10 I Cambodians—Let's talk about the Khmer Rouge, (James Heng)

• The significance of the term "Khmer": Cambodian Americans call their native language or nationality "Khmer", which is tied to their place in Cambodia and its historical empire that extended past Southeast Asia and had many trade routes. The term "Khmer" serves as a reminder of the Cambodian people's rich and diverse cultural heritage, and it is a symbol of pride and identity. 

"And that's why we all tried to use the word Khmer which is tied to our place in Cambodia. It was an enormous empire that extended past Southeast Asia and had a lot of trade routes. That was very lucrative. And that was where Khmer thrived under that empire."

• Cambodian names and pronunciation: In Cambodia, last names are typically used first when addressing someone, and names are often pronounced differently than in English, using French pronunciation. The Cambodian language uses a different alphabet than English, and it may be difficult for English speakers to transcribe names correctly.

"In Cambodia, we usually use the last name, as they use the last name first when they call him instead of the first time, so that is the opposite. And also, the spelling of the name because in Cambodia, we tend to pronounce it kinetically and use French pronunciation."

PMH

• The bombing of Cambodia during the Vietnam War and the Khmer Rouge regime: During the Vietnam War, the United States dropped over 2 million tons of bombs on Cambodia as part of a secret bombing campaign to disrupt North Vietnamese supply lines. The bombing caused widespread destruction and loss of life and contributed to the country's destabilization. The Khmer Rouge regime came to power in 1975 and was responsible for one of the worst genocides of the 20th century. It was responsible for the deaths of an estimated 1.5-2 million Cambodians, or around 21-25% of the population. This regime also caused food deprivation and significant trauma for the Khmer people

"I have gone through the bombing of Cambodia during the Vietnam War, right, and also the Khmer Rouge regime. So I went through all the horrible things, food deprivation."

• Political instability and French influence: Cambodia has a long history of political unrest, with different periods of war, occupation, and colonization. In 1863, France established a protectorate over Cambodia, which lasted until 1953. During this time, the country had significant French influence, including economy, culture, and education. After gaining independence from France in 1953, the country was ruled by a monarchy until 1970, but the Khmer Rouge overthrew this government in 1975.

"In 1863, France established its proc trade over Cambodia until 1953. So, for a long time, there was a lot of French influence in the country. In 1953, Cambodia gained independence from France, and a prince ruled the country as an autocracy until 1970. That's when the Khmer Rouge started forming."

• The Khmer Rouge regime: The Khmer Rouge regime, led by Pol Pot, aimed to create an agrarian socialist utopia. To achieve this, they evacuated the cities, forced people to work on collective farms, and abolished money, religion, education, and traditional culture of the Khmer people. They also targeted perceived enemies of the state, including intellectuals, ethnic minorities, and other perceived enemies, leading to the deaths of an estimated 1.5-2 million Cambodians. This event is also known as one of the worst genocides of the 20th century, and it had a significant impact on the Khmer people, leaving them with deep physical and psychological scars.

"This Khmer Rouge is we should probably spend some time just talking about it just because of how gruesome it was, and I know it's part of your history, too. But they essentially systematically eliminated the Khmer population, and a reign of terror lasted from 1975 to 1979."

• The Khmer people's goal of coming to the US: Many Cambodians sought refuge in the US due to the Khmer Rouge regime and the Vietnam War. 

"So, my uncle and aunt decided to flee Cambodia, seeking refuge in the US, right? So, they took me along; I have ten siblings. I'm the oldest."

Social History

• Cambodian cuisine: Cambodian cuisine, also known as Khmer cuisine, is known for its use of herbs and spices, as well as its distinctive noodle dishes. Cambodian noodle soup, also known as kuy teav, is a popular dish made with a particular type of flour and can be prepared as curry soup or lemongrass soup.

"We do have Khmer cuisine. We have this type of flour. It's flour but very similar but with different tastes and flavors. It's a noodle, and we have vegetables and soup prepared differently. We make it into either a curry soup or lemongrass soup, and the brass to go with the noodle. So, I can't jump that's like Cambodian noodle soup. Now, that's a popular dish in Cambodia."

• Traditional Cambodian practices: Cambodian Americans continue to practice traditional Cambodian customs, such as visiting temples and celebrating special occasions and memorials for deceased ancestors. Cambodian New Year is a significant celebration that happens every year in mid-April, also known as Choul Chnam Thmey. 

