Author Bio

Kathleen A. Culhane-Pera, M.D., M.A., is a family physician at Ramsey Family and Community Medicine Residency and West Side Community Health Center.

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Dorothy E. Vawter, Ph.D., associate director, Minnesota Center for Health Care Ethics, directs the Center's work on cross-cultural health care ethics.

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Phua Xiong, M.D., is a family-practice physician at the St. Paul Family Medical Center in St. Paul.

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Barbara Babbitt, B.S.N., R.N., M.A., has spent many years working to improve the way health care is delivered to culturally diverse families in the Twin Cities.
Mary M. Solberg, Ph.D., M.S.W., is a member of the religion faculty at Gustavus Adolphus College.

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Mary M. Solberg, Ph.D., M.S.W., is a member of the religion faculty at Gustavus Adolphus College.

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Main Description

Healing by Heart is a book of stories--stories of people's search for culturally responsive health care from U.S. providers. It offers resources to providers and institutions committed to delivering culturally responsive health care, paying special attention to building successful relationships with traditional Hmong patients and families. It makes available extensive information about the health-related beliefs, practices, and values of the Hmong people, including photographs of traditional healing methods.

Ranging in age from young infants to older adults, the patients in the stories present a wide range of health problems. The clinicians are from family practice, internal medicine, pediatrics, emergency medicine, surgery, obstetrics-gynecology, psychiatry/psychology, and hospice.

Each of the fourteen case stories is accompanied by discussion questions as well as two or three commentaries. The commentaries--written by patients, family members, shaman, Western clinicians (including Hmong physicians, nurses, and social workers), medical anthropologists, health care ethicists, social workers, psychologists, and clergy--are rich in personal reflections on cross-cultural health care experiences. Readers are rewarded with a combination of perspectives, including those of Hmong authors who have not previously published in English and scholars with years of professional experience working with the Hmong in Laos, Thailand, and the United States.

The editors offer a model for delivering culturally responsive health care with special attention to matters of cross-cultural health care ethics. The model identifies questions health care providers can focus on as they seek to understand the health-related moral commitments and practices prevalent in the cultural groups they serve, ethical questions that arise frequently and with great poignancy in cross-cultural health care relationships, and points to consider when a patient's treatment wish challenges the provider's professional integrity.

By sharing stories of suffering, confusion, and success, Healing by Heart couples an accessible method of learning about others with concrete recommendations about how to enhance cross-cultural health care relationships.

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Reviews

In Healing by Heart, a wide-ranging group of individuals draw from their experience with Hmong patients to present a clear and unique vision for achieving cultural competency in health care. . . . Healing by Heart raises fundamental questions, such as how can health care professionals diagnose or treat a patient from a group whose beliefs, explanatory models, and communication patterns are radically different from their own? . . . I recommend Healing by Heart to a wide audience of health care practitioners, anthropologists, sociologists, public health-oriented individuals, ethics committee members, and others interested in cross-cultural health care.
--JAMA Journal of the American Medical Association

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This is a 'must read' book for anyone interested in providing more culturally competent health care and addressing cross-cultural ethical conflicts.
--Robert C. Like, M.D., Director, Center for Healthy Families and Cultural Diversity, UMDNJ

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Table of Contents

List of Illustrations ix
Preface and Acknowledgments xi
Introduction 1

PART I Health-Related Cultural Beliefs, Practices, and Values

1 Hmong Culture: Tradition and Change
Kathleen A. Culhane-Pera, M.D., M.A., and Phua Xiong, M.D. 11

PART II Women's Health: Case Stories and Commentaries

2 Controlling Fertility: A Case Story 71

Hmong Preferences for Natural Family Planning
Marline A. Spring, Ph.D., and Mayly Lyfoung Lochungvu 73

Social, Cultural, and Ethical Aspects of Controlling Fertilityin the Hmong Community
Peter Kunstadter, Ph.D. 80

3 Woman with Pregnancy Complications: A Case Story 88

The Cultural Complexity of Obstetrical Care
Helen B. Bruce, R.G.N., S.C.M., M.T.D., C.N.M., and Chue Xiong, R.N. 92

Conflicting Cultural Practicesin Deciding about a Cesarean-Section
Carol A. Tauer, Ph.D. 98

4 Woman with Vaginal Bleeding: A Case Story 104

Culturally Responsive Care for a Hmong Woman with Vaginal Bleeding
Deu Yang, L.P.N., and Deborah Mielke, M.D. 106

Influence of Conversion to Christianity on a Hmong Woman'sDecision about Hysterectomy: A Pastor's Perspective
Lu Vang with Phua Xiong, M.D. 111

