Author(s): Pamela LaBorde, MD
Contributor(s): Binh Duong, Program Manager, Division of Refugee Assistance at the Department of Social and Health Services, Olympia, WA; Many Vietnamese community members. Diem Nguyen contributed photos.
Date Authored: July 01, 1996
Last updated: December 2010 by Oanh Doan and Sarah Gruen\
Vietnam occupies the eastern coast of the Southeast Asian peninsula. It is bordered by the South China Sea on the west and south, China to the north, and Laos and Cambodia to the west. The terrain of Vietnam is varied, with mountainous regions, thick forested areas, and lowlands leading down from the rugged mountains to coastal plains and river deltas. Major Vietnamese cities include Hanoi in the north, Da Nang in the mid coastal region, and Ho Chi Minh City (formerly known as Saigon) to the south.
Population of Vietnam
In 2000, the population of Vietnam was 78.5 million people. The majority Viet (Kinh) people account for 87% of the country’s population and mainly inhabit the Red River delta, the central coastal delta, the Mekong delta and major cities. The other 53 ethnic minority groups, totaling over 8 million people, are scattered over mountain areas (covering two-thirds of the country’s territory) spreading from the North to the South. These groups include the Tay, Thai, Muong, Hoa, Khmer, Nung, Hmong, Mien, Cham, Brau, Roman, and Odu (Embassy of Vietnam, London/United Kingdom, 2007).
History and Politics
Vietnamese culture is very complex, in part due to the participation of many groups in Vietnamese history. The earliest known inhabitants of the Indochinese peninsula were Austronesian tribes that migrated north from the islands of the South Pacific. The Khmer (people of Cambodia) are thought to have migrated east from India, the Laotians came from the highlands of China’s Yunan province, and the Vietnamese came south from the lower Yhangtze valley. The newer arrivals settled in the rich delta areas and coastal regions, forcing the Austronesian peoples into the mountains. Their descendants formed the diverse mountainous tribes. Many of these exist today.
The first Vietnamese believed they were the descendants of a dragon and an angel. They brought their economy based in rice farming with them from China. Rice production requires complex irrigation and collective farming, which led to the development of a strong sense of community in Vietnamese villages. Their first recorded history begins in 208 B.C. when Trieu Da, a defiant Chinese general, established his own empire of Nam Viet, which included northern Vietnam. Later, in the 1st century B.C., the Han dynasty expanded and incorporated Nam Viet into the Chinese empire as the province of Giao Chi. This was the beginning of a long Chinese occupation and domination.
Despite more than a millennium of Chinese occupation, the Vietnamese retained a strong and separate identity. There were numerous revolts against the Chinese (two of the most legendary in 40A.D and 248 A.D. were led by women), but none found lasting success until the tenth century Emperor Dinh Bo Linh called this new state Dai Co Viet (the Kingdom of the Watchful Hawk) and won Chinese recognition of independence with regular payments of tribute.
In the fourteenth and fifteenth centuries, the Vietnamese themselves became expansionists and they conquered Champa, an Indianized kingdom in central Vietnam. This campaign depleted the Vietnamese kingdom’s resources, and they again fell to the Chinese, this time to the harsh rule of the Ming dynasty. Again the Vietnamese revolted and won independence under Le Loi, a Vietnamese cultural hero. This independence lasted for the next four hundred years. The initial years of this period saw the establishment of unusually liberal legal codes that protected ordinary people from mandarins and allowed women to own property.
A lack of political cohesiveness between the north and south is not a recent development. The Mekong delta, which had been under Cambodian control, was seized in the sixteenth century by a Vietnamese clan who was constantly fighting a clan to the north. This conflict divided Vietnam at about the seventeenth parallel (the same division between North and South Vietnam in the twentieth century) and lasted for the next two hundred years.
The Portuguese were the first Europeans to sail to Vietnam in the mid-sixteenth century. Later the Dutch and English established small trading centers. The Catholic church, first through the Portuguese and later through the French, won many converts among the Vietnamese, despite many emperors’ efforts to eradicate the religion.
Significant French influence in Vietnam started in the seventeenth century. In 1627 a French missionary adapted the Vietnamese language to the Roman alphabet to create a writing style called quoc ngu. By the mid-nineteenth century, the French had gained control of Vietnam. Throughout French occupation there were pockets of Vietnamese resistance, but the efforts were not unified.
Under French rule, Vietnamese were second-class citizens. Even the highest ranking Vietnamese made less than the lowest ranking Frenchman. Many people were displaced from their lives as rice farmers and forced to work under horrible conditions in rubber plantations and coal mines. Though a Confucian system of education was well established, this was replaced by a French system where students had to read and write French or quoc ngu (even though about 80% of the population was literate with Chinese ideographs). It was during this time that resistance to French occupation solidified, and a young man named Ho Chi Minh formed his nationalistic ideals.
The Vietnam Conflict
In 1941, Ho Chi Minh formed the Vietminh in northern Vietnam to fight both the French and Japanese for control of Vietnam. During this period, the French backed emperor, Bao Dai, recanted allegiance from France to Japan and proclaimed independence. Loyalties were rapidly shifting, and Japan soon transferred support from Bao Dai to the Vietminh. Bao Dai abdicated his throne. When Japan surrendered to the Allies following World War II, Ho’s Vietminh declared independence. This independence was brief as the British soon landed in Saigon and returned authority to the French. With the Japanese retreat, the Chinese had invaded the North, but withdrew in 1946. While France was planning to reoccupy the North, Ho proclaimed a separate government for Vietnam, violating a previous agreement with France. Fighting broke out in Hanoi. Ho then retreated to create a rural northern base.
