INTRODUCTION
Demographic changes in the Seattle area are having a profound impact on the local health care delivery system. Health care providers need to hear from ethnic communities about their experience in trying to access health care. Offering culturally appropriate care requires being open to the perceptions, realities and expectations of a community that may be different from one's own.
The Cross-Cultural Health Care Program (CCHCP) in Seattle, WA works with health care providers, interpreters and community-based organizations to address these needs. Established in 1992, the CCHCP is funded by a grant from the W.K. Kellogg Foundation. This "Voices of the Communities" profile is one of a series developed by the CCHCP. The profiles and an earlier survey of 22 underserved ethnic communities are part of the CCHCP's effort to provide a forum for underserved communities to interact with the health care community. These profiles were developed by and in consultation with members of the profiled community.
Ethnic group
The Iu-Mienh, known as "Mien" in the United States, is an ethnic minority group of the People's Republic of China. The Mien are mostly known as the "Yao" in China and the rest of Asia. The history of the Mien people dates back as far as 2697 BCE. Today, the Mien live in the People's Republic of China, Vietnam, Thailand, Laos, Burma and elsewhere.
History
The Mien people were among the strongest supporters of the U.S.-backed Royal Laotian government against the Pathet Lao (Lao Communists) during the civil war in Laos. After the fall of Laos in 1975, it was not safe for the Mien people to remain. The majority of the Mien people living in the United States today are refugee immigrants from Laos. Many were afraid to come to the United States because they did not know anything about this country, had no education and could not speak the language.
Social system
Farming and hunting was the way of life for the Mien people in Laos. The Mien had large households with two or three generations living together. No one had access to public education in Laos. A few rich families sent their sons to private school in the city. Females were treated as second class. Wives were considered the property of their husband.
The Mien people have their own system of counting a person's age. Every year has a Chinese name rather than a number. The life expectancy is 60 years; Mien people have birthdays only up to 60 years.
Language
The Mien language uses the same writing system as Chinese. Many Mien people also speak Laotian, Mhong and Chinese. Many Mien live closely with Mhong and Laotians. There is much contact with different nationalities, each learning from the other.
Religion
The Mien people in Laos worship spirits and ancestors. Their worship involves sacrificing chickens and pigs. Their religion is similar to the Chinese religion Taoism. In Laos, a few families were converted to Christianity by missionaries. In the United States, almost half the Mien people are Christian. Among those who are not Christian, traditional spiritual practices are dying out.
Population size and age groups
There are approximately 1,500 Mien people in the Seattle area. The first Mien family arrived in 1978; the majority came in the early 1980s. Many families have relocated to California for security reasons, such as welfare policies.
There are three generations of Mien in Seattle. The first, the elders, are mostly 60 years old or over. Elders account for about 20 percent of the Mien in Seattle. The second generation, ages 40 to 60, make up about 40 percent of the Mien population here. The third generation, the remaining 40 percent, consists of the young people who grew up in the United States.
Community organizations
There are three main community groups. The Iu-Mien Association of Washington State consists of Mien people who came from northern Laos. The Iu-Mien Temple consists of those from southern Laos. The third is the Christian group, many of whom also belong to the Iu-Mien Association. All three groups celebrate the Chinese New Year together.
Traditional healing
Mien traditional practices of medicine are similar to the Chinese. Herbs, roots and certain parts of animals were used to cure sickness. Anything that could not be cured with herbal medicine was usually considered to be the result of an evil spirit. The Shaman (priest) was invited to contact the spirit with an offering of animals to heal the disease.
Medical care
In Laos, most Mien people did not have access to modern medicines or hospitals.
Maternal and child health
In Laos, childbirth took place at home. Pregnant women continued their usual work until giving birth. Birth defects were common and many babies died as a result of disease.
Medical care and providers
Medical practices vary by generation. Mien elders are reluctant to go to the hospital and will go only in an emergency. They feel uncomfortable at the hospital because they do not understand how the health care system works and do not understand English. When they do go the hospital, they expect to be given a prescription or shot to help cure their illness. Often they feel the doctors do nothing to help them. They complain of the long wait and the minimal result.
Like the elders, the second generation of Mien (ages 40-60) tend to avoid going to the hospital because they feel it is a waste of time to miss work when the result of going to the hospital is minimal. They will go only in an emergency. They prefer not to go to the hospital if they can do without.
The third generation, the young people raised in the United States, are more knowledgeable about the U.S. medical system. They tend to go to the hospital more readily than the two older generations.
Privacy
Mien elders and many in the second generation feel uncomfortable about hospital procedures such as undressing for a physical examination.
Mental health
Mien elders believe mental illness is caused by evil spirits. Elders who are Christian, together with Mien in the second generation, believe the cause is depression. The second generation sees depression as the result of being unable to adapt to life in the United States and to control their families and children. Young people's attitudes about mental health vary.
Language and interpreters
Mien elders do not speak or understand English.
Transportation
Transportation is a major barrier to health care for Mien elders. Many cannot drive or take a bus. Their family is usually at work in the daytime. It is inconvenient for the younger generation to miss work to take their elders to medical appointments.
Cost
Finances are the primary barrier in accessing the health care system. The elder generation usually has medical coupons but the second and third generations often have no medical insurance.
Suggestions
The Mien community sees a need for:
Profile prepared by: Paul Y. Chao, 13198 S.E. Newport Way, Apt. L201, WA 98006, (206) 643-3557 (home), (206) 575-6507 (work).
This profile is based primarily on interviews with five leaders and elders in the Mien community and on feedback gathered at a Yiu-Mienh community meeting.
References include:
Buell, Paul D., ed., Edward H. Kaplan, issue editor. Crossroads. Vol. 1, No. 1, Fall 1990.
Chao, Seng Fo. The Iu-Mien and their History. Portland, Ore.
This is a condensed version of the profile. For the complete profile and survey report, please contact the Cross-Cultural Health Care Program, (206) 860-0329.
This "Voices of the Communities" profile was made possible by a grant from the SAFECO Corporation.
January 1996