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An Introduction to Korean Culture for Rehabilitation Service Providers

Weol Soon Kim–Rupnow, Ph.D.

Copyright © 2001

Table of Contents

  1. Preface
  1. Acknowledgement
  2. Introduction
  3. Part I: Overview on Korea
    1. General Background about Korea and its Culture
    2. History of Korean Immigration to the U.S.
    3. Challenges of Adjustment
    4. Family Structure
    5. Role of Community
    6. Role of Religion
    7. List of Holidays
    8. Food Restrictions and Preferences
  4. Part II: Korean Culture Related to Disability Issues
    1. Concepts of Disability Within Korean Culture
    2. Attitudes Toward Disability
    3. Views on Acquired Disabilities in Comparison to Lifelong Disabilities
    4. The Concept of Independence Within Korean Culture
    5. Rehabilitation Services Typically Available in Korea
    6. Typical Patterns of Interaction Between Consumers and Service Providers in Korea
    7. Gender Differences and Male/Female Interactions in Service Provision
    8. Recommendations to Rehabilitation Service Providers For Effectively Working With Persons from Korea
    9. Building a Positive Relationship
    10. Involving Consumers and Family Members
    11. Expanding Capacity and Support
    12. Ways in Which Service Providers Can Become More Familiar With Korean Culture
  5. References

Preface

In 1997, 591,000 Korean–born persons were living in the United States (Shmidley and Campbell, 1999), making Korea one of the top ten nations of origin for immigrants to this country.

Despite various obstacles, many Koreans have been quite successful in the United States. The average American's knowledge of Korean culture is very limited, however, and some first–generation Koreans do not have strong English language skills. As a result, there exists the possibility of miscommunication between the newly–arrived and native–born Americans.

Cultural and language barriers can arise between disability service providers and their Korean–born clients, which may hamper the progress of rehabilitation. It is usually not possible for busy providers to learn several new languages or develop a deep knowledge of all cultures. Nevertheless, if providers understand some of the basic principles and common themes of a culture, they will have a better sense of how their clients perceive disability and what they consider to be appropriate goals and methods of rehabilitation.

In speaking of a therapist's role in this regard, Miles (1999) wrote:

It is hardly the therapist's job to try to change a client's fundamental beliefs – to do so might be seen as unprofessional conduct. Yet for most therapists, their work is more than a bag of techniques and gadgets. The therapist cannot avoid some engagement with clients' efforts to make sense of their disabilities, or those of their relatives. To listen attentively and with understanding requires the competent therapist to have some broad awareness of the range of human beliefs in the disability area, and at least an outward tolerance of some that may seem personally repugnant. One benefit of studying a little further is that it may be possible to hint at paths that would take clients toward a more positive position within their own belief system.

The author of this monograph is in an excellent position to help American service providers understand Korean culture and the perceptions of disability and rehabilitation that prevail within that culture. Weol Soon Kim–Rupnow, Ph.D., was born in Korea, but did her graduate work at the University of Hawaii. She is currently a member of the faculty of the University of Hawaii Center on Disability Studies and co–director of a federally funded research project to assist children with reading difficulties. She also works at the university's National Technical Assistance Center for Asians and Pacific Islanders with Disabilities and its National Center for the Study of Educational Supports for Persons with Disabilities.

Dr. Kim–Rupnow is also a service provider. She develops and implements Mental Health Treatment plans for clients who have behavior problems, for example, attention deficit disorders or autism, at community and school settings in grades K–12.

The author joins me in thanking Tai Kang, Ph.D., of the Department of Sociology at the University at Buffalo, State University of New York, who reviewed an earlier version of this monograph and made valuable suggestions.

This monograph is part of a series developed by CIRRIE — the Center for International Rehabilitation Research Information and Exchange — at the University at Buffalo, State University of New York. The mission of CIRRIE is to facilitate the exchange of information and expertise between the U.S. and other countries in the field of rehabilitation. CIRRIE is supported by a grant from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education.

In addition to developing this monograph series, CIRRIE conducts workshops on providing rehabilitation services to foreign–born persons. We hope that this monograph will be useful to you in your work with persons born in Korea. We welcome your comments that will help us to deepen our understanding of ways to increase the effectiveness of rehabilitation services for persons born in other countries.

John H. Stone, Ph.D., Director,
Center for International Rehabilitation Research Information and Exchange (CIRRIE)
Series Editor

Reference:

Miles, M. (1999). Some influences of religions on attitudes towards disabilities and people with disabilities. In R.L. Leavitt (Editor), Cross–cultural rehabilitation: An international perspective. (pp. 49–57). London: W.B. Saunders.

Dedication

This monograph is dedicated to my children, Kenneth and Hana, who are eager to learn their mother's Korean culture and teach me to view the world from their perspectives. It is also dedicated to all service providers, including my husband Robert, who enjoy lifelong learning and sharing their knowledge and skills with others.

Acknowledgement

I owe a debt of gratitude to several colleagues, especially Dr. Byong–ha Kim, of the Brain Korea 21 Project Force of Special Education, for numerous Korean materials and information. Sincere appreciation also goes to Dr. Robert Stodden, Dr. Peter Dowrick, Mr. David Starbuck, and Ms. Pam Haight at the Center on Disability Studies at the University of Hawaii for their valuable feedback, input, and proofreading. Their encouragement and support have been crucial to completing this monograph. Further, I would not have started without enthusiastic support from Ms. Terry Betker and Ms. Robecca Transu. I thank Ms. Cindy Nash for her friendship and proofreading my earlier draft, and Ms. Jee–wan Hong, Korean specialist librarian at the University of Hawaii, for checking on the Korean Romanization system. Finally, I am extremely indebted to friends and students whose real names I have changed to protect their privacy, for their real–life stories that highlight this monograph.

Introduction

The purpose of this monograph is to provide recommendations to busy rehabilitation service providers in the U.S. for effectively working with persons who hold traditional Korean values. The topics of Korean history, immigration, culture, language, religion, food, views on disabilities and rehabilitation services typically available in Korea are covered briefly to provide the reader with a quick overview and background. For those who seek more detailed information, the references cited in each section can be used as a starting point. For those with prior background knowledge of Korea, I suggest reading Part II first, in which I introduce Korean culture with case stories in the context of rehabilitation process.

I have used limited amounts of quantitative data for fear that people will generalize and create stereotypes about Koreans and their culture. The anecdotal examples cited here are to illustrate some typical Korean beliefs, behaviors and attitudes, but should not to be categorically applied to all Koreans. Individuals will act differently depending on their degree of assimilation of American mainstream culture. It is the reader's task to use the information appropriate to individual consumers whose level of assimilation and acculturation is unique. My hope is that this monograph will enhance awareness and broaden the knowledge base of traditional Korean culture related to disability issues. In addition, it is my aim to increase the reader's knowledge and respect for Korean culture, which can result in enhanced interpersonal relationships with persons from this culture.

The Romanized system of writing Korean sounds used in this monograph is the McCune–Reischauer Romanization system which is currently used by most academic libraries including the Library of Congress in the United States.

Part I: Overview on Korea

General Background about Korea and its Culture

Korea is a peninsular country located in the Far East, adjacent to China on the west and Russia to the north. It occupies approximately 86,000 square miles, and is roughly the size of Minnesota or New York state. To the east, Korea faces the islands of Japan. The peninsula is strategically important because it has the advantage of easy access to continents and oceans. It has the disadvantage, however, of being a target of aggressive neighbors. Although Korea has never initiated wars to conquer other people's territory, it has often been a battleground for power politics over the past thousand years.

Korea's climate is generally affected by East Asian monsoons and there are distinct differences between its four seasons. The summer months of June through August are mostly hot and humid while November through February are dry and cold winter months, with short periods of spring and fall in between. The mean temperature of the coldest month, January, is generally below freezing. The summer monsoon brings abundant moisture from the ocean, and produces heavy rainfall. The cool fall weather is the most pleasant of the year.

More than 70 percent of Korea is mountainous with the eastern regions consisting mainly of rugged mountain ranges and deep valleys. Historic Chinese records refer to the beauty of the Korean landscape as Kŭmsu Kangsan, which means "the rivers and mountains are embroidered on silk" and many Koreans find hiking in the hills and mountains a favorite leisure activity.

