Diversity Rx 2010
Seventh National Conference
On Quality Health Care for Culturally Diverse
Populations
October 18-21, 2010
THE HMONG CULTURAL/BELIEFS IMPACT WESTERN
HEALTH CARE
By Fuechou Thao
HMONG HISTORY
1. Theoretical framework about the Origin of the Hmong
a. Savina concluded that the Hmong were a subgroup of the Turanians, a
Caucasoid people, originally from Mesopotamia.
b. Eickstedt introduced the theory of ultimate southern origin_ either coming from
India, Burma, or Tonkin.
However, all researchers agreed that the Hmong were in China before the Chinese.
2. The Hmong’s Migration
a. From China to Southeast Asian (Laos) about 1810 and early 1900
b. From Laos to the U.S.A, Australia, France, Canada, etc in 1976
DEFINITION OF TERMS
The Chinese used the following terms:
Miao
Mong-Tse
Meau
Meau-Tse
The Lao and Thai used:
U.S. Government used:
We call ourselves:
loosely translated “barbarian”
Historical Chinese work compared our language to the
howling or crying of the hyena
Transliterating a cat’s head or all the non-Chinese
Son of the soils, the farmers
Meo
Highlander
Hmong or Mong
DEMOGRAPHY AND GEOGRAPHY
Country
Hmong Population
China
Vietnam
Laos
Thailand
Burma
U.S.
France
French Guyana
Canada
Australia
Germany
7,393,037
250,000
350,000
125,000
4,000
300,000
15,000
1,100
700
350
130
Total
8,439,317
1. Chij Tsaj, Hmoob Pa Tawg Teb ( The Hmong in Wanshan), (Guyane: Association Communaute
Hmong, n.d.), 17
2. Dao Yang , Les Hmong du Laos Face au Development (Vientiane, Laos: Edition Siaosavanth, 1975),
26-28
3. W.E. Garrett, “The Hmong of Laos: No Place to Run,” National Geographic, Vol 145,No. 1
(Washington, D.C.: National Geographic Society, January 1974), 80
4. Xeev Nruag Xyooj, “Txooj Moob huv Nplaj Teb” (The Mong in the World), Txooj Moob, Vol. 4
(Winfield, Illinois: Mong Volunteer Literacy, Inc., May 1989), 8-12
HMONG CULTURE
1. Family Life
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Basic nurturing institution, extended family
Organized strictly on the patriarchal side
2. Religion
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Traditional animists (Kev Cai Poj Yawm)
Animism: a belief system that combines the ancestor , supernatural power,
superstition and devil worship
No standardization in Hmong religion
Belief in life after death
Dealing mostly with superstition and devil worship through the notion of illness
and death.
3. Arts and Crafts
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The Hmong are known for their “Paj Ntaub” translated “Flower Clothes”.
Hmong observed the patterns, the cross-stitch embroidery and their applique
from the design of the cowries Shell and the shape of animals and plants from
China.
Those patterns were incorporated into costume design
Paj-Ntaub became one of the most distinctive features of traditional Hmong
culture.
4. Social Structure
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Emphasis on the clan system originating form a common ancestor
Clanship is the basic social and political organization
A Hmong at birth takes on his/her father’s clan and remains a member for life
Origin of the clan remains a mystery referring to a child of incest born from a
brother and a sister dating back to the Great Flood. Shaped like an egg, the
couple cut their offspring into pieces that became the different Hmong Clans
In Hmong Society, boys and girls are forbidden to date and marry within their
own clan
The traditional Hmong consisted of twelve clans that corresponded to their
rituals:
CLAN NAMES
RITUALS
1. Chang (Chun)
2. Hang
3. Her
4. Kue
5. Khang, Phang
6. Lee (Li, Ly), Lor
7. Moua (Mua)
8. Song
9. Thao (Thor)
10. Vang, Cheng, Fang, Vue
11. Xiong
12. Yang
Nrig
Tag
Dluag
Nkug
Pluag
Cai
Zag
Koo (Kong)
Dub
Vug
Mob
Yawg
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The Hmong took on Mandarin Clan name during King Wu of the Chou Dynasty
(1028-257 B.C.)
