An Asian Cultural Booklet What is APAMSA? Our primary mission is to promote awareness of Asian health care issues to medical students, health-care workers and the Asian Pacific Islander community and to form a collective voice for issues affecting API's in the public and political arena. In addition, we provide a forum for interested medical students to exchange information and cultural experiences. APAMSA was first started in 1993 by a group of Asian American medical students who wished to provide a forum for the discussion and promotion of Asian health issues. The first national APAMSA conference was held two years later in 1995, and today APAMSA has over 100 chapters throughout the world. In 2003, the APAMSA chapter of the University of South Florida medical school was formed. Our goals are to raise awareness of Asian Pacific health issues in the medical community and in Asian Pacific Islander communities of the Tampa Bay area. For more information about USF’s APAMSA, please visit: www.hsc.usf.edu/medstud/apamsa About this Booklet This booklet contains information compiled from various websites on the internet. Please disregard any cultural discrepancies that you may encounter from the information that we have provided. Shown above is the Laotian national instrument, the khaen, a type of bamboo pipe that has prehistoric origins. The khaen traditionally accompanied the singer in lam, the dominant style of folk music. Two frequently used Lao expressions are the responses bo penh nyang and thammadha. These two words are derived from a Buddhist perspective of acceptance of adverse situation. Bo penh nyang literally means "No problem", but dependent on the situation, it can also mean "never mind" or "are you all right?" or "I forgive and forget your action." The word thammadha means to accept one's fate - that one is born, grows old and will die. In everyday life, it is used to mean "average," "the norm" or "proceeding as usual." For example, if a man is fired from his job, he may not be sad; instead he may be thammada meaning he accepts his fate and does not harbour resentment. The shaman is one of the most important people in a Hmong village. He or she gives people hope in a crisis. The shaman is a spiritual healer who guides a person in difficult situations. In Laos, a village with a good shaman attracted new families. The important role of the shaman continues today in America. Although most Hmong are adapting to American medical customs, they still respect and visit a shaman. The Korean flag is called Taegukki. The central design symbolizes the principles of yin and yang from Asian philosophy of continual movement, balance, and harmony. The upper red section represents the positive cosmic forces of yang, and the lower blue section represents the negative cosmic forces of yin. The circle is surrounded by four trigrams, one in each corner. Each trigram symbolizes one of the four universal elements: Heaven, Earth, Fire and Water. Mental illness is not readily accepted and can be considered as stigmatizing or threatening. As a result, psychological and social stress may be experienced bodily. Hwabyung is an example of a Korean culture-bound illness, common in women. The cause of this illness is suppressed anger or intolerable tragic situations. Symptoms of hwabyung include a perceived stomach mass, palpitations, heat sensation, flushing, anxiety and irritability. Bad medical news is often shielded from the patient. The family may believe that the patient is in no condition to make a decision and that bad news dissolves hope. Because of traditional Korean values of loyalty, the patient may trust that the parents and family will make the best decision for them. Therefore, advance directives may seem unnecessary to the patient and family. Handshakes are appropriate between men; women do not shake hands. Respect is shown to authority figures by giving a gentle bow. Khmer (also known as Cambodian) is the official language of Cambodia. The Khmer language has the oldest written records of any Southeast Asian language in stone inscriptions dating back to the seventh century. Khmer New Year, a harvest festival celebrated every April, is the biggest festival of the year. It is a three-day festival. Pregnant mothers may drink homemade rice wine, herbal medicines, coconut water, or beer which are all thought to make the baby healthy. Some things to avoid include showering at night and drinking milk as these will make the baby fat and difficult to deliver. Smoking is part of Cambodian tradition culture. Cigarettes are to be included with the offerings made to a monk, given to guests at wedding receptions and provided to houseguests. Cambodians have beliefs that conflict with medical practices and procedures such as blood drawing, genital exams, x-rays, and surgery. For example, they believe that any blood drawn from them is not replaceable. Another example is the belief of X-rays destroying red blood cells, and these cells could not be regenerated. As for surgery, it is considered to be terrifying and is the last resort; therefore, Cambodians are very frightened when being hospitalized for surgery, and elective surgery is not an option. A Cambodian patient will seek a doctor who gives medications, because it makes them feel as if the illness is being taken care of when the doctor gives out drugs. Also, many times, these medications are shared among friends and family. They will take the drugs when they feel sick and stop when the symptoms go away. The individual also expects the drugs to be effective immediately. Treatment for chronic disease can be a problem in this population. Traditional Chinese will use herbs and special soups for all illnesses before he or she seeks out an alternative treatment