By Joanna Nolasco
For Northwest Asian Weekly
If you don’t have health insurance, Farm Sirisisangpha can tell you where to apply. If you don’t feel well, she can tell you which doctor to go to. And if you don’t feel any better after that, she can recommend a spirit doctor that may be able to help.
As the Mien community advocate for International Community Health Services (ICHS), a role that resembles that of a community health worker, Sirisisangpha navigates both Western medicine and spiritual-healing practices.
More than 30 years after immigrating to the United States, some Mien, particularly the elderly, still adhere to their traditional healing practices, seeking both medical and spirit-based cures.
“They come to the doctor. They take medicine [but] it doesn’t help,” Sirisisangpha said, explaining when she would contact a shaman for her patient. “Then they call me again, and then I tell them ‘OK you need to go to a shaman.’ ”
The Mien were originally from south and southwest China, eventually migrating to the mountains of Thailand, Vietnam, and Laos. In Laos, the Mien were farmers and hunters living in the rural parts of the country. They had little to no access to hospitals or modern medicine. Their traditional practices of medicine include spiritual healing with a shaman and the use of herbal medicine.
During the civil war, the Mien supported the American-backed Royal Laotian government in its fight against the Pathet Lao communists. After the fall of the government in 1975, many of the Mien immigrated to California, Oregon, and Washington.
Seattle’s tight-knit Mien community numbers a few thousand people. They live mostly in Rainier Beach, Skyway, and Renton.
Navigating the system
When Sirisisangpha, 58, arrived in the United States in 1980, she became so ill that she had to spend four days at a San Francisco hospital.
She didn’t speak English. She used hand gestures to tell the doctor that she didn’t want to take the medication. The doctor gestured back that she had to, without being able to communicate why.
That experience inspired Sirisisangpha to become a medical interpreter. “I have so many people here that cannot speak English and they really need help,” she said.
ICHS has seven advocates that serve the Mien, Chinese, Korean, Vietnamese, Filipino, and Samoan communities. They serve as a bridge between doctors and patients, they refer community members to medical services or insurance providers, and they educate patients about health issues.
“It’s important for people to have services where they are,” said Abbie Zahler, the ICHS community advocate supervisor. “It’s important to have someone come to them and say, ‘We’re here to help you.’ ”
‘Everything is doctor first’
After years of learning English and acclimating to the new culture, Sirisisangpha now understands the American healthcare system. When patients consult her about an illness, she always directs them to doctors and clinics first.
“Everything is doctor first,” she said.
“In this country, you have to see the doctor first,” said Chanseng Saechao, an 80-year-old shaman in Seattle.
About half of the local Mien have converted to Christianity, while the other half still worship spirits and ancestors. Traditionalists believe that family members must pay respect to their ancestors by offering food and money.
During Lunar New Year and events like birthdays, many Mien perform a ceremony in which paper money is burned and either a chicken, pig, or cow is blessed by a shaman, then cooked and eaten by the family as an offering for the ancestors.
If a sick Mien isn’t cured by Western medicine, they believe that the illness may be caused by their ancestors needing more money or food. This is particularly true when the symptoms are accompanied by a bad dream.
Traditional ceremonies and mental health
In addition, traditional healing practices are used to treat mental illness.
Many of the older generation suffer from post-traumatic stress disorder (PTSD) and depression, a result of fighting in Laos’ civil war and fleeing their homeland.
Mien believe that a traumatic event can scare one’s spirit away. Shamans perform a ceremony that will call the spirit back.
Mae Seng Chao, a Mien mental health case manager for the Asian Counseling and Referral Service (ACRS), said that patients often seek both Western-style counseling and traditional healing practices.
“They tell us the problem, and then they also go home and they tell the shaman the same problem,” Chao said. “Most people believe both are working.”
Doctors who work with the Mien take their spiritual beliefs into account when diagnosing them.
Carey Jackson, the medical director of Harborview Medical Center’s (HMC) International Medicine Clinic, has worked with the Mien for more than 20 years.
Jackson explained that shamans “diagnose at a different level and in a different way” than doctors. However, the two don’t necessarily contradict each other.
“As long as we know what’s going on, and providers know about the shamanistic system of the Mien, then they can work with it,” he said. “Otherwise, they’re going to find themselves kind of frustrated or confused. It does require a little bit of understanding of Mien culture.”
One of Jackson’s Mien diabetes patients consulted him about a jammed finger. She understood that she had to control her blood sugar and get her finger treated. But she also saw the series of misfortunes as signs that a spirit needed to be tended to.
“Knowing that that’s going on in her life, I can help make sense of her anxiety or missed appointments,” Jackson said. “I can appreciate how she’s seeing her health.”
Jackson believes that most Mien have become more accepting and understanding of Western medicine.
For example, when the Mien first arrived in Seattle, some attempted to plant opium poppies along I-5 because opiates can help with pain relief, anxiety, and diarrhea. Once they understood the law, they stopped planting poppies.
Worries about the future
While Sirisisangpha has helped the elder Mien adjust to American culture, she and others worry that the younger Mien born here won’t be able to sustain many of the traditions.
Although younger Mien often take part in the traditional healing ceremonies, few of them are learning how to conduct the ceremonies. She worries that only a few of the younger Mien are learning the traditional ceremonies.
“If they don’t learn and the older generation passes away, no one will know how to do it anymore,” said Saechao. “When the parents die, how can they find anyone to help?”
Sirisisangpha would like to start a class to teach traditional ceremonies. But she says she faces two obstacles: lack of funding and lack of interest among the younger Mien. ♦
Joanna Nolasco, a University of Washington student, originally wrote this story for a global health reporting class.
She can be reached at email@example.com.