A Hmong shaman dressed in an ornate red and pink costume is standing in a crowded living room in Winton, a small Central Valley town near Merced. She sways back and forth rhythmically as she shakes small ceremonial bells over a young pregnant woman. The woman sits quietly, with a rope lightly tied around her stomach. Her rope connects to another rope -- wrapped around the belly of a newly slaughtered pig that lays on a sheet of plastic on the living room floor. For the next two hours, the shaman chants prayers to the spirit world, offering the slaughtered pig as a sacrifice in exchange for a healthy birth. Throughout the ceremony, the shaman's husband burns pieces of paper money as offerings to the spirits.
Afterward, the pregnant woman and her family prepare for a feast. May Yang, the shaman, explains that this ceremony is the Hmong version of prenatal care. "This ceremony was to help the mother and baby," Yang said through a translator.
More specifically, to help their souls separate. Yang explained that the slaughtered pig was an offering to the spirits so that they would assist in the birthing process. It's part of their customs. Traditionally, in Laos, the Hmong were always more likely to visit a shaman than a doctor when they were sick or needed prenatal care. So when Hmong refugees began resettling to the Central Valley after the CIA's Secret War in Laos, they didn't go to the doctor.
The Hmong traditionally believe that if the body is sick, the soul is sick. So to heal the body, you must first heal the soul. Additionally, many Hmong were distrustful of western practices when they first arrived to the U.S., so they refused to get treated in hospitals, unless it was a crisis. That led to the Hmong filling up emergency rooms at local hospitals -- and it left doctors struggling to understand how to treat them.
But that's been changing ever since a non-profit called Healthy House Merced started a program that teaches shamans the basics of western medicine. Now shamans like May Yang visit Mercy Medical Center to learn things like what x-rays are, what heart monitors do, and when to call for an ambulance. "I learn about the disease," said Yang about the program. "I learn about diseases like Hepatitis B. And I learn about strokes, how it happen to human's body."
The shaman training program, Partners in Healing, is now in its twelfth year and has trained over 100 shamans throughout the Central Valley. The program also teaches shamans when to refer their patients to a doctor.
"It’s pretty much the shaman that do the referral," said Yang. "Because if patient call me ... more of the time I would tell them, 'You have disease, you have virus, or you have infection. You need to go to the doctor right away.' And the patient will listen and say, 'OK, if you say so. I’ll go see my doctor right away.' If the doctor cannot find anything then they will come to me and I will do the ceremony for them."
Changvang Her is an interpreter with Healthy House who interprets for shamans and the hospital’s Hmong patients. He also acts as a cultural broker between the shamans and medical staff. Her says the key is to explain things like CAT Scans in a way that’s sensitive to how shamans see the world.
"In order to make the shamans understand about the image here, I explain, 'The shaman they can see spirits, whereas the doctor use CT, x-ray, and microscope to see disease or illness.' So we make that comparison so they understand about the equipment."
Changvang Her says the Partners in Healing program helps make shamans and the Hmong community more trusting of western medicine. And the reverse is also true -- doctors now know what to expect from their Hmong patients. But that wasn't always the case; just as Hmong refugees didn't know what to do about western doctors, western doctors didn't know how to approach the Hmong.
Janice Wilkerson directs cultural programs at Mercy Medical Center. She said when the Hmong first starting coming to the hospital, the staff didn't know their practices. That led to the hospital making some mistakes they weren’t very proud of, and did not want to have happen again.
A series of mistakes is chronicled in Anne Fadiman's non-fiction book "The Spirit Catches You and You Fall Down." The true story is about a young Hmong girl in Merced with severe epilepsy who didn't get properly treated -- and ultimately died at a young age -- because of the cultural misunderstandings between the girl's parents and hospital staff. Wilkerson says there were other cultural misunderstandings too.
"When the Hmong would come to our emergency department, staff would sometimes cut off the knotted strings on their wrists, which was part of the Hmong shamans healing," said Wilkerson.
Wilkerson says they don't do that any more. Mercy Medical Center now permits Hmong shamans to come to patients' rooms to perform healing ceremonies. They even have a list of ceremonies that have been pre-approved by the hospital.
Wilkerson said it has been a two-way learning process. Doctors also attend traditional Hmong ceremonies where they get to spend time with shamans outside of the hospital setting and learn more about their healing traditions. Now physicians in cities with large Hmong populations, like Sacramento and Fresno, are looking to Mery Medical Center as a model. "It’s bridged that gap, from our physicians, our staff, to the Hmong culture."