"So, we have the meat stick like Shish Kabab we stick to them, and that's with some kind of Picco like papaya salad or cucumber or carrot salad. Yeah, I would love dishes in Khmer. I used to go to the plumping noodle plus the Cambodian style noodle or yeah noodle soup. So, in the community, we have several temples here in Seattle and Kent, and Olympia. So, we still go to the temple to celebrate special occasions like Halloween. It got a cost, but we go, and once a year, we do a memorial celebration for the dead like your ancestors."

• The effects of smoking and drinking in the Cambodian community: Smoking and drinking are common issues in many communities. Smoking can lead to lung cancer and other health problems, and excessive drinking can lead to stroke and other health issues. It's important to note that, in Cambodia, the smoking rate is high, and it's a public health concern. According to the World Health Organization, Cambodia has one of the highest smoking rates in Southeast Asia, with nearly half of men smoking. 

• Interactions with health care workers: Miscommunication and not addressing members of the community appropriately can place a barrier between the physician and patient.
• Traditional medicine and understanding of health conditions: Some community members use herbal medicine, and there is often misunderstanding involving certain medical conditions.

"Yeah, especially people who think they are not low blood count. Or they think if you draw more blood and it makes them more anemic. They don't understand that your body replaces whatever you make it. But that's what we do to our people; we do our patients. And sometimes we talk about high blood pressure, right? So, people thought that high blood pressure that you have too much blood in your body. That's why it caused high blood pressure, right? So, they would get a blood draw, which would help with my blood pressure. It's always completely misunderstood what it is. "

• Mental health in the community: Similar to many immigrant communities, mental health issues are seen as disgraceful and seeking treatment is discouraged. 

"So, people don't want to reveal that they have mental issues because it's embarrassing to be exposed that you have a mental problem or “mental issue.” Because when you have a mental issue, people will perceive you as like you are a crazy person. When people assume that you are a crazy person, then they feel embarrassed, and people don't want to associate with them. That's mental health. It is taboo. Yeah. So, people will look down on you." 

In summary, various aspects of Cambodian culture, history, and customs were discussed during the interview.

1. Bombing of Cambodia during the Vietnam War and the Khmer Rouge regime, which caused widespread destruction, loss of life, and trauma for the Cambodian people.
2. The history of French influence in Cambodia, and the impact of the Khmer Rouge regime on the Cambodian people.
3. The reasons why many Cambodians sought refuge in the US, and the significance of the term "Khmer" as a symbol of pride and identity for the Cambodian people.
4. The social history of Cambodians, how they were affected by war, occupation, and colonization and how they were able to preserve their culture despite the challenges.

• Timespan: 35:53 Min
• Transcription Type: Cleaned Verbatim
• Speakers: 2 (James Hang & Raj Sundar)

00:00

James Hang: The living condition is horrible. They give you an open building and then say you live here. Here's your space with a mat and pillow, and that's it. You sleep and share with another family, and sometimes it's so crowded. There's no running water or toiletry; the toilet is so disgusting. And so it was horrible.

00:20

Raj: Hey, everyone. I'm your host, Raj Sundar, a family physician and community organizer. Welcome to the health care for humans podcast. The show is dedicated to exploring the history and culture of Washington's diverse communities. So, clinicians are equipped with the right knowledge to care for all patients.

Welcome to part one of our two-part series on the Khmer or Cambodian community. I see a lot of patients from the Cambodian community. Because Washington State, along with California and Massachusetts, has 50% of the total Cambodian population in the US. I also knew the Cambodian people had suffered because of what had happened in their country.

But until I heard the stories you're going to hear in the next two episodes, I did not understand the extent of it. Because within the Cambodian American population, 42% have been diagnosed with PTSD and major depression. And when they want to share and find a way to heal, they cannot. Over 90% of Cambodian Americans report worrying, but the degree of understanding between themselves and their doctor is low. And I'm confident that's because many of us don't think about what happened in Cambodia and why they're in the United States now. From 1967 to 1975, Cambodia entered a period of civil war, followed by the rule of the Khmer Rouge Communist Party. The Khmer Rouge regime was ultimately responsible for the deaths of over 2 million Cambodians. That was 25% of the nation's population at that time. And people died through starvation, disease, and mass executions between 1975 and 1979. That's the war and genocide that people witnessed, which resulted in a massive exodus of Cambodian refugees who were forced to flee the country after the decimation of everything they had known.

