Death and dying: How to deal with a Hmong patient.
Dealing with a dying Hmong patient can be very easy or complicated. In Australia, we have discover that it is an easy process as long as the basis is covered. This include an understanding of the Hmong funeral, in a general form, and taking account the dynamic of the Hmong family and community facing such a crisis. The following information is drawn from one of our inf. sheet for health professional. I hope that this information assist you.
1. Understand the funeral.
To have a proper ceremony is of great importance to the Hmong, for as a result the soul will prosper in the afterworld. It is preferable to die in one's own home or, in the home of same subclan.
Back home in Asia, including China, the Hmong have no funeral home or undertakers. When a person dies, the corpse is kept inside the house, after having properly dressed up, tied and laid on a stretcher.
Soon after death, the person is given various paraphernalia to protect its souls from natural elements and malevolent spirits during the trip to the ancestral world, including a mature rooster is killed for showing the way.
This is followed by a session of pipe music by the name of "expiring chant" (qeej tu siav) and drum. This is to show the souls how to reach the other dead ancestors who are believed to live together in the other world. The souls have to thank all household spirits and all other spirits in different localities where he had lived.
Tus Tawkev uses a bamboo divine sticks, some wine, and chants a prayer for the dead and tells him that he can live under the chicken's wings if it is hot, or under its tail if it rains. He further instructs the soul of the dead person to take the middle path to reach the land of the ancestors with the chickens as his/her guide. Then the pipe man (txiv Qeej) blows his pipe (qeej) and the drum man (Tus Ntau Ntuas) beats the drum.
The soul of the dead man begins his trip, firstly by collecting the placenta, then climbing of the heavenly stairs in thirteen days, crossing of a salty river and a bitter spring as well as many other supernatural obstacles before reaching the ancestors.
Upon reaching the desired destination, the departed soul will recognize his or other ancestors when their roosters crow in response to his rooster.
While the corpse is kept in the house, relatives and neighbors will come all the time to visit and comfort the people in that house. At least one animal is killed per day to provide food for the visitors and workers and the animals are presented to the dead person to be part of his animal herd.
On the burial day, sons and daughters, especially for the married ones, and other relatives offer oxen for the dead. This does not mean that they respect the dead person greatly, but also want him to go to the world of the spirits with a lot of domestic animals to be raised for companionship and personal use. More importantly, the return to heaven is a lonely one, and the slaughtered animals will keep the dead company along the way.
When the procession reaches the burial site, the coffin is placed inside the grave and quickly covered with earth and branches on top of the grave by the mourners - as part of their last respect and helping. A well-placed grave will brings beneficial effects to the descendants and will give them blessing.
In the West, including Australia, the funeral ceremony is preserved and still practised in a modified format. The corpse is kept at the funeral home and is only brought to the house, if possible (eg. in Australia and France) for one or two days to do the ceremony.
The offering of animals are now limited. Some animals like pigs and chickens are killed at the dead person's house if possible. Other bigger animals like oxen may be killed at the abattoir so long the meat, liver and head are allowed to bring in for the funeral ceremony and presented to the dead person.
2. Death and dying.
Death is part of the life cycle and the Hmong understand and accept this well. In addition, the Hmong believe that a person is born with a mandate (txoj hmoo) to live to certain age. When the mandate expire, the person will have to depart. In some case, especially for the elderly, this mandate may be extended by performing elaborate shamanistic ceremony.
With this understanding, the health professional can apply this believe to the Hmong. I usually say to the patient, "We will do all we can do but it is up to his/her mandate of life (pheej nws txoj hmoo)" - the Hmong can accept this.
Secondly, knowing our limitation in the orthodox medical treatment, we need to encourage the Hmong to seek help from their own healers, like shaman, herbalist ect... The alternative treatment modalities do not contradict or affect our medical treatment but they are complementary.
3. Funeral Arrangement.
The Hmong funeral is a family and community affairs. The Hmong has a set unwritten format and this is activated at the passing of a loved one in their locality. The whole community comes together and in no time, the funeral "committee" is set up and begins to operate at once. It is ideal to have the ceremony at home but this is not always possible, especially in the USA, and the funeral may have to be carried out elsewhere.
4. Mourning.
Due to the family and community network, a Hmong family rarely has to go through the mourning process alone. Support from the extended family and the community is a natural part of the funeral ceremony and this is probably the most important factor to help the mourning process.
How to deal with death and dying of a Hmong patient?
1. Talk to the family. Be frank. No dogmatic statement, eg. he will die in
5 days... unless it is 100% certain.
2. Identify the family/clan leader for the patient. This is crucial. The
leader must be brought in to be part of the decision-making process.
3. Discuss with the leader about the impending death and ask "How, when &
where" the leader intend to do with the funeral. Then help the leader to
achieve this.
4. Never carry an autopsy without consulting with the family/clan leader
(even in the case of juridical requirement).
Summary:
Dealing with a Hmong patient is very easy. It is a matter of being open and involve the family and the family/community leader as part of the decision making process.
It is important to understand the idiosyncracy of the Hmong and at the same it is equally crucial to be understood.
Pao Saykao
http://www.lexicon.net/drpao/