from Western medicine. The herbal tea and the special ingredient soups usually require hours of slow cooking in an ancient style clay pot, before they reach maximum benefits. Western medicine is often reserved for more severe health problems, as many Chinese believe that Western medicine is "too strong" for them. Pregnant women usually want to eat to get the energy before going through the labor. This contradicts Western culture, where eating is avoided for fear of nausea and vomiting. There are rules that a woman follows during her postpartum period, called the “sitting month”. During this time, women are not to take baths, wash their hair, go outside in the cold temperature, drink ice water, or eat cold food like uncooked vegetables, salads, or fruits. The reasons behind these restrictions are based on the belief that women are undergoing a cold stage right after the delivery due to loss of blood. In order to restore the energy, women need to consume food that are considered "hot" such as soup and ginger. On the other hand, in Western culture, cold food such as orange juice, ice water, cold sandwiches, and ice cream are routinely offered to women during their inpatient stay. Thus, hospital food is usually left untouched and these women will have food brought in from home. The three main ethnic groups living in Malaysia are the Malays, Chinese, and Indians. The largest, accounting for more than half of the total population today, is the Malays. Perhaps the most significant influence that has served as a unifying and binding factor among the Malays is the religion of Islam. Today, almost all Malays in Malaysia are Muslims. The official language in Malaysia is Bahasa of the Malays; however, English is used when communicating between different communities. Silat, the Malay art of self-defense, enables a person to defend himself when being attacked. The aim of silat is to instill confidence in oneself in the face of adversity. Occasionally, a keris (small dagger) may be used. Wayang Kulit is a traditional theater art- form using puppets and shadow-play to tell the epic tales of the Ramayana. The puppets are made of buffalo hide and mounted on bamboo sticks. There may be as many as 45 puppets - handled entirely by a single master puppeteer, known as the Tok Dalang. Hanuman, the magical white monkey warrior in Rama’s simian army, is probably the best known monkey character in Ramakien, the Thai version of the Indian epic Ramayana. He has become a hero for Thai children. Thailand was the only country in Southeast Asia to remain independent during the colonial period. In 1939, it is officially known as "Siam" (now Muang Tai, "Land of the Free," or Pratet Tai, "Free Kingdom"). Thai culture has been strongly influenced by both China and India but is more so by Indian culture based on Buddhism and using a version of the Devanagari (Sanskrit) alphabet. The Thai literacy rate is highest in Asia. Yee Peng is the annual festival held to celebrate the full moon in the Thai Baby Names northern capital of Chiang Mai in Kasem Happiness M November. The highlight of the event Aran Forest M is the launching of the Khom loy or Daw Stars F floating lanterns into the night sky Kovit Expert M with the belief that misfortune will fly Mali Flower F away with the lanterns. It is also Niran Eternal M believed that the light will guide the Phailin Sapphire F people to the right path of their lives. Ratana Crystal F Solada Listener F Suchin Beautiful Thought F Sunee Good Thing F Tasanee Beautiful View F Vanida Girl F Virote Power According to the 2000 census, there are over 1.6 million people of Asian Indian origin in the United States. India is a boiling pot of religions and beliefs. Hinduism is the predominant religion of India followed by Islam. Other religions of India include Sikhism, Buddhism, Jainism, Christianity, and Judaism. The national language is Hindi, which is spoken by 40% of Indians. Most Indians, however, speak another dialect, such as Urdu, Gujurati, Punjabi, etc. Most devout Hindus practice vegetarianism. Vegetarianism among Hindus is based on belief in reincarnation, the idea that the soul of a person enters back into creation as a living being. Meditation and prayer are used by many Hindus. Some meditate silently, while others chant "Om" and other prayers aloud. Karma is a law of behavior and consequences in which actions in past live(s) affects the circumstances in which one is born and lives in this life. Thus, a patient may feel that his or her illness is caused by karma (even though there may be complete understanding of biological causes of illness). The Bindi is a sign worn by many women of the Hindu faith as a red dot on the forehead. Traditionally a symbol of honor and intelligence, today, it is common for women to wear it as decoration. The care provider should assess the client’s personal reasons for wearing the Bindi, since it may vary for women depending on age and assimilation into American culture. Many Indian women will look to their husbands or fathers to help them make important medical decisions. There are about 800,000 Japanese Americans according to a 2000 consensus. The major religions of Japan are Buddhism and Shintoism. A large majority of Japanese Americans live in California and Hawaii. The main diseases that afflict Japanese Americans are coronary heart disease as they adapt the Western diet. Filial Piety. In Confucian thought which places importance on family and social order, filial piety was felt to be extremely important. Children were expected to obey and respect their parents, bring honor to their parents by succeeding in work, and support and care for parents in their old age. Additionally, for many Japanese immigrants, “kodomo no tame ni” or “for the sake of