Ethnographic Review: The Role of Culture

Introduction

                As a native Hmong Patricia V. Symonds ethnography, Cycle of Life Calling in the Soul in the Hmong Village was definitely an interest to me. It was an opportunity for me to affirm aspects of my culture and religion that I already knew, but also broaden my knowledge. This ethnography related to many readings and discussions in class because culture versus biomedicine is not a specific global issue, but a very common issue. It presented global issues such as the absence of health care systems in areas such as the Flower Village in Laos. But it also helped me to further understand and support the aspect in which we discussed in class, that culture is a huge contributor to a group of people’s views on medical procedures, and western medicine. When approaching many different people with very different backgrounds one cannot simply assume that western medical procedures are just normal to everyone. Not every culture believes in drawing blood, surgery, medications, etc. Why? Why oppose something when the chances of doing this will save or better your life? We as humans tend to be “human” and forget that something that is normal to us is not normal to everyone. In something as important as medicine and illnesses it is not always the number one goal to heal with biomedicine because a procedure may go against everything that someone believes in. As professional doctors or health officials it is important to educate and understand different cultures to conceptualize why different cultures oppose certain medical procedure. It is these people’s jobs to either approach differences in culture in a respectful and correct manner or accept that healing with medicine and medical instruments is not always the only way to healing.

Patricia began her research from normal observation of pregnant Hmong women as a hospital clinic that she was working at. She realized that these women were very apprehensive to certain normal medical procedures while check-up. Through a Hmong interpreter at that hospital, Patricia slowly began to understand reasons the Hmong women were apprehensive to western medical practices. The Hmong women used the clinic to benefit from the Infants, and Children program (WIC), to receive food vouchers and so that their child can legally become American Citizens. Hmong women protested wearing scrubs, and being examined by a male doctor. They also protested getting injections and getting their blood drawn. While giving birth they restrained from showing little emotion of pain. To fully understand the way of birthing and the way of thinking of pregnant Hmong women, Patricia needed to research more about the Hmong culture as a whole. Her role was to not only research as the observer but become, interact, and be included in the culture to get the best data. The best way for her to get the most accurate information was to go to Laos and begin her ethnographic research in the Flower Village. Her years of research included the main topics of the balance of opposite sexes, roles of the mother, daughter and wives, the birthing process, and death. In gaining full knowledge of these categories from the fellow Hmong people in the village and participating and witnessing events such as weddings and funerals, she accomplished answering the question she began this research with. She contributes to the definition that ethnography is “the close range and extended participation and observation of a society by an anthropologist in order to gain general insights by a thorough acquaintance of the particular” (Janzen 2002). Patricia did successfully research and recorded the Hmong culture. Even with the language barrier she managed to get the help to translate long spiritual chants which play a huge role in the Hmong culture. Patricia’s work was clear and concise with little faults.

Impact of Gender and Gender Roles in a Culture in a Medical Setting

                What one culture views as the gender roles of men and women are different in every culture and are affected by the perception of medical procedures and they are approached. One of the first things that Patricia noticed while observing and interviewing the Hmong people was the difference in the power between the men and the women of the Hmong people. At first she noticed that the men had more power than the women in especially in decision making or holding high titles. A woman’s main role was to reproduce and birth what they believed to be an ancestor coming back into the world of light. They had to do so without showing any signs of pain and naturally laboring the infant. A Hmong woman’s role is to get married, reproduce, be a good housewife, and mother. Not only did the men who were interviewed agree with this in the Flower village but even the women. Even women and men living in the United States agreed upon these gender roles. Even young children knew their roles and at certain ages they were to hold higher responsibilities in their roles. (Patricia 2004)