You'll hear this story from two people in this series, James Hang, a Khmer interpreter, and a member of the Khmer Health Board. And Jennifer Huang is also a medical interpreter and a leader of the Khmer Health Board. After listening to this series, you'll understand that trauma many Khmer hold that you'll likely never think about, just like I didn't. You'll hear why there's such a stigma around mental health and being open to diagnosing a mental health disorder. And you will learn some nuances of caring for this population, including how to talk about substance use, how to ensure you're using the right interpreter, and how to talk about other traditional practices. If you learned something from this episode, please share this with one other person and go to healthcareforhumans.org. And sign up. Here's James Hang. Welcome to the show, James.

03:23

James Hang: Thank you. Thank you.

03:24

Raj: Before we get started, tell me about yourself. I know you have a long history of interpreting, especially at Harbor View. But tell me, what brought you to this region, Washington, and [Not sure 03:36] so?

03:36

James Hang:  yeah, I was born in Cambodia in 1967. So, I have gone through the bombing of Cambodia during the Vietnam War, right, and also the Khmer Rouge regime. So I went through all the horrible things, food deprivation. So, in 1983, my uncle and aunt decided to flee Cambodia, seeking refuge in the US, right? So, they took me along; I have ten siblings. I'm the oldest. And my dad lives away in the countryside and is a mechanical repairer of motorcycles and bicycles. He is pretty much making ends meet to feed ten children. But I mainly live in the city with my aunt, uncle, and grandpa. So, when they decided to escape Cambodia, they took me along. They hired a guy, poured, and took me with them, so we fled Cambodia to Thailand. And that was, like, late 1983 And when we got to Thailand, the Navy took us into custody. They detained us for three days. And then, in the evening of the third day, they came with the gun pointing at us in order into the small boat. Like 29. Yeah, I was crammed into the small boat. Then they towed the boat into the ocean for, like, in the night in the middle of the sea. This has cut the robe off and let us drift, so we're abandoned in the ocean for 18 days without food or water. So, we ran into Pirates and robbers, but they gave us food, took our jewelry, money, whatever. And then they gave us some food, and then we ate and then, and we lived off the rain. Occasionally it rained, so we collected rainwater to drink, and pirates captured women in the boat; six women were captured, and then two of my cousins died, two and four years old, dying in the boat from starvation. On the 10th day, they died, though. But on the 18th day, we got rescued by one of the fishing boats. They just came and threw the rope, towed us into the shore, and took them all day, like early in the morning until late at night, like around 9 pm, I think, before we got to the shore. So, it was like all day. And that's how we got turned over to the UN. The UN took care of us and transported us to the refugee camp. And when I was in the refugee camp, my goal was to come to the US, so I studied a lot of English daily. My uncle in the US has sent us some money, of course, so that I can pay for the tuition. So, I studied hard and learned English hard. Then I became an interpreter in the camp, and that was it. I enjoyed doing it.

06:03

Raj: James, what a story. Thanks for sharing that. I know you said you're also part of the Khmer Health Board. Is that right?

06:09

James Hang:  Yes. So, Jennifer spoke to me about forming a Khmer Health Board long ago. So, we didn't get a chance to do it until a few years ago. We get it started. We gathered all the professionals from the community to join the board, and that's how it started. We did a health fair and educated the community about diabetes, hepatitis, and high blood pressure. And we noticed that

06:33

Raj: yeah. It's called the Khmer Health Board. I think it's worth clarifying because people use Khmer and Cambodian.

06:39

James Hang:  American colonists Cambodian, but we call our native language or nationality Khmer.

06:45

Raj: Then we should use Khmer.

06:46

James Hang:  And that's why we all tried to use the word Khmer which is tied to our place in Cambodia.

