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Koreans culture health refugees immigrants


Introduction

Korea is a peninsula divided into northern and southern regions.The northern part of Korea (The country, North Korea or Democratic People's Republic of Korea) is bordered by the People's Republic of China and South Korea. The east and south coasts of (South) Korea or the Republic of Korea are surrounded by the Sea of Japan, or as it is referred to in Korea, the East Sea. Hereafter, at least in discussions of culture, we will not differentiate between South and North Korea, unless otherwise noted.

Korea has a unique cultural and artistic history, including invention of the first moveable metal printer. From about the17th to the 20th century Korea was a vassal state of China; and was under Japanese rule and control from 1910-1945. Following World War II Korea was divided into Russian and U.S. zones. In 1948 separate regimes of some independence were established. The Korean War between the northern and southern regimes as well as the United Nations (especially the U.S.) and China lasted from 1950-1953. When the war ground to a halt, the 38th parallel demilitarized zone or DMZ was established as a border and has been in place since then. The DMZ serves as an ongoing symbol of the Cold war. Today, there are approximately 40,000 American soldiers guarding South Korea from communist invasion.

The effects of the Cold War can still be seen as North Korea is communist, very poor, and isolated from most of the rest of the world while South Korea has a vibrant economy and far more open society. South Korea is now the sixth largest trading partner of the US. There are about 25,000,000 people in North Korea and 46,000,000 in South Korea.

There has been Korean immigration to the US since before the Korean War. There were numerous people who came to the US after the war and those who did so suffered a great deal of social stigma and resentment from the people who remained behind. The main influx occurred in 1972-1975. In the United States, Koreans are one of the largest groups of Asians. In 1999, the Bureau of the Census reports there are 837,000 Korean-Americans residing in the U.S. Estimates indicate that by the year 2000, one million Koreans will live in the US.

For the most part, Koreans are concentrated in just a few states: California, New York, Hawaii, Illinois and Texas. Los Angeles County contains the largest Korean community in the US. The median age of Korean-Americans is 29 years with only 6% of the population over the age of 65.

Korean-Americans are diverse in their paths taken here in the US. Many have established businesses in areas that socio-economically marginal. Others are successful in academic and related achievements. More traditionally-minded Korean-Americans believe that the right school is the stepping stone to achieving the American dream and migrate for that reason alone. Parents may exist on minimal income and work tedious and demanding jobs with an overriding life focus of sending their children to the best possible schools.

Spirituality

It is not uncommon for a Korean to encompass several spiritual views into a religious belief system. Among the religious views embraced by Koreans are Confucianism, Shamanism, Taoism, Buddhism, and Christianity.

  • Confucianism originated in China as religion and/or philosophical system. Confucianism was the official Korean religion from the 14th to the 20th centuries. Teachings formulated by Confucius emphasized devotion to parents, family, friends, and ancestral worship. Also central to Confucianism is ethicality and the maintenance of justice and peace.
  • Shamanism is the belief in good and evil spirits that can be influenced by Shamans, i.e., religious/spiritual practitioners with special relationship or insight into the spirit world. All aspects of nature are seen as having spirit, including rocks, trees, plants, animals, and inanimate objects. When a family moves into a new home or a new business is begun, Shamans may be called upon to protect the enterprise from evil spirits. Another belief related to the spirit world and ancestry is that misfortunes occur because ancestors are unhappy. The correct burial rituals following the death of a relative are thought to ensure a good fortune for the family. Some Korean-Americans maintain places (shrines or alters) in their homes where they are able to honor their ancestors in the traditional ways.
  • Taoism is a philosophical/religious system based on the doctrines of Lao-tse who lived in China in the 6th century BC. Taoism advocates harmony, simplicity, and selflessness.
  • Buddhism, which was also founded in the 6th century BC, is a religious and philosophical system based on the teachings of Gautama Siddharta (also spelled Siddhartha), the Buddha (in Sanskrit, "The Awakened," "The Enlightened"). The branch of Buddhism most commonly practiced by Koreans is Mahayana Buddhism, or the "greater vehicle," which also is practiced in Vietnam, China, and Japan.
  • Christianity was introduced in Korea by Catholic and Protestant missionaries. In the U.S., there are Korean-congregations of all denominations. In many cases, the church acts as a powerful support group, with services including income tax preparation, English education classes, health education, job availability, assistance with elderly family members, and information about U.S. citizenship.

