At the Diversity Rx conference, I attended a great session on “Listening to the Patient: how attitudes and culture affect the health care experience.” One presenter, Linda Xiong, talked about a project she led to determine ways to address the problem of Hepatitis B virus (HBV) prevalence among the Hmong in Merced, California. Chronic Hepatitis B is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death.
Seven thousand Hmong live in Merced, according to Linda. Merced is the setting for The Spirit Catches You and You Fall Down (see my blog post on that topic), in which Anne Fadiman wrote about culture clash and distrust between the Hmong and the Western medical system. Much has changed since the book was written but not all is rosy. According to Dr. Stephanie Chao from the Stanford Asian Liver Center, it is estimated that the Hmong have a 5000 times greater incidence of HBV than Caucasians.
Although a vaccine exists which can prevent HBV, detection and treatment is not straightfoward, making it a challenging disease to address. Click here for information from the CDC.
The research question Linda and her team asked: What does the Hmong community know, believe and recommend to address HBV disparities in Merced?
The researchers held focus groups made up of shamans (traditional spiritual healers), young Hmong professionals, Hmong clan leaders, Hmong women, and Hmong men. All the focus groups, except for the one with the young professionals, were conducted in Hmong.
While there were several valuable findings, some of the most fascinating ones related to leadership roles in the community, specifically to shamans and clan elders.
Although they were eager to learn about HBV, clan elders were not comfortable taking a leadership role in addressing the problem. They view health issues as outside their “jurisdiction”; although not without controversy (see recent article in the Pioneer Press), their typical purview includes resolving problems such as marital problems, domestic violence, and disputes involving funeral preparations.
Rather, the clan elders saw health issues as within the jurisdiction of shamans and, in fact, the shamans expressed a desire help address HBV in the community. Typically, a shaman assesses patients’ souls, complementing the medical doctor’s attention to the physical body.
As a result of the study, Linda’s project is seeking funding to implement a shaman-led project to educate their community about HBV and encouraging vaccinations and screening as appropriate. The foundation has been laid in Merced for this cross-cultural approach to HBV. As part of a community-hospital partnership known as “Partners in Healing”, Mercy Medical Center Merced (the site of many of the harrowing scenes in “The Spirit”) allows shamans to conduct healing ceremonies in the hospital. The program was described in a 2009 article in the New York Times.
The notion of using traditional healers to educate and promote Western medicine about HBV in the Hmong community is a fascinating one; it will be interesting to see whether it yields positive results in practice and can be successfully applied to other health issues.