06:52

Raj: Yeah. Make sense. Okay. For our listeners, let's start with the history because I don't think everybody is probably well-versed in the history of Khmer. So, the 10th to 13th century. I know, I'm going way back here, the 10th to 13th century, the anchor empire. It was an enormous empire that extended past Southeast Asia and had a lot of trade routes. That was very lucrative. And that was where Khmer thrived under that empire. After the 13th century, there was just a lot of unpredictable leadership and government policy. And I'm sure there were up and down in that history where there was political stability. But in 1863, France established its proc trade over Cambodia until 1953. So, for a long time, there was a lot of French influence in the country. In 1953, Cambodia gained independence from France, and a prince ruled the country as an autocracy until 1970. That's when the Khmer Rouge started forming. After seven years of struggle, in 1975, they overthrew the government and abolished the monarchy. This Khmer Rouge is we should probably spend some time just talking about it just because of how gruesome it was, and I know it's part of your history, too. But they essentially systematically eliminated the Khmer population, and a reign of terror lasted from 1975 to 1979. And the statistics are horrible to look at because an estimated 1.5 million to 3.3 million Cambodians, 20 to 40% of the population, died. Because they were executed, died of disease, and starvation forced labor camps. It was a horrible period in time for the history there. I think the Khmer Rouges' purpose was to start this revolutionary movement, and they wanted to erase all of the previous history and culture. It didn't end until 1979 When the Vietnamese came and asked the Khmer Rouge to end the reign of terror. And then ten years, there was the Vietnamese occupation, then 20 years of civil war; unfortunately, I'm not sure if there's anything else to share about that. James, it's just really hard to hear what I know. It's a big part of how the Khmer people ended up in the US as refugees.

09:10

James Hang:  Yep, I will describe it. That's history, the reign of terror that people suffered often, and family separation. One of my friends came to the US as an orphan. He didn’t even realize that he had any siblings after 50 years. And then he found through Facebook, where he discovered that he has a sibling, like the other four siblings, they're still alive. So, it's more emotional.

09:39

Raj: Yeah. I can hear it in your voice. I think it's just hard to even think about it. I just think about all the trauma that all the Khmer people came here carrying. the things that witnessed escaping the Khmer Rouge going to Thailand to try to escape. I think some people did that as your family did.

09:56

James Hang:  It's so unfortunate that we, the same people and be turned on each other to turn on each other when the Vietnamese came in, invaded Cambodia when they took over; that's the while you're in with the Khmer Rouge. They came in, and people in the village took a toll on my dad that my dad sacado [Not sure 10:14] Khmer Rouge, which he wasn't, and they took him. The Vietnamese took him, arrested him, and put him in a dungeon (Jail). He lived in the dungeon and could breathe through a small hole because of a crack in that dungeon. So, he could breathe through there, but [Not sure 10:29] he's a while. So, I've been here.

10:31

Raj: Yeah, in that context, I think that's where many Khmer people left Khmer during that time and came to Washington; there's probably a few waves of it. So, in 1975, when the Khmer Rouge took over, I think government officials and military officers came immediately. In 1979 I believed international support came from the US Congress and called for their admission as a special group into the United States. Then in the 2000s, once people had established families here and sponsored family members came outside the reign of the Khmer Rouge. I also read that before being admitted, many folks went to the Philippines for reeducation or education on the customs.

11:13

James Hang:  I did. I went to the Philippines. First, they transport us from this one camp called Khao I Dang. and Khao I Dang is the main camp. That's the first step that we get into that camp, and then you become legalized in the camp, then you get to interview and get permission to be reset or in the US. But before coming to the US, they transfer you from Khao I Dang camp to another camp in the Philippines called transit camp. So, you go to the transit camp, you'd stay there for a month, and then they will transfer you from the transit camp to the Philippines. And so that's where I was transferred to the Philippines. We were happy in the Philippines. The living conditions were horrible in the Khao I Dang or the transit camp. They give you an open building and then say you live here.

Here's your space with a mat and pillow, and that's it. You sleep, share with other family and sometimes it's so crowded. There's no running water or toiletry; the toilet is so disgusting. And so, it was horrible. But when we were transferred to the Philippines, we were offered better living conditions, like a building with a bedroom with running water and appropriate space to shower, and also, we had more freedom. Well, we can go to the mountain and enjoy the waterfalls. I was there for six months, and I enjoyed life over there. I didn't feel like coming to the US, or it's the best. It's the waterfall, and we enjoy the waterfall every day. And when I came here, I became culture shocked because everything was completely different. When I came on July 6, 1987, I stepped foot in Seattle, and I missed the Philippines so much. Like I've come so depressed from the culture shock, like Go anywhere you don't know your way around. When my uncle sponsored me here, I went to school, and he messed up my birth. I was born in 1967, but on the documents, he put 1970. So, when I came here in 1987, I was 17 on the paperwork. So, they fit me into high school. I never went to school like everything, like it's a culture shock. You're like, oh no. Well, I see the mill like, I guess I thought it was sweet at the pizza, and they all think, oh, my God, you're accustomed to eating rice every day. So, I feel hungry all day. But the first three months, it was a struggle. I wasn't happy being here, but gradually you get used to life here.

