Presentation to the California Public Health Association-North
October 23, 1997
by Afton Hirohama
Director of Communications and Development
National Asian Women's Health Organization
Good Afternoon. My name is Afton Hirohama, and I am the Director of Communications and Development at the National Asian Women's Health Organization, (NAWHO).
NAWHO is a non-profit health advocacy organization that has significantly changed the health and well-being of the Asian American community since its founding in 1993. NAWHO empowers Asian women and girls through a framework that reflects common denominators and differences within Asian American communities, and ensures equal and adequate access to health care and life advancement opportunities. Through our public education, leadership development, and public policy campaigns, NAWHO is working to improve the quality of life for Asian American women and girls in California and across the country.
Today I am going to talk about what NAWHO has learned in our Southeast Asian Women's Reproductive Health Empowerment Project. In 1995, NAWHO began its work with immigrant and refugee Vietnamese women in Alameda County to address the serious health needs of this community. With a bilingual project coordinator, we conducted focus groups and interviews with Vietnamese American women and men, and community health care professionals to assess reproductive health needs and barriers to accessing health services. This was to provide a foundation for later education and skills-building sessions with additional women from the community.
According to the 1990 US Census, there are approximately 615,000 Vietnamese living in the United States, with nearly half residing in California. The Census also identified 27.5% of Vietnamese Americans as living below the federal poverty level. Another 1987 survey of 2,800 Southeast Asians conducted by the California State Department of Mental Health revealed that 95% of Southeast Asians required psychological help, compared to 33% of the general population. Many Vietnamese women have experienced serious health problems as a result of physical trauma, inadequate health care in Asia, and low socioeconomic status here in the United States.
This population like many other Asian immigrants, greatly under-utilizes the American health care system. The Southeast Asian community faces tremendous challenges to receiving health and social services because of linguistic and cultural differences. In particular, Vietnamese women face many obstacles, as they are often responsible for the entire family's well-being, including economic management of the household. In the process of providing care for other family members, their own needs are often overlooked.
Recent immigration, poor English-language ability, and social isolation from mainstream society such as unfamiliarity with its cultural symbols and practices, affect women's ability to access health care and information about health. Among Vietnamese Americans, there are common traditional health beliefs and practices which differ greatly from those of the mainstream culture in the US. Health and social service professionals are often unaware of these differing value systems.
For example, many Vietnamese believe that good health is based on an equilibrium of hot and cold elements in the body. Vietnamese women believe that a great deal of body heat is lost during the delivery process; therefore, in order to reestablish equilibrium, they avoid cold food and drinks after delivery. Many health practitioners, unaware of this belief system, provide ice water for mothers during the postpartum period. Due to language barriers and/or cultural values concerning the authority of the doctor, Vietnamese women often will not drink the water offered to them and will not request warm water, which is vital to restoring fluids lost during delivery. Misunderstandings such as these, combined with the difficulty of navigating the American health care system, often influence Southeast Asian women to avoid health and social services until absolutely necessary.
Another example of these differences is the use of herbal medicine and assorted vegetable ingredients, which are often combined to alleviate illness and restore strength and vigor. Medicinal herbs, barks and roots have a special traditional significance for many Vietnamese. Some Vietnamese believe that Western medicines are too potent and severe, as compared to traditional prescriptions which they feel are more gentle and able to retain their effectiveness for longer periods of time. In Vietnam, where Western medicines are often scarce and expensive, traditional medicine is given official government sanction and is taught as part of the medical school curriculum. In the United States, many Vietnamese tend to continue to seek doctors who practice traditional medicine before they will seek a Western doctor when experiencing health problems.
Recently, a Commonwealth Fund report showed that Asian American women are the least likely to access clinical preventive health services, especially cancer screening and early detection. Vietnamese American women have the highest cervical cancer incidence rate in the country at 43 per 100,000, more than twice the rate of the second leading racial group. Studies have shown they are unfamiliar with the purpose and procedure of the pap test, demonstrating a need for better education targeted to this community. Vietnamese patients are also reluctant to ask for breast cancer screening services, because of feelings of shame and modesty. Research at the University of California, San Francisco, has shown that Vietnamese women in California are only half as likely as women in the general population to have had cervical or breast cancer screening tests. Additionally, Vietnamese women in the US are more likely to be diagnosed with late stage breast and cervical cancer than white women.
Health care professionals serving the Vietnamese community in the US, particularly if their ethnicity differs from that of their patient, should strive to understand and respect these cultural beliefs and practices of their patients. This sensitivity would facilitate the communication needed for effective provider/ patient relationships.
For example, verbal or facial responses may contradict true feelings. This may occur when a patient does not want 'to lose face' (meaning lose his/her good reputation or good standing), or conflict with the health care professional. To avoid confrontation or disrespect, disagreement, frustration, or even anger are not directly expressed. In another example, health care providers have found that many Vietnamese have been reluctant to have their blood withdrawn for testing purposes. This fear of having a blood test can be attributed to several reasons. First, there is no tradition of blood drawing for medicinal purposes in Vietnam. In addition, blood is viewed as a vital element of the body, and many Vietnamese question the value of having blood drawn out of their bodies, feeling that this must have a negative and weakening effect. In particular, pregnant Vietnamese women have expressed concern about blood tests.
On the issue of reproductive health, sexually transmitted diseases are very difficult to talk about, making it extremely difficult to provide Vietnamese women with the information necessary to protect and treat themselves. Sexual shame and modesty may influence women to underestimate their sexual and reproductive health risks or to under-utilized- preventive health care services. Recently, NAWHO examined contraceptive use and sexually activity among 674 Asian American women in six California counties. Of the 42 Vietnamese respondents aged 18-35, 51% said they had not seen a health care provider for reproductive and/or sexual health needs within the last 12 months, 24% had 1 visit, 12% had two and 12% had three or more.
Through our Project, NAWHO has strived to empower Vietnamese women by providing them with health information and education through group training sessions. These sessions focused on nutrition, pre-natal care, cancer, reproductive health, and family planning. These sessions were well attended, and it's important to note that when these women participated in the sessions, and especially in the focus groups, they were very active in asking questions, and expressing their concerns. Replicating that kind of environment and comfort for communication is key to improving their access to health care.
In the course of our work on Asian women's health, NAWHO has made recommendations in its work to facilitate better relationships between providers and patients. I would like to give you just a few.
Health care providers must be aware of the concerns mentioned, and take care to explain the purpose and effects of various medical tests to Southeast Asian patients without making assumptions about their health knowledge, beliefs, or practices. Health care providers should inquire about what traditional medicines their patients have been using, in order to ensure that there is no conflict between those medicines and any medicine prescribed by the provider. The health provider should also take care to acknowledge the patient's traditional health practices, to talk about what to expect from western medicines, and to develop a relationship of mutual trust and patience in treatment.
In addition, since awareness of medical prescriptions and actual knowledge of their mechanism of action, availability, side effects, etc. are not always correlated, we encourage health care providers and health educators to identify effective strategies to ensure that clients are fully informed and can demonstrate their understanding. More attention must be paid to developing clear, accessible information and culturally sensitive counseling on clinical procedures.
As California grows more diverse, health care must grow along with it, improving its services in a manner that will in actuality benefit all populations. NAWHO's role has been to draw attention to the serious and unique barriers that keep Asian women from accessing health services, to educate others, and to advocate for an improved delivery of care that involves Asian women at all levels.
We believe our work in health care does not just impact Asian women, although they are at the core of our mission. we believe that what we advocate for - high quality services, sensitive and competent care, complete and digestible information, will inevitably improve the quality of life for all women and their families.
Thank you.
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