Conclusion
My fascination with culture and how it influences health outcomes began at an early age. Growing up as a first-generation American-born Thai, I witnessed barriers my parents encountered within their social environment, especially health care. I was always their personal interpreter because it was a natural and convenient occurrence. Because of this, my parents expect me to accompany them to all of their health-related appointments.
After volunteering with Thai-based health clinics and organizations, a common trend I noticed among Thai Americans is that they experience little-to-no access to health care, especially those who are undocumented and have low-English proficiency. Anxiety, discomfort and fear – emotions often associated with being undocumented in the United States – influence their approaches to biomedicine. On the other hand, exposures and utilizations of certain health systems also affected their choices. Thus, barriers to health care leads to pluralistic approaches to treatment.
These recurring issues drove me to investigate health-seeking behaviors and how Thai people in Eastern Massachusetts respond to different illnesses. Though it was not on my list of semi-structured interview questions, discussing about (un)documented status was a topic I thought would be difficult to discuss because it is a taboo topic that is not openly talked about. An unanticipated occurrence was that participants were actually open to sharing their status with me. As a bilingual researcher who worked with the undocumented Thai community, I wanted participants to feel comfortable discussing factors that contribute to their overall health. I tried to help them feel at ease by
informally sharing my family’s stories, speaking in our native language and showing my interest in working with my community. Mutual hardships, or conditions caused by difficulty or suffering, were important for some informants to acknowledge – they share undesired difficulties living in the United States. I believe those who took part in this study were surprised because they had never encountered a researcher interested in understanding the Thai community. A few participants also mentioned how therapeutic it was to share their practices and health belief systems, suggesting their hesitation in speaking about these topics with others.
Anthropological Blind Spot
My first participant, Jane, spoke about geographical barriers that limit the Thai community’s access to herbs, generational differences and how one’s birthplace impacts a person’s take on traditional and Western beliefs.
I think you have to include age in your study. Most of people my age and younger live in apartment. They wake up, go to work, then come back home late. No time.
The older lady or anyone who we saw in temple, most of them have families, have kids. They are more likely to have space to plant herbs. Another thing, ask where they come from. If you ask people who come from not Bangkok, they will know more about traditional medicine. In Bangkok, they don’t really care. Everything city, Western, fashion. There’s no land. You have land, but nobody is going to do anything about it, like my family. Other provinces have more land to grow.
- Jane, 5/29/18
With this information, I decided to start each interview by asking for each participant’s age and where they were born. I initially thought asking for their age seemed rude and disrespectful. Especially if I were to ask older participants what their age was, they might be offended or even call themselves “too old” (Nut’s Interview, July 14, 2018). But after
considering Jane’s suggestion, it was beneficial to analyze associations between age, birthplace and health-seeking behaviors. I found that these factors did heavily influence perceptions of Thai Americans and their responses to various illness episodes.
More or Less a Road to Success
Through the immigration process, individual identity is reformed. Expectations, from themselves or their surrounding support groups, affects outlooks on everyday life.
Of the fourteen participants, nearly half moved to the United States to study the English language. All agreed that they would continue to reside in Eastern Massachusetts to enhance their English-speaking skills and pursue better career opportunities. They believed learning this skill would lead to a successful life in the United States. But relocating to study English reveals another barrier – limitations to educational endeavors in the U.S., employment, financial instability, and distress. All fourteen participants work(ed) restaurant jobs – occupations they had never expected to do. They expressed that it was the best way for them, especially in the short run, to make money without proper documentations. Those who speak decent English worked as waiters/waitresses, while low-English speaking Thai Americans work in delivery or in the kitchen. But very often, it just stops there. There is no progression up the career ladder, and their job title remains static.
Pom, a long-time family friend, spent over 25 years working her way up from being a garment worker, to a restaurant server, and now a restaurant owner. She believed that having this employer title would ease her lifestyle and relieve her stress. That she and
her husband can both live comfortably with people working for them. But the success of establishing a business led to more stress in maintaining the restaurant’s quality service and food.
Because I get older I don’t want to work hard. But when we open the restaurant, I work hard more than before. Because the restaurant looks like your daughter. Or like your kid. You have to take care everything. We have feet, we have to see everything. We have to decorate. You have to think how you gonna get more people to coming. How to create some food. Anything.
- Pom, 7/14/18
The couple takes pride in finally achieving the American Dream with their established business, but they have this fear of losing their hard-earned success through burn out and not having enough money to run the restaurant. As a result, Pom and Seng have to work harder, spend hours maintaining the restaurant and recipes, and make sure customers leave the restaurant feeling satisfied with their meals.
My conversations with informants, particularly with Song and Beer, also made me realize that receiving a college degree does not always open new doors. Song has a Bachelor in Chemistry from Thailand and a Master in Business Administration (MBA) from an American college. She initially wanted to continue her stay in the United States because she loved her daily lifestyle. Her qualifications would have worked. But due to her documentation status, companies where she applied to work did not accept her because they were unable to sponsor her. Song had to grab the first opportunity and secured part-time jobs at a Thai-owned shipping company and restaurant. She left for Thailand in 2018, after her family suggested that she inherit her father’s company. “It’s best I utilize my degree than work in a country that devalues foreign degrees,” says Song.
Beer has a college degree in Computer Science and has worked with information technology (IT) for seven years while living in Thailand. Working under cyber security, she claimed to be “well-paid and comfortable.” But after going through a break-up with her long-term partner, she decided to move to Massachusetts in 2016 to start a new life.
She only knew one person in the United States at the time and believed this country would provide her better opportunities and people to date.
I’m 32 now. I’m at an age where I want to get married already. All these men I’ve been meeting has expressed interest in short-term relationships, which is what I don’t want! I’m tired of working this job as a waitress; I have a strong
background in IT but I can’t even do that here. The quickest way for me to work with something related to computers would be to marry an American citizen.
Someone with a green card would work too, but that delays the process. Either way, if I get married to someone who is legal in the U.S., then I would be able to finally obtain a work permit.
I was a bit confused and asked, “What about the option of going back to Thailand?” She was also tired of her routinized lifestyle back home – waking up early, going to her office job, then coming back home to sleep. I asked, “How is that different than working in the United States?” Enthusiastic about Western customs, Beer describes her present life as relaxed and unconfined. “My life is the opposite living here. But I prefer it more than my life in Thailand. I’m able to take days off when I’m sick and I have vacation days. I feel it’s much easier for me to enjoy my time here.” Although she earned more money working an office job in Thailand as opposed to working restaurant jobs that require longer hours and labor, she feels that she now has the freedom to choose when to work.
All participants have gained both support and expectations from their friends and families, and don’t want to disappoint them with the unforeseen outcomes to their hardships. Revealing the harsh realities of the American Dream would go against their pride and self-esteem. For Thai immigrants to relocate to ‘the land of opportunities’ just to work jobs unrelated to their background is often questioned and looked down upon. I couldn’t help but notice the differences between what I see in person, as a housemate of three participants, and what they post online. On Facebook, they hide their daily work routines, and upload photos of themselves living the ‘ideal’ lifestyle – fashion, travel, aesthetic portraits, and eating out at extravagant restaurants. But to follow these trends, they have to work 10-hour shifts five to seven times a week at restaurants that pay under minimum wage. Working much harder to live equivalent lives as ‘true Americans’ reveal underlying social violence that impacts immigrant communities.
Devaluing of Mainstream Practice
During their time in the United States, ranging from two to twenty years, all participants had used some form of traditional Thai medicine to treat their illnesses. Not everyone pursued or believed in the same practices, but they were aware of and knew family members and/or friends who do so. They follow a sequence that best fits their etiological beliefs. Informants chose traditional Thai medicine, biomedicine, or
combinations of both to treat their illnesses. Some alternate between Thai and Western medical systems to treat illness. But when experiencing serious outcomes like broken limbs and/or non-communicable diseases, they all agreed that Western medicine is most
effective and choose this health system as their first resort. Urgency of illness contributes to individual health seeking and decision-making choices.
Participants also shared the integration of Buddhist practices into their daily lives.
But routines are not all the same. Practices include morning offerings to significant figures (Buddha statues, monks, Kings, and ancestors), meditation, praying, amulets, and different forms of fortune telling. But the practices they have seen in Massachusetts are very “expensive and Westernized” (participant interviews). Thais do not often visit Thai massage parlors because practices are adapted to the liking of American standards. To Beer, “The pressure they use here is much weaker and they don’t really touch the
pressure points. It’s usually just grazing over the muscles and doing smaller movements, not really treating.”
Final Word
To my knowledge, there are limited studies on Thai Americans in general. To conduct qualitative research on the Thai community in the United States, especially through the lens of a Thai American anthropologist, can make significant contributions towards understanding local realities that impacts not just social, economic and political determinants, but also overall health of the population. By understanding the narratives of participants, as well as incorporate my own self-reflections, it gives readers access to private worlds that are not often portrayed through social interactions. I believe this study can broaden cultural meanings and understandings of health. Though there are present challenges to providing health care to underserved populations, it is significant to
understand the lifeworlds that affect health choices, behaviors, and decision making. This study demonstrates the value of anthropological examinations of health seeking behaviors and individual decision making amongst the Thai community of Eastern Massachusetts.
While health-seeking behaviors and preferences in health systems are all not consistent within my sample population, my study has shown that healing and medicinal choices are linked to cultural beliefs, socioeconomic factors, and length of time staying in the United States.
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