to support the marriage and take good care of the bride as
one of their beloved family members, in contrast to American weddings
where both the bride and groom make committments to each other. A bride price
is often paid to the bride's family, and the bride brings money with
her into the marriage. The bride becomes a part of the
groom's family, clan, spiritual lineage, and cultural practices. See Divorce Link, Polygyny Link,
Wedding Link, and Widow Link for more information.
Most Hmong medicines are natural products of the Earth, including fresh
plants, dried insects, and powdered rocks. In the U.S.,
either grow their own herbs indoors and outdoors, obtain them from
other herbalists in the U.S. and Southeast Asia, or gather them in
local woods and meadows. Medicines are drunk as teas or placed on
skin as poultices. Most medicines are used for short periods of
or used preventively rather than chronically. See Medicine Doctor Link for more
Many Hmong seek medical attention in order to obtain efficacious
Western medicines, and often prefer medicines to procedures or
operations, although people also fear side effects of short-term and
long-term medications. Some view Western medicine as too potent
or fast for Hmong bodies
to handle. Some people also express concern that the medications
they receive are inferior, with the best medication
being saved for non-Hmong patients.
Doctor: The medicine doctor is usually a woman
who, like a physician, examines the patient's body, makes a diagnosis,
and offers an herbal medical treatment. They may also charge fees
for their medicines, although in some situations (such as infertility)
people don't pay if the medicines don't work. All herbalists have
learned from other more experienced herbalists. Herbalists also
have spirits who help them diagnose and treat efficiently.
Menstruation is believed to clean out a woman's uterus and many
view a menstrual cycle as being required for a woman to be
belief may interfere with the acceptance or compliance of certain
Natural treatments may include herbal medications, acupuncture,
massage, coining, cupping, incense, drawing blood and
examining its color, and ritual healing. Treatments are often
determined by the help of elders, herbalists, or ritual healers, who
use traditional Hmong techniques to heal the ill and wounded.
Treatment may be decided by a Hmong family member in common illnesses
such as colds or pains.
New Year's Celebration:
This is a holiday of rest, religion, and celebration. In the
past, it has been associated as a time for picking a mate, with the
couple's marriage following in a month or two. Dietary changes
associated with this holiday involve only eating meat and rice and
forbidding rice soup during the first 3 days of the year.
Breaking dietary rules is believed to curse the person into not being
able to find enough meat to eat during the rest of the year.
Ntxwv Nyoog is an evil god who guards the gates of hell.
Christian Hmong consider Ntxwv Nyoog to be the
Hmong women are reluctant to expose their bodies to anyone, even their
husbands, and may perceive the request as being for the physician's
pleasure rather than for diagnostic purposes.
Pregnancy Link or Labor and Delivery Link
Opium: Historically, Hmong grew opium as a cash
crop in the mountains of China and Southeast Asia. Opium was used
as an effective medicine for pain, and some people became
addicts. Opium addicts in refugee camps were not allowed to
immigrate to the U.S. until they had not kicked their habit.
Despite this measure, opium addiction has continued in the U.S.,
although not at as high a rate given the difficulty of obtaining
option of donating organs to others
is often refused by some Hmong who believe that losing one's
organs can damage the patient's future reincarnations.
Hmong believe that the body is a whole that functions in harmony when
all of its parts are together. Organ transplantation is hard for
some to accept; however, with exposure to Western healing options, this
procedure is increasing in acceptance.
Exam: Hmong women may refuse routine pelvic
exams as they feel that
such procedures are both intrusive and unnecessary. When done
without the woman's consent, many view this procedure as a form of
rape. The physician should respect the patient's right to refuse
pelvic exams. Failure of physicians to respect this right has led
to a decrease in Hmong people seeking prenatal care. See Birth Control Link for more
Hmong parents may choose to bury the placenta at their home so that the
of the person can find it, once deceased, to aide in the spirits
journey back into the spirit world where the ancestors reside.
See Pregnancy link for more
Polygyny is still practiced by some Hmong men, although these men only
have one legal wife, so the other "wives" are mistresses. Some
people may not tell their physician about multiple wifes due to its
illegality in this country, but may admit to multiple relationships.
