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Health Communities Conference – November, 2002 1Hmong Shamanism and Hmong Health Care Choices

At http:// www.crosshealth.com/Hmong%20Shamanism.doc

INTRODUCTION

I. The story of How sickness came to earth – with qeej music

Before the earth began, a man and a woman, who were brother and sister, lived

in the sky. Their first children were a boy, Lu Tu and a girl, Gao Tse, who learned how

to make music and dance. Then the man and the woman had other children. There were

two boys: Teng Chu, the older, held up the sky; and Lolo Chu, the younger, who caused

lightning and rain. Their last child was an egg. The man and the woman waited three

years for the egg to hatch, but nothing happened. So they broke open the egg to see what

was inside. Many, many people came from the egg, and they spread out over the earth.

There were so many people that they had to be given last names.

The man who lived in the sky looked at all of his children and said, “We have

made many people to live on the earth; we have children who make music and dance and

children who support the sky and bring lightning and rain. We have done enough.”

Then the man and his sister died and went to earth to be human. He took the name Mon

Yalu.

Later, Lolo Chu’s wife had children and they were also eggs. They waited nine

years, but the eggs did not hatch. Lolo Chu sent a message to earth to ask his father

what to do. Mon Yalu returned to heaven and looked at the eggs. “Before I was born on

earth, he said, “your mother gave birth to eggs, and there were people inside. These

eggs do not have people inside, they are filled with evil spirits that will make people sick

and die. To save the people of earth, you should burn these eggs.”

http://www.crosshealth.com/Hmong%20Shamanism.doc


Lolo Chu said, ”These eggs are my children; they are like my heart; I will keep

them.” Mon Yalu went back to earth and, one year later, the eggs hatched. The evil

spirits came out of the eggs and chased Lolo Chu and his wife all over heaven, trying to

eat them. His wife could not escape and she was eaten, but Lolo Chu flew away to earth

and was saved. “ I cannot have this,” said Lolo Chu; “I will make a hole in the sky so

the spirits will go to earth and leave me alone.” Lolo Chu cut a hole in the sky, the evil

spirits went to earth and people got sick and died for the first time.

To help the people, Gao Tse went to earth and taught them ua neeb (pronounced“wa

neng”) (doing shamanism), so they could heal sickness. Lu Tu taught people to sing and

play instruments at the funerals of those who died. (“How sickness came to earth” Vim li

cas mob thiaj los rau ntiaj teb, from Living Tapestries [Folk Tales of the Hmong].)

This presentation shares insights regarding the importance of interviewing for the

meaning, beliefs and interpretations which patients and their families bring to the

experience of symptoms. The method incorporates both traditional stories and

commentaries shared by the broad Hmong community as well as interviews with eleven

Hmong shamans (traditional healers, five males, six females, ranging in age from thirty-

five to eighty-five) and thirty-two community-referred Hmong patients (fourteen males,

eighteen females ranging in age from twenty one to eighty-five). This inquiry was led by

Creative Theatre Unlimited, St. Paul, MN, an organization with a twenty year history of

work in the Hmong community. In a collaborative effort researchers were brought

together from the University of Minnesota’s Center for Spirituality and Healing, The

Hmong Circle of Peace (St. Paul, MN), UCare Minnesota (Minneapolis, MN), Boston


University School of Medicine, and the Park Ridge Center for the Study of Health, Faith

and Ethics (Chicago, IL).

I. America is blessed with the presence of Hmong people who were fortunate to

escape Laos after the Vietnam War. The twin cities of Minneapolis and St. Paul, MN,

with its Caucasian population of north European descent, are now home to an estimated

60,000 Hmong. Their presence in Minnesota has gifted the medical community with

innumerable insights into efficient, effective and empathy care for all people.

WESTERN BIOMEDICINE AS “ALTERNATIVE TREATMENT”

With the influx of immigrants and refugees from around the world over the past 30

years, health professionals increasingly recognize that for many, Western biomedicine is

considered “alternative medicine.” Physicians, nurses and others struggle with challenges

raised to conventional beliefs about health, disease, treatment and the relationship

between healers, patients and families. Ethicists are also increasingly cognizant that

normative autonomy-based bioethical reasoning is not shared universally. These trends

are directing health professional educators to provide proactive preparation for cross-

cultural care and communication.

One such effort is the inclusion of Anne Fadiman’s, The Spirit Catches You and You

Fall Down in required healthcare professional curricula. This award winning non-fiction

book depicts the unfortunate consequences of well-meaning, scientifically competent

physicians who discount the importance of cultural difference. While the subjects are

Hmong from Southeast Asia, the message is universal: culture is something you work

with, not a problem to be subdued.2 However, there is an additional crucial message

regarding cultural competence. If well-meaning health professionals believe, after


reading the book, that they now “know” the Hmong, they may unwittingly participate in

patient harm. Cultural humility, not cultural competence, should be the goal.

