Although refugee health care emerged as a special interest in the United States following the influx of almost a million Southeast Asians since 1975, few studies have been done of the influence of refugee traditions on the use of Western medical services. The illness patterns, medical beliefs, and health care behavior of a Southeast Asian refugee group, the Mien from Laos are described in this study. A cohort of 119 Mien refugees living in Richmond, California, was observed for a 6-month period. In-home interviews were undertaken about all episodes of ill health, including treatment and health care decisions. This study shows that the Mien integrate traditional healing beliefs and practices with the use of American health services. Such findings are important because the increasing cultural diversity in the United States, particularly in Western states, necessitates that health care professionals understand the importance of cultural factors for access to and the use of health care by all patients including refugees and other immigrant groups.
Using primary care as an example, this paper examines how the bureaucratic structures and culture of the international health agencies have affected the planning and delivery of health programs. Many primary health care programs were ineffective, as research undertaken in Nepal has shown, because they reflected the perspective and needs of the health bureaucracies involved rather than those of the local villages receiving services. Similarly, work in other South and Southeast Asian countries reveals that primary health care was interpreted differently in different bureaucratic settings and adapted to bureaucratic needs, but not necessarily adapted to village cultures and conditions. Social scientists, who are trained to analyze and articulate different cultural contexts, can play a key role in helping international health bureaucracies become more sensitive to the rural village cultures they serve.