Listen: 1636740_1996-10-18_doctor_pua_2448

MPR’s Lorna Benson profiles Pua Xiong, a first-year resident who works at St. Joseph's Hospital in St. Paul. Xiong describes how her quest for a medical degree has forced her to confront a multitude of cultural barriers.

Female doctors are no longer an unusual sight in U.S. hospitals and clinics. In fact, in 1996, twenty percent of all physicians in Minnesota are women. But for some immigrant ethnic groups the percentage is much lower. For example, in the Hmong community there are only three women doctors in the nation.


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[NON-ENGLISH SPEECH] LORNA BENSON: Dr. Pua Xiong chats with a young Hmong woman named Tong. This is Tong's first visit to a Western medical doctor, and she appears anxious as she answers questions about a massive lump protruding from her right side. The skin on her stomach and back is hard and swollen. Tong tells her doctor that her appetite is fine, but she's lost a lot of weight in the past year.


INTERPRETER: After the birth of my child, I was 110 pounds. That was when my child was already two years old. When at the time I gave birth to my second baby, I was 78 pounds.

LORNA BENSON: Tong first noticed the lump about six months ago, when it was still quite small. She tells Dr. Xiong about all of the other doctors she's seen before her. They're mostly Hmong shaman and medicine men, who use prayer and herbal medicines to heal. When she did not appear to be getting better, a shaman finally told Tong she should go to a Western doctor. Tong, who does not speak much English, chose Pua Xiong.

TONG: She understands Hmong, how I see my pain.


TONG: Yeah, pain.

LORNA BENSON: Dr. Xiong understands because, being Hmong, she's familiar with traditional medicines and treatments. Xiong says her patients don't have to explain themselves to her, and that makes it a lot easier for them to seek help from a doctor trained in Western medicine.

PUA XIONG: It has been hard for the Hmong as a whole to really accept and cope and just have things done to them without really understanding all the reasons behind it or why things are being done.

LORNA BENSON: Xiong's patient, Tong, has tried nearly everything to get rid of the lump on her side, including acupuncture, massage, and herbs. Her family believed someone had wished illness on Tong and used black magic to put stones in her body. When Dr. Pua Xiong first examined Tong, she feared her patient had cancer.

PUA XIONG: It turned out to be her kidney. She has this huge what's called hydronephrosis of her kidney due to a stone that was right at the hilum of the kidney, where your urine would drain down into your urether, to your bladder. And she had a huge stone obstructing that.

LORNA BENSON: Do you find that ironic? So she did have a stone in her.

PUA XIONG: Right. Yeah, and so you wonder if sometimes that these things would be right. She said that she did see the person who did the black magic take out several stones. And scientifically, it's really hard to prove how he or she could have taken the stones out without opening the body up or anything. But then, science doesn't explain everything.

LORNA BENSON: While tong's traditional Hmong doctors may have recognized part of her problem, their treatments did not cure her condition. In fact, her right kidney was so badly swollen by the time she sought out conventional medical treatment, the organ suffered severe damage. Dr. Xiong is still waiting to see if Tong's kidney will regain some function. For many Hmong people, the transition to life in the US has not been easy. Dr. Pua Xiong appears to have bridged the gap well. But she credits some of that to arriving here when she was very young and impressionable.

Pua was seven years old when her family fled Laos following the Vietnam War. Because of her youth, Pua adjusted easily, quickly picking up English and Western culture. By the time she reached fifth grade, she would often accompany older relatives and Hmong friends to the hospital, where she would translate for them. Her adoption of Western culture was cemented when she resisted a firmly rooted Hmong tradition and put off marriage until age 22.

PUA XIONG: I got married pretty late, according to Hmong culture. [LAUGHS] Yeah, I was an old maid. And I married after I finished college. So that was quite different from the usual. The usual is someone who might not have finished high school yet or may just have graduated from high school. So that was unusual, as I've always been.

LORNA BENSON: As a first-year medical resident in Saint Paul, Pua Xiong treats a diverse group of patients. 40% are Hmong and most have low incomes. Because Pua is Hmong, she has a special rapport with her Hmong patients. She's extremely protective of their traditions, and there are certain things she will not tell her patients out of respect for their shared culture. For example, Hmong people do not talk directly about death and dying.

PUA XIONG: Recently, I had a patient who was not going to live long. And my superiors were telling me to tell her that she's not going to live long and to tell her that she may die. And so I had a really hard time just trying to do what they expect me to do but at the same time to balance my cultural meanings and my cultural practices.

LORNA BENSON: At first, Pua told her supervisors she would not tell the woman about her impending death. Then, after some coaxing, Pua finally agreed to talk with her patient.

PUA XIONG: I was going to go and talk to her in my own way. But unfortunately, I never got that chance because she passed away before I had the chance to go and talk to her.

LORNA BENSON: Dr. Pua Xiong spends her spare time trying to improve the childhood immunization rate of Hmong immigrants. She says Hmong parents are suspicious of immunizations because many had bad experiences getting immunized in Thailand's refugee camps. Her other goal is to be a good role model for young Hmong girls. As one of only three female Hmong doctors in the US, Pua Xiong hopes Hmong girls will look to her as proof they can pursue their dreams. For Minnesota Public Radio, I'm Lorna Benson.


Digitization made possible by the State of Minnesota Legacy Amendment’s Arts and Cultural Heritage Fund, approved by voters in 2008.

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