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Refugee stress and folk belief: Hmong sudden deaths
Abstract
Since the first reported death in 1977, scores of seemingly healthy Hmong refugees have died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the changing impact of traditional beliefs as they manifest during the stress of traumatic relocation. In Stockton, California, 118 Hmong men and women were interviewed regarding their awareness of and personal experience with a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranormal attack acts as a trigger for Hmong SUNDS.
... In contrast to the novelty of SUNDS to Western science in 1981, Hmong and other South-East Asian populations have long feared the personal experience epitomized by SUNDS. Culture-specific names have been given to this experience; Hmong refer to the terrifying nighttime occurrence of the crushing spirit on their chest as dab tsog (Adler, 1995;Bliatout, 1982;Fukuda, Miyasity, Inugami, & Ishihara, 1987;Holtan et al., 1984). Victims of visits from this spirit report that dab tsog sat on their chest with crushing force, making it impossible to move and "took their breath". ...
... Victims of visits from this spirit report that dab tsog sat on their chest with crushing force, making it impossible to move and "took their breath". Although parallels are drawn between SUNDS and the dab tsog experience, the high fatality of the medical syndrome of SUNDS differs from that of dab tsog: historical and ethnographic reports indicate that the experience of dab tsog is not rare or fatal, and is often experienced repeatedly by the victims (Adler, 1995(Adler, , 2011. Thus, the cultural pattern, collective knowledge and universal description of dab tsog suggest a prevalent bio-psychosocial condition of which only a limited number of cases results in a SUNDS fatality. ...
... Additionally, terrifying encounters with nocturnal spirits, whether as part of the traditional belief structure or exacerbated by conflict or loss of that structure (e.g., due to culture dislocation as part of the refugee experience) have been hypothesized as causes of severe psychological stress that may act as a trigger for SUNDS (Adler, 1994(Adler, , 1995(Adler, , 2011Bliatout, 1982;Holtan et al., 1984). ...
Concerns regarding sleep disorders in Hmong immigrants in the US emerged when an astonishingly high mortality rate of Sudden Unexplained Nocturnal Death Syndrome (SUNDS) was documented in Hmong men. Stress, genetics, and cardiac abnormalities interacting with disordered sleep were hypothesized as contributing factors to SUNDS. Most recently, sleep apnea has been implicated in nighttime deaths of Brugada Syndrome. This syndrome is thought to comprise a spectrum of sudden cardiac death disorders, including SUNDS. However, little research since has placed SUNDS in its context of Hmong cultural beliefs, health, or the prevalence of other sleep disorders. Because the epidemiology of sleep disorders and terrifying nighttime experiences in Hmong is poorly documented, we investigated the prevalence and correlates of sleep apnea, rapid eye movement (REM) sleep stage related disorders, and insomnia in 3 population-based samples (collected from 1996 to 2001) comprising 747 Hmong immigrants in Wisconsin. Participants were questioned on sleep problems, cultural beliefs, health, and other factors. A random subsample (n = 37) underwent in-home polysomnography to investigate sleep apnea prevalence. Self-report and laboratory findings were compared with similarly collected data from the Wisconsin Sleep Cohort (WSC) study (n = 1170), a population-based longitudinal study of sleep. The results inform a unique Hmong sleep disorder profile of a high prevalence of sleep apnea, sleep paralysis, and other REM-related sleep abnormalities as well the interaction of culturally related nighttime stressors with these sleep problems. For example, experiences of dab tsog (frightening night spirit pressing on chest) was prevalent and related to sleep apnea indicators, sleep paralysis, nightmares, hypnogogic hallucinations, and insomnia. Understanding the role of sleep disorders and the cultural mechanisms that may trigger or condition response to them could ultimately provide a basis for screening and intervention to reduce the adverse health and emotional consequences of these conditions in Hmong.
... Many Hmong refugees have struggled with depressive disorder, traumatic brain injuries and other refugeerelated mental health problems since their arrival in refugee camps and resettlement in a third country (Westermeyer 1988;Adler 1995;Westermeyer and Her 2007:381). Many times, I have heard the elderly individuals recall their 'lost home' by saying 'thaum peb nyob saum roob…' (when we lived in mountains…). ...
... Some of them never had the chance to arrive at Thailand. Those who did make it, suffered from and were haunted by nightmares (Adler 1995;Westermeyer & Her 2007). ...
Various types of urban art emerged and prospered in recent decades when degenerating cities were embracing art as a marketing strategy. This urban-rejuvenation approach sheds less light on the agency and motivation of artists. This paper examines how ethnic artists represent traumatic memory, reflect nostalgia and mobilize individuals to collaborate with one other to build resilience. This study contributes to the literature that explores the agency and creativity of underrepresented minority artists in global society at large.
... Many Hmong refugees have struggled with depressive disorder, traumatic brain injuries and other refugeerelated mental health problems since their arrival in refugee camps and resettlement in a third country (Westermeyer 1988;Adler 1995;Westermeyer and Her 2007:381). Many times, I have heard the elderly individuals recall their 'lost home' by saying 'thaum peb nyob saum roob…' (when we lived in mountains…). ...
... Some of them never had the chance to arrive at Thailand. Those who did make it, suffered from and were haunted by nightmares (Adler 1995;Westermeyer & Her 2007). ...
In this paper, I scrutinize how ethnic artists represent traumatic memory, reflect nostalgia, and mobilize
individuals to collaborate with one another to build resistance. I mainly focus on three French Hmong
artists and their creations, namely, oil paintings, sand performances, and graffiti – although several other
artistic mediums are used by these artists. I use ‘urban art’1 to refer to artworks with non-traditional tools/
skills delivered in an urban space. Some Hmong artists have trained in Fine Art colleges; others are selftrained artists. Their efforts and endeavors reveal the multiple facets of urban art as a means of identitymaking and resistance-building in contemporary French society.
... We conclude that a possible common denominator between ISP/RISP and those other conditions at the physiological level may well be at least transient fluctuations of electrolytes (or inappropriate concentrations of electrolytes on either sides of nerve or muscle cell membranes) and that it is possible for an individual to have a cluster of disorders rather than a single disorder, with associated genetic defects (or mutations). Finally, we hypothesize that a condition known as Sudden Unexplained Nocturnal Death Syndrome (SUNDS ) might be an extreme case of sleep paralysis (Nimmannit et al., 1991;Randall, 1992;Adler, 1995). SUNDS is a very rare condition that is prevalent in southeast Asia (mainly in northeast Thailand and in Laos), interestingly in populations where HypoKPP is endemic (but generally induced by environmental factors), and which affects mostly young adult males. ...
... There is no doubt that sleep paralysis (whether ISP or RISP) has been documented since as early as Hellenistic times, but with a wide variety of interpretations throughout time that reflect the culture, folklore, and belief system of different populations or ethnic groups worldwide. The hypnogogic/hypnopompic hallucinations that are part of the secondary features of ISP/RISP have been interpreted as being: 12 indigestion ("hypocrites") for the Hellenic Greeks, guilt for the Romans and the Egyptians, witchcraft for the Mexicans, for the Yoruba people and for the Africans (Ohaeri et al., 1992), 13 demons for Medieval Europe, djinns for the Arabs, vampires for Europeans, hags (witches) for the Irish and Scottish (actually such hallucinations are still called "Old Hag" attacks in parts of the United States and of Canada, particularly in Newfoundland; Ness 1978), spectral foxes or spirit encounters for the Japanese, cats for the Chinese, ancestral ghosts for Southeast Asians (e.g., Wing et al., 1994;Adler, 1995), or the spirit of a dead unbaptized baby to different people in different parts of the world, etc. ...
