Healing in the Diaspora: Hmong American and Hmong Lao Practices of Care

International audienceThis chapter asks: How does the medical travel of plants, humans, and kinship reconstitute a displaced community? How are the processes of transnational caring, as care work, shaped by the cultural, historical, social, and political characteristics of Hmong diaspora? While migration for care can be hopeful, we ask why does care also entails ambivalence? In answering these questions, we draw on both of our fieldwork from Laos; one multi-sited ethnography carried out in Hmong herbal medicine markets in Laos and consisting of interviews with traditional healers, with plants sellers, and pickers in different villages; another multi-sited ethnography investigated sites of returns for health and healing for Hmong Americans that included visiting herbalist and consuming Hmong herbs in Laos

Une médecine traditionnelle hmong en mouvement : circulation des remèdes, déplacement des thérapeutes et transmission des savoirs

International audienceNumerous works in health anthropology have highlighted the use of medicinal plants (herbal tea, poultice, etc.) by the Hmong who migrated from Laos to the United States from the end of the 1970s and during the 1980s. These uses by Hmong Americans, often combined with western medicine, are reinforced through the circulation of family advice from Laos. The medicinal plants available in the US are cultivated from domestic gardens, imported dried from northern Laos, or brought directly by Hmong therapists travelling from Laos. The objective of this contribution is to highlight the ways medicinal plants, traditional therapists, and the mountainous landscapes of northern Laos, work together to produce hybrid territories and identities, creating therapeutic experiences for the Hmong living in United StatesDe nombreux travaux réalisés en anthropologie de la santé ont mis en évidence la perpétuation de l’usage de plantes médicinales sous des formes diverses (tisane, cataplasme, etc.) au sein de la diaspora hmong ayant migré aux États-Unis à partir de la fin des années 1970 et au cours des années 1980. Ces usages, le plus souvent combinés à des traitements biomédicaux, circulent sous la forme de conseils familiaux transmis au sein du foyer ou de la famille élargie dans le territoire d’accueil. Les plantes médicinales utilisées proviennent soit de plantations réalisées dans des jardins domestiques autour des maisons, soit sont importées sous forme séchée depuis le nord du Laos, soit apportées directement par des thérapeutes hmong voyageant du Laos. L’objectif de cette contribution est de mettre en évidence la manière dont les plantes, les figures des thérapeutes traditionnels et les paysages de montagne du nord du Laos participent à la construction d’ancrages territoriaux et identitaires hybrides et ouvrent des perspectives thérapeutiques bénéfiques pour la diaspora hmong aux États-Unis

Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Abstract Background Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition’s Quality Measurement Enhancement Project sought to collect data from primary care providers’ (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs’ perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare. Methods Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes. Results Three themes with sub-themes emerged. Theme #1: Minnesota’s current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity. Conclusion Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs’ perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them