Most of the larger rivers and rice fields are located in the western region. The west coastline consists mainly of mud flats and has some of the highest tides in the world, while the eastern coastline has many sandy beaches with clear blue water. The south coast is dotted with bays and many small islands (Korean Overseas Information Service, 1994).

Korea claims more than 5,000 years of history. The discovery of Paleolithic sites suggests that people probably have inhabited the Korean peninsula for about 40,000 years. The first political state, called Kochoson, emerged in the northern portion of the peninsula more than 5,000 years ago. According to Korean mythology, all Koreans shared the bloodline of Tangun, the founder of the country and a descendant of the gods. The existence of a Korean state has been recognized through documented records since the three kingdoms period (57 BC–668 AD): The kingdoms were those of Koguryo, Paekche and Silla. Silla unified the peninsula in 668, which led to the Tongil (unified) Silla period (668–935). The succeeding Koryo Dynasty (918–1392) is known by Westerners for its gorgeous pottery of blue and green celadon with incised designs. The name Korea originated from "Koryo." Although the Mongol empire conquered Koryo in the thirteenth century, the dynasty continued its state structure under the Mongols (Korean Overseas Information Service, 1994).

The Choson Dynasty was established in 1392 and lasted until 1910, when Japan imposed colonial rule (1910–1945). Korea was liberated from Japanese rule in 1945 at the end of World War II. Korea then became entangled in an ideological battle and the country was divided into two parts. The north established the People's Republic of Korea backed by two powerful communist allies, China and Russia, while in the south the Republic of Korea was supported by the U.S. In 1950, the communist government of North Korea launched an attack on South Korea, triggering the Korean War (1950–1953). United Nations forces from 16 countries, including the U.S., intervened to defend South Korea until an armistice was signed in 1953.

It took almost a decade after the end of the Korean war for South Korea to establish stability and generate a consistent program of development. During the past three decades, South Korea has achieved remarkable economic growth, with per capita income now 13 times that of North Korea (Central Intelligence Agency, 2000). In the 1990s, South Korea also established a civilian government after its military–dominated one and has maintained its commitment to democratize its political processes. Koreans' sense of many thousands of years of shared history and culture has played an important role in uniting the Korean people whenever the country faced such difficulties as in foreign invasion or colonial occupation. Seoul, the capital city of Korea, has become a tourist attraction because people can easily trace its millenniums of history in old palaces and city gates and find state–of–the–art technology in its subways and many skyscrapers representing worldwide trade and commerce.

Americans sometimes ask, "Are you from the south or north?" Almost all Koreans who have come to the U.S. since the Korean War are from South Korea. Unfortunately, under its strict Communist government, North Koreans have very limited freedom of movement within the country, let alone for foreign travel and emigration. Reports from the U.S. State Department indicate that the Communist government often ignores basic human rights and strictly controls the food, housing, health and general living conditions of North Koreans (U.S. Department of State, 1999).

The Korean people are the descendants of a number of tribes that migrated into the peninsula from central Asia, Manchuria, Siberia and other areas of the continent. Koreans and other Asian people share similar physical and cultural characteristics. Over several thousand years, foreign troops from China, Japan, and other countries have swept through the Korean peninsula at various times, but Koreans never considered themselves part of those countries. Koreans remained independent and maintained their own distinctive language, culture, dress and cuisine.

Generally Koreans lead a conservative and family–centered life, deeply rooted in Confucianism, which emphasizes harmony within a prescribed hierarchy. Koreans enjoy peace and have fought wars only in self defense. Westerners used to call Korea "The Land of Morning Calm," but they began to call it the "country with a wonderful culture" or the "country of progress and growth" after the 1988 summer Olympics was held in Seoul, Korea (Nahm, Jones, & Lee, 1994, p. 75).

The Korean language belongs to the Altaic family, which covers a wide range of nations from Turkey in the west to Japan in the east. A highly inflected, polysyllabic and atonal language, Korean is structurally different from Chinese but similar to Japanese. Korean and Japanese incorporate a rich vocabulary from Chinese, much the way English includes a large number of words derived from Latin and Greek. The Korean language has two major characteristics that are different from English, the order of its words and the method it uses to build up words. While English sentences have the order of subject–verb–object (e.g., "I eat cookies."), Korean puts the verb at the end of the sentence (e.g., "I cookies eat.")Koreans add many endings to a verb to mark its style or grammatical role in the sentence. One such ending is –yo, which is used to change a word from casual to polite style.

Korea has long had a distinct spoken language, but there was no Korean alphabet until the mid–fifteenth century. Koreans borrowed Chinese characters to transliterate phonetically the very different sounds and structure of the Korean language. The awkward system of Chinese characters, called idu, was so difficult that only a limited number of educated scholars were able to learn to read and write.

The Korean alphabet, called Hangŭl, was created in 1443 by a board of scholars under the direction of King Sejong, who wanted his people to express their thoughts in writing easily, regardless of status or education. Hangŭl was based on the scientific, phonemic analysis of the Korean language, and the consonant letters were given shapes related to the appearance of the organs of articulation. The various combination of 10 vowels and 14 consonants can express any phonetic sound.

Today Hangŭl, with little modification since its invention, is acclaimed as having one of the most remarkable phonetic alphabets ever produced. This simple and highly efficient alphabet has enabled Korea to develop a literacy rate of 98 percent, one of the highest in the world (World Fact Book, 1998). The fact that almost all Koreans speak, understand and write the same language has been a critical factor contributing to the spirit of national unity.

Korean script is much easier to master than Chinese or Japanese and foreigners often learn the basics of reading and writing in as little as a week. On the other hand, understanding the language itself is much more difficult. Korean is a complex language with a structure very different from English. There are various forms of interpersonal communication, used according to whom one is talking or writing. Consequently, it is easy for foreigners to make mistakes such as being impolite by using a casual style with adults. Koreans usually do not mind the errors, however, and are eager to help foreigners learn their language.

The essence of Korean culture is harmony with order, contrasted with American mainstream culture that stresses individualism. Influenced by Confucianism, Koreans value harmony within family, community and the society as a whole. They have strong ties to family and value education, hard work and ambition to excel. The commonly cited virtues in traditional Korea include filial piety, respect for elders, benevolence, loyalty, trust, cooperation, reciprocity and humility (Hur & Hur, 1999). These traditional values are often challenged, however, by younger generations influenced by western culture.

History of Korean Immigration to the U.S.

The first wave of Korean immigration to the U.S. began in 1903 and continued through 1920. Approximately 8,000 Koreans, mostly plantation laborers and their families or women "picture brides," immigrated to Hawaii during this period. The causes of this immigration were many. Some left Korea to escape from famine or from the Japanese colonial state. Others sought new opportunities for better lives, attracted by the promises of American Christian missionaries (Reardon, 1996).

The second wave, from 1950 through 1965, brought approximately 17,000 Koreans to the U.S. Most of these immigrants were wives and children of American military men who had served during the Korean War (1950–1953), and orphans adopted by American families.

The number of Korean immigrants accelerated with the passage of the 1965 Immigration Act which eliminated quotas that had been imposed on Asians. The act opened the gates for a third major wave of Korean immigration. The annual number of Korean immigrants increased rapidly, from a few thousand in the 1960s to more than 30,000 between 1976 and 1990.

Unlike the immigrants that came before the 1960s, these Koreans, with college education and middle class backgrounds, entered the U.S. seeking better education and opportunities for their children. By 1994 when Korea had achieved great economic prosperity as well as political freedom and a civilian government, emigration had decreased to about 16,000 per year. The approximately half million Koreans in the United States in 1994 constituted the third–largest Asian population in the U.S., following Filipinos and Chinese (Hansen & Bachu, 1995).

Challenges of Adjustment

The language barrier was often among the biggest challenges experienced by the first generation of Korean immigrants (Kim & Yu, 1996; Kwak & Lee, 1991; Min, 1998). As explained earlier, Korean language structure is quite different from English. Until the late 1990s, English classes taught as a foreign language in Korea had focused on reading comprehension based on rote memorization of vocabulary and grammatical rules. Opportunities to practice listening and speaking with native English speakers were very rare. Thus, when Koreans arrived in the U.S., they found themselves experiencing communication difficulties similar to those of persons with hearing and speech impairments. The frustration is well portrayed in this poem written in the Korean language:

I do not see, although I have eyes. Then, have I become blind? No, I have not.
I do not hear, although I have ears. Then, have I become deaf? No, I have not.
I do not speak, although I have a mouth. Then have I lost my speech? No, I have not.
I have become an old stranger who wants to raise a young tree (to educate his child) in this wealthy land.