Bao Dai, with the support of France, returned to Vietnam, but by 1954 the French withdrew following defeat by the Vietminh. In an attempt to end the conflict, the 1954 Geneva accord divided Vietnam along the seventeenth parallel into North and South. Bao Dai’s government in the south denounced this division. Ngo Dinh Diem, prime minister under Bao Dai, recruited U.S. monetary aid. Soon, the US was training the South Vietnamese army. In 1955, Ho began accepting Soviet aid in the north, heightening the U.S. interest in the South. During this time, Diem held a referendum to defeat Bao Dai and declared himself president of the Republic of Vietnam (the South). In 1964, the Tonkin Gulf resolution was passed by the U.S. Congress, leading to increased U.S. participation.
As the fighting continued, the Vietcong (a Vietminh backed communist group) attacked the South with guerrilla warfare. Among the chaos, many isolated groups arose in opposition to both the Vietcong and Diem. Eventually Diem was murdered by his own staff. The U.S. continued to support the South Vietnamese succession of leaders including Gen. Duong Van Minh, who staged the coup against Diem. The final leader of the south was Nguyen Van Thieu. With no permanent end in sight, U.S. troops retreated after the signing of a cease-fire agreement in 1973. Fighting soon resumed, and in April 1975 Thieu fled to Taiwan. Communist forces took Saigon days later.
Three “Waves” of Refugees
The Vietnamese people who worked with the U.S. government or who sympathized with the South feared for their lives once Thieu lost power. In 1975, 130,000 Vietnamese fled to the U.S. with the collapse of the Thieu regime. They escaped with the help of the US, and were mostly young, well educated, English speaking, urban dwellers. Fifty-five percent were Catholic, and many were able to bring their families intact. Most were kept at relocation centers on U.S. military bases until sponsors were found to help them resettle. This is referred to as the first wave of immigrants.
The second wave of refugees was a more diverse group. It included people with differing ethnicity’s, nationalities, religions, and languages. As a group, these people were less educated, less literate (in Vietnamese and English), less familiar with Western ways and ideas, and more rural than those in the first wave. Due to the Vietnamese invasion of Cambodia, military offenses against the hill people of Laos, and the continued anti-Sinitic policy of the new Vietnamese government, 455,000 refugees from SE Asia settled in the U.S. between 1979 and 1983.
With relations between China and Vietnam deteriorating, and with the ethnic Chinese remaining in Vietnam being persecuted, at least 500,000 fled from 1977 to 1979. During the second wave, escape attempts were long and arduous; only half those attempting escape are thought to have survived. Hoards of people attempted escape by boat. Travel by boat was filled with peril, many died due to disease, mishaps on overcrowded boats, or at the hands of pirates.
Those in Northern Vietnam boated to Hong Kong or to nearby Chinese provinces. From these destinations, many came to the U.S. Others stayed in Hong Kong. People escaping Vietnam from the south boated to Thailand, Indonesia and the Philippines. Some spent years in internment camps in these countries prior to entering the U.S. Of those who survived, many suffered malnutrition, disease, and horrible treatment at the hands of camp guards.
A third wave of refugees arrived from 1985 to 1991 and continues to arrive in small numbers. This group included both Vietnamese and ethnic Chinese people who were brought to the U.S. through family reunification programs. Additionally, in 1988 and 1989, the U.S. government negotiated the release of political detainees held in “re- education” camps. Many people in this wave spent years in camps under devastating conditions.
Rural people of the second wave are less likely to speak languages other than Vietnamese. Some have difficulty learning to read and write a second language because as farmers, many were not literate in their native Vietnamese. If they had learned to read and write, they seldom used these skills. Local Vietnamese-American Associations and others have established ESL programs in the Seattle community.
Refugees from Vietnam include a heterogeneous group of people other than Vietnamese. The divisions and prejudices have continued with relocation to the U.S.
Chinese: The Chinese occupied Vietnam for almost one thousand years, leaving a large ethnic Chinese population in Vietnam. This population spoke Chinese, and was mostly urban. By the turn of the century, about 745,000 ethnic Chinese had settled in the cities of Saigon and Cholon, playing a major role in trade throughout the last 100 years. Many Vietnamese harbor anti-Chinese sentiment and see Chinese as untrustworthy, especially in business.
Cham: With a pre-war population of about 30,000 centered in South Central Vietnam, the Cham had Hindu and Islamic influences. In Vietnam they were associated with Malay people and looked down upon. This has continued in the U.S.
Montagnards: (French for mountaineers). This group was made up of an estimated thirty tribes, or 800,000 people, prior to the war. They lived in the mountains of Northern and Central Vietnam. The groups were migratory hunters who practiced some rice cultivation. During the war they were often linked to the CIA by the Northern army, and were marked for annihilation by the North Vietnamese government. Many fled to the U.S.
Khmer: (Mostly associated with Cambodia). About 500,000 lived in pre-war Vietnam. They maintained their own language, customs, and religion, though many intermarried with ethnic Vietnamese. Most lived in the south around the Mekong delta and adopted Vietnamese customs in addition to their own. They were generally accepted by mainstream Vietnamese.
Current U.S. Immigration Trends
In 2009 there were 1.1 million immigrants from Vietnam in the U.S., designating them as the fifth largest immigrant group. The number of Vietnamese residing in the U.S. has greatly increased since 1980 when there were only 231,120 (Terrazas, 2008). The number of Vietnamese gaining permanent residency has been decreasing since the peak in 1992, with a slight peak in the early 2000s.
