Originally published in 18XEEM, April 2008, Issue 04
Why are we here? What is the process of getting to medical school? What is it like to be a medical student? What does it take to become a doctor? These were some of the questions that Dr. Ia Kue helped answer and facilitate during a Future Doctors Gathering in her humble home for a group of eager students currently pursuing the medical field. “It’s a long, difficult, and sometimes lonely journey that takes a lot of dedication, sacrifice, and determination to get to.”
With this in mind, Dr. Kue, came up with a meeting to bring Hmong students from all over Michigan to discuss and share their experiences, in hopes of helping them get through this rigorous educational procedure. If there is anyone who has the most knowledge on what it is like struggling through medical school to attain a professional career, while juggling other cultural and social activities, only to make it out in the end, as successful and as enlightened as never before, it would be Dr. Kue.
Dr. Kue is the first female Hmong osteopathic medical student in the United States, the first female Hmong Family and Osteopathic Physician in Michigan and the first to open and manage her own clinic: Lifetime Family Care, PLLC. She is a pioneer in Hmong women leadership, not because of these numerous accomplishments, but because of her perseverance and determination in higher education and empowering youth to live their dreams. Some of the things she shared with us while we sat in her office were extremely heartwarming, and it showed through that she is a dedicated,hardworking and genuine person. Her gentle voice revealed that she was a caregiver, not just to her kids, but also to her patients, in always being compassionate and thoughtful about their well-being.
“It took me 13 years to get started here. I remember when I first started going to medical school, all of the older ladies were saying, why do you want to do this? You have kids, and you are a nyab. You should just stay home and let your husband work. A lot people were unsure of our decision. But after we finished, people came up to us and they apologize to us and admitted that this was the right thing.”
18XEEM: When you were a little girl did your parent’s expect you to become a doctor? DK: No… because they didn’t know any better, as far as what we could do or what potentials we had. My dad is a proponent of education, so he is always emphasizing education. What type of education –he didn’t know, he just wanted us to finish high school and at least go to college, that was what they kept enforcing. But as far as going to medical school, no I don’t think that they ever dreamt that this could be a possibility, nor did I.
When you and your family moved to the US, how did you cope with learning to speak and write the English language at the age of 8? What was your motivation? I was the oldest of 5 kids, my parents spoke no English, and similarly to a lot of people, I just had to learn it because I was interpreting for them… when we’d go shopping or the doctor’s office. I was forced to learn it in a way, and that’s what motivated me to learn it quicker than probably my siblings. Because it was do or die, you know. We were sponsored by a church in Illinois, there were maybe 4 other Hmong families around the area, so I was always surrounded by friends who were not Hmong. I joined clubs in school, played in a jazz band, and so those things helped me to learn English faster.
You married at a very young age, 17; do you think things would have been different if you didn’t marry young? Definitely, things would be different, because who knows whom I’d end up with or what that life situation would be like, but I’ve always loved school. Even if I didn’t get married at that age, I would have continued to pursue something in school. When I dropped out of 10th grade my teachers were very disappointed, because I had a grade point average of 3.9 and worked really hard to get there. When I got married, it just kind of ended; my dad was also very disappointed. But he made my husband promise that I would go back to school and at least get some sort of degree. And so my husband agreed that he would send me to school.
As a Hmong woman, what was one of the biggest challenges you faced in your life? I think that I was very lucky, though there are challenges. I was lucky because when I married my husband,his parents were very supportive of my education too so that automatically relieved a lot of pressure there. I think one of the biggest challenges with all Hmong women is to trying to be a good nyab (wife), a good mother, have lots of kids for your parents, to be able to provide for your family, and at the same time pursue what you want to do and not compromise that. If you want to continue being a domestic Hmong woman, and at the same time you want have a career, then your responsibilities double. If you want to be one or the other its okay, but most of the time, I fought really hard to be the best at both and that made it more complicated. At times I felt that I couldn’t, and I was disappointed because of that, but I tried my best and left the rest to God. I wouldn’t have done it any other way.
What was one of the biggest sacrifices you had to make in getting this far, and how did you go about making that decision? I think the biggest sacrifice I had to make was my family. I had to go to school at Michigan State and I had to leave them for 2-3 days at a time. That was a huge sacrifice. I remember the first whole semester, when I used to drive to school I would be so broken hearted about leaving my family that I would cry all the way driving from home to Michigan State. It was also challenging for my husband and kids.
In addition to that, I also had to sacrifice a lot of my friends, because all I had time for was school and family. I didn’t have any time for anything else. A lot of my peers at that time were all housewives and they worked and they were happy with that. I tried to convince them to go to school with me too but really nobody else was interested so I just kept pushing by myself. At the same time, I tried to keep my family in line with me along the way. I didn’t want to lose them behind. Every step of the way I would keep them up to date. I would call my husband everyday and let him know what I was doing, where I was at and I’d write to my kids everyday from school or I would call and talk to each of one of them and ask how school was –if they were sick or doing okay. The key thing for me was having constant communication with them. They came to visit me often, if I didn’t come home within 2-3 days, they would make a trip up there or if I had exams on Mondays and I couldn’t come home on the weekends, they would stay with me on the weekends.