Such diversity among Korean-American spiritual beliefs requires that assessment precede implementation of any type of spiritual care.

Communication

The language spoken in Korea is Han-gul, which originated in the fifteenth century with King Sejong. Han-gul is thought to be the first phonetic alphabet in East Asia. Research shows the Korean language to have a sense of belonging to the Ural-Altaic languages, which include Turkish, Japanese, Mongolian, and Tungus. The Korean language has also been tremendously influenced by Chinese. On its own, the Korean language consists of fourteen consonants and ten vowels. However, more than half of the words used originate from Chinese. The multiple Korean words with Japanese and Chinese origin originated from the long history of control by China and the annexation of Korea by Japan from 1910-1945. The Japanese forbade public use of the Korean language and required the use of Japanese written and spoken language.

There are different communication styles with various vocabulary and verb endings in use among Koreans. This aids in the delineation of social rank or familiarity of the people speaking. When abroad, Koreans are likely to behave in a reserved manner until they are able to conquer the language of the country and feel connected to the individual to whom they are speaking. It is culturally unacceptable and disrespectful to assume familiarity between acquaintances too soon and to address others by their first names unless the person is a family member or well-established friend.

Another important aspect of Korean communication is the use of nonverbal communication. A common characteristic of Korean-Americans is a reluctance to make eye contact. This is especially true between people of different genders, ages, and social status. However, among familiar persons, eye contact and speaking in the first person may feel more comfortable. Confucianism teaches that "silence is golden." Therefore, many Koreans are comfortable with moments of prolonged silence throughout their chores and daily activities. Meaningful conversation is highly regarded while small talk is seen as pointless. Communication of feelings through facial expressions is uncommon. Smiling and joking are activities that are acceptable only in certain situations under certain conditions. Otherwise, these expressions demonstrates a lack of intelligence and respect.

The concept of Kibun is of great importance in understanding Korean relationships. The definition of Kibun does not exist in the English language but the close equivalents are mood, feelings, and state of mind. Through the maintenance of one's Kibun, an inner, peaceful environment is maintained. It is the responsibility of those persons interacting in one's life to assess that person's Kibun so they can meet needs and communicate effectively. This unique assessment is called nunchi. The state of Kibun is easily disturbed, such as when a young person shows irreverence to an elder.

Another communication issue of importance is touch and interpersonal space. Over-familiar touch is poorly tolerated by many Korean-Americans. In public areas, Korean-Americans accept touching which may occur when it is due to situations of overcrowding. However, in family situations, physical expression of love through hugging and kissing is infrequent. When it is initiated, touch is begun by the elder person and the younger person is then allowed to exchange the touch. In relation to health care, touch in the process of providing care is accepted because it is required for the improvement of one's health. "Therapeutic touch" is less likely to be accepted.

It is necessary to acknowledge and respect Korean communication patterns when in contact with patients in the health care setting to promote rapport and ensure compliance.

Education

There is a high value on education by traditional-minded Koreans and this is due partly to the influence of Confucianism, which emphasizes strong family ties and structure. Often, teachers are seen as extensions of the family. It is believed that after the Korean War, there was much emphasis placed on education in order to strengthen the country's potential for economic growth and development. Increased education was also believed to be the way to progress in society and status. This explains the reason why parents will sacrifice all they have to send their children to prestigious schools. Korean-Americans have a very strong work ethic that emphasizes hard work and devotion to the family. A student's study habits are geared by this same work ethic since obtaining an education is also seen by many as an occupation.

Family and Social Roles

For Koreans, there exists a strong belief in filial duty - treating parents with respect and obeying them, caring for them when they are old, giving them a proper burial, and even worshipping them with ceremonies after death. All of these are incorporated into the fundamental ideas of strong kinship values and family ties from Confucianism.

In the traditional Korean family, father and sons are the heads of the household and decision makers while women are viewed as "outsiders" whose position in the family is inferior since she ends up leaving the family to marry into another family. The eldest son is the one who inherits the family leadership and wealth. He also has the responsibility of caring of the parents. Younger sons typically leave the family home but lived close by and still under much influence and control by the leaders of the family. Men are the financial providers, often working outside the home. Females in traditional families typically have no identity or role other than protecting the family she is identified with and being a suitable wife. Wives are expected to stay home and care for the children and do household chores. It is also a primary concern of the wife to provide the family with a male heir as this is seen as the primary method for ensuring continuity of the family line.

