Today I am joined by Jill Hertzler, MSW. Prior to the current iteration of her career, Jill spent 12 years in clinical practice. After earning her Master of Social Work from the University of Washington in 1997, she provided psychosocial assessment, referral, and treatment for OB/GYN practices in Seattle, WA. In particular, she worked with many Hmong patients who lived in the area and provided services in pre-natal care and teen pregnancy.
The renowned book The Spirit Catches You and You Fall Down, by Anne Fadiman, provides the account of a true story of a Hmong family from Laos living in Merced, CA. It chronicles challenges and triumphs of communicating in a healthcare setting with cultural sensitivity by medical professionals trained in Western Medicine with Hmong families. The book was the inspiration for this interview.
The Hmong have historically been a society of nomadic and agricultural people and have been recognized by the government of China as one of its minority groups. Thousands of economic and political Hmong refugees resettled in the United States (especially in the West Coast and Minnesota) after the Vietnam War. For millennia, the Hmong have responded to persecutions and pressures to assimilate by either fighting or migrating. Historically and despite pressure to assimilate, the Hmong did not adopt the customs of Chinese culture, but rather preferred to keep to themselves, marry each other, speak their own language, wear their own dress, and practice their own religion. A significant part of Hmong history and identity involves sustaining traditions and customs.
Hmong culture prescribes a different understanding of the human body than Western Medicine. For example, Hmong societal norms hold that the body contains a finite amount of blood that is unable to replenish itself, so repeated blood sampling can be considered fatal. Medicine is religion and religion is society. Community leaders have religious and healing roles. Due to different conceptual understandings and beliefs, an absence of a language interpreter is only part of the difficulty communicating in a Western Medicine setting. This description has been compiled from The Spirit Catches You and You Fall Down.
Central Question for this Article: How can people communicate with sensitivity across cultures about different values yet shared goals?
Jen: Jill, could you tell us about your work with Hmong youth?
Jill: After getting my Master of Social Work, I worked as a perinatal social worker in an outpatient pregnancy clinic, teen pregnancy clinic, midwifery unit, and Labor and Delivery Unit – the patients served included the migrant population outside the city [Seattle]. North of the city there is a lot of farm country. Many of the farmers were migrants and included a significant number of Hmong.
Jen: What was it like to work with the Hmong at the teen pregnancy clinic?
Jill: It was interesting because the outpatient clinic had Hmong patients who were multigenerational teen moms. One of the largest indications of when you’ll have a baby is when your mother had a baby. The Hmong people were farmers so they would have lots of children to work the land. Also, since historically most of their children would not survive, the Hmong communities expected youth to marry and have children in their teens – it was the cultural norm. But for these teens, being Hmong but also part of another culture led them come to us under the radar seeking birth control. These were teens who were married at 16 and felt like they were Hmong at home but American when at the public high school. In their communities, they were expected to both become teen parents and finish high school. These Hmong teens really walked that line – their primary self was split. So I think these young women were learning to define their American selves. Also, the teens is a time of differentiation so to an extent you’re making your own identity separate from your family and your family history.
Jen: Beyond communicating with your patients, how were the Hmong community leaders part of the conversation on teen pregnancy?
Jill: One of my colleagues had worked with the Hmong doing home health visits, so she knew everybody, and had developed trust and understanding with the Hmong community over time. She also got to know their leaders, priest is the word we used. My colleague got to know one of the priests and was the first to raise a conversation about teen pregnancy. She had a unique capacity to bridge cultures. We were reaching a high point of teens coming to us and saying they want the depo shot and didn’t want anyone to know. They wanted the shot because it’s not pills in your medical chest and not condoms in your drawer. If nobody can see you come and get the shot, then nobody knows. More and more teens were coming to us and we needed to consider how we tell the community leaders that there is something happening in the community that they should be aware of; that these girls don’t want to be getting pregnant at 15 or 16 and that having ten children isn’t necessary anymore because they are likely all going to live. We were probably the first people to sit down with one of the leaders and discuss how we can work together to address this.
Jen: What other circumstances necessitated communicating with cultural sensitivity and how did you approach those situations?
Jill: The Hmong don’t name babies immediately, because historically so many pass away. In America there is a birth certificate information form. The expectation in America is that you name your baby before it is first discharged from the hospital. We want citizenship for these [Hmong] newborns and want them to have a social security number. We want to give newborns all the benefits of being an American citizen, and if you wait to name the baby there is going to be a hold up and administrative hurdles to these benefits. So we discussed with the Hmong leaders; how do we match your needs as a community? We found out what we had to do, and the babies would go home without a name. The key is to get the family to come in for the post-partum check-up (around 6 week post-partum) and have the naming closer to then. We learned from the community leaders how families may want us to refer to the baby. Some families would ask for the baby to be genderless for a time. This was 20 years ago; genderless was not as known in the US as it is today. So how did we move through this? We were taught language and words to use so that we could be respectful and grow compliance. And we taught the leaders the benefits of allowing girls to have reproductive rights, what the implications of that were, and the benefits for the community – such as for these teens to be able to focus on their education. You know, with these conversions we were challenging all sorts of norms of what these young women’s roles were so we asked the leaders, what do you want for these young woman, because that can happen with education. All aspects of life and culture don’t have to change, and the conversation was starting.