Vietnamese American communities often face cultural obstacles to maintaining good health and obtaining preventive care. These include lack of access to a regular physician, and sometimes a misunderstanding or mistrust of Western healthcare. When healthcare material is culturally adapted to this population and translated into Vietnamese, it helps healthcare organizations provide the best care for members of this group.
Vietnamese is the seventh-most spoken language in the United States – as many as one million people who are aged five and older speak Vietnamese at home. A ccording to the 2000 census, more than 1.2 million people with Vietnamese origins live in the United States. They tend to live in metropolitan areas in the West, especially in California and Texas.
The vast majority of Vietnam-born people in the United States came here as refugees from 1975 to the present. Principally, this has been in three different waves of immigration. The first group of refugees came to the U.S. in 1975 with the help of the U.S. government after Vietnam was reunified and the Communist system spread throughout the country. These refugees were mostly educated, urban professionals and their families. In contrast, the second wave arrived from the late 1970s through the 1980s, and included farmers and other rural Vietnamese who escaped Communist Vietnam in small boats. They endured great losses and hardship through the refugee process, often suffering years at internment camps prior to entering the U.S. Because they were generally less educated and less familiar with Western ways, they have subsequently had a harder time adapting to life in the U.S. The third wave of refugees continues to arrive and have come under American programs to free political prisoners in Vietnam or through family reunification programs.
Healthcare Beliefs in the Vietnamese Community
Although some Vietnamese refugees are Catholic, Buddhism is a strong influence on most Vietnamese refugees’ healthcare beliefs and practices. For example, Buddhists generally profess profound respect for elders and those in authority, like doctors and nurses. This means that many Vietnamese in this country will rarely be confrontational with their American medical team. Traditional Vietnamese might even consider direct eye contact with a “superior” impolite. Buddhism also stresses disconnection to the present and teaches that life is a cycle of suffering and rebirth. Therefore, pain and illness are sometimes endured and medical remedies are delayed. Preventive health care can seem to have little meaning within this philosophy. Finally, Buddhism also treats the family as more important than the individual “self”. Healthcare decisions are frequently made as a family.
A traditional Vietnamese belief is that health is a state of balance between two forces, known as “Am” and “Doung” in Vietnamese, based on the more familiar concepts of yin and yang in China. When speaking of health, these forces are frequently translated as “hot” and “cold,” although these concepts do not necessarily refer to temperature. Illness results when there’s an imbalance of these elements in the body, either as a result of pregnancy or fatigue, or even brought on by diet or over-exposure to “wind,” one of the body forces. Balance can be restored by a number of practices that include changes in diet, herbal medicines, or western medicines and injections. There are also a variety of common folk remedies that patients may use to release excess “wind” from the body, including cao gio(vigorously rubbing a coin dipped in mentholated oil across the skin), and bat gio(pinching the skin).
Most Vietnamese-Americans also recognize the more “western” concepts of the causes of disease. They generally understand that disease can be caused by germs and contaminants in the environment. However, western medication is sometimes viewed as too strong for the smaller body structures of Vietnamese and therefore they may self-adjust medication, or discontinue medicines after their symptoms disappear. Addressing these views in translated information about preventive medication may educate and reassure this population that they are in fact receiving the correct treatment for their condition.
One of the most important ways to improve healthcare for this population is by providing culturally appropriate explanations and educational health literature in Vietnamese. By working with Vietnamese families and community groups, healthcare organizations can perhaps dispel some misunderstandings about Western healthcare.