1. Hmong & Health Care by Linda Meehl

2. Father’s History He was sent to America in 1977 after being in a neglected refugee camp He did not speak, write, or understand English Suffered torture in Laos before leaving. Nervous around those with any authority- real or perceived.

3. The Son He was born in the United States Speaks, reads, writes & understands both languages

4. Case Story An 8-year old Hmong boy was hospitalized with a ruptured appendix. After surgery, the child complained of post-operative pain. The child's father requested an X-ray. An untrained interpreter communicated this request to the physician.

5. Case Story Continued The physician declined to order an X-ray and conveyed his rationale in a way the family perceived as disrespectful to the patient's father. The untrained interpreter became so emotionally involved that he and the physician exchanged angry words "eye to eye."

6. Barriers & Solutions / Suggestions # 1 Barrier: Not enough qualified interpreters–family / friends may omit / change information presented to patient Solutions / Suggestions: 1. Ensure that certified interpreters are available 2. Do not use family or friends of the patient

7. Barriers & Solutions / Suggestions # 2 Barrier: Provider and facility insensitivity to the linguistic needs of the Hmong patient sends a loud negative message to the ethnic communities about accessing health care Solution / Suggestion: Cultural competency training for health care providers and administrators

8. Barriers & Solutions / Suggestions # 3 Barriers: Difficulties with trusting authority figures Solution / Suggestion: 1. Add patient’s previous experiences with medical care to patients chart. 2. Explain in short, easy-to-understand terms what is happening and why.

9. Barriers & Solutions / Suggestions # 4 Barrier: Cultural misunderstandings / miscommunications Solution / Suggestions: Patients need to work with medically trained interpreters and health care staff need to know the basics of other cultures to work effectively with them.

10. Barrier & Solutions # 5 Barrier: The father believes in the power of a shaman, a healer who goes beyond the capacities and expertise of physicians in the US health care system. Solution / Suggestion: Offer the father the option of working with a shaman along with the traditional physicians.