Won's poem cited in Choy, 1979, p. 248.

Limited English proficiency led to problems such as underemployment, which is exemplified by the author of the preceding poem, a high school teacher in Korea who could find employment only as a school janitor in the U.S. The language barrier also caused miscommunications with American employers and service providers and difficulty participating in the American mainstream.

I have seen many Koreans who could not understand or speak English fluently enough to attend their child's teacher–parent conference without an interpreter, although they had lived in America for more than a decade. These parents spoke only Korean at home. They find employment in Korean–owned businesses or work at jobs that require little English proficiency. These parents do not have time to attend school to learn English because they must work full time to make ends meet. Younger generations of Koreans who studied in the American educational system, however, quickly adapted to the American culture and language and became highly successful professionally and financially.

Cultural differences present additional hurdles that make it difficult for Korean immigrants to adjust to American mainstream culture. One of these is the American emphasis on individualism. Because Koreans emphasize harmony with order, they tend to be influenced by the opinions of other members of their family or community when making decisions. If they make a decision based on their own preferences without considering others, they are likely to be labeled "selfish." It is interesting to note here that language usage reflects subtle differences between individualism and collectivism – e.g., the accurate Korean translation of the pronoun "my" as used in "my family" and "my country" is "uri" which means "our."

As reflected in the previous poem, Koreans set high priority on their children's education and are willing to make tremendous sacrifices to help them get the best education possible. Once these children are educated within the culture of the American educational system, however, they may not accept the values of collectivism and filial piety that require personal needs and goals to be downplayed for the good of parents or siblings. Resulting family tension caused by different degrees of assimilation among family members can become problematic. In addition to individualism, many parents are concerned about their children's easy access to illegal drugs, sexual freedom and related problems in American society (Kwak & Lee, 1991; Pang, 2000).

Racial discrimination against Asian Americans, including Koreans, has been well documented. The most infamous examples include the discriminatory immigration laws to prevent Asians from coming to America or becoming citizens (Chin, Cho, Kang, & Wu, 2001). The current portrayal of Asians as "a model minority" that has succeeded through education and hard work, and whose income almost matches that of Caucasian Americans, is somewhat misleading. For example, immigration law has given priority to Asians who are highly educated, skilled or wealthy enough to start their own business in the U.S. Thus the majority of recent Asian immigrants are already above average in terms of education and income. Although civil rights and immigration laws have been amended over the years to decrease overt racism against people of Asian origin, subtle racism continues to burden Asians. Asian stereotypes based upon physical characteristics and heavily accented English are often perpetuated by popular media and political leaders, and there are still many cases of employment discrimination and victimization through racial violence (Abelmann & Lie, 1995; Chin, Cho, Kang, & Wu, 2001; Kwak & Lee, 1991; Pang, 2000).

Family Structure

Koreans regard family as the basic social unit and consider harmony at home the first step toward harmony in the community and in the nation as a whole. Many Koreans consider themselves extensions of their families and often regard the welfare of the family as more important than that of individual members. The family relationship has been strongly influenced by Confucianism, which emphasizes harmony and order within a system of prescribed roles for husband, wife, son and daughter. The relationships emphasize subordination and interdependence: e.g., parents love their children, while children respect their parents and are filially pious.

Parents are expected to support their children's education, often sacrificing their own comfort in the process. In return, adult children are obligated to support their aging parents. Usually, the eldest son in the family is expected to live with his parents in the same household. Even if the children live separately, they are expected to visit their parents often, especially on special occasions such as birthday celebrations, memorial services to ancestors and national holidays like New Years and Korean Thanksgiving.

The roles of family members are based on gender and age. Exchanging roles and sharing power are not encouraged, due to strong beliefs that order and harmony exist when there are distinctions between the roles and duties of men and women. This results in the husband taking the lead and the wife following. Children are ranked by age, with the younger required to respect the older. For example, young children are not allowed to call their older siblings by their first names but terms such as "Ŏnni" (older sister) and "oppa" (older brother) must be used by younger sisters and "nuna" (older sister) and "hyŏng" (older brother) by younger brothers. Many first–generation Koreans retain the traditional authoritarian family system in which the father acts as decision–maker in family affairs. Direct openness of expression and assertiveness by children is often seen as rude or aggressive. Expression of feelings or needs are discouraged, especially for boys. Silence and humbleness are valued more than storytelling and bragging.

There is a growing body of research about the gap between first and second generation of Korean immigrants (Kwak & Lee, 1991; Min, 1998). The cause of this gap is the language barrier. Full communication between these groups is often difficult because many of the first generation do not speak English well, while most members of the second and third generations do not speak Korean.

Another reason for the gap is the different degrees of assimilation to American culture. The first generation often holds traditional Korean values. For example, parents may want to decide their children's future in terms of a school major, a career choice, and even a marriage partner. These parents tend to disregard their children's rights, insisting that the parents know what is best for the children. The American–educated children may ignore or rebel against their parents' authoritarianism.

Role of Community

Koreans generally have a strong group identity as reflected in Korean–American phone directories, which have long list of numbers for non–profit organizations. Koreans may identify with a region, religion, surname, school or economic group. In general, co–workers, friends, class alumni or religious colleagues are likely to provide extensive support in time of celebration, such as a wedding or the birth of a child, as well as in time of hardship such as hospitalization or the death of a family member.

Depending on the age, people are often addressed as "brother," "sister," "uncle," "aunt," "grandma" or "grandpa" by neighbors or even strangers on the street. Such terms reflect Koreans' strong sense of collective group identity as in the myth of Koreans sharing the bloodline of Tangun, the founder of the country.

In the work environment, individual identity is closely tied to the position held within an organization. A clue to the importance of position lies in the way Koreans address each other. They would never use personal names, but call each other by their job titles, for instance, "President Kim" or "Director Lee." These terms reflect the fact that the traditional Korean community functions within a rigid hierarchical order of human relationships based upon age or status. In the same manner, to Koreans "friends" refers to close relationships within the same age group, a narrow definition compared with the American concept of friends. Trust is an important virtue among friends. Kindness and generosity are also highly valued. Gift giving or food sharing is a common cultural practice in the Korean community and is a token of appreciation or friendship.

Role of Religion

For many Koreans, spiritual aspects of life and religion are a source of strength and support. Statistics indicate that most Koreans have a religion – Christian, 49 percent; Buddhist, 47 percent, Confucianist, three percent; Shamanist, Ch'ondogyo (Religion of the Heavenly Way) and others, 1 percent (CIA, 2000). Historically, kings in the United Silla and Koryo dynasties encouraged Buddhism, while those in the Choson dynasty switched to Confucianism, blaming corrupted Buddhism for the previous kingdoms' demise.

Currently, Koreans enjoy freedom of choice in religion and lead a rather harmonious life despite their diverse religions, even among family members. The various belief systems are mutually reinforcing and do not conflict with values that underlie the daily lives of Koreans. Koreans tend to be open to the teachings of other religions and respect others' choices, so they are puzzled when violent wars break out over religious conflicts in other parts of the world.

It is not a surprise then, that the beliefs and values reflected in common Korean culture are a sophisticated mixture of Buddhism, Confucianism, Shamanism and other religions. Influences from Buddhism are reflected in attitudes of benevolence toward all living creatures and beliefs about this world and a thereafter in the concept of karma. Confucian influences are seen in ancestor worship and the moral codes for proper human relationships. Shamanism is reflected in animistic orientation and thinking. The Ŭmyang theory (Yin–Yang in Chinese) is seen in folk religious beliefs of the human as an integral part of nature, which requires people to learn the ways of nature and harmonize with them (Kwak & Lee, 1991).

Confucianism is more a philosophy than a religion, but the teachings of Confucianists pervade the way Korean people have thought and behaved over the past five to six centuries. Many believe that Korea was influenced more by Confucianism than was China, Confucius' native country. In addition to Confucianism, the lives of Korean immigrants are also heavily influenced by Buddhism and Christianity in ways that are briefly summarized below.

