Written by Howard Yu and Edited by Lac Ta
Miracle cures are only miraculous if a patient is willing to get help. Unfortunately for the Vietnamese-American community, cultural barriers prevent access to timely screenings and proper medical interventions, which negatively impacts the health of the individuals in these communities. While the leading cause of death in the general population of the United States is heart disease, the leading cause of death in the Vietnamese-American population is cancer [1]. Most common of which are cancers of the lungs, colon, stomach, breast and liver; all of which can vastly improve a patient’s outcome if there is early detection [2]. The disproportionate amount of morbidity and mortality due to cancer-related diseases found in the Vietnamese-American demographics results from a variety of medical and sociocultural barriers that prevents patients in this community from seeking medical advances that the rest of America is receiving.
At the core of the medical barriers hampering a Vietnamese-American patient’s care-seeking behaviors is the belief that western medicine is too harsh on the body [3]. However, given that most people view their clinician as a health care provider but also as an authority figure, patients will often feel the need to hide cultural healing practices. One such cultural practice is “coining”— rubbing a coin or other hard objects with a smooth edge against muscle tissues, which is understood as a dermabrasion therapy that will relieve the body from ordinary ailments by releasing “negative energies” from the body [4]. The resulting skin abrasions are often mistaken as a sign of abuse, specifically when observed in pediatric patients, and are thereby hidden from physicians who are unfamiliar with Asian cultures [4]. Since disease prevention practices are often emphasized, patients often focus on the importance of a well-balanced diet as well as spiritual balance. However, few patients adequately recognize the importance of early detection methods such as screenings and physical exams, and even fewer actively seek out these preventative interventions.
Moreover, a sizable barrier to better health outcomes that is often overlooked by clinicians is the widespread practice of cultural traditions in the Vietnamese-American culture. Morbidity and mortality of cervical cancer is disproportionately high in Vietnamese American women compared to the total number of individuals in the U.S. population [2]. Due to the cultural taboo of pre-marital sexual activities, coupled with a predominant cultural belief in “fatalism”—the idea that all events are determined by fate and therefore interventions are futile— female patients are often deterred from the idea of screening, thus leading to late detection of disease and an inflated mortality rate in this particular patient group.
Cultural schema affects other aspects of the patient-physician relationship as well, further complicating the delivery of treatment and potentially lowering patient compliance. Vietnamese-American immigrants tend to view time as polychronic, whereby time is thought to occur in cycles and can be divided into various phases or periods, contrasted with the western perception of time as monochronic, viewing time as linear [5]. A patient’s polychronic perception of time leads to non-adherence to long-term treatment plans and ill-timed interventions. Healthcare providers must also take into consideration that patients in this community put a heavy emphasis on the importance of family and many of whom identify themselves through their relatives. This can be translated to a patient’s care-seeking behaviors in several ways. For one, patients will often find pride in sacrificing their own health for the advancement of their family. Such sacrifices are often implicitly ushered by social forces in the patient’s surrounding, by revering such practice as a benchmark for personal maturity. Ultimately, this sense of family obligation translates to lower rates of screening and lowered favorability to interventions that stresses early detection. Furthermore, by choosing to identify themselves with their family members, patients often put the burden on family members to provide not only emotional support, but also to monitor and administer treatments, rather than relying on licensed care provider.
The leading cause of death in the Vietnamese-American community is not due to a lack of answers, but it is due to the failure in translating the achievements and advancements of modern clinical science to a patient population that is held back by cultural barriers. Improvement in outcomes for this patient group will require a systematic change in the education and training of healthcare providers. The goal of which is to produce a generation of clinicians who understand and respect the prevailing culture of the patients that they serve while cleverly navigating across these cultural divides to produce an effective patient outcome.
References:
- Hastings, K.G., Jose, P.O., Kapphahn, K.I., Frank, A.T.H., Goldstein, B.A., Thompson, C.A., Eggleston, K., Cullen, M.R., Palaniappan, L.P. 2015. Leading Causes of Death among Asian American Subgroups (2003–2011). PLoS ONE. 10(4): e0124341.
- Asian American Cancer Health Disparities. Aancart.org. Web.
- Kim, W., Keefe, R.H. 2010. Barriers to Healthcare Among Asian Americans. Social Work in Public Health. 25(3-4): 286-295.
- Tan, A.K., Mallika, P.S. 2011. Coining: An Ancient Treatment Widely Practiced Among Asians. Malaysian Family Physician. 6(2-3): 97-98.
- Carteret, M. 2010. Cultural Values of Asian Patients and Families. Dimensions of Culture. Web.