Healing across Cultures: The Cham Refugee Experience in Healthcare (Tagoipah Mathno, Ep 20)

• Timespan: 44 minutes & 39 seconds
• Transcription Type: Cleaned Verbatim
• Speakers: ( Tagoipah Mathno & Raj Sundar)

00:00

Raj Sundar: What does it mean to hold the identity of being chopped an indigenous group in Southeast Asia?

0:05

Tagoipah Mathno:  Even though I've been lucky to be surrounded by rich diversity, I still was surrounded by this narrative, this commentary that you guys came out of nowhere. You have no history, and you don't have a voice in some sense, right? You're not supposed to exist. And it's just as a kid, I either hid internally, never talked about my identity growing up.

0:28

Raj Sundar: Hi, I'm Dr. Raj, Sundar, a family physician, and a community organizer. You're listening to Healthcare for humans, to show dedicated to educating you on how to care for culturally diverse communities, so you can be a better healer. This is about everything that you wish you knew, to really care for the person in front of you, not just a body system. Let's learn together. Welcome back to healthcare for humans. You just heard from Tagoipah, a social worker with a decade of combined experience in coalition building and organizational development. In today's episode, we're talking about the Cham community, and indigenous groups spread across Vietnam, Cambodia, and Malaysia. The Cham people are one of 54 ethnic groups within Vietnam alone, and helps us see what it means to have an identity that transcends nation state boundaries. So what do I mean by that? Well, many communities around the world don't have a nation to call their own. One of the most prominent examples of communities whose historical territories transcend current national boundaries are Native American tribes. Take for instance, the Duwamish, Navajo Churkey, among many, many others. These tribes possess distinct cultural identities deeply rooted in their ancestral lands, and their historical territories extend well beyond the confines of our current national boundaries and precede the establishment of modern nation states. The absence of a nation for indigenous trarchitectureibes means we have a tendency to erase their identity, as our current understanding predominantly revolves around the connection between culture, identity, and a physical homeland. This is also true for the charm people. There charm community has a rich and ancient history that stretches back over a millennium. The charm people established a civilization along the coast of what is now central and southern Vietnam. They're known for their shipbuilding seafaring and created impressive architectures. Successive waves of invasions during this period led to the decline of the Empire. Today, the Cham people are dispersed across different regions of Vietnam, Cambodia, and Malaysia, and are striving to preserve their cultural heritage and maintain their unique identity. I want you to know all of that for this episode. But ultimately, the point is not that you should know of every indigenous tribe or ethnic group in every nation, but to recognize that identity can transcend national boundaries. And know the indigenous group that you interact with in your life where you live. This understanding is especially important for the people who hold the label Asian, which is a broad and overarching label that encompasses a vast array of different cultures, and fails to capture the nuances and variations within the Asian continent. Yes, it's a continent, right? Being labeled an Asian can mean a lot of different things. I think of identity as a multifaceted tapestry woven from different threads, including religion, heritage, and personal experiences, sometimes linked to once nation and sometimes not. You'll hear Tagoipah share today her experience identifying with Cham, and Muslim more than Asian today. I hope all of us can honor these nuances, because it'll help us better comprehend and engage with the complexity of human experiences. Without further ado, here's Tagoipah. Welcome to the show, Tagoipah.

4:10

Tagoipah Mathno: Hello.

4:12

Raj Sundar: Tell me about yourself before we get started.

4:14

Tagoipah Mathno: Yeah, so my name is Tagoipah. I am a second generation Cham person from the Cham refugee community here in the greater Seattle area.

4:24

Raj Sundar: Today's episode will focus on your identity, as you said, Cham refugee. You said that together I want to clarify. I was going to just say Cham but you said Cham refugee. Why did you use that specific terminology?

4:38

Tagoipah Mathno:Yeah, so I say that because there's a big difference when we talk about in general immigrant refugee communities is that refugees are a group of people who didn't necessarily want to leave, they're forced to leave. So I want to be very clear about that. That my family, living in my community came here during the Vietnam War, they were forced to leave. So I always bring that up. I'm a second generation, I was born in America, but my parents are refugees as they had their way and they want to come to America. My family and my community are refugees due to the Vietnam War. And during that time as well, there was a lot going on with the Khmer Rouge. So my community was escaping the Vietnam War as well as the Khmer Rouge at the same time, so they were fleeing literally for their lives, not knowing what was gonna happen.

5:31

Raj Sundar: Yeah. Let's talk about the identity of Cham. What does it mean to be charmed? Because I've actually it's, there's, I want the real answer. But let's start out with a definition answer to which is, who are they? Because I don't think people actually know and a lot of people don't know who Cham people are.