In the U.S., 82% of the Korean-American families are headed by a man and his wife while only 12% are single, female head of households. In Confucianism, there are five moral codes and three moral bonds that are held central to relationships and stress the need of harmony and order. These apply especially in the family structure.

Children are indulged until school age. At that point, proper behavior is a must as mischievous children are seen as a disgrace on the family. Discipline is withheld longer that typically seen among native Americans. Boys and girls are separated before puberty. The male children may receive more educational resources while the females seen as ones that will eventually leave the family. All children are taught the strict respect of their elders including older siblings. As students, one is taught to listen and not to question the teacher who is seen as an authority. Overall, children are to be seen and not heard. It is found that children raised in America with American culture have great conflicts with their traditional parents as beliefs begin to clash. Children with disabilities are seen as a punishment on parents from the ancestors. Very little support is available to these families in Korean communities.

Arranged marriages, although not common, still occur. Many Korean youth are so deeply involved in their studies that little room for the adolescent to develop American-style socialization skills. Therefore, it is common for these young Koreans to look to the family for guidance in finding a mate. This may include the meeting of some prospective spouses or the actual choosing of the person. Anytime a marriage is looked down upon, it is blamed upon the woman. These situations include a marriage to a non-Korean especially an American serviceman, and more so in the case of divorce. Divorce is unacceptable in an arranged marriage as it is seen as a disgrace on the two families who brought the couple together. Homosexuality is also not allowed, hence usually remains hidden so as to not cause the family to be ostracized by the Korean community.

Diet and Nutrition

Among Koreans The typical (traditional) diet is mostly vegetables, with rice the main staple along with vegetables and small amounts of meat. The sugar, fat and caloric intake are usually lower than other groups in the U.S. Three meals per day are usually eaten in silence, with breakfast viewed as most important. Ginseng, a common additive, is seen as possessing healing and other powers. Common seasonings include garlic, ginger, red and black pepper, soy sauce, green onion, and sesame oil. Kimchee, a hot, fermented cabbage, is eaten as a condiment. It is common to offer food and drink to visitors but important for visitors to not accept upon first asking; respect is shown by allowing several offers before accepting.

Health Care Beliefs and Practices

World Health Organization (WHO) data shows that the disability adjusted life expectancy (DALE) of Koreans (living in Korea) is 65 years overall (men and women). DALE measures the "expected number of years to be lived in what might be termed the equivalent of 'full health'" (WHO, 2000).

Among older or tradition-minded Koreans, illness is often seen one's fate and hospitalization may be seen as sign of impending death. Illness is sometimes attributed to disharmony in the natural forces, e.g., yin and yang. Yin gives way to "cold" illness such as depression, hypoactivity, hypothermia, abdominal cramps and indigestion. Yang guided health includes hyperactivity, hyperthermia, stroke and seizures. Treatment of hot/cold illnesses is through the use of the opposite force to achieve balance. For example, the common cold is treated with hot soup made from bean sprouts. Congestion is cleared by adding dried anchovies, hot spices and garlic to this hot soup. Another health concern is the kior chi force, which is the life-force of the body. Withdrawing blood, sweating and sex are seen as reducing of this force

Common health related practices include the use of herbs, acupuncture, cupping and moxibustion which is the burning of a soft material at specified spots (corresponding to internal energy channels) on the skin. In Korea and in large Korean communities elsewhere there are herbalists and herb shops. Traditional medical treatment is based upon physical assessment and observation of behavior; then utilizing metaphysical and cosmological means of treatment. Medical treatment addresses curative aspect more than preventive practices, although health promotion is becoming more encouraged. The physician is seen as powerful and very trustworthy.

DNR orders would be common since prolonging life is seen as unacceptable. On the other hand, discussing a person's terminal status is resisted. Organ donation and transplantation is seen as a disturbance in the integrity of the body. Much of a patient's care is provided by the family while hospitalized. Pain responses vary from openly expressing to stoicism. Family and friends can provide a great deal of information on how the patient copes with illness and pain.