Isolated sleep paralysis (ISP) is a poorly understood phenomenon that has attracted increased attention in recent years both in the medical community (Dahlitz & Parkes, 1993; Hishikawa & Shimizu, 1995) and in psychological research (Fukuda et al., 1987, 1991; Fukuda, 1993; Takeuchi et al., 1994; Wing et al., 1994). Although the occurrence of ISP is relatively common, recurrent ISP (RISP) is a rarer variant of sleep paralysis characterized by frequent episodes or a complex of sequential episodes whose total duration may exceed 1 hour, and particularly by the range and sense of perceived reality of the subjective phenomena experienced during episodes. Although such phenomena are usually categorized as hypnagogic or hypnopompic hallucinations, there is at present no integrated model that adequately explains the ensemble of physiological, neurological, cognitive, and psychological components of RISP. As researchers who experience RISP, in this paper we attempt to synthesize information on RISP gathered from various sources and to conjecture possible connections between RISP and other as yet poorly understood phenomena at different levels: at a neurophysiological level, with anxiety disorders (Suarez, 1991; Paradis et al., 1997), the Periodic Paralyses (Stedwell et al., 1992), and with Sudden Unexplained Nocturnal Death Syndrome (SUNDS) (Nimmanit et al., 1991; Randall, 1992; Adler, 1995); at a neurocognitive level, with lucid dreaming (LaBerge, 1985); and finally, at a level that examines the possibility of the manifestation of paranormal phenomena during RISP episodes, with Out-of-Body Experiences (OBE) (Tart, 1968; Osis, 1981) and with Near-Death-Experiences (NDE) (Moody, 1976; Ring, 1979). Finally, we performed a statistical analysis on RISP by use of a sample of 250 direct or indirect respondents to a message posted initially by one of the authors on the sleep web site of the University of California in Los Angeles (UCLA). Preliminary results indicate that over 90% of respondents experience intense fear during their RISP episodes, about 50% have invoked a paranormal or supernatural explanation, and that a typical RISP episode may be described as consisting of three main phases. We conclude with a brief description of possible strategies to cope with RISP.
... The community most severely affected was immigrant Laotian Hmong men. 2 These men, in relatively good health with a median age of 33, were dying at a rate of 92/100,000 from SUNDS. 3 Since the discovery of the high prevalence of SUNDS among this group, one study has observed a link between sleep paralysis (at two to four times higher occurrence in this community), a belief in the dab tsog (a crushing nightmare spirit which sits on the chest and 'took their breath'), and stress as possible catalysts for SUNDS, and resulting deaths. 4 In the 35 years since SUNDS was first identified among the Hmong, the Center for Disease Control's initial statement on the cause still holds, a definitive 'cause [of death] remains unknown'. ...
... 4 In the 35 years since SUNDS was first identified among the Hmong, the Center for Disease Control's initial statement on the cause still holds, a definitive 'cause [of death] remains unknown'. 2,3 One intriguing and fanciful explanation attributed the deaths to the 'Nightmare'. It was postulated that the nightmare 'is not a bad dream, but rather, in traditional terms, the nocturnal visit of an evil being that threatens to press the very life out of its terrified victim'. 2 Generally, those who have experienced such incidents reported feeling paralysed, unable to speak, helpless, and overtaken by intense fear and terror. 2 Modern victims have described the incidents as 'I imagined that somebody was laying in bed with me, but I couldn't see them because I was struggling to turn over but couldn't move'. ...
Sleep paralysis is a relatively new term to describe what for hundreds of years many believed to be a visitation by a malevolent creature which attacked its victims as they slept. The first clinical description of sleep paralysis was published in 1664 in a Dutch physician’s case histories, where it was referred to as, ‘Incubus or the Night-Mare [sic]’. In 1977, it was discovered more than 100 previously healthy people from various South East Asian communities had died mysteriously in their sleep. The individuals affected were dying at a rate of 92/100,000 from Sudden Unexplained Nocturnal Death Syndrome. No underlying cause was ever found, only that subsequent studies revealed a high rate of sleep paralysis and belief in the dab tsog (nightmare spirit) amongst members of the community. The nightmare/succubus is descended from Lilith. The earliest reference to Lilith is found in the Sumerian King list of 2400 BC known as Lilitu or she-demon, she bore children from her nocturnal unions with men. In other derivations, she was Adam’s first wife who rather than ‘obey’ became a demon that preyed on women during childbirth. In modern Middle Eastern maternity wards, some women still wear amulets for protection. Today, clinical cause of these disturbances is sleep paralysis due to the unsuitable timing of REM sleep. During the ‘Nightmare’ episode, the sleeper becomes partially conscious during REM cycle, leaving the individual in a state between dream and wakefulness. For some, culture and the tradition of the nightmare is explanation enough.
... Expanding this research area from the design perspective has a sense of urgency as studies show that mental, emotional and physical health problems abound among displaced people who lose their cultural connections (Bammer, 1994;Adler, 1995;Papadopoulos et al., 2004). With a home's spatiality hosting many cultural practices and impacting social change (Pader, 1993), designers, facility managers, affordable housing providers and policy makers who are cognizant of how the built environment relates to culture and identity can create spaces that meet diverse needs and support various ways of living, that is, culturally sensitive housing (Hadjiyanni, 2005(Hadjiyanni, , 2007Hadjiyanni and Helle, 2008). ...
... All three groups face a host of challenges in their adjustment process from lacking language and job skills to racial discrimination. These challenges contribute to emotional distress and acute homesickness, hindering their chances for societal and economic advancement (Adler, 1995;Inui, 1998;Dion, 2001;Thornburgh, 2006). Low incomes and regular remittances to their home countries (Levine, 2007) leave little money to procure appropriate housing (Mattessich, 2000;Robillos, 2001). ...
Personalizing a residential environment has long been recognized among the dimensions of home. Little research though has focused on understanding the home-making process of aesthetic construction under conditions of displacement. Questions still abound: What does the notion of aesthetics entail in displacement? Do immigrant groups construct a sense of difference in the home, and if so, how? And, what can impede their efforts? Answering these questions sheds light on the opportunities that arise when interdisciplinary connections between architectural, housing and consumer studies are formed.
... In addition to displacement, the Hmong Lao have suffered political discrimination and (Adler, 1995;Tapp, 1988;Westermeyer, Neider, & Callies, 1989;Westermeyer, Vang, & Neider, 1983). ...
Accounting responds to the societal pressures acting upon it. This research examines the long history of subjugation of the Hmong Lao and hoe it led to the development of accounting records that have acted as a tool of micro-resistance against oppression. The Hmong are an ethnic minority in the People's Republic of Laos who maintain a system of image-based accounting records. The methodological approach of Michel de Certeau is used in this research because it focuses on tools of everyday resistance; accounting is an important tool of everyday resistance for the Hong Lao. Hmong Lao accounting challenges definitions of accounting because the records are non-traditional both in format and how they are preserved. They are image-based records preserved on traditional costumes. Through choices concerning the form and method of disclosure, the Hmong Lao were able keep the contents of their accounting records secret while preserving them in plain view. This paradox is central to their records being tools of micro-resistance. 2
... and Australia (Hamilton-Merritt, 1993). Ramifications of oppression, dislocation and war continue to disadvantage the Hmong Lao economically, politically and socially (Westermeyer et al., 1983;Adler, 1995;Westermeyer et al., 1989;Tapp, 1988). ...
Accounting responds to the societal pressures acting upon it. This research examines the long history of subjugation of the Hmong Lao and hoe it led to the development of accounting records that have acted as a tool of micro-resistance against oppression. The Hmong are an ethnic minority in the People's Republic of Laos who maintain a system of image-based accounting records. The methodological approach of Michel de Certeau is used in this research because it focuses on tools of everyday resistance; accounting is an important tool of everyday resistance for the Hong Lao. Hmong Lao accounting challenges definitions of accounting because the records are non-traditional both in format and how they are preserved. They are image-based records preserved on traditional costumes. Through choices concerning the form and method of disclosure, the Hmong Lao were able keep the contents of their accounting records secret while preserving them in plain view. This paradox is central to their records being tools of micro-resistance.
... and Australia (Hamilton-Merritt, 1993). Ramifications of oppression, dislocation and war continue to disadvantage the Hmong Lao economically, politically and socially (Westermeyer et al., 1983;Adler, 1995;Westermeyer et al., 1989;Tapp, 1988). ...
Accounting responds to the societal pressures acting upon it. This research examines the long history of subjugation of the Hmong Lao and hoe it led to the development of accounting records that have acted as a tool of micro-resistance against oppression. The Hmong are an ethnic minority in the People's Republic of Laos who maintain a system of image-based accounting records. The methodological approach of Michel de Certeau is used in this research because it focuses on tools of everyday resistance; accounting is an important tool of everyday resistance for the Hong Lao. Hmong Lao accounting challenges definitions of accounting because the records are non-traditional both in format and how they are preserved. They are image-based records preserved on traditional costumes. Through choices concerning the form and method of disclosure, the Hmong Lao were able keep the contents of their accounting records secret while preserving them in plain view. This paradox is central to their records being tools of micro-resistance.
