An Asian Cultural
Booklet
What is APAMSA?
Our primary mission is to promote awareness of Asian health care
issues to medical students, health-care workers and the Asian Pacific
Islander community and to form a collective voice for issues affecting
API's in the public and political arena. In addition, we provide a forum
for interested medical students to exchange information and cultural
experiences.
APAMSA was first started in 1993 by a group of Asian American
medical students who wished to provide a forum for the discussion and
promotion of Asian health issues. The first national APAMSA conference
was held two years later in 1995, and today APAMSA has over 100
chapters throughout the world. In 2003, the APAMSA chapter of the
University of South Florida medical school was formed. Our goals are to
raise awareness of Asian Pacific health issues in the medical community
and in Asian Pacific Islander communities of the Tampa Bay area.
For more information about USF’s APAMSA, please visit:
www.hsc.usf.edu/medstud/apamsa
About this Booklet
This booklet contains information compiled from various websites on
the internet. Please disregard any cultural discrepancies that you may
encounter from the information that we have provided.
 Shown above is the Laotian national instrument, the khaen, a type
of bamboo pipe that has prehistoric origins. The khaen traditionally
accompanied the singer in lam, the dominant style of folk music.
 Two frequently used Lao expressions are the responses bo penh
nyang and thammadha. These two words are derived from a
Buddhist perspective of acceptance of adverse situation.
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Bo penh nyang literally means "No problem", but dependent
on the situation, it can also mean "never mind" or "are you all
right?" or "I forgive and forget your action."
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The word thammadha means to accept one's fate - that one is
born, grows old and will die. In everyday life, it is used to
mean "average," "the norm" or "proceeding as usual." For
example, if a man is fired from his job, he may not be sad;
instead he may be thammada meaning he accepts his fate and
does not harbour resentment.
 The shaman is one of the most important people in a Hmong village.
He or she gives people hope in a crisis. The shaman is a spiritual
healer who guides a person in difficult situations. In Laos, a village
with a good shaman attracted new families. The important role of the
shaman continues today in America. Although most Hmong are
adapting to American medical customs, they still respect and visit a
shaman.
The Korean flag is called Taegukki. The central design symbolizes the
principles of yin and yang from Asian philosophy of continual movement,
balance, and harmony. The upper red section represents the positive
cosmic forces of yang, and the lower blue section represents the negative
cosmic forces of yin. The circle is surrounded by four trigrams, one in each
corner. Each trigram symbolizes one of the four universal elements: Heaven,
Earth, Fire and Water.
Mental illness is not readily accepted and can be considered
as stigmatizing or threatening. As a result, psychological and
social stress may be experienced bodily.
Hwabyung is an example of a Korean culture-bound illness,
common in women. The cause of this illness is suppressed
anger or intolerable tragic situations. Symptoms of hwabyung
include a perceived stomach mass, palpitations, heat
sensation, flushing, anxiety and irritability.
Bad medical news is often shielded from the patient. The family
may believe that the patient is in no condition to make a
decision and that bad news dissolves hope.
Because of traditional Korean values of loyalty, the patient
may trust that the parents and family will make the best
decision for them. Therefore, advance directives may seem
unnecessary to the patient and family.
Handshakes are appropriate between men; women do not
shake hands. Respect is shown to authority figures by giving a
gentle bow.
Khmer (also known as Cambodian)
is the official language of
Cambodia. The Khmer language
has the oldest written records of
any Southeast Asian language in
stone inscriptions dating back to
the seventh century.
Khmer New Year, a harvest festival celebrated every April, is the
biggest festival of the year. It is a three-day festival.
Pregnant mothers may drink homemade rice wine, herbal medicines,
coconut water, or beer which are all thought to make the baby healthy.
Some things to avoid include showering at night and drinking milk as
these will make the baby fat and difficult to deliver.
Smoking is part of Cambodian tradition culture. Cigarettes are to be
included with the offerings made to a monk, given to guests at
wedding receptions and provided to houseguests.
Cambodians have beliefs that conflict with medical practices and
procedures such as blood drawing, genital exams, x-rays, and surgery.
For example, they believe that any blood drawn from them is not
replaceable. Another example is the belief of X-rays destroying red
blood cells, and these cells could not be regenerated. As for surgery, it
is considered to be terrifying and is the last resort; therefore,
Cambodians are very frightened when being hospitalized for surgery,
and elective surgery is not an option.
A Cambodian patient will seek a doctor who gives medications,
because it makes them feel as if the illness is being taken care of when
the doctor gives out drugs. Also, many times, these medications are
shared among friends and family. They will take the drugs when they
feel sick and stop when the symptoms go away. The individual also
expects the drugs to be effective immediately. Treatment for chronic
disease can be a problem in this population.
Traditional Chinese will use herbs and
special soups for all illnesses before he
or she seeks out an alternative
treatment from Western medicine.
The herbal tea and the special
ingredient soups usually require hours
of slow cooking in an ancient style clay
pot, before they reach maximum
benefits.
