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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Vietnamese Americans
Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

Vietnam is a long narrow country that would stretch from Minneapolis to New Orleans
Majority are closely related to the Chinese
Over 1,200,000 Vietnamese in the United States

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

1975 Vietnamese War brought 130,000 to the US and mainly came from urban areas and had some familiarity with Western lifestyles and thus adjusted well in the United States
A quarter million more left in 1978–1979 because of the communist regime in Vietnam and became the “boat people” for the next 10 years

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Many remained in squalid concentration camps for years
Later immigrants were less educated, poorer, and came from rural areas of Vietnam and came without their families intact

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Third wave—Orderly Departure Program–provided safe and legal family repatriation in the United States
Fourth wave in 1987—Amerasian Homecoming Act brought military families, political detainees, children of American servicemen, and more women

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Place high value on education and the teacher is well respected
Educational system in Vietnam emphasizes observation, memorization, and repetitive learning
Some continue to experience discrimination in the United States

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications

Vietnamese has several dialects, all of which are understandable to each other but not with other Indochinese countries
Similar in structure to Chinese with borrowed words, polytonal, and one syllable
Only Asian language that uses the English alphabet

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Language translations are not easily and directly translatable—in any language
Blue and green are the same work
No way to say “no,” only “yes”
Hot and cold are not related to temperature but to perceived bodily imbalances that are called am and duong

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Words used in the affective domain are always difficult to translate in any language
Expressing emotions is considered a weakness, and thus may revert to physical symptoms to describe emotional stress
Caution on touching the head, do not put your feet up and bare the soles of your feet, and do not point or beckon with the upturned finger

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Men greet each other with a handshake, but not women or men and women
Men can walk hand in hand as can women without a sexual connotation
Direct eye contact, especially with those in a perceived higher status position, is deemed disrespectful

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Most are present oriented with many becoming more futuristic as they acculturate
Punctuality depends on occupation and educational level and language ability
Age is not so important as in the European American culture, age is calculated at time of conception, not birth; use the 10-month calendar, resulting in many given Jan. 1 as a birth date

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Use a family name, middle name, and first name and written in that order
Relatively few family and middle names, with first name having some meaning
Naming procedure can be confusing for Americans so many Vietnamese give the American order of names; thus adding more confusion—just ask if you are unsure.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles

Traditional families are patriarchal and extended resulting in difficulty for some when women are in authority positions
Women make most of the healthcare decisions; otherwise roles are divided by gender
Reversal of roles in the United States may cause family disharmony until adjustment

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Children are an extension of parents and are expected to be obedient and respectful of elders
Grandparents take a significant role in rearing the grandchildren
Permissive US lifestyle with teenagers and dating can cause family disharmony

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Eldest male has the responsibility for parents to the extent that it is more supreme than his responsibility to his wife and children
Elders may feel alone and be depressed with clash of values from their home country and the United States culture
To smile in the face of diversity is demonstrative of strong moral character

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Lesbian and gay relationships are not discussed —carry a significant stigma for most
Pseudofamilies are formed by gender groups in the United States in order to share resources and improve economic status

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Variations in skin color requiring different assessment techniques than for white-skinned people
Small in stature compared with European Americans with narrower shoulders and wider pelvic structure
Published growth charts are not accurate for Vietnamese—and other groups

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Sparse body hair, few apocrine glands, 40% have palatine tori, flat nose bridge causing more difficulty in fitting eye glasses
Betel nut pigmentation among older women from chewing betel leaves
High rates of depression and anxiety-related disorders—especially post-traumatic stress syndrome

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

High rates of malaria, Tbc, parasitosis, hepatitis B related to the tropics, refugee camps, and crowded living conditions
New arrivals should also be screened for round worm, whipworm, liver flukes, trichinosis, scabies, lice, and impetigo

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Drug Metabolism

More sensitive than other groups to propranolol, atropine, diazepam, and psychotropics—beyond body size
More sensitive to the effects of alcohol
Many adults and some children have lactose intolerance

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

High-Risk Behaviors

Lower socioeconomic rural immigrants may not be aware of tobacco causing cancer or aware for the need of health screening and breast exams and pap smears
High rates of liver and gastrointestinal cancer and “sudden unexplained death syndrome”
Low use of alcohol, tobacco, and recreational drugs

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

High-Risk Behaviors Continued

Reliance on family for healthcare may mean the illness is more severe when seeking health care
Some may not trust healthcare providers based on situations in refugee camps
Usually have great respect for all healthcare providers