... Hmong marry Hmong: there is little intermarriage between highland-dwelling Hmong and lowland-dwelling non-Hmong Laotians, which is one of the reasons Hmong culture has remained largely unchanged for generations (Michaud, 1997 (Hamilton-Merritt, 1993). Ramifications of oppression, dislocation and war continue to disadvantage the Hmong Lao economically, politically and socially (Adler, 1995;Tapp, 1988;Westermeyer, Neider, & Callies, 1989;Westermeyer, Vang, & Neider, 1983). ...
Acknowledgements We wish to thank the Traditional Arts Ethnology Centre, Luang Prabang for its assistance with information and translation, Hmong embroiderer Maiying Xiong for her generosity in sharing her knowledge of Hmong Lao accounting records and her embroidery skills, and our anonymous interviewees. Abstract This research examines the use of accounting as a tool of micro-resistance using he methodological approach of Michel de Certeau. The accounting of the Hmong Lao is used as an example of micro-resistance. These records are non-traditional in format and the medium on which they are preserved, not by choice but because past oppression limited the options pertaining to all aspects of Hmong Lao accounting records. The records are image-based and preserved on traditional costumes, which enabled the Hmong Lao to keep the records' contents secret while preserving them in plain view. This paradox is central to the records being tools of micro-resistance.
... The literature that does exist regarding health and the Hmong is presented predominately from an anthropological case study point of view rather than a public health or medical perspective. For example, research on the Hmong has addressed the high incidence of sleep paralysis in the community and its folk explanations (Adler, 1995), as well as Hmong beliefs regarding illness causation for specific conditions such as epilepsy (Fadiman, 1997), and measles (Henry, 1999). From this literature one can begin to piece together the worldview of the Hmong and get a general idea of the way that Hmong culture differs from mainstream American culture and therefore what potential misunderstandings could occur in health care situations. ...
Obtaining quality healthcare can be challenging for immigrant populations. Barriers to care affecting immigrant populations include language differences, lack of health insurance, and different cultural beliefs. A prime example visible in California is the Hmong community. Prior research on the Hmong, though limited in scope, confirm instances of these barriers at work. This leads to a lack of trust in Western medicine and lost opportunities for disease prevention and treatment. In extreme cases it has even lead to death. This Senior Research Project examines satisfaction with the healthcare system, utilization of health services, health beliefs and practices, and the medical encounters of Hmong students living in San Diego. The results demonstrate that in order to provide effective healthcare to immigrant populations, healthcare providers must be aware of and willing to work within that culture's schema in order to facilitate trust. This study includes surveys and interviews with Hmong students. The inclusion of dual control groups -students whose parents were born in the United States, and students whose parents immigrated but are not Hmong -enable distinction and separation of uniquely Hmong experiences from those of other immigrants and those of non-immigrants.
... The United States accepted the majority as migrants. There are over 100,000 Hmong people in America at present (Adler, 1995). In Australia, the number is far less. ...
This article is a detailed exploration of traditional Hmong explanations about death in birth. It is based on an ethnographic study with Hmong now living in Australia. The discussion encompasses stillbirth, neonatal death, and maternal death, as well as the ethnomedical knowledge and practices which pertain to death in birth. Stillbirth and neonatal death are perceived as non-significant events where no burial ceremony is needed. However, with a maternal death, a proper burial ritual must be performed to ensure that the soul of the dead person can be reborn again. The Hmong have several layers of explanations about the causes of death in birth. These include personal attribution, the nature of being, the soul, the supernatural beings, and the mandate of life. Most death in birth cannot be helped but in some situations it may be prevented. In this case a shaman and other traditional healers are consulted. The article finishes with discussions on the importance of life in birth and the value of children in Hmong culture.
... The United States accepted the majority as refugees. There are over 100,000 Hmong people in America at present (Adler, 1995). In Australia, the number is far fewer than those in the US. ...
This paper examines the cultural construction of childhood illness among Hmong refugees from Laos who are living in Australia. It focuses on traditional patterns of beliefs and practices related to health and illness of newborn infants and young children. The Hmong treat childhood health and illness seriously, and for them there are several causes of childhood illness, including nature, souls, supernatural beings and human aggression. The roles of traditional healers who play an important part in childhood health and illness are also discussed. Lastly, the paper attempts to make clear some implications for child health services for immigrants such as the Hmong in Australia and elsewhere. The paper intends to contribute an anthropological perspective on child health which is particularly important in a multicultural society. A clear understanding by health professionals of cultural beliefs and expectations is essential if misunderstanding is to be avoided, and culturally appropriate and sensitive health care for immigrant children, such as the Hmong is to be available. Children who are often sick will look pale when they are born. They will have more fever than the healthy ones. This will be because their plig [souls] have left their bodies; that is why they are like that (A Hmong grandmother, Fieldnotes, 1994).
... Sudden Unexpected Nocturnal Death Syndrome among healthy Hmong refugees has been attributed to nightmare or attack by evil spirit that threatens to press the life out of its terrified victim (Adler, 1995). ...
... The interplay between biological processes and local conditions has been part of scholarly inquiry for over a century (Krieger 2004). Anthropologists were instrumental in early debates, showing how local cultural beliefs can result in culturally specific health outcomes (e.g., Hahn and Kleinman 1983;Adler 1995). More recently, the concept of local biologies is gaining widespread prominence for its ability to move beyond the scrutiny of culture to shed light on various aspects of the interplay between social and biological processes (Koch 2011;Adelson et al. 2013). ...
The province of Papua, Indonesia has one of the fastest growing rates of HIV infection in Asia. Within volatile political conditions, HIV has reached generalized epidemic status for indigenous Papuans. This article explores the merits of using the concept of local biologies as an analytic tool to assess the range of factors which affect a local pattern of untreated HIV and rapid onset of AIDS. A research team conducted 32 in-depth interviews with HIV-positive indigenous persons and 15 interviews with health care workers in urban and peri-urban sites in the central highlands region. The results show fear of gossip and stigmatization, regional political conditions and gaps in care interweave to create local biological conditions of evasion of care and rapid onset of AIDS. The normative emphasis in contemporary scholarship on stigma as shaping subjective responses to HIV needs to be complemented by a full assessment of the physiological impact of health services, and the ways political conditions trickle down and mediate local biological patterns. The concept of local biologies is highly effective for explaining the full scope of possible factors affecting the intersection of social and physical realms for HIV-positive persons.
... be an extreme case of sleep paralysis (Nimmannit et al., 1991; Randall, 1992; Adler, 1995). SUNDS is a very rare condition that is prevalent in southeast Asia (mainly in northeast Thailand and in Laos), interestingly in populations where HypoKPP is endemic (but generally induced by environmental factors), and which affects mostly young adult males. ...
Isolated sleep paralysis (ISP) is a poorly understood phenomenon that has attracted increased attention in recent years both in the medical com-munity (Dahlitz & Parkes,. Although the occurrence of ISP is relatively common, recurrent ISP (RISP) is a rarer variant of sleep paralysis character-ized by frequent episodes or a complex of sequential episodes whose total du-ration may exceed 1 hour, and particularly by the range and sense of per-ceived reality of the subjective phenomena experienced during episodes. Although such phenomena are usually categorized as hypnagogic or hypnopompic hallucinations, there is at present no integrated model that ade-quately explains the ensemble of physiological, neurological, cognitive, and psychological components of RISP. As researchers who experience RISP, in this paper we attempt to synthesize information on RISP gathered from vari-ous sources and to conjecture possible connections between RISP and other as yet poorly understood phenomena at different levels: at a neurophysiolog-ical level, with anxiety disorders (Suarez, at a neurocognitive level, with lucid dreaming (LaBerge, 1985); and finally, at a level that examines the possibility of the manifesta-tion of paranormal phenomena during RISP episodes, with Out-of-Body Ex-periences (OBE) (Tart,1968; Osis, 1981) and with Near-Death-Experiences (NDE) (Moody, 1976; Ring, 1979). Finally, we performed a statistical analy-sis on RISP by use of a sample of 250 direct or indirect respondents to a mes-sage posted initially by one of the authors on the sleep web site of the Uni-versity of California in Los Angeles (UCLA). 1 Preliminary results indicate that over 90% of respondents experience intense fear during their RISP episodes, about 50% have invoked a paranormal or supernatural explanation, and that a typical RISP episode may be described as consisting of three main phases. We conclude with a brief description of possible strategies to cope with RISP.
