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Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Thailand

This subject guide is a collaborative project with the Children's Medical Center Pediatric Palliative Care Team, the Lamar Soutter Library, and Interpreter Services.


SOUTHEAST ASIA—including Vietnam, Cambodia, Laos, and Thailand




 General Cultural Information:

Vietnam occupies the eastern coast of the Southeast Asian peninsula. Vietnamese culture is very complex, in part due to the participation of many groups in Vietnamese history. Vietnamese has three dialects; all are generally understood by most Vietnamese speakers. Many refugees of the first wave are bilingual. Older urban people may speak some French, and those who had government jobs in South Vietnam speak some English.

Family Structure:

The traditional Vietnamese family is patriarchal, patrilineal, and patrilocal, often with two or four generations under one roof. There is the immediate family (nha) and the extended family (ho). In Vietnam, the immediate family is the nuclear family plus the husband's parents and the grown sons' spouses and children. The extended family is the immediate family plus family members of the same name and relatives residing in close proximity. Father has ultimate responsibility and acts as an authority leader while delegating tasks and involving others in decision making. In Vietnam, the father often worked outside the home, while the mother cared for the children and managed the household. Grandparents helped with childcare, and children helped with various chores. Younger siblings are to respect and obey older siblings, and aunts and uncles are treated as patients.

Religious Practice:

In Vietnam there are many religions and this diversity extends to the US. Confucianism underlies many Vietnamese traditions shared by people of various religions.


This was the predominant religion in Vietnam, practiced by an estimated 90% of the population prior to the war. In Seattle, the majority of Vietnamese are Buddhist. There are two main forms in Vietnam. The southern Hinayana believes only monks and nuns can achieve enlightenment, while the northern Mahayana believe laymen can attain enlightenment as well.


More a code of behavior than a religion, it emphasizes filial piety and obligation, altruism and the belief that man creates his own destiny. Music, respect for authority (including teachers), and social rites are very important.


Founded by a Chinese philosopher, Lao-tzu, this religion teaches that the goal of becoming an Ultimate and Unconditioned being can be achieved through thrift, humility and compassion. Taoists may worship many gods, and value simplicity, patience, and contentment. They avoid confrontation and strive for harmony both between men and between man and nature. Some Taoist groups also worship deities or other religions. They have an organized clergy and temples. Though many Vietnamese do not practice this religion, Taoism has strongly influenced Vietnamese culture.


Introduced in late sixteenth century by Portuguese, Spanish and French, Catholics in Vietnam have intermittently suffered persecution. Before the collapse of South Vietnam, an estimated 2 million people (of a population of 17 million) practiced Catholicism.

Other Beliefs/Sects

Many Vietnamese practice animism (worship of spirits and natural forces), ancestor worship, astrology, and are very superstitious. Older refugees in the US continue these practices and beliefs, while many younger people in the community do not. Cao Dai and Hoa Hoa are both sects with little influence.

Food in Daily Life:

Many Vietnamese are lactose intolerant as adults so do not consume much milk. The traditional diet is mostly rice, fish, and vegetables, plus pork or chicken when available. In the US, older people still prefer a traditional diet, though more meat is available than was in Vietnam. Many parents complained during interviews that their children eat poorly, preferring western fast foods with few fruits and vegetables. The vegetables available here are similar to those in Vietnam, but the fruits are very different. In Seattle's international district, there are several Vietnamese markets that carry more traditional foods.

Communication Style:  

Vietnamese is the official language of Vietnam. There may be different dialects but they are understood by each dialect. It is written in Roman alphabet. It is spoken softly by both genders. Names are in order of family name, middle name, and given name.

People may not express disagreement to avoiding offending someone. Silence may be used to express disagreement. Negative emotion and expression are expressed through silence. Greetings include exchange of names, smile and a gentle bow. Men shake hands with each other, however women do not. Hugging and kissing in public is rare.  Eye contact is avoided to display respect. They also maintain personal space. Medical information is not easily disclosed. Women are shy to discuss sex, child-bearing, and contraception.

