A Hierarchy of Medicine: Health Strategies of Elder Khmer Refugees in the United States
Lewis, Denise C., The Qualitative Report
This study addresses ways Khmer refugee elders utilize traditional herbal medicine with Western biomedicine in the treatment and prevention of illnesses. Methods include semi-structured and informal interviews with elders and family members, semi-structured interviews with local health care providers and Khmer physicians, and participant observation of everyday life and actions specific to health beliefs and behaviors. Data reveal a reliance on traditional medical ideology for understanding and treating illnesses. Utilizing a traditional ideology, Khmer elders rely heavily on traditional treatments and use Western biomedicine as supplements or adjuncts to traditional preventive and curative practices. This research has important implications for health care providers who treat SEA elders, especially for diet and treatment of chronic illnesses often associated with aging populations. Key Words: Aging, Complementary and Alternative Medicine, Diabetes, Hypertension, and Southeast Asian
Complementary and Alternative Medicine: A Matter of Perspective
Complementary medicine and alternative medicine are defined as health therapies that are secondary to mainstream Western biomedicine. Complementary therapies, such as chiropractic or massage therapy (Eliopoulos, 1999; Lorenzi, 1999), may be used along with biomedicine whereas alternative medicines, such as acupuncture or acupressure, are thought to replace Western biomedicine (Cherniack, Senzel, & Pan, 2001; Eliopoulos; Lorenzi). Cambodian refugee elders, however, follow a reverse order of health care preferences. Traditional Khmer health strategies often are employed as a primary treatment and Western biomedicine, when it is used, is added to complement Khmer medicine or as an alternative solution when Khmer medicine is not readily available.
Since 1975 over 1.2 million Southeast Asian (Cambodian, Laotian, and Vietnamese) refugees have been resettled in the United States. Moreover, U. S. Census data indicate that the U.S. population of Asian and Pacific Island elders (of which Southeast Asians constitute approximately 22%) is projected to increase by 256% by 2020 (United States Bureau of the Census, 2000). Experiences of aging refugees and other immigrants differ significantly from elders who have not participated in international migration (Ikels, 1998; Villa, 1998); yet, little is known of health strategies aging refugees and immigrants employ. In particular, information on the prevalence of diabetes and hypertension among Asian and Pacific Islander populations is scarce (National Heart Lung and Blood Institute, 2000; National Institute of Diabetes and Digestive and Kidney Diseases, 2002). The purpose of this paper is to describe Khmer elders' use of traditional health care practices as primary mechanisms and Western biomedicine as complementary or alternative mechanisms arranged in a hierarchy of use through an investigation into health strategies surrounding diabetes and hypertension.
Shared Health Beliefs and Behaviors
Great variation exists in caregiving beliefs and behaviors for immigrant or refugee families (Fadiman, 1997; Frye & D'Avanzo, 1994; Jenkins, Le, McPhee, Stewart, & Ha, 1996). Beliefs and behaviors are defined as ways of thinking about and putting into practice health strategies that are influenced by particular events, such as actual first-hand experiences and observations as followed in Southeast Asia versus second-hand descriptions of customs within the context of life in the United States. Individuals' and families' health statuses are a consequence of the confluence of traditional beliefs and behaviors and adaptations to life outside one's country of origin (Fadiman; Ong, 1995).
Berman, Kendall, and Bhattacharyya (1994) argue that it is important to step back from a discussion of health strategies to consider a multi-tiered analysis of macro socioeconomic systems, health care systems, and micro-level household health producing behaviors. …