5:51

Tagoipah Mathno: Yeah, so I say Cham, people are indigenous to the lands of Southeast Asia. The land that most people know nowadays is Vietnam and parts of Cambodia. So we're a smaller ethnic minority group, but we're one of the indigenous communities. And I say one because there's so many different ethnic groups out there that we just don't know about, or we're not taught about.

6:12

Raj Sundar: Yeah. Yeah. When I read about the history, they were descendants of the people who once ruled the kingdom of Chava, which existed from seventh to 15th centuries. And it was a major center of trade and culture, and actually had a significant impact on the development of Southeast Asian civilization, overall. And they had a history of being conquered and ruled by many different empires, including Camai, Vietnamese and French. And they're now a minority group in Vietnam, Cambodia and Malaysia. There's a large period of history where Vietnam specifically took over the kingdom of Cham. And because of that people, were either forced out or assimilated, and in sometimes very violent ways. There's periods of history where cham people weren't fully welcomed into the country. The other note to make about people who identify as Cham is that there is a large percentage of people who are Muslim, and it combines Islam with traditional Cham beliefs and practices. So like boss are often very beautiful, and they say, "impressive". How does that resonate with you?

7:24

Tagoipah Mathno: Oh, greatly. Because usually when I encountered people, they don't know the what Cham mean, or if you do, that means you grew up around us and with us. That's usually the two facts I encounter in my lifetime. So that's like, Thank you for the signal of various third, we have such a long, rich history. And I think what a lot of people learn about Southeast Asia is more so through the lens of the French colonization. And what I mean by that is not even learning about how France colonized Southeast Asia, but more so who has held the dominant narrative of te history of Southeast Asia and has been the colonizers. And so no one here is about the Cham community of the Champa Kingdom because what people tend to ask me oh, what country is it? And I'm like, we then have what we call a country we had a kingdom way back in the day before all these borders were built by white Europeans coming in and trying to tell us like, this is how you're going to female we were all kingdoms, neighboring kingdoms, with our own learning our own government or our systems of rule. And ours was champa (Champa) when I was growing up, you hear the Champa Kingdom name but as I got older, it really sunk into me, making me question Oh, internally, my community, we talk about our people in terms of kingdoms combating again, the dominant narrative, but outside of my community. The way people would ask me questions, like, "what country is that?" and really trying to force me into this box, this narrative, only a very narrow lens of what they know, right? And that was problematic. Because I don't fit in any box that they've been sent to me in terms of main media, right? And just looking down to the only no major countries or Cambodia, or Eutopia. And unlike no fandoms and people are going like, Oh, are you Indian? Are and then they start they are you Mexican? I've done legit and so they're only meaning really well known countries. And they just shows me like mad we really haven't been taught to really criticize, like, where's our lens coming from? How has it been shaped in the way we pre-ask an approach to get to know other people? How is it in some ways oppressive onto the other? Well, it's like misidentifying them.

9:34

Raj Sundar: Yeah. Especially in conversations with indigenous communities, I think this understanding of your identity is linked to some artificial boundary of like nation state boundary. And if you're not part of the nation state boundary, like who are you? Is there an original nation state boundary for I can't even imagine you could live in a place without the you know what I mean? And I think for the Cham community, there's about 2 million people in Vietnam, Cambodia. And I think I want to emphasize that point that when somebody's from Vietnam, it doesn't mean they're Vietnamese, like they could hold a lot of different identities. Do you ever say "my family is from Vietnam"?

10:24

Tagoipah Mathno: Yeah, I tend to follow up saying that my family's from Vietnam, but we're not Vietnamies. Because an automatic saying "so your Vietnamese then?" Then they try to argue with me, and I would say "no, I'm Cham.". And they're like, "No, you're Vietnamese, because your family's from there". So that means their nationality is the first off hold on. I wasn't born to Vietnam. I've only been there once in my whole entire life. And to just simply erase the fact that I said, No, I'm not just really shows like, why are you trying to place certain identities upon me just because you can't comprehend or understand?

10:55

Raj Sundar: What? Can I know what those reactions are, if you feel comfortable sharing.

10:59

Tagoipah Mathno: Here's the thing. I grew up and raised in America, my parents, they have US citizenship. So to also erase that identity away from us that we are also American, in our own way, in our own right. It just shows what are you saying that we also don't have roots here in this country in this land, even though we're forced to come here. And then to also say, place an identity on us that has been oppressive. And like you talked earlier about the colonization, so we had a kingdom, but of course, that neighboring kingdoms to battle it out for land, or power, or whatever, even though that has happened so long ago, and like ancient times, there's still this feeling of you're still trying to conquer me. It was like, first off, now we have our own language, we have our own history, we are on our people. So that's comes up for me on one and the other people likely I don't know what that is some curiosity is just gonna be a conversation is gonna be an argument or a debate. Let's see our tones here. Some people genuinely have not heard. So I gotta give grace at that. I've never heard of the Cham community before. Tell me more. I've had people who really has politely just asked or to say thank you so much for sharing that information with me.

