Introduction: Although this work focuses on lowland Lao (Lao Lum), readers should note that there are other ethnic and cultural groups from Laos living in America, including the Hmong, Mien, Tai Dam, and ethnic Chinese from Laos. As with other first generation refugees or immigrants, assimilation has been difficult for many older Laotians.
Religion: Most Laotians practice Theravada Buddhism, with some regional variations, generally according to the area of Laos from which a person originated. Many Laotians also practice a mix of Buddhism and Brahmanism. In either or both cases, what a person does in life rather than his or her beliefs is the central canon. There are also strong elements of animism found among some Laotians. Overall, the basic tenets of Buddhism guide many traditional Laotians. These tenets include the Four Noble Truths:
To follow this path to enlightenment, it is necessary to become and remain a member of the sangha, i.e., a monk. Realistically, few (at least in this life) are able to effectively follow this path, hence there is a focus on rebirth to a better state based on merit or karma (kamma).
Background: Some health care beliefs and practices are related to Brahmanistic and animistic beliefs. Illness may be attributed to the loss of one of the thirty-two spirits (think also in terms of souls) thought to inhabit the body and maintain health. As with other Southeast Asians, "winds" also play a role in health and illness and bringing the winds into balance restores health or well-being. Laotian views of physical and mental wellness are also tied to a person's ability to sleep and eat without difficulty.
Access to care remains a significant problem for many Laotians. Barriers to obtaining and effectively utilizing health and other services include:
Health histories may be incomplete for several reasons, the most basic of which is a reluctance to volunteer information. Such reluctance has its origin in a cultural value of privacy in personal matters, especially related to family, sexual, and illness (vulnerability) issues. Trust or its lack is a major issue.
In general, persons who are sick will look first to the family and/or community for understanding of the problem and treatment. Traditional treatments may be tried first; or, if the loss of spirit is thought to be the problem, a ceremony performed by a family member, elder, or, if possible, an acharn or teacher/healer. The last resource is to seek treatment at a clinic or hospital. Note that traditional practices are often continued while utilizing western medicine.
Traditional treatments or indigenous practices: The following treatments for illness include procedures similar to those used by other Southeast Asians:
Spiritual healing practices: Laotian views of health, illness, and healing are complex and multidimensional, and encompass to a very strong degree, spiritual components. Evidence of the spiritual (or in many cases, spirit) components is seen in several phenomena:
In general - as is so with people of any culture - health care providers should be aware that traditional practices and beliefs of Laotians are dynamic and changing. In some cases, there may be little or no reliance on traditional practices. In other cases, illness will result in a turning back to more traditional practices, especially as it becomes apparent that Western medicine does not have all the answers.
Healthcare issues: Respect for individuals, families, and the culture is critical. Respect includes being polite as most people might define politeness. Respect also encompasses respecting the privacy of individuals, families, and the culture. When a personal question is necessary, it might be prefaced with assurance that the question and answer are not for public discussion. If the information will not be charted, one might say, "This is between you and me. I will not talk about this with anyone else."
Respect also includes explaining procedures and medicines to patients. Traditional medicines are mixed, dosed, and prepared according to individual patient needs. That same model may be expected of Western medicines. It is thus a good idea to explain medications and dosing on an individual basis.
Some Laotians value the relating of symptoms more than the health history. Explaining links between questions or problems will help in eliciting information.
When there is a terminal illness, it is usually a good idea to ask the patient how much he or she wants to know about the diagnosis and prognosis. The entire family will want to be present for the patient's last days. If the patient is hospitalized and is Buddhist, they should be told directly that a monk will be welcomed by the institution. The presence of a monk is helpful to the patient and the family.
Social issues: As noted earlier, significant numbers of Laotians have created more or less traditional communities in the U.S. The extended family is the central social unit within the community. Home and family are headed by the husband or oldest man, with elders of both sexes given great respect.
When visiting a Laotian home one should note the shoes lined up just outside or inside the front door and despite being told "never mind" go ahead and remove the shoes before going into the home. Many homes will have both a mat on the floor and chairs, a couch, etc. It is well to sit on or below the level of the oldest person there. If an older person is sitting on the floor it is impolite for the visitor to sit in a chair.
Laotians tend to be reserved in most interactions (and all health care interactions). Effusiveness and expression of strong feelings - including strong positive feelings - is not valued. As much as possible do not use children to translate for adults. Doing so puts both parties in an untenable social situation of the child showing superiority to the adult.
The head is the highest (literally and figuratively) and thus one should not touch another's head, and preferably not his or her shoulder either. It is generally understood that it is necessary to touch other people's head during the course of some physical examinations. Modesty is highly valued, especially in women from waist to knees - and most especially in younger women.
The traditional means of salutation (coming or going) is called wai, and involves placing one's hands together as if praying and inclining the head. The height at which the hands are held depends on the social or spiritual status of the person being greeted, with the hands held higher for persons of greater status. Western greetings are well accepted, except that many women are not comfortable shaking hands with men.
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