The Vietnamese granted lawful permanent residence status in 2001 numbered 28,691. Of this total, 49% were immediate relatives of U.S. citizens, 43% were family-sponsored immigrants and only 6% were refugees (Terrazas, 2008). This shows a significant decrease of refugees admitted from Vietnam since 1990. The number of unauthorized immigrants in the U.S. that were born in Vietnam is estimated to be about 160,000 and has not seen much increase since 2000 (Terrazas, 2008).
The majority of immigrants from Vietnam reside in 6 states: California has the vast majority of immigrants, followed by Texas, Washington, Virginia, Florida and Massachusetts (Terrazas, 2008). The metropolitan areas of Los Angeles and San Jose in California are home to the largest number of Vietnamese immigrants.
The Vietnamese language which is spoken by the majority Viet population has regional accents (Northern, Central, and Southern). All are generally understood by most Vietnamese speakers. Vietnamese is a tonal language with six basic vowel tones. It is very different from English; verbs do not change forms, articles are not used, nouns do not have plural endings, there are no prefixes, suffixes, or infinitives and no distinction among pronouns. Honorific pronouns are used to address people of different status or age.
Vietnamese immigrants who had higher education in Vietnam are more likely to be fluent in English.
Many of the country’s 54 ethnic groups have their own distinct languages, though only a few of the ethnic minority languages have their own script (Visiting Arts Vietnam Cultural Profile, 2006).
Many customs are rooted in both the Confucian respect for education, family, and elders, and the Taoist desire to avoid conflict. Vietnamese tend to be very polite, avoid talking about feelings, and are stoic.
Traditionally, Vietnamese people list their family name first, then their middle name, with their first (given) name listed as last. Family members use different given names (first names aren’t passed down), and the name reflects some meaning. Most names can be used for either gender. Many in the U.S. have adopted Western customs of naming or if naturalized, may adopt Western names. Each family member has a designated kinship term, and these are used when family members address one another.
Birthdates are written as follows: Day/Month/Year. For example, May 14, 1992 would be written: 14/5/92.
Status, Role, Prestige
Vietnamese culture is concerned more with status (obtained with age and education) than with wealth. If one were to rank them in their importance, education would likely come first, followed by age and then wealth.
Thua (meaning please) is added in front of the honorific name to show respect to elders. To show respect, more traditionally minded Vietnamese will bow their heads to a superior or elder. The depth of the bow is not a factor.
In Vietnam, professions that are high status include doctor, priest, and teacher.
To address people formally, use Mr. or Ms. or a title plus the first name. There are also several other honorific forms when addressing people of different relationships in Vietnamese, but they are not used in English.
Many may greet by bowing slightly. Usually, elders or higher ranking people are greeted first (the family head).
Phrases of Courtesy in Nine Languages: A Tool for Medical Providers
This language learning tool features videos of native speakers saying phrases of courtesy in nine languages, including Vietnamese. Phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a learning speed. The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. View Vietnamese videos.
Displays of Respect
To avoid confrontation or disrespect, many will not vocalize disagreement.
Praising someone profusely is often regarded as flattery, and sometimes even mockery. Most people are very modest and deflect praise.
Insults to elders or ancestors are very serious and often lead to severed social ties.
Many will smile easily and often, regardless of the underlying emotion, so a smile cannot automatically be interpreted as happiness or agreement.
Vietnamese often laugh in situations that other cultures may find inappropriate. This laughter is not intended as ridicule.
Breaking a promise can be a serious violation of social expectation. It is very difficult to re-establish a lost confidence.
When inviting a friend on an outing, the person who offers the invitation usually offers to pay to the bill.
During social gatherings, Vietnamese will often arrive late so as not to appear overly enthusiastic. However, they are punctual to appointments in professional settings.
When giving gifts, often the giver minimizes the value of the item, even though it may be great. The recipient of a gift is expected to display significant gratitude that sometimes lasts a lifetime. Some may be reluctant to accept a gift because of the burden of gratitude. Vietnamese may refuse a gift on the first offer, even if they intend to accept it, so as not to appear greedy.
Speaking in a loud tone with excessive gestures is considered rude, especially when done by women.
Summoning a person with a hand or finger in the upright position is reserved only for animals or inferior people. Between two equal people it is a provocation. To summon a person, the entire hand with the fingers facing down is the only appropriate hand signal.
Marriage, Family, Kinship
Marriage in Vietnam in the 1950s and earlier was very different than today and in the U.S. Previously marriage was influenced by Buddhist theology and Confucian philosophy. Vietnamese believed that fate in marriage, as well as wealth and position, were preordained, though choice could play some role in activating a positive or negative fate. Traditionally, children lived with their parents until marriage, and then the couple moved to the husband’s father’s household.
The extended family arranged marriage, but individuals were usually consulted on the choice of their mate. The typical engagement lasted six months, with little contact between the bride and groom prior to the marriage. Traditionally the marriage was at one of the couples’ homes. Men usually married between 20 and 30 years of age, and women at 18 to 25 years of age. Women kept their maiden names legally but used their husband’s name formally.
As Western influence increased in Vietnam during this century, parents began to take more of an advisory role in the choice of their child’s mate, and arranged marriages are heavily declining. Parents are interested in securing a good mate for their child out of concern for their future. It is not unusual for parents to desire a mate of high status with a career that will be lucrative, such as doctor or lawyer. Currently, parents are more open to the choices of their child, and while they are consulted on the choice of partner, ultimately it is the child’s choice.
f the parents agree to the child’s choice they will meet the parents of the mate and arrangements for marriage will continue. However if the parents disagree with the child’s choice they are likely to attempt to convince them otherwise, but will cease if the child is insistent. Though rarely given absolute choice, family still bears heavy influence over the decision to marry. When married, the new couple will likely establish their own household, rather than remain with the husband’s family.
