Jan. 9, 2023

Cambodians—Do you know what happens to unprocessed trauma? (Jennifer Huong, S1, Ep 11)

Cambodians—Do you know what happens to unprocessed trauma? (Jennifer Huong, S1, Ep 11)

This is Part II of our conversation on the Cambodian community with Jennifer Huong, a DSHS-certified Khmer interpreter and one of the founders of the Khmer Health Board Member. She was born in Kampong Cham, raised in Phnom Penh, Cambodia, escaped to Thailand refugee camps in 1981 and resettled in Salem, Oregon in mid-July 1983.  She has been advocating for the community for the last 30 years as a Cultural Mediator/Caseworker and Medical Interpreter. 

In this conversation, you will  

  • Understand how unprocessed trauma manifests
  • Hear how the lack of community spaces can lead to further isolation
  • Learn how a complex healthcare system can undermine the care that clinicians are trying to provide and what it means to listen and ask about items not on the initial “agenda” 

Next Steps:

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  • Timespan: 18:21 Min
  • Transcription Type: Cleaned Verbatim
  • Speakers: 2 (Jennifer Huong & Raj Sundar)


Raj Sundar: Hi, you're listening to healthcare for humans. The podcast is dedicated to educating you on the aspects of humanity that make you a better healer for culturally diverse communities. These are the things patients expect us to know, but we don't know yet. Let's learn together. 

I'm Dr. Raj Sundar, a full-spectrum family physician and a community organizer. Welcome to Season 1, where we talk about the history and culture of immigrant communities. This is part two of the series on the Khmer community. And if you're just joining us in this podcast, pause it if you're able to, and listen to part 1, where we give more context to the Khmer community and what they've been through, and then come back to this episode. So, we know that healthcare systems fall short in so many ways. 

One way it falls short for immigrant communities is by addressing trauma. Now, addressing trauma is not straightforward. Sometimes people don't want to share their trauma. And we're going to talk about the nuances of this throughout this series. But what we know is that often for these communities right now, what we do is nothing. Well, not nothing; we shuffled them through our healthcare system. Through acute and chronic visits through 15-minute clinic visits to hospitalizations, we try to address their medical conditions. And we give the nod to maybe they've experienced something traumatic in their past. But we never really address it or even acknowledge it. And addressing it, yes, we can refer him to a therapist, if we're really lucky, a trauma therapist. But good luck finding one that speaks Khmer and knows how to deal with massive trauma. 

I know that is something we need to work towards, creating those systems for individual interventions like that. But I want to consider what it means for entire communities to heal. Because they've experienced the same thing together. So as a clinician, you're just part of a system. I know that. So maybe the question for you is, how can you merely acknowledge this or add it to your differential diagnosis when you care for these patients? And if you're a leader with more power and resources, think about what entire healing communities look like. And how are physical spaces important, especially in this age of zoom and virtual meetings? I'm talking about places where people can connect with their physical bodies. And how do we create an environment of healing through that? Here's Jennifer Huang, a Khmer interpreter, and leader of the Khmer Health Board, who is going to talk to us about what she has experienced and doing this work for 30 years, where she feels like the community is in its healing process. Jennifer, let's start with your story. Tell me about yourself. How did you end up in Washington?


Jennifer Huong: I came to the United States in 1983 in mid-July. The first state I resided in was Salem, Oregon. So I was in Salem, Oregon, with my mom and brother. I graduated. Sick and abandoned, I moved to Seattle, went to college, get a full-time job.


Raj: I saw your name everywhere when I searched the Khmer community. So, you started the Khmer Health Board with James, right? And I think you have a lot of roles in society. So, tell me what parts you've had. And what do you do now?


Jennifer Huong: I started my first full-time job in 1993 as a refugee woman bilingual advocate for domestic violence. I was there almost four years hoping, from, I think, early 90, I think 91 to 94 when I moved to Harborview. So, I was there helping learn about domestic violence, assisting clients with English as a second language, ESL teacher, and then creating co-parenting education for refugees and immigrants. Then I came to a community meeting and heard about the job at Harborview looking for bilingual Cambodians. So, I thought this job might be suited more, so I came. They say it's a grant, and it's a two-year program. But I've been with them for 28 years already. So, I learned a lot of stuff from the very beginning. No medical background, no nothing. I was scared and stressing out because I felt intimidated because people were like medical school doctors and all those professions.


Raj: Yeah, so, house call program, you go to people's houses, is that right?


Jennifer Huong: Community House Call at the time, so you provide continuity, interpretation, and case management when they have complications. Family issues, school problems, and parenting. In 1994 I spent my time mostly with many younger children because of the start of gangs and deportation and dropping out of school, running away. So, I spend my time at juvenile and school with the parent-teacher conference and probation counselor on behalf of the parent. Those are the things that I knew. And then, the program keeps evolving and changing, adapting to older adults with chronic diseases such as diabetes, hypertension, stroke, kidney disease, dialysis, and cancer on and on. Then now, the population is getting older – they’re getting people with end of life palliative care, hospice, chronic disease for the past 10 years. So I’ve been learning and keep telling my bosses (?), my salary is still the same. My capacity to deal with covid has been exhausted. I have a lot of people in my program dying.

I don't have the capacity for emotional strain. It hit me, and I feel like my population is already isolated, and there is a language barrier. But then, when COVID came, there was a second isolation. And then it took us back to 40 years ago during the Khmer Rouge. You know, it hit me. Now I'm older. I'm not 30 years younger likeI used to be. So, it hit me harder. I just want to retire, but remember then I don't get my medical insurance. Medical coverage is hard. And now that my children are grown up and independent, but I have two elderly parents. My husband had one. I have one. Somehow my patients don't have anybody, andit’s just devastating.


Raj: Yeah. It's a segue into the history of Cambodia. We talked about this with James. About the Khmer Rouge, right? Yeah, we talked about how more than some people say about 3 million Cambodians,


Raj: were executed almost


Jennifer Huong: Yes. Like 500 doctors in the entire country before that. I think it may be 10 or 15 left right after the war. My father was one of them. My aunt and uncle raised me; my biological parent was also killed during the Khmer Rouge. She gave me to her sister. That's why I was raised with them. 


Raj: You mentioned PTSD, all the physical pain that people experience. But it's actually not physical. It's emotional. How do we approach a population that’s been through so much trauma? The Khmer Rouge was horrific. You were there. RightHow did you process it, if you're okay with me asking it, and how do we help others process this? It's hard. It's hard even to bring it up now.


Jennifer Huong: Exactly. It's hard to process it, and they keep saying, you're doing fine. You're doing fine. Yes, I am doing fine, but you know that there's so much we want to forget it. But then every time you have a crisis, and PTSD provokes it, like an awakening, and I saw that. I told my doctor that with some patients that we know when he was 15 years, and they are like that it was a major surgery coming up, it just hitting everybody and everybody that normal function like me, working, we thought that we were okay, we were not okay until we talk to someone, and someone said, “Oh my God, that's what you go through?” And I say, “Yeah, that's what we go through.” But who can we talk to? Our parents wouldn’t understand it. If you talk with your children, it feels like you give a burden to them. And you thought that they could not process it. So, it's like a generation of mental health. Historical trauma is there. But people don't accept it. Especially a man. We don't see a lot of young men coming to a doctor, as much as a women. Even women, if you don't speak, they don't talk. And then if they told you to see someone to talk about it, they say, “No. Talking about it just brings up a bad memory.” What is the point of, sometimes somebody needs someone to talk to, but they don't have the capacity and education, that understands those kinds of things?


Raj: If you show up at the doctor, I know it's not an easy thing to process, and we don't have the right therapist, and we only have 15 minutes. Is there anything helpful for your doctor to say or help you through? Is it just acknowledging if surgery is coming up and saying, “Yeah, I know? This can feel scary, but you know, it will be okay. And we’re here with you.”


Jennifer Huong: Yeah, it's tough to say, but so when you offer surgery, people will be saying, I don't want it. One is like surgeries is going to be hard to recover. The second is for my support; my children are busy caring for their families. Nobody had time to take care of me. And I don't want to go to rehab. Not many patients have this kind of support. See, we have a temple. Usually, the elder women could go to the temple we call Nun, and they have their period. But since COVID, Temple gathering is not allowable. And then they don't have a place to go. So, everybody's just staying where they are. And even if they don't have transportation, they will figure out ways to call a friend or somebody to carpool and go to the temple because that's all activities they can do - meditation, chanting. But then, COVID. We don’t have community centers like other communities. Cambodians have been here for 40 years. You ask James: we don't have a physical space like Ethiopian, Eritrean, Somalian, Filipino, Chinese, or Korean. We don't have those physical spaces. Andmany ages ago when I started that job, I came from ReWa. I already knew that we need a nursing home, at least for the Southeast Asians, the Cambodians, the Laos,, and the Vietnamese. The hospital cannot find a nursing home for the patient to go to for temporary relief, and the family have no capacity to take [them]. Why are we struggling; why they have the challenges, and why do we have more difficulty than others? Nobody has seen that. I see that because I've been here from the beginning. Every 5 years, I told them, “no, we need this; we need that,” you know,11:35

Raj: it's tough because social isolation becomes especially hard during times of holidays. Yeah. Are there specific holidays that we should know about?


Jennifer Huong: We havetwo big  holidays; I think one is new year, around April 13 to 15. And the second one is like Halloween called Pchum Ben around October. And another one is called  Uposatha which is around September, like other holidays called Moon Festival.