And the branching out of the clans from twelve to eighteen occurred during the
Ming Dynasty (1368-1644);
5. Political Organization
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A complex hierarchical political system;
Reflected the former political system of the Hmong kingdom between 400-900
A.D.;
“A loose federation of tribal heredity Monarchy”
Power was decentralized to the localities;
The full scope of the traditional Hmong political system has not been welldeveloped;
In the 19th century, some alterations in the Hmong political structure were made
under the auspices of the territorial organization of the Royal Laotian
government:
 Nai Ban (headman or village chief)
 Tasseng (district chief)
 Nai Kong (a higher layer of civil tribal administrative officials)
 Chao Muong (Mayor)
 Chao Khoueng ( Provincial Chief)
The strongest basic unit of the Hmong political system remains with the
patrilineal clan system with its household at the local level;
Members of the same clan refer to clan-brother or clan-sister;
Grouping the members of a clan of the same and common ancestors in one
particular area is typical_ Hmong enclave;
Place a high value and offer much respect to elders;
Tus Tsaws –Ntug (the clan Leader/householder)-final authority in familial
matters; Role is to maintain peace and harmony within his family, clan members,
and other clan members;
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A Hmong is responsible to answer to his family, to the clan, and to the
householder;
As mountain dwellers, the Hmong survived on small scale agricultural economy
“Ua Teb” (Farming) at a subsistent level;
The notion of division of labor is very important within the family, between
members of the villages, and between villages;
The Hmong believe in the spirit of collective teamwork and the notion of free
labor exchange existing within the traditional and cultural realm of Hmong life;
HMONG LANGUAGE
1. General Characteristics
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Has always been an oral language until the end of World War II.
Is a subgroup in the Sino-Tibetan language family of Asia (considered a preSinitic language in the Miao-Yao family).
Is a monosyllabic and tonal language.
e.g.
Kuv
hlub
koj
‘I‘
‘love’
‘you’
The ending in each word, kuv, hlub, and koj, are tone-markers. The Hmong do
not pronounce them.
Therefore, pronouncing the –s or the ending sounds is difficult for Hmong.

Orthography was based on the Romanized Practical Alphabet (RPA) system
developed by missionaries of the Christian and Missionary Alliance (CMA) in the
1950’s.
2. Morphology: Words
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Words in Hmong consist of monosyllables and do not change their forms.
Hmong words do not have suffixes so English morphology is difficult for Hmong
speakers.
A) No –s ending in plurals
e.g.
English:
Hmong:
Pen
Cwj-mem
B) No –ed in past tenses
e.g.
English:
Hmong:
I love you (present)
I loved you (past)
Hmong:
Kuv hlub koj (present)
Kuv hlub koj (past)
C) No –ing in participles
e.g.
English:
Love  Loving
Pens
Cwj-mem
Hmong:
Hlub  Hlub
D) No Noun Declensions
e.g.
English:
government,
nervousness,
assistance,
subtraction,
criticism,
casualty
E) No Verb Conjugations like French or Spanish
e.g.
French:
Je chante une chanson.
J’ai chante’ une chanson.
Je chanterai une chanson.
Hmong:
Kuv hu nkauj (for three)
F) No Grammatical Gender (no masculine or feminine like English and French)
e.g.
English:
Hmong:
Waiter  Waitress
txais-tos  txais-tos
EDUCATION
History, legend and Hmong elders all maintain that the Hmong in China once had a
writing system before the invasion of the Han Chinese. Due to heavy and continued
suppression by the Han Chinese, the Hmong were unable to keep their books; they
threw them into the Yellow River and hid their writing by only using the characters as
designs for the women’s skirts and collar. So sometime in their past the Hmong lost
their writing system.