In the Seattle area, there is still a general preference for marriage within the Vietnamese community, though the younger generation does not put as much emphasis on this as the older generation. The older generation does not push their values on the younger generation, but may especially prefer a Vietnamese mate for their child if one of the parents does not speak much English.
In the U.S., most young Vietnamese date in the same way as other American youth, with two main exceptions: premarital sex and cohabitation before marriage are uncommon.
Divorce in Vietnam is considered shameful for the woman. In the U.S. there is less of a stigma associated with divorce. Divorce is uncommon among Vietnamese in both countries, though in Vietnam the divorce rate is lower than in the U.S. This can partly be attributed to the values of a patriarchal society and that the notion of marrying for life is more pervasive. A man is considered responsible for his spouse until death. In Vietnam, the husband is the most powerful member of the family who makes the major decisions and brings in the primary income.
Many Vietnamese community leaders in the U.S. are concerned about the growing divorce rate. The higher U.S. divorce rate may be attributed to the fact that women in the U.S. have more freedom and often have the means to support themselves. If a woman is financially dependent on her husband, divorce is unlikely.
Some immigrant women are not fully adapted to life in America. Women who are unable to speak English or who do not know how to drive are especially dependent on their husbands. Wives who are mothers generally put their children first, and keeping the marriage intact is seen as best for the children. So even if the woman is able to support herself, divorce will not usually be considered unless there is domestic abuse.
In Vietnam, tasks were divided along gender lines: fathers typically worked outside the home while mothers were responsible for domestic duties such as homemaking and raising children. Vietnamese culture is based on a patriarchal system, meaning the husband acts as the head of the family. His responsibilities include managing money and supporting the family.
The male dominancy trait is also apparent socially among older generations of Vietnamese. Men will answer questions for their wives. For example, if someone asks his wife, “How are you today?” the husband might respond, “She’s OK”.
However, the gender gap between men and women became closer during the Vietnam War, when many men were absent from the home and women took on more independence out of necessity. This trend has continued with migration to the U.S. Many of the jobs available in the U.S. were of lower status and fit the expectations of refugee women, but not of refugee men. Refugee men have been forced to take lower status jobs than they would have taken in Vietnam. This has created a situation where many families are dependent on the income of the mother, causing readjustment of family roles and expectations.
Due to the effect of migration and Western influence, traditional gender roles are changing, and Seattle families display varying degrees of traditionalism. In general, Vietnamese men and women working outside the home in the Seattle area share domestic duties.
Previously men had more education than women. The gap is closing, and now everyone has an equal opportunity to receive an education, especially in the U.S. This higher educational attainment means that more women are now working outside of the home.
Women who have emigrated from Vietnam tend to extend the absence from work after giving birth in order to raise children. It is likely that they will remain at home until the children are ready to start school. But if both parents were raised in the U.S. it is more likely that they will place their children in childcare so both parents are able to work.
While Western culture promotes individuality, the family unit is very important in Vietnamese culture. This emphasis on collectivity includes an obligation to provide for the welfare of family members. Family members are expected to work and behave for the good of the group. Families may publicly denounce a member who is ill behaved; they may also pronounce family achievements. Each member has a designated kinship term, and these are used when addressing one another.
Even though the family is viewed as a unit, the father or an older male has the ultimate responsibility and acts as an authority leader while delegating tasks and involving others in the decision making. (See Gender Roles section). From a very young age the father and other family members educate the children on “filial piety,” a key part of Vietnamese culture which requires that children give parents and elders respect, love, and care.
In Vietnam, the family is patriarchal, patrilineal, and patrilocal, often with two to four generations under one roof. There is the immediate family (nha) and the extended family (ho). In Vietnam, the immediate family is the nuclear family plus the husband’s parents and the grown sons’ spouses and children. The extended family is the immediate family plus family members of the same name and relatives residing in close proximity. Grandparents help with childcare and children help with chores. Younger siblings are to respect and obey older siblings, and aunts and uncles are treated as parents.
There are few nursing homes in Vietnam. If elderly relatives need care they will live with the younger generation. Only in rare situations will a senior citizen reside in a nursing home, such as when they do not have a family to support them. In the U.S. it is not common for elderly relatives to live in a nursing home if they have children they can live with, but it is more common than in Vietnam. Many of the older generation do not speak English fluently and would not be comfortable in a nursing home where Vietnamese is not spoken.
Domestic abuse exists in all cultures. However, it is important to know that Vietnamese women in the U.S. may be less likely to report abuse to authorities or even discuss it with friends. Marital conflicts and domestic violence are considered to be intensely private family matters. Any perception of wrongdoings brings embarrassment and shame to the entire family, not just a given individual.
To compound matters, women are traditionally considered to be responsible for maintaining the harmony in the home, so if marital conflict does arise it may be viewed as the fault of the woman (Shiu-Thornton, Senturia, & Sullivan, 2005).
It is common for Vietnamese women in the U.S. to seek conventional prenatal care when pregnant.
Both in Vietnam and the U.S. it is considered shameful and dishonorable to the family if an unmarried woman is pregnant. Therefore, women who are pregnant outside of marriage may try to keep the pregnancy secret from family members for as long as possible.
Chinese culture has strongly impacted Vietnamese medical beliefs. The balance of the equal and opposite forces of yin and yang can provide explanations for illness. Yin is the female principle and is associated with cold, the breath, the right side and even numbers while yang is the male principle and is associated with heat, the blood, the left side, and odd numbers. The harmony of these forces can be affected by different foods and behaviors. Yin and yang are very important and are believed to be able to affect the pregnant women and her child (Bodo & Gibson, 1999).