12:06

Raj Sundar: There's a way to approach that with kindness. I also want to reflect back that was a powerful analogy to talk about what is being conquered now feels like where another identity is imposed on you. Right? So some context for folks who are listening because this month is Asian American, Native Hawaiian Pacific Islander month. We don't acknowledge the Native Hawaiian and Pacific Islander communities enough, right? That's a fact. But in the Asian American Community, even most people in that community are Chinese, Indian, Japanese, Korean, maybe some Filipino. So we've forget actually, the Asian American Community is also large and quite diverse by themselves. There's way to categorize this for people to have general understanding of what this means. East Asians are Chinese, Japanese, Korean, could say Taiwanese. South Asian is India, Bangladesh, Pakistani.  South East is Burmese, Cambodia, Filipino, Malaysia, Vietnamese. But there's different countries, which is obvious. But today, we're really focusing on even within a country, there's a lot of diversity, that's important for people to know. So you're not imposing that country's identity on to indigenous population or smaller populations who live there. So Tagoipah, that was a brief rant, but reflecting back on your personal experience growing up, as somebody who holds a Cham identity, how did it feel, being a minority within the Asian community in many ways, right?

It's interesting, because growing up, I have been really lucky enough and bless the habits surrounded by such diversity that really also showcase some of my culture. I grew up with the East African community who are also you mentioned like pseudo Smalley patients who are Muslims. So it's interesting because I would tell people I didn't consider myself Asian until college. And the reason why because you mentioned it, being a minority within a minority, right being an ethnic minority within another minority groups that also intersect that with like religion being belonging to a Muslim community, practice Islam. And it's just there wasn't anyone else that looked like me around me that was both Asian and Muslim at the same time, but I would connect more so with my East African peers, my Somali peers and or even other cultural elements, because a lot my Asian friends were third generation, while again, my other peers were Ethiopian or a smiley, right. They were second generation are also from the refugee community so we connect them more culturally. So it was a really interesting identity developed for myself. I felt To be honest, really removed from the Asian community. We went through different things in our homes and what was acceptable I come from a very traditional household, there's like very traditional patriarchal gender roles. Focus was like certain things where I wasn't allowed to mix with the opposite gender. Well, my other friends, I have friends who are guide, but then for me to navigate differently than my other peers who are Somali that we get it like we kept it, like, we don't have to say it. And also what contributed to me not identifying as Asian growing up is that I kept hearing the narrative that from other Asian particularly, I will say this from the Vietnamese community, we want to hear people say we came out of nowhere to their land, like we were the outsiders. And my sister had an experience where one time she was, I think, on campus at the University of Washington with a friend as she was meeting a mutual friend or something for the first time, and he's Oh, wait your child. I thought you guys don't exist at all. And he was very, like, adamant about that. You guys don't exist, you're extinct. I know, as she was like, sorry for exist.

13:50

Tagoipah Mathno: It's interesting, because growing up, I have been really lucky enough and bless the habits surrounded by such diversity that really also showcase some of my culture. I grew up with the East African Community who are also you mentioned like small patients who are Muslims. So it's interesting because I would tell people. I didn't consider myself Asian until college. And the reason why is because you mentioned it, being a minority within a minority, right being an ethnic minority within another minority groups that also intersect that with like religion being belonging to a Muslim community, practice Islam. And it's just there wasn't anyone else that looked like me around me that was both Asian and Muslim at the same time, but I would connect more so with my East African peers, my Somali peers and or even other cultural elements, because a lot my Asian friends were third generation. While again, my other peers were Ethiopian or a smiley, right. They were second generation are also from the refugee community so we connect them more culturally. So it was a really interesting identity developed for myself. I felt to be honest, really removed from the Asian community. We went through different things in our homes and what was acceptable I come from a very traditional household, there's like very traditional patriarchal gender roles. Focus was like certain things where I wasn't allowed to mix with the opposite gender. Well, my other friends, I have friends who are guide, but then for me to navigate differently than my other peers who are Somali that we get it like we kept it, like, we don't have to say it. And also what contributed to me not identifying as Asian growing up is that I kept hearing the narrative that from other Asians particularly, I will say this from the Vietnamese community, we want to hear people say we came out of nowhere to their land, like we were the outsiders. And my sister had an experience where one time she was, I think, on campus at the University of Washington with a friend as she was meeting a mutual friend or something for the first time, and he's Oh, wait your child. I thought you guys don't exist, at all. And he was very, like, adamant about that. You guys don't exist, you're extinct. I know, as she was like, sorry for existing.

