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Articles > Burmese Culture

Apr 10, 2017
posted by Nwe




Burma is currently known as Myanmar, and the people as

Myanmarese, so named by the present government.

Burma is ruled by a military dictatorship that took power in 1962.

Since then, and particularly since the 1988 state of martial law,

refugees have been fleeing a country rife with blatant and

systematic human violations. The army constantly scours the

forests and hillsides razing villages, murdering and raping

inhabitants and displacing communities who may re-build their

homes and ‘villages’ numbers of times. Families becomes

separated and many children end up orphans in their

communities, or in refugee camps. Youth are enrolled as soldiers

and a large number of minorities and dissidents are forced into

involuntary labour for the government.

Thousands of Burmese refugees and also Karen, Shan, Chin and

other ethnic hillside tribes have fled across the Thai-Burma border

and some to refugee camps in Thailand. Burmese who arrive in

Thailand often find themselves marginalized, rated as secondclass

citizens and seen as cheap labour for the government. Life in

the refugee camps is often not much better than outside the

camps and so many of the Burmese seeking refuge in New

Zealand have been deprived of basic human rights including

health care, safety and wellbeing, education, and food, for a

considerable period of time. Many suffer with psychological (and

some, physical) trauma from their pre-migration experiences,

their journeys and the extensive losses of family and community


Since the host cultures and language of New Zealand is so

different from that of the Burmese, the acculturation process,

particularly following the hardship of pre-settlement conditions,

can be experienced as very challenging and alienating.

Photos: 1st author’s own, 2nd by kind permission Refugees International, 3rd

Wikipedia, Burmese Culture (Gnu Free Licence).




Welcome ‘mingalaba’

Goodbye ‘Twe ohn mae nor’ (actually means ‘see you again’)

Main language

The main language spoken in Burma is Burmese, a tonal language. There are many

tribes with different languages and dialects, and most don’t understand each other’s

language. However, many do speak Burmese. It is important when treating a

Burmese client to find out whether they speak Burmese or another dialect before

engaging an interpreter. The current situation in New Zealand is that there are a

number of dialects with limited or no available interpreters. Sometimes it will be

necessary to engage a Burmese interpreter and a responsible community member

who speaks the client’s dialect to work together. The interpreter assistant will need

pre- and post-session briefing along with the interpreter.

Specific gestures and interaction

It is respectful to use specific forms of address when speaking with a


o ‘U’ is a term of respect used for addressing a male

o ‘Daw’ would be used to address women

o ‘Saya’ would be used to address a teacher, master or traditional healer

It is disrespectful to touch another’s head (except for medical examination)

Pointing a finger or gesturing using a finger is considered insulting

Special concepts

‘A-nah-dah’ expresses the Burmese cultural value of solicitousness for other

people’s feelings.


Years of repression have had a negative impact on the traditional Burmese culture.

However, it remains a family and religion-oriented culture with the following features

amongst most ethnicities:

Families are usually extended, although many refugees and immigrants have

more nuclear families (this may be due to immigration policies rather than to

changing traditions)

Social class lines are strong and so there is little social mobility

Initiation into adulthood begins at nine and for boys with the shin-pyu ceremony

which is traditionally followed by several weeks in a monastery as a

novice (this is often not possible after resettlement)

The nahtwin ceremony for girls is followed by having the ears pierced

Thanaka, a pale yellow paste applied to the cheeks and forehead is still used and

some refugees may arrive in New Zealand wearing this application (more often

girls and women)



Factors seen to influence health

Traditionally, health is thought to be related to harmony in and between the

body, mind, soul and the universe. Imbalances amongst these elements (e.g.

the "hot" and "cold" states within the body) can cause illness. As in most other

Southeast Asian cultures treatment would then be with medicines or foods, and

practices that hold the opposite quality to restore balance

Supernatural factors such as spirit possession by a Nat or an ancestor can

cause ill health

Spiritual factors such as bad karma or non-observance of a religious ethic is

seen as a possible causative factor

Traditional beliefs:

o A culture bound illness referred to as Koro in which there is a fear that the

genitalia will recede into the body and that if they recede completely, death

will occur

o Among women, menstrual flow is thought to be critical to health and,

depending on the flow, an indication of good or poor physical and mental


Western medicine and the concept that illness can be the result of external

factors such as accidents and infectious diseases is accepted by many, especially

those who have lived in refugee camps or come from urban areas. As with many

resettled peoples, the degree to which traditional practices are adapted and

modified varies enormously

Traditional treatments and practices

Dietary changes are commonly used to treat illness. Depending on the illness,

an increase in or reduction of one or more of the six Burmese tastes (sweet,

sour, hot, cold, salty, bitter) may be indicated

Herbal medicines are used by many Burmese, particularly for minor ailments

(e.g. Yesah which is a herbal cure-all substance, lotions for aches and pains,

pastes applied to wounds and abscesses)

Western medicine has been integrated into much of the urban Burmese culture.