In Vietnam, particularly in rural areas, prenatal care is lacking, but there are many traditional practices that women follow to ensure an easy pregnancy and a healthy baby. Overeating is discouraged because it can make the delivery complicated. There are certain foods that will disturb the woman’s yin/yang balance including “hot” foods such as alcohol, coffee, unripe fruit, red meat, spicy soups, garlic, ginger and red pepper or “cold” foods such as ice cream, ice water, bananas, oranges, and gelatins. Foods that are acceptable include poultry, fish, pork, ripe fruits and vegetables, rice, chicken eggs and ginseng.
Physical activity is encouraged throughout the pregnancy, while reclining for long periods is discouraged to prevent the fetus from growing too large. Sexual relations are believed to lead to respiratory illness or mental and physical deformation of the child (Bodo & Gibson, 1999).
Traditionally in Vietnam, husbands are not present during delivery. Only the nurse or doctor is in attendance. The husband and male relatives are required to wait outside until the baby is born. The system in the U.S. encourages men to be present during the birthing process. Therefore, it is common for the father to be present at the delivery.
The baby’s first cry proves it has a soul and is therefore a moment of celebration (Bodo & Gibson, 1999).
In rural Vietnam, midwives or women experienced with assisting in child birth deliver babies. But if a hospital is accessible it will generally be used.
According to the Chinese calendar, when a child is born it is considered one year old. This form of tracking time is not practiced by all, but some Vietnamese in the U.S. continue to honor it. Therefore, if someone is seven years old, they may report they are eight years old. This is commonly referred to as the “Vietnamese age” or the “real age.” The hour, day and year of the baby’s birth are of astrological importance because they can signal future details of the child’s life (Bodo & Gibson, 1999).
Post Partum Practices
In Vietnam, women whose medical beliefs are based on Chinese medicine and the harmony of yin and yang often refuse to bathe, drink cold juice or water, or wash their hair in the post partum period so as not to upset the hot/cold balance of their body. The theory is that blood, which is hot, is lost through delivery, so the body is at risk of becoming too cold or of getting too much air.
Traditionally an herbal solution is used to wash the mother and child after birth. If this is not possible, even though water cannot be applied to the woman’s body, she is allowed to partake in a sponge bath (Bodo & Gibson, 1999). This abstinence period, called the sitting month, traditionally lasted for about 3 months or 100 days (For more information, see Postpartum Practices poster). Vietnamese women in the U.S. may abide by these rules but will limit this period to about 1 month. It is more likely the women in the U. S. will continue this practice if receiving pressure from the older generation.
During this cold period, Vietnamese believe the woman needs to be warmed up (Bodo & Gibson, 1999). This is accomplished through the ingestion of spicy foods and drinks. In rural Vietnam a fire was lit next to the mother’s bed. Therefore, after birth in the U.S. it might be beneficial to offer the woman heated blankets.
Another belief is that if the female is weak and the husband strong and powerful they should not share a bed. If they do sleep in the same bed the female will incur damage to her immune system making her ill. This is related to the yin/yang balance.
Another post-partum practice consists of applying cooked rice to the breasts. The warmth of the rice will cook the milk, if this is not observed it is believed that the child will have a stomachache from ingesting raw milk.
Infancy, Childhood and Socialization
Ceremonials during Infancy and Childhood
In Vietnam it is not customary to have a baby shower. Instead, there is a “One Month Ceremony.” Friends and family gather at the house of the child when it is one month old and will bring presents for the child and family.
The “One Year Ceremony” is similar to the One Month Ceremony. Once again, friends and family gather at the house of the child with a gift to offer the child. This celebration is different than a birthday party. The family arranges objects like a pen or a comb on a tray, which is presented to the child. Each object has a different meaning that is associated with the child’s future endeavors. For instance, if the child chooses a pen it could be surmised that the child might be a teacher. This is practiced in Vietnam but less commonly in the U.S.
Traditionally, infants and toddlers in many Southeast Asian countries have wear amulets or “protection strings” around their necks, wrists, or waists. A CDC report identified a case in which the likely source of lead exposure in a young child in the U.S. was a traditional amulet made in Cambodia with leaded beads that was worn by the child. Read more about Considering Lead and Other Heavy Metal Toxicities in the Evaluation of Nonspecific Symptoms.
Infant Feeding and Care
Most Vietnamese women breastfeed their infants for the first 6-12 months (both in the U.S. and in Vietnam).
Child Rearing Practices
“Children sit where their parents place them.” This traditional Vietnamese expression characterizes the Confucian-based parent-child relationship. Though parents in Seattle have adopted various degrees of Western parenting styles, they take their responsibility to teach their children very seriously. The first priority is to teach filial obedience and respect; the second is to provide as much educational success as possible.
In many homes, homework must be completed when arriving home from school and television is only allowed on the weekends. If the parents don’t feel the teacher is providing enough homework, they may make homework assignments themselves, or write questions for the child to answer.
In Vietnam, corporal punishment was the norm. In the U.S., parents are aware that this is not accepted and they have had to change methods of discipline. Some parents feel that their children are harder to control here than they would have been in Vietnam and are frustrated that their children seem to lack respect for their elders.
Adolescence, Adulthood, and Old Age
Initially, refugee families had to deal with many issues in adapting to their new home in America. Elders were the leaders in families, had the strongest influence in decision making, and were respected and sought after for advice. Younger family members were to be obedient and respectful. Also, elders held property rights of the family, and could retire once their children could support the family. Today, although the younger generation still respect this traditional hierarchical family structure and values the elders’ opinions, they are more independent financially and able to make their own decisions.