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

Meal time is a family affair
Holidays usually have special foods and dishes
Smaller body size means few calories required
White rice is the main staple
Wide variety of fruits, vegetables, and meats

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Ascribe to the hot (duong) and cold (am) theory of foods requiring different foods for certain illnesses—varies by region of migration so just ask and they will tell you.
Traditional diet may be high in sodium and in the United States low in calcium and high in fat

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family

Women have children over a longer period of time than European Americans
Abortions common in Vietnam—great stigma to have a child out of wedlock
Many are not familiar with birth control methods in the United States
Women over the age of 40 have an average of 6 abortions and 4 pregnancies

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Specific food practices to have a healthy pregnancy and baby and to balance equilibrium in each trimester of pregnancy
Maintain non-strenuous physical activity to prevent miscarriage, have a healthy and small baby, and quick delivery
Prolonged labor if idle, afternoon napping can cause a large baby

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Invasive procedures during labor are disliked and feared
Many prefer squatting position for birthing
Touching the head can cause distress because the soul resides here
Specific postpartum rituals that vary among rural and urban Vietnamese

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Older women assume responsibility for the baby’s care
Caution on praising the child because jealous spirits will steal the child
Cutting child’s hair or nails can cause an illness

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Death is a normal part of life
Reincarnation and ancestral spirits support the sometimes stoicism seen with death
Prefer to die at home without extensive life- prolonging measures
May buy casket in advance

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

A Vietnamese friend tells you she balances her food choices according to hot and cold properties. In Vietnamese, the words for hot and cold are

Yin and yang.

Am and duong.

Fret and cho.

Garm and sard.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: B

The Vietnamese words for hot and cold for balancing foods are am and duong.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued

Gather around dying person and express great emotion
Call religious leader only at the request of the family
Flowers are reserved for the rites of the dead
Family wears white for 14 days after death, followed by black arm bands for men and white headbands for women

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

Buddhism, Confucianism, and Taoism are the majority
Animism by a few from highland areas of Vietnam
Some may maintain a religious altar in the home
Family is the main reference point throughout life

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices

Good health is achieved by having harmony and balance with the am and duong—an excess of either one may lead to discomfort or illness
Illness can be naturalistic or supernaturalistic
Traditional medicine depends on northern or southern Vietnamese ancestry

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Many fear any invasive procedure
Believe that body fluids cannot be replaced
May discontinue any medicine that causes side effects
Most are reluctant to take medicine on a long-term basis

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Responsibility for Health Care

Family care for ill member in the hospital in Vietnam and may wish to do so in the United States
Crisis-oriented care in Vietnam
Many believe Western medicine is too powerful for Vietnamese and therefore say they will take the medicine and then either do not or only take part of it

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Common Vietnamese Treatments

Cai gio
Be bao or bar gio
Giac
Zong
Moxibustion
Acupuncture, acupressure, acumassage
Multiple herbal therapies

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Cai gio

“Rubbing out the wind” is used for colds, sore throats, flu, sinusitis, etc.
Ointment or hot balm is spread across the back, chest, and/or shoulders and rubbed with the edge of a coin
Dermabrasion procedure to let out bad wind as the blood is brought to the surface

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Be bao or bar gio

“Skin pinching” for headaches or sore throat
Produce ecchymosis and petechiae
Very specific technique

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Giac

Cupping or cup suction
Dermabrasion procedure to relieve stress, headaches, joint and muscle pain
Small metal or glass cup is heated by placing wormwood or cotton saturated with alcohol and set afire
Cup forms a suction as it is turned upside down on the skin and then removed, leaving large ecchymotic round areas

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Zong

An herbal preparation relieves motion sickness or cold-related symptoms
Ointment or herbs are put in boiling water and then inhaled. Can be purchased commercially.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Moxibustion

Used to counter conditions associated with excess cold, including labor and delivery
Pulverized wormwood or incense is heated and placed directly on the skin along certain meridians

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Acupuncture, Acupressure, Acumassage

Used for a wide variety of conditions and illnesses—some of which have been proven scientifically—especially for some pain conditions
Needles, pressure, or massage along the Qi channels of energy flow

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

The parents of a two year old bring her to the ER because of a persistent productive cough. The nurse finds several quarter-sized ecchymotic area on the child’s back. The nurse recognizes these marks as

a. Cai gio

b. Be bao or bar gio

c. Giac

d. Zong

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

Giac, cupping, leave round ecchymotic areas when the cup is removed.