II. The story of Shee Yee

Shee Yee (Siv Yis) was a special healer sent by god to live with the Hmong people in the

cave near [a mountain in southwest China]. His mission was to provide medical cures for

all the people. He married a Hmong woman...[but later] abandoned his people and

traveled alone in Mongolia.... [An] orphan boy wandered the north for years until he

found Shee Yee [who] was moved by the orphan boy's determination to find him. Shee

Yee taught the orphan boy everything he knew. The orphan boy returned to his people

and taught the elders what he had learned.... This created a tradition of shaman, earth

medicines and magic that is still practiced to this day. [Source: This legend is part of

Hmong oral tradition. It is known by everyone and has no real source other than the

combined cultural memory of the Hmong people.] The foremost Hmong traditional healer

is the shaman. There is no equivalent health professional in Western biomedicine: the

power of the shaman as a healer goes beyond the capacities and expertise of physicians.

Being "chosen" (yuav ua neeb) is the first step in becoming a shaman, and this is

generally precipitated by an unusual illness. Both men and women, even children, can be

"chosen." One interviewee describes it as follows:

When I was twelve years old, I began to experience some body shaking and felt

something awaking me. ... I was very ill and passed away for seven days and seven

nights. My family thought I was going to die. They tried everything to help me, until they

invited a shaman to look into my illness. Immediately, the shaman informed my family


that I [was] chosen to become a shaman. The shaman called my soul and performed the

shaman ceremony. During the ceremony, my body was shaking and felt the emotional

movement.

Once a person has been "chosen" to be a shaman, their "treatment training" is provided

almost entirely from the spirit world. Another shaman might help guide them in

determining external details of their practice (i.e. tools needed [see glossary], altar set-up

[teeb thaj neeb] etc.) but they do not provide "training" or "education" in any of the skills

needed to be a shaman healer; that information is provided by the spirits.

There is no indication that training, education, learning or attempts to gain the right

amount of knowledge in order to achieve a level of power are part of Hmong shaman

traditions. Some shamans specialize in the very illness that afflicted them when they were

chosen and will only treat people with similar ailments. Others may be referred to as

"generalists" and treat more common spiritual causes of illness. It is also the case that a

shaman must first be able to treat his/her own family in order to take on the role of

community healer.

The Professional Practice

The act of being "chosen" requires that the person make a life-long commitment to being

a healer. This includes the responsibility to be open and accessible to the entire

community, it often involves certain diet restrictions, ritual regimens and it can be quite

dangerous. Unlike physicians, Hmong shamans do not provide a physical diagnosis of the

people they help. Rather, they try to determine the "soul status" (ua neeb saib) of the


person through their entrance into the spirit world to confront the spirit(s) causing the

illness.

The goal of the shaman's confrontation is not to overcome or defeat the spirits that have

taken the soul. They engage in negotiation (puaj dab) for the person's soul. This might

involve offering gifts such as spirit money (ntawv nyiaj) and/or the souls of animals in

exchange for the soul of the sick person. Negotiation with the spirits often requires

outsmarting the spirit and tricking it into giving up the person's soul. There is great risk

involved in this engagement and stories are told of shamans who have died because the

spirits they were negotiating with were too powerful for them and took their souls.

We are there to rescue the victim. In order to communicate with the spirit, we have to use

their language. Our purpose is to have a good understanding of each other and a mutual

respect of one another. Also, we are there to make peace between good and evil.

When a family approaches a shaman and asks if they can help the ill person, the shaman

takes several steps to determine if they will be able to assist them. They never charge for

their services. This is not to say there are no costs involved for the family of the ill

person. There may be need to provide an animal for sacrifice. Incense (xyab) must be

burned; spirit money provided, a temporary altar built, etc. Families may choose to

reward the shaman in some way for a successful soul retrieval.

III. [CHARLES] THE IMPORTANCE OF STORIES


Awareness of the "back story" healing expectations that patients may have appears to

be an important adjunct to biomedical knowledge. The stories of any culture are valuable

in providing health practitioners in any setting with important insights into world-views,

expectations and desires of patient. In 1985, Creative Theatre Unlimited published Living

Tapestries (Folk Tales of the Hmong). This book was one of the first English language

collections of the stories of these Southeast Asian refugees who were beginning to settle

in this country following their disastrous assistance efforts for the United States military

in Vietnam. This ancient culture has never had its own written language and the

gathering, translation and publication of stories was just one attempt to preserve and

promote this rich tradition. The following story from that volume illustrates the spiritual

nature of the Hmong world-view.