According to Dao Yang, PhD, the first school began operating in the Hmong homelands
at Xiengkhoung Province, Laos in 1939 and there were only nine Hmong students who
attended. Once more elementary schools were set up throughout other highland areas
of Laos, Hmong children were able to attend school to learn the Lao language. The
Laotian school system was divided into two grade school levels. The first level was
called Primary Grade school which included grades 1-3, and the second level was
called the Upper Grade School which included grades 4-6. Secondary School also was
divided into two levels as Junior High which was grades 7-10, and High School which
included grades 11-13. In 1971, there were 340 Hmong students enrolled in public and
private secondary schools in Vientiane and 37 Hmong students enrolled to study at the
universities in various countries abroad. In 1972, Dao Yang, PhD was the first Hmong
in Laos to earn a doctorate degree in economics and social development from the
University of Paris, in France.
Education is the most important driving force in the development of the Hmong
Community in the United States. In the short period of 35 years ( 1975-2010) of their
residence in the United States, more than 10,000 Hmong students have earned
bachelor degrees, more than 1,000 earned master degrees and more than 500 earned
doctorate degrees at American Colleges and Universities.
HMONG BELIEFS
Hmong traditional beliefs regarding the cause of illness, and their descriptions of
symptoms are very different from commonly used Western medical concepts. Western
health practitioners may become confused, frustrated and may conclude that the
Hmong patient is answering inappropriately by presenting a traditional belief in relating
his or her symptoms. However, health practitioners can learn to correctly diagnose the
patient’s ultimate health concern and respond accordingly to the patient’s needs through
an appropriately trained interpreter or a cultural broker. Common traditional Hmong
concepts regarding causes of illness are as follows:
FOOD AND DRINK
Many illnesses, especially those which manifest themselves as stomach aches or
digestive problems are thought to be caused by eating or drinking something that does
not agree with the body. This does not necessarily mean that the food and drink was
contaminated, rotten, or poisonous. This idea is not dissimilar from the symptoms
caused by a Western “allergy.” However, the Hmong perceive bad food and drink to
cause different symptoms than do allergies in Western medicine. For example, a
chronic feeling of bloating in the abdominal area may be described as “ having a lump
in the stomach,” or “kem plab”.
A common folk practice for differentiating between “bad food” and “bad drink” as the
cause for a stomach ache is for a second party to massage the stomach of the sick
person in a upwards motion towards the throat, and outwards along the arms to the
fingers. A finger is then pricked and a drop of blood is allowed to drop into a bowl of
water. If the blood floats, the illness is thought to be cause by drinking, and if it sinks
then it is thought to be cause by food. Other symptoms believed to be caused by food
and drink:
ANIMISM & ANCESTOR WORSHIPERS
Hmong Community Leaders in the United States estimate that at least 70 percent of
Hmong refugees have chosen to retain their traditional beliefs. Ancestor
Worshippers/Animists view most major illnesses as spiritual or traditional belief
problems.
Each Hmong family has a group of ancestor spirits, which belong to the father’s or
husband’s side. From time to time the ancestor spirits are in great need of certain things
from the descendents’ family to be used or spent in the spiritual world by causing illness
in a member of the family. To make an appropriate diagnosis a shaman or diagnostician
must be called in and ritual of animal sacrifice will be offer to the ancestor spirits.
NATURE SPIRITS
The Nature Spirits own and control their properties such as the hills, mountains, trees,
rivers, caves, animals and its kingdom. In general, nature spirits are not malevolent
towards humans. However, if a person offends, they may cause illness to the Offender,
the Family members of the offender and the Immediate Families.
Tossing a rock into the river may offend the river spirit. However, health usually returns
to the sick person once an appropriate ritual is conducted. If an offense has transpired a
Hmong Shaman, Diagnostician and Tamed Good Spirit Master will be called in to make
an appropriate diagnosis.