16:07

Raj Sundar: How did you reincarnate? I could come here.

16:12

Tagoipah Mathno: So, you know. So growing up when you have, even though I've been lucky to be surrounded by rich diversity in South Seattle. But I still was surrounded by this narrative, this commentary that you guys came out of nowhere, you have no history, and you don't have a voice in some sense, right? You're not supposed to exist. And it's just as a kid, I either hid internally never talked about my identity, growing up until I got older to college. And I think some people will have the experience of what we were taught to assimilate and to quiet and whitewash ourselves. Right? I actually had it so lucky that my community, we're very prideful in our identity, that we're like, No, I will forever say I'm a child, Muslim, American. Before I will say I'm Asian, because they taught me at an early age that this is who you are. And at home, right? You speak down. Don't ask me to speak because I was like, Oh, my. So embarrassingly bad now. But as I gotten older, but yeah, I give praise to my community, my elders, for instilling in us like who we are at a very early age, he is you're charming, you're Muslim, or you're Muslim, and you're Tom, don't hide from that. That's who we are less, I would say. My community is the one that really steered me to the path of social work on supporting and helping others because that's of the teaching of Islam, right? You live within your means. But you're always are doing the best to better the community to support everybody else around you at the same time and social because the only career that really resonated with me because of those the teachings and values I have from growing up in my community. But yeah, so I have just been so lucky in my community. And still that What did me there's household of stories where you might need some charm people who have a Vietnamese last name. And that has to do what you mentioned earlier assimilation, for survival. I don't blame those folks, because you do what you do to survive. But I also have relatives are hardcore, no, we're keeping our Arabic name, we are not changing anything. So I just have to say there's like strong resilience and quietness and just that's really powerful. I have to give kudos to my elders for instilling that in me early on that I know who I am. And I didn't realize until I got to college, and I got to my social work program, meeting other students who were on their own journey of just owning their identity and relearning their roots. And I'm still learning about what is the history of our people. But I was really blessed. I didn't realize until college just like this is one of the areas that I feel like was a gym. For me, especially that really prepared me to be strong and advocating for myself, my people or other communities who have been marginalized, like how do we stay true to our voice, especially when I was doing youth work, I would tell us do not westernize your name. If you can pronounce it complicated European names for Hollywood celebrities, we can see all we can say your name. You correct me it was also a way to show young people you have the power as well to correct me as an as you're older, that I also have a place for growth like this is to respect you and who you are when you come into like when we come into the space with each other.

19:35

Raj Sundar: There's so many parts to that I want to repeat back to you on as I think about identity in that we all hold a multitude of identities. We have the choice and autonomy to choose what fits for us. So it's mostly about the person choosing that for themselves. So people who are interacting with you. The problem is that they're imposing an Asian identity aren't you? You may or may not right? There might be some Cham people are like, Yeah, I'm Asian, right? Yeah. And that's fine. But that's not how you identify. And so it's important to respect people's layers of identity and what they grew up identifying with or feeling close to, because of values, beliefs, whatever it was for you was Cham, and also Islam, because of common experience and shared values there. And a two is about being a minority within a minority. Right, we talk about the Khmer Rouge we've talked about even in this podcast, and how the Cambodian people have suffered a lot, right? So we're trying to support that community. But when you're a minority within a minority, we don't think about other people within the community.

20:43

Tagoipah Mathno: Oh, completely. There's a reason why, e ven though like, obviously, like the US now versus 50 years ago, looks completely different. And you hit it earlier, like my intersecting identities really created a lens of how I view and approach the world. What I mean by that is, I can only see my work or whoever interacting with only the lens as a Cham person or Asian person, as a woman, as a daughter, or second generation or whatever I can't, because there's so many other layered identities connected to it. And I forgot to also mentioned spiritual identity, in terms of Yeah, the Asian community that the dominant narrative is that most Asians are not Muslim, even though the largest Islamic country is an Asian country. So I Yeah, because when we talk about social justice work, and it's been interesting, in some spaces are people who are now just coming into realizing how oppressive systems are right, that we always tend to view things from, we're always the victim lens, and for some folks of color, and I'm just like, hold on, stop. Yes. There's a whole long history of colonization from white communities on communities of color. But have we also looked at other communities of color to have their history of colonization, oppression and violence? Let's look deeper. There has been are we also acknowledging that not only have we been hurt, but can we cause the same amount of damage and her onto other communities, some friends of mine weren't ready to have that conversation. And then some years later, I just realized that my ancestors are the oppressors. So it's really interesting that we don't talk enough about what is the complex issue, they're in relations to one another, we've been almost named as completely non-existent. We're visible, we had communities who had tried to literally wipe us out with any written document. So we're just not there at all. But we don't have enough of those conversation. It where do we talk deeper terms of those systems of power? Where is that contract coming from? How harmful it is, right?

22:54

Raj Sundar: Yeah, I think it's an important lens, because now we bought all lumped it to white and bipoc. I'm bipoc to. Okay, yeah, I didn't do anything. Let's let's talk briefly, or as much as you want, but the richness of Cham tradition. I want to talk about what memories you have what you still think of as "home" like that feeling of these people stay, right?

23:23

Tagoipah Mathno: Yeah, it's the mix. And the thing with culture it's interesting that it changes over time and generation especially now we're in America. Cham folks here versus Cham folks in Vietnam or the way my parents were raised, completely different instead of holly change and the next generation after me. I think the biggest thing when you talk about the Cham community or for me, is just the gatherings I think most folks will say that right? For what weddings, for example, I always tell people this that it's a very communal thing. Weddings are embedded in my memory because you would have the grandmas who are the headshot: meaning they're the ones who dictate the menu on how certain things will get close. They are the leading command for this wedding for the suit. Now, the people who help cook the food are all the aunties and uncles whoever is around not just family blood relatives, but anyone in the community. And we have this I will say this like beef, like a thick stew back in the day before we had pre-shredded coconut like you would shred the actual coconut by hand on this like wooden stone with a metal like reading of the end to scrape the clock as you're grounded overnight with a big pot. like legit it's like shears you're because you're feeding the masses. you're feeding the whole entire community. But what like wonderful about it, everyone pitches in just drop by the wedding house and pitches where they can and when we do for like bridal nights the dessert you would hit up certain people that can be who are known for certain types of desserts and dishes and become together and cooks everyone has a role and men are cooking all night long, I don't know how late they might get like a two hour nap. And if they're lucky or something, and like the younger kids, I did the sweet like, I knew how to cut certain things a certain way for all and I was able to pass that knowledge on to the next generation. So I would say food is number one. And I think also the way we dress. So again, I mentioned with Muslim, there's a different way we would change our outfits. And our traditional outfits are very colorful. And in Southeast Asia, there's always gold everywhere. And the way we work the jobs in Vietnam is it wasn't like full coverage where some people went, I know that you cover your neck and everything, it was really different. So there are certain even clothing that they don't make anymore, that I grew up with. And I regret not trying to convince my mom to buy more of the 60s almost like artifacts. So they're just like certain things that was like a blend of both the Southeast Asian culture and Islamic culture together for my upbringing.

Yeah sounds incredibly delicious. And I think communal, right? I can imagine everybody contributing for this sweating and people coming together. And sure begun, and I think that's the way to do celebration. Okay, last part of this episode that I wanted to cover was about you receiving a health care. Maybe I'll start out we've talked about identity a lot. How has it shaped how you've received health care? Or no way that has been helpful or maybe not? Don't know how it's affected it when you've had interactions with healthcare system throughout your life?

25:55

Raj Sundar: Yeah, sounds incredibly delicious. And I think communal, right? I can imagine everybody contributing for this sweating and people coming together. And sure begun, and I think that's the way to do celebration. Okay, last part of this episode that I wanted to cover was about you receiving a healthcare. Maybe I'll start out we've talked about identity a lot. How has it shaped how you've received health care? Or no way that has been helpful or maybe not? Don't know how it's affected it when you've had interactions with healthcare system throughout your life?

