Policy Advocacy

Testimony

CALIFORNIA HMONG REFUGEE RESETTLEMENT

November 16, 2004
State Capitol, Room 4202
Sacramento, California

Testimony from Dr. Ho Luong Tran
President and CEO
Asian and Pacific Islander American Health Forum

Ladies and gentlemen:

I am here to present my testimony today on Hmong health related issues. My name is Ho Tran. I am not Hmong, but a refugee from Vietnam coming to the US in 1979. A a physician I have worked with refugees since 1989, as the coordinator of English as a second language refugee program, and afterward Administrator of the Refugee Health Program at the Illinois Department of Public Health. I believe that I can testify with confidence about the important and specific health issues that are related to the newly arrived Hmong refugees and provide recommendations.

My testimony is intended to inform you about the health concerns that affect the incoming 15,000 Hmong refugees from the Wat Tham Krabok in Thailand. They belong to an ethnic group that traditionally lives in the highland areas of Laos and Thailand. In 2001, almost 200,000 refugees have already resettled in the US, concentrated in Minnesota, Wisconsin, California and North Carolina.

The breakdown of the incoming population is of approximately 50 percent under the age of 15, and less than 5 percent of 65 years or older. They speak Hmong and only about 50 percent are literate in Hmong. English skills and literacy levels are low with about 10 percent of adults having some.

The Hmong refugees relied on traditional practices for health care. Illness has either a non-spiritual or a spiritual cause. Non-spiritual causes include harmful exposures to extreme cold, or unsuitable food or drink and spiritual ones are due to the "loss of souls," and/or actions or misdeeds which are believed to have offended an ancestor’s spirit. They rely heavily on herbal remedies, spiritual ceremonies, and forms of touching to treat a variety of maladies.

Special Health Needs

Immunization Status: It is highly probable that most of the residents in the Wat had not been adequately immunized. A mass immunization campaign of the Hmong refugees was implemented in May 2004. At this time, one dose of multiple dose vaccinations was administered; and additional doses are needed upon resettlement.

Respiratory Illnesses: The Wat is located near a stone quarry, where several of the Hmong worked outside of the camp. The quarry produces a great deal of dust and there are reports of high numbers of respiratory conditions as a result, such as Asthma. Approximately 25 percent suffer from asthma.

Acute Ear Infections: Exams of Hmong at the Wat found high rates of ear infections that might result in a high number of individuals with hearing loss.

Malnutrition is a common problem and is a major contributor to developmental delays in children 0-5 years of age, a diminished immune system.

Tuberculosis: The estimated incidence of tuberculosis in the general population in Thailand is 141 cases per 100,000; however, the rates among the Hmong are unknown. All refugees 15 years and older will have a chest x-ray. Refugees less 15 years of age will be tested depending on history and risk factors. Refugees are screened for TB as part of their health assessment before coming to the United States. Of the refugees tested to-date, the TB rate among the Hmong at the Wat is below 3 percent.

Parasites: Due to their living conditions, the Hmong are at a high risk for parasitic infections. To address this concern, they will be treated for intestinal parasites before they depart. It is highly recommend that all refugees be tested for parasites regardless of the presence of symptoms.

Scabies : Scabies is a significant problem for this population. The received treatment before entering the country. However, scabies is very difficult to completely get eradicated and service providers should be aware of it as a potential issue.

Oral health: Preliminary exams of the Hmong at the Wat indicate that 60 percent have serious dental health problems. Most of the refugees have never had any dental health care and as a result one of the most prevalent personal health problem faced by refugees are periodontal disease, caries, gingivitis and calculus, and tooth decay.

Reproductive health There are several traditional practices during pregnancy that providers should be aware of and sensitive to. Hmong women often take medications made from plants to prevent vomiting and nausea, to strengthen the fetus and prevent miscarriage, and to provide energy to the baby and themselves. They also are prone to refuse vaginal examinations, particularly if they are performed by male providers. Mothers and mothers-in-law often help with the birth, which generally occurs in the squatting position. The husband helps cut the cord and wash the newborn infant. Women prefer natural tearing and a woman requiring a Caesarean section under general anaesthetic may have concerns that when her body is cut under an anaesthetic, her soul will be lost. After the delivery, it is customary to stay warm for three days post-partum, and touching cold water post-partum is prohibited. Traditionally, women eat hot rice and chicken soup with special herbs for 30 days after the delivery. As a result, Hmong women may refuse the hospital diet.

Mental Health As with many other refugee groups, this population of Hmong arrive for resettlement with a substantial health burden secondary to their pre-migration experience, migratory experience and life in refugee camps. Refugee epidemiology of infectious and parasitic diseases, psychiatric disorders, and chronic diseases can be said to proceed in stages based on the context of the forced migratory experience. Infectious and parasitic diseases are associated with pre-migration experiences and exposure to risk factors in the country of origin. Chronic diseases are associated with pre-migration experiences and exposure to risk factors on the host country (in this case the intermediary host, Thailand). Forced displacement and torture constitutes two of the most extreme forms of human stress, with the potential for long-term suffering. Mental health problems, and some psychiatric disorders, can be thought of as linking pre and post-migration experiences with the experience of migration itself.

At this time, there is little information (mostly anecdotal) available about the mental health status of the Hmong presently in Wat Tham Krabok, Thailand.. Rates of psychiatric disorders and substance addiction are not available, but percentages of diagnosable disorders and levels of distress and psychosocial adjustment problems are probably within the typical range.

Important issues & recommendations for the Western-trained health professional

  1. Establishment of trust is extremely important.
  2. When assessing a client, take into consideration the family and clan structure:
  3. Incorporate ideas and suggestions from family members and relevant persons in the individual’s life, who have perceived power and authority, into assessments and treatment plans.
  4. Use holistic approach.
  5. Consider the individual as part of the collective whole.
  6. Mobilize and work within and with the family’s cultural strengths, indigenous resilience, and traditional or spiritual healers (shaman, medicine man, church leader).
  7. Avoid demonstrative expressions of power and authority
  8. Consider asking the individual to put feelings in writing during and after counseling or educational sessions. Hmong do not verbally express feelings openly.
  9. Be flexible and be ready to use a Hmong leader, community leader, or someone else the individual trusts to help bridge the gap between Western and traditional cognitive domains involving health and well-being.

For any entering refugees to the US, health departments of states that receive a large influx of refugees provide an initial health assessment and screening. The purpose is to protect the general population of infectious diseases that refugees might bring over, but concurrently assessing on-going medical issues for referrals for treatment and follow-up and screening for diseases prevention. The program also provides services on other issues that are quite important to this special population, such as mental health screening, dental, vision and parasitic infections. These services only last for the duration of six months and it is not sufficient for the Hmong refugees to get acquainted to the US health care system, the culture, not to get acculturated.

Recommendations

Reduce access barriers by ensuring that safety net programs such as Medi Cal Healthy families and community health centers are available

Ensure public services are not denied based on language ability by enforcing and strengthening existing language requirements and funding interpretation/translation services

Develop a culturally competent and diverse workforce through provider training, pipeline programs, and working with community based organizations

Ensure the collection of health data that is disaggregated by Asian American sub groups, including Hmong, for all state and county health data systems.

Back to top

Back to Policy Page