Oh, East is East and West is West, and never the twain shall meet,
Till Earth and Sky stand presently at God's great Judgement Seat;
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 influences:

  • 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
  • Religion
  • Language
  • Age
  • 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 "no."

Family: The focus is on the extended family - except that there is significant family breakdown after exposure to American culture

  • 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 family members
  • 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.
  • Cultural clashes

  • Choices, freedom - there may be too much of both in America
  • Respect: for age, gender, position - and not enough of this
  • 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 individuals.

    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 concept.
  • 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 Khmer/Cambodian section.
  • Problems

  • 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 disrespectful.
  • 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 problems unsolvable.
  • 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 of home.
  • 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 Buddhists.
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