For those from the hill tribes who may not have been exposed to western

medicine, many come to New Zealand as refugees and will likely have had some

experience of it in the refugee camps

Integrated practices are common and many clients may integrate herbal and

other traditional practices with western interventions. Practitioners may need to

assess for potential drug interactions

(See Chapter 2, Introduction to Asian Cultures, ‘Traditional

treatments/practices’ pg 6, for additional information on some practices).


Important factors for Health Practitioners to know when treating

Burmese clients:

1. Given the traumatic circumstances that many Burmese refugees will have

experienced by the time they arrive in New Zealand, they may feel vulnerable

and powerless, particularly in the face of authority and need sensitive and

respectful healthcare service

2. A history of sexual assault and abuse amongst refugee women and girls may

evoke strong emotional and psychological responses to gynecological

examinations. Same gender health providers are vital for these examinations

3. Women are often not forthcoming about their induced abortions, many of which

might have resulted from rape

4. Whilst women traditionally have pre- and neonatal support from the midwives,

women in the refugee camps will not have had this, nor will they necessarily

have had adequate information on reproductive health due to cultural and

language barriers, and to access difficulties

5. Migrated Burmese women are likely to suffer isolation from their kin networks

who provide childrearing and moral support

6. Traditional practices are often continued while utilizing western medicine

7. ‘A-nah-dah’ (solicitousness for other people’s feelings) may result in Burmese

clients agreeing to suggestions that they are not comfortable with. It is best to

check with clients whether treatment prescriptions are compatible with other

beliefs and practices, and that the instructions are understood

8. It is useful to provide treatment instructions in varying forms such as spoken

word, written (an interpreter can assist with this), and pictorial

9. Despite extreme deprivation and poverty, trauma during flight and exceptionally

difficult living conditions in refugee camps, many Burmese arrive in New

Zealand with remarkable personal resource, courage and positive outlook

towards a better future. It is important that practitioners harness this potential

in encouraging self-care, use of resources and opportunities to improve their

physical and mental health

10. When doing HOME VISITS:

Give a clear introduction of roles and purpose of visit

Check whether it is appropriate to remove shoes before entering the home

(notice whether there is a collection of shoes at the front door)

If food or drink is offered, it is acceptable to decline politely even though the

offer may be made a few times

If the father/head of household is required for the interview/family session

this will need to be arranged in advance as traditionally this would not be

seen as part of his role

Dress modestly

Diet and Nutrition

Rice, and both meat and fish are eaten. Traditionally foods are seen to have ‘hot’ and

‘cold’ qualities and when available these will be consumed as appropriate. Dietary

changes as prescribed by western health practitioners may need to incorporate this

system. Current rife poverty has created food insecurities and there is a high degree

of malnutrition amongst the population.


Dying and Death

Like many of the other Buddhist-based cultures, the Burmese value approaching

dying and death with an attitude of equanimity and mindfulness. In some cases

this may be more valued than measures to manage symptoms. For example,

clients or families may elect for a greater degree of alertness over complete pain

control or being in a highly sedated state. It is important to counsel clients and

families that with current standards of care, many clients can have some degree

of pain control and remain alert

Clients with terminal illness, or who are dying need to be informed through the

family, particularly an elder. In New Zealand there may not be an appropriate

family member in which case a caretaker or close friend may be the one to give

the news. Practitioners need to check with clients who they would like involved in

their treatment and decisions. The process of Informed Consent may be new to

many families and this process will need to be explained. If the client does not

want to make any decisions for themselves, they will need to have a Durable

Power of Attorney

Clients generally will prefer to die at home

The services of a monk need to be made available to Buddhist clients

Buddhists will generally allow hospital staff or funeral directors to prepare the

body for burial

Burial needs to take place by the 3rd, or 5th or 7th day


According to Metha’s (2012) report on health needs for Asian people living in the

Auckland region, the following were noted as significant 1:


Overall Cardiovascular (CVD) hospitalizations

Diabetes (including during pregnancy)

Child oral health

Child asthma

Cervical screening coverage

Cataract extractions

Terminations of pregnancy

1 The Metha 2012 report refers to three ethnic groups stratified in the Auckland region:

Chinese, Indian, ‘Other Asian’ (includes Southeast Asian). Ethnicities include Korean, Afghani,

Sri Lankan, Sinhalese, Bangladeshi, Nepalese, Pakistani, Tibetan, Eurasian, Filipino,

Cambodian, Vietnamese, Burmese, Indonesian, Laotian, Malay, Thai, Other Asians and

Southeast Asians not elsewhere classified (NEC) or further defined (NFD)

Unless otherwise specified, the term ‘Asian’ used in this CALD resource refers to Asians in

general and does not imply a specific ethnicity or stratified group.


