Delivering clinical services to Vietnamese Americans: implications for speech-language pathologists.(Report)

In order to prepare for a future in which speech-language pathologists (SLPs) might provide clinical services to an estimated 5% to 10% percent of the Vietnamese American community, this article offers a review and summary of the best of what we currently understand with regard to (a) Vietnamese history and immigration patterns; (b) probable demographics of consumers within the Vietnamese American community who would need services; (c) the culture and structure of the Vietnamese American family, including the influence of the community on the family; and (d) traditional Vietnamese medical practices contrasted to those of the European American community. The article summarizes six broad guiding principles for SLPs to follow when contemplating the provision of service delivery to Vietnamese American clients. Additional references are provided for practitioners wishing to extend their competencies beyond the scope of this preliminary review.

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Over the past 25 years, there has been a large influx of Vietnamese immigrants and refugees to the United States. In 1997, the U.S. Bureau of the Census estimated that there were 849,000 Vietnamese Americans in the United States, representing 8.4% of the total Asian and Pacific Islander population (T.-U. Nguyen, Dale, & Gleason, 1998). By the year 2000, Vietnamese Americans were projected to be the third largest Asian and Pacific Islander population in this country.

Although the Vietnamese American population in the United States is growing, relatively little about its specific history or culture is known by most speech-language pathologists (SLPs). This population shares some characteristics with other Asian and Pacific Islander groups, but many aspects of its history and culture are unique. Of particular importance to the field of speech-language pathology is the Vietnamese attitude toward individuals with disabilities. Even fewer reports are available to help clinical practitioners understand the attitudes of the Vietnamese American population toward persons with communication difficulties. Anecdotal reports and studies of other Asian American populations have indicated that some Asian immigrants have difficulty understanding or accepting individuals with disabilities (Ryan & Smith, 1989; Sonnander & Claesson, 1997).

This article provides an introductory overview of Vietnamese American culture and traditions in order to assist SLPs in preparing clinical service delivery to consumers within this growing population. The objectives were to (a) outline the history and immigration patterns of this community, in both the distant past and projected future; (b) provide information about demographics and the little that is known concerning Vietnamese Americans' attitudes toward disabilities; (c) describe the structure of the family, including the influence of the community on the family; and (d) summarize traditional Vietnamese medical practices and contrast them with to those of the European American community.

In 2000, SLPs as a group were still predominately European American by ethnicity and culture. If SLPs are going to be expected to provide clinical services to the Vietnamese American population, they will need access to information about the values, beliefs, traditions, and practices of members of this group in order to make reasonable and culturally appropriate recommendations regarding clinical interventions. Using demographic data and the clinical experiences and observations of a group of professionals with expertise in diversity training, this article will map out preliminary culturally appropriate implications for SLPs wishing to provide services to consumers within Vietnamese American communities. Each historical summary of the literature is followed by a brief discussion of the implications for SLPs. Readers seeking more in-depth discussions are referred to the extensive reference section on "Additional Resources" at the end of this article.

VIETNAMESE HISTORY

Prior to 1975

Throughout their long history, the Vietnamese have been proud of their ability to maintain a distinct cultural identity while incorporating positive aspects of the different cultures that sought to rule them. The first country that sought to control Vietnam was China, which governed Vietnam directly from 111 B.C. to A.D. 939 (Duiker, 1983, cited in Holleman, 1991). During that time, a variety of Chinese beliefs and traditions--including the religions and philosophies of Confucianism, Buddhism, and Taoism; the system of Chinese medicine; and the Mandarin system of examination for government positions--were introduced to Vietnam. In A.D. 939, the Vietnamese overthrew their Chinese rulers and remained independent of China, with the exception of a short period during the 15th century (Holeman, 1991). Powerful Vietnamese lords governed various sections of the country, with one group controlling the North and another controlling the South, and they expanded Vietnam's boundaries.

During the 16th and 17th centuries, European merchants and missionaries arrived (Holleman, 1991). Although most of the Europeans eventually left, the French formally took control of Vietnam in 1883. They instituted a variety of changes in government and in the education system, including the introduction of the Romanist alphabet version of written Vietnamese and Western medical practices (Holloman, 1991).

The French fled Vietnam during World War II, and the Japanese occupied parts of it (Holleman, 1991). Although the French returned to Vietnam after the war ended, they found themselves in an armed struggle to retain political control culminating in the final surrender in 1954. The Geneva Agreement of the same year divided Vietnam into two parts at the 17th Parallel and mandated elections to reunite the country. The South Vietnamese government's cancellation of the planned elections in 1956 precipitated a campaign of guerrilla warfare by North Vietnam.

The United States became involved militarily in Vietnam in 1961 and was heavily involved in the conflict between North and South Vietnam by 1966 (Holleman, 1991). After years of warfare, negotiations to cease the bombing of the two countries began. North Vietnamese forces then moved into South Vietnam and took control of the country in April of 1975. The civil war took a heavy toll: Roughly 10% of the Vietnamese population was killed or wounded (Karnow, 1984, cited in Holleman, 1991). Immediately after the fall of Saigon, the capital of South Vietnam, former South Vietnamese military officers and other individuals involved in the government were imprisoned or confined for weeks, months, or years. They risked death if they attempted to escape (Lynch, 1997; Zhou & Bankston, 1998).

Emigration to the United States

With the fall of Saigon, numerous Vietnamese immediately fled the country. Most of the individuals in this first wave were middle or upper class, well educated, and Catholic, and they spoke English (Egawa & Tashima, 1982). Many of them had also been associated with the government of South Vietnam. Refugees initially moved into various communities throughout the United States; however, many refugees later resettled near friends or relatives in the country's warmer regions (Zhou & Bankston, 1998).

In 1978, tensions with China precipitated a second wave of emigres of Sino-Vietnamese heritage (Zhou & Bankston, 1998). Other Vietnamese also left at that time on foot or in leaky, aging boats, facing the dangers of storms and pirates. These "boat people" were less wealthy and less educated than the first wave of emigrants, and an estimated 50% perished in transit (Trueba, Cheng, & Ima, 1993; Zhou & Bankston). Survivors were sent to refugee camps in Southeast Asia, where many suffered from anxiety and stress while sometimes waiting months or years for sponsorship and resettlement in other nations (Zhou & Bankston).

In response to the plight of the people in this second wave, the United States passed the Refugee Act of 1980 and widened the scope of resources available to assist refugees, defined as people who left their native country and could not return because of fear of persecution and physical harm. Refugees became eligible for cash assistance, medical benefits, and other services (Kibria, 1993, cited in Menjivar, 1997).