Post Traumatic Stress Disorder
(PTSD): Elders in the Hmong community, who were children in Laos during the
war years, are
susceptible to PTSD. Many lived through the Secret War in Laos,
the Vietnam War, the life-and-death risk of finding one's way to
Thailand refugee camps, and assimilation into the American
culture. When working with the middle aged and elderly patients,
one must be
sensitive to the likelihood that these individuals may suffer from this
disorder, and the healthcare worker should adjust their care
accordingly--from referring patients for psychiatric and psychological
care to being aware that loud noises or physical exams can trigger
Pregnancy is understood as resulting from sexual intercourse between a
man and a woman, when they bring their body fluids together,
specifically semen and blood. Special considerations should be
considered regarding Hmong women's beliefs about pelvic examinations
and blood draws (see Blood Draw Link
and Pelvic Exam Link for more
A shaman ceremony may be performed before labor and delivery in order
ensure the woman's health during labor and in order to separate the
woman's soul from the baby's soul to prevent both of them from dying,
in case either should die. The shaman may also place an amulet,
copper bracelet, or string around the woman's abdomen for protection
against evil spirits, which should be left on in respect for the
woman's belief about the items protection.
Historically, ceremonies were done to help the birthing process.
customs include drinking water from a cup with a key in it in order to
unlock the birth canal, drinking herbal remedies that increased the
pregnant woman's power to push the baby out, or making 2 paper dolls
and cutting them apart to separate the mother and baby's soul. An
elder woman may be requested to reposition the baby through
massage and external version. If
problems arise, mothers may apologize and ask
forgiveness for any disrespect they may have shown toward elders in the
family (especially the mother-in-law) mother has shown toward elders in
her family (especially the woman's mother-in-law) in order to ease the
pain of labor and delivery. The mother-in-law then chants and
touches the mother's stomach to invite the baby to be born. The
father may also beg for forgiveness as well. Women and their
may accept or refuse the range of medical options (i.e., anesthesia,
pitocin, internal monitors, or Cesarean section) depending on their own
level of trust, knowledge of English and biology, concern about the
baby's well-being, familiarity with success and complications of
procedures, and desire for medical assistance.
COMPLIMENTING THE NEWBORN:
newborn parents by
saying the child is pretty; It may draw the attention of bad spirits to
Hmong woman will never ask for ice water during labor as she believes
that it will cause her future health problems. Following
childbirth, the woman's diet consists of warm chicken and rice for one
month, and all food must be warmed.
First time mothers may have very little information about the labor and
delivery process, or they have learned the basics in school. Some
women may avoid prenatal care due to the fear of receiving a vaginal
exam while others will expect full prenatal care services.
Traditionally, pregnant women were encouraged to eat a healthy diet,
avoiding displays of anger towards relatives, avoid lifting heavy
objects, particularly above one's head,
and avoid daytime naps (as naps are believed to inhibit delivery of
the baby). Pregnant women should also avoid bodies of water where
evil spirits reside, as a spirit may enter her vagina without her
knowledge and cause a miscarriage.
MINOR COMPLICATIONS OF PREGNANCY:
For minor problems during pregnancy, women and their family members may
consult elder women who may offer herbal medicines and massage to help
alleviate pregnancy problems.
also massage or reposition a baby lying in the wrong
Hmong may choose to bury the placenta at their home so that the spirit
of the person can find it, once deceased, to aide in the spirits
journey back into the spirit world where the ancestors reside.
care did not exist
in Laos and Thailand. Traditionally,
pregnant women did not cconsult a midwife or traditional healer when
pregnant unless she noticed problems, such as pain and bleeding. Most
Hmong women trust health care providers to aid in the well-being of
both the mother and her fetus. Some women will accept
procedures but refuse invasive procedures such as pelvic exams,
amniocenteses, blood draws (see Blood
Draw Link and Pelvic Exam Link for more
information). Some women may
all procedures done at hospitals as they see the hospital as a place
where people's souls are stolen by the spirits from others who have
ROLE OF THE FATHER IN THE
Traditional deliveries involve the husband sitting on a stool
supporting his wife from behind as she takes on a squatting position.
