HospiceCare: Caring for Cultures
HospiceCare Seminar on Hmong Culture
By Laura Salinger
Underneath the umbrella of the already sensitive-by-nature field of hospice
care work, are the varying cultures of the people who seek hospice care. In
the ever-diversifying United States, the cultural fabric of this country is
consistently in flux. When dealing with death, an unsettling subject that many
tiptoe around already, the need to understand different cultures and their
view of the end-of-life process is imperative. That is why HospiceCare Inc.
recently hosted “Insights on the Hmong Culture: A Focus on Healthcare and
End of Life.”
As one of the nation’s newest refugee populations, the Hmong culture is
still often misunderstood. At HospiceCare’s seminar, the goal was to bring
insight about the culture and religion of the Hmong people, while delving into
how the Hmong community approaches healthcare and the end-of-life
process. Charles Vue, the Student Services Coordinator for the UW-Eau
Claire Office of Multicultural Affairs, and HospiceCare staff member Leon
Bernido headed up the discussion which drew a generous crowd to the
Underneath the umbrella of the already sensitive-by-nature field of hospice
care work, are the varying cultures of the people who seek hospice care. In
the ever-diversifying United States, the cultural fabric of this country is
consistently in flux. When dealing with death, an unsettling subject that many
tiptoe around already, the need to understand different cultures and their
view of the end-of-life process is imperative. That is why HospiceCare Inc.
recently hosted “Insights on the Hmong Culture: A Focus on Healthcare and
End of Life.”
As one of the nation’s newest refugee populations, the Hmong culture is
still often misunderstood. At HospiceCare’s seminar, the goal was to bring
insight about the culture and religion of the Hmong people, while delving into
how the Hmong community approaches healthcare and the end-of-life
process. Charles Vue, the Student Services Coordinator for the UW-Eau
Claire Office of Multicultural Affairs, and HospiceCare staff member Leon
Bernido headed up the discussion which drew a generous crowd to the
HospiceCare campus on Madison’s west side.
“For the most part, a lot of healthcare givers do not have an understanding of how the Hmong people have come to America and the
struggles they have had,” says Bernido, an RN at HospiceCare. “A lot of healthcare providers may not understand the challenges they
have faced trying to fit into mainstream society. For us as healthcare providers-clinicians, nurses, and doctors-I think it’s very important
for us to understand where our patients come from. The Hmong people certainly have different needs when they are dealing with the end
of life. Their diet and their spiritual needs certainly are different than the Christian patients we have here.”
One of these differences, according to Vue, is simultaneously a hurdle that health care workers need to overcome. It is a general
sense of mistrust for the Western healthcare process. This sense of mistrust is more noticeable in older Hmong community members
who view religion as integral to the end-of-life process and place much of their trust, when it comes to health and spiritual needs, with
Hmong Shamans.
“Most Hmong may listen attentively to health care professionals, out of respect, but they do not necessarily agree and/or cooperate,”
Vue says. “Some Hmong people will not communicate dissatisfaction with the quality of health care they receive. Instead, if they are
dissatisfied with their care, they may refuse care and turn to traditional treatments.”
Vue says this mistrust of healthcare may stem somewhat from how the Hmong population was received in the United States.
“We came to a country that we didn’t know much about,” he says. “We noticed that we weren’t consistently treated warmly. Some people
were very nice, some were very cold.”
Vue suggests that healthcare workers do a few simple things to gain the trust of their Hmong patients: listen and learn how to
pronounce their names.
“One way to really serve your patient effectively is to be able to listen,” he says. “Build better rapport with Hmong patients and
families by asking how to pronounce their names.”
He also encouraged health care workers to not readily discount the traditions and religious needs of Hmong patients, but instead to
be flexible when it comes to honoring these needs. Vue says that when his mother-in-law had major surgery, his father-in-law wanted
“perfect healing.” This means, among other things, that a shaman must sprinkle magical water on the surgery site. For the Hmong, this is
deemed crucial for healing. For a Western doctor, looking to protect a sterile surgery site, this is a nightmare. Vue and his wife,
however, were able to advocate for her parents and compromise with the doctors.
“My wife and I had to be very diplomatic between the two (the health care provides and his wife’s parents),” Vue says. “We were
able to get what we wanted because we were able to articulate.”
Unfortunately, not all Hmong patients have such formidable advocates for their healthcare. So Vue and Bernido emphasize the
importance of cultural sensitivity in the healthcare profession. First and foremost, they hope to give a little insight on how the Hmong
view death.
“They believe that death is merely a phase people go through when passing from this plane of existence to the next,” Vue says.
“Traditional Hmong view life as a continuous journey.”
“Life is a circle,” Bernido adds. “There is no end.”
The bad news for healthcare workers is that traditionally, the Hmong community does not want to talk about death.
“Talking about death is a curse,” Vue asserts.
However, this does not mean that those facing the end-of-life should not get the best care possible. Honoring the dietary needs of ill
“For the most part, a lot of healthcare givers do not have an understanding of how the Hmong people have come to America and the
struggles they have had,” says Bernido, an RN at HospiceCare. “A lot of healthcare providers may not understand the challenges they
have faced trying to fit into mainstream society. For us as healthcare providers-clinicians, nurses, and doctors-I think it’s very important
for us to understand where our patients come from. The Hmong people certainly have different needs when they are dealing with the end
of life. Their diet and their spiritual needs certainly are different than the Christian patients we have here.”