Western medicine is often reserved for
more severe health problems, as many
Chinese believe that Western medicine
is "too strong" for them.
 Pregnant women usually want to eat to get the energy before going
through the labor. This contradicts Western culture, where eating is
avoided for fear of nausea and vomiting.
 There are rules that a woman follows during her postpartum period,
called the “sitting month”. During this time, women are not to take
baths, wash their hair, go outside in the cold temperature, drink ice
water, or eat cold food like uncooked vegetables, salads, or fruits. The
reasons behind these restrictions are based on the belief that women
are undergoing a cold stage right after the delivery due to loss of
blood. In order to restore the energy, women need to consume food
that are considered "hot" such as soup and ginger. On the other hand,
in Western culture, cold food such as orange juice, ice water, cold
sandwiches, and ice cream are routinely offered to women during their
inpatient stay. Thus, hospital food is usually left untouched and these
women will have food brought in from home.
The three main ethnic groups living in
Malaysia are the Malays, Chinese, and
Indians. The largest, accounting for
more than half of the total population
today, is the Malays.
Perhaps the most significant influence
that has served as a unifying and binding
factor among the Malays is the religion
of Islam. Today, almost all Malays in
Malaysia are Muslims.
The official language in Malaysia is
Bahasa of the Malays; however, English
is used when communicating between
different communities.
Silat, the Malay art of self-defense,
enables a person to defend himself when
being attacked. The aim of silat is to
instill confidence in oneself in the face of
adversity. Occasionally, a keris (small
dagger) may be used.
Wayang Kulit is a traditional theater artform using puppets and shadow-play to
tell the epic tales of the Ramayana. The
puppets are made of buffalo hide and
mounted on bamboo sticks. There may
be as many as 45 puppets - handled
entirely by a single master puppeteer,
known as the Tok Dalang.
Hanuman, the magical white monkey
warrior in Rama’s simian army, is
probably the best known monkey
character in Ramakien, the Thai
version of the Indian epic Ramayana.
He has become a hero for Thai
children.
Thailand was the only country in
Southeast Asia to remain
independent during the colonial
period. In 1939, it is officially known
as "Siam" (now Muang Tai, "Land of
the Free," or Pratet Tai, "Free
Kingdom"). Thai culture has been
strongly influenced by both China
and India but is more so by Indian
culture based on Buddhism and using
a version of the Devanagari (Sanskrit)
alphabet.
The Thai literacy rate is highest in
Asia.
Thai Baby Names
Kasem Happiness
M
Aran
Forest
M
Daw
Stars
F
Kovit
Expert
M
Mali
Flower
F
Niran
Eternal
M
Phailin Sapphire
F
Ratana Crystal
F
Solada Listener
F
Suchin Beautiful Thought F
Sunee
Good Thing
F
Tasanee Beautiful View
F
Vanida Girl
F
Virote
Power
Yee Peng is the annual festival held to
celebrate the full moon in the
northern capital of Chiang Mai in
November. The highlight of the event
is the launching of the Khom loy or
floating lanterns into the night sky
with the belief that misfortune will fly
away with the lanterns. It is also
believed that the light will guide the
people to the right path of their lives.
According to the 2000 census, there are over 1.6 million people of Asian Indian origin in the
United States. India is a boiling pot of religions and beliefs. Hinduism is the predominant
religion of India followed by Islam. Other religions of India include Sikhism, Buddhism,
Jainism, Christianity, and Judaism. The national language is Hindi, which is spoken by 40%
of Indians. Most Indians, however, speak another dialect, such as Urdu, Gujurati, Punjabi,
etc.
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Most devout Hindus practice vegetarianism. Vegetarianism among Hindus is based
on belief in reincarnation, the idea that the soul of a person enters back into creation
as a living being.
Meditation and prayer are used by many Hindus. Some meditate silently, while others
chant "Om" and other prayers aloud.
Karma is a law of behavior and consequences in which actions in past live(s) affects
the circumstances in which one is born and lives in this life. Thus, a patient may feel
that his or her illness is caused by karma (even though there may be complete
understanding of biological causes of illness).
The Bindi is a sign worn by many women of the Hindu faith as a red dot on the
forehead. Traditionally a symbol of honor and intelligence, today, it is common for
women to wear it as decoration. The care provider should assess the client’s personal
reasons for wearing the Bindi, since it may vary for women depending on age and
assimilation into American culture.
Many Indian women will look to their husbands or fathers to help them make
important medical decisions.
There are about 800,000 Japanese Americans according to a 2000 consensus. The major religions of
Japan are Buddhism and Shintoism. A large majority of Japanese Americans live in California and Hawaii.
The main diseases that afflict Japanese Americans are coronary heart disease as they adapt the Western diet.
 Filial Piety. In Confucian thought which places importance on family and social order, filial
piety was felt to be extremely important. Children were expected to obey and respect their
parents, bring honor to their parents by succeeding in work, and support and care for parents
in their old age. Additionally, for many Japanese immigrants, “kodomo no tame ni” or “for the
sake of the children” became the motto by which they endured to bring a better life standard
for their children’s generation. Thus an element of expectation from parents and a sense of
obligation on the part of the children to support and care for their parents may exist. Even
though adequate care may be difficult to render by the children, reluctance is often
accompanied by guilt if parents are placed in an institutional long-term care facility.
 Informed Consent and End of Life Care. It is a common saying that Japanese are born Shinto
but die Buddhist. In Shintoism, the emphasis is on purity and cleanliness. Terminal illnesses,
dying and death are considered “negative” or impure and akin to “contamination.” Thus, open
frank discussions that occur with informed consent procedures, choices in treatment, and
advance directives may be difficult at first. However, at some point most Japanese are said to
embrace Buddhism in later life. As such, death is considered a natural process, a part of life.
Life continues after death in the form of rebirth. They may be more open to end-of-life
discussions. Conversion to Christianity or other religions would certainly have some impact on
views of death, dying, and end-of-life issues
Traditionally, organ donation is not favored because of the importance of dying intact, and
because the concept of brain death, as opposed to death occurring “naturally” when the heart
ceases to beat, is sometimes difficult to understand.

Mental Illnesses. There is a general stigma associated with mental illnesses. Thus, there is less
seeking of direct medical assistance by either the person afflicted or by their family. There is the
concept of shame or “hazukashii”, in which the individual is taught to avoid bringing shame to
his family name.
Family and Friendship
Family is very important to the
Filipino. Parents generally set
up their children with whatever
they can afford so buying them
their first car and first home is
very common. In turn, adult
children are expected to live in
the same home and take care of
their parents when they get
older.
Face
Similar to other Asian cultures,
the Filipino puts great emphasis
on saving face for himself and
other people. For example,
when invited to an event, a
Filipino will easily say yes even if
he has no intention of going—to
save the inviter’s face. He
would not state a contradictory
opinion directly, instead
phrasing his opinion as a
question or just keeping silent.
Faith
The main religion is Roman
Catholic.
Fiesta and Food
Filipinos are a happy-go-lucky,
life-loving group and will give a
party at the drop of a hat. The
roast pig is the ultimate symbol
of lavishness.
Three “Waves” of Refugees
Traditional Medical Practices
The First Wave. In 1975, 130,000 Vietnamese fled
to the US. They were mostly young, well educated,
and English speaking urban dwellers. Fifty-five
percent were Catholic and many brought their
families intact. Most stayed at military bases until
sponsors helped them resettle.
The mountain dwelling groups believe that sickness
comes from the wrath of the gods. The physician is
a priest who negotiates with the gods to eliminate
the sickness. These groups often resist invasive
techniques, and women often refuse anesthesia for
childbirth.
The Second Wave. Between 1979 to 1983,
455,000 SE Asian refugees settled in the US. This
group was more diverse and included people with
different nationalities, religions, and languages.
They were less educated, less literate in their native
language and in English, and more rural. Hoards of
people attempted escape by boat.
The Third Wave. These refugees arrived from
1985 to 1991 and continue to do so in small
numbers. They are Vietnamese and Chinese
brought to the US through family reunification
programs.
What the physician should know: Your
Vietnamese patients may be rural people from the
second wave and have difficulties learning to read
and write a second language because as farmers,
many were not literate in their native Vietnamese.
The peasant groups and urbanites from Vietnam
employ a medicinal system based on Chinese
medicine. Many believe that traditional herbal
remedies, tonics, massage, and avoidance of
excess are the pathways to good health.
Dermabrasive procedures based on hot/cold
physiology are often used to treat cough, myalgia,
headache, nausea, backache, motion sickness, and
other maladies. To release excessive air, cutaneous
hematomas are made over the face, neck, anterior
and posterior trunk. This can be achieved by
pinching on oiled skin with the edge of a coin (cao
gio) or by cupping (giac hoi or hut hoi). Cupping
involves flaming a cup, placing it on the skin, and as
the air in the cup cools, it pulls on the skin and
leaves an ecchymotic area.
Acupuncture is used widely for musculoskeletal
ailments such as arthritis pain, stroke, visual
problems, and other ailments.
Interpersonal Relationships
Praising someone abundantly is often regarded as
flattery or mockery. Insults to elders or ancestors
are very serious and can lead to severed social ties.
Experience with Western Medicine
From experiencing poor living conditions during the
war and in camps, little access to healthcare,
starvation, and abuse, many Vietnamese came to
the US with severe health problems such as TB,
hepatitis B, malaria, malnutrition, anemia, leprosy,
and intestinal parasites. In the US, poverty, crowded
living conditions, and lack of utilization of healthcare
still pose health risks.
Many refugees may suffer from PTSD, depression,
anxiety, psychosis and adjustment reactions. In
traditional Vietnamese culture, it is not acceptable to
discuss stress or emotional disorders, so many with
these disorders present initially with somatic
complaints.