                I would have to agree that each culture has its own gender roles, and although it may seem unfair or unrealistic to other cultures it is the norm and lifestyle of that group of people. Even the American culture in the 1900’s gender roles was similar to the Hmong. The men were the workers who brought in the money, while the wives were stay at home mothers and housewives. It is clear that this is not evident in the twenty first century. Both men and women have equal rights of having an education, having a job, and holding any position they earn. Sometimes you even see that men are the stay at home fathers in such cases as my household. Depending on the cultural structure and beliefs gender roles are going to evident because that is the normality of that culture. Although through time gender roles can possibly change, each culture is different. This is important to note because in medical procedures such as giving birth Hmong women are apprehensive to western medicine not only because it is new to them, but because culturally their role as a wife is to only show their intimates to one male being their husband. They show no or little pain even in an ER while giving birth because their role as a member of the clan, a mother, and a wife of that clan is to be strong. They are to not scare the spirits of the ancestor entering the world with their expressions of pain from labor. On the contrary women in America are dramatized in media and movies to show pain when giving birth. Take the show 16 and Pregnant for example. In various episodes you see these teenage moms, much like the girls in the Flower village giving birth. They show sincere pain and most of the time ask for an epidural. This is perfectly normal in the American society, whereas in the Hmong a pain reliever is not present but more importantly pain is to be held in as Hmong mothers.

                Another example of this is was a topic we discussed in quiz section of my medical anthropology class.  In the Mali culture that not only girls but boys have menstrual periods. Boys at a certain age like girls in Mali have a menstruation, where there is red leakage from their sex. The Mali people believe that as a gender role this signifies represents womanhood and manhood. But researchers have found that this “menstruating” in the boys are in fact a parasite in the body.  The problem is how to approach this issue without offending the belief of something so specific to a gender in a culture. It is a global issue that health care isn’t provided in many areas such as Mali. Without the convenience and knowledge this alters the cultural beliefs in things such as male menstrual periods. As people of biomedicine it is important that we (westerners) erase the normality of the science behind what we believe attributes to a male or female. In order for us to grasp the understanding of why on earth anyone would believe that boys menstruate, is to become that culture. Just because our specifications of what a boy and a girl should experience during puberty are different from another does not mean one is right and one is wrong. As westerners we don’t usually believe that the menstrual period of a girl makes her a complete woman. Just because she has her period doesn’t mean she is ready to be a mother or a wife. In the Hmong culture it is. But this is our norm in our society. It is the belief. Just as it is the sole belief that it is normal for boys to have periods and is part of manhood. One cannot just intervene with bags of medicine and medical tools to change what is not seen as a condition but a natural part of life. If this means that the Mali boys choose to not get treatment for this parasite, it is our duties to understand and respect their decision.

 Cultural Differences in Views of Birthing

                Patricia began this research because she was interested in the birthing process, and why women were so apprehensive to the way medical procedures were in the United States. Just like anything she found out that it was a lot more than the power shift between men and women of the Hmong and the simple fact that western medicine is something that they aren’t used to. As Scrimshaw states in Chapter two: Culture, Behavior, and Health that, “people around the world have beliefs and behaviors related to health and illness that stem from cultural forces and individual experiences and perceptions”. (2006) In the Hmong culture giving birth to a child is more than just reproducing. The Hmong believe as previously stated that life is a cycle. When one dies they go to a land with all the ancestors that have passed. When it is time an ancestor’s soul will be reborn in a clan member as a child. This cycle is never ending. With these dimensions one would imagine that the process of reproduction and birthing is seen as a more than just another baby being born.

                Perceptions defined as “the process of gathering information through any or all of our senses, followed by the acts of organizing this and making sense of it” (Lecture slide 4-1). Perception of medical procedures is something that in medical anthropology is reiterated all the time. Majority of this is due to what I have presented and Patricia has presented about culture. The beliefs of a culture make up how they treat illness, heal, and even bring a child into this world. Some cultures don’t have access to health clinics and aren’t exposed to western medicine. Through time and evolution they have come up with their ways of healing illnesses. The adaptation of their ways of healing is what they believe to work and are the “normal” procedures.

                Since the Hmong believe that the process of birthing is the reincarnation of an ancestor, the process is a spiritual and natural bringing. Women give natural birth either by their selves of with the help of other ladies and midwives. Patricia noticed that pregnant Hmong women in the hospital clinic refused to get their blood drawn. This would seem like a normal procedure to in the American culture is not to the Hmong. The injection and cutting into the body of the mother goes against the nature of bringing in the ancestor or baby into this world. Hmong women especially were against getting cesarean sections because this did not allow the natural process of reincarnation to occur. This would upset the ancestors, or create an unbalance between nature and spirits. In Laos it isn't an option to have a cesarean section, but even Hmong women in the United States refused this. No matter what the medical conditions were the Hmong women would not allow a C section. In Laos this could mean the miscarriage or still birth of a child, or even the death of the mother. This is preventable in the United States with the medical knowledge and skill of doctors and pediatricians.