EVIL SPIRITS
The evil spirits are believed to live everywhere, especially in uninhabited areas such as
forests and jungles. If offended, they necessarily attack the perpetrator by causing acute
pain, violent pain, sickness and death.
The powerful Hmong Shaman, Tamed Spirit Master, or Evil-Spirit Master can deal with
problems of this sort, and treatment usually entails fighting off the evil spirits, rather than
appeasing it with ritual and sacrifice.
TAMED EVIL SPIRITS
Throughout Southeast Asia there is a common belief that a person, by joining a
religious cult or by studying under the established masters, can learn to control evil
spirits. The only two tamed evil spirits are “Nyuj Ciab, and Zeb Ntais.” They can be
controlled under a specialty Master who are thought to be able to magically insert the
“Nyuj Ciab, and Zeb Ntais” into anyone whom they target. People may also seek out
and hire them to inflict sickness and death upon an enemy. Common symptoms of an
attack by the evil-spirits include acute pain, violent pain, and sickness and death.
It is believed that the only way to escape from such a tamed evil-spirit attack is to bribe
the attacker with more money or hire a more powerful master to fight off the evil spirits.
LOST SOULS
A prevalent concept throughout many Southeast Asian cultures is that good health is
the union of one’s souls always with the body. The Hmong believe that each person
has twelve souls - there are three major souls and nine shadow souls-united in the
body. The more souls lost and the longer they are lost, the sicker the person will be.
The souls can be lost in numerable ways such as being frightened, depression, trauma,
kidnapped by evil spirits, on a long trip, and simply get lost.
There are many different types of ceremonies to call the souls back to their bodies.
Ceremonies range greatly in complexity from a basic calling ceremony to the most
elaborate, enlisting specialty soul callers.
CURSES
In the Hmong society it was believed that elders, particularly those of the same clan,
had the right to curse their descendants if the descendants did not carry out the filial
duties. A person who is morally right could curse anyone who has done him a serious
wrong. Curses could cause a wide range of illness, economic disaster, and even
death. The only way to remove these effects was for the person who originated the
curse to take it back through appropriate ritual and ceremony.
WEATHER
Traditionally Hmong elders believe that chronic illness, old injuries, etc, will reoccur as
various forms of pains or aches in the body when the weather changes sudden. It also
believed that changing weather can bring on colds, influenza, and muscle aches which
western people might call arthritis or rheumatism. Heat exhaustion and sunstroke are
also recognized by the Hmong as being caused by overexposure to the sun and heat.
OLD AGE
Hmong understand that as the human body ages, it degenerates, and various ailments
occur. Long term hard work and having borne many children are often cited by the
elderly for body aches and pains and respiratory and digestive problems. In Hmong
culture and society old age begins at age 30. The lifespan was shorter than the
American average. Being considered old in Hmong society was perceived as something
desirable, even though illnesses were anticipated with advancing age.
EXPIRATION OF BIRTH VISA
The Hmong believe that each person receives or carries a visa from God to be born as
human being. God determines the length of stay on earth and the expiration date of the
visa. Life-threatening illnesses and unexpected or unexplained sudden death are
thought to be cause by that person’s visa being expired. The Hmong Shaman is the
only one who has the power to extend, renew, or restore the expiration date. For routine
preventive care a shaman is called in to perform ritual of trance or incantation, make
negotiations to extend or renew the visa, offer animal sacrifices, restore supplies and
goods by the family members such as the younger brothers, daughters, and son in-law,
son and daughter in-law at a ritual ceremony.
HOUSE SPIRITS
There are six house spirits who play an important roll in the house in guarding the
individual person’s souls and spirits and while fending off any outside spirits. The spirits
of the ritual hearth or large stove and the spirit of the cooking hearth, which is in the
middle of the floor, help to protect every member of the entire family from harm or
misfortune. The spirits of the ancestors live in the central pillar and protect everyone in
the household against devils. The spirit of the door helps to protect the house and
everyone’s souls in the entire family against devils. The spirit of wealth and prosperity
lives against the middle of the back wall and protects the entire household and every
member of the family. The spirit of the marital bedroom lives in a gourd in the bedroom
and the gourd needs to be kept clean, to protects and produce the animal of the family.