26:32

Tagoipah Mathno: Yeah, so bless my mom. I don't know how she did it. As a refugee woman who barely spoke English, she navigated the healthcare system somehow with a family. Making sure that we were at all our doctors' and dentists' appointments. I don't know how she did it in also navigating social services and making sure that it was taped to, we were fortunate, I actually grew up with Neighbor Care. And they were one of the very few spaces I saw like Southeast Asian artwork on the walls. I believe it was the embroidery from the Hmong community on the walls. And I grew up with that, seeing that all the time. Until I got older, I was like, Oh, I recognize this artwork. Because I seen it in my healthcare clinic as a child. In the fact that I was very Southeast Asian, I could see the details of it. I was like, I was being seen by the Healthcare Clinic in LA and this particular health care clinic, there were a couple of folks who I believe were able to provide in person translation for my mom, but most the time, not. I had to push her like, hey, was there an interpreter? Do you understand what's going on here? She explained it to me. If not, then who can tell there's still a push and struggle for it. And I think because for me, like I mentioned earlier, being so blessed to have been raised in a community who valued on holding your identity at the center, to not let other narrative dominant culture influenced that, you know, to always have a translator for us, you know, there were Muslims, because they have Muslims on staff as their medical assistants. And my aunt was one, and I wrote recognize one of the providers who stands up or we would recognize the same Vietnamese or Clyde translator has been there for like over 20 years or so. Because they know the community means then that will like that. It's like they're the life support. They're the bridge between the systems. And that shows you if they leave, oh, man, I don't know what what happened. It's really hard. And again, I'm very privileged where to navigate some of those things because I speak English. And I know what are my rights, and I'm very the opposite. I would say the older generation who was also taught to stay quiet or cause trouble, because you don't get kicked out as country because we don't have citizenship yet because we're refugees. When my grandfather was alive, he had a doctor's appointment. I specifically wrote for an interpreter. And when I showed up with my grandparents to the doctor's appointment, they like Oh, get rid of the interpreter. And I'm like, I don't speak Vietnamies. My grandparents speak Vietnamese. I could barely speak down. I speak English. So I was so upset. I for sure complain. And the doctor was like rude. I'm still seeing that struggle now in healthcare clinics with my family. And it's very frustrating.

29:11

Raj Sundar: What's the gap? Both places have interpreters, right? I think there's a part of both language and cultural interpretation, maybe? Yes. Like some clinics do it well, others don't. We all know that if you interacted with those clinics, but where's the gap? Because it took a while for people to acknowledge interpreters are important, right? I don't know how that was ever possible. But I think people will acknowledge that. So mostly, I see access either through in person or some industrialized solution with video cams or connecting to a bigger interpreter service. But you're right. I personally have seen patients leave some of my visits. And I'm like, I don't know if they fully understood what I was trying to communicate either because there's one type of interpretation where they are being culturally responsive. To get the message across from what I'm saying, there's another word cut, they cut out a lot of things that I'm saying, they self-filter, because they're like, oh, they won't get it anyway, I'm not gonna say it. So I, as a provider, sometimes I'm in that place of I don't know what to do next. And how do I best support either systems or this individual interaction? So for example, in your mom, let's say I talk about diabetes and hypertension, for 20 minutes. After that visit, I can be like, yeah, like, I think we both understood each other. And how do I make sure to get to that point?

30:34

Tagoipah Mathno: Oh, that's a good one. I appreciate you breaking it down, what is the gap? Especially no interpretations need it. But it's more than just that right? Is? How does your patient in front of you grasp what helped me to them? They think in terms of health care in the US, we have such a Western lens on it, we treat the symptoms, but you don't really, truly treat the wholeness of the person. And now we're seeing a such connection between the mind and the physical and emotional all of it together. And I would say, here's the thing, I come from a refugee community. And if you can't see the threat, it's not a threat, right? And you can't see that humans within your body. I'm fine. I could still physically get up. So I'm completely fine. What does health means to them? I think that's the thing. That's the in terms of the cultural gap, like how can you understand your patient coming in? And how do you communicate in some phrases or use certain words, that's going to resonate with the doctor my diabetes? Yes, you could take your medicine, they know that pills were at a certain time, because that's doctor's orders, they have it, my mom has it. But my mom still doesn't grasp the fact that we should use less sodium in your food, even though fish sauces and everything in southeast food, maybe there is a fair conversation again, with interpreters understand the importance of like how to translate certain things across. And there's also for interpreters or the patients to their medical staff, you're gonna give me scientific stuff, I'm not going to remember. But if you're gonna tell me that I need to cut out fish sauce out of my diet, I'm gonna remember that. And I need to know why it has to be a really good reason why I need to cut it out. And how do we talk about health in a different way versus from a science? I think once you get to know the community, the patient comes from, like, their culture and everything like that, then you might have a better way of okay, how do I approach the topic on this? And this, to make sure they leave here understanding why I recommended this or something like yeah, to the last time they don't know, they're just like, oh, we just do it, because we're told, that's it. And here's another thing too, when I said that something triggered within me was that we're not taught to critically analyze anything. And I think for some patients, for folks from certain immigrant refugee communities, they're not taught to question anything back. They're just taught to Okay, as is II said, as is. And my parents generation were taught that I on the other hand, was like, wait, I need to know more information. So here's another thing too, this is where I experienced that there's a language barrier. Not only that, I don't speak German as well. But the language barrier that I encounter with my elders, we have a different way of speaking, I'm very direct and blunt. They have more of a roundabout way of talking. My uncle describe that we have a more flowery language, but your approach to explaining things I was like, that's a good point, I have a very direct way that comes off as really harsh. I can't speak the language, my native tongue anymore as much. But it's the way I approach my conversation with some of my elders, that really puts a gap between us. So maybe that's something also we need to go beyond like, direct language, but how are we presenting information? How is our tone of voice? And how are they interpreting what we're saying? The way we're presenting information?

