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There is an invaluable link between traditional medicine and Burmese culture in Burma dating back to 600 BC (Department of Traditional Medicine, 2019).

These traditional medicinal recipes were written in Burmese scriptures and later translated by Buddhist monks onto pieces of palm leaves and bamboo (DeFilipps & Krupnick, 2018).

Traditional medicine in Burma has four central tenets that encompass its practice.

1. Day Tha Nar Naya - the teachings of Lord Buddha

2. Bay Thit Za Naya - the disciplines of medicine

3. Weiz Za Da Ra Naya - the knowledge and wisdom, or a term for someone with supernatural powers

4. Net Khat Ta Naya - the aspects of astrological science

(Department of Traditional Medicine, 2019)

Today, Burma has the Department of Traditional Medicine, which was established in 1989, traditional medicine hospitals, government publications, courses, books, and even nine official herb gardens.

This merging of traditional and more westernised medical practices shows how Burmese culture values the roots of their healing practices. To have traditional medicines not only studied and practiced but also integrated into Government policy pays homage to the earliest healers.

References:

DeFilipps, R.A., & Krupnick, G.A. (2018) The medicinal plants of Myanmar PhytoKeys, 102 (1-341) https://doi.org/10.3897/phytokeys.102.24380

Department of Traditional Medicine. (2019) Milestones of Traditional Medicine in Myanmar. https://www.dtm.gov.mm/sites/default/files/Book-%20Minlestones%20of%20TM%20in%20Myanmar%20(eng%20version).pdf

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Betel nut in Burma and dental care for refugees

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Betel nut in Burma and dental care for refugees

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A presenting health concern for Burmese refugees on entry to Australia is that of oral health. According to studies, oral cancers are very prevalent in Southeast Asian populations, and one of the major contributors to a decline in oral health is betel nut (Saraswat et al., 2020)(NSW Health, 2021).

Betel nut is a popular psychoactive substance and plays a role in cultural, social, and religious practices (NSW Health, 2021). It is also classified as a carcinogen, and long-term effects can include teeth and gum discolouration, ulcers, gum disease, and oral cancers (Alcohol and Drug Foundation, 2024). People who use betel nut commonly mix it with other substances, such as tobacco, and tuck it into their mouth between the teeth and gums (NSW Health, 2021).

The Australian Refugee Health Practice Guide recommends that upon entrance to Australia, all refugees should be referred for a dental review (Narayanasamy et al., 2024). There is a chance that they have not previously had dental care, and in the case of betel nut and its cultural significance, they may be unaware of any side effects or long-term harm (Saraswat et al., 2020). The NSW Health Guide and the Australian Refugee Health Practice Guide recommend that clinicians communicate and educate patients on the risks of betel nuts and refer them to dental practitioners who can check for signs of cancer (Narayanasamy et al. 2024)(NSW Health, 2021).

Clinicians should be aware that partaking of a substance such as betel nut is not an act of ignorance on the part of the individual. The perceived benefits of social inclusion and a link or reminder to their homeland and cultural practices can be very important to a person who is displaced.

Further information regarding dental care can be accessed in the Burmese language via https://www.dhsv.org.au/oral-health-advice/Professionals/oral-health-resources/translated-materials.

References:

Alcohol and Drug Foundation. (2024). Betel nut. https://adf.org.au/drug-facts/betel-nut/

Narayanasamy, S., Gardiner, J., Chaves, N. (2024). Hearing, Vision and Oral Health. Australian Refugee Health Practice Guide. https://refugeehealthguide.org.au/hearing-vision-and-oral-health/

NSW Health. (2021). Betel nut products and preparations. NSW Government. https://www.health.nsw.gov.au/oralhealth/prevention/Pages/betel-nut-preparations-use.aspx

Saraswat, N., Pillay, R., Everett, B., George, A. (2020). Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: an integrative review. BMC Cancer 20, 477. https://doi.org/10.1186/s12885-020-06944-9

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1.4 Clinicians recognise the family and community

context of people from migrant and refugee

backgrounds and its impact on consent,

treatment and follow-up (Migrant & Refugee Women’s Health Partnership [MRWHP], 2019).

This knowledge will be essential to me in the workplace as a Registered Nurse because I will be in regular contact with patients and their families who may be classed as CALD (Culturally and Linguistically Diverse).

Because I did not grow up in a country where I was the minority, I will now need to consider how any potential biases I have could affect my clinical skills.

In my experience, situations and issues such as consent, treatment, and follow-up in the Australian medical system would typically be driven by my own decision-making and preferences. In contrast, many people from a refugee or migrant background may come from communities where a collective approach to healthcare and subsequent decisions is the norm, unlike a more individualistic approach (MRWHP, 2019. p 14).

