Hmong may not communicate dissatisfaction with the quality of health care. Instead, they will refuse care and go somewhere else for treatment. Older Hmong listen attentively to health professionals, but will avoid direct eye contact because it is rude. Recent immigrants are unaccustomed to doing things at specific times, and this becomes an area of difficulty for them. As a result, information about appointment times, etc., needs to be written and carefully explained.
Grandparents participate in decisions about their grandchildren s health care.
Many recent refugees seeking western treatment have intestinal parasites, tuberculosis, anemia, depression or post traumatic stress syndrome. Constipation and diarrhea are more common due to the lack of roughage in the diet. Perfect health is a balance between the spirit and the body. When someone is ill, Hmong will seek out the help of a shaman to determine if the cause of the illness is in the realm of the spirit. Spiritual causes require religious remedies.