13:33

Raj: Yeah, hundreds of 1000s of Khmer came to the US. It sounds like they all had similar experiences as you did in a family community; they all went to the Philippines for the transit camps, right?

13:46

James Hang: Yeah. Lived there for six months. So, adults go to ESL classes to learn English, and for me, they fit me into the schools throughout pass-out preparation, secondary school, and something like that. They teach you the way of life in the US, the history, and how to use the toilet in the US, right? You don't squat, just sit or whatever. But I ended up being an interpreter for the entire school of Khmer students. Because of my English, they tested me in school, so I scored 100% on the test. I said [Not sure 14:20] Madigan, so they sent me around in the school to interpret for opera students.

14:24

Raj: What a story.

14:25

James Hang:  So, I ended up being a medical interpreter in the camp that was up in my mobile rolling in the camp to do interpreting for the community.

14:36

Raj: Oh, yeah. I think you’ve mentioned rice. I think it's a good time to segue into nutrition. I believe rice gets a bad rap. Indian culture also eats a lot of rice. I think rice is the typical base of the meal for Khmer meals. It always comes back to this period of 1975 to 79. Because I think before then, the Khmer empire, I guess, had like 1000s of varieties of rice. They still compete in the international Rice Research competition. Different kinds of rice win prizes. I think rice is an integral part of the culture, but between 1975 and 79, the Khmer cuisine lost some of that knowledge because many people were starved. You were given ration, so you're forced not to cook, so people didn't carry that forward to America. What do you think?

15:22

James Hang:  We do have Khmer cuisine. We have this type of flour. It's flour but very similar but with different tastes and flavors. It's a noodle, and we have vegetables and soup prepared differently. We make it into either a curry soup or lemongrass soup, and the brass to go with the noodle. So, I can't jump that's like Cambodian noodle soup. Now, that's a popular dish in Cambodia. When it comes to noodles, it’s my favorite dish because there are a variety of vegetables. You can put the vegetable into the bowl, as most meals for deliberate are noodles and mainly the vegetable that I put in there and then with the soup and the broth and then enjoy it.

16:05

Raj: Yeah, noodle soup, vegetables, and then rice. Anything else with Cambodian cuisine because you know about that.

16:11

James Hang:  So, we have the meat stick like Shish Kabab we stick to them, and that's with some kind of Picco like papaya salad or cucumber or carrot salad. Yeah, I would love dishes in Khmer. I used to go to the plumping noodle plus the Cambodian style noodle or yeah noodle soup.

16:28

Raj: Okay, good. Part of counseling is also about substances like smoking and alcohol. I was just looking at the statistics, and the World Health Organization said in 2,000, about 41% of people in Cambodia smoked. And in 2020, about 20% smoked. That's pretty high, like one in five. Is that true also in Washington? Do you feel like many people still smoke?

16:52

James Hang: I still see people smoke. But I know people have friends who smoke until they see the effects of smoking. Like they see their family member, friend, or someone they know in the community die from lung cancer or liver cancer. And then they like a wake-up call for them. So, they decide to stop smoking. So, for smoking, I think more and more people have started to cut down on drinking. You're talking about consuming more and more people continue to drink. The new generation they do things at a higher rate because I think it's a social function. And when you join your social function, wedding, where a party gets together, alcohol is the main drink for the functions. So, I hang out with my friends, and they all drink. They pushed me and forced me to drink. But I know that is bad for me. So, I reject it. And so, I have friends who drink and are heavy drinkers who end up in a stroke. Having a bad stroke, he is in a wheelchair, he had pretty much paralyzed, and he was hospitalized at U DUB and rehabbed for a month. He did a sweet 16 birthday for his daughter. He got permission from his doctor to come to his daughter's 16th birthday for two hours, giving her two hours at night. He came in a wheelchair, and 300 skiffs were among all the friends, and they witnessed this effect of the alcohol; that's why he's in that wheelchair. And his message to all the friends that make sure you guys go checkup. I got ahead, had high blood pressure, and continued drinking heavily. So nowadays, in the community, people have started to realize.

19:13

James Hang:  So, in the community, we have several temples here in Seattle and Kent, and Olympia. So, we still go to the temple to celebrate special occasions like Halloween. It got a cost, but we go, and once a year, we do a memorial celebration for the dead like your ancestors. They believe that all the spirits they're out there. So once a year, they go to the temple and bring food, clothes, and everything to offer to the spirit of the dead ancestors. So, it's a big celebration, and also Cambodian New Year. It's in mid-April and varies from April 15,14th or around it. Once in a Lifetime, they do a big celebration. Like I do for my parents. We go to the temple, get the blessing and be thankful to our parents for what they have done for us, raised us, and given life to us. And so, we whole family go there and invite friend, neighbor family and come and join the celebration. And a monk will chan and bless them to have a long, healthy life. In 2016, my parents still lived in Cambodia. So, I went back home, and I did that. So, I become a monk for a week. And we bless my parents to thank them for what they did for us, show respect for them, and bless them with good health and long life.

20:47

Raj: That's awesome. I feel like everybody should do that. Bless their parents for all they have done for you. Let's transition to relevant things to know in a clinic visit. One is with naming. I think there are a lot of problems with the probably medical record because of this. Because it's usually spoken and written in the order of the last name, then the first name, compared to typical American terms, is that right?

21:13

James Hang:  Yes. So, in Cambodia, we usually use the last name, as they use the last name first when they call him instead of the first time, so that is the opposite. And also, the spelling of the name because in Cambodia, we tend to pronounce it kinetically and use French pronunciation. For example, somebody named Pat Ha, Soboba. Pa, right. But in Cambodia, when I spell it, P Ha, ha. So, when you come here, many people in the community, because of that, will accept the way the boss at work pronounces the name, so they end up saying that's not their real name. At first, when you call your name, like PHA, your name is Pi, and someone calls you Fa. And then you sit there like Fa? What was Fa? My name is Pa, but they realized people mispronounce their name, so they recognize it and start to accept it.

22:11

Raj: yeah. It suggests we should clarify what you want to be called rather than assuming. And then, you set the birth dates. Sometimes it's messed up, too.

22:20

James Hang:  Yeah. So, for the birth date, we use day, month, and year in the order. But in the US, we use month, day, and year. So before coming here, they just said September 1, they say 1/9/1970, but we came to America, they thought that January 9/1970. So many people ran into this car problem; this is not my birthday because the system he is in is the opposite.

22:46

Raj: Okay. And clinic visits. Sometimes I also see children interpret for families. From my understanding, when people came from Cambodia, a lot of people could speak Khmer but could not write. Then the children learned English and no Khmer, so they interpreted. How should I navigate that? Because I don't necessarily want the children to, but it seems like they have taken on that role for the family and everything else.

23:12

James Hang:  Yeah. So, my mom grew up in the countryside, she speaks but she does not write Khmer does not read Khmer. and when interpreting, using your family member to beat the interpreter or grab a stat, like a front desk person who the committee assumes that person speaks Khmer, but this big, broken Cambodian for example that happened at

[Not sure 23:36] Pac Man, this guy came to the clinic to see the doctor. And that day, I was busy helping other patients, so they grabbed one of the receptionists to proclaim, and I knew where to go when she came to the US at a very young age. So, she grew up here speaking some Cambodian. Okay, so they use her as an interpreter if the doctor understands the culture because he came in for scrotum pain. Okay? And if the doctor understands the culture, he will not even think twice about asking the question. Are you sexually active? Because he is a monk, right? So, the girl that they have to interpret for that monk, you have to use the term appropriately, so she doesn't know how, so she and Abdullah the F word use the F word. And so, the monk looks like and then he called me and say, Man, why you have the girl to interpret. It was so embarrassing the way she was saying it was so vulgar. So, when they come to private parts, I'm suing in your language it will be how appropriate. I was using a word that's not offensive, though. That's what happened. That's one of the situations. And we have a family member interpret for the mom. The doctor says have you had hepatitis before? The kid said No. Have you had one, but they don't know what the word Hepatitis is? So, they speak half Cambodian, half Khmeran, and half English. They use the word hepatitis in the peasant. So, they are like, what appetite? I don't know why that's not a Khmer word.

25:12

Raj: I think it seems obvious because it takes all clinicians should be trained to use medical interpreters, just out of convenience. Or maybe somebody's not available, and sometimes family members are used. People should know not to discuss sensitive topics like sexual activity or drug use with family members. So sometimes, it's just hard to interpret it.

25:32

James Hang:  We have people who use the suppository; they're supposed to use this opposite story, then patients end up going home and drinking it and come back to the clinic, and when they are asked why are you throwing up? How did you use the laxative before the colonoscopy is how you use it? Oh, I drink it

25:49

Raj: I know. I think we also don't recognize the importance of making sure we talk about every single part of prescribing medication and talking about illness because they leave the visit or the hospital. They go to the pharmacy that sometimes doesn't have the instructions in Khmer. Then they go home. There's nobody to ask, maybe a family member who was there, and they say the wrong thing. So important to talk about, like, from the first step to the last stage of yes, this is depository beating, where you insert it. This is how often you need to. And let's check back in because it's essential to check that understanding or ask them to repeat what to do. Okay. I also want to talk about beliefs around health and my experience with Western medicine. Are there any traditional medical practices that we should know about? Like cupping, pinching, or rubbing? Do people still do that? Can you explain what those are?

26:43

James Hang: Still doing it by routers. He was sick last week, and he did the coining. He's an electrical engineer, right?

26:48

Raj: Everybody's going to know your brother does it.

26:53

James Hang:  So, he was sick last week. He is an electrical engineer. He talked to the doctor like I did the coining yesterday. And so, coining is the most common practice in Cambodia or here too. Especially the elderly, like my sister-in-law and grandma. She's 84. Every time she gets sick, she wants coining. And after coining, she gets it, and she feels better. And only one particular person that she wants to give a coin to. Because everybody else at, your hands are not strong enough. Coining is just a core, and you rub oil on your skin and just rub it with a lubricant. And they have a specific area that they coined. They coin under the shoulder here and end up back at the to define your spine. There are two big muscles. My mom used to pinch me down and coin me when I was sick and Cambodia. It is torture. As I call you my dad, my mom will pin me down and coin me, and I scream to the top of my lungs. But after that, I feel better.

27:57

Raj: People still do it, though, in Washington.

28:00

James Hang:  People continue to do it and pitching to, you know, my dad, he loves to do that. He loves to pinch between here, right? When he gets sick, if he feels that dizziness, I pinch him as he feels better. I also love cupping my dad. I cup until he got a big bump on his forehead right here.

28:18

Raj: Wow yeah. So, there are side effects if you notice anything on the skin sherbert

[Not sure 28:21] could be from some other alternative treatments. I think people also believe things are hot or cold.

28:26

James Hang:  People would say go back to the coining, right? They say your body carries too much air. Yeah, too much air in your body. So, you coin to them to alleviate the relief, that air to balance out. So, you coin to release that air from your body, you feel better because of the hot and cold balance but based on when I was looking at cross-cultural healthcare program, I think her name is Erosan Gupta. She wanted to record

[Not Sure 28:57] over there said based on the study that you did up coining, you know why people feel better based on the study is it coining Because you increase the blood flow. And the coin increases the blood flow into your body. That's why you feel better. And I come to the well, yes, we go when you wrap on your skin, and dilate your blood vessel, right, and so it increases the circulation and makes you feel better. But when people back home believe that, after coining, the redder your skin, they say the more influential the coining is.

29:31

Raj: I want people to know because even if people don't tell you if a clinician doesn't understand this, they're just not going to say to you. They're going to do it anyway. But it's helpful to bring it up and say, do any of these things. And if you are, be careful, don't do it so hard. You're getting skin wounds or bumps. Yeah, and it can be helpful for some people. But just be careful. And there's also medicine if you want to take it. On top of that, if you're having pain in your neck or Back Pain.

30:01

James Hang:  Herbal; they also buy herbs because people still use herbs. They ordered herbs from Cambodia, say somehow a healer from Cambodia, and made a discount herb to treat diabetes.

30:15

Raj: Yeah, I've been with patients, they just show me the bottles, and then I have no idea what to do. They're like; I'm taking all of it. Talking about the leaves, some people don't worry that when we're doing a lot of blood draws, we're taking blood away and not replaced yet. I find that sometimes people don't get labs and don't share that worry with you. Do you think that's also still common? Historically, that's been true because people thought it was painful. It'll make them weaker, and it destroys red blood cells.

30:45

James Hang:  Yeah, especially people who think they are not low blood count. Or they think if you draw more blood and it makes them more anemic. They don't understand that your body replaces whatever you make it. But that's what we do to our people; we do our patients. And sometimes we talk about high blood pressure, right? So, people thought that high blood pressure that you have too much blood in your body. That's why it caused high blood pressure, right? So, they would get a blood draw, which would help with my blood pressure. It's always completely misunderstood what it is. Right.

31:22

Raj: We probably need to spend more time explaining illnesses or high blood pressure because sometimes I just say hypertension or high blood pressure, and I assume we're talking about the same thing.

31:32

James Hang:  Look, I think the best way to explain to a patient that makes them understand you're talking about water, Pipe like water hoses. If you turn on the water too vigorously, the pressure in the hoses gets tight and can explode, or the balloon you put too much air in then explodes. And I explained to people as they understood, but you said the word “pressure,” they didn't get the concept until you gave them an example of something like a balloon and then exploding. So, your blood vessels are the same; with too much pressure, they explode like a balloon. Is it always like that?

32:08

Raj: No doubt. Yeah, it makes me think maybe take that step further, and everybody should use examples or metaphors and analogies when using these terms, or something everybody knows because that helps people understand a concept of what's happening. Another thing I brought up is that many believe when we prescribe medication, it's temporary. I have high blood pressure. So, I take medication until the bottle is empty, then it'll be done afterward.

32:39

James Hang:  Because high blood pressure is not a symptom. So, the most common thing I see, and people talk about is that I don't feel sick and don't need to take medicine; I feel fine. So that's why some of them decide not to take medication. They don't understand how blood pressure affects them until they have a stroke. Then they say, oh, how it is. So that's how the habit people from back Khmer say, only when I get sick, I will go to see the doctor. They don't see this preventive care. Or some people. They say, oh, I don't want to see a doctor. I see Dr. Negative telehealth. This has made me worried. Or they just don't want to hear the truth. Right?

33:16

Raj: Yeah. The last piece I want to talk about is the emotional health of the community. Because we talked about the collective trauma of living through the Khmer Rouge, coming back and being accustomed to American culture, and seeing family members struggle or die to go through starvation a lot there. But I don't think we talked about the mental health of the Khmer population that much. I think there's some shame in talking about mental health. What's the best way to talk about it, or how do we bring this up? How do we make sure people are supported in their healing?

33:51

James Hang:  So, people don't want to reveal that they have mental issues because it's embarrassing to be exposed that you have a mental problem or “mental issue.” Because when you have a mental issue, people will perceive you as like you are a crazy person. When people assume that you are a crazy person, then they feel embarrassed, and people don't want to associate with them. That's mental health. It is taboo. Yeah. So, people will look down on you. And in the past, like when you had a mental health problem, people would chain you back home because you were mentally prob; you bother people, and then you destroy people. So, people don't want to talk about it scared to talk about it about mental health because they don't want people to perceive them as a crazy person.

34:45

Raj: So, as clinicians, what are places we can refer to connect people within the community that will be helpful for their help?

34:53

James Hang: The main community organization is the Asian Counseling and Referral Services.

34:59

Raj: Thank you so much, James. It's been great talking to you. Thanks for taking the time.

35:03

James Hang:  Okay, you're welcome.

35:06

Raj: Thank you for joining us on another episode of the healthcare for humans podcast. I hope with this episode, you will better understand what the Khmer community has been through, and you'll learn nuances of how to take care of this population. Stay tuned for the second episode of the series. And if you liked this episode, share it with one other person and go to healthcareforhumans.org and sign up to join our community. See you soon.

Disclaimer:

This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participant's past, current, or future employers unless explicitly expressed, so always seek the advice of your physician or other qualified healthcare providers concerning your personal questions about medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land and makes a regular commitment to Real Rent Duwamish.

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