Ever since she was a child, Youngsville resident Sendra Yang has had to translate between English and Hmong for her parents, whether at parent-teacher conferences at school or the doctor’s office.
“Being a child and having to go with your parents to interpret for them when they’re sick, sharing with the provider, 'Hey, my mom’s been sick for like three days, what can we do?' It has been really hard,” said Yang, 42. “That struggle and that interpretation need is still very real.”
Yang’s parents are among many Hmong people — an ethnic minority group in Southeast Asia — who fled Laos and neighboring countries for the U.S. in the mid-1970s after the Vietnam War. In the following decades, a wave of Hmong immigrants moved to rural western North Carolina, mainly to look for jobs in the area’s manufacturing industry. Yang’s family moved from southern California to Hickory in 1992 and her father worked for more than two decades at a plastic packaging facility.
There are more than 13,000 Hmong people in North Carolina, according to the 2020 U.S. Census, making it the fourth largest Hmong population in the country, after California, Minnesota and Wisconsin. Between 2010 and 2020, the number of Hmong people at least 65 years old has nearly doubled.
As Hmong immigrants like Yang’s parents are getting older, those who did not become fluent in English are relying more on their children to help as interpreters, especially as they develop more health issues.
Yang’s father, Mer Yang, said that while Sendra and her sister Linda were growing up, he mainly spoke in Hmong at home so they would be able to help translate for him. But as adults, his children are juggling many priorities.
“Our people, old like me — we cannot speak English that well,” said Mer Yang, 72. “It’s not easy because your kids have to work. Some people have four, five kids — they [are] busy every day. Old people like us, sometimes they have no time to help.”
Translating between two languages and cultures
Mer Yang has gained some understanding of English over the years, but he didn’t have time to fully learn the language while working and supporting his family. He’s been going to the doctor a lot more since he retired eight years ago, but still needs a family member to help him understand his health issues and convey his own concerns.
“When I tell [the doctor] that I feel pain right here, he doesn’t understand... the pain,” Mer said. “The pain that I tell him, he doesn’t understand.”
Translating between Hmong and English can be challenging in the healthcare context. Many English terms don’t exist in Hmong, such as diabetes and cancer. To describe diabetes, Hmong Americans use words that translate to “sweet blood.”
“The Hmong language is very descriptive,” said Honey Yang Estrada, president of the North Carolina Community Health Workers Association and also the daughter of Hmong refugees. “A lot of times for our words, there’s not an exact one-to-one translation and it makes it really tricky. So being able to interpret specifically those healthcare terms is really critical.”
Estrada added that she wants to see more Hmong interpreters at hospitals, local health departments, and other institutions that serve the Hmong community.
“Of course, the families are going to take care of their family member, but in the same breath, it’s also up to the systems to make sure we are providing for our community members,” Estrada said.
Mer Yang’s children have had to find creative ways to help interpret for him at doctor’s visits. For example, his daughter Linda Yang once accompanied him to the doctor when he was experiencing knee pain and said it helped to have an X-ray of his knee.
“I think the best explanation I gave was really just pointing to the X-ray, the image, saying, 'Yeah, it’s bone against bone rubbing against each other. That’s why it’s so painful',” said Linda Yang.
The differences between Western medicine and traditional Hmong health beliefs also present challenges with medical interpretation. As a 2020 review on health issues in the Hmong community described, many Hmong people practice Shamanism, which views illness as the result of a spiritual imbalance, and often prefer to use herbal treatments when they are sick.
“Our older generation, because they were born in Laos, they come from a time where they used a lot of herbs to heal, to help themselves feel better and for their wounds and their pains,” Linda Yang said. “And so, they still try to seek out those herbal medications.”
Linda Yang added that she encourages her parents to take the medications that they’re prescribed and to also communicate with their doctors about the herbal medicines they consume.
A clear need for more institutional help
Linda Yang, like other Hmong Americans of her generation, has also served as an interpreter for her parents when they have needed to apply for social security and food stamps.
A 2023 study by the Urban Institute found that language access was the largest barrier that Hmong families in North Carolina experience when accessing social safety net programs, like Medicaid and SNAP. It noted that the adult children of elderly Hmong people struggled with the process of helping their parents apply to these programs.
“They lacked full Hmong fluency and were concerned that they would inadvertently misinterpret information shared by their parents or report incorrect information in the application that would render their parents ineligible,” the study authors wrote. “They also expressed frustration at the lack of interpreters and Hmong staff at HHS offices, which caused their parents to feel intimidated.”
North Carolina health officials have acknowledged the need to accommodate a growing and substantial Hmong community. The state and local governments, like Catawba County, offer some translated materials and interpretive services in Hmong.
But Catawba County community health worker Sao Vue, who is Hmong herself, said that there aren’t many people like her working in her role, which is to help people in the county gain access to a variety of health and social services.
“Not everyone can talk in English and Hmong and fluently in both languages, too,” Vue said, who immigrated to the U.S. from Laos in 2010.
Vue understands well the challenges of navigating the healthcare system as an immigrant with little understanding of the language and culture. She recalled what it was like to be pregnant when she first arrived in the U.S. and attending doctor’s appointments.
“They might tell me all kinds of things, but I didn't understand,” Vue said.
For example, when a doctor told her that her baby wasn’t receiving enough oxygen and suggested they induce labor, she did not understand what “induce” meant. Vue was fortunate to have a Hmong-speaking nurse in the room to explain what was happening to her.
“Once that person that speaks your language and also knows your culture comes to you and explains,” Vue said. “That opens your view and makes a clear understanding of why the doctor, nurse, and everybody who sees your health beyond your knowledge, is taking everything so seriously.”
Beyond interpretation services
The need for interpretive services is just one of many needs for Hmong elders, said Sendra Yang, who co-founded the NC Hmong Women Association in 2021. Her organization is launching an effort this year with Sharon Morrison, a UNC Greensboro professor, to conduct a community assessment on the needs of North Carolina’s Hmong community. She hopes the work will lead to solutions that will them understand how to support older folks like her father.
“I think it’s more than just interpretation services,” Sendra Yang said. “It could be like looking at the top health care needs of our senior generations and developing education around that.”
