• The word “Hmong” is an ethnic description, rather than race or national origin.
• Social scientists estimate that there are around 12 million Hmong in the world.

Mainland China - 9,700,000

Vietnam - 1,200,000

Laos - 400,000

Thailand - 300,000

USA - 300,000

Myanmar (Burma) - 100,000

Source: Lao Human Rights Council, 2000

• Until recently, almost all these people lived in the mountains of Southern China, Laos, Thailand and Northern Vietnam.
• The Asian Hmong culture is agrarian, with religious beliefs based in animism (including the use of shamans for guidance, healing, and other ceremonies).
• The Hmong of Laos carried out U.S. military objectives in Southeast Asia from the 1950’s through 1970’s.
• Many died or fled to refugee camps in Thailand after 1975.
• When refugee camps closed, families went to Wat Tham Krabok (WTK).
• Thai government decided to close WTK, and in December 2003 the U.S. State Department agreed to resettle up to 15,500 Hmong from the camp.

• Hmong Americans generally have a positive view of their new country, and the younger generation tends to understand both cultures.
• Hmong Americans tend to be friendly to members of other groups and welcome attempts to learn more about their culture.
• About forty percent of the Hmong in the United States were born here. The proportion of Hmong who have personal memories of Laos is decreasing rapidly.
• Many Hmong customs are not practiced in the U.S. especially by those who have converted to Christianity.
• The language is a great barrier to the elderly, many of whom have had no schooling and had no reading skills prior to coming to the U.S.
• The handshake is a new concept to traditional Hmong people; this is especially the case among women.
• Traditional Hmong usually do not shake hands. Persons greet one another verbally.
• Many Hmong women feel embarrassed shaking the hands of a male.
• Holding hands too tightly during a handshake will embarrass Hmong women.

White Hmong

Black Hmong

Flowery Hmong

Red Hmong

Blue (also called Green) Hmong

• Most Hmong in the United States are from the White or Blue (Green) Tribes
• According to Hmong legend, these tribes were developed by ancient Chinese conquerors who forced the Hmong to divide into different groups and to identify themselves by wearing distinctive colors of clothing.

• Clans or extended family groups are more important than tribal membership. There are about 20 clans, all identified by family names.

Cha/Chang

Cheng

Chue/Chu

Fang

Hang

Her/Heu

Khang

Kong

Kue

Lor/Lo/Lao

Moua

Pha

Thao/Thor/Thoj

Vang

Vu/Vue

Xiong

Yang

• Decision-making results from collaboration between the head of the household and the clan leaders. Decisions are made by community consensus rather than by an individual.
• Clans are exogamous. Members of the same clan - those who have the same family name - are not allowed to marry.
• Many clan elders are gradually being replaced by younger leaders who are well-educated and fluent in English and better able to help their families and others with the complexities of modern American society.
• However, clan leaders are still held in high regard and receive deference from the young.
• Newer leaders rely on the moral authority and blessings of the elders.

• Men and women with different last names may marry even if they are first cousins or otherwise closely related.
• Often, young people meet potential mates at the New Year’s festival.
• Men generally marry at any age between 18 and 30 years, while women often marry between 14 and 18. Surveys of Hmong Americans indicate that the majority believe that it is best to put off marriage until they are at least 18 years of age.
• Traditional Hmong marriages required the prospective groom to secure a go-between, most often a relative, who bargained with the young woman’s family for a bridal price, usually paid in silver bars. Currently, the use of negotiators to arrange a marriage remains fairly common among Hmong Americans.
• When a suitor could not reach an agreement on bridal price with the woman’s family, the couple sometimes eloped.
• If the young woman did not want to elope, the suitor would sometimes kidnap her with the help of his friends and following payment to her family, she would be recognized as his wife.
• While they may have seen this as a culturally acceptable way to enter into marriage, American law defines this kind of activity as abduction and rape. American culture and law has made it necessary for the Hmong to change many of their attitudes and practices with regard to family. Those who have failed to drop older practices have found themselves in conflict with the American legal system.
• Polygamy became more common during the Vietnam war due to the custom that required Hmong men to marry the widows of their dead brothers in order to provide a means of support for the brothers’ families.
• Even before the war, wealthy men often had several wives as symbols of affluence.
• Clan leaders sometimes married several times to establish political alliances.

• Hmong Americans generally regard the husband as head of the family. He is expected to make decisions for the family in consultation with the clan elders.
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  Hmong women wield a great deal of power in the family since they are seen as having primary responsibility for the household. As chief care-givers for children, Hmong women can be extremely influential in their communities.
  