Nearly half of Koreans consider Buddhism their religion and think of "Buddha's birthday" as a national holiday parallel to "Jesus' birthday," Christmas. Buddhism is reflected in the beliefs of reincarnation and retribution. For example, all creatures alive in the world must go through an endless cycle of birth, getting old, illness, and death. In the Buddhist belief, disability is part of a natural life process. Buddhists emphasize benevolence and believe in reincarnation, in other words, what you are now depends upon how you lived in your previous life. How you live your life now will decide your life after death.

Christianity was introduced to Korea in the eighteenth century through the Jesuit missionaries. It spread so quickly that the king considered a threat to national unity and actively persecuted the early missionaries. In the late nineteenth century, Protestant missionaries arrived and established many hospitals and schools. Koreans have embraced Christianity in its many forms. Currently, nearly half of the Korean population is Christian and many of the largest Christian churches in the world are located in Korea. Membership in Korean-American Christian churches also has grown rapidly.

Buddhist temples and churches in Korean–American communities have made significant contributions to the overall welfare of Koreans by providing spiritual comfort and opportunity for fellowship as a wide variety of supports to those adapting to the foreign land. Support includes job referrals, counseling, translation and interpretation assistance and teaching Korean language and cultural education to second generation Korean–Americans (Kim, 1991). Most Korean churches and temples in the United States hold Korean–English bilingual worship services, and members frequently meet in small group for worship and prayer, which contributes to group unity.

List of Holidays

Korea officially follows the Gregorian calendar, but some holiday observations are based on the lunar calendar of the Orient to encourage Korean traditional customs.

Holidays on the Gregorian calendar

Holidays on the Lunar calendar

The three consecutive holidays that mark Sŏllal and Ch'usŏk are the most celebrated holidays and many people return to their hometowns for family gatherings. In the morning, people wear new clothes and offer thanks to their ancestors in a special ceremony, as they remember good things about them. After the ceremony on Sŏllal, the children bow to their parents and grandparents while saying their New Year's greetings. The elders give blessings and some good luck money to their young ones. On Ch'usŏk, people often visit their ancestors' tombs to cut grass and pay their respects (Life in Korea, 2001).

Food Restrictions and Preferences

A typical Korean meal includes rice, some type of soup and various vegetable side dishes including Kimch′i, which appears at almost all meals. Kimch′i includes vegetables (cabbage, radishes, cucumber, and various leaves and roots) fermented with different spices, commonly garlic, ginger, green onion and red pepper. Because of its ingredients and fermentation process, Kimch′i has many nutrients. Over the years, Koreans have created many types of foods from Kimch′i. Occasionally a main dish of lean meat, fish or poultry will be served. Instead of animal protein, Koreans get protein mainly from bean products such as bean curd (Tubu in Korean, Tofu in Japanese) or cooked beans with rice and other grains (Life in Korea, 2001).

Some Koreans living in cities do not drink water straight from the tap, fearing contamination. People often drink hot tea, prepared by boiling large kernels of roasted barley or corn and straining the grains. They store the tea in the refrigerator to make cold drinks in summer.

As a remedy for colds or flu, people often eat hot soups, made especially of garlic, ginger, onions, and red pepper, which are believed to have therapeutic effects and help breathing by clearing the sinuses. Ginseng or other herbal medicines are often used to boost energy (Readron, 1996). Koreans relate cold food with physical imbalance or illness, so cold drinks are not popular except during summer. Some believe, though, that hot soups help overcome summer heat, while cold food during winter works well to maintain metaphysical balance. In addition, a new mother is supposed to be bedridden and eat seaweed soup (Miyŏkkuk), which is believed to cleanse the blood and boost milk production.

Koreans produce several types of grain alcohol, most notably Soju. Women are not expected to drink but alcoholism is not unknown among Korean men. There is some social pressure to drink, such as passing glasses during a party and going to bars to treat friends and co–workers (Hur & Hur, 1999). A large percentage of Korean men suffer from kidney or liver problems due to excessive consumption of alcoholic beverages.

The Korean diet offers a healthy group of foods, low in animal fat and high in fiber, but a high level of sodium is found in Korean dishes such as Kimch′i, soy sauce, bean paste, hot sauce and fermented fish sauce.

Excessive sodium consumption is thought to cause health problems. Recent research indicates that salt overload can boost the chances of high blood pressure, stroke, heart failure, kidney disease, diabetes, cataracts, brittle bones, asthma and early death (Carper, 2001). Traditionally, Koreans have used salt to preserve food, as well, so Koreans with high blood pressure or diabetes are often told to reduce the sodium in their diet.

Part II: Korean Culture Related to Disability Issues

Concepts of Disability Within Korean Culture

Their culture profoundly influences what Koreans believe about the cause and treatment of disability. Some Koreans believe it can be caused by supernatural agents such as punishment from God or the curse of the devil for their sins or those of their parents or even their ancestors. Others think that the mother did something wrong during pregnancy such as creating an imbalance of metaphysical forces (Ŭmyang in Korean), failing to follow prescribed dietary and nutritional practices or violating certain taboos. For example, even a bad thought or an accidental killing of an animal or insect by a pregnant mother can harm the natural development of the fetus according to the Buddhistic belief in karma, which holds that no living things should be killed.

Modern Koreans with education in biology and medicine believe that genetic defects or diseases cause disability. It is common to observe Koreans with a complex mixture of the belief systems described above, depending mainly on their education, religion, and family backgrounds.

Beliefs have a direct implication for prescribed methods of treatment. People who associate supernatural agents with disabilities tend to feel helpless, depressed or blame themselves or ancestors when they discover a disability in themselves or their family. They tend to seek little help and leave everything to fate. The person with illness or a disability is often cared for by parents, who usually expect their child to outgrow such conditions. Those with a scientific education believe that disabling conditions may be overcome with appropriate medical intervention, and actively seek medicine, therapy, or surgery from health professionals. Unlike westerners, however, many Koreans use herbal medicines, acupuncture and other natural remedies. Being spiritually oriented, many Koreans using western medicine also offer prayers and conduct religious rituals to regain physical and mental health.

Korean professionals working in rehabilitation categorize disabilities as:

  1. impairments of the human body and internal organs
  2. disabilities in intelligence, behavior or emotion and
  3. handicaps created by the society, which include limitations that stem from environmental factors such as negative perception and attitudes toward people with disabilities, poverty and malnutrition, barriers in architectural and the media, (Special Education and Rehabilitation Center for Excellence, 2001)

It is noteworthy that environmental factors are included as a cause of disability in addition to functional limitations. This integrative view is parallel to a holistic paradigm of disability as described in the Long Range Plan (1999–2003) of the U.S. National Institute on Disability and Rehabilitation Research (NIDRR):

...disability is a product of the interaction between individual and environmental characteristics along a continuum from enablement to disablement. Individual or intrinsic factors include person, biology, and behavior, whereas environmental or extrinsic factors are related to socioeconomic status, education levels, access to health care, nutrition, living conditions, and personal safety

NIDRR, 2001

This integrative view explains the Korean professionals' perspectives on disability better than the medical model, which is structured to scientifically identify the causes of disability and treat the symptoms largely in isolation from other aspects of a person's life. Korean professionals believe that the best tools for removing societal barriers that confront people with disabilities are information and education, both of which can improve public awareness and cooperation (Special Education and Rehabilitation Center for Excellence, 2001).

Attitudes Toward Disability

Koreans are generally homogenous and conservative in terms of values and customs. People tend to stare at or gossip about those people whose dress code and behavior deviate from the social norms. For this reason, people with disabilities are likely to be isolated. The general public tends to avoid people with disabilities because of uneasiness associated with not knowing what to do. When helping a person with disabilities, Koreans usually overprotect or overcompensate, which only serves to frustrate those they are trying to help.

In to the special editorial section of JoongAng Ilbo (Korea Central Daily of Hawaii, April 20, 2001, Friday, page 22) written specifically for the twenty first annual celebration of a "Changaein ŭi nal" (Day for People with Disabilities), the editor criticized the lack of a long–range planning and support by the government and nonprofit organizations.

"In Korea, it is hard to find convenient facilities for people with disabilities in public parks and recreation facilities, buildings and parking lots. Korea's Employment Promotion Law for People with Disabilities requires employers with more than 300 employees to reserve two percent of their positions for people with disabilities. A survey by the Korean Ministry of labor, however, showed that employers do not fulfill that requirement. For example, only 0.91 percent of jobs in 1,900 privately owned companies with more than 300 employees, and 1.48 percent in state, city, and other government organizations are held by persons with disabilities."