33:50

Raj Sundar: Yeah, all excellent points. And I think you talked about it very eloquently. But my question then is, okay, so let's go back to the situation that I was talking about, where I want to have a little more confidence in what's been communicated. I think there's a gap in how clinicians communicate, right? Let's go back to hypertension. This medical diagnosis that is supposed to be defined as high blood pressure. And then you're like, what is blood pressure? Because when you talk about blood, people think of different things. So you need like probably a good analogy or metaphor. It'd be nice if the clinician was using plain language and could have a conversation with an interpreter because I think this is a Western paradigm where they're not supposed to be in the room, right? They're just here as a third party interpreting, but it'd be interesting to use them as a cultural navigator at the same time, right? There's this concept of high blood pressure, which is your blood vessels are have high pressure, and they're going to lead to stroke and heart attacks. Can you help me what are some analogies that could help the interpreter and it'd be like, hey, like, what about this? There's I don't know, I don't know if that captured, but why don't we use the second one? Okay. Tell that to the patient. Okay. Did they get it? Because actually sometimes like you'd see the patient when they get it and they don't get it.

35:09

Tagoipah Mathno: Yeah, there’s almost like a realization that goes over their whole mind.

35: 13

Raj Sundar: Like, I get it. Like, why that make sense? So achieving that reaction, it’s almost like outcome that I’m seeking. I do feel like I haven’t thought about it enough. But just the current way we're doing it sometimes misses that because this is a common occurrence, not just the appearance. Like a lot of times I have visits with patients that have had a diagnosis for five years. They're just "I take the medication, because the doctor told me to. And I'm taking it, so I must be fine". Because you told me to take it and I take. You're right. I'm glad you're taking it like it's a little more complicated. And the second part that stuck with me is that it's one thing to say you have high blood pressure, we need to decrease the salt. It's another thing to say. You do have high blood pressure, we somehow communicate that. And what could be helpful is cutting down the fish sauce. They're like, Oh, yeah, I eat a lot of fish sauce. You really want me to do that? Like, yeah, like a little bit, it has a lot of sodium, I don't need you to give it up. It's clearly an important part of your food. We got to say that too. Because sometimes we believe up saying the doctor told me to not eat fish sauce Who was this guy? Like? How am I gonna eat any of my food? So it's like being specific enough to incorporate people's whole identity of what's important to them? And also not asking them to give it up, Right? As you're saying the whole health? There's probably a conversation, we could have that. But how do you do that effectively?

36:35

Tagoipah Mathno: You know what I think the fact that the only times I hear providers approaching this like really authentically wanting to make sure they're supporting and serving their patients from this lens, are, most of them are doctors of color from the community. And he always asked his question, how can we better approach talking to our patients who are especially from different cultures and oral I think it's smart and responsible to have that relationship with interpreters. Hey, your role is really well. And I understand that you're not supposed to stray off the narrative. But is there an agreed upon, we could talk about metaphors, please navigate me, I'm really pressing you. You're right. There's a power dynamics with the doctor and the patient, but also with interpreter. So some of that some folks might be like, You're the doctor, and you tell me what to do. And I can't go against the rules. No, go back and break some rules. Because who set the rules? The people who set the rules are folks who don't look like us and who don't understand our struggles. And so again, let's push back. And I think your approach of just let me talk to the interpreter. We use these metaphors. Well, we'll have the interpreter have buying into this conversation of the patient's health. I think it's going back the patient's health. There's a whole community structured around it is not just you at the provider, you need the interpreter. But I say yes, how are we not just talking about the facts? But how are these information interpreted? How's it hitting, right? Because like you said, you have explained in English, you talk about high blood pressure, you're gonna lose me, unless you're talking about how does it feel within my body? What's causing it and what's long term? And how does it connect to my values. And I will say this also, just because I'm a woman of color, we never sent ourselves we're taught to center our families and everyone around us. We're taught to take care of everybody, right? We don't care enough about you know what, your family is important to hear that. But your family can't be there without you. So you need to take care of yourself. For my mom would be if anything happens her oh my gosh, I wouldn't not know but what happened to my family. She takes care of so many people that ricochets out. If she was to fall sick, and that's it. You can't watch these young kids. Their parents can't go to work, pay the bills. She can't watch my grandma, chickens of my uncle's make sure they meet their appointments and they get their medication, things like that it ricochets out. How are we talking about health here, not just only the individual in terms of physical ailment, or what they're feeling and talk about holistically. I found a holistically outside of their bodies and how it ricochets the people around them. I come from a community where in this also stems in the teaching of Islam. That it's not about the individual, we're part of a larger system. And I think that's beautiful, because my role is really crucial to this other person, or to someone I never met before. And how do you talk about Altair in that way. They might shift your paradigm to something like Oh, okay, this might be the solution. So it would be been looking for.