Concepts of Health and Wellness:

Yin-yang imbalance is believed to cause health problems. Some believe in supernatural causes such as punishment from the gods. Family is responsible for healthcare. Many home remedies are used to cure illness before considering biomedical medicine. Patients may feel uncomfortable and frightened for invasive procedures because they believe souls are attached to different parts of the body. They fear the souls can leave, causing illness or death. Patients may also not accept blood to be drawn. They fear that it is irreplaceable. In times of serious and terminal illness, clinicians should consult the head of family before consulting the patient. 

Death and Afterlife: Death is accepted as a natural process. Buddhist practices emphasize the presence of ancestral spirits, and reincarnation. There is much that goes into preparation for a funeral. Most patients prefer to die at home, and families prefer to care for them at home, in the belief that death outside of the home leads to an unrested soul. After the death of a relative, family members gather around the body expressing strong cries and emotion. Prayers are performed as a means of acceptance. Family may need extra time with the deceased. The body is to be highly respected. Families may want to wash the body, however, they may accept for the funeral home to handle it. Sometimes rice is placed in the mouth of the deceased. Cremation is also common among Buddhists. Attitudes of organ donations may vary, generally the body is religiously believed to be kept intact. 

Local Community Information:

Vietnamese Buddhist Center                                                                                                        

96 Dewey Street, Worcester, MA 01610-1020

508 755-7817 

Vietnamese Alliance Church of Boston

286 Ashmont Street, Dorchester Ctr, MA 02124-3810

617 265-4296



Vietnamese Americans - Early history, Modern era, Relations with vietnam, Significant immigration waves, Acculturation and assimilation, Cuisine 

Lipson, J.G., Dibble, S.L., & Minarik, P.A. (Eds.). (1996). Culture & Nursing Care: A Pocket Guide. San Francisco: UCSF Nursing Press.





General Cultural Information:

The kingdom of Cambodia, formerly known as Kampuchea, is a country in Southeast Asia. Cambodia has an area of 181,035 square kilometers (69,898 sq mi) and a population of over 14 million .A citizen of Cambodia is usually identified as "Cambodian" or "Khmer", though they strictly refer to ethnic Khmers. Most Cambodians are Theravada Buddhists, but the country also has a minority number of Muslim Cham, as well as ethnic Chinese Vietnamese and small animist hill tribes. 90% of its population is of Khmer origin and speaks Khmer language, the country's official language. However, in recent decades, many younger Cambodians and those in the business-class have favored learning English. In the major cities and tourist centers, English is widely spoken and taught at a large number of schools because of the overwhelming number of tourists from English-speaking countries. Even in the most rural outposts, most young people speak at least some English, as it is often taught by monks at the local pagodas where many children are educated Agriculture has long been the most important sector to the Cambodian economy, with around 59% of the population relying on agriculture for their livelihood.  Other important sectors include garments, construction and tourism.

Family Structure:

The domestic unit is classically a nuclear family consisting of parents and children; however, there is much flexibility in allowing other arrangements. Residence after marriage is local but often, for practical reasons, with the parents of one of the spouses.  Aged parents often live with their adult children. Major family decisions are shared by the husband and wife. An inheritance is ideally divided equally among children without regard to gender or age order, although the child who supported the parents in their old age may be favored and a child no longer living in the village may receive less property. Kin groups larger than the family have no socially prescribed role, although they can be a source of emotional bonds and personal alliance.

Religious Practice:

The dominant religion is Theravada Buddhism (95%) [The practices are listed under Vietnamese culture]. Other religions practiced are Islam (3%) and Christianity (2%).

Food in Daily Life:

  The staples are rice and fish. Traditionally, a home meal is served on a mat on the floor or with the diners seated together on a raised bamboo platform. Meals are eaten in shifts according to status, with adult males and guests eating first and food preparers last. Breakfast typically consists of rice porridge or rice noodles. Lunch and dinner may be a combination of a spiced broth with fish or  meat and vegetables, fish, fresh vegetables eaten with a fish-based paste, and stir-fried vegetables with chopped meat. A strong-smelling fermented fish paste called prâhok is the quintessential flavoring of Khmer food. Fruit is savored, and its display is considered a mark of abundance. It often is given as a gift. Teuk tnaot, a liquid tapped from sugar palms and drunk in various degrees of fermentation, generally is not taken with meals.

Communication Style:

Chinese and Vietnamese is mostly spoken in Cambodia and Khmer is the major dialect. It is also the name of the people. The major form of greeting is Sompeah, which is a gesture where palms are joined with the fingers pointing upward. Generally, the tone of voice is soft and polite, to display respect. Loud tone and too many gestures is considered rude. The communication is style is not blunt to avoid hurting someone's feelings. Khmer rarely say no, as disagreement is seen as impolite. Laughing or smiling may be a sign of nervousness.

Concepts of Health and Wellness:

Maintaining equilibrium is considered practicing good health. Health is to be indivually maintained with family and community influences. Hold natural and supernatural causes responsible for illness. A natural cause would be an imbalance (ie. hot/cold). Supernatural causes may be spells, ancestral sins, or punishment. Many also believe that evil spirits or ancestors cause mental illness, however mentally ill family members are cared for with compassion. Adult women care for ill family members. Patients may be uncomfortable giving blood, to avoid heat loss. Surgery is also feared. To perform procedures clinicians should carefully explain them.

Death and Afterlife:

Buddhists believe in reincarnation. In times of chronic illness, patients prefer to be cared for at home, because it enhances family and community support and care. Prayers are recited by monks while family faces death with quiet and passive manner. Body is to be washed by the family/monks. The body is positioned in a prayer position. Families may place a coin in the mouth. Organ donation is unlikely due to the belief in rebirth. Autopsy is also unlikely to be agreed on, unless careful explanation is disclosed.

Local Community Information:

Cambodian Community of Massachusetts

375 Broadway, Room 204

Chelsea, MA 02150

(617) 884-8004/8006


Cambodian Crisis Committee

28 Hulst Road

Amherst, MA 01002


Cambodian American Assoc.

70 Boltwood Walk

Amherst , Ma 01002

Phone : (413) 253-0696


Cambodian Mutual Association

of Greater Lowell

120 Cross Street

Lowell, MA 01854            

978 454-6200



Cambodian American League of Lowell

60 Middlesex St

Lowell , MA 01852


Cambodian Student Journal

P/O Box 1213

Lowell, MA 01852

508 459-5951


Khmer Family Association

8 Gardner Street, Suite 4

Allston, MA 02134


 Cambodian Americans - History, Origins, Cambodia under the french 

Lipson, J.G., Dibble, S.L., & Minarik, P.A. (Eds.). (1996). Culture & Nursing Care: A Pocket Guide. San Francisco: UCSF Nursing Press.



General Cultural Information: 

Laos, officially the Lao people's Democratic Republic  ia a country in Southeast Asia. Laos traces its history to the kingdom of  Lan Xang or Land of Million Elephants, which existed from 14th to the 18th century.69% of the country's people are ethnic Lao, the principal lowland inhabitants and the politically and culturally dominant group. The Lao belong to the Tai linguistic group who began migrating southward from China in the first millennium AD. 8% belong to other "lowland" groups, which together with the Lao people make up the Lao Loum.  Hill people and minority cultures of Laos such as the hmong (Miao), Yao(Miao), Dao, Shan, and several Tibeto-Burman speaking peoples have lived in isolated regions of Laos for many years. Mountain/hill tribes of mixed ethno/cultural-linguistic heritage are found in northern Laos which include the Lua (Lua) and Khmu people who are indigenous to Laos. Today, the Lua people are considered endangered. Collectively, they are known as Lao Soung or highland Laotians. In the central and southern mountains, Mon-Khmer  tribes, known as Lao-Theung or mid-slope Laotians, predominate. Some Vietnamese, Chinese and Thiland Thai minorities remain, particularly in the towns, but many left in two waves; after independence in the late 1940s and again after 1975. The official and dominant language is Lao, a tonal language of Tai linguistic group. The written language is based on Khmer writing script. Midslope and highland LAo speak an assortment of tribal languages. French, still common in governament and commerce, is studied by many, while English, the language of the Association of Southeast Asian Nations, has become increasingly studied in recent years. 

Family Structure: 

A tendency toward matrilocality among ethnic Lao means that the main house at the center of a group of related women almost always contains a stem family. The oldest daughter and her husband move out after the marriage of the next daughter but try to live nearby or in the same compound. The main house usually is inherited by the youngest daughter, who is responsible for the care of aging parents. The proximity of nuclear households and their continued relationship with the main house creates the appearance of a modified extended family. However, these new units move eventually, separate from the original main house and become main houses. Among highland patrilineal groups, there are large houses containing extended families of related brothers, while in the southern highlands, there are extended families of related women. Men generally are recognized as the household head for religious and political purposes.

Aside from the inheritance of the main house by the youngest daughter among ethnic Lao, inheritance tends to be equal between sons and daughters. Residential practices determine what is inherited, with those moving away, most often sons, selling land to their sisters or leaving it in their care. The passing on of a house and productive land signals the passing of authority from one generation to another. Jewelry and woven cloth pass from mothers to daughters. Among patrilineal highlanders, houses and land, if they are held by residentially stable groups, are passed through sons, usually the eldest, while daughters are given a substantial dowry. Kinship among the Lao is reckoned bilaterally, and there is little genealogical consciousness beyond two generations except among the former aristocracy. Patrilineal clans and lineages can be found among the Hmong, Iu Mien, Khmu, and others; these clans are exogamous.

Religious Practice:

Most Laotians are Buddhists [The practices are listed under Vietnamese culture] , however in America, many have converted to protestant Christianity.

Food in Daily Life:

Sticky rice is the staple. Chinese, Vietnamese, Hmong, and some other groups favor nonsticky varieties that can be eaten with chopsticks or spoons rather than with fingers. Spoons and forks are used to manipulate the dishes that accompany the rice, while sticky rice may be dipped directly into condiments of chili paste and fish paste. Soup is a regular feature of meals. In the countryside, people eat chopped raw meat and foods gathered from the surrounding forests. Hygiene campaigns have caused a decline in the eating of raw foods in cities.Laab , finely chopped meat with spices, is a favorite dish that can be eaten raw or cooked. For most lowland Lao, fish dishes are a central part of the diet. Relatively little pork is eaten, and chicken, buffalo, or beef is more common. An important culinary change in the main cities since the revolution is a spread of dog eating, which previously was associated with Vietnamese and Sino-Viet groups. Dog meat is considered a "strong" male dish and is accompanied by strong liquor. Rice whisky often accompanies snack eating among males, and heavy drinking usually occurs on ceremonial occasions. At the New Year heavy female drinking also occurs. In the countryside and mountains, fermented rice "beer" is drunk from jars using bamboo straws. In the cities, beer consumption is widespread. 

Communication Style:

Lao is in the Thai language family. Therefore Thai is spoken and understood. Body language is an important form of communication in the Laotian culture. It is important to show honor and respect in the Buddhist culture. The elderly are highly respected.

Concepts of Health And Wellness:

Traditional medicine involves massage and herbs. Chants and healing rituals are used to cure illness since it is seen as a spiritual problem. Coin rubbing is another form of treatment for many illness including headaches, and nausea.   

Death and afterlife: Usually cremation is practiced unless the death is brutal, then the body is buried. Traditionally, the remains are placed somewhere in a temple as they are believed to be powerful and may help grant wishes. Many people who have converted to Christianity perform the burial rituals.

Local Community Information:

Wat Buddhabhavana of Massachusetts, Inc.
25 Milot Road
Westford, Massachusetts 01886
Contact person: Ven. Mangkone Sananikone

Wat Lao Dhammaram
159 Richardson Road
Fitchburg, Massachusetts 01420

Contact person: T. Sommala

Wat Lao Mixayaram of New England, Inc.
45 Bernier Street
Lowell, Massachusetts 01851

Watpa Keomany Xayaram, Inc., of Massachusetts
213 Electric Avenue
Lunenburg, Massachusetts 01462-0221
Contact person: Ven. Khamsing Keomany


Laotian Americans - History, Modern era, Significant immigration waves, Settlement patterns, Acculturation and assimilation, Values, Proverbs, Festivals



General Cultural Information: 

Thailand is an independent country lies in the heart of Southeast Asia. Its tradition incorporates a great deal of influence from India, China, Cambodia, and the rest of the Southeast Asia. Thailand's national religion Theravada Buddhism is important to modern Thai identity. Thai Buddhism has evolved over time to include many regional beliefs originating from Hinduism, animism as well as ancestor worship. The official language of Thailand is Thai, a Kradai language closely related to Lao, Shan in Burma, and numerous smaller languages spoken in an arc from Hainan and Yunnan south to the Chinese border. Thai is the principal language of education and government and spoken throughout the country.

Family Structure:

The ideal is for a married couple to establish its own household as soon as possible. However, especially among poorer couples, residence with the parents of the husband or wife is common. The nuclear family is the core of the domestic unit, but it often includes members of the extended family including unmarried siblings, widowed parents, and more distant unmarried or widowed male and female relatives. The husband is nominally the head of the household, but the wife has considerable authority. Female members of the household are responsible for most domestic chores. 

Religious Practice: 

Thailand has prevalence of Buddhism that ranks among the highest in the world [The practices are listed under Vietnamese culture]. The national religion is Theravada Buddhism. According to the last census (2000) 94.6% of the total population is Buddhists of the Theravada tradition. Muslim is the second largest religious group in Thailand at 4.6%. Thailand's southernmost provinces –Pattani, Yala, Narathiwat and part of Songkhla, Chumphon have dominant Muslim populations, consisting of both ethnic Thai and Malay.The southern tip of Thailand is mostly ethnically Malay, and most Malays are Sunni Muslims. Christians represent 0.5% of the population. A tiny but influential community of Sikhs in Thailand and some Hindus also live in the country's cities, and are heavily engaged in retail commerce. There is also a small Jewish community in Thailand, dating back to the 17th century.

Food in Daily Life:

Rice is the staple food at every meal for most people. A meal will include rice, dishes with gravy, side dishes, soup, and a salad. Whereas in central and southern Thailand polished white rice is eaten, in the north and northeast people eat glutinous or sticky rice. Fish and shellfish are popular. Curries are eaten throughout the country, but there are regional varieties. Northern and northeastern food is similar to that of Laos and consists of more meat, including meat served as sausages, or as larb (a salad is usually made of raw meat). Chinese food has influenced the national cuisine, especially in regard to noodle dishes. Sweets are eaten as snacks. A popular snack is green papaya salad. In the past, there were marked differences between the food of the common people and that of the nobility. Whereas commercial alcoholic drinks are common throughout the country, non-commercial alcohol made from rice is still drunk. 

Communication Style: 

The traditional form of greeting is the wai, which is a sign of respect usually given from a person of lower age status to someone of higher age status. It is performed by joining the right and left palms, and fingers pointing up, sometimes a person may also bow their head as well. Thai usually greet with the first name rather than the sirnames. It may take several meetings to form a relationship. Body language is carefully observed so it is important to be aware a persons body language when communicating. It is difficult to say no, it is seen as a sign of disrespect, therefore it is usually done through body language. 

Concept of Health and Wellness: 

There are many practices in the Thai tradition that are performed for good health. Healthy eating is considered daily care of the body. Massage therapy is also a form of enhancing general health.

For a good health during pregnancy, women generally consume a lot of ginger, garlic, and onion. Coconut milk is also consumed for nutrients to the mother and fetus. There is a belief that a baby’s activity level determines the sex of the baby. Pregnancy is considered a hot condition, therefore the mother wears warm clothing, keeping the diet mostly of warm foods. Family is an important concept in the Thai tradition and therefore the mother and the father are actively involved in childcare.

Death and Afterlife: Buddhists believe in death and rebirth which continues until ignorance and craving are eliminated. Funerals involved burials or cremation. Mourners and monks accompany the funeral ceremony and burial. If a person has died a violent death, the body is buried immediately. 

Local Community Information:,9087,0,0,1,0

Dhammayutti Nikaya

Wat Boston Buddha Vararam
523 Pleasant Street
Malden, MA 02148
Tel: (781) 321-1568
Fax: (781) 388-2420



Culture of Thailand - traditional, history, people, clothing, traditions, women, beliefs, food, customs