Largest study of Hmong shamanism prompts new patient care guidelines
MINNEAPOLIS / ST. PAUL--In the largest study of its kind, researchers from the University of Minnesota, Creative Theatre Unlimited and UCare Minnesota (UCare) have found that Hmong cultural attitudes and behaviors influence how, why and with whom Hmong Americans access health care in Minnesota. As a result, researchers hope to put in place a new set of guidelines that will enhance cross-cultural medical competence and improve care of Hmong patients in Minnesota.
Gregory Plotnikoff, M.D., M.T.S., medical director of the University of Minnesota's Center for Spirituality and Healing; Charles Numrich, executive director of Creative Theatre Unlimited, St. Paul; Deu Yang, L.P.N., case manager at UCare; and two other local Hmong health care providers have completed a two-year study of 32 Hmong patients and 11 shamans, or traditional healers. Researchers wanted to increase understanding of Hmong healing traditions and how they impact health care choices in Western medical settings, including primary and emergency care.
The study was funded by UCare, a health maintenance organization serving more than 100,000 members enrolled in state public health programs and Medicare, and implemented by Creative Theatre Unlimited.
"Practitioners who work with Hmong patients need to recognize the power of religious and cultural beliefs that either cause or heal illness, and the contemporary role of shamanic healing," said Plotnikoff. "Our study offers clinicians a practical guide to working with this community and suggests that practitioners consider referring Hmong patients to shamans just as they would to clergy."
As a result of the research, a new set of patient interview questions was drawn up to improve the medical community's understanding of Hmong culture and traditions. Study results and suggested patient questions are published in the June issue of Minnesota Medicine, a clinical journal for physicians. UCare, which insures nearly 13 percent of the state's Hmong population, will use the findings to educate its staff and health care providers.
The study found that more than half of the patients interviewed use both shamans and physicians for their health care, regardless of age, gende, or length of time in the United States. Unlike physicians, shamans do not provide physical diagnosis; they treat the spiritual manifestations of acute and chronic illness. There is no contemporary equivalent to shamans in Western medicine.
Patients said they used shamans to restore balance to their bodies and souls and to heal spirituality-related conditions such as stress, unhappiness and fear. They reported seeing Western health care practitioners for such physical illnesses as hypertension, intestinal conditions and diabetes. Shamans reported seeking health care services from physicians and indicated a willingness to serve as a physician referral source to treat Hmong patients.
Study findings reveal the use of herbs and other traditional home remedies that include "cupping" and "spoon rubbing." They also support the essential role of communication between provider and patient. Subjects report that the type of questions asked about their illnesses and religious tradition, and the listening skills of practitioners affect the quality of their visits and overall satisfaction with the level of care.
According to the 2000 U.S. Census, the number of Hmong living in Minnesota has increased 148 percent since 1990. St. Paul boasts one of the largest urban Hmong populations in the world, bringing wide-ranging cultural and religious traditions to the state.
The Center for Spirituality and Healing at the University of Minnesota is a nationally recognized leader in integrating complementary and conventional medicine. Creative Theatre Unlimited's mission is "community building through the arts." The organization has worked with members of the Hmong community since 1982 to assist in the preservation and promotion of Hmong arts and culture. UCare Minnesota is an independent nonprofit HMO established in 1984 by the University of Minnesota Medical School's department of family practice. UCare offers income-based health programs such as Prepaid Medical Assistance and MinnesotaCare, as well as three health plans for seniors.
For more information about this study, call the Center for Spirituality and Healing at (612) 624-9459 or visit www.csh.umn.edu/research.
Gregory Plotnikoff, M.D., M.T.S. Charles Numrich Chu Wu, M.A. Deu Yang, L.P.S. Phua Xiong, M.D. Tonya Femal, Academic Health Center Communications, (612) 625-2640 Kristin Smith, Center for Spirituality and Healing, (612) 624-7669 Elizabeth Bjorkland, UCare Minnesota, (612) 676-3567 Charles Numrich, Creative Theatre Unlimited, (612) 676-3238 Deane Morrison, University News Service, (612) 624-2346