country of about 7000 islands peopled by diverse ethno-linguistic by hcj


									An Asian Cultural
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

       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:

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
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

                               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

                             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)

                             The Thai literacy rate is highest in

                             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,

      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.


   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


   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

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