Hmong story cloth, the Ban Vinai refugee camp in Thailand. Anonymous.

Following their assistance to the U.S. military during the Vietnam War, the Hmong were forced to leave their homeland. Driven from the mountains of Southeast Asia by unfriendly communist governments, they suffered in Thai refugee camps before finally resettling in the U.S. Integration into this society would be slow and painful.

Many social service, religious, and community agencies stepped forward to help Hmong families with housing, language classes, and health care. Such services were, of course, alien to people whose cultural life had not changed significantly for thousands of years.

The Hmong are animists and traditional folk tales provide cultural stability. A 1985 book, Living Tapestries, contains the story "When All the Animals were Refugees." In it, a group of male monkeys leaves the females and babies behind to search the desert for food and water. After a long time, they finally find an oasis where life would be good for all of them. Sadly, the male monkeys have traveled so far they cannot remember how to get back to their families, who are now lost to them forever. This tale was a daily reality for Hmong refugees as they arrived in a new country. Here, life offered hope and promise, but people would have to live without all the family members who had been left behind or who had died during their escape from Laos and Thailand.

In addition to the stress and sadness of resettlement, cultural conflicts immediately began to disrupt lives. In The Spirit Catches You and You Fall Down, author Anne Fadiman describes the difficulties faced by a Hmong family with an epileptic daughter. Epilepsy, an illness well known to the Hmong, is regarded with a certain ambivalence. They recognize it as a serious condition, but also believe that epileptics have greater access to the divine. In fact, Hmong epileptics often become shamans. Fadiman tells of a girl whose parents felt that the doctors gave her "too much medicine" while her doctors condemned her parents as noncompliant.

Stories similar to this one were repeated hundreds, perhaps thousands of times in Hmong communities all over the U.S. Until recently, there seemed to be little hope that these opposing traditions of healing could combine to serve the best interests of Hmong patients.

Shamanism is revered in the Hmong community among those who follow "the old religion" (animism). In a 1996 article, author Chu Wu describes the origins of shamanism. "Shu Yee…was a special healer sent by God to live with the Hmong people in the cave near [a mountain in Southwest China]. His mission was to provide medical cures for all the people. He married a Hmong woman…[but later] abandoned his people and traveled alone in Mongolia…[An] orphan boy wandered the north for years until he found Shu Yee, [who] was moved by the orphan boy's determination to find him. He taught the orphan boy everything he knew. The orphan boy returned to his people and taught the elders what he had learned from Shu Yee…This created a tradition of shaman, earth medicines, and magic that is still practiced to this day."

According to Dr. Phua Xiong, a Hmong-American physician, "About fifty percent of the Hmong still practice traditional religion and ways of healing, which includes shamanism. So shamanism is very much alive." With as many as 75,000 Hmong people living in Minnesota, it is clear that this ancient practice is a force in the health care of many who also participate in other medical systems.

Since they came to the U.S., the Hmong have struggled to survive and retain their culture. Families are torn between preservation of ancient traditions and assimilation. Many Hmong see the shaman as a symbol of cultural stability and make regular visits for spiritual, medical, and cultural guidance. Many Hmong, though, have abandoned the ways of their elders, thinking them useless for their new lives. As Hmong society changes from an Asian agrarian one to a largely urban American one, the role of the shaman is changing. For shamans to carry out some of the most basic elements of this ancient craft (such as slaughtering pigs or chickens) they must break the laws in communities where Hmong now live. Conflicts between the treatment of diseases by western doctors and the spiritual approach of the shaman have been documented in many articles, medical records, lawsuits, and social service cases.

Creative Theatre Unlimited, a nonprofit organization dedicated to building community through the arts, in collaboration with the Center for Spirituality and Healing at the University of Minnesota, recently launched an initiative called "Hmong Shamanism in Minnesota and Hmong Patient Choices." The purpose of this study is to understand how shamanism is practiced in Minnesota's Hmong community. Who practices shamanism in Minnesota? How has shamanism affected the nature and scope of the changes in Minnesota's Hmong culture over the past twenty years? How do cultural attitudes, values, and uses of shamanism affect the choices and utilization of health care options in the Hmong community? To answer these questions we are conducting in-person, semi-structured interviews of five to ten shamans and thirty to forty Hmong people who participate in a shaman's care and western health care. Designed to investigate patients' and practitioners' experiences, these interview techniques examine the interaction between Hmong patients and the shaman and their attitudes, ideas, and behaviors toward improving health and health care.

Pahoua Vue, a Hmong shaman in St. Paul, recognizes the importance of including the entire community in his work. "Doctors don't always recognize what we do," he says. "We are sure we can help the doctors and patients but hospitals and clinics always turn us away." Dr. Gregory Plotnikoff, medical director of the Center for Spirituality and Healing, hopes this research will bring these two worlds closer together. "Every physician knows that care is enhanced when working with a patient's belief system," he says. "Care is diminished when working against a person's belief system."

By gathering information about traditional beliefs and practices, the project may help an older Hmong generation leave a legacy for the next generation. Many Hmong youth are essentially ignorant of the rich heritage they can claim and have difficulty understanding how the culture of their ancestors applies to the life they live here. Learning about the shaman's role in modern society may be very helpful for Hmong born in the U.S. as they continue to struggle with cultural transition for years to come. This project also provides an opportunity to gather important historical information, hidden in the shadows of the dominant culture, before the primary sources of information are gone. Many of the shaman practitioners who came from Southeast Asia in the late 1970s and early 1980s have already died. Others are quite elderly and will not live much longer. When dealing with a culture that relies on oral tradition, much that is valuable can be easily lost.

Pahoua Vue says he hopes the study will provide written documentation of a tradition that has been passed on from one generation to another, and that it will help bridge the gap between shamanism and medicine. "Both are trying to save a person's life," he said. "The shamans and doctors are always trying to find good ways to help people. They need to continue in ways where they can both help."