KARMA
The concept of Karma is a common belief throughout Asia. Karma is not directly a part
of Animism or Ancestor Worship, the Hmong believe that souls return to earth time after
time, and life on earth is designated by luck, and by karma. Thus, people born with birth
defects, mental retardation, handicaps, and chronic illnesses are often regarded as
paying for sins committed in past lives.
DEPRESSION OR STRESS
Depression or stress is not perceiving by the Hmong in the same way that Westerners
perceive it. However, they recognize that stressful situations can result in various health
problems, especially that which we in the Western would call mental illness. Some
examples include family financial problems, aggressiveness, depression, insomnia,
sadness, and loss of appetite. The Hmong refer to those who exhibit changes in
personality as “having something wrong with their liver.” This does not mean that they
think there is something pathologically wrong with his or her liver; rather, the Hmong
language uses “liver” as a term to describe anyone exhibiting various sets of symptoms.
For example, a common Hmong term for someone who becomes destructive and
begins to verbally abuse others after some kind of emotional trauma or loss is “siab
phem, tsiv siab, kho siab” which translated having an “ugly liver, angry liver, rigid liver”.
HMONG TRADITIONAL HEALERS
Western health practitioners may wonder why they lack credibility with some of their
Hmong clients. Part of the reason is that differences between Western and Hmong
health practitioners are so great that some Hmong clients wonder if the American doctor
or nurse is competent. Hmong traditional healers provide health care to their patients in
a completely different and unique way, and just as Western countries have different
types of healers such as MDs, DOs, and chiropractors, the Hmong also have healers
from different schools of practice. It is quite common for individuals to study and master
more than one healing art. Although being a traditional healer does not usually bring a
person wealth in Hmong society, it does bring status and peer admiration. Common
Hmong traditional healers and practitioners are as follow:
ACUPUNCTURISTS
It is thought that the skill of acupuncture was adapted by the Hmong from the Chinese.
Most Hmong acupuncturists do not use the hundreds of points used by their Chinese
counterparts, but rather concentrate on several key points. Although, the practice of
Hmong acupuncture is not very common it is utilized on occasion by both Christian and
Non-Christian Hmong. Hmong acupuncturists practice the following skills:
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Message on arms and legs with herbs
Massage on body, arms, legs, fingers and toes then use needle to prick on the
areas.
Both Christian and Non-Christian Hmong occasionally approach the
acupuncturist for certain medical problem.
HERBALISTS
The Hmong have experiences in using herbal medicine for treatments as well as
healing art techniques, they prefer self-care for sickness at home before seeking
Western health care unless an emergency takes priority. When someone is sick, a
member of the family seeks the advice of the herbalist who is knowledgeable in herbal
medicines and practices that could cure the sick person. More commonly, Hmong
women are responsible for growing herbal plants and hence almost every Hmong family
grows herbal plants. It is logical then that Hmong women are more specialized than
men in the knowledge of herbal medicines and in preparing and prescribing the use of
herbal medicines. In the Hmong community throughout the United States, almost every
family grows and keeps gardens of herbs on their back and front yard. For the common
practice of the Hmong herbalists, they need to:
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Keep gardens of herbs on back and front yards
Search for natural herbs in the forests
Dry and preserve herbs
Harvest fresh herbs
Believed to impart some spiritual power to the herbs which give more healing
strength
Both Christian and Non-Christian Hmong approach the herbalists for any type of
medical problems.
HMONG SHAMAN (TXIV NEEB)
The Hmong shaman is the most commonly known traditional healer existing for many
thousand years. The shaman can be either male or female and shamanism is the only
Hmong traditional healing art that can not be studied or passed on to another. The
healing spirits call “Dab Neeb” chooses their host by causing prolong illnesses such as
intolerable foods, fatigue, weakness etc. The shaman master is able to store the
appropriate and good spirits “Dab Neeb” to the individual to teach him or her how to
heal others through incantation with the spirit world. Each shaman is thought to have a
different level of healing powers and some specialize in certain fields of illness.
However, Hmong shamans are capable of dealing with almost any kind of sickness.
Moreover, they are able to diagnose and refer patients to other sources if they are
unable to cure the patients. All shaman maintain an altar and many tools:
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The Gong “Nruas”
The Rattle “Txiab Neeb”
The Buffalo Horn “Kuam”
The Rattle Rings “Tswb Neeb”
The Sword “Riam Neeb”
A Hat of red or black clothes
A Bowl of holy water
A Bowl of uncooked rice for incense base
A few dozen incense (sticks)
A Bowl of uncooked rice with eggs
The common practice of the shaman
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Performing a ritual of trance or incantation
Making negotiations
Offering animal sacrifices
Renew or restore the appropriate spirits, and souls
Ritual ceremony
Diagnosis of patient sickness
TAMED GOOD SPIRITS MASTER (Txiv Khawv Koob)
Healers of this type are the counterparts of the Tamed Evil-Spirit Masters. They are
thought to have similar powers in removing foreign objects from the body that cause
illness, stopping blood flow from a fresh cut or wound or nose bleeding, healing broken
bones, fire burn, speeding up labor and delivery, and removing various aches and
pains. However, they do not have the power to fight off attacks by Tamed Evil-Spirits, to
insert foreign objects into victims, nor do they possess the power to cause illness in
others with the spirits. The Tamed Good-Spirit Masters have only the power to cure
and, consequently, are more well-accepted in Hmong society.
TAMED EVIL-SPIRIT MASTER (Txiv Khawv Koob)
This person is thought to be capable of causing illness as well as curing those under
attack by another Tamed Evil-Spirit Master. This type of healer also has the added skill
of being able to magically insert into or remove foreign objects from a person’s body.
The foreign objects cause various types of acute pains and illnesses and eventually
death. The Tamed Evil-Spirit Masters are viewed with fear by the Hmong society, so
they keep their skills a secret.
DIAGNOSTICIAN
There are several types of Hmong Diagnosticians who are capable of diagnosing what
is wrong. They will refer to other healers for cure, but not themselves provide cures for
clients. They have learned the art of fortune telling; reading various omens, using the
first day that the client got sick, lost, or disappeared to find out what’s wrong.
Other diagnosticians specialize in using one or more “tools” to ask the spirits what is
causing the patient to get sick. In the ritual of diagnosis they use been seeds, rice
grains, coins, wood or baboon sticks, or chicken eggs. Diagnosticians are able to
negotiate and offer animal sacrifices while conducting the ritual of diagnosis. In general,
the majority of diagnosticians must refer their clients to other healers or a shaman for
treatment or cure.
SOUL CALLERS
Almost every male head-of-household and some female in Hmong society knows how
to perform simple soul-calling ceremonies. In difficult cases, more complex ceremonies
must be held by skilled practitioners. Soul-calling ceremonies are the most common
practice by non-Christian Hmong. Soul calling involves the sacrifice of two chickens, two
or more eggs, a pig, a cow, or buffalo.
HERBAL MEDICINES
Name of Med:
Scientific Name:
Part used:
Indication:
Preparation:
Method of use:
Tshuaj Rog Ntsuab
Name of Med:
Scientific name:
Part use:
Indications:
Preparation:
Kuab Tub Sab
Mirabilis Jalapal
Stem and Leaves
Weak and loss of appetite
Used as a tonic in combination
Leaves
Weak or tired
Boiled with chicken
Orally-eat the chicken and drink the broth
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