39:27

Raj Sundar: I think the birthplace of Western medicine, which has spread throughout the world, is this individualistic nature, right? We can unpack that history, but it is that based on one on one visits and I'm treating this individual so that relation and interconnectedness is almost never there when it's acknowledged but that's not the core of it, right? I'm taking care of you and your family and community through this interaction. That's so much more powerful if you actually approach it through that lens, but nobody's trained that way in our systems, really are not designed to be that way. And then to have what you said of their component of acknowledging and honoring the culture and beliefs and values that a community holds of, hey, as Asian woman, you've centered everybody around you your whole life, maybe not. But expectation has been there in different forms. I want you to be healthy,because it'll help you take care of others better. There's like honoring that expectation, but challenging it at the same time. But like, it's also important for you to be well, and I, as a doctor want you to be well healthy and happy. And I don't know if other people will say that to you. But I do. And you have to do that respectfully, right? Because they think of the native Hawaiian episode that we did with Dr. Miley totally, this came out pretty explicitly where I said something about how we talked about living longer all the time. And she was like, that's not really going to resonate with a lot of people, because we're already suffering, and so much, and just saying, like, you're gonna live a lot longer. That give me "Oh, like, that's not a great selling point. But if you say, I want you to live longer to pass on your wisdom to the next generation, and that is something really meaningful. So navigating this honoring and challenging when appropriate, I think.

41:08

Tagoipah Mathno: But yeah, that's a good point is like, we're approaching health in a way and we come in with our own assumptions of what we might think a patient might hear that's valuable, like you said, a long life. No, we need to get healthy and happy. That's more valuable. How do you talk about I want you to live a life of little pain as possible. Little suffer as possible. Oh, how does it feel to not have your ankles hurt all the time when you're walking? When you're having to stand on your for your job or your care taking? How do you feel to not pull your back in some of them may have never know what that might feel like. And they probably have never been asked that before. So it's probably important, it's really crucial at times with the patient and the doctor relationships. You're in a position where you could actually you have their ear here, I know I'm your doctor, but you know your body, I don't. Help me figure out how to help you. I want you to live a life where there's like little team as possible. So you could do what you can and hopefully use less medication see me? Let's see, all right, and sprays it that way that gives them the power. Because again, I think also with health care, in terms of patient-doctor, relationships is always doctor, you tell me what to do and I'll do it. And what's also the patient's responsibility that they how do you empower the patient to take control of their health?

42:27

Raj Sundar: Yeah. Okay, anything else? last thoughts?

42:29

Tagoipah Mathno: I appreciate you opening this conversation. Because again, I mentioned earlier, my layered of identities really informed me of how I moved through this world, right? Because I'm not going to just approach it through only one lens, like I have to acknowledge, like I have so multiple identities. How has that impacted me? How does other people see me? And then, how does that inform how to approach it? How do we build that trust? And within this month of May, of how do we talk about the inclusivity of communities were never part of the conversation or immediately out of the conversation, right? And I appreciate a provider like us actually taking time to hear stories, how do I take this in with patients, you might not have a sound patient, but you might have someone who has similar identities as a John community, or and I also want to note something to that, with each generation, there's mixed feelings of communities culture changes. So how are you also acknowledging that there's crossover with communities we talk about, there's such diverse in the diaspora of the Asian community, the mixing of the Native community, there's just community, the Chinese community and the Filipino community. We don't talk about that enough. And how about those folks who hold identity? Are they also being seen when they're going to serve social services? Because we understand there's been so much mixing because communities do not stay the same culture changes. It will always happens.  But how as we, we're in a role of providing certain services to people, or recognizing that and making sure we're holding ourselves accountable to be very adaptable to that change.

44:04

Raj Sundar: Thanks again, everyone, for joining me on another episode of Healthcare for Humans. If you liked this episode, as always, may I ask you to please share it with one other person, so they can also hear it. I'll see you next time.

44:23

Speaker 3: This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participants past, current or future employers unless explicitly expressed so. Always seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land that makes a regular commitment to Real Rental Duwamish.

The transcript ends here.