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THE METTA Center’s biggest challenge, though, lies in attracting Khmer patients who, because they treat themselves with traditional methods, are skeptical of Western health care. Cambodians are especially prone to heart trouble and diabetes, two conditions that respond well to Western medicine — yet many patients who bring these conditions under control with Western medication end up putting themselves back at risk by abandoning the treatments for traditional medicine. At times, doctors at the Metta Center don’t even know what they’re competing with; recently, a group of doctors sent a Khmer herbal diabetes treatment to the lab for analysis, so they could find out exactly what their patients were ingesting.

Another concern for Metta doctors is the traditional approach to pregnancy and childbirth. Many Khmer women treat herbal medicine as a substitute for prenatal check-ups. What’s more, the medicine often takes the form of herb-infused wine or vodka, which raises concerns about the harm alcohol can do to a fetus. (Cambodians say that when taken medicinally, the alcohol is just a medium, and used in small amounts.) In May, state health commissioner Howard Koh reported that just 45 percent of pregnant Cambodian women in Massachusetts receive adequate prenatal care — the lowest rate of any group in the state. Yet a 1989 study of 500 pregnant Cambodian refugees in Massachusetts found that they had low complication rates during pregnancy, and delivered healthy babies despite their lack of prenatal care.

Despite their concerns, however, health professionals in Lowell have come to recognize the value of understanding and accommodating traditional practices. Lowell hospitals and schools no longer report coining lines or the red circles left by cupping as suspected cases of child abuse. And at Lowell General, hospital staffers respect the Cambodian belief that heat is essential to recovery from childbirth; they obviously can’t duplicate the native practice, in which a woman lies on a bed perched over hot coals after delivery, but patient advocate Joyce McLaughlin says, “We make sure the Cambodian patients have a warmed blanket. And we are careful not to give them cold water.”

Understanding can’t eliminate all the risks associated with allegiance to traditional medicine. A few years ago, the state poison-control center reported a case of strychnine poisoning caused by a Cambodian herbal treatment. In that case, the patient had swallowed seeds she was supposed to suck on. And medical workers do sometimes see Cambodians who delay necessary trips to the hospital so they can try to treat themselves. But that practice cuts across cultures, McLaughlin says: “I don’t think we see that any more in the Cambodian population than we see in the general population.”

At its best, Lowell’s new approach means better, more responsive care for patients like Mallis Phay, a counselor with the Massachusetts Department of Mental Health, who says she tried to stop coining after a doctor embarrassed her by commenting on it during a physical. Then she started again. “I just couldn’t stay away,” she says. “I usually do it when I get dizzy or am coming down with a cold, and I feel better afterward. That’s the magic.”

Tinker Ready is a Cambridge-based health and science writer. She lived and worked in Cambodia for a year in 1996.