... The USA accepted the majority as migrants. There are over 100 000 Hmong people in America at present (Adler 1995). In Australia, the number is far less than in the USA. ...
Childbirth, including the period immediately following birth, is an event in which traditions play an important part (Symonds
1991; Liamputtong Rice 2000a; Liamputtong 2004, 2007a, b).
... Answers to these questions attain special significance under conditions of displacement when a group's cultural practices are altered or implicated into the web of social changes that accommodates migration (Bammer, 1994). Asking these questions from within the domestic domain, the site of many cultural practices and traditions, is even more adamant as research shows that not being able to practice one's traditions negatively impacts displaced peoples' mental, emotional, and physical wellbeing (Adler, 1995;Papadopoulos, Lees, Lay and Gebrehiwot, 2004). Designers who are sensitive to the intertwining of cultural identity SAMANEH VAHAJI AND TASOULLA HADJIYANNI, 36 definitions can better respond to the diverse needs of users by creating culturally sensitive housing, housing that supports various ways of living (Hadjiyanni, 2005(Hadjiyanni, , 2007. ...
Although much controversy surrounds the Muslim veiling tradition, little has been studied about how immigrant Muslim veiled women navigate the practice of veiling while living in western-type houses. Through interviews with ten Muslim veiled women in Minnesota, this study explores the relationship between veiling and domestic environments. The findings point to both dress and interior spaces as being forms of enclosure, one being mobile (dress), that help women construct their cultural and religious identity while providing them with privacy, protection, and a sense of control. Residing in typical, suburban American homes however, the women we interviewed experienced difficulties being unveiled in one of the few places where the veil can come off. Designers who are cognizant of cultural differences in housing needs can create homes that support various ways of living, that is, culturally sensitive housing.
... The US accepted the majority as migrants. There are over 100 000 Hmong people in America at present [21]. In Australia, the number is far less than that in the US. ...
In this paper, I discuss childrearing beliefs and practices in Hmong culture. In particular I focus on issues related to souls and ceremonies for a newborn infant in Hmong society. The Hmong believe that each living body has three souls. For a newborn infant, the first soul enters his or her body when he or she is conceived in the mother's womb. The second soul enters when the baby has just emerged from the mother's body and taken its first breath. The third soul, however, will have to be called on the third morning after birth, as will be discussed in this paper. If all three souls are secured in the infant's body, he or she will be healthy and hence thrive well. On the contrary, the infant may become ill and eventually die if all three souls do not reside in his or her body. This, therefore, makes a soul calling ceremony on the third morning after birth essential in Hmong culture. I will show that for Hmong society to survive, the Hmong strongly adhere to their cultural beliefs and practices related to a newborn infant. These beliefs and practices tie the Hmong with not only their family and their society at large, but also the supernatural world.
... The United States accepted the majority as immigrants. There are over 100,000 Hmong people in America at present (Adler, 1995). In Australia, the number is far less than in the US. ...
In this paper, traditional Hmong explanations about miscarriage and the ethnomedical knowledge and practices which pertain to it are explored. They are derived from in-depth interviews and participant observation with the Hmong who are now living in Melbourne, Australia. The loss of pregnancy creates considerable anxiety in Hmong society. This is not only because it calls for a socially justifiable explanation for a family's failure to extend their lineage, but also reduces the venue for a soul to be re-born into the family. This is a threat for Hmong society since it means the extinction of the family, clan and lineage and hence Hmong society. The cultural construction of the causes of miscarriage among the Hmong surrounds two main categories: the natural world which is related to the woman's body and her behaviour; and the supernatural world. These explanations point to the influence that individuals, both living and dead, have on pregnancies. In traditional Hmong society, health is perceived as a harmony between the social, and religious or supernatural realm. A woman being unable to bring forth an offspring because of miscarriage indicates disharmony with the living and/or between the living and the dead.
... The USA accepted the majority as migrants. There are over 100 000 Hmong people in America at present (Adler 1995). In Australia, the number is far less than in the USA. ...
To examine traditional and changed beliefs and practices related to the puerperium of Hmong women in Melbourne, Australia.
An ethnographic study of reproductive health among Hmong women in Australia.
Melbourne Metropolitan Area, Victoria, Australia.
27 Hmong women, three shamans, two medicine women and one magic healer who are now living in Melbourne.
In the Hmong tradition, the first 30 days after birth is seen as the most dangerous period for a new mother. There are several beliefs and practices which women must observe in order to regain strength and avoid poor health in the future. Lying near the fire in the first three days is one such belief. The woman's body during the puerperium is considered polluted. Hence, there are several rules to restrict the woman and the substance of her body. It appears the Hmong continue to observe their post-birth confinement practices regardless of their new environment. Most women mentioned that this is to avoid ill health and misfortune in the future. There are only a few customs which they have to modify due to changes in their living situations in a new country.
Hmong cultural beliefs and practices concerning the puerperium in particular, and childbearing in general, have specific implications for midwifery care. Since midwives will continue to encounter many traditional beliefs and practices of the Hmong when providing birthing care to Hmong women, it is essential that their cultural beliefs and practices be taken into account. This will not only help to avoid misunderstanding, but also result in culturally appropriate and sensitive care for immigrant women.
... Embroiled in the fighting between U.S. forces and the Communist Pathet Lao, many Hmong were forced to leave their homeland in the mountains and escape to Thailand. The United States accepted the majority as refugees, and over 100,000 Hmong people now live in the United States (12). In Australia, the number of Hmong is far lower-about 1,500 (13). ...
This study of cultural beliefs and practices related to childrearing and child health among the Hmong in Melbourne, Australia, used in-depth interviews and participant observation of 27 Hmong mothers and some Hmong traditional healers between 1993 and 1998. Traditional Hmong beliefs and practices include: taking notice of the birth date and time, placing a silver necklace on the newborn, not praising the newborn, not taking the infant out during the first 30 days, breastfeeding, the infant's sharing a bed with the parents, and a soul-calling ceremony on the third day after birth. All Hmong mothers follow cultural beliefs and practices to prevent the ill-health or death of their newborn infants, but some aspects of these practices have had to be modified to suit the new living environment in Australia. Health care professionals need to acknowledge the different ways of caring for a young child among the Hmong so as to avoid misunderstandings and to provide sensitive care. Hmong beliefs and practices also have implications for health promotion campaigns and can be a valuable source of ideas in the efforts to promote infant health and reduce infant deaths in Australia and elsewhere.
Purpose
Showing empathy can be, at best, a tricky prospect; teaching empathy is downright daunting. The authors taught an interior design studio project that designed hypothetical transitional housing for refugees coming to Canada. As the project evolved, it became imperative that students needed to address tangible issues experienced by the refugee client, namely trauma, rootlessness and marginalization and authentically empathize with their client. Hence, instructors needed to accurately structure and facilitate this engagement. The purpose of this paper is to present a summary of the evolution of this studio project as a case study, the revision of the project's pedagogical goals and establishing a new set of design parameters that engage the “self” and the “other” through alternate modes of thinking and reasoning.
Design/methodology/approach
The paper is centered on a reflective case study of the studio project and the student's work. The results of the reflection are contextualized within pedagogical framework that emphasize alternate forms of teaching and learning that promotes authentic empathetic engagement.
Findings
The summary of these reflections arises from organically questioning the nature of traditional design studio pedagogy. It proposes divergent approaches, such as “abductive reasoning”, posing the project as a “wicked problem” to encourages lateral explorations and connections.
Originality/value
This paper questions the value of prescriptive design process and guides student learning by providing an experimental toolkit that encourages alternative exploration, research and thinking.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
There is a growing concern in relation to the problem of insufficient sleep, particularly in the United States. In the early 1990s a Congressionally mandated commission noted that insufficient sleep is a major contributor to catastrophic events, such as Chernobyl and the Exxon Valdez, as well as personal tragedies, such as automobile accidents. Adolescents appear to be among the most sleep-deprived populations in our society, though they are rarely included in sleep assessments. This book explores the genesis and development of sleep patterns in adolenscents. It examines biological and cultural factors that influence sleep patterns, presents risks associated with lack of sleep, and reveals the effects of environmental factors such as work and school schedules on sleep. Originally published in 2002, Adolescent Sleep Patterns will appeal to psychologists and sociologists of adolescence who have not yet considered the important role of sleep in the lives of our youth.
Relocating to the U.S. in the late 1970s, many Hmong refugees experience high rates of mental distress, partly due to factors such as one in four living below poverty and differences in assimilation levels between the young and the old. Spatial elements that supported the well-being of our interviewees included a wall that held the Shamanist altar; a stairway that accommodated a freezer where meat for celebrations was stored; open and connected living and dining areas that hosted gatherings; and extra sleeping areas that enabled extended family members to live together. Suppressing their abilities to nourish connections were open kitchens that allowed the smells from frying and using spices to permeate the rest of the house and the lack of a yard through which to nourish one’s spirit.
This chapter fuses my story as a refugee and an immigrant with a review of interdisciplinary discourses around home, culture, and identity to unravel the meaning behind the “and” in the saying “a human is a place and the place is neglected.” None of the three dominant paradigms of thought that have guided scholarship around movement fully captured my story: assimilation, transnationalism, and resistance. As a way to quench my thirst for deciphering what home means in displacement, I connected with refugees in Cyprus and immigrant and minority groups in Minnesota. Trusting me with their experience of absence, helped me embrace the idea of homes as transbodied spaces produced at the junctures of presence and absence. Although absent, home mediators, from scholars to advocates can impact people's right to home.
The book’s Introduction makes the case for why discourses that focus on eliminating disparities must encompass a critical evaluation of home environments. Part of the challenge is moving beyond housing, which is often discussed using measurable and quantifiable parameters, and instead exploring how spatial characteristics can support or suppress people’s attempts to construct meaning in their lives, which can impact well-being and delineate the construction of disparities. This shift in paradigms is called oikophilia, a new lens through which to explore the home-making stories of Hmong, Somalis, Mexicans, Ojibwe, and African Americans in Minnesota. The chapter closes by summarizing the book’s theoretical and practical implications, calling on home mediators to be more intentional in their support of Culturally Enriched Communities, communities in which everyone can thrive.
On the basis of empirical observation focused both on Malay parents' prevention and treatment of their children's ailments and on adults' medical knowledge related to children's health, the author shows how Malay children's traditionnal diseases are subjected to two alternative interpretations. They are either explained as any other human diseases - through naturalistic, mechanistic, personnalised or impersonnal causes - or thanks to etiologies that are specific to infancy. In this case, whatever their diversity, they share two major features: they tend to "transfer" the origin of the illness into the infant's close kin (genitor/genitrix and siblings) and they tie up the child's suffering to the household's recent history.
The Hmong are an ethnic minority with ancient roots in China. There are now more than 100,000 Hmong refugees in the United States, with the highest concentration in Minnesota and Wisconsin. As the Hmong make America their home, their practice of traditional healing-Hmong shamanism (kev ua neeb)-has been particularly challenged by the multiple forces that accompany acculturation, such as the problems faced when individuals are confronted with health care, social services, and legal systems that have no understanding of Hmong traditional beliefs and cultural attitudes. At the same time, the tension between acculturation and traditional beliefs modulates the Hmong's participation in American biomedicine. Due to the dynamic interaction of souls, spirits, and people, and the impact of their interactions on health and illness, many Hmong find Western medicine less than adequate in meeting their needs. Those who do not seek Western treatment will try a variety of traditional healing practices, including shamanism, herbalism, and other home remedies and magic healing. Nevertheless, shamans and shamanism are not opposed to conventional physician care.
Writing from These Roots documents the historical development of literacy in a Midwestern American community of Laotian Hmong, a people who came to the United States as refugees from the Vietnam War and whose language had no widely accepted written form until one created by missionary-linguists was adopted in the late twentieth century by Hmong in Laos and, later, the U.S. and other Western nations. As such, the Hmong have often been described as "preliterates," "nonliterates," or members of an "oral culture." Although such terms are problematic, it is nevertheless true that the majority of Hmong did not read or write in any language when they arrived in the U.S. For this reason, the Hmong provide a unique opportunity to study the forces that influence the development of reading and writing abilities in cultures in which writing is not widespread and to do so within the context of the political, economic, religious, military, and migratory upheavals classified broadly as "globalization." © 2007 by the University of Hawai'i Press. All rights reserved.
America's healthcare system in the twenty-first century faces a variety of pressures and challenges, not the least of which is that posed by the increasingly multicultural nature of American society itself. Large numbers among the Hmong, immigrants from the landlocked Asian nation of Laos, continue to prefer their own ancient medical traditions. That these Hmong Americans should continue to adhere to a tradition of folk medicine, rather than embrace the modern healthcare system of America, poses questions that must be answered. This book takes up the task of examining Hmong American concepts of health, illness and healing, and looks at the Hmong American experience with conventional medicine. In so doing, it identifies factors that either obstruct or enable healthcare delivery to the Hmong, specifically a target sample of Hmong Americans resident in Colorado. Drawing upon scientific methods of data collection, the research reveals attitudes currently held by a group of American citizens toward health and medicine which run the gamut from the very modern to those which have prevailed in the highlands of Southeast Asia for centuries.
This paper examines three different videos about Hmong history that have been created and uploaded onto www.youtube.com by Hmong American students during the past three years. These videos narrate a tale of Hmong history, which mainly revolve around migration and resettlement. This paper examines different aspects of these videos, including images, written text, and oral comments by interpreting visual and vocal narratives.
As globalization brings cultural changes, interior designers and architects are striving to understand the new design requirements of changing populations. The purpose of the study is to examine Korean temporary residents' housing perceptions and housing adjustment behaviors in U.S. residences. Working from Morris and Winter's (1978, 1994) theory of family housing adjustment, qualitative study was conducted with Korean female temporary residents visiting the United States. Using a purposive sampling strategy, 27 women between the ages of 33 and 54 participated in interviews, observations, and documentation of their previous housing conditions in Korea. Results indicated that planned total duration of stay and length of residency in the United States were the primary factors affecting housing perception and adjustment; consequently, four representative types of cross-cultural temporary residents were postulated to define different consumer housing types. These residents voiced a range of views on their U.S. temporary housing. The positive impressions of the temporary housing included surrounding natural environment, built-in storage, combined open kitchen and living room, and exterior building appearance, whereas the sample viewed the following features more negatively: carpeted floor, interior lighting, bathroom condition, foyer, and types of heating systems. In response to the negatively perceived conditions, the temporary residents changed their behaviors, modified existing housing attributes, endured less-than-ideal circumstances, or moved. Among cultural housing attributes, a carpeted floor was the most difficult for Korean temporary residents to adapt to.
The notion of ‘culture’ has long been recognized as an inherent component of both art and design education. What remains uncharted territory are ways by which educators can assess a student’s understanding of the complexity behind the production of ‘culture’. Contextualizing current pedagogical approaches within anthropological and interdisciplinary theoretical paradigms sheds light on the limitations of present undertakings. Static and stereotypical interpretations of ‘culture’ fail to account for the complex, multi-dimensional, hybrid, dynamic, intertwining, and ever-changing facets of ‘culture’ that characterize border crossings and modernization processes. This paper posits that concepts, an artistic synthesis of knowledge, can be the medium through which students can unravel the myth of ‘culture’ and expose its dynamic and changing nature, the tensions and contradictions involved, as well as the multiple ways of belonging. Marking the beginning of the design process, concepts that speak of ‘culture’ can propel a new era in infusing designs with social justice.
This paper discusses the perceptions and experiences of Hmong women, who are now living in Australia, in regard to childbirth. It is based on an ethnographic study of reproductive health among Hmong women in Australia. In general, Hmong women were satisfied with care received during pregnancy, birth and postpartum period. However, the women also had many difficulties during these periods, due largely to the different systems of cultural beliefs and practices related to childbearing. Issues related to communication also presented problems, as women could not speak English proficiently. The results indicate that health professionals in birthing services need to acknowledge cultural diversity as well as variability among women, for individual circumstances present important differences in terms of the care needed.
