Under the knife: Medical “noncompliance” in Hmong immigrants
Author(s):
Hu, Jun
Format:
Thesis
Degree granted:
Ph.D.
Publisher:
Ann Arbor : Emory University, 2000.
Pages:
394
Language:
English
Abstract:
This dissertation is a medical and anthropological investigation of medical “noncompliance” in the Hmong immigrants following their resettlement in the U.S. since the Vietnam War. The research focused on the Hmong as a minority population whose cultural beliefs and healing practices are different from that of the biomedical models, and critically examined the concept of noncompliance, with the ultimate goal of developing practical solutions to improve healthcare for the minority populations. The research was conducted from September 1996 to August 1998 in Central California among the Hmong and medical communities. Extensive observations and interviews focused on the health behaviors, perceptions, and interactions between the Hmong and medical professionals. The ethnographic research was facilitated with chart reviews of patients who had appendicitis and videorecordings of medical encounters. The research findings indicate that “noncompliance” in the Hmong immigrants represents the condensations of the historical, social, cultural, political and economic problems of the Hmong, and their resistance against racism. The retrospective chart review compared healthcare for 118 Hmong patients and an equal number of Caucasian controls. Appendiceal perforation was significantly increased in the Hmong patients, 66%, as compared to 37% in the Caucasians (p < 0.001). This was associated with significant delays of the Hmong, 39 hours longer in seeking healthcare (p < 0.01), and relatively shorter delays of 2.35 hours to undergo surgery in the hospital (p < 0.01), than the Caucasians. The Hmong experienced more open abdominal appendectomies (40%), as compared to more laparoscopic appendectomies performed in the Caucasians (87%), contributing to longer hospital stay in the Hmong patients. The research led to the development of a five-stage typological theory of noncompliance, ranging from delayed medical care outside of the healthcare system, refusal to comply with medical therapy, to full-fledged conflict and physical threats to medical professionals. A “Minority Healthcare Model” (MHM) is developed to integrate health education in the community, incorporation of folk healing practitioners into the healthcare system, collaboration with community organizations, and recruitment of outreach healthcare workers. Nonetheless, medical “noncompliance” in the Hmong patients also challenged the present medical principles, which often turned out to be inaccurate, pointing to scientific reevaluation of the principles.