One of these differences, according to Vue, is simultaneously a hurdle that health care workers need to overcome. It is a general
sense of mistrust for the Western healthcare process. This sense of mistrust is more noticeable in older Hmong community members
who view religion as integral to the end-of-life process and place much of their trust, when it comes to health and spiritual needs, with
Hmong Shamans.
“Most Hmong may listen attentively to health care professionals, out of respect, but they do not necessarily agree and/or cooperate,”
Vue says. “Some Hmong people will not communicate dissatisfaction with the quality of health care they receive. Instead, if they are
dissatisfied with their care, they may refuse care and turn to traditional treatments.”
Vue says this mistrust of healthcare may stem somewhat from how the Hmong population was received in the United States.
“We came to a country that we didn’t know much about,” he says. “We noticed that we weren’t consistently treated warmly. Some people
were very nice, some were very cold.”
Vue suggests that healthcare workers do a few simple things to gain the trust of their Hmong patients: listen and learn how to
pronounce their names.
“One way to really serve your patient effectively is to be able to listen,” he says. “Build better rapport with Hmong patients and
families by asking how to pronounce their names.”
He also encouraged health care workers to not readily discount the traditions and religious needs of Hmong patients, but instead to
be flexible when it comes to honoring these needs. Vue says that when his mother-in-law had major surgery, his father-in-law wanted
“perfect healing.” This means, among other things, that a shaman must sprinkle magical water on the surgery site. For the Hmong, this is
deemed crucial for healing. For a Western doctor, looking to protect a sterile surgery site, this is a nightmare. Vue and his wife,
however, were able to advocate for her parents and compromise with the doctors.
“My wife and I had to be very diplomatic between the two (the health care provides and his wife’s parents),” Vue says. “We were
able to get what we wanted because we were able to articulate.”
Unfortunately, not all Hmong patients have such formidable advocates for their healthcare. So Vue and Bernido emphasize the
importance of cultural sensitivity in the healthcare profession. First and foremost, they hope to give a little insight on how the Hmong
view death.
“They believe that death is merely a phase people go through when passing from this plane of existence to the next,” Vue says.
“Traditional Hmong view life as a continuous journey.”
“Life is a circle,” Bernido adds. “There is no end.”
The bad news for healthcare workers is that traditionally, the Hmong community does not want to talk about death.
“Talking about death is a curse,” Vue asserts.
However, this does not mean that those facing the end-of-life should not get the best care possible. Honoring the dietary needs of ill
Laura Salinger is
a freelance
writer based in
Madison, Wis.
a freelance
writer based in
Madison, Wis.
patients, respecting their spiritual needs (including the use of a shaman), listening to the patients
and their family members, and expecting a lot of visitors for Hmong patients (it is believed they
should family with them at all times) are a few things that Vue suggests will go a long way to
improving the relationship between a Hmong patient and their healthcare providers.
Regardless of cultural background, dealing with the end-of-life process is never easy. In fact, the
Hmong culture is not the only culture that avoids talking about death.
“It’s the last great taboo we have,” says Dan Chin, director of public affairs for HospiceCare. “We
rarely talk about death because it is something we are so uncomfortable with. However, this topic
is going to affect all of us at some point.”
HospiceCare is a formidable partner in easing the fear and pain surrounding end-of-life,
providing the necessary support for those in need of services. Chin qualifies that it is never too
soon to seek out help from HospiceCare for those facing life-limiting illnesses.
“Our mission is to create a community where end-of-life care is expected, accepted and
available to all,” he says.
For 31 years, HospiceCare Inc. has been a nonprofit, community-based hospice dedicated to
providing expert physical, emotional and spiritual support to patients and families dealing with life-
limiting conditions. HospiceCare is nationally recognized for its comprehensive in-home, inpatient,
respite, and residential care, and the hospice services HospiceCare provides in skilled nursing and
assisted living facilities throughout south central Wisconsin. With offices in Madison and
Janesville, HospiceCare serves more than 650 patients each day throughout Dane, Green,
Jefferson, Rock and Walworth counties. For more information visit www.hospicecareinc.com.
and their family members, and expecting a lot of visitors for Hmong patients (it is believed they
should family with them at all times) are a few things that Vue suggests will go a long way to
improving the relationship between a Hmong patient and their healthcare providers.
Regardless of cultural background, dealing with the end-of-life process is never easy. In fact, the
Hmong culture is not the only culture that avoids talking about death.
“It’s the last great taboo we have,” says Dan Chin, director of public affairs for HospiceCare. “We
rarely talk about death because it is something we are so uncomfortable with. However, this topic
is going to affect all of us at some point.”
HospiceCare is a formidable partner in easing the fear and pain surrounding end-of-life,
providing the necessary support for those in need of services. Chin qualifies that it is never too
soon to seek out help from HospiceCare for those facing life-limiting illnesses.
“Our mission is to create a community where end-of-life care is expected, accepted and
available to all,” he says.
For 31 years, HospiceCare Inc. has been a nonprofit, community-based hospice dedicated to
providing expert physical, emotional and spiritual support to patients and families dealing with life-
limiting conditions. HospiceCare is nationally recognized for its comprehensive in-home, inpatient,
respite, and residential care, and the hospice services HospiceCare provides in skilled nursing and
assisted living facilities throughout south central Wisconsin. With offices in Madison and
Janesville, HospiceCare serves more than 650 patients each day throughout Dane, Green,
Jefferson, Rock and Walworth counties. For more information visit www.hospicecareinc.com.