ROLE OF THE MOTHER IN THE
CHILDBIRTH PROCESS: Many pregnant women are confident of
their natural ability to deliver infants with the assistance of their
husbands and female relatives without needing much assistance from
health care providers, while other women look to physicians and
midwifes to help them through the process. Mothers are taught to
throughout the delivery as they are taught to be stoic throughout their
lives, and because loud sounds may scare the baby from
wanting to be born. Some women and their family members will
resist procedures, such as rupturing the placental membranes, placing
internal monitors, performing multiple vaginal exams, and vigorously
massaging the uterus after delivery of the placenta, while others will
accept other procedures when the rational is explained, their
permission is obtained, and respect is gained.
Qeej: The qeej is a traditional musical bamboo
in funerals and entertainment. The notes are actually words, so
that the people who know the language can hear the words in the
Reincarnation: The Hmong believe in
reincarnation. As with other religions that believe in
reincarnation, actions throughout life (such as the way one person
treats another or one's ancestors) will influence the person's fate in
the next life, and actions in their previous life influence their fate
in this life. Burying a person with missing organs, body parts,
or with the inclusion of mechanical devices, may cause the person to be
unable to find one's ancestral spirits after death, leading to the
person being formed into a lesser being in his/her next life.
Religion: Traditional Hmong religion is animistic,
with belief in multiple souls in the body, reincarnation, presence of
multiple spirits and gods, and connections between supernatural spirits
and human souls that cause illnesses and influence health.
Animists believe in a Life Circle which connects the physical world
(World of Light) with the spiritual world (World of Dark). Humans
are a part of both worlds, cycling between life and death via
reincarnation. Each human is believed to have
more than one soul (with discussions of 3, 5, 7, 9, or 31 souls per
person, although some people assert there is only one soul), which
function in harmony for life and health. If part of the unit
is disrupted, the person's spiritual, mental, and physical health will
be affected and the person becomes ill. Souls may leave the body
because they are frightened, caught in a dream world, fallen down,
stolen by spirits, or gone to be reincarnated. Soul-calling is a
ritual that returns the soul back to the patient. (See
Soul Loss Link for more
addition, if an organ or body part is removed, the
body is no longer considered whole; this can cause harm to both the
person and their family. If the body's parts are not in
order, or if artificial parts are still in the body when one dies, some
sources state that the soul that guards the grave will be upset and
will not find its ancestors in the spiritual world. The soul may
haunt living ancestors on Earth,
and the deceased may be demoted to a lower reincarnation life.
Others believe that there are two different souls, with one guarding
over the body and another that seeks out its ancestors in the spirit
world. And yet another group of people believes that after the
body disintegrates, the soul that guards the body of the deceased will
join the soul that finds the ancestors in the spirit world. See Life Circle Link, Spiritual Sources of Illness Link,
Dab/Spirits Link for more information.
Also known as a magical healer. See Magical
Healer Link for more information.
are sacrificed for different reasons for various healing and religious
purposes. If a sick patient's soul was stolen and taken to the
spirit world, a shaman might exchange the animal's soul for the human
soul. If an evil spirit is threatening a sick person, the shaman
can command the animal's soul to stand guard and protect the vulnerable
patient's soul. Or, when a person dies, the animal's soul will
accompany the person's soul on the long and dangerous journey to the
ancestral world. Chickens and pigs are usually sacrificed.
However, for more serious illness and funerals, cows are used.
Despite reports of sacrificing dogs, legal and social issues have made
this historically rare practice an obsolete practice in the United
kind of god who resides in the sky and created mankind. Christian
Hmong believe Saub to be God.
(Tus ua neeb) There are varying levels of healers who perform healing
rituals. Shamans are revered as healers and many are considered
family and community leaders. Shaman can be men or women who have
been chosen by the shaman's helping spirits (dab neeb). The
choice is recognized by another shaman who arrives to divine and cure
the patient's serious illness. The patient who is recognized to
be a shaman may be either an adult or a child.