In addition, Unexmundi, August 2014 lists the following as major infectious diseases

in Burma:

Hepatitis A and E

Typhoid fever


Dengue Fever

Yellow Fever

Japanese Encephalitis

African Trypanosomiasis

Cutaneous Leishmaniasis


Crimean-Congo hemorrhagic fever

Rift Valley fever




Lassa fever

Meningococcal meningitis



According to Metha’s (2012) report on health needs for Asian people living in the

Auckland region:

Asian women have lower total fertility rates (TFR) in the Auckland region as

compared with European/Other ethnicities

All Asian groups had lower rates of live births than their European/Other


Teenage deliveries occurred at significantly lower rates among the Asian groups

as compared to European/Other teenagers

Asian women have more complications in live deliveries because of diabetes

compared with European/other ethnicities

Asian women had lower rates of hospitalizations due to sexually transmitted

diseases than European/other ethnicities (but across all ethnic groups studied,

women had a much higher hospitalization rates compared to men)

Pre-migration health conditions and health issues for women from Burma:

Women in Burma face considerable health problems because of extremely poor

living conditions, inadequate health services, and lack of basic education. Health

care is even more deficient in the ethnic minority regions, where constant

relocations and heavy losses of men's lives have left women with the complete

responsibility of raising their children

Maternal mortality rates are 580 per 100 000 live births (as compared to 80 for

Malaysia and 10 for Singapore). Most maternal deaths result from induced

abortions, largely conducted in secret and unsanitary conditions

17-22% of women use modern contraception (substantially lower than the goal

of 30% set in 1997 by United Nations Fund for Population Activities) and the NZ

Ministry of Health. Women frequently resort to abortion to control family size.

14% of married women aged 15-49 years have had an abortion during their


married lives. This rate is much higher in the major teaching hospitals in

Rangoon and Mandalay where the abortion rate is 330-500 per 1000 live births

Oral contraceptives are avoided by many as they are believed to cause menstrual

irregularity, while Depo-Provera injections are thought to provide regularity

(despite the common adverse reaction of irregular bleeding)

In more rural areas prenatal and neonatal care is provided by a midwife or ‘letthare’

(traditional birth attendant). In cities however, clinics and hospitals are

frequently used. Beliefs about diet during this period make nutritional counseling

essential, especially amongst the hill-tribes

Iron-deficiency is found in a high percentage of pregnant women

For women with more traditional practice, the postpartum period is viewed as a

time of susceptibility to illness particularly after the blood loss (a ‘cold’ condition).

The body should be kept warm with external heat and ‘hot’ foods eaten. This

would be particularly significant in New Zealand given the change in climatic



Adolescent Health

According to Metha’s (2012) report on health needs for Asians living in the

Auckland region:

o Alcohol consumption is less prevalent amongst Asian students as compared to

NZ European students

o Almost all Asian youth reported good health

o Most Asian youth reported positive relationships and friendships

o Most Asian youth reported positive family, home and school environments

o 40% of Asian youth identified spiritual beliefs as important in their lives

o 75% of Asian students do not meet current national guidelines on fruit and

vegetable intake

o 91% of Asian students do not meet current national guidelines on having one

or more hours of physical activity daily

o Mental health is of concern amongst all Asian students, particularly

depression amongst secondary student population

In addition, adolescents who migrate without family may encounter the following


o Loneliness

o Homesickness

o Communication challenges

o Prejudice from others

o Finance challenges

o Academic performance pressures from family back home

o Cultural shock

Others who live with migrated family can face:

o Status challenges in the family with role-reversals

o Family conflict over values as the younger ones acculturate

o Health risks due to changes in diet and lifestyle


o Engaging in unsafe sex

o Barriers to healthcare because of lack of knowledge of the NZ health system,

as well as associated costs and transport difficulties

Child Health

According to Metha’s (2012) report on health needs for Asians living in the

Auckland region:

o There are no significant differences in mortality rates of Asian babies

compared to European/Other children

o There were no significant differences in potentially avoidable hospitalizations

(PAH) as compared to other children studied

o The main 3 causes of PAH amongst all Asian children studied were ENT

infections, dental conditions or asthma

o The rate of low birth weights were similar amongst ‘Other Asian’ babies and

their European/Other counterparts

o Asian children had similar or higher rates of being fully immunized at two and

five years of age as compared with European/Other children studied

o A lower proportion of Asian five-year olds had caries-free teeth compared to

the other ethnic groups studied

Pre-migration conditions and issues for Burmese youth:

Serious economic deterioration resulting in extreme poverty, inadequate health

services and deprived living conditions have rendered child health in Burma one of

the lowest in Southeast Asia:

Because of the lack of potable water and sanitation, intestinal and respiratory

infections, malaria, malnutrition, and vaccine-preventable diseases are rife

About 28% of schoolchildren have goitres, and in some areas these rates are

even higher

Young girls are frequently abducted, raped and trafficked into sex work. Migrated

adolescents who have experienced these conditions will likely need mental health

support, as well as their families

Some young boys are taken by the army and trained as soldiers from an early

age. Migrated adolescent boys who have been through this experience will need

mental health support and reintegration programmes


The Burmese New Year Thingyan (based on a lunisolar calendar) usually around 13

April, also known as the water festival, has its origins in the Hindu tradition. It is also

when many Burmese boys celebrate shinpyu a time when a Buddhist boy enters the

monastery for a short period as a novice monk. It is considered an obligation of

Buddhist Burmese parents that sons spend some time in service at a Buddhist




Buddhism in Burma is predominantly of the Theravada tradition and practiced

by about 90% of Burmese. Practitioners are mostly among the dominant ethnic

Burmese, the Shan, the Rakhine, the Mon, the Karen, and the Chinese who are

well integrated into Burmese society. The culture and world view of the people of

Burma is very influenced by Buddhism, and although some of the ethnicities

mentioned also practice other religions, it is often in conjunction with Buddhist

principles. There are 12 Burmese festivals, each for one calendar month and

most are related to Buddhism

Nat worship is practised usually in conjunction with Buddhism mostly by the

ethnic Burmese and more so in rural areas. Nats are a collection of deities

including spirits of trees, rivers, ancestors, snakes and the spirits of people who

are believed to have met violent or tragic deaths, and wreak destructive

vengeance on people who annoy them. Originally they were thought to be

infinite, but a canonical number of 36 was fixed with Buddha included as the 37th.

Many houses contain a nat sin or nat ein, which essentially serve as altars to

nats. Villages often have a patron nat

A small percentage of Burmese are Christian including Catholics, Protestants,

Baptists and followers of the Wa church (an ethnic minority from China) which is

Baptist in character

Hinduism and Islam are also represented in smaller numbers

(See Chapter 2, Introduction to Asian Cultures, pgs 12-16 for more information

related to religions and spiritual practices).


Every effort has been made to ensure that the information in this resource is correct

at the time of publication. The WDHB and the author do not accept any responsibility

for information which is incorrect and where action has been taken as a result of the

information in this resource.



1. Chelala, C. (1998). Burma: a country’s health in crisis. The Lancet, 352,

1230. (On-line, downloaded August 2006). Available at:

2. Kemp, C.E. (2002). Infectious diseases. Retrieved August 2006 from: Link no

longer available at February 2015.

3. Kemp, C.E. (2005). Burma: Health Beliefs and Practices. Retrieved August

2006 from: Link no

longer available at February 2015.

4. Lim, S. (2004). Cultural Perspectives in Asian Patient Care (handout). Asian

Support services. Waitemata District Health Board.

5. Mehta S. Health needs assessment of Asian people living in the Auckland

region. Auckland: Northern DHB Support Agency, 2012.

6. No author. Burmese Cultural Profile. Retrieved August 2006 from: Link no longer

available at February 2015.

7. No author. Burmese Culture. Updated February 2015 from:

8. Rhode Island Department of Health. (n.d.). Burmese Health Sheet. Retrieved

July 2006 at (link

no longer current at February 2015).

9. Rasanathan, K. et al (2006). A health profile of Asian New Zealanders who

attend secondary school: findings from Youth2000. Auckland: The University

of Auckland. Available at:,,

10. The State of The World's Children 2015 Country Statistical tables.

Downloaded February 2015). Available at:


11. Thein, N.N. (2005). Cultural Support for Asian Service Users. Manual for

training at Blueprint centre for learning.

12. Thein, N.N. (2006). Personal correspondence and consultation on Burmese

culture and healthcare.


Useful Resources

1. RAS NZ (Refugees As Survivors New Zealand) can provide assistance to

mental health practitioners on clinical issues related to refugee and cultural

needs, and contacts for community leaders/facilitators. They can be contacted

at +64 9 270 0870.

2. ARCC can provide information on resettlement issues and contacts for

community leaders. Contact +64 9 629 3505.

3. Refugee Services can be contacted on +64 9 621 0013 for assistance with

refugee issues.

4. The website has patient information by language and

information about Asian health and social services.

Attached Documents: