CULTURAL ORIENTATION: SOUTHEAST ASIAN
- Oh, East is East and West is West, and never the
twain shall meet,
- Till Earth and Sky stand presently at God's great
- But there is neither East nor West, Border, nor
Breed, nor Birth,
- When two strong men stand face to face, tho' they
come from the ends of the earth!
- (Kipling, 1930)
Introduction to Cultural Factors
Culture includes the common "values, norms, beliefs, and practices
of a particular group" (Pickett, 1993, p. 104). Culture is affected
by ethnicity, socialization, religion, and other forces (Spector,
1991), including common experiences. Spector (1991) and Leininger
(1978) give more detailed and expert discussions of culture. Cultural
- Social class and experience
- Social and cultural changes
- Understanding oneself and one's own psychology, culture, and
other issues that affect perception and action
- Assessment of personal and cultural views of health problems:
See last page
Southeast Asians: Differences
Among those one might consider from Southeast Asia are Cambodians,
Lao (lowland and "tribal"), Vietnamese including Amerasians, Thai,
and Chinese from these countries. Differences include:
- Social, educational, and other class differences
- Experiences, e.g., refugee, length of time in U.S.
- Individual, familial, other personal issues
Southeast Asians: Similarities
Communication (If you want to know, you have to ask)
- Expression of feelings, maintaining equanimity and relation to
perception and expression of pain
- Complaints - many are loathe to complain
- Medication effects - rather than inform the nurse or doctor,
some discontinue medications if side-effects experienced
- "How are you?" seldom gets other than "Fine, thank you."
- "Yes" or "no" questions seldom helpful as many avoid saying
Family: The focus is on the extended family - except that
there is significant family breakdown after exposure to American
Family may be involved in decision making - reluctance to make
a decision, e.g., sign a paper, may be due to the need to involve
Gender, age, relationship difference/similarities are
important - thus a woman may not translate for a man; a person of
one social class may be reluctant to communicate with a person of
another, and so on.
Choices, freedom - there may be too much of both in
Respect: for age, gender, position - and not enough of
The great myth of passivity & acceptance of fate: Again
and again one reads that Asians are passive and accepting of fate. In
some cases (when there are no options) this may be so. But when
options and possibilities exist, expect great effort - especially
from more traditional Chinese and Vietnamese families and
Influences on health beliefs and practices (also see
discussions of specific cultures)
The Chinese concept of balance (yin yang) includes food,
drink, illness, medications, or treatment and may be expressed as
"hot" or "cold." Do not expect many lay persons to discuss the
Bodily "humours" such as blood, bile, and phlegm are important
to understanding the basis of illness and wellness. "Wind" also
play a role in health and illness.
Magico religious articles such as amulets, strings, statues
are valued by many, especially Cambodian, Laotian, and Thai.
Spirit possession is a reality for some.
Herbal remedies, traditional medicines are discussed under
Access is still the greatest problem - especially for the poor
- and even for some who are not poor. Western health care systems
are built on different values and belief systems, hence are very
difficult for many to understand (myself included).
The problem of "making it" in America - Many never feel at
home or accepted here.
Living and dying in a strange land that often is uncaring and
Fitting western notions to other people - sometimes it works
and sometimes it does not.
Western medicine: Now we have the answer - Some people (Anglo,
Asian, Hispanic, etc.) think that we really do have the answer to
everything. We don't, of course. Some diseases are fatal and some
Dying and death
Talking about death - many patients and families will not want
to do this
Going home - terminal illness brings the knowledge that at
least in this life, going home is unlikely. It may bring great
comfort to know that ashes will be taken back to Cambodia or
wherever the birthplace. Ask the person who is dying about dreams
Family staying with the patient - Usually there are people who
want to stay 24 hours with a dying patient. Be sure to let people
know this is OK.
The cultural influences of religion, e.g., maintaining
consciousness and "wholesome thoughts" is important to many
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