Black Shaman: These
shaman have been chosen by the shaman's helping spirits, allowing them
to fall into a trance and travel to the spirit world with the
assistance of the shaman's helping spirits. There are two
shaman, depending on whether they cover their face with red or black
cloths during trance. During a diagnostic ceremony, (ua neeb
the shaman travels into the spirit world to fight and negotiate with
evil and ancestral spirits on behalf of the patient. The shaman
returns from his trance to tell the patient's family that the spirit
has been defeated and that the patient will recover. If the
not recover, the shaman tells the family that the spirits have not
kept their promises or have changed their minds. Once the sick
has recovered, the shaman conducts the curing ceremony (ua neeb kho)
and sacrifices an animal whose soul will either guard the sick person,
or be payment to the evil spirits (see Sacrifices
Link for more information). Then, the patient's family, and
possibly extended family, participate in the feast of the sacrificed
Heal without falling into a trance and are
lower level healers than Black-Faced Shaman. They only perform
some of the shamanic healing
Hmong society is traditionally a patrilineal, patriarchal, and
patrilocal society. Eighteen clans are recognized.
Intra-clan marriages are considered incestual and therefore taboo, so
marriages only occur between clans. Men hold the most power in
decision making in matters concerning money, politics, or health (see Decision Making Link for more
information). The family is obligated first to the husband's
before the wife's, as the wife becomes part of her husband's clan
through marriage. There are also societal distinctions based on
style of clothing, dialect, and rituals that divide Hmong into White
and Green/Blue divisions (Hmoob Dawb and Moob Leeg or Moob Ntsuab).
Soul loss can occur in several ways: 1) ancestral spirits or evil
spirits may steal the ill person's soul; 2) the soul may be frightened,
perhaps by surgery; 3) the soul may be caught in the dream world,
perhaps during anesthesia; or 4) the soul may not have gotten up after
the person fell. Soul loss or "poob plig" can be
remedied by a Soul Caller calling the spirit back to the person's body
in a special ceremony lasting up to
three days. Soul-calling ceremonies start at the location of the
soul loss (i.e., the operating room) and continue back to the doorway
of the sick person's house. The soul-caller calls the soul,
enticing it with incense, rice, spirit money, and chicken. Other
situations that may result in soul calling include the birth of a
newborn child, prevention of illness, and promotion of health such as
at New Year's.
Paper designed as spirit money is often burned as an offering or
payment to spirits and souls in religious and healing ceremonies.
See Dab/Spirit Link and Religion
Link for more information.
Spiritual Sources of Illness: There are several types of supernatural illnesses.
Soul loss is caused by a person's soul leaving the body (see Soul Loss Link).
Tame household spirits can make people sick when they haven't received
the attention they need, or when a social taboo has occurred.
Ancestral spirits can cause illnesses when they need something, usually
spirit money or an animal sacrifice. Wild evil spirits generally
people sick by their very nature, while wild benign spirits only bother
people if they are disturbed. Shaman -helping-spirits can
their choice of someone to become shaman by making that person
surgeries are more easily accepted than others. Operations on the
gallbladder and appendix, for instance, are accepted more rapidly than
those on the heart or brain. Surgeries of special
concern involve the liver, due to its importance in the Hmong tradition
of anatomy and its belief in shaping a person's personality, as well as
surgeries involving blood loss (see Blood Link
for more information). Also, the Hmong believe that the body is a
whole that functions best and in harmony when all of its pieces are
together. As familiarity with Westernized medicine spreads, the
variability in individual beliefs about operations increases as
well. See Anatomy
Link for more
many people accept blood transfusions, there are some concerns about
donating blood, as some people feel giving blood makes them more
vulnerable to weakness and illness. Also, some people's
reluctance may be related to the belief that blood cannot be
regenerated. In addition, some Hmong people share the same
Westernized concerns of contracting disease or illness from donated
Transplantations: See Organ Transplantation Link.
Oral Medication believed to dissolve blood clots. See Traditional Healing Link for
more information about techniques used to heal within the Hmong medical
Vaginal Exam: See
Pelvic Exam Link
Vasectomy: See Birth Control Link
Visitors in Hospital Settings:
Many Hmong patients want to have immediate family as well as clan
members present when a family member is sick in the hospital.
tend to be large, and it is culturally
important that the extended family show their respect by being present
for a family member's serious health problems. While many
policies surrounding how many people can visit patients, bending this
rule can both show respect for the patient's culture as well as
facilitate the Hmong family decision-making process. Having all
members present may speed this process when time is of the essence and
decisions need to be made quickly. See Decision
Making and Family Decision Making
for more information.