  
  
  
  
  
  
  

• Every child born is seen as a reincarnated soul.
• If a child dies within three days of birth, no funeral ceremonies are held since the child did not yet have a soul.
• After 3 days of life, a shaman evokes a soul to be reincarnated in the baby’s body. At this time, the child is believed to join human society.
• The family’s ancestors are called upon to join the living in blessing and protecting the baby.
• The baby is then given a silver necklace that is supposed to keep the newly reincarnated soul from wandering.
• Traditionally the Hmong husband delivers the baby with the help of another woman. Then, he must stay home at least two or three days to care for his wife.
• After delivery, the woman must stay inside the house for one month, except to visit her husband’s relatives. During this time, she can only eat boiled chicken with herbs and hot cooked rice.
• When an unwed girl becomes pregnant, the parents build a temporary shelter for her outside of her parent’s house where she can deliver the baby. During the first month after delivery, she cannot enter into anyone’s home but must stay in the shelter. This is so that the mother and the new child will have their own family spirits.

• Hmong families are “child-centered” places where small children are regarded as treasures.
• Sons are valued more than daughters.
• The eldest son has a duty to perform the ancestor worship in the home.
• Brothers and sisters never touch or kiss each other.
• Boys and girls are not free to do what they want.
• Girls are under strict supervision.
• Gender segregation is the common rule in just about every social interaction.
• Hmong parents expect to exercise a high degree of control over their children, which is frequently inconsistent with American beliefs about personal freedom.
• Differences between young Hmong and their parents may create problems.
• Hmong teenage runaways have become a major problem among Hmong and other Southeast Asian refugee groups.

• The Shaman is a person capable of making contact with the spirit world and dealing with it on behalf of others.
• Shamanism - a form of traditional religious practice that many Hmong in the United States continue to hold. (Shaman - in societies practicing shamanism: one acting as a medium between the visible and spirit worlds; practices sorcery for healing or divination. [Source: Webster’s dictionary)]
• Part priest, part sorcerer, magician and seer, healer, prophet, male or female, shamans can enter into a state of trance, travel beneath the sea or among the stars to the northern lights, transform themselves into wolves, seals or monsters, call upon benevolent spirits and fight to the death against malevolent ones, exercise justice, heal the body and save the soul, condemn, forgive, take or give life. Mediums, sages and sorcerers, they act as intermediaries between the world of the living and the supernatural world of shadows and spirits. (Source: Cyber Web definition)

• It is the traditional Hmong belief that when a man dies he will be reborn as a woman and that when a woman dies she will be reborn as a man if she had fulfilled her childbearing destiny in her lifetime.
• Before the Hmong came to America, the death of a family member was announced by firing three shots into the air (by gun or fireworks). This action was also thought to frighten away evil spirits. Today, this tradition is rarely followed by Hmong in the United States because of laws regulating the use of guns and fireworks in populated areas.
• The deceased is washed, dressed in new clothes, and left to lie in state. Mourners bearing gifts visit the home of the deceased, where they are fed by the family of the departed.
• A shaman makes an offering of a cup of alcohol to the dead person and tells the soul that the body has died.
• By performing the ritual, the soul will be provided with the essentials such as: food, water, money and clothing for the long journey it will take.
• Colorful bits of paper, representing money for use in the spirit world, are burned and the shaman tells the soul the route it must follow to get to the ancestors and how to avoid dangers during the journey.

• Folktales and legends have traditionally been passed orally from generation to generation.
• Efforts have been made especially by older Hmong to record and preserve these ancient stories as their younger generation is drawn into the mass media-based American culture.
• Young Hmong Americans, like young Americans of many ethnic groups, are frequently more familiar with the lore of pop culture than with the lore of their ancestors.
• Many Hmong stories convey moral lessons, relaying happy outcomes for honest, hard-working, and virtuous individuals and unfortunate outcomes for evil, lazy, or selfish ones.
• Paj ntaub (flower cloth, Hmong Story Cloths, Hmong traditional needle work) refers to the embroidery, appliqué and batik that explores the changing cultural and contemporary political and social parameters discussing both shared understandings and deeply personal meanings
• Each Paj Ntaub tells a unique story.

• Traditional Hmong methods for healing are based on shamanism, which includes the use of herbal medicines and massage.
• Shamanistic health practices stem from the belief that illness is essentially spiritual in nature.
• Shamanistic view of the world sees reality as composed of 2-parts: the visible (material reality that we see around us) and the invisible (realm of spirits, including the souls of the living, the spirits of the dead, care-taker spirits, malevolent spirits and others).
• Hmong recognize that illness can result from many causes, including natural causes, but they consider the chief cause of illness the loss of one’s spirit or soul.
• Fear, loneliness, separation from loved ones, and other emotional stresses can rip the soul away from the body.
• The “Soul-caller,” who could be a family elder, is one of the most important roles of traditional Hmong health care experts.
• In less serious illnesses, parents or other family members may be able to perform the rituals needed, e.g., if a baby cries in the night, an adult family member may go to the door and swing a burning stick back and forth to light the way for the baby’s soul to return.
• Hmong women are often experts in herbal medicines. This can be a resource for western medicine as it starts to integrate other medical traditions.