Interviews with 13 Minnesota Ojibwe families in their homes shed light on how domestic spaces can support or suppress efforts to restore social, cultural, spiritual, and temporal continuity. Having lost their past to forced relocation, assimilation, and discriminatory policies, Ojibwe are employing visual and performative cultural expressions like the display of Native objects, craft making, spirituality, traditional foods and eating patterns, and strong family and community connections to re/claim what was lost and to construct their Ojibwe identity. With an understanding of how homes mediate continuity with the past, designers can create culturally sensitive housing solutions that support well-being.
The aims of this study were to explore individual and collective understandings of psychological well-being among young Somali (black African Muslim) asylum-seeker or refugee women. Three groups and five individual semi-structured interviews were undertaken and themes were identified using Interpretative Phenomenological Analysis. Themes included resilience and protection; identity and beliefs; and concealment, distancing and secrets; which reflected acculturation, Islamic and Somali cultures. Spirit possession was explored in relation to culture and religion, mental health, protection and treatment. The women ‘get on’, cope with life, and value support from family, services and religion. However, the pressures to navigate conflicting and changing cultural and religious positions, and to conceal distress, frustrate accessing support. The young Somali refugees’ understandings of mental health and psychological well-being provide an insight for clinicians into the complexities of approaching services for help, and developing shared understandings transculturally. Clinically, the findings raise the paradox of how Somali women value support, yet also value concealment and fear disclosures. The variation and tensions reflected in the data from a small number of women highlight the importance of not stereotyping refugees, but exploring their individual beliefs and providing a range of service options.
Coming to Minnesota to escape a devastating war, Somali refugees found themselves living in rental units that had little resemblance to the dwellings they left behind. Interviews with eight Somali women in their Minnesota homes reveal the difficult choices they had to make in order to preserve Somali cultural traditions and practices amidst strong American influences. As a way to construct the Somali sense of difference, women appropriated their living environments by relying on all five senses and various forms of cultural expressions that range from burning unsi to adorning the walls with Somali handicrafts. Unwilling to let go of valued Somali institutions, many had to make bounded choices like cooking while veiled in open kitchens, limiting children's play to accommodate formal impromptu visits, and restraining their social gatherings to the bedrooms to continue the tradition of gender separation. By proposing design solutions to the housing problems revealed through the study, this paper hopes to alert those who work with refugees and other immigrant groups that, with a little extra care, a house can be transformed into a home that fosters a sense of belonging and eases the stresses of adjusting to new life circumstances.
From mid-1980s to early 1990s, there were several studies evaluating a condition known as "nocturnal sudden death syndrome" among the healthy, young Hmong (immigrants from Laos) individuals who mysteriously died from unknown causes during the night. To date, very little has been reported on the mortality patterns in the Hmong. The purpose of the present study is to examine causes of death (COD) and compare age-adjusted mortality rates (AAMR) in the Hmong with those of non-Hispanic white (NHW) population in California, which may yield useful data for health prevention and planning purposes.
This study was based on 2,744 Hmong deaths occurred in California from 1988 to 2002. To calculate AAMR, Hmong population at risk of dying was derived by interpolating Hmong population counts from the 1990 and 2000 decennial censuses. For comparison, AAMR were calculated for both Hmong and NHW, and the statistical test, incidence rate ratio, was used to examine differences in relative mortality risk of each major COD between Hmong and NHW.
AAMR are highest in neoplasm (184.0/100,000), circulatory (277.9/100,000) and respiratory (100.0/100,000) diseases for both Hmong and NHW. The AAMR for all COD during the entire study time period was 879.5/100,000 in males and 736.0/100,000 in females. AAMR for all other COD range from 4.9/100,000 to 67.2/100,000. Hmong experienced 1.3-1.9 times higher mortality rates for certain COD, compared to NHW.
The interesting findings of this study are the differences in AAMR observed for lower ranking COD between Hmong and NHW. Hmong were found to be experiencing 1.3-1.9 times higher mortality rates for injuries and poisonings, digestive diseases, prenatal conditions, ENMID (endocrine, nutritional, metabolic, immunity disorders), infections and parasitic illnesses, and congenital anomalies when compared to NHW. However, while Hmong women were found to have statistically significantly higher mortality risk for injuries and poisonings (P-value < 0.05), ENMID (P-value < 0.05), and infections and parasitic ailments (P-value < 0.05) when compare to NHW women, Hmong men were observed to be at statistically significantly higher mortality risk for just infections and parasitic diseases (P-value < 0.05) when compared to NHW men.
Sudden and unexplained death in sleep (SUDS) is a leading cause of death of young men in several Asian populations, but the history and epidemiology of SUDS are not well known.
Autopsy records were reviewed in Manila in a study of the classification of SUDS. Death certificates filed in Manila during 1948-1982 were then reviewed in a study of SUDS incidence. A nested case-control study of death certificates examined birthplace as an indicator of SUDS risk.
The classification of SUDS cases in Manila during 1948-1982 (N = 722) evolved from the folk term, bangungut ('to rise and moan during sleep'), to various descriptions of post-mortem artefacts. The characteristics of victims in each of the groups were similar: 96% male, mean age 33 years, and modal time of death 3:00 a.m. The deaths were seasonal, peaking in December-January. SUDS victims were more likely than deceased controls to have been born outside of the Manila region (relative odds = 2.11; 95% CI: 1.59-2.78). The SUDS rate for men aged 25-44 years increased from 10.8 to 26.3 per 100000 person-years from 1948 to 1982.
The death certificate classification of SUDS in Manila has changed considerably, obscuring an increase in incidence. SUDS appears to be a regional phenomenon in Southeast Asia and environmental causes are likely because the deaths are seasonal, increased over the timespan studied, and are more common among migrants to Manila than among those born there.
A State refugee screening programme in Victoria.
To determine the longitudinal incidence of tuberculosis (TB) in South-East Asian refugees in the first five years after re-settlement, and to determine predictors of risk.
A retrospective cohort study of 1101 refugees from Laos, Cambodia and Vietnam screened for TB after arrival in Australia, in the 6-month period from July 1989 to January 1990. Incident cases of TB were identified by matching the refugee database with the TB notification database for 1989-1994, giving five years of follow-up data. Preventability was assessed for incident cases by reviewing medical records.
The development of active tuberculosis in the first five years after re-settlement.
The incidence of active TB was 363/100000 during the first year after re-settlement, and 109/100000/year during the first five years. There were no incident cases of TB in refugees with initial skin test reactions <10 mm. Skin test reaction size was the only predictor of risk of TB.
There is a high risk of tuberculosis in South-East Asian refugees, particularly in the first year after re-settlement. This risk decreases with time. Migration stress, concurrent illnesses and poor nutrition may be explanations for this observation. Refugees are at high risk for TB, even after pre- and post-migration screening, emphasising the importance of preventive therapy and follow up in this group.
Given the widely acknowledged inverse relationship between birth weight and blood pressure, a raised blood pressure in the offspring of smoking mothers as compared to those whose mothers did not smoke, would be anticipated by virtue of the reduction in birth weight associated with smoking during pregnancy. The objective of the present study was to test the hypothesis that maternal cigarette smoking during pregnancy has an effect on blood pressure in childhood independent of its effect on birth weight. Data was obtained from a prospective cohort study of 1708 pregnant women and their singleton offspring, delivered live at term, in Perth, Western Australia, commenced at 16 weeks gestation with serial blood pressure measurements through early childhood. Statistically significant associations were found between maternal smoking during pregnancy and systolic blood pressure at age six, between birth weight and systolic blood pressure at ages three and six, and between maternal smoking during pregnancy and birth weight. The relationship between birth weight and blood pressure in early childhood differed significantly on the basis of maternal cigarette smoking or not during pregnancy. This differential relationship persisted after adjustment for the child's current weight and socio-economic status. We concluded that intra-uterine exposure to maternal cigarette smoking increased children's blood pressure at age one through to age six. This was not wholly attributable to an effect on birth weight or confounding of the association between birth weight and subsequent blood pressure by the child's current weight or socio-economic factors. Furthermore, maternal smoking during pregnancy does not account for the acknowledged elevation in blood pressure associated with low birth weight. The present study is an exploration of a possible causal pathway underlying the birth weight/blood pressure association rather than simply a confirmation of such an association which has been detailed in many other papers.