Historically, many couples met during the New Year celebration; today,
younger generations meet in a variety of ways, including the
internet. Weddings were traditionally arranged by the husband's
family and clan. Marriage
is seen as a step from childhood into adulthood. Traditionally,
the bride leaves her family behind to become a part of her husband's
family and clan, and she adapts to his customs, traditions, religion,
and language, if they differ from her own. Historically, married
woman do not wear wedding rings; rather they wore
a turban with black and white stripe removed to signal
that she is married. See Marriage Link
for more information.
White Fabric Cross: Two
sections of white fabric sewn in a cross may be placed on a person's
shirt during a shaman's ceremony to extend the life of the person whose
fate has expired.
widow can either stay to live with her husband's family, remain single,
or marry her deceased husband's younger brother, or marry someone
else. If she marries a man from another clan, her children may
stay with her deceased husband's family due to the social perspective
that the children will be better taken care of by the father's family
than by the new husband's family and by religious belief that the
children's souls belong to the father's ancestral lineage.
Dragon spirits that hide in the water and steal souls of those who play
around it. Pregnant women are careful to avoid water for fear
that these spirits will cause miscarriages.
A massage followed by a finger prick believed to release built-up
pressure within the body.
This website was completed with the help of the following people who
reviewed the website and offered suggestions for its improvement.
The following people were chosen to review the website due to their
extensive knowledge about Hmong culture, health care, and beliefs.
Website Reviewed By:
1) Dr. Kathleen Culhane-Pera, University of Minnesota Medical School,
Assistant Professor of Family Medicine/Community
Health and co-editor of Healing By
2) Bea Larson, Hmong-English Language Instructor, Hmong Family
author of Hmong Roots and the
later volume Hmong Roots with Paper
Dolls and Story Cloths, Community Cultural Competence Educator.
Tria Lor, University of Minnesota Medical
4) Dr. Glen Nordehn, University of Minnesota
Medical School, Duluth,
Assistant Professor of Family Medicine
Dr. Jim Boulger, University of Minnesota Medical School, Duluth,
Professor of Behavioral Sciences and Family Medicine
1) Brad Ingersoll, University of Minnesota Medical School, Duluth
2) Toni Winslow, University of Minnesota Medical School, Duluth
Website Research & Design:
Autumn Erwin, University of Minnesota Medical School, Duluth, MSII
*For comments or suggestions please contact firstname.lastname@example.org
1. Cha, D. (2004). Field
Hmong Culuture. Madison's Children's Museum.
2. Culhane-Pera, KA, Vawter DE, Xiong P, Babbitt
Solberg M, eds. Healing By
Heart: Clinical and Ethical Case Stories of
Hmong Families and Western Providers. Nashville TN:
University Press. 2003.
Culhane-Pera KA, Xiong
P. Hmong Culture: Tradition and Change. In, Culhane-Pera, KA, Vawter DE, Xiong P, Babbitt B,
Solberg M, eds. Healing By
Heart: Clinical and Ethical Case Stories of
Hmong Families and Western Providers. Nashville TN:
University Press. 2003: 11-68.
3. Fadiman, A. (1998). The Spirit
Catches You and You Fall Down (1st ed.). New York: Farrar,
Straus, and Giroux.
4. Larson, B. (1998). Hmong
(4th ed.). Duluth, MN
5. Hennepin County Website "Hmong
6. Hmong Cultural Center, Inc., St. Paul, MN. http://www.hmongcenter.org
7. Hmong Nationality Archive. http://www.hmongarchives.org/index.php
8. Lao Family Community of Minnesota. http://www.laofamily.org/
9. The Hmong: An Introduction to their History and Culture. http://www.culturalorientation.net/hmong/hhist.html
10. This is Home: The Hmong in Minnesota. Minnesota Public Radio
11. WWW Hmong Homepage. http://www.hmongstudies.org/
12. MMA Publications
Website. "Laying the Body to Rest." http://www.mmaonline.net/publications/MNMed2004/January/Maas.html