Chinh Duy Le, MD
UCI Senior Health Center
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• Objectives:
 1. To raise awareness of cultural affects in health care
for Vietnamese American seniors.
 2. To emphasize the importance of culturalappropriate approach for health care in diverse
society.
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Strongly influenced by Chinese and French culture due to prolonged
colonization by these governments in history
ASDFGHJ. (2009). Location Vietnam ASEAN [vector graphics], Retrieved May 5, 2011, from:
http://en.wikipedia.org/wiki/File:Location_Vietnam_ASEAN.svg.
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Mr. Nguyen is 75 y.o. Vietnamese male, walk-in for an
assessment for weight loss.
He was doing fairly well until 3 months ago when he
started losing his appetite and weight (~15 lbs/3
months).
Denies any symptom and depressed mood.
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
PMHx: Lung TB diagnosed and treated in 1990 in
VN
Chronic hepatitis B
How Mr. Nguyen’s PMHx information would affect your
clinical management for Vietnamese seniors?
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TB in Orange County of 3 million people
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300,000 persons with TB infection (latent TB).

200 active TB cases/ year, ~6.2 cases/ 100,000 residents (3.8/100,000 in States)
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87.2% were among foreign-born; Vietnamese: 34%; Mexican: 25%;
Philippines: 19%; Korean 6%
Chronic Hep B and liver cancer.
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Social history: Finished high school in VN; joined the
army until 1975; spent 8 years in communist reeducation camp; speaks primarily Vietnamese at
home; unable to complete your health screening form
in English.
Would Mr. Nguyen’s social history give you any
information that may affect your health care for
Vietnamese seniors?
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Vietnamese American:
Immigration Waves
First wave: April 1975.
Speak more English. More
acculturated to American
culture.
Second wave: 1978 – 1990.
May have trauma from a
dangerous journey
Third wave: 1990 – 2000.
May represent majority of
VN American elderly. Most
have trauma from war or reeducation camp.
PH2 Phil Eggman. (1984). 35 Vietnamese Boat People 2 [photograph], Retrieved May 6, 2011, from:
http://en.wikipedia.org/wiki/File:35_Vietnamese_boat_people_2.JPEG.
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Identify structural brain alterations associated with THI
and investigate association with posttraumatic stress
disorder and depression.
Mean cortical thickness in some areas significantly
thinner in ex-political detainees with THI compared to
those without.
More depression and PTSD in ex-political detainees
with THI compared to those without.
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Only English at home
Non-English at home
English spoken
"very well"
Non-English at home,
English spoken
less than "very well"
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On physical exam you find lines of red bruises along ribs and
midline in his back…. You probably would….
Coin rubbing1
Cupping therapy2
1. Jugana Loder. (2008). Gua Sha [photograph], Retrieved May 6, 2011, from: http://en.wikipedia.org/wiki/File:Gua_Sha.jpg.
2. Alanna Ralph. (2004). Fire cupping [photograph]. Retrieved May 6, 2011 from:
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http://en.wikipedia.org/wiki/File:Fire_Cupping.jpg.
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What are common cancers in VNese American
seniors?
White Men
All Cancer* 1432.0 1.00
Stomach
Liver
Cervix
Breast
Lung
37.1 1.00
28.2 1.00
454.3 1.00
White Women
VN Men
VN Women
907.8 1.00
883.7 0.66
534.7
0.63
19.8 1.00
14.6 1.00
7.7 1.00
88.0 2.54
141.8 5.24
51.3
61.9
13.7
2.92
4.55
1.74
23.5
114.2
0.19
0.56
129.3 1.00
206.8 1.00
285.5 0.64
Cancer death rates for older Asian-Americans_ Lauderdale, D.; Huo, D.
*Death rate/100,000. Cancer Causes Control (2008) 19:135–
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After evaluation, you think Mr. Nguyen probably has
depression and needs antidepressant treatment. ..
What could be cultural barriers in diagnosis and
treatment of mental health issues in VNese elderly?
1.
2.
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3.
Social stigma.
Traditional health beliefs:
Hot/cold (Yin – Yang)
Herbal medicine (“northern medicine”, “southern
medicine”)
Acupuncture.
Lack of sensitive and specific testing instruments
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Mr. Nguyen…
General Issues in Health Care
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Other cultural barriers in health care
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1. Advanced directive
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2. Responsible party
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3. Death and dying truth telling
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4. Care-giver burden
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5. Attitude toward health maintenance
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Racial and Ethnic Approaches to Community Health
(REACH) 2010 Risk Factor Survey, 2001–2002
MMWR, August 27, 2004
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Cultural Aspect of Health Care in
Vietnamese American Elderly_ Summary
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1. Vietnamese American seniors do have difference in
their medical profiles.
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2. Culture and traditional health beliefs have strong
impact on health care for VNese seniors.
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3. A culturally appropriate approach is important in
medical care for VNese elderly to improve our patient
care.
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