Our Lady of Peace Hospice (OLP) is honored to care for Somali, Latine, and Hmong families. With a focus on continuing education, we’re learning more everyday about cultural differences, and how to better serve Hmong, Latine, and Somali families at end-of-life. Beliefs play a big role in medical care and we’re always striving to improve.
In February, OLP invited medical professionals from across the Twin Cities into our residential hospice for an evening of education. They joined us in person and via Zoom for the event, moderated by retired OLP hospice doctor, Nancy Baker. Our panel of experts included Miguel A. Ruiz, MD, University of Minnesota, Abdul Esse, MD, University of Minnesota, and Yer Xiong, M.D., MPH, Allina Health and OLP Hospice. These physicians addressed the beliefs of Somali, Latine, and Hmong families, and how the care we provide to their loved ones is received, processed and evaluated. Here is a summary of what they shared with our audience:
General information presented by Dr. Baker:
- Culture is complex, dynamic, and everchanging.
- We need to come at this from a place of humble curiosity
- While we group people for the sake of higher-level discussions, it’s paramount to remember that each individual is unique in the care they need.
- It’s not just the one life impacted by palliative care, as stories of care will continue.
- It’s critical to recognize autonomy to foster justice & equity.
- 8-8 1/2 % of Minnesotans were born outside of the U.S.
How do beliefs play a role in medical care?
Points made by Dr. Xiong regarding Hmong culture and hospice:
- When we talk about illness or sickness, it falls into 2 categories
- Medical – “I have a headache; I’ll take some Tylenol.”
- Spiritual – For the same symptoms, a person may go to a Spiritual Healer who would say something like “You’re getting these headaches because your late husband is trying to send you a message.”
Points made by Dr. Ruiz regarding Latine culture and hospice:
- People from the Latine community do not think of themselves as Latine, Latino, Latinx, etc. They instead identify with their Country of origin.
- “Latine” is the best term, “Latinx” is also OK.
- These terms were coined by English speakers, so they’re not as preferred as country of origin.
- How they interpret/perceive what is going on in their lives informs how they feel about care.
- There are certain myths that can create aversions to care such as:
- Insulin causes blindness.
- Morphine kills people.
- This is why it is important to always ask questions such as:
- Why do you think what is happening is happening to you?
- How would you approach this in your home country?
Points made by Dr. Esse regarding Somali culture and hospice:
- 60% of Somali people are nomads or semi-nomads.
- Decisions are made by family & clan, per paternal lineage.
- Family decisions outweigh individual decisions.
- Somali Language was written in 1972
- Adult literacy is only 20-25% – Because of this, Interpretation is more critical than translation.
- Somali people often believe diseases are caused by God.
- Similarly, suffering is caused by God and part of God’s plan.
- As a result, there are religious implications to suppressing suffering.
- There is no concept of preventative care in Somali culture.
- Similarly, there is no concept of Hospice/End-of-Life/Palliative Care.
- There is no Somali word for “cancer.”
- People turn to Spiritual Healers who practice:
- Cauterization
- Blood letting
- Herbal medicine
- Etc.
- When asked, “How do you feel about U.S. Medical Doctors,” Somali patients reply, “They ask too many questions!”
- There is a mistrust of MDs by some in the Somali community.
- They’re not accustomed to learning about side effects, risks, etc. of treatment, and may misinterpret sharing of these concepts as diagnosis. Such as saying “it’s not a heart attack” brings to bear the idea that it could be a heart attack.
- Back home, these things aren’t readily discussed.
- Since the belief is that “God determines the outcome,” news like, “There’s nothing that can be done” would not be common back home as it suggests that the doctor is speaking to something reserved only for God.
What is the role of family in decision making?
Points made by Dr. Xiong regarding Hmong culture and hospice:
- Accessibility & acceptance are foreign.
- Hmong is a newer written language and literacy is low, so verbal Interpretation is far better than written translation in reaching the community.
- Family and community play a central role in decision making.
- When a Hmong community member is ill, it is common for everyone in the family & community to show up and support them – both emotionally and financially.
- This can sometimes be to the individual’s detriment as they can feel like “they no longer have a say” in their care.
Points made by Dr. Ruiz regarding Latine culture and hospice:
- Family is who the patient family believes it is.
- It is important to ask, “Who is this to you?”
- Many people may be on their own, with family in their home country.
- May rely on friends as family.
- Technology has damaged the medical environment, as some people in the community have high suspicion of technology.
- A diagnosis can offset the balance of their belief systems.
- A child may say of their parent, “Please, don’t tell him the diagnosis – he may just give up,” creating an ethical dilemma.
- When the condition is serious, families won’t want the patient to know.
- It is important for members of the Latine community to connect at a human/personal level with their provider.
- Good question to ask: “How do you make decisions with your family?”
Points made by Dr. Esse regarding Somali culture and hospice:
- Believe in predestined fate – “You will die, and that is acceptable.”
- It is common to have someone come in at the last minute and share a story of someone with a similar diagnosis making a miraculous recovery, advising against provider recommended care.
- Children make decisions for their parents.
What are the barriers to acceptance of hospice?
Points made by Dr. Xiong regarding Hmong culture and hospice:
- Being an orphan is important in Hmong culture.
- Children do not want to become orphans.
- Hospice is perceived as giving up.
- Example: Provider, “Grandma has an illness that we’re not able to treat anymore.” Family member, “Are we giving up on Grandma?”
- There is no word for hospice in Hmong.
- Even native Hmong speakers are still looking for right words, some arriving at “next level of care.”
- It’s important to ask, “What is your belief system,” as not everyone in the Hmong community believe the same.
- It is considered to be an honor to be present when a loved one passes.
- It’s critical to use the right, professional, interpreters and not rely on family.
- “Families have assumptions about what is best, and we need to be objective.”
- It’s common, and very important to pass in burial clothes, which translates to, “Old people clothes.”
Points made by Dr. Ruiz regarding Latine culture and hospice:
- The Spanish word for hospice translates to, “house of the orphans” – which is clearly negative in their culture.
- Best to refer to it as palliative care.
- Providers are not currently doing a great job of explaining end-of-life care, plus…
- Providers are up against huge forces of belief.
- Critical to focus on:
- Education
- Connection
- Trust
- It’s important to have burial within 24 hours of death.
- Caring for elders is highly respected.
- Important to come from a place of “we’re here to help YOU care for your loved one.”
- We must ask, “What practices might be helpful to your family?”
Points made by Dr. Esse regarding Somali culture and hospice:
- A provider stating, “You have 1 year to live” is very difficult as this is something determined by God.
- Within Somali culture, it’s common to be met with multiple interpretations of/reactions to the same concepts.
- Doctors who bring up certain concepts are dismissed as having “assimilated” to Western culture and are no longer understanding of Somali culture.
- There is fear of ulterior motives of doctors such as harvesting organs, etc.
- While parents may accept fate, children are often not OK with parents passing, so they push for longevity.