This diffused hierarchical tradition is apparent for both families that reside in the United States and in Vietnam, but more so with those in the U.S. Like most immigrant families, one of the most common issues that Vietnamese refugee families face is the barrier of language and culture, not only with those outside of their culture, but also within their own families. As Vietnamese youths attend school and interact with others in American society, they become assimilated to the American way of life. This can create a clash between the traditional elders and the Americanized youths for the elders might not approve of certain behaviors and speech patterns. As a result, some elders might feel isolated and disrespected.
For more detailed information on geriatrics and older Vietnamese Americans, see Stanford’s Ethno Med Health and Health Care of Vietnamese American Older Adults. This is an on-line learning module, but you can download the module as a PDF and print the cultural profile by filling out a short survey. Additional cultures and geriatric information also available on their site.
Nutrition and Food
Many Vietnamese from the older generations are lactose intolerant as adults so do not consume much milk. The traditional diet is mostly rice, fish, and vegetables, plus pork or chicken when available. Red meat is avoided. In the U.S., most older people still prefer a traditional diet, though more meat is available than was in Vietnam. In Seattle’s International District, there are several Vietnamese markets that carry more traditional foods.
Those who were interviewed for the 2010 update to this profile reported that their children eat poorly, preferring Western fast foods with few fruits and vegetables.
See related: Nutrition and Fasting in Vietnamese Culture
Drinks, Drugs and Indulgence
Traditionally, women do not smoke in public, and public drunkenness is a disgrace. Alcohol use seems to be increasing among adolescents according to several people interviewed. The rate of smoking is very high among Vietnamese men, in fact it is higher than in the general population (Chan, Thompson, Taylor, Yasui, Harris, Tu, Acorda, & Jackson, 2007). Crack cocaine is an illicit drug used by some both in Vietnam and the U.S.
Religious Beliefs and Practices
In Vietnam there are many religions and this diversity extends to the U.S. Confucianism underlies many Vietnamese traditions shared by people of various religions.
This was the predominant religion in Vietnam, practiced by an estimated 90% of the population prior to the war. In Seattle, the majority of Vietnamese are Buddhist. There are two main forms in Vietnam. The southern Hinayana believe only monks and nuns can achieve enlightenment, while the northern Mahayana believe laymen can attain enlightenment as well.
More a code of behavior than a religion, it emphasizes filial piety and obligation, altruism and the belief that man creates his own destiny. Music, respect for authority (including teachers), and social rites are very important.
Founded by a Chinese philosopher, Lao-tzu, this religion teaches that the goal of becoming an Ultimate and Unconditioned being can be achieved through thrift, humility and compassion. Taoists may worship many gods, and value simplicity, patience, and contentment. They avoid confrontation and strive for harmony both between men and between man and nature. Some Taoist groups also worship deities or other religions. They have an organized clergy and temples. Though many Vietnamese do not practice this religion, Taoism has strongly influenced Vietnamese culture.
Introduced in late sixteenth century by Portuguese, Spanish and French, Catholics in Vietnam have intermittently suffered persecution. Before the collapse of South Vietnam, an estimated 2 million people (of a population of 17 million) practiced Catholicism. This is the religion of many first wave refugees.
Many Vietnamese practice animism (worship of spirits and natural forces), ancestor worship, astrology, and are very superstitious. Older refugees in the US continue these practices and beliefs, while many younger people in the community do not. Cao Dai and Hoa Hoa are both sects with little influence.
The Celebration of Tet
Tet is the Vietnamese New Year, celebrated on the first day of the first month on the lunar calendar, usually between January 19 and February 20. It symbolized new beginnings, with various rituals added by different religions. In Vietnam, Tet was a time to pay debts, forgive others, improve self, and make friends out of adversaries.
The celebration lasted three days, beginning at home. The first day was to be with family and pay respect to one’s ancestors. The second day was in honor of teachers, and the third day was to visit friends. Most families saved throughout the year for Tet, houses were cleaned, decorated, and even repainted. Large expense was put into the celebration to ensure that the new beginning was a positive one. Buddhists in rural areas would erect bamboo poles and drape amulets from them to repel evil spirits.
The celebration of Tet has continued in the U.S. Older Vietnamese think of Tet very traditionally, while many younger Vietnamese think of Tet as a time for food, friends and parties.
Death Rituals in Vietnamese Society
A personal story by Dieu Hien Hoang.
Medical Examiner Dialogue – Vietnamese Buddhist
A perspective about death taken from conversations with community members.
Traditional Medical Practices
The practice of traditional medicine varies greatly between the majority Viet people and ethnic minorities such as the Mien and Hmong.
For example, the Mien and Hmong believe that there are supernatural factors, more so than biological factors, which contribute to sickness. Consequently, they seek treatment from priests who they believe can communicate with higher beings. Women from these groups often refuse anesthesia when giving birth.
The lowland peasant groups and urbanites from Vietnam employ a medicinal system based on Chinese medicine. This system is based on the premise that living things are composed of four basic elements — air, fire, water and earth — with the associated characteristics of cold, hot, wet and dry. This hot/cold belief system is common to many Vietnamese, regardless of their educational status, occupation, rural or urban. Many seek traditional herbal remedies, tonics, massage, and avoidance of excess as the pathway to good health.
As mentioned above, traditionally, infants and toddlers in many Southeast Asian countries have worn amulets or “protection strings” around their necks, wrists, or waists. A CDC report identified a case in which the likely source of lead exposure in a young child in the U.S. was a traditional amulet made in Cambodia with leaded beads that was worn by the child. Read more about Considering Lead and Other Heavy Metal Toxicities in the Evaluation of Nonspecific Symptoms.
