PP Presentation

Riverbend City: Community Health Mission

Welcome to Riverbend City

Riverbend City has a rich history of diversity, from its early days as a lumber and milling center to the present day.

While many nationalities and groups are represented in Riverbend City, the city is home to the second largest

concentration of Hmong in the United States. Within this community, there are health and wellness issues that are

specific to the Hmong population as well as health and wellness issues that are seen across the spectrum of the city's

inhabitants.

Instructions

This mission asks you to explore the Shoals neighborhood and identify health concerns illustrated by the

conversations and dialogues. Go to the Shoals neighborhood, where you may select the locations in any order. When

you have selected a location, click on the highlighted characters to hear their conversations.

Shoals Neighborhood

During the Vietnam War, Hmong villagers were recruited by the U.S. to fight the "Secret War." Afterwards, the

Hmong were persecuted for their anti-communist role. Thousands of Hmong fled to refugee camps in Thailand. The

Hmong began resettling in the late 70s and Riverbend City was a main destination. There have been subsequent

waves of immigration from the refugee camps since then.

 Park - Soccer Field

 Market

 Funeral Home

Shoals Neighborhood - Park - Soccer Field

While watching their children playing soccer, several Hmong parents catch up with each other and discuss various

concerns – including medical issues and frustration with the medical system.

Kia Sia and Pa Foua chat about diet.

KIA SI MOUA:

Hey, long time, no see.

PA FOUA LEE:

Yeah, I've been in Merced visiting my parents.

KIA SI MOUA:

Didn't they feed you while you were there? You look like you've lost weight!

PA FOUA LEE:

Ha ha! I ate like crazy, but I'm really working at eating better. Lots of salads and stir fry and trying to stay away

from the junk.

KIA SI MOUA:

I wish I could say the same. Pheng and the kids go crazy if I don't have snacks in the house and if that stuff is there,

I eat it.

PA FOUA LEE:

Yeah, I know. But when my cousin found out she had diabetes, I got really scared. She's been having such a hard

time with it. The doctors tell her one thing; her family, on the other hand, wants her to just go to a shaman. They

don't understand why she has to change everything she does. So... I knew I weighed too much, and I thought maybe

I could do something before I get sick myself.

KIA SI MOUA:

Too bad... I guess no more nab vam for you, huh?

PA FOUA LEE:

Not as much, that's for sure.

KIA SI MOUA:

Well, I'll just take your share!

Khai asks Christina about her experience with a new medication he has been

prescribed.

KHAI VANG:

Has Bee's team been practicing? They look a lot better today.

CHRISTINA CHA:

Yeah, Thao got some help with coaching them and they're finally starting to understand how to work together.

KHAI VANG:

It looks like it's working. Hey, I have a question for you. Isn't your father taking medicine for cholesterol? My

doctor says I have to start taking it, but I don't like the idea.

CHRISTINA CHA:

Don't get me started on that. He's supposed to, but he won't ever take it. The same bottle we bought for him four

months ago is still half full.

KHAI VANG:

He doesn't like taking them?

CHRISTINA CHA:

He thinks they cost too much money, so he cuts them in half and even then, he won't take them every day.

SHENG XIONG:

My aunt does the same thing. She says they make her legs hurt all the time.

KHAI VANG:

What did her doctor say about that?

SHENG XIONG:

What-you think she actually told the doctor? She doesn't trust him a bit. She tried to ask if there was Hmong

medicine she could take instead and he gave her this big lecture about how she couldn't take any herbal medicine

anymore. She was so mad. She said he talked to her like she didn't understand English. She hates when they do that.

CHRISTINA CHA:

They're all like that. It's terrible. My parents only go to the American doctors if they're totally sick. I feel bad. I work

in the hospital and I know they don't mean to come across like jerks, but most of the doctors just don't understand

anything about Hmong people and our culture. And a lot of those doctors don't even try to learn. You can tell that

they think so much of how we do things is just dumb.

KHAI VANG:

Yeah, even with me... I mean, I speak English fine, but a lot of times it seems like Hmong medicine doesn't exist for

them. It's just, "Do this because I said so."

Shoals Neighborhood - Market

Recent immigrants to the United States and Canada are at increased risk for developing Type 2 diabetes, obesity,

and hypertension. Many factors contribute to this, but one of the most significant continues to be nutrition and diet.

Gao Na and Bo discuss changing food choices.

GAO NA LOR:

Don't you know anything about Ka Poon? You don't need all that junk to make curry noodle soup! How many

people are you trying to feed?

BO VANG:

I know! It's crazy isn't it? I just have six people to feed, but it feels like I am cooking for a whole village. Thao's

mother likes it when I cook traditional foods. Thao and the boys want fried everything, and Mai has decided she

won't eat meat.

GAO NA LOR:

Thao's mother is right. You should cook more traditional.

BO VANG:

Well, except for the fact that her doctor says she has that diabetes. They told her she is not supposed to eat rice or

noodles.

GAO NA LOR:

What?

BO VANG:

Yeah, she told me that the doctor said she should stop eating rice, no fried food, no sweets. She says it's too hard and

she just wants to eat like she did back in Laos.

GAO NA LOR:

I would be the same way. That's ridiculous... no rice? What kind of doctor tells a Hmong person she can't eat rice?

BO VANG:

I know. I don't know why they won't just give her some medicine to make it go away. That's what she needs.