Further, obtaining consent for procedures may also involve family involvement and agreement. This can also depend on the level of care the individual requires, for example someone who is elderly and may rely more heavily on family members to help form their healthcare decisions (MRWHP, 2019. pp 14).

I have seen this to some extent in my own family, as my maternal Grandparents did not speak English upon their immigration to Australia from France in the 1970s. Through family stories, I have heard how challenges can arise from misunderstanding information or struggling to make sense of unfamiliar systems.

Initially, I did not recognise the extent of migrant family and community context as important in the healthcare setting, as it was only information I had heard but not personally experienced. Upon reflection, I can see how language barriers, misunderstanding a new healthcare system, and feelings of displacement or discrimination could determine how effective the healthcare system would be for someone from a CALD community.

Reference:

Migrant & Refugee Women’s Health Partnership. (2019). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds. Competency Standards Framework for Clinicians January 2019. https://moodleprod.murdoch.edu.au/mod/resource/view.php?id=2371109

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According to the 2016 census taken in Australia, 32,655 Burmese-born people were living in Australia, an increase of 50.1% from the number recorded in the 2011 census (Department of Home Affairs, 2018).

The key reasons people from Burma may become Refugees trying to enter Australia are armed conflict between the army and minority groups, political and/or religious repression, and natural disasters (Refugee Council of Australia, 2021).

Reflecting on what events may lead to someone becoming a refugee requires acknowledging that people's lives and motivations differ significantly. We are privileged in Australia to live mostly in peace and have the ability to be ourselves without consequence.

When I encounter a situation or event that is unfamiliar to me, I am reminded of a line from a poem by British-Somali poet Warsan Shire,

"you have to understand,
that no one puts their children in a boat
unless the water is safer than the land".

(Shire, 2021)

References:

Department of Home Affairs. (2018). Myanmar-born Community Information Summary. Australian Government. https://www.homeaffairs.gov.au/mca/files/2016-cis-myanmar.PDF

Refugee Council of Australia. (2021). Key issues for refugees from Myanmar (Burma). https://www.refugeecouncil.org.au/myanmar-burma/

Shire, W. (2021). Home, and: Conversation about Home (At the Deportation Centre). Transition 132, 336-342. https://muse.jhu.edu/article/856613.

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Key issues for refugees from Myanmar (Burma) - Refugee Council

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Myanmar has for decades produced many refugees, and many of them have come to Australia. Why do people from Myanmar or Burma leave? Where do they go? How many

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Social inclusion and non-discrimination are two of the World Health Organisation's social determinants of health in its outline of non-medical factors that can influence a person's health outcomes (World Health Organisation, 2024).

Not understanding customs or the language in a new country can be a source of distress for a refugee and could significantly affect their health.

Arriving in a new country is already a challenging experience for any individual, but arriving in a country where you do not speak the language or understand the culture is a completely different challenge.

Many Burmese refugees living in Australia had significantly more mental health issues post-migration. Their experiences settling in a new country seemed more traumatic than the traumas they faced in their country of origin (Corderoy, 2011) (Schweitzer et al., 2011).

The emotional distress of leaving Burma and the added stressors of trying to find work, learning a new language, and adapting to education were significant (Corderoy, 2011). This distress can lead to social isolation and significantly affects a person trying to adjust and assimilate into a new country.

An Australian news report detailed how a migrant resource centre supported Burmese refugees in South Australia. This centre, and others like it, helps refugees and migrants with skills or situations we may consider basic in Australia, such as calling triple-zero or putting the bins out (Fantin, 2016). This is another example of how a person could feel or become socially isolated.

References:

Corderoy, A. (2011, March 7). Harsh reality of life in the lucky country. Sydney Morning Herald. https://www.smh.com.au/national/nsw/harsh-reality-of-life-in-the-lucky-country-20110306-1bjig.html

Fantin, E. (2016, February 14). Refugees from Myanmar embrace new life in Mount Gambier. ABC News. https://www.abc.net.au/news/2016-02-14/burmese-refugees-finding-homes-in-south-australia-mount-gambier/7154840

Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. https://doi.org/10.3109/00048674.2010.543412

World Health Organisation. (2024). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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burmese refugees smiling and holding hands in australia

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Burma is a primarily Buddhist country, and Buddhism is considered integral to the Burmese identity (Evason, 2017). The main type of Buddhism practised in Burma is Theravada, which places significance on the teacher, the teaching, and the monastic community. This is also known as Buddha, Dharma, and the Sangha (Evason, 2017).

There is a minority of practising Christians and Muslims in Burma; however, religious conflict causes tension in the population. Religions such as Christianity are associated with colonialism and the British rule. Muslims, in particular Rohingya Muslims, are subjected to violence, Government restrictions, and general intolerance. As a result, many Rohingya Muslims have become displaced, having fled Burma across the border to Bangladesh (Omer, 2023).

