Vietnamese diabetic patients and their physicians: what ethnography can teach us

Objectives To describe the cultural context of type 2 diabetes mellitus among Vietnamese immigrants in the United States, including people''s ideas about cause and proper treatment; and to suggest ways in which better control of the disease can be achieved in this population. Design The method was ethnographic. A native speaker used a structured interview guide to talk with 38 Vietnamese patients, and family members of 2 other patients, being treated for type 2 diabetes. In addition, 8 Vietnamese health providers—5 physicians, 2 nurses, and an herbalist—were interviewed. Setting A low-income area of southern California populated by a large number of Vietnamese. Participants Forty patients being treated for type 2 diabetes and 8 health practitioners. Results Three quarters of the patients had not achieved good control of their diabetes. Ideas about the cause and proper treatment of the disease were culturally shaped. Many patients used eastern (herbal) medicine and described a strong aversion to insulin injections. Patients stopped taking their oral medications when using eastern medicine, and a quarter lowered their dose whenever they felt “out of balance.” Almost two thirds had used traditional home remedies for diabetes. Two had received nonstandard medical care from neighborhood physicians trained in Viet Nam; 1 of these patients died during the study. Conclusion The Vietnamese community and physicians serving that community need culturally appropriate education about type 2 diabetes and modern therapy for the disease.Close to 800,000 Vietnamese immigrants were living in the United States in 2000.¹ Nationally, mortality related to type 2 diabetes mellitus is higher for Asians and Pacific Islanders than for non-Hispanic whites,^2,3 and there is evidence that many Vietnamese are unfamiliar with the clinical manifestations of the disease. For example, a telephone survey of 426 Vietnamese in Houston, Texas, found that 60% did not recognize any signs or symptoms of diabetes when important symptoms such as increased urinary frequency were read to them.⁴For Vietnamese immigrants, lack of past contact with diabetic patients may be a factor in their unfamiliarity with the disease. Type 2 diabetes is relatively uncommon in Viet Nam, where it is called tieu duong—literally, “urinate sugar.” (In rural areas of the country, people have traditionally diagnosed it by seeing ants attracted to the urine.) In the United States, however, its prevalence is increasing in Vietnamese as in other ethnic groups, perhaps because Vietnamese immigrants have adopted a higher-calorie diet and more sedentary lifestyle that puts people at risk of developing obesity, a major risk factor for the disease. One primary care physician in San Jose, California, reported that half of his Vietnamese patients had type 2 diabetes (Dr Alfonso Bañuelos Jr, oral communication, July 2000).Our study was carried out in Orange County, California, home to the largest number of Vietnamese (nearly 140,000) outside of Viet Nam.⁵(p33) As in national data, county figures show higher diabetes-related morbidity and mortality among Asians and Pacific Islanders than among non-Hispanic whites.⁶ In July 2000, we investigated factors underlying this increased risk. Through preliminary inquiries, we had learned that knowledge of diabetes—especially early symptoms such as thirst—was minimal in the local Vietnamese community.