THE STORY OF TUAM LOS PEJ AND XYUAM LIS KOO

“A young boy named Tuam Los Pej and a young girl named Xyuam Lis Koo

lived in the same village and walked to school together every day. One day as

they were walking home, they saw two birds in a tree talking to each other…and

two chickens talking to each other. Xyuam Lis Koo asked, ‘Do you know what

they are saying?’ The boy listened and then made the sounds of birds and

chickens. The girl said, ‘You do not understand them….’”

“Xyuam Lis Koo knew that she was to marry someone else that night and never

see Tuam Los Pej again. She said to him, ‘You do not understand the birds or the

chickens, and you will not understand what I say to you. When you do, it will be

too late, and you will be sad. Goodbye.’”


“The next day, Xyuam Lis Koo was not at school. Tuam Los Pej went to her

house, and her mother told him that she had gone away to marry someone else.

Tuam Los Pej was very sad. He went to all the places they had been together and

cried: ‘You were right; I understand too late and I am sad. Now I will die for

love.’ Then Tuam Los Pej died.”

“When Xyuam Lis Koo heard this, she went to the boy’s grave where she cried

and cried. When her tears touched the ground, the grave opened up and she

jumped in. The grave closed up and she was gone. When her husband heard about

this, he went to the grave with his neighbors and told them to dig up the grave and

get his wife; but they dug, and found nothing. Xyuam Lis Koo’s husband went

home, very sad.”

“One of the neighbors went back to the grave to get his pipe. At the grave, he

heard voices, like two people talking. He ran back to the husband and told him to

dig up the grave again. Now Xyuam Lis Koo and Tuam Los Pej had turned into

two stones. The husband was very angry and put the two stones on opposite sides

of the river, so his wife could never be with Tuam Los Pej again.”

“The next day, the husband his friends went back to the river and found that the

two stones had changed into two large trees, their branches joined together over

the water. The husband was angry, cut the trees down and burned them, so his

wife could never be with Tuam Los Pej again. In the fire, Tuam Los Pej and


Xyuam Lis Koo changed into butterflies and flew up to heaven, where they are

with each other forever.”

CONSULTING THE SHAMAN

As much as this story may resemble a “happily-ever-after,” “true love will always

prevail” fairy tale, it is much more than that. Traditional Hmong view life as a cycle of

birth and re-birth, with the physical and spiritual worlds coexisting side-by-side. Every

person, animal, object has a spiritual element that survives independently and can directly

affect the physical world. The Hmong believe that a person has several souls; some

traditions say three others, as many as thirty. As seen in the story above, this belief

system affects every aspect of traditional Hmong life. More specifically, it is the basis for

Hmong healing traditions. A person’s souls and physical body must function

harmoniously as one unit for spiritual, mental, and physical health. When this

relationship is unbalanced, illness afflicts the individual. This condition is referred to as

(poob plig), “loss of soul,” clearly the cause of Tuam Los Pej’s death. This is a term that

has no clear meaning or corresponding treatment in Western medicine. As much as the

visions of the spirit world are part of the ancient oral tradition of the Hmong, spiritual

disease and healing are still important concepts in this immigrant community. The

shaman continues to play an important and powerful role in the interpretation of the

world and of personal lives, and represents a powerful health care professional for

referrals and collaborative care. The following patients’ descriptions of their illness

would certainly give any practitioner pause.


“The purpose for seeking a shaman is for when your spirit has departed …

because as a person you have a spirit that guides your body. Sometimes when you

are in a frightening situation, your spirit may depart from your body. Going to the

doctor may not work for that purpose. If there is a lot of pain, then seeking a

shaman would help, because the shaman may tell you that you lost your spirit.

The shaman may be able to perform the ceremony to call your spirit back to join

with your body. The healing ceremony may cure you and you would feel better.”

“If I go and seek a doctor for my lost spirit, the doctor may not know what to do

or how to detect my problem, because the doctor only gives me medication for

my illness and that may not be able to call my spirit back.”

As we recently reported elsewhere (Minnesota Medicine 85, no. 6 (2002): 29-34),

up to 75% of the people referred by community leaders, who volunteered to be

interviewed in our study, use shamans for spiritual healing on a regular basis. We cannot

claim that the same holds true of the entire community, but it is a significant enough

number to give clinical practitioners cause to pay attention to the spiritual needs of

Hmong patients they may see. Additionally, it seems only logical to take these facts into

account when serving any number of immigrant communities in clinical settings. In fact,

this reality goes beyond immigrants to other patients who might have moral, ethical or

spiritual reasons for accepting or rejecting certain medical treatments. It is only by asking

as many appropriate questions as necessary, and listening carefully, that practitioners can

find the appropriate path to effective healing. Hmong shamans recognize this need for

themselves as well as others.