GAO NA LOR:

Well, I've always said these doctors don't know what they're talking about with Hmong people. They make their big

diagnosis and tell us to take their medicines, but I think they would be happy if we all would just die. I would rather

have traditional medicine to start with. That way I know what I am taking is the best thing for me.

Shoals Neighborhood - Funeral Home

Hmong people have a culture built on animism and the belief that after death the soul reincarnates. Hmong funerals

usually last three days or sometimes more, and involve a large number of family and friends. While the funeral is

one of the most important Hmong rituals, it is also a time to connect with family and friends.

Pheng and Kao Sua discuss her grandson's recent illness.

PHENG HER:

Kao Sua. I haven't seen you in a long time. How have you been?

KAO SUA FANG:

Not good at all.

DHIA HER:

What's the matter?

KAO SUA FANG:

Oh, my son and his wife are making a big commotion in the family and everyone is upset.

PHENG HER:

What's the problem?

KAO SUA FANG:

My grandson, Thao, he's sick all the time, but Bee and Mai Doua have to be the Big Americans. Always at the

hospital or the clinic. We try to tell them they need to have the shaman come and help, but they don't want anything

to do it that.

PHENG HER:

So many of the young people are like that. I think they make things worse when they all the time go to the doctor.

They don't even try traditional medicine. Like they're ashamed of being Hmong.

DHIA HER:

I don't know why they like the hospital so much. No one knows what they're doing and they just ask you stupid

questions about things that don't matter.

KAO SUA FANG:

I know! I don't tell my son this because it makes them angry, but I don't think these American doctors are good

people. My sister went to the hospital and they told her that her heart was very sick so they wanted to cut her open.

She was scared and said "No, no!" But the doctor told her she would die if she didn't let him fix it. But I think he did

something very bad because after the operation, she still was very sick and weak. In less than one year she died...

just like the doctor said she would.

DHIA HER:

I'm not surprised. You don't know what those people will do to you once they have you in that place.

Thao, Kou Lee, and Tony Cha talk about health insurance.

THAO CHA:

How has business been for you this year?

KOU LEE:

Not too bad. We moved to new offices at the beginning of the year and we've been getting lots of customers. That's

good because costs have gotten very high, so we need all the business we can get.

TONY CHA:

I was talking to Padou and she was very excited because she just qualified for benefits.

THAO CHA:

You can offer your employees benefits? Can you afford to do that?

KOU LEE:

I have to if I'm going to compete for good employees. If I don't give paid vacation and health insurance, I just end up

training people for some other business that does give them benefits. Padou is a good example. She has a friend who

works for a bigger company and she's always telling Padou how good the benefits are. I know she likes working for

family, but if I didn't have health insurance available, she would have left.

TONY CHA:

Well I know for us, we're lucky that Christina gets it from her job.

THAO CHA:

Things are so different here. When we lived in Thailand, who ever thought about insurance and vacation days?

KOU LEE:

Yeah, it's different here, that's for sure.

Sua Zong and Mai Doua discuss Sua's family reaction to her son's recent illness.

SUA ZONG VUE:

Mai Doua, how have you been? I haven't seen you in so long. How are Tong Pao and Thao?

MAI DOUA HER:

Oh, I've been crazy busy! Tong Pao is doing really well. He's working for an investment company in town and they

really like him. After all his work getting through school, it's nice to see it paying off.

SUA ZONG VUE:

And Thao?

MAI DOUA HER:

Well, he's doing pretty well now but this last year has been rather hard for him.

SUA ZONG VUE:

Why? What happened?

MAI DOUA HER:

Well it turns out he has asthma, which was hard enough to deal with, but it caused a lot of conflict with Tong Pao's

family. They're very traditional... even more than my parents... and it really upset them that we were taking him to

the hospital instead of to a shaman. I mean, we did go to the shaman, too, but the truth is we are both more

comfortable with Western medicine than traditional ways.

MAI DOUA HER:

Yes, I think you're right. It just can be very difficult to do what you think is right and at the same time respect your

parents and their ideas.

SUA ZONG VUE:

I think that's true for most Hmong people our age.

SUA ZONG VUE:

But Thao is doing better now?

MAI DOUA HER:

Yes, much better. He's even on the soccer league again. Of course he has my coordination, but all the medicine in

the world wouldn't help him with that!

Mission Complete!

You have now visited several locations within the Shoals community and you were able to hear the residents of this

neighborhood talking about their experiences with the medical community and with the health issues that face them

in their new home. Consider how these experiences reflect real or potential health disparities. As you prepare your

response for the discussion question in your course room, think about how this information would relate to the

creation of a health promotion and disease prevention (HPDP) program.

Download Summary Document

Credits

Simulation Subject Matter Expert:

Ann Leslie Claesson, PhD, BSN

Subject Matter Expert:

Carol M. Patton, DrPH, RN, FNP-BC, CRNP, CNE; Mary A. Bemker, DSN, PsyS, RN

Interactive Design:

Matthew Johnson, LaVonne Carlson, Chris Schons, Justin Lee, Pat Lapinski, Mark Bune, Tara Schiller,

Marc Ashmore

Media Instructional Designer:

Felicity Pearson

Instructional Designer:

Laura Badaracco Amend

Project Manager:

Jesse Rosel, Karen Dodd, Julie Greunke

Editor:

Tom Kapocius

Image Credits:

© iStockphoto.com Licensed under a Creative Commons Attribution 3.