The use of multiple-drug prophylaxis for tuberculosis (TB) has not been shown to be more effective than prophylaxis with isoniazid alone. The boundary between inactive pulmonary TB (class 4 TB) and culture-negative "active" pulmonary TB (class 3 TB) is often unclear, as is the intention to treat such patients as a preventive measure or as a curative measure.
We compared the effectiveness of single drug preventive therapy with isoniazid to the effectiveness of multiple drug preventive therapy for patients with asymptomatic, inactive TB, in a retrospective cohort study of 984 Southeast (SE) Asian migrants and refugees who received prophylaxis between 1978 and 1980.
The rate of TB developing in this cohort was 122 per 100,000 person-years. There was no significant difference in development of TB between people who received isoniazid only and those who received multiple drugs. The only significant predictor of TB was noncompletion of prophylaxis [relative risk (RR) = 62, 95% confidence interval (CI) = 20-194]. Subgroup analysis on people who had completed therapy showed noncompliance as a significant predictor of TB (RR = 16, 95% CI = 1.4-179). The risk of noncompletion (RR = 4.7, 95% CI = 2.37-9.39, P < 0.0001) and noncompliance (RR = 2.2, 95% CI = 1.03-4.7, P = 0.03) was higher for patients who received multiple drugs compared with isoniazid alone. Multiple-drug therapy cost 30 times more than isoniazid alone.
We did not find evidence in support of the empirical practice of giving multiple drugs for prevention of TB. This practice is also more costly and more likely to result in noncompliance and adverse drug reactions.
Asian Americans are one of the fastest growing groups in the United States. A majority of them are foreign born, which makes
their health-related situation very complex. Many still have the diseases they brought with them from their native lands.
In addition, they acquire new diseases attributed to the changes in their living conditions and lifestyle. They are vulnerable
to the physical effects of acculturation-related stress as well. The health care needs of these new Americans are not being
adequately met. This article describes the barriers to their ability to use health care services and analyzes the reasons
for the health care system's inability to respond to their needs. Finally, it urges social work to contribute to the system's
responsiveness and suggests approaches to social work intervention with and on behalf of Asian Americans.
We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy.
Healing is the alleviation of sickness, which includes both medically defined problems of pathophysiology (disease) and personal definitions of not being well (illness). Refugees from Southeast Asia now have a special need for healing because their health problems are changing from those of concern to public health, which are well documented and for which there are known effective treatments, to those that are primarily a personal concern and that are difficult to diagnose and treat effectively because of their chronic nature and their cultural and emotional components. The finding among refugees of physical complaints for which there is no identifiable medical cause is explained by cultural tendencies in Southeast Asia that promote focusing on somatic symptomatology, and by a delayed somatic response to refugee trauma. To prevent escalation of medical intervention, physicians need to be sensitive to Southeast Asians' attitudes toward health and their expectations and apprehensions regarding Western medicine.
Recent life-change data were gathered from 279 survivors of documented myocardial infarctions and from 226 cases of abrupt coronary death in Helsinki. In nearly half of the infarction cases, recent lifechange data were also collected through a separate interview of spouses. Spouses provided the life-change data for all coronarydeath victims. In all but one group of subjects, marked elevations in magnitude of life changes during the six months immediately prior to infarction or death were seen, compared to the same time interval one year earlier. This elevation was particularly apparent for sudden-death victims. Women showed recent increases similar to those of men. Spouses agreed moderately well with survivors of myocardial infarction as to survivors' recent life-change data during the preceding year.
Sudden Unexpected Nocturnal Death Syndrome has been regarded as having an exclusively pathophysiological etiology. A focus on factors affecting Hmong refugees in the United States, such as traditional belief, gender roles, and the impact of war, migration, and rapid acculturation, reveals the event that may provoke the fatal syndrome. A supranormal nocturnal experience, traditionally known as the "nightmare" and familiar to the Hmong, appears to act as a trigger for the fatal disorder.
Sudden death during sleep has occurred among previously healthy Southeast Asian male refugees, but routine autopsies have not determined the cause of death in any of these cases. We report the first systematic attempt to define the cardiac abnormalities associated with this syndrome. Among 18 hearts examined, 14 showed slight to significant cardiomegaly, characteristic of increased cardiac work load. The reasons for the cardiomegaly remain unexplained. Conduction system anomalies were present in all but one heart. These included persistent fetal dispersion of the atrioventricular node and/or bundle of His, present in 14 hearts; accessory conduction fiber connections, found in 13 cases; and congenital heart block, observed in one case. These abnormalities were associated with variations in the structure of the cardiac base, suggesting a common aberrant developmental process. Although the functional significance of these findings has not been established, the conduction system anomalies may be the substrate for sleep-related cardiac arrhythmias and sudden death.
(JAMA 1986;256:2700-2705)
Fifteen Hmong refugees with major depression were compared with 15 Hmong controls matched for gender, age, marital status, and rural-urban origins from the same population. Relatively few premigration factors were correlated with patient status, although social attributes with continuity from Asia to the US inveighed against depression. Numerous postmigration factors were strongly associated with patient status. Some of these latter were probably causative (e. g., sponsor characteristics), some probably resulted from stressful conditions (e. g., residence change), and some probably acted as both cause and effect (e. g., marital and health problems). As measured by self rating scales, the patients expressed considerably higher symptom levels prior to seeking treatment as compared to controls. Two years later at the time of follow up, the former patients reported fewer depressive symptoms than the controls. These findings are assessed in light of the diachronic studies of major depression and of depressive symptoms in the general population.
This paper describes a syndrome of psychological and physical symptoms involving body paralysis and hallucinations traditionally interpreted in Newfoundland as an attack of 'Old Hag'. Folk theories of cause and treatment are outlined based on 13 months of field research in a community on the northeast coast of Newfoundland. Data derived from the responses of 69 adults to the Cornell Medical Index (CMI) indicate that there are no significant differences in psychological or physical illness complaints between adults who have experienced the Old Hag and adults who have not had this experience. The striking similarity between the Old Hag experience and a clinical condition called sleep paralysis is analyzed, and the implications of viewing the Old Hag as sleep paralysis are discussed within the context of current theoretical issues in transcultural psychiatry.
Psychological stress has been reported to be a risk factor for sudden cardiac death in individuals both with and without underlying structural heart disease. From a group of 80 patients presenting with life-threatening ventricular tachyarrhythmia, six were identified without underlying structural heart disease. Five of these six patients experienced marked psychological stress. Each of these five patients underwent arrhythmia evaluation, demonstrating recurrent rapid monomorphic ventricular tachycardia related to changes in tone of the sympathetic nervous system. Subsequently, solitary beta-adrenergic blocker therapy was given to each patient. During therapy, four of the five patients had a marked reduction of both arrhythmia and symptoms during a follow-up ranging from 29 to 49 (mean, 38) months.
A syndrome of sudden and unexpected death during sleep occurs among adult Southeast Asian refugees in the United States. Surveillance for sudden deaths was conducted among Laotian-Hmong refugees in the Ban Vinai refugee camp in northeastern Thailand to determine if a similar cause of death occurs there. Sixteen sudden and unexpected deaths associated with sleep were found that were similar to the sudden deaths noted among Southeast Asian refugees in the United States. A case-control study in Ban Vinai revealed associations between sudden death in sleep and membership in the Green-Hmong subgroup, a family history of sudden death, and previous non-fatal sleep disturbances. Sudden and unexpected death during sleep of young adults is a regional phenomenon within Asia and occurs in populations that are culturally and genetically distinct. Migrants from affected populations in Asia carry with them the susceptibility to sudden death in sleep.