There is much stigma attached to mental illness. Hwanbyung is a traditional illness that arises from suppressed anger or emotions that usually stem from conflicts with the family. Symptoms include headache, decreased appetite, insomnia, and decreased energy. This illness is seen as fate and the cure is more management and treatment of the symptoms only.

Pregnancy and Childbearing Practices

The South Korean government formerly required that households limit their number of pregnancies to two children. This was promoted through the use of contraception which is taught by and available through government agencies. However, in recent years, the falling birth rate has resulted in the government now encouraging more pregnancies. Children receive minimal teaching about sexual practices. The only formal instruction received concerns the menstrual cycle, which is taught to the females only.

During pregnancy women are taught to avoid certain foods and smoking. Introversion is common during pregnancy. The woman begins pregnancy with the Tae Mong, a dream about the conception of the child. The woman focuses on Tae Kyo during pregnancy and avoids unpleasant thoughts. This practice is believed to be the education of the fetus and during this time the woman focuses on art and beautiful objects. Women usually give birth in the supine position much like the Western methods.

Death Rituals

Traditional Korean belief values dying at home. If the person has died in the hospital, it is considered a misfortune to bring that person's body back to the home. However, death at home includes keeping the body present for at least several hours for viewing and showing respect. Korean-Americans are more accustomed to reserving a place in the home where pictures of the deceased may be looked upon. Cremation is typically performed on those who do not have relatives and their ashes are usually dispersed over a body of water. Respect for the dead is shown by an outward display of grief which is expressed through moaning and rituals with crying. It is an obligation of the eldest son to remain near the deceased and to moan to display his emotion. He must also hold a cane to signify his need for emotional support during this time.

Folk Practices

In addition to practices discussed above, a shamanistic health practice for healing the body and soul is hanyak, which is the use of herbal medicine to create personal harmony. Shamans are consulted as a last resort for treatment or spiritual option, but their services are not related to hanyak. Although shamans provide profound spiritual services to people, they are considered part of the lowest class by Koreans.

Health Risks

Common health risks/problems of Koreans in the U.S. are listed below. Also see the Infectious Diseases section of Refugee Health ~ Immigrant Health.

  • anemia
  • osteoporosis and decreased calcium intake
  • spontaneous hypoglycemia - insulin autoimmune syndrome
  • parasitic infections from raw foods
  • liver cancer and hepatitis
  • diverticulosis or inflammatory bowel disease
  • peptic ulcer disease
  • CVA
  • hypertension
  • hypercholesterolemia for Korean-Americans eating high fat American diets leading to obesity, coronary artery disease and other cardiovascular disease
  • circulatory effects from alcohol consumption including facial flushing, palpitations, and other unpleasant effects
  • vitamins A and C deficiencies
  • protein deficiency is common
  • gum and oral disease
  • lung disease and TB
  • alcoholism and tobacco abuse

Comments on Caring for Korean-Americans

  • Encourage health promotion because Korean-Americans have typically focused on curative rather than preventative measures.
  • Allow the family to care for the patient. In Korea, patients do not typically have long-term stays in the hospital and are usually released to the care of their family at home, for both acute and chronic illnesses.
  • Be aware of the use of herbal medicines and assess for there use to prevent drug interactions.
  • Assess for the use of alternative forms of healing like acupuncture that they might currently be using or have used.
  • Collaborate with all persons involved in the patient's health care, i.e. herbalist, dietician, etc.
  • For language and cultural barriers, have an interpreter available. Be aware of communication styles and patterns such as: no eye contact, smiling in inopportune times represents lack of respect and intelligence, and family as a good resource for how the patient may respond to pain and illness.
  • Korean-Americans do not traditionally use social workers since there really is not that kind of job available in Korea. Encourage patients to use personal resources such as the church; and also encourage use of of the social worker when appropriate.
  • In Korea, since physicians hold a higher status, nurses are expected to carry out the orders explicitly.
  • Provide teaching instructions in varying forms such as spoken word, written and pictorial. If possible, written instructions could be provided in Korean or demonstrations for treatments can be used.

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Authors: Tanya Beller, Michelle Pinker, Sheila Snapka, Denise Van Dusen

Reference

World Health Organization (2000). Healthy life expectancy rankings. Accessed on the World Wide Web on October 14, 2000 at http://www-nt.who.int/whosis/statistics/dale/dale.cfm?path=statistics,dale&language=english