                Another example relating to birthing is the Mozambique women demonstrated by Rachel R. Chapman. Unlike the Hmong women in Laos they have access to nearby or in various villages of health clinics where they can receive prenatal care.  It is estimated that half a million women die each year from pregnancy, and the infant mortality rate one hundred and forty seven deaths per one thousand births (Chapman 2003). Even with these resources Mozambique women still aren’t using the health clinic as much as they should. Research has shown that more women come to the health clinic in their later pregnancy stages like the third trimester versus in the early stages of pregnancy. Researchers found with that women are delaying prenatal care and exposure due to society. Due to the poverty, economic crisis, political issues, shortage of land and food along with various other reasons the Mozambique women are pressured to find a husband and have a child to keep their safety and stability. Yet with the scarcity of men and everything else women are afraid of witch craft by other women and neighbors to kill unborn infants, so they try to hide it as long as they can.

Tying this all back into perception, culture and medical approaches can clash. As a person who has knowledge of western medicine and is educated I know that western medicine, and biomedicine is the primary source in healing. Research and research has been done on almost every condition there has been presented. Even ordinary procedures like birthing has been researched and recorded to assure the best procedures for the patient in any condition. That is why there is specialist in this field like Pediatricians. They go to year and years of education to be able to hold the title and do what they are trained to do. With that I do not argue that the primary source in healing is biomedicine. Whether that is because of a parasite causing boys menstrual bleeding, or pregnant Hmong and Mozambique women to get prenatal care biomedical attention is needed. But as Patricia clearly demonstrates, there is so much more to reasons of apprehension. Part of the process of manhood for boys is to have menstrual periods. It is their belief of manhood. It is the Hmong’s belief that the reincarnation of an ancestor is giving birth and a natural process. It is the necessity for Mozambique women to not seek prenatal care and expose their unborn child until it is absolutely necessary. An effort is needed to educating ourselves with different cultures to understand their “norm” as well as providing education of biomedicine and its importance without being offensive to a group of people’s beliefs. “Experience has shown that health programs that fail to recognize and fail to work with indigenous beliefs and practices also fail to reach their goals” (Scrimshaw 2006).

Conclusion

                The views on medicine and treating illness and approaching medical procedures are varied within every different culture. It would be easy for everyone if all cultures and beliefs were the same, so the approach and understanding to an illness or medical procedure can be all the same universally. But as social workers, public health and global health workers, NGO’s, etc. who want to help and sponsor and make western medicine available for those in need of it, need to understand a culture before the efforts can be achieved. It is one thing as an NGO to come up with a good amount of money, global health workers to an area and expect the health to dramatically improve. The failure for an NGO to successfully brand their name on an expedition to be successful with positive outcomes makes them look bad. The staffing, training, and research of various health care workers to help a group of people improve the health systems, and living will only be a waste of time if they are closed to the beliefs of a culture. They will only find that their target group will only be more apprehensive than they are relieved to have western medicine available. Ethnographic research, like Patricia’s book on the Hmong is not only for interested readers, but for reasons of finding ways to approach the health care system or a heath aspect in any culture.  “If you wish to help a community to improve its health, you must learn to think like the people of that community. Before asking a group of people to assume new health habits, it is wise to ascertain the existing habits, how these habits are linked to one another, what function they perform, and what they mean to those who practice them”. (Paul, 1997)

Bibliography

Chapman R. Rachel

2003 Endangering Safe Motherhood in Mozambique: parental care as a pregnancy risk. Social Science and Medicine.

Janzen M. John

2002 The Social Fabric of Health. University of Kansas.

Scrimshaw C. Susan

2006 Culture, Behavior, and Heath.

Symonds V. Patricia

                2004. Gender and the Cycle of Life Calling in the Soul in a Hmong Village. University of Washington press.