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Asian remedy raises few alarms elsewhere People in cities with closer ties to Hmong culture say the issue no longer is a concern.

By: Jeremy Olson, Omaha World-Herald, May 3, 2002, Friday

The use of the Asian folk remedy cao gio probably wouldn't lead authorities to remove children from their homes in American communities with deeper ties to Hmong and Vietnamese cultures.

What happened in Omaha this week - police suspecting child abuse and removing 10 children from two families who performed cao gio on them - appears the result of a lack of cultural awareness, said Hoa Tran, a bilingual liaison for the Lincoln Public Schools.

Cao gio, commonly called coining, involves the rubbing of warm oils or gels across a person's skin with a coin, spoon or other flat object. It leaves bright red marks or bruises, but many Asian families believe the marks represent bad blood rising out of the body and allow improved circulation and healing. "Over here, it is no problem," said Tran, who also interprets for Lincoln police.

Employees at an Omaha elementary school notified police when they discovered the marks on some of the children. Authorities in Omaha then removed the children from their families Tuesday after some of them indicated that the bruises were painful.

Misinterpretations of coining have occurred in many cities and created distrust of American health care, according to a March 2000 report in the Journal of the American Academy of Nurse Practitioners.

Mark Pfeifer of the Hmong Cultural Center in St. Paul, Minn., remembers child abuse complaints related to coining taking place in the 1980s, but not since then. The Twin Cities has a large Hmong population.

"I haven't heard of that issue here for a long time," he said.

Lincoln's increased knowledge of coining stems from the large Vietnamese population that started moving to the city more than a decade ago, said Lincoln Police Chief Tom Casady. "We've had a longer period of time to learn of the practice of coining and to incorporate that into our child abuse training."

New Lincoln police officers are trained to recognize coining and to differentiate it from child abuse. Tran, whose family uses coining, educates Lincoln teachers and students at the University of Nebraska Medical Center in Omaha about it.

Lincoln police still receive tips about children who have bruises that are the result of coining and must investigate them. Police in most cities have a better-safe-than-sorry approach to investigating child abuse complaints. But police officials there could not recall making arrests or removing children from their homes in any recent cases.

Lincoln police and other officials were careful not to judge the Omaha police decision, noting that child abuse can occur within families that practice coining, and that such remedies can be harmful if used inappropriately.

Nationally, fear of losing their children prevents many Asian women from doing coining, even if they believe in it, said Ruth Davis, head of the nursing school at Millersville University in Pennsylvania and author of the nurse practitioner report.

Health care providers should know better than to mistake it for abuse, and so should anyone who works with Asian children, she said. "If you take a coin and rub your skin, you're going to get a bruise. Physiologically, that is what happens, but it's not used as a form of punishment."

Vanderbilt University Medical Center includes an image of the long red bruises created by coining on its Web site so its doctors can correctly distinguish the practice from child abuse.

"The back or chest is vigorously rubbed with a coin and these lesions are produced," the Web site statement says. "The lesions themselves are of no significance. They should not be mistaken for child abuse in pediatric patients."

The University of Washington offers a pictorial description of coining at ethnomed.org

Doctors who used to discourage coining found that that only created resentment among Asian patients, according to a 1980 article in the Journal of the American Medical Association. The authors found that coining is used to treat colds, flu and headaches and applied the most often to the back, neck, chest or head.

A supervisor of child-protective services in Minnesota said investigations should take place if there is any suspicion of abuse. But Dorothy Renstrom said that removing children isn't always necessary and that authorities should offer to teach families about alternatives to coining.

She first learned of coining when she worked in Lincoln.

Many doctors believe coining is legitimate and have used it. Dr. Laeth Nasir of the NU Medical Center said he uses a variation on patients suffering from tendinitis.

Anh Tran, a health outreach worker in Lincoln, said her relatives use coining, but she doesn't like it. She has been in contact with one of the Omaha families - which previously lived in Lincoln - and said she believes what is happening to them is wrong.

"It would never go this far here," she said. "In Lincoln, it's well-known. It's nothing new."

Tran, the Lincoln schools liaison and police translator, believes in coining as a low-cost remedy, but it is not the only one for his family.

"We also take American medicine," he said, "like Tylenol or something."



GRAPHIC: Color Mugs/4 Dinah Lor Aaron Lor Kanoo Lor David Chang Color Photo/1 VANDERBILT UNIVERSITY/1, This patient has undergone the Asian folk remedy of coining, or cao gio. The Vanderbilt University Medical Center in Tennessee uses the photo to help its doctors distinguish these long, red bruises from ones inflicted during child abuse.; VANDERBILT UNIVERSITY/1