If you have spent any time in the states of Minnesota, Wisconsin or California, you may have heard of a community of people who call themselves “Hmong.” Maybe you watched a powerful gymnast by the name of Sunisa Lee win a gold medal for team USA at the 2024 Summer Olympics. Or perhaps you read the book “The Spirit Catches You and You Fall Down” by Anne Fadiman. For those of you who are new to who the Hmong people are, I invite you to join me as we explore three barriers this patient population faces and how we as genetic counselors can engage in intentional and meaningful interactions with Hmong patients in our genetic counseling practice.

The Hmong are an ethnic people with roots in China who have migrated over time to a handful of countries in Southeast Asia. During the Vietnam War in the 1970s, the Hmong were recruited by the United States for a covert operation termed “the secret war” in Laos. After the war, many Hmong fled the country as refugees. According to the 2021 UW Census Bureau, it is estimated that there are roughly 327,000 Hmong who call the United States home. With the growing population of Hmong people accessing the health care system, we will all likely encounter a Hmong patient at some point in our practice. 

The Hmong do not have a country of their own. Due to their migratory history and the role of the Vietnam War for the Hmong diaspora, some considerations genetic counselors should keep in mind are:

• Potential exposure to agent orange during the Vietnam War.
• Cause of death for family members may be unknown.
• It may be appropriate to ask about ethnicity along with ancestry.

Before the 1970s, the Hmong had little to no contact with Western medicine. The relative newness of Western medicine can lead to some conundrums for medical providers such as:

• Distrust of the medical system.
• Late diagnoses or intervention due to preference to seek herbal and cultural remedies first.
• Noncompliance with medical instructions or follow up. 
• Refusal of medical treatments, surgery or autopsy.

The Hmong have an oral language tradition. The most commonly used Hmong written language was developed in the 1950s, a mere 73 years ago. Additionally, with the migration of Hmong into various Southeast Asian countries, some vocabulary used in daily speech is borrowed from the native population of those countries. Some language barriers for Hmong patients are:

• Not all Hmong patients can read or write the language.
• There can be a mismatch between the vocabulary and dialect of patients and interpreters.
• There are no Hmong words for certain medical terms, which can increase the time in session spent on explaining words such as “cancer” or “DNA.”

Now that we are aware of some of the barriers Hmong patients face, how can we as genetic counselors approach Hmong patients with sensitivity and intention? As a first-generation Hmong American genetic counselor, I have a few thoughts:

• If possible, allot extra time for sessions with an interpreter or meet with them before the appointment starts. 
• Use visual aids for Hmong patients with low English proficiency to demonstrate genetic concepts.
• Be aware of your body language and tone.
• Give patients ample time to discuss decision-making with family members.

Most importantly, Hmong patients are not a monolith. As with all patients, the family structure and experiences will vary. Approaching Hmong patients with curiosity and openness to learn about the culture and their journey to meet with a genetic counselor is key to a successful genetic counseling session.

---