Cambodians in Minnesota |
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Increasing the cultural competence of health care providers serving diverse populations
In order to provide equitable and effective health care, clinicians need to be able to
function effectively within the context of the cultural beliefs, behaviors, and needs
of consumers and their communities. According to the 2002 Institute of Medicine
report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health
Care, racial and ethnic minorities tend to receive lower quality health care than
non-minorities even when access to insurance and income is accounted for. Failing to
support and foster culturally competent health care for racial and ethnic minorities
can increase costs for individuals and society through increased hospitalizations and
complications.
Formerly known as Kampuchea, Cambodia
faces the gulf of Thailand and is bordered by
Thailand, Laos, and Vietnam. Cambodia has
a population of over 14 million.
Between 1969 and 1973, Cambodia was
invaded by the U.S. and Vietnam, with more than 2 million Cambodians made refugees by
the war. By 1975 the country was faced with
famine, and the Communist Khmer Rouge,
heavily influenced by China, took power.
Prior to 1975, a limited number of Cambodians who lived in the U.S. were children of upper income families or children who had received government funded scholarships and were sent abroad to attend school. In 1979, the U.S. government settled
150,000 refugees in various towns and cities throughout the country. The 2006 American Community Survey showed the largest Cambodian-American populations
were in California, Massachusetts, Washington, Texas, and Minnesota.
The 2000 Census showed 172,000 Khmer refugees living in the U.S., with over 8,000 living in Minnesota.
Social structure
Cambodian people are also referred to as Kampuchean or
Khmer. They speak Khmer, Chinese, Vietnamese, and French. Throughout history,
their culture has been heavily influenced by Thailand, Laos, China, and India.
Khmer are generally respectful, polite, and speak softly, communicating carefully and
indirectly. Sompeah is a gesture of greeting with both palms brought together with fingers pointed upward. The higher the sompeah, the higher the status of the person being greeted.
Khmer often raise large families if financially able to
do so, with extended family members living together or nearby. The spokesperson for the family may be the
father, or the eldest son or eldest daughter. Men are
generally recognized as head of the family with women
expected to be care givers—although roles are changing
as Khmer become acclimated to American society and
values. Women now often work outside the home. Elders
are important in decision making and often take care of
their grandchildren. Men and women protect and care
for the disabled in the community.
Religion
Most Cambodians are Theravada Buddhists, one of the two major branches of Buddhism.
Followers of Theravada, meaning the “Doctrine of
the Elders,” adhere to the earliest surviving record of
Buddha’s teachings. Buddha is believed to have lived
and taught in northeastern India sometime during the
fifth century BC. The two largest Cambodian Buddhist
temples in Minnesota are located in Hampton and
Rochester. Other Cambodians practice Islam, Cham,
Christianity, or animist religions.
Health considerations
Khmer often attribute good health to equilibrium, adopting the Chinese philosophy
of balancing hot and cold. Many Khmer also believe in
the inherent properties of balancing hot and cold foods.
Food is deemed either hot, cold, or neutral. For example, chicken is hot, vegetables are cold, and rice is neutral.
Khmer people who eat a traditional Cambodian diet eat
rice at all three meals and prefer warm tea or water to
drink. Most Khmer do not use ice and rarely consume
dairy products. Many are lactose intolerant.
Khmer who subscribe to traditional beliefs attribute
illness to natural or super natural powers. Illness may be
considered punishment for sins committed in a past life.
Many believe evil spirits or ancestors cause mental illness.
Common health problems for older refugees who came
to this country 30 years ago include nutritional deficits,
hepatitis B, tuberculosis, malaria, and HIV/AIDs. Older
Khmer may suffer from post traumatic stress disorder as a result of war and the brutality of the Khmer Rouge in Cambodia.
Khmer may seek traditional practices before they seek
Western medicine, and often hold traditional healing
ceremonies in the home. They may reject or not
appreciate the value of preventive care, screening, or early
detection.
Khmer are known for enduring pain stoically. Rather than asking general questions about pain or symptoms, clinicians should ask very specific questions. Common treatments for pain include herbal medicines, acupuncture, acupressure, cupping, coining, moxibustion, and use of Tiger Balm.
In cupping and coining, cutaneous hematomas are made
on the face and trunk by pinching and pulling the skin to
release excessive air, by rubbing oiled skin with a coin or
spoon, or by cupping—heating air in a cup with a flame,
then placing the cup onto the skin. As the air cools, it contracts and pulls on the skin, leaving a purple mark.
Moxibustion, often combined with acupuncture, is the
process of making circular superficial burns on the skin
with ignited incense or other material placed directly on
the skin.
Health care providers should be aware of dermabrasive
procedures used by patients that leave marks on the skin—and not misinterpret the marks as a sign of
physical abuse.
In the hospital, many family and friends may visit patients and often like to sleep in the patient’s room.
Khmer may fear surgery and giving blood due to the
belief that these procedures will result in heat loss.
End of life
Most patient’s families prefer to discuss end of life issues with the physician, protecting the
patient from the knowledge of a poor prognosis. Many
patients prefer to die at home with family care and
community support. When a person dies at home, the
body may be kept in the home for 24 hours to allow for
visitation and ceremonies.
Buddhists believe they will return in another life and
should prepare for death calmly and thoughtfully. The
family and monks may wash and shroud the body.
Monks recite prayers and burn incense. Due to belief
in rebirth, Buddhists rarely allow organ donations or
autopsy.
Resources for Cambodians
United Cambodian Association of Minnesota.
UCAM supports the adjustment of Cambodians
in Minnesota to American society through social
services and cultural support. Its main programs
focus on elders, families, youth, health, and legal
services. Programs also serve low income people
from many cultures. Central to the UCAM
mission is providing Cambodians the skills they
need to achieve long-term economic stability.
Wilder Southeast Asian Social Adjustment
Program. Wilder Services provides culturally specific
mental health programs for Cambodian, Hmong,
Laotian, and Vietnamese immigrants living in
the Twin Cities.
Culture in context
Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community.
Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.
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