Scientifically valid, well controlled studies on the prevention of mental disorders are sparse. Nonetheless, much quasi-experimental and descriptive work does exist. Published findings permit an evaluation of the mental health effects of policies, procedures and programs designed for refugees. The federal government assigns legal status to refugees and is paramount in matters of refugee relocation and readjustment within its borders. In matters of social adjustment and prevention of mental disorder, agents of the federal government must consider the accumulation and distribution of knowledge, skill and expertise on refugee social and mental health issues; policies and procedures for relocation; premigration education, training, assessment, and orientation; postmigration support and acculturation; and the development of treatment resources to meet the mental health needs. Once refugees arrive in the United States of America, much of the actual implementation of policy and procedures has been left to state governments. At this level there have been neither the resources nor the expertise to develop programs for the mental health of refugees. Limited resources have been wasted and the mental health of refugees has been neglected or made worse by some state initiated programs.
Sudden death during sleep has occurred among previously healthy Southeast Asian male refugees, but routine autopsies have not determined the cause of death in any of these cases. We report the first systematic attempt to define the cardiac abnormalities associated with this syndrome. Among 18 hearts examined, 14 showed slight to significant cardiomegaly, characteristic of increased cardiac work load. The reasons for the cardiomegaly remain unexplained. Conduction system anomalies were present in all but one heart. These included persistent fetal dispersion of the atrioventricular node and/or bundle of His, present in 14 hearts; accessory conduction fiber connections, found in 13 cases; and congenital heart block, observed in one case. These abnormalities were associated with variations in the structure of the cardiac base, suggesting a common aberrant developmental process. Although the functional significance of these findings has not been established, the conduction system anomalies may be the substrate for sleep-related cardiac arrhythmias and sudden death.
A psychologically stressful environment reduced the threshold of the dog's ventricle for repetitive response. Elicitation of such a response indicates the presence of electrical instability and a predisposition to ventricular fibrillation, the mechanism of sudden death.
Recent life-change data were gathered from 279 survivors of documented myocardial infarctions and from 226 cases of abrupt coronary death in Helsinki. In nearly half of the infarction cases, recent lifechange data were also collected through a separate interview of spouses. Spouses provided the life-change data for all coronarydeath victims. In all but one group of subjects, marked elevations in magnitude of life changes during the six months immediately prior to infarction or death were seen, compared to the same time interval one year earlier. This elevation was particularly apparent for sudden-death victims. Women showed recent increases similar to those of men. Spouses agreed moderately well with survivors of myocardial infarction as to survivors' recent life-change data during the preceding year.
Meaningful information was available on 26 patients who died suddenly in a 44,000 industrial population. The data, past illnesses, prodromal symptoms, and psychosocial information were obtained from the plant medical records, the private physicians, and mainly from direct interviews with the surviving next-of-kin, usually the wife. The data suggest that the majority of these patients, all men, had been depressed for a week up to several months. The sudden death then occurred in a setting of acute arousal engendered by increased work and activity or circumstances precipitating reactions of anxiety or anger. The findings suggest that the combination of depressive and arousal psychological states or abrupt transition from one such state to another may produce disharmonious responses in the hormonal and autonomic nervous systems, as well as central nervous system mediated behavior, which are conducive to the sudden death.
In the period July 15, 1977, through March 30, 1982, there were at least 51 sudden, unexplained deaths in the United States among refugees from Southeast Asia. These deaths involved relatively young (median age, 33 years), previously healthy persons. All except one were male, and all died at night. Available data from studies among young adults in this country suggest that this specific phenomenon has an unusually high incidence among Laotian and Kampuchean refugees and, furthermore, has not previously been observed in the United States. Interviews with families of the decedents and a case-control study have failed to establish causal factors, but emotional stress cannot be ruled out as a contributing element. While reviews of the forensic investigations have confirmed the absence of important common pathological or toxicological findings, preliminary findings of special postmortem cardiac studies, now in progress, suggest that at least some of these deaths may be associated with developmentally abnormal conduction system pathways. Further studies are required to confirm this association, to define the apparently sleep-induced mechanism that triggers these deaths, and to explain the male preponderance in this disorder.
Young, male, Southeast Asian immigrants living in the United States have a high incidence of unexplained, sudden, nocturnal death. We report the cases of three patients, two Laotians and one Filipino, who were resuscitated and subsequently studied extensively. Each patient was having ventricular fibrillation when first examined by paramedics outside the hospital, and episodes of fibrillation recurred in the early hospital course. Clinical evaluation found no significant coronary atherosclerosis or structural cardiac disease. One patient is asymptomatic after 2 years; the second patient died suddenly at 4 months; and the third is asymptomatic but had inducible ventricular tachycardia on electrophysiologic testing 6 months after resuscitation. The mechanism of sudden death in young Southeast Asian men appears to be ventricular fibrillation. The cause of the arrhythmia is unclear, although in our patients the arrhythmia was not an isolated event; underlying predispositions to further cardiac arrest persisted.
The Nightmare: The Psychology and Biology of Terrifying Dreams. Basic Books
- E Hartmann
Hartmann E. The Nightmare: The Psychology and
Biology of Terrifying Dreams. Basic Books, New York,
1984.
The American Medical Association Guide to Better Sleep. Random House
- W C Dement
- S H Frazier
- E D Weizman
Dement W. C., Frazier S. H. and Weizman E. D. The
American Medical Association Guide to Better Sleep.
Random House, New York, 1984.
Narcolepsy and hypersomnia. In Sleep: Physiology and Pathology (Edited by Kales A.), pp. 119-130
- Rechtschaffen A Dement
Rechtschaffen A. and Dement W. C. Narcolepsy and hypersomnia. In Sleep: Physiology and Pathology (Edited by Kales A.), pp. 119-130. J. B. Lippincott, PA, 1969.
More cities report death syndrome. St Hmong Sudden Unexpected Nocturnal Death Syndrome: A Cultural Study
- H G Bissinger
Bissinger H. G. More cities report death syndrome.
St. Paul Pioneer Press 6 February, Fl, 4, 1981.
Bhatout B. T. Hmong Sudden Unexpected Nocturnal
Death Syndrome: A Cultural Study. Sparkle Publishing,
OR, 1982.
Sleep Disorders: Insomnia and Narcolepsy. Brunner/Mazel
- H Kellerman
Kellerman H. Sleep Disorders: Insomnia and Narcolepsy.
Brunner/Mazel, New York, 1981.
Dab Neeg I?mooh: Mylhs, Legend,s, and Folktales from the Hmonp of Laos
- C Johnson
Johnson C. Dab Neeg I?mooh: Mylhs, Legend,s, and
Folktales from the Hmonp of Laos. Macalester College.
Spirits, shamans, and nightmare death: survivor stress in a Hmong refugee
- Tobin
Tobin J. J. and Friedman J. Spirits, shamans, and
nightmare death: survivor stress in a Hmong refugee.
Am. J. Orthopsychiat. 53, 439, 1983.
Refugees from Laos: In Harm's Wq
- J Cerquone
Cerquone J. Refugees from Laos: In Harm's Wq. U.S.
Committee for Refugees, Washington, DC, 1986.
Belief as oathoeen. belief as medicine: " voodoo death " and the " 'plac;bo phenomenon
- R A Hahn
- A Kleinman
Hahn R. A. and Kleinman A. Belief as oathoeen.
belief as medicine: " voodoo death " and the " 'plac;bo
phenomenon " in anthropological perspective. Med.
Hmong: History qf a People
- K Quincy
Quincy K. Hmong: History qf a People. East Washington University Press, Cheney, 1988.
- A Rechtschaffen
- W C Dement
- Hypersomnia Narcolepsy
Rechtschaffen A. and Dement W. C. Narcolepsy
and Hypersomnia. In Sleep: Physiology and Pathology
(Edited by Kales A.), pp. 119-130. J. B. Lippincott, PA,
1969.
Hmong deaths Rejiigee Health Issues Quarterly. Update: sudden unexplained death syndrome among southeast Asian refugees. 4, I
- R G Munger
- M G Hurlich
Munger R. G. and Hurlich M. G. Hmong deaths.
Science 213, 952, 1981.
Rejiigee Health Issues Quarterly. Update: sudden
unexplained death syndrome among southeast Asian
refugees. 4, I, 1989.
Inclusionism versus reductionism in the study of culture-bound syndromes
- Hufford
Hufford D. J. Inclusionism versus reductionism in
the study of culture-bound syndromes. Culture, Med.
Psychiat. 12, 503, 1988.