Sisters return to their Merced, Calif., Hmong community to practice family medicine

June 15, 2013


"I still can't believe we are here," says Dr. Lasley Xiong, 30.

"This is something we've been waiting for forever," adds Dr. Lesley Xiong, 31.

"Here" is Merced, Calif., where the Xiong sisters began practicing medicine at Dignity Health Medical Group last fall.

Sisters return to Merced, Calif.And "this" is their life's mission — to close the health care gap the large Hmong population in Merced faces due to language, cultural and financial barriers first encountered during a wave of immigration in the late 1970s.

While the U.S. has always prided itself on being a melting pot of cultures, the Hmong refugees from the mountainous regions of Laos have faced great obstacles in trying to integrate into American life. Large numbers of Hmong people were resettled in the U.S. after the 1975 withdrawal of U.S. troops from South Vietnam. The Hmong refugees came with low rates of literacy. Their age-old traditions were based on animism, worship of ancestral spirits and shamanistic healing. As they struggled to make sense of the 20th century Western world, they were particularly suspicious of Western medicine. That cultural divide was well documented in the 1997 award-winning book, The Spirit Catches You and You Fall Down, by Anne Fadiman, which chronicled the story of a young Hmong girl, Lia Lee, diagnosed with severe epilepsy. The misunderstandings between her American doctors, who were trying to aggressively treat her condition with hospitalizations and drug therapies, and her refugee family, who considered her epilepsy as a potential sign of divinity to be moderated with herbs and animal sacrifice, led to a tragic outcome.

Bridging cultures
That the story of Lia Lee and the story of the Xiong sisters both take place in Merced is no accident. Like the Lees, the sisters' parents, Jouachao Blong Xiong and Youa Vang, are refugees who fled Laos when it was overrun by communist troops supported by the North Vietnamese Army. The Hmong became targets of persecution and retaliation because of their role in the CIA's "secret war" to disrupt military supplies along the Ho Chi Minh Trail.

"My parents tell the story of their escape — a 15- to 20-day journey, hiding in the jungles, evading the communists, crossing the Mekong River at night and living in a U.N. refugee camp in Thailand," says Lesley Xiong.

The Xiongs finally arrived in the U.S. in 1979, settling first in Santa Ana, where Lesley was born, and then in Merced, where Lasley and six more children were born and raised. Today, the Hmong residing in the U.S. number more than 260,000 — mostly in California, Minnesota and Wisconsin.

Unlike the Lees, however, the Xiongs integrated a bit more readily into American culture. Family patriarch Jouachao Blong Xiong first worked as a security guard, and eventually became a medical assistant at Golden Valley Health Centers in Merced, part of a Federally Qualified Health Center system.

"Even though both of our grandfathers had been shamans, my father embraced Western medicine," says Lasley Xiong. "He was able to work as a bridge, both culturally and linguistically, for others. They trusted him and took his advice."

Called to heal
Their father also embraced the notion of education for his daughters, who attended Merced public schools and then the University of California-Davis, where Lesley majored in cell biology and Lasley in genetics.

"We both knew early on that we wanted to be doctors," says Lesley Xiong. "We have a brother with Down syndrome and spent a lot of time helping our parents negotiate medical issues with him. We saw firsthand how difficult it was for Western physicians to communicate with Hmong patients and their families, and we felt it was our calling to help solve these problems."

After undergraduate school, Lesley Xiong attended Georgetown University School of Medicine in Washington, D.C. Lasley Xiong went to Lake Erie College of Osteopathic Medical School in Erie, Pa. Both did their training in Modesto, Calif., through the Valley Family Medicine residency program, and now share an office in Merced, where they practice as part of the Dignity Health Medical Group.

"We feel as though we have come full circle now," says Lesley Xiong. "We grew up here, and we have come back to serve our community."

Second generation sensibilities
For Eileen Barsi, senior director of community benefit for San Francisco-based Dignity Health — as well as for the Merced Hmong community — the Xiongs' return in 2012 has been "thrilling."

"The advantages of having clinicians from the same culture as the population we are trying to serve cannot be overstated," Barsi says. "We have been trying to strengthen our partnership with the Southeast Asian community for many years by acknowledging and honoring cultural differences and finding ways to work together. But the realm of energy these two women bring to a room — creating an environment of familiarity and safety — is vitally important to a patient-centric practice."

Although Barsi says Dignity has reached out to the Hmong in many ways — providing interpreters in the emergency room, hiring a shaman to work in its Mercy Medical Center Merced, teaching Western medical staff about Hmong cultural beliefs, providing educational videos for a Hmong TV station — with their innate knowledge of the two cultures, the Xiongs take those efforts to bridge the cultural gap "so much farther."

The Xiong sisters say they plan on spending lots of time educating their Hmong patients about the resources Western medicine can provide to not only fight, but also prevent, disease.

"Our generation is much more open to the recommendations of Western medicine than our parents' generation," Lesley Xiong says. "They may use shamans, but they are also open to things like surgical procedures." The Xiong sisters think this is adaptive, for it allows people to hold to ancient traditions as they embrace modern science.

"Shamans provide the Hmong with a spiritual aspect to health, just as other cultures believe and pray to God," says Lasley Xiong. "It would be sad to lose all the ceremonies and traditions of our ancestors."

Role models
The sisters think of themselves as teachers and counselors as well as physicians. "We want to encourage others to pursue higher education and medical degrees as well," Lesley Xiong says.

As for their personal journeys, the two are rooted in Merced. For one thing, Lesley Xiong is married and expecting her first baby this summer. And though the Xiongs still have relatives in Laos, "this is where our home, our family and our community is now," Lasley Xiong says.


Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.