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Ethnographic Study among Seattle Cambodians: Dizziness

Author(s): Elinor Graham, MD, MPH; Jip Chitnarong
Date Authored: November 01, 1997

Methods

Participants

Three bilingual Cambodian interpreters and twenty-six Cambodian speaking informants participated in the study. Twenty-one were women and eight were men. The interpreters have worked at least three years with non-English speaking Cambodians. Three informants had a high school education in the USA. Most had little to no education in Cambodia. All of the informants lived in Cambodia until at least 17 years of age. Most were raised in rural and urban provincial towns. Two came from the capital city. Their ages ranged between 31 to 71 years. The informants were identified through the Refugee and Children's clinics, and the Community House Calls Program, which provides services to the Seattle Cambodian community.

Data collection

Two focus groups of bilingual Cambodian interpreters were conducted in English. The initial focus group provided primary terms and definitions used in translation for fever and dizziness. The final one assured the quality of translation, reviewed and validated the findings.

Two focus groups and seventeen semi-structured interviews were held with non- English speaking Cambodians. The interviews were done in English with paraphrased and summary interpretation by an interpreter who was trained in interview techniques. The focus groups and the interviews lasted approximately one and a half hours. Handwritten notes were taken and an audiotape was made with informed consent from the informants. Transcripts of the tapes were made. They were edited by the interviewer and the interpreter to verify linguistic and cultural information.

The informants were asked to describe fever and dizziness, their causes, common symptoms associated with fever and dizziness, symptom management, and their worries and fears. The informants associated both fever and dizziness to a syndrome called "wind illness," or known in Cambodian as khyol (pronounced khyol). It was decided that in order to understand fever and dizziness" in the Cambodian cultural context, the study needed to explore the association between fever, dizziness, and wind illness.

Participants

Three bilingual Cambodian interpreters and twenty-six Cambodian speaking informants participated in the study. Twenty-one were women and eight were men. The interpreters have worked at least three years with non-English speaking Cambodians. Three informants had a high school education in the USA. Most had little to no education in Cambodia. All of the informants lived in Cambodia until at least 17 years of age. Most were raised in rural and urban provincial towns. Two came from the capital city. Their ages ranged between 31 to 71 years. The informants were identified through the Refugee and Children's clinics, and the Community House Calls Program, which provides services to the Seattle Cambodian community.

Data collection

Two focus groups of bilingual Cambodian interpreters were conducted in English. The initial focus group provided primary terms and definitions used in translation for fever and dizziness. The final one assured the quality of translation, reviewed and validated the findings.

Two focus groups and seventeen semi-structured interviews were held with non- English speaking Cambodians. The interviews were done in English with paraphrased and summary interpretation by an interpreter who was trained in interview techniques. The focus groups and the interviews lasted approximately one and a half hours. Handwritten notes were taken and an audiotape was made with informed consent from the informants. Transcripts of the tapes were made. They were edited by the interviewer and the interpreter to verify linguistic and cultural information.

The informants were asked to describe fever and dizziness, their causes, common symptoms associated with fever and dizziness, symptom management, and their worries and fears. The informants associated both fever and dizziness to a syndrome called "wind illness," or known in Cambodian as khyol (pronounced khyol). It was decided that in order to understand fever and dizziness" in the Cambodian cultural context, the study needed to explore the association between fever, dizziness, and wind illness.

Translation and Language Equivalents

Dizziness (vilmuk) literally means "spinning face." It was often reported to be one of the symptoms of wind illness and thought to be related to illnesses such as high blood pressure and anemia.

Clinical Features

The informants described dizziness as a result of one or more of the following conditions: disturbance of balance created by sudden changes such as weather changing from hot to cold, deficiencies such as lack of food or sleep, or excessiveness such as overeating; specific health conditions and illnesses such as morning sickness, common cold, anemia, or high blood pressure.

  1. Disturbance of balance

    Wind illness was one of the most common complaints when balance was disturbed whether from the body exposed to sudden change of weather, from lack of food and sleep, or overwork. Dizziness from imbalance in life activities or circumstances was commonly associated with the condition of wind illness described in detail below.

    Factors found to be associated with dizziness were: not having enough blood or iron, losing blood from having blood drawn or having a heavy period, feeling too tired or having low energy, women not getting enough rest after delivery, overeating which caused poor blood circulation, being in an over crowded room, and over worked. A 39- year-old woman said, "I got dizzy when I did not have enough sleep and worked hard. My job was sewing and I had to look at things for a long time."

    Not only physical but mental balance was also important in maintaining a well being. A 70-year-old-man talked about desire, "desire was like an ocean that is never dry. If you like to eat, you always want to eat more. But when you eat it makes you sick. So cut down eating, it will help your sickness. The more desire you have, the more suffering you are."

    The interpreters and the focus groups observed that there were less men than women who complained about dizziness. They thought perhaps men did not want to complain about it if they had it. Women were more likely to get dizzy than men because they were weaker physically, they had less energy, and they lost blood from delivery. Furthermore, women worried about children, and family responsibilities.

  2. Specific health conditions and illnesses

    Common cold, flu, morning sickness, car or bus motion sickness, high blood pressure, and nasal polyps were all reported to cause dizziness.

Concerns Associated with Dizziness

The informants said they did not worry about dizziness that was caused by wind illness. A 47-year-old man said, "if the dizziness is from khyol, it should go away after coining. But if it did not go away, you might have some illness inside you. You should go to see a doctor."

However, chronic dizziness would be managed differently. Persistent dizziness that did not get better after coining and taking Tylenol or Advil should be evaluated by a medical doctor. They also worried about dizziness in a person with high blood pressure. One informant said, "people who have high blood pressure can fall down and become paralyzed and disabled." A 70-year-old man who has high blood pressure and has experienced dizziness shared his story. "I take care of myself by coining and pinching (and taking high blood pressure medication.) But if I feel dizzy and numb on my face, I need to go to the doctor. It is severe."

For more information about dizziness in Cambodians, go to Ethnographic Study of Wind Illness

Health Practices for Wind Illness, Fever, Dizziness

Multiple health practices were used by study informants and were consistent with complex cultural meanings of fever, dizziness, and wind illness. They included traditional, self, medical, and dual treatments.




Wind illness

Coining (cupping, pinching)

Drinking warm fluid

Eating warm rice soup

Keeping body warm with blanket

Avoid bathing

Use of western medicines - Tylenol or Advil (may avoid taking simultaneously with coining in some people)
Fever

Wash or cool forehead with damp cloth if the body is warm

Treatments of wind illness listed above

Going to a western doctor for diagnosis
Dizziness

Treatments for identified underlying illness (ie, anemia)

Treatments of wind illness listed above

Going to a western doctor for diagnosis or using western medicine for illness associated with dizziness symptoms

Discussion

Dizziness (vilmuk) was clearly associated with the folk concept of wind illness or khyol. Our informants had a clear concept of types of wind illness and the illness syndromes each person reported were remarkably similar, as were the traditional treatments recommended. The life circumstances, or external factors which they thought produced wind illness were also very similar among informants.

Conclusion and Practical Implications

Western providers need to be aware that when Cambodians complain of dizziness and fever, they often believe that they have wind illness, a folk illness syndrome common throughout Southeast Asia. Coining is the most common treatment for this condition among Cambodians.