PART III Children's Health: Case Stories and Commentaries

5 Children with High Fevers: Case Stories 117

Hmong Health Beliefs and Practices Concerning Childhood Fevers
Kathleen A. Culhane-Pera, M.D., M.A., and Va Thao, L.P.N. 120

State-Ordered Medical Care for Our Son: Parents' Perspective
Parents (Anonymous) 129

Family-Centered Cultural Collaboration in Pediatric Care
Donald Brunnquell, Ph.D., and Stephen Kurachek, M.D. 133

6 Bottle-Fed Toddler with Anemia: A Case Story 141

Iron-Deficiency Anemia in Bottle-fed Toddlers
Cher Vang, M.P.A., and Christopher L. Moertel, M.D. 144

A Culturally Informed Public Health Responseto Pediatric Anemia in the Hmong Community
Elanah Dalyah Naftali, Dr.P.H., R.D., and Mao Heu Thao, L.P.N., B.A. 149

7 Infant with Down Syndrome and a Heart Defect: A Case Story 156

Defining Best Interest for a Hmong Infant: A Physician's Challenge
Gregory A. Plotnikoff, M.D., M.T.S. 159

"Why Do They Want to Hurt My Child?": The Mother's Perspective
Phua Xiong, M.D 165

PART IV Chronic Disease: Case Stories and Commentaries

8 Man with Diabetes and Hypertension: A Case Story 173

Type 2 Diabetes Mellitus in the Hmong Community
Kevin A. Peterson, M.D., M.P.H., May Lee Vang, A.A.,
and Yer Moua Xiong, M.P.H.176

"I Tell You This Story of Healing": A Shaman's Perspective
Yer Moua Xiong, M.P.H., as told by Nkaj Zeb Yaj 183

9 Young Woman with Kidney Failure and Transplant: A Case Story 186

Endstage
Mai Neng Moua 190

Painful Cultural Differences in a Hmong Family:The Mother's Perspective
Phua Xiong, M.D. 198

PART V Mental Illness: Case Stories and Commentaries

10 War Veteran with Depressionand Posttraumatic Stress Disorder:
A Case Story 207

Social and Spiritual Explanations of Depression and Nightmares
Bruce T. Bliatout, Ph.D., M.P.H., M.S.Hyg., Dr.Ac. 209

Depression and Posttraumatic Stress Disorder:Prevailing Causes and Therapeutic Strategies with Hmong Clients
Vang Leng Mouanoutoua, Ph.D. 216

11 Domestic Violence: A Case Story 222

Traditional Hmong Concepts of Wife Beating
Mymee Her, Ph.D., and Chue Pao Heu 224

Changing Gender Roles and Domestic Violencein the Hmong Community:
A Feminist Perspective
Pacyinz Lyfoung, J.D. 234

12 Woman with Psychosis: A Case Story 239
Cultural Interpretations of Psychosis
Joseph Westermeyer, M.D., Ph.D. 241

Integrating Hmong and Western Approaches to Spiritual Illnesses
Thomas Vang, M.S. 251

PART VI End-of-Life Care: Case Stories and Commentaries

13 Hospice Patient with Gallbladder Cancer: A Case Story 255

Cultural Complications in End-of-Life Carefor a Hmong Woman with Gallbladder Cancer
Kathleen A. Culhane-Pera, M.D., M.A. 258

The Husband's Plea for Provider Honesty
Phua Xiong, M.D. 265

14 Pregnant Woman with a Brain Hemorrhage: A Case Story 269

Strategies for Health Care Providers and Institutions
to Deliver Culturally Competent Care
Elizabeth C. Walker Anderson, B.A.,
and Patricia F. Walker, M.D., D.T.M.&H. 273

Accommodation of Cultural Differences in End-of-Life Care
Karen G. Gervais, Ph.D. 280

15 A Widowed Mother's Search for a Good Place to Die: A Case Story 284

Providing a Spiritually Appropriate Place
for My Mother's Care and Death
Mrs. Chang's Daughter (Anonymous) 287

"Please Help Me": A Physician Respondsto a Hmong Woman's End-of-Life Struggles
Kathleen A. Culhane-Pera, M.D., M.A. 289

PART VII Culturally Responsive Health Care

16 A Model for Culturally Responsive Health Care 297

Recommendations for Health Care Practitioners 305

Recommendations for Health Care Administrators and Educators 343
Recommendations for Public Policy Makers 347
Dorothy E. Vawter, Ph.D., Kathleen A. Culhane-Pera, M.D., M.A.,
Barbara Babbitt, B.S.N., R.N., M.A., Phua Xiong, M.D.,
and Mary M. Solberg, Ph.D.

Editors and Contributors 357

Index 363

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