"Changaein munje," 2001, page 22

Employers indicated that they would rather pay fines than hire people with disabilities. Access to information technology is very limited for people with disabilities. For example, 11 percent own personal computers and 6.9 percent connected to the Internet while for the general public, the respective rates are 66 percent and 37 percent ("Changaein munje," 2001, page 22).

Negative attitudes toward disabilities have not improved at all over a 15 year–interval. According to surveys conducted by a private research firm, 83.1 percent of the sample in 1984 and 82.4 percent in 2000 indicated that they would rather abort than raise a child with disability ("Changaein munje," 2001, page 22). This single survey result demonstrates the unfavorable perceptions of disability and the hardships that persons with disabilities must endure in Korean society.

Efforts have been made to eradicate prejudices against people with disabilities and their accompanying stigma. For example, the Korean Broadcasting System (KBS) recently produced three special TV shows about people with disabilities within three months, an unprecedented number of shows on a single topic (Cho, 2001). This program, "Sunday Special," covered various topics during prime evening hours and received numerous awards and consistently high ratings. The shows focused on the hopes and dreams of people with disabilities and the attitudes of Koreans toward them.

The first episode depicted the life of Kich'ang Kim, a famous artist who lost his hearing at age six. He learned to read as a result of his mother's dedicated tutoring. He could not endure the ridicule and teasing at a regular school and dropped out. Rather than dwell on what he could not do, his mother discovered his talents in art and sent him to a master artist for private lessons. It did not take long before his artistic talents began to blossom and earn awards in national art competitions.

A woman artist with a prestigious college degree and wealthy family background fell in love with Kim and married him, despite her parents' opposition and threats to disown her because of his disability. Later in his life Kim said that his deafness, combined with his wife's inspiration, had opened the door for him to pursue endless experiments with his art.

In 70 years as an artist, he created more than 10,000 works encompassing a wide variety of genres, including traditional and contemporary, oriental and western paintings. He overcame childhood ridicule and frustration to become an internationally renowned artist through exhibits in America and Europe. Most of his works were sold. Later in his life he contributed much of his wealth to building an advanced facility to provide wellness services and job training for people with disabilities. Although he became a wheelchair user after several strokes, he never stopped painting until he died at the age of 88. Kim became a role model for young people with disabilities. He said, "Use your talents to learn the skills that are employable, then make money, get married, and support your family." (Cho & Cho, 2001).

The second program episode portrayed the love and dedication of an American couple with sight impairments (Cho & Nam, 2001). In spite of their own disabilities, the couple was successful in adopting and raising four Korean children who also had sight impairments and had been abandoned by their biological parents. Ellen, one of the adopted children, was a high school senior getting ready to go to a college. She remembered clearly the day her mother took her shopping and left her in a mall and never came back. Ellen was not sure what would have happened to her if she had been left to fend for herself without the unconditional love provided by her adopted parents. Now she wants to be productive and pay back her parents. The story raised the question, "Why can't everyone accept the differences in individuals and love them as this American couple does?"

The third program concerned several Americans with disabilities who regained mobility, communication capability and sensory ability by taking advantage of highly advanced technology (Cho, 2001). It urged a change in Korean public policy by pointing out that the employment rate of people with disabilities in the U.S. has increased fourfold since the passage of the Americans with Disabilities Act.

The three shows offered snapshots of Korean attitudes toward disability and provoked a new understanding of people with disabilities and the innovative tools that can support them. The presentation of individuals with disabilities in this case was powerful and beautiful. It showed them overcoming internal and external obstacles, striving to reach their full potential and contributing to their own welfare and that of their families and communities. It remains to be seen whether Korean attitudes toward children with disabilities will move in a more positive direction.

Views on Acquired Disabilities in Comparison to Lifelong Disabilities

Some Koreans believe that lifelong disability is a kind of payback for something they did wrong in the past. As a result, many Koreans with disabilities and their families often suffer from shame, helplessness, denial, withdrawal and depression. Many view acquired disability as the result of some sort of bad luck or misfortune. People generally accept illness and disability due to aging as a fact of life, however.

If a disability is acquired through a work–related accident or military service, a glimpse of pride may be observed in the client and his family along with overwhelming distress. For example, a firefighter who was injured in the line of duty shared during a TV interview, "I saved other people's lives through my sacrifice." The following paragraph, translated from a Korean newspaper article by Park (2001), describes the essence of Korean views on acquired disabilities:

"I never realized that anyone could become disabled at the blink of an eye until I had a car accident and had to rely on a wheelchair to get around," said sobbing Mrs. Jo who became paralyzed from the waist down after a truck crashed into her car eight months ago. Mrs. Jo continued, "It is desperately needed that we, the society, should all be aware and consider the problems faced by people with disabilities like our own, not somebody else's. I want to be an independent mom for our children as soon as I can, so I bought a wheelchair and I have been getting vocational rehabilitation training."

It is alarming that nine out of ten people with disabilities become disabled because of automobile and industrial accidents and diseases. According to the Korean Ministry of Health and Welfare, 89.4 percent of 133, 500 people with disabilities registered as such in the year 2000 have acquired disabilities, and less than five percent were disabled by genetic defects or early birth and delivery related complications.

The most common causes of acquired disabilities include high blood pressure, stroke, and accidents. "Throughout developed countries worldwide, disabilities are considered part of everybody's life and a wide variety of education and prevention programs for all have been implemented," emphasized Dr. Yongch'an Pyŏn, a researcher at the Korean Ministry of Health and Welfare. Dr. Pyŏn also said, "Considering that most acquired disabilities can be prevented, we need to provide systemic safety education to the general public as well as to improve traffic and industrial facilities to prevent accidents." (Park, 2001, page 23)

The Concept of Independence Within Korean Culture

Because Koreans believe interdependence among family members is more important than independence, they accept that all people need help from others many times in their lives. In particular, dependency of young children, old grandparents, or sick family members is usually expected.

Family members feel obligated to take care of their basic needs and to keep up their morale. When a child falls on the ground, Korean parents usually run and pick the child up right away while Westerners wait and see whether the child can get up independently. It is common to see infant babies and young children sleep with their parents in the same room in Korean society. Korean parents often tell their children, "Don't worry about anything now. Just study hard, go to a college and get a good job; until then I'll take care of everything." Independence is expected after the completion of schooling, which usually culminates in college degrees. Children are expected to secure a job, earn their own living, save for the future, get married, start a family and support that family.

Parents of adult children with disabilities often experience conflict between the child's independence and interdependence. They want to encourage the self–sufficiency of their children, but at the same time, protect their children's well-being. As these children with disabilities grow into adults, they want to find meaningful work consistent with their goals and talents and make enough money to support themselves and family members. Adults with disabilities who have found employment say that work has played a key role in developing their self–esteem and a sense of belonging in society. They do not want to rely on the social welfare system. The sense of pride they have as taxpayers proves even more valuable than the income they bring in.

Rehabilitation Services Typically Available in Korea

Korean laws enacted for people with disabilities include the Promotion of Special Education in 1977, the Welfare Law in 1989 and the Promotion of the Employment of People with Disabilities in 1990 (Special Education and Rehabilitation Center for Excellence, 2001). Since enacted, these laws have been amended to improve and expand services and promote equal opportunities for people with disabilities. This section introduces the typical special education and rehabilitation services made available by these laws in Korea.

The Special Education Law defines who will qualify for special education services, and the scope and level of services and responsibilities of government organizations toward those with disabilities. The Korean Ministry of Education provides compulsory education for students in grades one through six (to extend through grade nine in 2002). Consequently, the law specifies government support to private institutions that accommodate students with disabilities. The Special Education Law provides that one or more special schools be established in each city and province. The number of Korean schools for students with special needs has increased from 28 in 1969 to 123 in 1999, with a total enrollment of 23, 966 (Special Education and Rehabilitation Center for Excellence, 2001). The criteria that determine which students receive special education and rehabilitation services are based on traditional, functional-limitation categories.

Currently, there are 12 special schools for students with sight impairments, 15 for those with hearing and/or speech impairments, 16 for those with physical disabilities, 74 for those with mental retardation and cognitive disabilities and six for those with emotional disabilities. These schools offer general education and skills training designed to prepare students with disabilities for fruitful jobs.

The Ministry of Education sponsors an annual skills competition to give special education students an opportunity to demonstrate their skills in many different vocational areas and to encourage them to learn employable skills. The winners are presented with awards and earn the chance to acquire better jobs.

Although the Korean Special Education Law specifies that school principals at regular schools should follow the requests of students with disabilities and their parents for an integrated education, the majority of Koreans are not prepared to accept full inclusion. To prepare for inclusive education, the following requirements must be satisfied:

  1. people with disabilities must be accepted and understood by school administrators, teachers, students, their parents and others without disabilities
  2. regular teachers must be trained in special education
  3. average class sizes of 30–40 students must be reduced
  4. team teaching, resource rooms, itinerant education and other special services that facilitate delivery of services for students with special needs must be established
  5. students without disabilities and their parents must have a greater understanding of the benefits of inclusive education (Mitchell, 1999)

Currently, there are more segregated special schools, rehabilitative hospitals and welfare services than integrated ones.

The Welfare Law for people with disabilities defines disability grades according to type and severity of disability. The law also defines the responsibilities of government organizations and the general public. The law requires the provision of medical insurance or medical aid, education and vocational training to promote self–sufficiency, and protection of basic human rights through medical rehabilitation programs and welfare centers. The government has developed and enforced various measures to reduce the economic burden on people with disabilities. For example, the National Rehabilitation Center provides such items as artificial limbs, hearing aids and wheelchairs for economically–disadvantaged people with disabilities. Social welfare services are intended to subsidize the subsistence and promote the welfare of persons with physical and mental disabilities, socially disadvantaged children, the elderly and single mothers with children.

The Industrial Accident Compensation Insurance program enacted in 1963 is the oldest and most important social security program to insure workers against industrial accidents. Compensation is available for occupational injuries, disease or death that occur in the course of employment. The medical benefits include:

  1. diagnosis
  2. provision of pharmaceuticals, medical treatment materials, artificial limbs and other prosthetic devices
  3. medical treatment, surgery, and other care
  4. hospitalization
  5. special nursing in medical facilities and other matters to be determined by the Minister of Labor

Sick pay is equivalent to 70 percent of the average wage. Disability benefits are paid according to disability grades, either in the form of a compensation annuity or lump sum disability compensation. Disability grades are classified into 14 grades (Korean Overseas Information Service, 1994). These categories adhere to traditional, medically derived approach, and as a result, consumers' actual needs are often neglected. Many unsatisfied consumers question whether the benefits called for by the policy are made available to the extent that sufficiently meet the needs of the injured.

The Law for Promotion of the Employment of People with Disabilities was designed to encourage industries to employ people with disabilities. There are huge disparities, however, between entitlements called for by a law and their implementation. As mentioned earlier, the employment rate for people with disabilities is lower than the two percent required by the law. The infrastructure for proper delivery of services needs to be developed and implemented from policy to practice levels.

Typical Patterns of Interaction between Consumers and Service Providers in Korea

Service providers such as doctors, nurses, teachers and therapists, whose jobs require higher education degrees and intensive training, are well respected in the Korean community. Consumers tend to listen to their advice and follow their directions as passive recipients. Korean service providers are not familiar with the concept of empowerment of or partnership with consumers and tend to administer services as authority figures. Service providers are generally the primary decision makers and few choices are given to consumers. Overall wellness and illness issues are defined by government agencies and experts.

The choice of treatment options for individual consumers is also usually determined by service providers. A recent trend, however, encourages consumers to become better informed by gathering information from a variety of sources, including informal social networks and to be proactive in seeking second opinions before making decisions about their rehabilitation.

Some consumers expect clear and understandable explanations regarding procedures and treatment. They also want to have time to review and think before proceeding, particularly when considering treatment related to surgery or Western medicines that are unfamiliar to them. Many believe that tampering with their bodies surgically or with strong medicines is disrespectful to their parents.

Gender Differences and Male/Female Interactions in Service Provision

As noted in the section on Confucianism, many Koreans adhere to distinct gender roles and responsibilities. Mothers are understood to be the caretaker of the home and children, while fathers are bread winners and primary decision makers. Usually mothers (often daughters–in–law) have the major responsibility of caring for young children or elderly parents and providing bedside care in case of illness. Recent trends in nuclear family living arrangements, feminist reforms and women working outside of the home, however, have made caring for young children and aging parents a major social issue, requiring more government support.

Korean parents expect their boys to be active and tough and not show much emotion, while they raise their daughters to be docile and caring. Their preferred professions for sons include medicine, law and politics. On the other hand, they want their daughters to be homemakers, teachers and nurses.

In the Korean community, respect for and trust of teachers are deeply rooted cultural traits. To Koreans, a teacher's love of students is parallel to parental love. Parents and teachers, in their respective roles, support, complement and supplement each other's teachings. Thus the gender of teachers is not a major issue. Parents are perceived as devoted supporters of education and providers of children's basic necessities. Teachers provide intellectual nurturing and social learning.

One of the Confucianists' moral codes states, "Boys and girls from seven years old cannot sit together unless they are relatives." Until recently, most secondary schools or classes were segregated by gender so that few boys and girls had friends of the opposite sex, although this gender code is not heavily enforced in adult professional or group settings. Traditional Koreans believe that sexual relationships between men and women should be postponed until after marriage and that overt expressions of affection should be reserved for the privacy of one's own home.

Korean consumers feel more comfortable with professionals of the same gender if touching body parts is required for the purpose of physical examination, treatment or therapy. If a professional of the same gender is not available, they prefer to arrange for a third party to be present rather than endure the discomfort of a one-on-one situation.

Recommendations to Rehabilitation Service Providers For Effectively Working With Persons From Korea

The following are general suggestions for building positive and collaborative relationships with consumers who hold traditional Korean values, regardless of their age or type of disability. The recommendations are divided into three sections: building a positive relationship, involving consumers and family members and expanding support and services considered to be critical elements in the rehabilitation process. "You" and "I" are used in this section to make the recommendations more personable and inviting. The term "consumer" includes categories such as client, student and patient.

Building a Positive Relationship

Building a relationship with consumers that is productive and mutually beneficial is fundamental to successful service delivery. This section focuses on recommendations for attitudes, manners and ways to improve communication as a multi–culturally competent service provider.

Be open and respect individual differences.

Mutual respect and trust take more effort cross–culturally. You have to know your own culture and its biases, as well as those of the consumers. You have to be open enough to understand the consumer's perspective. I have been a consumer and a service provider. As a strategy to enhance awareness and flexibility, I often ask myself questions such as, "Am I thinking like an American?" "Can I see this situation differently from a consumer's perspective?"

Reversing our roles in my mind sometimes helps me better understand the consumer's position. When I do this role–playing, I am often pleasantly surprised. For example, some consumer attitudes that I have found bothersome may be considered appropriate in their cultures and this mental role–reversal has helped me improve my working relationships with these consumers. To illustrate further how a conflicting situation can be altered by cross-cultural appreciation, let me introduce In–ja's experience while she was recuperating from the delivery of her first son.

In–ja's sister flew from Korea to assist her with her newborn child for a month. In–ja's mother–in–law, a 65–year–old European American who had little exposure to Asian culture, also flew across several states to see her first grandson. During her visit, the grandma became upset after In–ja's sister quickly stopped her when she approached the crying infant. In–ja's sister checked the baby's diaper, gave him a bath, and dressed him, while rejecting help from grandma. She could not speak English, so her intentions were indicated by hand gestures and saying "no." The grandma complained to her son, who told In–ja that her sister was too possessive with the baby to allow grandma near him. In–ja told her mother–in–law that her sister's behavior indicated respect for an older person according to Korean custom and her intention was to do the work for the grandmother. The grandma understood and her growing tension toward In–ja's sister switched to friendly smiles. In–ja also talked to her sister about the misunderstanding and suggested that she share the responsibility of taking care of the baby with grandma. They not only got along well together for the rest of their stay, but appreciated each other's help. The grandma learned to say "Thank you" in Korean, "Kamsa hamnida." In–ja's sister learned to respond automatically, "You're welcome."

In–ja created a win-win situation for both her mother–in–law and sister by helping them understand different cultural values. This story illustrates well how individuals, both service providers and consumers, might experience problems when minority persons with cultural values and beliefs almost totally opposite from those of the majority culture seek rehabilitation services.

Avoid stereotyping and labeling

Stereotyping and generalization keep you from being open–minded. Every Korean is unique in terms of personality and the degree to which they assimilate American culture. The information you have learned about Korean culture from this monograph and other sources may not apply to individual consumers with whom you are working.