the children” became the motto by which they endured to bring a better life standard for their children’s generation. Thus an element of expectation from parents and a sense of obligation on the part of the children to support and care for their parents may exist. Even though adequate care may be difficult to render by the children, reluctance is often accompanied by guilt if parents are placed in an institutional long-term care facility. Informed Consent and End of Life Care. It is a common saying that Japanese are born Shinto but die Buddhist. In Shintoism, the emphasis is on purity and cleanliness. Terminal illnesses, dying and death are considered “negative” or impure and akin to “contamination.” Thus, open frank discussions that occur with informed consent procedures, choices in treatment, and advance directives may be difficult at first. However, at some point most Japanese are said to embrace Buddhism in later life. As such, death is considered a natural process, a part of life. Life continues after death in the form of rebirth. They may be more open to end-of-life discussions. Conversion to Christianity or other religions would certainly have some impact on views of death, dying, and end-of-life issues Traditionally, organ donation is not favored because of the importance of dying intact, and because the concept of brain death, as opposed to death occurring “naturally” when the heart ceases to beat, is sometimes difficult to understand. Mental Illnesses. There is a general stigma associated with mental illnesses. Thus, there is less seeking of direct medical assistance by either the person afflicted or by their family. There is the concept of shame or “hazukashii”, in which the individual is taught to avoid bringing shame to his family name. Family and Friendship Family is very important to the Filipino. Parents generally set up their children with whatever they can afford so buying them their first car and first home is very common. In turn, adult children are expected to live in the same home and take care of their parents when they get older. Face Similar to other Asian cultures, the Filipino puts great emphasis on saving face for himself and other people. For example, when invited to an event, a Filipino will easily say yes even if he has no intention of going—to save the inviter’s face. He would not state a contradictory opinion directly, instead phrasing his opinion as a question or just keeping silent. Faith The main religion is Roman Catholic. Fiesta and Food Filipinos are a happy-go-lucky, life- loving group and will give a party at the drop of a hat. The roast pig is the ultimate symbol of lavishness. Three “Waves” of Refugees Traditional Medical Practices The First Wave. In 1975, 130,000 Vietnamese fled The mountain dwelling groups believe that sickness to the US. They were mostly young, well educated, comes from the wrath of the gods. The physician is and English speaking urban dwellers. Fifty-five a priest who negotiates with the gods to eliminate percent were Catholic and many brought their the sickness. These groups often resist invasive families intact. Most stayed at military bases until techniques, and women often refuse anesthesia for sponsors helped them resettle. childbirth. The peasant groups and urbanites from Vietnam The Second Wave. Between 1979 to 1983, employ a medicinal system based on Chinese 455,000 SE Asian refugees settled in the US. This medicine. Many believe that traditional herbal group was more diverse and included people with remedies, tonics, massage, and avoidance of different nationalities, religions, and languages. excess are the pathways to good health. They were less educated, less literate in their native language and in English, and more rural. Hoards of Dermabrasive procedures based on hot/cold people attempted escape by boat. physiology are often used to treat cough, myalgia, headache, nausea, backache, motion sickness, and The Third Wave. These refugees arrived from other maladies. To release excessive air, cutaneous 1985 to 1991 and continue to do so in small hematomas are made over the face, neck, anterior numbers. They are Vietnamese and Chinese and posterior trunk. This can be achieved by brought to the US through family reunification pinching on oiled skin with the edge of a coin (cao programs. gio) or by cupping (giac hoi or hut hoi). Cupping involves flaming a cup, placing it on the skin, and as What the physician should know: Your the air in the cup cools, it pulls on the skin and Vietnamese patients may be rural people from the leaves an ecchymotic area. second wave and have difficulties learning to read Acupuncture is used widely for musculoskeletal and write a second language because as farmers, ailments such as arthritis pain, stroke, visual many were not literate in their native Vietnamese. problems, and other ailments. Interpersonal Relationships Praising someone abundantly is often regarded as flattery or mockery. Insults to elders or ancestors are very serious and can lead to severed social ties. Experience with Western Medicine From experiencing poor living conditions during the war and in camps, little access to healthcare, starvation, and abuse, many Vietnamese came to the US with severe health problems such as TB, hepatitis B, malaria, malnutrition, anemia, leprosy, and intestinal parasites. In the US, poverty, crowded living conditions, and lack of utilization of healthcare still pose health risks. Many refugees may suffer from PTSD, depression, anxiety, psychosis and adjustment reactions. In traditional Vietnamese culture, it is not acceptable to discuss stress or emotional disorders, so many with these disorders present initially with somatic complaints.
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