“I wish for more study. I hope some day shamans and doctors can work together

to tackle patients’ problems. Shamans and doctors have much knowledge and

wisdom to offer to each other. They can learn from each other's techniques and

use some skills to assist patients better.”

We heard over and over from patients that the ability of care providers to listen was

high on their list of desirable traits.

“I think, the workers and doctors, the way they ask questions and listen to Hmong

explain their illness is very important, because the person may have many illnesses in

their body or may be stressed and want to inform a doctor and would like for him/her

to listen. Although the doctor may not consider it to be important, but the doctor

should try their best to listen to what we are saying and to see what is. Because

English is not our language and we may want to say a lot about our illness, we may

not be able to because of the language barrier. And if there is an interpreter, they may

only say one-third of what one really wants to say about their illness to the doctor

because there are many words in the Hmong language so it’s not very satisfying.

Therefore the trust for the doctor may not be there because there is no connection

therefore you cannot build that trust.”

In addition to the wide variety of healing stories gathered, the study reveals the innate

wisdom of the Hmong community in seeking out health care choices from a variety of

available sources.


III. CONCLUSION

Shamanism appears to be considered effective care by many Hmong, irrespective of age,

gender, or degree of acculturation. Many Hmong who see physicians also rely on

shamans for restoring health and balance to their body and soul.

Despite 25 years of Hmong acculturation and conversion to Christianity, Hmong

shamanism maintains its traditional role in health and healing.

The Hmong shaman may represent a powerful complementary health care professional.

The presentation includes an overview of Hmong healing terminology and practical

guidance for efficient, effective and satisfactory Hmong patient care.

Presenters:

Charles Numrich, Director of Creative Theatre Unlimited, developed the initial proposal for the study and was Project Coordinator. He is currently serving as Community –Based Faculty Member at The University of Minnesota’s Center for Spirituality and Healing.

Chu Yongyuan Wu is Facilitator of The Hmong Circle of Peace, St. Paul, MN and shamanism expert who served as Co-Principal Investigator and conducted most of the project interviews.

A Hmong shaman – Probably Nhia Yer Yang.

Web access to study information: http://www.csh.umn.edu/Research/topics/hmongchc.html


Recent publications, etc.

“Healing Together,” St. Paul Pioneer Press, March 12, 2000 “Among The Hmong,” The Bulletin of the Park Ridge Center, Chicago, IL “Hmong Shamanism in America; The Medicine Healer,” Presentation to the White

House Commission on Complementary and Alternative Medicine Policy, March, 2001

“Hmong Shamanism in The United States,” Proceedings of the Eighteenth Annual International conference on the Study of Shamanism and Alternative Modes of Healing, September 1-3, 2001

“Hmong Shamanism; Animist Spiritual Healing in Minnesota.” Minnesota Medicine, Volume 85, Number 6/June 2002; 29-34

“Giving the best care: Hmong shamanism and Western medicine,” The Kiosk, University of Minnesota, September, 2002

Plotikoff, G.A. Numrich, C.H. Wu, C.Y. Yang, D. Xiong, P. “Shamans and Conventional Care: Are We Prepared?” HEC Forum, An Interprofessional Journal on HealthCare Institutions’ Ethical and Legal Issues: Volume 14, No. 3/September 2002

“Hmong Wameng,” KFAI-FM, Minneapolis, October 1, 2002

Conference Presentations

Eighteenth Annual International conference on the Study of Shamanism and Alternative Modes of Healing, September, 2001

“Religious Healing in Urban America,” Harvard University, Sept, 2001; (Proceedings from this conference are being published by Oxford University Press)

The conference of The American Society of Bioethics and Humanities, Nashville, TN, October, 2001;

A special presentation for the employees of UCare, Minnesota, June 2002; “Theoretical Foundations and Experiential Learning in Complementary and

Alternative Therapies, July, 2002: “Healthy Communities: Embracing Cultures, Changing Systems” November 2002.

Upcoming Publications

Plotikoff, G.A. Numrich, C.H. Wu, C.Y. Yang, D. Xiong, P. ”Listening Skills: Gifts from the Hmong.” Journal of Clinical Ethics, (Due out late 2002)

Plotikoff, G.A. Numrich, C.H. Wu, C.Y. Yang, D. Xiong, P. “Hmong Shamanism in Minnesota” Religious Healing in Urban America, Oxford University Press, (Due out 2004)

Numrich, C.H. Wu, C.Y. “Hmong Shamans…Tricksters in pursuit of harmony” Shaman’s Drum, Winter, 2003

At - Trinity Health - Livonia, Michigan (MI) … Religious... · Web viewMany, many people came...

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