ABSTRACT
OBJECTIVE: To illustrate one aspect of different cultural beliefs and practices in relation to childbirth of the Hmong women, namely the soul loss concept, and how mainstream health services are able to provide culturally sensitive care to women from different cultural backgrounds by illustrating the case of a Hmong woman who gave birth in a Victorian maternity hospital.
METHOD: Ethnographic interview and participant observation methods.
RESULT AND CONCLUSION: A Hmong women had a caesarean operation and since then her health has been deteriorating. She believes that her ill health has happened because her soul left her body due to the general anaesthetic for the operation. This case might have been prevented if the cultural beliefs and practices of the Hmong women are taken into account when they come to use the service. There is no doubt that a caesarean operation was essential for the survival of the infant in this particular case. However, it could have been managed differently. Nevertheless, the agreement of the hospital to allow the Hmong woman and her family to perform a soul calling ceremony in the operating theatre to regain her health as well as the concerns about her well-being of the hospital staff are positive aspects. They illustrate how mainstream health services can provide culturally sensitive care to consumers from different cultural backgrounds if they are informed of these cultural beliefs and practices.
INTRODUCTION
In most societies birth is seen as a time of vulnerability for a mother and her newborn and societies provide a system of knowledge and behaviours for coping with this life crisis.1,2 These many different systems share common goals, namely, the maintenance of well-being and preservation of life of a new mother and her newborn.3,4 The following case study shows the consequences of not recognising the importance of different systems and also describes how the problem was finally resolved.
THE CASE STUDY OF MAI
Mai is a Hmong woman who is 34 years old and has six children. Four children were born in a refugee camp in Thailand and two in Australia. Five of her children were born naturally. However, when Mai had her last child she was advised that she needed a caesarean operation since the foetus was in a transverse lie. Mai refused the caesarean operation and insisted that she could give birth naturally. She was told that if she attempted a vaginal birth the foetus may not survive. Because of the concern about the survival of her foetus, Mai agreed to give birth with a caesarean operation. However, the caesarean operation was done under a general anaesthetic and she was alone in the operating theatre since her husband was not allowed to stay with her. Since this birth Mai has been physically unwell. She has seen a number of specialists for her health, but they have not been able to find anything wrong with her.
Mai believes that under the general anaesthetic, while she was unconscious, one of her souls which has its duty to take care of her well-being left her body and was unable to re-enter her body. Because she was moved out of the operating theatre and she gained her consciousness in a recovery room, she believes that her soul has been left in that operating theatre. She strongly believes that the departure of this soul is the main cause of her ill health because she frequently has bad dream in the last ten months. It happens every two to three times each week. Each time, after the dream, she would feel very ill and have bad pain on her body. Her dream is always that she is wandering to far away and strange places. She does not know where she is going since she has never seen these places before. It is also as if she just has to keep walking and there is no ending. Mai believes that this is the sign of her soul, which has left her body, wanders in another world.
The Hmong believe that each person has three souls. A soul is able to wander off occasionally and it usually is able to return to its body. Ill health occurs when a soul leaves the body because it is frightened away for various reasons and is unable to find its way home.5,6
In order to regain her health, Mai must undergo a soul calling ceremony and this must be performed at the theatre in which the caesarean was done and where the soul is still waiting to be called back. The soul calling ceremony is usually performed by a shaman, but it can also be performed by an older person who has the knowledge of soul calling ritual.6-8 It requires the burning of an incense, an egg, a bowl of raw rice, and a live chicken. We asked her if she had considered to have a soul calling ceremony done at the operating theatre in the hospital where she had the caesarean operation. Her quick response was that this would not be possible since the hospital staff would not understand her customs and would refuse the request since the ceremony involves a live chicken and the burning of an incense stick. Her husband made a comment that it was hard enough to accompany his wife into an operating theatre, it would have been impossible to perform a ceremony which is alien to western health care providers. Because Mai was unable to perform a soul calling ceremony at the operating theatre the family believed that the soul had transformed into another living thing because it had left her body for a lengthy period of time. Thus, as a consequence, her health was deteriorating.
Concerned about the well-being of Mai, we promptly discussed the possibility of arranging to bring Mai back to the hospital to perform soul calling and immediately contacted one of the senior hospital administrators. Through this person the Deputy Chief Executive Officer of the hospital agreed responding that "the hospital is more than happy to do anything for the woman if this can help her".
We contacted the operating theatre Manager to arrange for the soul calling ceremony and as the operating theatre is busy during the week and the date is not important, Mai agreed to have the ceremony performed on Sunday morning. At eight o'clock Mai, her husband and a shaman met us at the ground floor of the hospital with the essential ingredients including a live chicken in a cardboard box. When we reached the operating theatre the Charge nurses were expecting us. They were very helpful and supportive. They showed Mai where she was put to sleep and where she regained her consciousness. They showed Mai even the path that she was carried to the operating theatre because they wanted to ensure that the ceremony was being performed appropriately. At 8.30 am the shaman performed a soul calling ritual in the operating theatre. It took him about twenty minutes in the operating theatre to be able to persuade Mai's soul to come home with her.
CONCLUSION
There is little doubt that a caesarean operation was essential for the survival of the infant in this particular case. However, it could have been managed differently. For example, an epidural anaesthetic could have been used, and Mai's husband should have been with her in the operating theatre so he would be able to call her soul into the recovery room for her.
Nevertheless, the agreement of the hospital to allow Mai and her family to perform a soul calling ceremony in the operating theatre to regain her health as well as the concerns about her well-being of the hospital staff are positive aspects. They illustrate how main stream health services can provide culturally sensitive care to consumers from different cultural backgrounds if informed about these cultural beliefs and practices.
Within a multicultural society like Australia, different cultural sensibilities need to be understood not only as a matter of cultural tolerance, but primarily because they may have a direct effect upon the health and well-being of a mother and her newborn as well as upon the use of health services.
The authors would like to thank the Mercy Hospital for Women in Melbourne and its staff for giving permission and arranging for Mai to have a soul calling ritual in an operating theatre to regain her well-being.
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