Illness experience of Chinese immigrants with chronic fatigue and weakness

Chronic fatigue and weakness are common complaints afflicting patients seeking relief from physicians world-wide. People of Chinese decent comprise the largest visible minority and fastest growing language group in Canada (Statistics Canada, 1996). Traditional Chinese health beliefs and practices are vastly different from the biomedical model on which the Canadian health care system is based. Purpose. To clarify the illness experience of Chinese immigrants suffering from chronic fatigue and weakness and to determine its practical clinical significance. Theoretical framework. Kleinman's (1980) Explanatory Model of Illness, Goffman (1963) and Kleinman and colleagues' (1995) theories on stigma. Method. Ethnographic study with a quantitative component. 50 Chinese patients referred by their family physicians were interviewed using the EMIC (Explanatory Model Interview Catalogue) a semistructured instrument, for studying illness experience (Weiss, 1997). Results. The impact of migration is a dominant theme in most patients' narratives of their health problems. Patients reported multiple symptoms, predominantly somatic. Due to the "unknown nature" of their illness and the inability to live up to the Chinese ethos of hard work and family glory, participants felt stigmatized not just for themselves but for their families. Avoid disclosure was their preferred strategy for minimizing the pain of perceived stigma. Social and contextual issues, such as interpersonal conflict and underemployment were the most prominant perceived causes of their fatigue. Informants sought help from multiple sources for their illness, with the majority relying on self-help, family, and friends. Despite limited efficacy of treatment from Western physicians, participants were satisfied with doctors who were supportive and showed interest in their concerns. Practitioners of traditional Chinese medicine were regarded as healers who could "get to the root" of their illness, but financial constraints deterred help-seeking from this group of caregivers. Conclusion. Findings of this study indicate the complexity of patients' explanatory models of illness. The practical significance of illness experience and its impact on stigma, help-seeking, course and outcome should be studied further in the context of the Canadian multicultural mosaic. Clinicians need to pay attention to adjustment issues confronting immigrant patients who suffer from an ill-defined chronic illness, as well as other disorders.