MERCED — When Palee Moua teaches Hmong elders how to manage adult-onset diabetes, she usually starts with a metaphor.
As the director of cultural services at the Merced-based Healthy House, she might relate tackling diabetes to crossing a treacherous river, like the Hmong did during the Vietnam War when they fled to Thailand after the Communist invasion of Laos. Those who stayed behind and chose not to make the change might have found it easier at first, but then they risked injury or death.
She says choosing to ignore or deal with diabetes is a similar choice with similar consequences.
An estimated 80,000 Hmong live in the Central Valley, one of the most concentrated immigrant populations in the state. About 8,000 — or 10% — of those Hmong residents live in Merced County. Healthy House officials hope that by tracking lifestyle changes among Hmong residents, they can help manage and prevent diabetes.Â
As many as two out of five adult Hmong are estimated to have Type 2 diabetes.
The more metaphors Moua offers from Hmong history, the more her clients begin to understand that controlling diabetes necessitates a lifestyle change. But it’s still a huge challenge, said Moua. Historically, the Hmong in Laos did not have experience with diabetes; even now, they still see it as a Western disease and they have many misconceptions about it.
“They think it is a disease that will go away with medication,” said Moua. Many Hmong adults take medication for a short while and then assume the diabetes has been cured, she said. Â
Grant Helps Launch Diabetes Project
To address this underserved population, Healthy House – a not-for-profit organization whose mission is to build respect and understanding among different cultures and ethnicities and improve the health and well-being of all people – is in the beginning stages of a project to increase diabetes screening and care for Hmong residents.
Healthy House, formally known as Healthy House within a MATCH (Multidisciplinary Approach to Cross-Cultural Health) Coalition, was established in 1996 after a group of health care providers and community residents realized some ethnic groups, such as the Hmong, were not getting adequate health care because of cultural differences.
It recently received a $50,000 grant from the Anthem Blue Cross Foundation to begin the project, dubbed the “h-wish” or Hmong Way to Invisible Sweet Health.
The grant will allow for education, diabetes outreach and intensive case management for Hmong adults in Sacramento and Merced over the next year. Healthy House will work with the Hmong Health Collaborative, a group of nine organizations in the Central Valley with a mission to ease health disparities and improve health access. Two organizations from the collaborative, Hmong Women’s Heritage Association in Sacramento and Lao Family Community in Merced, will be involved.
Candice Adam-Medefind, executive director of Healthy House, said the organization plans to screen at least 750 people in Merced and Sacramento. Healthy House then will refer patients with diabetes to agencies, programs and care providers.
“We’ll get them immediately to primary care referrals and will call them back in a couple weeks to set up education classes and do intensive case management,” said Adam-Medefind. “Throughout the year, we’ll be following up every couple of weeks, checking their blood glucose levels and helping them to develop lifestyle plans.”
One of the staples of the Hmong diet is white rice, but the Hmong also eat other starchy foods — such as sweet potatoes, yams, rice cakes, taro roots and yucca — that affect their blood sugar. In Laos, eating a high-carbohydrate diet did not pose the same health problems that it does in the U.S. because people had more active lifestyles and also ate more leafy green vegetables, said Moua.
“Back home, we ate more vegetables and walked a lot out in the field. Here, everywhere we go, we just go by car,” Moua added. “The Hmong are doing a lot of gardening but not enough for them to sweat.”
Naina Kaloowalla, a nurse at Healthy House, said the Hmong equate diet with poverty or prosperity. They view meat and rice as signs of wealth; being chubby also is equated with success. Food that isn’t salted is considered bland.
It’s important that the Hmong understand they only need to reduce certain foods in their diet, not eliminate them, said Adam-Medefind. It’s also vital to honor the predominantly healthy part of the Hmong diet, she said. “We give real credence to the indigenous diet. They grow lots of greens that most Americans wouldn’t recognize,” she said.
Lifestyle, Language Pose Challenges
Apart from diet, the project also will address the more sedentary lifestyles the Hmong have in the U.S. Many Hmong believe exercise is a waste of time. “They don’t understand why someone would exercise for the sake of good health,” said Adam-Medefind. “The idea of getting exercise is just absurd. They go out and farm!”Â
Even translating medical terms will be a challenge. For instance, there’s no word for diabetes in Hmong; instead, they call it sweet blood. Â
The project will address whole families and communities, instead of just individuals. Healthy House will send interpreters into Hmong homes to teach an entire family about the need for exercise, a healthy diet and medication to control diabetes.
Western culture is “based on individuals and individual protection,” said Adam-Medefind. “The Hmong are an Eastern communal culture. We need to deal with the whole community and the whole family and make sure everybody is on board. We can do a lot to help these people when we go into their homes and work with them. We understand they are a highly communal people and that the health of any individual is dependent on the entire family unit.”
Another benefit of working with the whole family is educating the younger generation before they develop diabetes. They are facing the same obesity problems that other young Americans are, said Adam-Medefind.Â
Healthy House also will work with local shamans –Â the indigenous spiritual leaders of the Hmong –Â through its Partners In Healing program, to educate them on diabetes symptoms and management.
“It’s critical that we talk with the shamans,” said Adam-Medefind. “The Hmong trust the shaman. They don’t understand the Western medical establishment. In their mind, ‘That doctor’s no good because he sends me to someone else. Why doesn’t he take care of me?'”
In fact, Healthy House was established to avoid the tensions that can exist between indigenous spiritual healers and the Western medical establishment, said Adam-Medefind.