References:

Evason, N. (2017). Myanmar (Burmese) Culture. https://culturalatlas.sbs.com.au/myanmar-burmese-culture/burmese-myanmar-culture-religion

Omer, S. (2023) Rohingya refugee crisis: Facts, FAQs, and how to help. https://www.worldvision.org/refugees-news-stories/rohingya-refugees-bangladesh-facts

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Though its origins are not completely clear as to who created this dish and which area it originated from, there seems to be an overarching agreement that Mohinga is the national dish of Burmese culture. Mohinga is a fragrant fish and rice noodle soup generally eaten at breakfast time and most commonly bought from street food vendors (Wiens, 2014).

There are mentions of Mohinga in poetry dating back to the last ruling dynasty, the Konbaung, from 1752 to 1885 (Remitly, 2023).

Masterchef contestant and food blogger Suu Khin refers to Mohinga as a comfort food that is quintessentially Burmese and a reminder of her Burmese heritage (Khin, 2024). If you'd like to try her recipe, just click the photo at the top of this blog post!

References:

Khin, S. (2024, January 15). Mohinga - Fish Noodle Soup. burmalicious by suu. https://www.theburmalicious.com/blog/mohinga

Remitly. (2023, October 20). All about Mohinga: Meet the National Dish of Myanmar (Burma). Remitly.  https://blog.remitly.com/lifestyle-culture/nationaldishes-mohinga-fascinating-facts-myanmar-burma/

Wiens, M. (2014, August 10). Myanmar Street Food - DELICIOUS Mohinga (မုန့်ဟင်းခါး) in Yangon!. [Video]. https://youtu.be/I8vE8mIIdPw?si=JA8hp6lbM1x4ZJKN

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Mohinga - Fish Noodle Soup — Burmalicious by Suu

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Proudly presenting our national pride: Mohinga, a Burmese fish soup with fermented thin rice noodles. It all starts with making a smooth flavorful broth from extracting natural sweet juices of fleshy fish, ideally catfish, combined with other spices and aromatics. Waking up to a heavenly waft of m

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Burma is a country in South East Asia. It was renamed Myanmar in 1989, and its residents are mainly of the Burman ethnicity. Other ethnicities include Karen, Shan, Han Chinese, Mon, Yangbye, and Kachin (Aung-Thwin & Aung, 2024).

It is an incredibly diverse country due to its location and proximity to Thailand, China, and India. The official language spoken is Burmese, however it is only after Burma gained independence from colonialism that this was reinstated. Before this, English was the official language, and people were expected to have basic English language skills (Aung-Thwin & Aung, 2024).

Reference:

Aung-Thwin, M.A., & Aung, M.H. (2024) Myanmar https://www.britannica.com/place/Myanmar

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One of the traditional musical instruments in Burmese culture is the harp or saung-gauk.

This instrument is a boat-shaped item with a long neck carved from the root of a tree and silk strings running from tuning pegs. There is evidence of it being played for the King and the royal court as far back as the 8th century (Royal Collection Trust, n.d.).

Music is an important aspect of Burmese heritage and modern life, with many varieties and genres of music popular throughout the country, ranging from traditional to a more western pop sound (Insight Myanmar, 2022).

If you want to hear musicians playing a traditional song, also known as the King's bedtime music, you can click the link above (mitv, 2019).

References:

Insight Myanmar. (2022, July 16). Burmese Music. https://insightmyanmar.org/all-about-burma/2022/7/16/burmese-music

mitv. (2019, August 27). Burmese Traditional Performance (King's bed time music). [Video]. https://youtu.be/nJEmfyEtndI?si=ZUIY8Kqf_UpnJW89

Royal Collection Trust. (Accessed 2024, August 23). Burmese harp (saung-gauk). https://www.rct.uk/collection/74400/burmese-harp-saung-gauk

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Burmese Traditional Performance (King's bed time music)

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The national flower of Burma is the Padauk, a beautiful, fragrant yellow flowering tree that blooms in April. The tree trunk symbolises strength, and the flowers symbolise romance and youth (Myanmar National Portal, 2018).

The yellow flowers remind me of an Australian native plant and the national floral emblem, the golden wattle. Golden wattle trees flower in late winter and spring, producing vibrant yellow flowers (Australian Native Plants Society (Australia), 2024).

A positive aspect of living in Australia is our abundance of native flora, many of which grow in backyards and local parks. I think someone new to Australia could find some peace while sitting underneath a golden wattle.

References:

Australian Native Plants Society (Australia). (2024). Acacia pycnantha. https://anpsa.org.au/plant_profiles/acacia-pycnantha/

Myanmar National Portal. (2018). National Symbols. Government of Republic of the Union of Myanmar. https://myanmar.gov.mm/national-symbols