Provide them an empathetic ear and learn from them about their own unique needs, values, and attitudes. Be flexible and let go of your own assumptions, which could negatively impact expectations, the services provided, resources employed and outcomes. They can also produce hurt feelings in both the consumer and yourself. Be in control of how you present yourself to consumers and how you perceive them. One of my American friends often said that he enjoyed living in Korea immensely for about eight years because he kept an open mind and was willing to learn from individuals he met. Although he spoke Korean fluently and worked on a doctoral degree in Korean literature back in America, he was always humble and did not want be called a Korean expert for fear that he might become too proud to keep his mind open for growth and improvement.

Use Korean greetings to break ice and to build rapport instantly

One of the most useful phrases is "Annyŏng haseyo?" The word "Annyŏng" means "peacefulness" and "well–being" and "haseyo?" is a suffix that makes a noun a verb and shows respect. Together this phrase means generally, "How are you?" You can use this phrase any time of the day – morning, afternoon, or night. You may use this greeting with a stranger or with those with whom you are acquainted. You may use the word "Annyŏng" alone with a person younger than you.

Another useful expression is "Kamsa hamnida," which means "Thank you." I can practically guarantee that if Korean consumers hear you use a Korean greeting they will feel instantly connected and appreciate your attitude toward them.

Show respect, especially to those who are older than you. Age difference is one of the most important elements that define relationships among Koreans. For example, you must not talk back to someone older than you. In addition, the language that you use varies depending on the age of the person to whom you are speaking. Calling an adult by his or her first name may make the person feel offended or uncomfortable. First–generation Koreans are not accustomed to Americans' use of the first name as a gesture of friendliness.

When you hand something to an elderly person you should hold the object with both hands. Koreans bow their heads slightly as a greeting, rather than saying, "Hi!" or waving. These are just a few examples of how to express respect to older people. If you try to implement these expressions of respect and have a genuine interest in the culture, Koreans will respect you as a well–mannered person and will likely listen to you more seriously than to service providers who use more casual styles of greeting.

Have open and ongoing communication

Positive relationships begin with communication. Free exchange of knowledge about services, needs and expectations might not take place with the first–generation Korean immigrants due to their limited English proficiency. Ask consumers if they need an interpreter. If feasible, use a family member or friend of the consumer as an interpreter. This may compromise the objectivity of the interpretation, of course, because family members may sometimes feel embarrassed or ashamed to disclose certain information. Some consumers might feel offended if providers ask for private information such as socioeconomic and marital status in order to fill out intake information.

Building trust is another issue you must deal with if you bring in an interpreter who is a stranger to the consumer. Although the person may speak the same language, the consumer may have strong reservations about airing family problems to an outsider. You may have to wait until the consumer gets to know the interpreter better and builds trust. Open and ongoing communication with consumers should involve informing them of the pitfalls as well as the benefits of the service system. In this way, you establish trust and respect.

Provide written information

The majority of first–generation Koreans, who were not educated in the American school system, may speak little English but may understand more than they can speak. Often they can read fairly well if they finished the equivalent of secondary school education in Korea. So it is a good idea to provide brochures about any important information regarding the services you are providing. You may be able to find Korean brochures that contain the same information as English brochures. You may give written memos, especially regarding medicines, treatment–related terminology and appointment dates and times. If they do not understand, they can use an English–Korean dictionary or can ask a friend to assist them later.

Take advantage of non–verbal communication

Although hand–shaking is common, many Koreans feel uncomfortable with physical contact with strangers such as hugging or kissing on the cheek as a social greeting. Rather they bow slightly or smile, reserving friendly touching or hugging for family members and friends. It is common to see hands or shoulder holding between same sex friends though most are not homosexual. Among strangers, however, touching is considered disrespectful or harassing unless it is part of a physical examination or treatment. Particularly taboo is pointing at or touching the head of another.

Koreans usually do not make direct eye contact, considering it impolite, until they are comfortable with each other. Silence or long pauses during conversation usually means the person needs more time to think about the issue before giving an answer. Do not pressure clients for a prompt response.

Avoid potential misinterpretation

Some Koreans are not in the habit of using an automatic "you're welcome" as an immediate response to "thank you" or saying "excuse me" after burping or sneezing. Some Koreans tend to be less verbal or spontaneous in–group situations as a result of the cultural emphasis on humility as opposed to independent thinking and assertiveness.

In a group setting, being spotlighted in a negative sense may bring about an overwhelming sense of shame, so it is better to discuss such concerns privately. Keeping the head–down when scolded or disciplined is generally a sign of regret or acceptance of the consequences, while looking straight into the speaker's face is interpreted as a sign of defiance. American service providers usually expect consumers to exhibit openness and assertiveness, but Koreans may restrain their feelings and endure hardships because they have learned in Confucian ideology that harmony and order are maintained through perseverance and calm acceptance of authoritarian decisions.

Involving Consumers and Family Members

Active consumer involvement is an important element in successful rehabilitation. Considering Koreans' high regard for family, a service provision model that recognizes how consumers view themselves in relation to their family will likely succeed. This section will provide tips on involving Korean consumers and their family members as partners to enhance your service provision.

Invite parents into the process from the beginning. In the following scenario, Mary, a state Vocational Rehabilitation (VR) counselor, shares her success story with a consumer, Jin–nam.

Jin–nam is a young man with a sensory disability. Though it has been corrected now, he was teased in school about his hearing impairment. This, in addition to his status as a minority immigrant, made it untenable for him to remain in school. I have found Jin–nam to be personable, bright, and industrious. He passed the GED test for an alternative high school diploma through self–study and demonstrated responsibility as a cookie baker in his family business. Jin–nam has worked with me to learn practical information about several careers in which he is interested and has taken tours of community college programs in his areas of interest. Jin–nam's parents were invited to the tours and they were introduced to one of the VR staff members who could speak Korean. Although his primary interest was agriculture, he chose technology as his career according to his mother's wishes. His mother, who communicated regularly with me through the Korean–speaking staff, encouraged Jin–nam to be a technologist, because it is considered a white–color job with more prestige than farming. He is now attending the office technology program at a community college. He is happy with his second choice because his parents' dream means a great deal to him.
Mary later admitted that if she had not involved Jin–nam's parents from the beginning, she and Jin–nam might have spent a lot of time exploring many other programs. She added that bringing in a staff member who spoke the same language as Jin–nam's parents also facilitated the communication process.
Mary also advises service providers to be aware of the possible pressures on some Korean young adults. Their parents might have high expectations that may not correlate with their childrens' abilities or desires. As illustrated here, many Korean young adults, by custom, are dependent upon their parents for guidance and may need career counseling both individually and with their parents.

Diagnostic assessment for children and young adults should also involve parents. Some aspects of children's behaviors are considered normal in Korean culture but not in America. One example is Attention Deficit Disorder (ADD). In Korean society, children, especially boys, are expected to be active. Some parents often encourage their boys to be active and tough rather than timid. They often laugh when their boys get a report card saying, "not paying attention," or "easily distractible," considering this part of the growing–up process. One mother, whose son was diagnosed with ADD, complained to me that the teachers were picking on her son.

Professionals involved in assessment should not overlook culture in identifying certain disability types. In addition, compounding factors such as learning English as a second language can hinder accurate diagnosis of a disability. For example, Jin–nam's hearing impairment was identified much later than it might have been because school personnel, as well as parents, considered Jin–nam's hearing problem temporary and due to the difficulty associated with learning a new language.

Yŏng–hi's story offers another example of complex issues related to an accurate assessment of a minority child's disabilities.

Yŏng–hi was a five–year–old girl who came to the U.S. six months ago. When she started kindergarten, no one at her school heard her speak a word for about a month. The teacher contacted her mother to ask if Yŏng–hi had hearing or speech impairments. The mother could not believe that Yŏng–hi had been mute during the past month, so she decided to come and observe her daughter at school without letting her know. Knowing how talkative Yŏng–hi was at home, the mother was shocked to find out that her daughter would not say a word in her regular classroom, the ESL (English as a second language) classroom, or on the playground. In addition, she exhibited no facial expressions and looked numb throughout the day.
Her concerned teacher approached me, a Korean–English bilingual tutor at that time, and explained the situation. I worked with Yŏng–hi in a small group of new immigrant students who were learning English as a second language. Yŏng–hi would not speak nor smile for about one week. One day I decided to deal with the problem indirectly and to play a game with the group explaining rules and procedures in both Korean and English. When the game took an exciting turn and created a funny situation, she suddenly burst into laughter. The other students in the group followed her. She began to speak to me in Korean. I smiled with a big sigh of relief. In less than a year, she became a fluent English speaker and mainstreamed into a regular classroom.