• There is a stigma associated with mental health disorders in the Hmong community. To be diagnosed with a mental health issue is not acceptable for many people in the community because it places a label on that individual as “crazy.”

• Western-style health care professionals often have difficulty winning the confidence of Hmong patients because the concepts of illness are different.
• Hmong have the tendency to turn to the traditional Eastern medicines before seeking professional assistance and Western practices.
• Hmong are shy about their bodies, particularly women. This can be a conflict if it is not approached properly.
• Hmong use methods called coining and cupping – both have led to false reports of child abuse since they leave marks.

• America is a nation of immigrants (99.3%)
• Minnesota has been resettling refugees for decades.
• We have 30 years of experience resettling Hmong to Minnesota.
• The Hmong community is vibrant, strong and ready to help new arrivals.
• Africans are currently the largest refugee group to come to the state.

• U.N. interviews for family status
• U.S. interviews to establish refugee status
• IOM (International Office of Migration) pre-departure medical screening
• Initial screening within 90 days of arrival in U.S.
• June-December 2004 U.S. arrivals

• Majority of Hmong were born at refugee camps in Thailand.
• More than 60% of the refugees coming are under age 18, and

• Significant protein malnutrition
• Improper nutrition delays development
• Respiratory illness (possibly environmentally caused)
• Possible TB exposure

• Understand that some new Hmong will see you as the professional and expect you to know it all. The saying: “You are the expert, tell me what is wrong with me.” Be humble.
• They may fear you as the authoritative figure, since most of these people have lived in fear and close scrutiny. Be considerate.
• They will defer to family members that have been in the U.S.A.– and expect them to make the right decisions for them. Be respectful.

• Humility matters. An individual who commits a couple of cultural faux pas’s but carries an open and flexible attitude usually succeeds more at building rapport than someone who is an expert on Hmong cultural norms but conveys arrogance. Without question, it is possible to come across to Hmong people as too authoritative.
• Complementary treatment. Find out what, if any, care is under way. Ask about herbal and other treatments and the sources of the herbs. Find out what condition they are treating with herbs. Look for opportunities to integrate. Ask for a sample.
• Build trust. Health care providers need to establish a relationship with the Hmong family before care begins. Building trust is essential. Providers need to be open to the family's suggestions. Respect those suggestions and show respect for the family.
• Keep it private. Hmong share information among certain clan members. All staff and all interpreters, whether on staff or available from outside the hospital setting, must honor the privacy of patients and their families. This policy needs to be communicated to the Hmong. Do not share information on terminally ill Hmong without first consulting the family.
• Hold a conference. Hold a care conference if there is a major problem or major surgery is needed. The location is important. Hold the session in a conference room, not in the patient's room. Invite all the family's decision-makers-not just the parents--to the conference. It is a very important event. Some participants may not speak English, even if the parents do. Direct your communications to the father.
• Provide a Hmong interpreter. Federal law requires the health care provider to have an interpreter available. Don't rely on a child to interpret. The interpreter needs to act as a neutral party. Make sure a qualified interpreter attends. The Hmong may be fearful and distrustful at the outset. Be very clear and explain everything about the child's condition and intended care. There will be a lot of questions asked afterwards as well.
• Use a normal tone of voice. Watch your body language. Hmong present who don't speak English fluently will listen and learn from the tone of voice used and body language.
• Allow time to get consent forms signed. Doing so may involve discussion with Hmong elders and family members.
• Allow amulets. Allow Hmong to wear them, if possible.
• Address Hmong women properly. Traditionally, it is considered rude to call a Hmong woman by her first name. Refer to her as Ms. or Mrs.
• Remind Hmong about scheduled immunizations. Contact parents to remind them or to schedule the next immunization. Explain why many immunizations are needed.
• Be a patient listener. When you ask them how they got sick, Hmong are likely to give you a long answer.
• Repeat information about medicines. Doing so will help insure Hmong understand.
• Explain purpose of taking blood for tests. Explain what the test is and why so much blood is needed.

• Explain the western medical system
• Foster an environment of trust and welcome
• Work closely with sponsoring families
• Connect patients to primary care providers with expertise in health care for the Hmong:

• Connect patients with mutual assistance agencies