Raj: What about diet and nutrition? Anything we should know about what Cambodians eat and how we should talk to them about nutrition


Jennifer Huong: rice is the main dish. People will say they cannot live without rice. During the Khmer Rouge, people were used to that, and then malnutrition became, but when they came to a lot of food, they say,
why do I have to restrict my diet?” And then when we do education around diabetes, the explaining that rice is one of the most carbohydrates. My grandparents, great grandparents, when you eat those, you do a lot of activity, and you don't have a lot of other sugar. You really have rice and fish and vegetable. But in authentic Cambodian, pure Cambodians mainly eat this and a lot of vegetables. But now vegetables are expensive and hard to grow here, and people don't access them.


Raj: Yeah. Okay, Jennifer, one question I'll ask you is, in your personal experience, has a doctor or clinician made you feel seen and heard when caring for you? And what does that look like?


Jennifer Huong: I went to my doctor, but nobody ever really talked about anything, except if I told her, but lately, I've been coming to see her after college. I said I had a hard time, and they did a little bit and asked me to see a therapist. So, I think it will be helpful to talk to my doctor, and she can understand it rather than just take medicine and therapy.


Raj: what would have been helpful to you? This is important because I think this is why I want to do this podcast. As you went there, you wanted help and left because you didn't feel like you got what you wanted.


Jennifer Huong: if they have at least 10 or 15 minutes to listen to how I seem emotionally, not just I have physical pain, or I came for physical pain, or I look stressed or tired, and they want to know anything wrong anything going on anything you want to talk about. I did tell them I had a hard time with that. She didn't take it further. I told her I have anxiety and stress, but she didn't go down and figure out why I have that, or digging a little bit, , just like rushing. I just want to get to the point if I see you for your ankle pain, and that's it, and if you want to see for other reason, here is the next appointment. I think it is to support bill billing purposes, not to care about me. When I have medical insurance and know I take my time, I pay my money to go because I want expert validation to check that I'm sick or not sick. I'm being abandoned, but at least I am one human being to listen to how I feel. So, for one example, in June, I left work, and I walked to the train, I fell, and I hurt my ankle. And I say, oh, it just twisted and got swollen. And I just stayed home. And until I get better, I see if I go to the doctor, they will tell me the same. No, put a hot pad, take Tylenol, which will save me money, and that's what I did. I got a bit better. I came to work, and my colleagues said, oh, it doesn't look good; you should check and have an x-ray I said, okay, and I just got it. And then the second week, I said, Okay, I have insurance. Why could not I get it? So I went, told her, and she sent me for X-ray. And then let an X-ray, and they told me I needed to pay for two bills. One is for more images, and one is for radiologists. I will say how insurance, hospital, and healthcare in this country are not helpful. And I speak English, and I still have challenges. And then I'm going to say that I was scared there that people aren't going to see Doctor because of the bill. You make it so big a deal. And that's why people don't want to go. I have to call them; yeah, I already have insurance. I will take care of it. That's why I don't want to stress myself. I work so hard. I have this money to pay you to take care of this, but you didn't.


Raj: Jennifer, I think we could talk for hours, probably. Thank you so much for taking the time to do this. I think it'll be helpful for doctors to understand just a little bit more about things happening in the Khmer community. I know many things need to change, like physical spaces for people to gather. The whole American healthcare system is so confusing, especially if you don't speak English and you only speak Khmer. But hopefully, at least the clinician can be more aware so that they can listen a little bit more,


Jennifer Huong: hopefully


Raj: better understand the trauma the population has been through and still carries with them. That's unprocessed, right?


Jennifer Huong: Yeah. I think now, a lot of older first-generation men and women around my age and about It's never been addressed and unprocessed. Nobody hears about it. They do all kinds of things to minimize it. They deny it, and they think they don't have a problem fixing it. And then it becomes problematic.


Raj: I believe that. Okay, thank you again


Jennifer Huong: You're welcome. Bye.


Raj: Bye. 

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The transcript ends here.


Jennifer HuongProfile Photo

Jennifer Huong

I was born in Kampong Cham, and raised in Phnom Penh, Cambodia. After Khmer Rouge, I escaped to Thailand refugee camps in 1981, where I spent about two years in several camps. In 1983 after spending 8 months in a Philippines refugee camp, I resettled in Salem, Oregon in mid-July 1983. I went to McKay High School and graduated in 1987. I moved to Seattle and went to Seattle Central Community College for two years, getting my AA degree. I started work at Refugee Women’s Alliance in Seattle, Washington in 1990 as a bilingual advocate for domestic violence. In 1994, I started work at Harborview Medical Center with the Community House Calls program founded by two medical directors. My role was and continues to be as a Cultural Mediator/Caseworker and Medical Interpreter. The program just had its 26th anniversary on April 18th, 2020. I was one of the first staff with this program, along with five colleagues from East Africa. The program now has ten caseworkers/ cultural mediators in the program, and we provide a bridge with patient/family/community and healthcare teams to provide culturally sensitive care In 2015, I completed my BA of Applied Behavior Science in Social and Human Services at Seattle Central Community College. Three years ago I was very fortunate to work with my colleagues from Public Health to start the Khmer Health Board (KHB). I am very proud and excited to see KHB established and moving forward with many generations that had passion and commitment to help our community.