Staff at most hosptials would be baffled by an instruction like this on a bedside chart: to prepare patient for surgery, provide 15 minutes of soft chanting and tie a red string around the neck.
It’s different at Mercy Medical Center in Merced. There, nurses know they must call a shaman.
Mercy is the nation’s first hospital with a formal policy for Hmong shamans, allowing the traditional healers, working alongside doctors, to help patients recover.
Hospitals across the country are paying attention as they seek to accommodate cultural beliefs of diverse patient populations.
In the San Joaquin Valley, the Hmong are one of a few ethnic groups—including some indigenous Mexican cultures—that practice shamanism. For those with traditional beliefs, calling on a spiritual healer is as important to good health as making an appointment with a doctor. They may go without care if they can’t have a shaman nearby, sometimes with devastating consequences.
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Traditionally, the Hmong believe a soul can become lost or captured by spirits. The spirits can affect the person’s health and well-being, and until the soul is restored, the Hmong believe, the physical body won’t heal. The shaman, in a trance, negotiates with spirits for the return of the soul.
Other Valley hospitals may allow shaman healing ceremonies, but only Mercy guarantees the right in writing. The Hmong Health Collaborative—a group of area agencies—hopes the other hospitals will follow Mercy’s lead.
That remains to be seen. Not all the hospitals are sure they want to single out one group of spiritual healers. But in the months since Mercy adopted its policy in June, the hospital has been receiving calls from as far away as Malaysia from people who want to know how it works.
A national need
Nationwide, hospitals are learning to become more creative in their outreach to communities, health experts say.
The Joint Commission, the agency that accredits most U.S. hospitals, found examples in an anoymous survey. {snip}
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But a written policy that details procedures for accommodating a specific cultural belief is rare, said Jacqueline Voigt-Dieball, cultural-competency manager at the University of Michigan Health System.
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The hospital, owned by the national nonprofit chain Catholic Healthcare West, is licensed for 174 beds and sees an average of four Hmong patients a day. Caring for patients’ spiritual health as well as their physical health is part of the hospital’s mission, she said.
“The whole healing process has to be a holistic approach,” Wilkerson said.
Chants and string
Mercy’s policy lists nine healing ceremonies that shamans are allowed to perform.
Most involve soft chanting to promote healing, strengthen the body, keep the body safe or call the soul back to the body.
Shamans can tie strings around a neck and wrist. A red string around the neck helps in healing, and a white string around a wrist maintains a soul during hospitalization.
A shaman, or “txiv neeb” in Hmong, can ask the Mercy hospital staff for permission to do ceremonies that go beyond chanting. An example would be a request to sprinkle water over incisions. According to Mercy’s policy, hospital staff are to try to make accommodations.
The ceremonies can occur in patient rooms, in the emergency department or in surgery preparation areas.
The hospital ceremonies are brief—10 to 15 minutes. By contrast, healing rituals conducted in private homes can last hours and typically involve a drum, bells and the rattling of rings.
Before the policy, Hmong healing ceremonies were occurring, but the hospital gave shamans only tacit, informal consent. One private social-service agency—Healthy House within a MATCH Coalition—pushed for a formal policy. The nonprofit multicultural health organization works closely with the Hmong community.
A written policy “recognizes the value of this complementary healing service,” said Marilyn Mochel, clinical director at Healthy House.
While many Hmong have excelled in college, become professionals and embraced Western beliefs, Mochel estimates that 70% of Hmong in the Valley follow traditional beliefs and can benefit from a shaman healing policy.
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A long road
There are more than 55,000 Hmong between Sacramento and Bakersfield; about 7,000 live in Merced County, which has a population of about 246,000. In the decades since they fled the remote mountains of Laos after a Communist takeover in 1975, they have had to reconcile traditional healing practices with Western medicine.
Unfamiliarity with Western medical practices has led to distrust among the Hmong refugees who settled in the Valley. Some of the biggest fears surround surgery—that the removal of body parts could affect them in the next life after reincarnation.
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During evening classes, the shamans looked through microscopes, learned about prescription drugs, X-rays and blood tests, and toured the hospital, including stops inside empty operating rooms.
Shamans invited doctors to their homes, where the physicians learned about Hmong healing beliefs and witnessed traditional spiritual healing ceremonies.