A few examples of Chinese medicine practices are listed here. Dermabrasive procedures, which are based on hot/cold physiology, are often used to treat cough, myalgia, headache, nausea, backache, motion sickness, and other maladies. Cutaneous hematomas are made over the face, neck, anterior and posterior trunk (sparing the genitals) to release excessive air. These are made in many different ways; by pinching and pulling on the skin, by rubbing oiled skin with the edge of a coin or spoon (cao gio), or by cupping. Cupping (giac hoi or hut hoi) is done by heating the air in a cup with a flame, then placing the cup onto the skin. As the air cools, it contracts and pulls on the skin, leaving an ecchymotic area.
A technique used mostly by the Mien culture is moxibustion. Small circular superficial burns on the torso, head, and neck are made by igniting combustible material placed on the skin or with sticks of burning incense. This is often combined with acupuncture, which is used widely (in Vietnam and the U.S.) for musculoskeletal ailments such as arthritis pain, and for stroke, visual problems, and other ailments.
It is important to note that although these traditional practices are still prominent among these groups who live in Vietnam as well as in the U.S, with the increased Western influence, there is more awareness of the benefits that the Western medicine has to offer. As a result, many (especially those of the younger generations) often seek treatment from doctors who practice Western medicine.
Typical associations made by Vietnamese
Palpitations, dizziness, faintness, feeling of panic
Impotence, sexual dysfunction
Weak Nervous System:
Headaches, malaise, inability to concentrate
Weak Stomach or Liver:
Om (translated “I’m Skinny”):
Means “I’m sickly”
Dark urine, flatulence, constipation
Too much air can cause illness such as myalgia, cough, headache and nausea. With fever, the body is at risk for becoming too cold, so one is dressed warmly, cold foods are avoided (fresh fruits and vegetables), and fluid intake is restricted. Neutral foods (rice, eggs, chicken broth, teas and sweats) can be eaten.
Traditionally, mental illness is a shameful thing among most Vietnamese cultures. Because of this shame, mental illness is often feared or denied. The hill people think of mental illness as bad karma that has accumulated because of misdeeds done in past lives. Due to the stigma of mental illness, many refugees tend to somaticize and will avoid referrals to mental health clinics.
Due to the sensitivity of the subject, it is often preferable that mental health practitioners use the term behavioral health rather than mental illness. Furthermore, it is difficult for health practitioners to gain trust from their patients; therefore, mental health practitioners in Vietnam often use placebo medication to gain the trust of their patient and meet the patient’s expectations.
See: Saving Face: Recognizing and Managing the Stigma of Mental Illness in Asian Americans, a 68 minute training video authored by Elizabeth J. Kramer, ScM and Francis G. Lu, MD, University of California, Davis.
Experience with Western Medicine
In the Country of Origin
Western medicine in Vietnam consisted of many things, mostly antibiotics, Vitamin B12 shots for “feeling bad,” and IV fluids.
In the United States
Many Vietnamese from the second wave of immigration had severe health problems on arrival to this country as a result of poor living conditions during the war and in camps, injuries, starvation, abuse, and little access to health care. Health problems experienced in this population include TB, hepatitis B, malaria, malnutrition, conjunctivitis, trichinosis, anemia, leprosy and intestinal parasites. Once arriving in the U.S., poverty and crowded living conditions posed health risks, along with under-utilization of health care.
One survey of Southeast Asians done at the University of Washington Refugee Clinic (which is now the International Medicine Clinic at Harborview Medical Center) showed that some elder Vietnamese continue to use traditional methods, described in the section about traditional medical practices. Many use traditional remedies in parallel to Western health care, but may be reluctant to reveal this to a doctor who practices Western medicine.
There are many cultural barriers to care in the U.S. Laura Uba characterized these barriers in a 1992 publication, as summarized below. Members of Seattle’s Vietnamese community who were interviewed in 1996 and again in 2009 agreed that most of these factors are relevant to their community.
Perspective on Western Medicine
Laura Uba, in her 1992 publication, indicated that Vietnamese generally distrust Western medicine. This is a common misconception. It is true that patients often cast doubts on Western treatments if results are not quick and often will not return for further treatment. However, this is frequently due to lack of understanding about treatment methods and effects of medicines. For example, as described in Uba’s paper, some patients may think procedures are meant to cure or alleviate pain, and feel frustrated when, for example, they still cough after a diagnostic X-ray. When a patient is prescribed antibiotics, it is critical that the provider explain the importance of taking the full course of medication.
Attitudes towards Suffering
Many see suffering and illness as an unavoidable part of life. Some also feel (the Hmong in particular) that the length of one’s life is predetermined, and life prolonging or life saving care is futile. Also within the community, stoicism, a masculine trait among mostly older gentlemen, is a highly respected personal trait which can prevent people from seeking care.
Etiology of Illness
Illness may be attributed to organic or physical problems, an imbalance of yin and yang, an obstruction of chi (life energy), a failure to be in harmony with nature, punishment for immoral behavior (in this or past lives), or a curse placed by an offended spirit.
Some traditional Vietnamese believe in organic causes of illness unless there is an obvious upset of supernatural forces, while most Hmong believe minor illness is organic but serious illness is supernaturally caused. Though immigrants may wish to use a shaman or spiritual healer, they can be expensive. Also, they are not easy to find in the U.S., and since many specialize in different types of disorders, one may not be able to find the right healer for their malady.
Resistance to Invasive Procedures
Many believe that surgery upsets the soul or can actually cause one’s spirit to leave the body. Some think injections may hurt the spirit, and therefore are hesitant to receive immunizations. Resistance to venapuncture is common for fear of upsetting the hot/cold balance. Also, during the war, peasants thought that when military doctors drew their blood, it was being given to the U.S. troops to strengthen them. Many less educated people do not realize that the body can make more blood, and believe venapuncture will weaken them.
Poor Physician-Patient Communication
Southeast Asian cultures value politeness, respect for authority, and avoidance of shame. Because of this, many will not ask questions, will not voice disagreement or concern, and will not reveal intentions or actions that seem in contrast to the physician’s wishes. If patients disagree or do not understand, they may simply listen and answer yes in respect, then not return for further care or comply with recommendations.
Significant Health Disparities
Chronic hepatitis B and hepatitis B associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7–14% and an incidence rate for liver cancer six times that of non-Latino whites (Nguyen, McPhee, Stewart, Gildengorin, Zhang, Wong, Maxwell, Bastani, Taylor, & Chen, 2010).
Patient Education about Hepatitis B in the Vietnamese Language
ABC’s of Hepatitis***
Hepatitis B: What we can do***
Vietnamese American women have higher rates of cervical cancer than any other racial or ethnic group (including Hispanics), according to the Fred Hutchinson Cancer Research Center’s (FHCRC) cancer registry. According to a recent study at FHCRC, traditional health beliefs and risk-factor knowledge contribute to low cervical-cancer screening rates in Vietnamese-Americans (FHCRC, 2010).
Patient Education about Cervical Cancer in the Vietnamese Language
Prevent Cervical Cancer: Take Care of Yourself and Those You Love***
Good Health for the New Year (video about pap testing)***
Cervical Cancer – What Vietnamese Women Should Know (from National Cancer Institute)
Recommendations for Medical Providers
Focus groups conducted in 2003 (Ngo-Metzger, Massagli, Clarridge, Manocchia, Davis, Iezzoni & Phillips, 2003) with limited English proficient Chinese and Vietnamese Americans, and interviews conducted with Vietnamese community members in 2009, elicited the following recommendations for providers and health care facilities:
Show respect for patients’ health beliefs and practices. Vietnamese patients sometimes use both Western and Asian medicine concurrently. Patients reported that they often encountered negative reactions from Western clinicians and therefore were reluctant to tell their providers about their use of Asian medicine. They regarded providers’ knowledge, inquiry, and non-judgmental acceptance of their beliefs and practices as being a part of effective patient-provider communication.
Provide a trained medical interpreter for LEP patients. Patients state they strongly prefer the use of a trained interpreter rather than a family member. The use of children as interpreters for parents disturbs the family dynamics, making the adults uncomfortable. Vietnamese culture stresses the importance of showing respect for elders. Patients also worry that family members’ knowledge of the language does not include all necessary medical terminology.
Understand that patients may exhibit confusion over how to obtain urgent care in the U.S. They may be accustomed to the walk-in system in Vietnam.
Be aware of the patients’ personal situation and direct them to social support services.
Provide prompt communication about test results.
Provide translated health education materials and instructions about prescribed medication. Explanation about how to participate in their care is appreciated. MedlinePlus is an excellent source of patient education materials translated into Vietnamese. Also see our collection of Vietnamese patient education materials.
Greet patients in a warm and welcoming way. Treat patients with respect and dignity. Extend respect to family members as people who can provide additional information and improve patient-provider communication.
Encourage patients to ask questions. Fear of looking stupid in the eyes of a person of higher status may prevent some Vietnamese patients from asking questions.
Seattle Community Life
According to the 2000 census, metropolitan Seattle has the sixth largest Vietnamese population in the U.S. The Vietnamese population in the greater Seattle area increased 181% between 1990 and 2000 (Pfeiffer, 2001).
According to the US Census Bureau, 2005 American Community Survey, the Vietnamese population in Seattle is 10,062; in King County it is 29,952; and in Washington State it is 60,543.
Common Acculturation Issues
Many Vietnamese people have adopted Western customs, but it is important to remember that these customs are not necessarily internalized, especially by older refugees. It seems that the Vietnamese community in the U.S. has a mixture of Western and Vietnamese beliefs. Nguyen Quoc Tri summarized and compared American versus Vietnamese philosophy as follows: Americans generally believe that human nature is evil but perfectible; that humans should have mastery over nature; they live oriented to future time; they are accustomed to movement, migration and mobility; they value accomplishment, individuality and self-reliance.
In contrast, Vietnamese traditionally believe that human nature is basically good but corruptible; that man should strive for harmony with nature; they live oriented to the past, not the future; they are traditionally attached to one place, especially the ancestor’s land; they value the process of being or becoming and mutual dependence.
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Embassy of Vietnam, London – United Kingdom. Retrieved on September 14, 2010 from vietnamembassy.org.uk/population.html
Fred Hutchinson Cancer Research Center. Cervical Cancer: Some of Our Key Research. Retrieved on September 13, 2010 from fhcrc.org/research/diseases/cervical_cancer/
Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Lezzoni LI, Phillips. RS. Linguistic and cultural barriers to care: Perspectives of Chinese and Vietnamese immigrants. Journal of General Internal Medicine. 2003;18(1):44–52. ncbi.nlm.nih.gov/pmc/articles/PMC1494812/
Nguyen, TT, McPhee, SJ, Stewar, S, Gildengorin, G, Zhang, L, Wong, C, Maxwell, AE, Bastani, R, Taylor, VM, Chen, MS. Factors Associated with Hepatitis B Testing Among Vietnamese Americans. Journal of General Internal Medicine, 25(7), pp 694-700. Retrieved on August 16, 2010 from escholarship.org/uc/item/4354g63q
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