A World Apart: Cultural barriers hamper Portland’s Hmong community in health-care system

PhD student Jennifer Kue is working to understand the barriers that prevent Hmong women from seeking breast and cervical cancer screenings.

Jennifer Kue is studying the reasons Hmong women are reluctant to undergo screening for breast and cervical cancer.

Jennifer Kue was just a little girl when she began assisting Portland’s Hmong community. Learning English was a snap for this child of Hmong immigrants, so helping her parents, grandparents, aunts and uncles navigate American society – translating and interpreting, making phone calls, setting up appointments – was a role she fell into naturally.

Over the years, the Ph.D. student in OSU’s Department of Public Health has turned her informal advocacy into a professional calling.

“I knew I wanted to work with immigrants and refugees because of the struggles and challenges my own family went through,” Kue explains. “I knew I was in a unique position to help newcomer communities – to help them establish their lives in the U.S. more easily than my parents did.”

Health Screens

Toward that end, Kue is working with Professor (and principal investigator) Sheryl Thorburn and with research assistants and OSU graduates Karen Levy Keon and Patela Lo to understand the barriers that prevent Hmong women from seeking breast and cervical cancer screenings. The team is exploring factors that may explain the extraordinary rates of cervical cancer mortality in this ethnic group from Southeast Asia (three to four times higher than among the broader population of Asians, Pacific Islanders and non-Hispanic white women), as well as their low rates of preventive mammography and Pap tests. Kue is co-investigator and project coordinator of the study that was funded by the National Cancer Institute (NCI). Lo’s participation is funded by NCI through the American Recovery and Reinvestment Act.

“Cervical cancer is so preventable when detected early,” Kue laments. “But in our culture, women don’t talk about issues like these – issues that are so personal, so private.”

About 80 women and men are participating in the study, answering questions about medical mistrust, historical discrimination, cultural beliefs and familial relations. Along with a team of bilingual interviewers, the researchers are exploring topics such as: perceptions of and experiences with the U.S. health care system; men’s influence on women’s decisions; levels of health literacy; and wariness toward hospitals and treatments.

Trust Among Kin

Kue’s own ethnicity, along with a decade’s experience as a caseworker and researcher at Portland’s Asian Family Center, have been essential to building trust among the participants, whose lives typically revolve around close-knit kinship networks.

“Jennifer is highly committed to her community and passionate about improving their health and well-being,” says Thorburn. “She is a critical link between the research team and the Hmong community.”

In addition to her research on the Hmong Breast and Cervical Cancer Project, Kue is focusing her doctoral dissertation on Hmong knowledge of hepatitis B, along with risk perceptions and barriers to screening and vaccination. Previous research, she notes, has found high rates of hepatitis B infection among the Hmong, accompanied by low levels of screening and vaccination.

“It’s not enough to provide written information for people,” Kue insists. “In our community, communication is word of mouth. You have to have that personal connection. You can’t just pass out pamphlets and expect to solve the problem.”

Laotian Dreams

When Kue talks about her homeland, her emotions run raw. She was just a year old when her mother and grandparents fled communist forces after the fall of Saigon in 1975, traveling by foot through the Laotian jungle at night, crossing the Mekong River and eventually finding safety in a Thai refugee camp. There, they were reunited with her father and his two older brothers, both of whom had been soldiers who had fought for the United States during the Vietnam War. A year later, a California church sponsored the family’s emigration to the U.S.

Kue dreams of living and working in Laos someday with her husband and two small children.

“I’ve never been back to see the place I was born,” she says, brushing at the tears welling up in her eyes. “It’ll be an emotional trip.”

As for the study, she hopes to translate the results into tools for change, to design a culturally sensitive intervention based on the findings.

“We have a commitment to the community to go that extra step – not just get this information and let it sit on a shelf,” Kue says. “We need to find what works.”