My parents and all my siblings were such a huge support, helping every way they could. When I did come home –the free time that I had, I spent with my kids. I taught my girls how to play the piano, so that was our time together. That was my way of trying to balance my life, but I really had no life outside of that. Since our kids were little, we have set a day where we have family time together so every Friday night is family night… even now that they are teenagers they won’t go out with their friends because they know its family night on Friday’s. Every Sunday night, we have a family meeting night. That was another way we kept our family together.
Recently, you did a presentation on the book, “The Spirit Catches you and You Fall Down”. As a Hmong and a Doctor, do you see yourself in the same shoes as the parents of the patient, or the doctors of the patient? I would say that I would be that person who stands in the crossroad between two cultures. It’s really neat to be in that position because you can see everything that is going on on both sides; on the parent’s side as well as the medical side. I can’t really say one or the other. I believe that her [Lia’s] parents did the best they could as parents; with the limited knowledge they had in medicine to take care of Lia. They loved her.
On the other side, her pediatricians also did the same; they were limited because they didn’t understand the culture, but from a medical point of view, they did their best. The flaw was that they didn’t take the time to understand the parents and that made a huge difference. No matter how smart they were,how much time they sacrificed, because they missed that small piece –that knowledge into the culture, it made the world a difference in the way things turned out. They were, as one of the doctors said, ‘excellent physicians but imperfect healers’because their world view was the opposite of their patients and they just couldn’t identify with them. It was a tough situation on both sides.
Do you find yourself in that position sometimes while working with patients of other cultural backgrounds? Yes, I do and it is very tough. Even with me being Hmong, its very hard for my Hmong patients to adhere to their treatment regime. For example if they have high blood pressure, I would give them enough medication for 3 months, sometimes I don’t see them for another 6 months or a year later, when they are having symptoms. However, things are changing, as I’m able to spend more time in educating them.
More importantly, they are starting to see the consequences of uncontrolled diseases in the Hmong community, so awareness has definitely increased adherence. It is a challenge for all health workers when working with a culture whose world view of illness is so different than our own. But I think that if we focus on what we have in common as people and respect each other for our differences, then we can overcome many barriers. I’m finding that doing what is right (from a medical perspective) is not always the best initial step. The most important thing is building a firm relationship. It is extremely important to gain that trust and respect from your patients first. They want to know that you actually care about their health –I think this ultimately breaks all cultural barriers and only then can you provide services to your patients. Because of this, I’ve actually learned a few Polish words to try to impress my Polish patients…who usually just giggle at me.
How do you deal with patients when they don’t take your word for it? I believe that you can never force a patient to do what they don’t want to do, regardless of their cultural background. My job is to educate them about their illness, provide them with options, and then provide them with my recommendations. Then it’s pretty much up to them. If it is a difficult decision then I give them my best judgment by suggesting something like, “if I were in your situation… this is what I would do,” but I never guarantee the outcome. Once I feel that they are well knowledgeable with the situation, they can make the decision that’s best for them. Sometimes I’ll talk to their daughter, or their parents, or someone they trust and respect to get them to encourage and support their family member in making the best decision.
Where do you see the future of the Hmong community going in terms of our history, culture and language? I think we can look at the Hmong communities at large and we can see that Hmong people have progressed very fast. Within the last 30 years, we have had people who’ve gone on to higher education, or have their own businesses. We have come very far and will continue to grow if the people who have accomplished what they have accomplished will reach back to the community and the young people; I think that will help them to catch up. I do also see a generation of –for lack of a better word, a lost generation of youth. I think that we –those of us who have gone forward, need to spend a lot of energy to try and wake up our youth, instill within them dreams, and remind them where their parents came out of. My parents were always telling me, “We want a better life for you, we don’t want you to have the kind of life that we did.” I saw that kind of life –where they came from and the struggles, it is a big motivation for me to keep pushing forward. I want our young people to see that too. I want them to know that it doesn’t matter where they are at; if they want to pursue their dreams… it is very possible.
As a leader in your community, what is the one thing that you would want others to learn from you and apply it to what they are doing in their lives? Find something that you are gifted in and do what you love to do and be excellent at what you do. There are four things that will help you get there, and I call them the four D’s: Determination, Discipline, Discernment, and Dedication. Those are the things that will lead you to your Dream (which is actually the first to start with: to have a dream, a goal or a target to hit). I want our young people to know that each one of us, has a purpose for our existence. Once we find out what that is, then life begins. I believe that the God who created us would be very disappointed if we just wasted our lives away.
“The four D’s: Determination,Discipline, Discernment, and Dedication. Those are the things that will lead you to your Dream.”
To the Hmong women out there, whether they are married or not, they can do both. They just have to sacrifice a bit more. But I want and hope to see more women becoming more independent and at the same time be able to maintain the humble role as a Hmong wife and mother. To be able to make decisions with their children, to be a good role model for their family and also for our community.