Methods
A questionnaire was developed exploring (1) translations and terminology, (2) ideas of disease causation, (3) recognition of symptoms and signs, and (4) experience with healers, treatments, and home remedies. One to two hour interviews were conducted with key informants who were selected for ease of communication and knowledge of their culture and asthma. Three Cambodia, three Oromo, two Somali, two Tigrinians, and one Amharic informant were interviewed by the principal investigator with their consent. The interviews were conducted between July 20 and August 25, 1994.
Clinical Features
People reported that asthma is worsened by not eating, cold temperatures, changes in weather, and emotions. One woman reported that her children get asthma when they play too much or are very active, when they get a fever, when they smell the pet dog next door, and experience changes in weather. None of the people interviewed reported a relationship between asthma and smoking.
Treatment
In the refugee camp and in urban areas of Cambodia, asthma is treated with IV medication and oxygen. Some Cambodians may never have seen an inhaler before coming to this country.
Translation or Language Equivalents
Asthma is a recognized disease in Cambodia. Asthma is called /jum’ ng huurt/. /Jum’ ng/ means disease, and /huurt/ roughly translates as ‘hot’ or the feeling of exhaustion, fatigue, and shortness of breath that occurs after running or lots of activity. The Cambodian ICM said there is no clear word for wheeze. One patient described it as a cat’s cry. The ICM was able to find it in the Cambodian medical dictionary: /kraet’kraut/ which was defined as wheezing or the sound of tight breathing. None of the people interviewed, however, were familiar with this term. The Cambodian word for pneumonia means “swelling of lung.” Another type of cough reported was that of whooping cough described as “chicken cough” or /kgohk muan/. One woman with asthma stated that asthma was difficult to live with because it was hard to explain, it did not show, and one did not look sick.
Cultural Knowledge and Traditional Treatment
No one was sure what caused asthma. Most suggested that asthma was inherited. Two children with asthma were thought to have inherited it from their fathers who also had asthma. One woman reported that asthma was not communicable. It was interesting to learn that one interpreter was confused about the difference between inflammation and infection. She said that interpreters often use the terms interchangeably, most often using infection in place of inflammation.
Asthma was distinguished from other illnesses with cough such as tuberculosis and pneumonia. The cough is different with each disease. Tuberculosis was recognized as a communicable disease with a green, productive cough which is very severe at night. More stigma was associated with tuberculosis which was perceived as a very serious illness.
Most felt that asthma is not curable; however, one woman believed that moving residence could cure the disease. All had experience with traditional and western medicine. People did not report using home remedies except for herbal teas.
The traditional Cambodian healer is the /krou k’mai/. One woman with asthma flew back home for two weeks to get treatment from a /krou k’mai/. She had to drink a blood-colored thick liquid and swallow baby mice 7 times to be cured. Her symptoms subsequently improved for 1 year. One man with asthma also saw a /krou k’mai/ in the Thai refugee camp who gave him a liquid to drink which consisted of red wine with /grong/ (big ant in tree with red color, an insect found in Cambodia), 7 toads which were fried/burned, and /tk gai/ which is a type of animal. This mixture has a sour taste and is taken 3-4 times/day. It is said to clean up the lungs. His wife reported that it could be found in the Cambodian grocery stores here but was very expensive ($300/jar). She had also heard of drinking blood from a black dog with wine to treat asthma.
There are no such healers here in the US, although one woman had heard from a friend that there is a healer in California who performs moxibustion. In addition, she had seen a Chinese herbalist here and has tried herbal medicine that was also very expensive. The children do not use herbs because they are too strong.
Other Considerations
The ICM could not think of a direct analogy for preventative medication (specifically, cromolyn) except for vaccines and avoiding certain foods with certain illnesses.
