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E. A. Graham, MD, MPH and Jip Chitnarong
Harborview Medical Center, November 1997
A grant from the Institute for Ethnic Studies at the University of Washington funded an ethnographic study on fever and dizziness in Cambodians. These symptoms are common complaints among Cambodian patients seen at Harborview Medical Center.
Methods (In the Ethnography on Fever)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.
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.
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.
Common cold, flu, morning sickness, car or bus motion sickness, high blood pressure, and nasal polyps were all reported to cause 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
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 |
For more information go to Traditional Treatments in Ethnographic Study on Wind Illness
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.
For more discussion, go to Ethnographic Study on Wind Illness
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.
See also: