Vietnam

Vietnam is located on the eastern coast of southeast Asia, and the total area is equivalent in size to the state of New Mexico. The major cities situated in Vietnam are Ho Chi Minh City in the southern region, Da Nang in the mid-coastal region, and the capital city of Hanoi in the northern region.

Learn more about Vietnam

Language

Vietnamese is spoken by approximately 65 million people natively, and there are more than 2 million speakers of Vietnamese out of the country.

Immigration History

More than 600,000 Vietnamese refugees arrived in the United States during the period from 1975 to 1980, making this the most concentrated period of Vietnamese immigration to the United States. A substantial number of these, around 10,000, settled in the greater Portland area. From 1983 to 1999, an additional 450,000 Vietnamese refugees arrived in the United States.

Today, Southeast Asians are the largest refugee group in the United States, and 71% of these are Vietnamese. The states with the greatest settlement numbers are California, Florida, and New York. Currently, around 50,000 people of Vietnamese descent live in the greater Portland area. As these former refugees enter middle and advanced age, they may be increasingly represented in our general treatment population. Many early refugees saw great hardship during their immigration process, including extreme violence, long periods in internment camps, separation from their families, and losing all of their material possessions prior to arrival in the United States. Their stories are rarely heard, and they may be shared only with trusted individuals. Professionals who interact with this population should be sensitive to the varied immigration experiences of former refugees.

Value Dimensions

A person's values are affected, influenced, and changed by the cultures to which they belong. The following graph shows a comparison between the United States and Vietnam in relation to five value dimensions: Power Distance Index (PDI), Individualism (IDV), Masculinity (MAS), Uncertainty Avoidance Index (UAI), and Long-Term Orientation (LTO).

PDI reflects the extent to which cultures accept that power is distrubuted unevenly. IDV is the belief in the individual as opposed to collectivism where everybody in a group sticks together and supports each other. MAS refers to the way roles are distributed between males and females and whether the country is a more masculine or feminine country. UAI is the way a country deals with lack of structure or uncertainity. A high uncertainty avoidance country wants to avoid the lack of structure and responds with many rules and laws. LTO values thriftness and perseverance while its opposite, Short-Term Orientation, values tradition, rituals, and social obligations.

Vietnamese Culture

Names

Vietnamese names are traditionally written in reverse order of American names: family name, middle name, personal name. Some people have reversed the traditional order to conform to the U.S. custom of putting the family name last. It may be helpful, especially with older patients, to verify which name is their family name and which is their personal name so there will be no confusion. It is acceptable to address a patient or client whose first name is Hanh as “Mrs. Hahn.”

Pronunciations of some common names:

Pham: Rhymes with “mom” Ly: Rhymes with “Lee” Le: Rhymes with “Lay”

Social Customs

Traditionally, the family is the chief source of social identity and the center of Vietnamese living. Older Vietnamese people often come from large families with eight to ten siblings. Often several generations live in the same household. The traditional family structure is paternal. The Vietnamese value system has traditionally centered around allegiance to family above all else. Reputation in the community and a “good family name,” along with respect for the elderly, are highly valued. The male head of the family makes all major decisions, while the female head of the family is the “soul” of the family who serves the family and holds it together. Today, remnants of these roles and values run strong and deep in Vietnamese communities.

The strong family orientation enables grown children to stay at home with no stigma attached. The general philosophy is that children are not expected to be independent at age 18 as is sometimes true in America. Parents provide what they can, and do not generally expect children to leave home at the earliest opportunity. Likewise, older people generally live with younger family members. Nursing homes are generally considered only as a final solution when no family situation is available.

Vietnamese show great respect to elders, superiors and strangers. To welcome someone, they may clasp both hands against their chests. Shaking hands upon first meeting is generally acceptable for both men and women, although men being introduced to women should use propriety. In any case, Vietnamese will usually shake hands with westerners to avoid embarrassment for both parties.

Trust is the most important part of facilitating an effective exchange of information. The key to building trust is to assist and support them. If you sense that trust is not forthcoming, try to find a person who is trusted by the patient and enlist them as as an intermediary communicator.

Healthcare

Healthcare in 1970s Vietnam was severely limited in comparison to the U.S. People chose very carefully when to see a doctor, and they tended to wait until illnesses or injuries become critical before seeking treatment. Factors contributing to a general reticence toward health care are cost, language differences, fear, and wanting to “save face” by not disclosing to doctors. Even with Medicare readily available, you may find that common illnesses such as diabetes have not been identified or treated until the advanced stages. The concept of preventative care is a western paradigm that may not be the experience of older Vietnamese people.

You may encounter people whose attitudes toward death and dying seem at odds with the American propensity to enhance longevity with stepped-up health care in advanced age. They may never have expected to live past the age of sixty or so, and efforts to prolong life in advanced age may seem culturally different to them. Those things said, most elder patients accept the model of western medicine, and although they may believe in traditional or alternative healers, they may not choose to intermingle traditional treatments with western medicine.

Religion

Roman Catholicism has a strong place in Vietnamese history and culture. There are several Catholic churches in the Portland area with large numbers of Vietnamese people in their congregations. Many Vietnamese people in Portland also attend Lutheran churches. Many Vietnamese Catholics and Lutherans may maintain traditional Buddhist, Confucianist, and Taoist practices including traditional rituals.

Holidays

Christmas is observed by many people of Vietnamese descent, including non-Catholics who participate from a secular point of view. Official western holidays are generally observed on fixed dates. Traditional religious holidays are determined by the lunar calendar, so their dates change every year. One of the most important holidays is “Tet,” or Lunar new Year, which usually falls in the month of February. It is traditionally celebrated as a family reunion. Vietnamese do not traditionally celebrate each individual’s birthday, as Tet is considered to be everyone’s birthday. This means that everyone turns one year older on Tet. When you ask a person his age, he may give his age in relation to the Lunar New Year. If you need to know chronological age, verify date of birth.

Speech

Speech Sound Disorders

Incidence

Speech sound disorders are not generally recognized as a disability in Vietnam. Consequently, there is no formal statistical data regarding the incidence of speech sound disorders in Vietnam. Hwa-Froelich & Westby (2003) 1) found that blindness, deafness and physical conditions that affected a persons’ abilities to carry out daily activities were seen as disabilities, but that cleft palate, speech or learning problems and mental retardation were not considered disabilities. Instead, these conditions are believed to be caused by the child’s nature, stubbornness, laziness or fate.

Range of Acceptable Intelligibility

The lack of clinical attention given to speech sound disorders and communication disorders as a whole in Vietnam seems to indicate that there is a wide range of acceptable intelligibility. The fact that speech sound disorders are not considered a disability implies that they are somewhat culturally accepted. However, this statement is not based on solid research evidence and should be amended should any conflicting evidence be presented.

Treatment

Vietnam has limited speech language pathology support for children with a speech sound disorder. Fewer than ten individuals living in Vietnam have held the title of “speech therapist” and none of those individuals have a degree in speech-language pathology. These individuals have degrees in medicine, physical therapy, dentistry, linguistics, psychology, nursing and other areas.

The overall level of special education services available in Vietnam is increasing. The first teacher-training program to offer training in special education took place in 2003. However, speech sound disorders do not qualify as a disability. Consequently, children with speech sound disorders are generally included in general education settings and do not receive special education services.

Educational Views of Southeast Asian Parents

A study conducted by Deborah A. Hwa-Froelich and Carol E. Westby in 2003 documented the differences in views between Southeast Asian parents and Head Start staff in early childhood education. The articles identifies views in four domains: education, parenting, child learning and beliefs on disabilities, and discipline. The study consisted of nine Southeast Asian families, ten children, and four Head Start staff who were interviewed and observed in various settings and situations. In general, the Southeast Asian families and the Head Start staff had differing oppinions and beliefs in relation to the four domains and were unware of each others differences.

In relation to education, the Head Start Staff stated goals of independence, self-esteem, and age-appropriate goals among others as the most important. However, the Southeast Asian families interviewed listed respect, being liked by others, obeying authoritative people, working hard, and being successful by attaining higher degrees as educational goals. Some of the goals encouraged by the Head Start staff were considered objectionable because the children would stop listening to their parents. The Southeast Asian families in this study also viewed problems with learning as the child being lazy and would attempt to correct the problem through stricter discipline. If stricter discipline did not work, parent's often considered it fate and therefore unchangable. The families in this study did not view speech, learning problems, or mental retardation as disabilities, but instead an issue of fate, laziness,or stubbornness. According to the families in the study, children with disabilities such as blindness, deafness or physical conditions were not capable of performing any useful tasks and would be totally reliant on their families for the remainder of their lives.

Implications for the SLP

Language Evaluation Tools

Note: This is not an all-inclusive list, these are only some of the existing tools that address Vietnamese speech and language. Investigate the validity of each test as it applies to a specific client before proceeding.

• Assessing Asian Language Performance, Second Edition

• Bilingual Language Proficiency Questionnaire

• Bilingual Verbal Ability Tests

• Bilingual Vocabulary Assessment Measure

Cultural Tips for Working with Vietnamese Families

Note: These tips represent the opinions of individuals and may not apply to everyone. They are intended only as awareness measures and as general guidelines for interpersonal interaction.

Social DO's

• Always approach the oldest person present to get information. If he or she does not speak English, he or she will refer you to someone else who does.

• The universal “OK” sign (tip of thumb to tip of forefinger, other three fingers pointing upward) is fine to use, but keep a neutral facial expression when doing so. Westerners often grimace or give an otherwise strained look when using this gesture, which can confuse.

• Be attentive to nonverbal cues

• Patriarchal family - the wife deals with the home matters and the husband deals with outside matters.

Social DON'Ts

• Don’t speak loudly or yell. Politeness means using a soft voice. In public places, be reserved, not outspoken.

• Don’t beckon “come here”with your finger up. This is a gesture intended for animals. If you must beckon, turn palm down (back of hand up) and flutter the fingers slightly.

• Using waving motions of any kind to call or summon people is impolite.

• Don’t point your finger at someone’s face. Never point toward an older person.

• Don’t cross your fingers. This is an obscene gesture in Southeast Asia.

• Western man (stranger) should not touch a Southeast Asian woman, including shaking hands.

• Westerners should not kiss or hug Southeast Asian children in greeting.

• Don’t look directly into someone’s eyes when talking. This is considered disrespectful.

• Don’t take photos in groups of three.

• Don’t point with your foot, or gesture with your feet.

• Southeast Asian people generally do not display strong feelings in public. This includes anger and displays of affection.

• Don’t hug someone of the opposite sex as a greeting.

• Don’t refuse a favor when someone offers to do something for you.

• When meeting with people, don’t sit with crossed feet. Don’t put your feet up on a desk or a table. Don’t sit on desks or tables.

• Don’t touch the head of a Southeast Asian without asking first. Always ask before moving to a position near the head.

• Don’t give something to someone by throwing it on a table.

• Southeast Asian Behaviors That May Offend Americans

• Not saying “thank you” when appropriate.

• Not keeping appointments.

• Not being on time.

• Asking someone how much money he or she makes, or how much something cost.

• Vietnamese parents see teachers as people with authority over schooling and they are not supposed to interfere. Parents may think teachers incompetent for seeking parent involvement.