Yŏng–hi's temporary state of muteness also illustrates newcomers' stress during their adjustment period. It is important to note here that immigrant students used to be called SLEP (Students with Limited English Proficiency) in the 1980s and now the label has been changed to ESLL (English as Second Language Learners).

You may already notice how the two labels demote or promote a positive self–concept in these learners. The first term focuses on the individuals' English proficiency, implying a disability or limitation compared with the majority culture, while the second implies that the students have already acquired their first language and are now learning an additional language. Because they possess an extreme sense of pride and shame, many Korean parents would not want their child to be placed in a special class because of discriminatory labels that would single out their child from the larger group. If they can afford it, they would rather find a private therapist or a tutor. Even parents of children with disabilities want teachers to be strict in discipline and to have high expectations for academic performance. Thus, they prefer a lot of homework within a rigorous curriculum. Long–range goals for education and career are developed at a rather early age.

Respect healing rituals

A person's culture can serve as a barrier or a facilitator during the rehabilitation process. Some service providers might view Koreans' spiritual emphasis as a barrier to the supposedly expeditious rehabilitation process, but much depends upon how individuals balance their inner world with extrinsic factors in their lives. Those who use meditation or prayer to boost their inner strength, in combination with scientifically–developed medicines or therapeutic methods, are likely to have a better chance of recovery than those who insist on using only one of the two methods.

Make good use of natural supports

The American rehabilitation system values individual responsibility and individualized services, while Korean culture tends to emphasize the interdependence of family, friends, and community. Involving not only family members but also a circle of friends, especially members of their religious organizations, can benefit consumers by offering additional support.

In group residential settings such as hospitals, nursing homes and group homes, some Korean consumers may crave Korean food. If feasible, let relatives and friends bring in ethnic foods that they believe promote wellness and produce therapeutic effects.

Empower consumers and their parents

Some service providers admit that the more involved and assertive the consumer, the better the services. They recommend that consumers and parents get involved in obtaining the necessary documents for services and participate in meetings for developing Individualized Educational Plans (IEP), Individualized Family Service Plans (IFSP) or Individualized Written Rehabilitation Plans (IWRP).

They also recommend that they connect to more services and resources, be assertive in their preferences and communicate closely with service providers. Most Korean consumers, however, are likely to be passive recipients. Remember that an "assertive" person is perceived as "aggressive" in Korean culture. Koreans are not familiar with American concepts such as empowerment, advocacy, personal choice and independent living so valued by the mainstream rehabilitation service system in the U.S. In addition, most people do not understand what planning documents are required, the importance of consumers' involvement in an IEP or IWRP and the alternative types of services.

Once you establish rapport and trust with Korean consumers, you may need to explain their rights and responsibilities in the special education and vocational rehabilitation system and empower them to be active participants by teaching the values of self-determination and assertiveness. Kalyanpur and Rao describe empowerment as "changing the role of a service provider from that of an expert to that of an ally or friend who enables families to articulate what they need." (National Center for the Dissemination of Disability Research (NCDDR) (1999). It might not be easy at first to establish a partner relationship with Korean consumers as defined above because they are accustomed to a hierarchical relationship.

Structured approaches with clear directions and expectations might suit most first–generation Koreans best. Providing many options and freedom of choice might not be widely appreciated as it is in American mainstream culture. Even worse, the service provider who offers too many options is likely to be considered incompetent. Korean consumers may be able to collaborate with you better when you give them a clear explanation of the pros and cons of a few options you have already screened based upon your expertise and experience in the system.

Expanding Capacity and Support

A truly productive working relationship extends beyond the provision of services to the formation of a partnership at an individual level. This section deals with expanding capacity and support to ensure positive rehabilitation outcomes at a system level. There is a wide array of services and supports needed by Koreans with disabilities and their families, but the three most critical include:

  1. interpretation (translation) services
  2. mental health services
  3. policy and system level support

Be creative in finding interpretation and translation services

As noted above, the language barrier is the most significant problem experienced by a majority of first–generation Korean immigrants. From the intake process and assessment to intervention strategies, the language barrier for Korean-speaking consumers with a disability will affect the outcome of the rehabilitation process. Along with culturally appropriate interventions and strategies, the incorporation of Korean language in all steps of the rehabilitation process is needed (Park & Turnbull, 2001). Individual cases were discussed earlier.

There are several ways to reduce the cost for interpretation or translation services at the institutional or national rehabilitation level. There are some Korean informational brochures available about the prevention and treatment of common diseases as well as those about rehabilitation programs and services. Sharing informational brochures at the national level, as well as an international exchange among rehabilitation research institutes would help prevent duplication of cost and effort.

It is also useful to have access to staff members who speak Korean within the agency or in related non–profit organizations. Jin–nam's mother, in the story cited previously, felt very positive about the resourcefulness of his son's counselor and said in Korean, "Although she could not speak Korean, she introduced me to a Korean staff member. Whenever I am frustrated with communication, being able to explain the problems to her in my native language reduces my stress level." She was most impressed by the counselor's initiative and promptness in locating the appropriate human resources.

Provide mental health support

Many Korean consumers and parents view disabilities as the result of their incorrect behavior, and are not only embarrassed but also suffer an extreme sense of shame. As a result, they are less likely to report a disability and to get the support and services they need. It is important to reassure them that no one should be blamed and that positive attitudes can facilitate recovery.

Be an empathetic listener as a way of providing emotional support that is not specific to the consumers' disability. Help them identify what they are feeling and help them find healthy ways to vent their depression and frustration. Assist them in avoiding self–defeating behaviors such as isolating themselves, overeating and drinking. Have them stop using their disability as an excuse for these behaviors. Encourage them to focus on the things they can control and do well, rather than dwelling on deficits. If there are too many issues for you to handle, seek external help. Remember you are a human being first, then a service provider, and you may feel exhausted and simply need a break.

Some Korean family members often sacrifice their own needs to care for their loved ones who are ill or who have disabilities. This can result in severe emotional distress manifested by vague abdominal pain and depression (Min, 1998; Pang, 2000). Try to arrange respite services and external mental health support for them. Many Koreans under–utilize mental health services because they may fear that mental illness is a sign of a spiritual crisis or fear losing face by exposing inner weaknesses. In addition to cultural stigma associated with mental health, poverty, lack of health insurance coverage and language barriers are primary reasons for the pervasive under–treatment of mental illness. Help consumers expand their formal and informal networks to find extra support from other Korean consumers with similar disabilities.

Policy and system level support

You and the personnel in your organization may need in–service training to develop culturally competent skills and to prevent discrimination against particular ethnic or disability groups seeking rehabilitation service and support systems. Compared with the overall disability community, Koreans are less likely to be identified as having disabilities and are also less likely to be served through public assistance and welfare services. This is due partly to guilt or shame associated with disability and the belief that disability is a private family matter.

Under–identification and under–utilization of services by minorities with disabilities need to be addressed at the policy level. As a strategy to improve the underlying social and institutionalized inequities, minority persons including Koreans and other Asians, especially those with disabilities, need to be supported in becoming role models and leaders in the field of rehabilitation services (Stodden, Hemphill, Kim–Rupnow, & Ah Sam, 2000). Having minority role models in the system can benefit both service providers and consumers by assisting them to bridge the cultural gap between mainstream and minority cultures.

Building strong links between various rehabilitation agencies and other service organizations is another way to broaden opportunities and improve services, better utilizing human and fiscal resources by sharing Korean language materials and translators among agencies.

Ways in Which Service Providers Can Become More Familiar With Korean Culture

Below is a list of ways in which you can become more familiar with Korean culture.

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©2001 by the Center for International Rehabilitation Research Information and Exchange (CIRRIE).
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This publication of the Center for International Rehabilitation Research Information and Exchange is supported by funds received from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education under grant number H133A990010. The opinions contained in this Publication are those of the authors and do not necessarily reflect those of CIRRIE or the U.S. Department of Education.