Misunderstandings : The Hmong Fear Western Medicine

“In the Spirit Catches You and You Fall Down”, Anne Fadiman explores the subject of cross cultural misunderstanding. This she effectively portrays using Lia, a Hmong, her medical history, the misunderstandings created by obstacles of communication, the religious background, the battle with modernized medical science and cultural anachronisms. Handling an epileptic child, in a strange land in a manner very unlike the shamanistic animism they were accustomed to, generated many problems for her parents. The author dwells on the radically different cultures to highlight the necessity for medical communities to have an understanding of the immigrants when treating them.

Lindo’s upbringing was significant because her family was very traditional. As a result of her family abiding by tradition, Lindo was betrothed to Tyan-yu as a young girl. Lindo’s family treated her as if she was from a different family. When Lindo’s family lost everything in a flood, her father decided to move the family to Wushi. Lindo was old enough to move in with Tyan-yu’s family, so her family left her in Taiyuan with her future in-laws. When Lindo moved in with her new in-laws, Huang Taitai immediately put Lindo to work cooking, cleaning, and sewing. Lindo not only lost her family by moving in with the Huangs; she also lost her childhood innocence since she was forced to abandon playing with other children so she could be put to work. As a child, Lindo faced adversity due to her lack of American opportunities and therefore matured quickly.

I believe it’s intended for them because of the way they perceive the Hmong people. They have in mind that the Hmong are uneducated and disrespected people that don’t follow American doctor’s rules and the prescriptions that are given to them. They don’t know have doctor gives them is in no means part of their routine. They also believe that Hmong often take everything the doctors say as a joke. One other thing they dislike about the Hmong is that they have lots of family rituals that Americans are not familiar with and think that they are weird and disturbing. For instance, they dislike knowing that the Hmong kill and sacrifice the animal’s right in their own home, but what they don’t know is that they only do this in times of an illness to help someone get better or for family celebrations (Fadiman 107). They only sacrifice animals for special and necessary occasions. What Americans don’t see and understand is that their “$1.99-a-pound chicken breast actually had to get its throat cut in a processing plan”, yet they’re still shocked when they know or hear about a Hmong doing it right under their own home (Fadiman 107). With this being said, I do think that the intended audience is American people for how they are perceived in the book and the way they acknowledge the

Many live under the assumption that those who come to the United States want to become Americanized and assimilate to the melting pot our culture has formed into. This is the populations ethnocentric belief, which is the belief that the ways of one’s culture are superior to the ways of a different culture, that wants others to melt into the western ways. In Ann Faidman’s The Spirit Catches You and You Fall Down, Faidman fails to completely remain objective when demonstrating how cross-cultural misunderstandings create issues in the healthcare field, specifically between the Hmong and western cultures that created dire consequences between the Lee’s and their American doctors. Faidman uses her connections with the Hmong and the doctors who cared for them in order to disclose the different views, beliefs and practices the Hmong and Western cultures practiced. With her attempt to be culturally relative to the situation, Faidman discusses the series of events and reasons as to why the Lee’s faced the fate that they did and how it parallels to the ethnocentrism in the health care system.

I believe Lia’s epilepsy and her state of condition was so severe that by the time she got to the hospital there was not much you could do for her. If there was no language and cultural barrier between the Lee’s and the medical providers, Lia could possibly have gotten the help she needed to live longer but not alive. In the book, it states “If Lia had not had seizures, she would have presented in a coma and shock, and the outcome would probably have been the same, except that her problem might have been more easily recognized. It was too late by the time she got to Valley Children’s. It was probably too late by the time she got to MCMC”. This implies that Lia’s outcome would have been the same no matter what. Perhaps if there were never such

Many years ago, an epileptic Hmong girl named Lia Lee entered a permanent vegetative state due to cross-cultural misunderstanding between her parents and her doctors. An author named Anne Fadiman documented this case and tried to untangle what exactly went wrong with the situation. Two key players in her narrative were Neil Ernst and Peggy Philp, the main doctors on Lia’s case. As Fadiman describes, “Neil and Peggy liked the Hmong, too, but they did not love them… [W]henever a patient crossed the compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle.” (Fadiman 265) At first glance, this statement seems to implicate Neil and Peggy as morally blameworthy for a failure to be culturally sensitive enough. However, upon further inspection of the rest of the book, it becomes clear that Neil and Peggy’s failure to be more culturally sensitive to their Hmong patients was caused by structural issues in the American biomedical system. To prove this point, this paper will first present a background to Lia’s case, then discuss possibilities for assigning blame to Neil and Peggy, then show evidence for the structural issues in American biomedicine, before finally concluding.

I believe there was a clear miscommunication in the message and the Hmong did not entirely understand Dr. Ernst’s actions. I think they thought that if they got on the doctors “bad Side”, they will attempt to take control of your child, which is not the case. Neil and Peggy come off as helping and caring to me. One of the greatest sorrows of the situation is that this message was never truly communicated. However, Neil's message has elements of arrogance. While it is likely true that the doctor's understanding better the health problems and consequences of the issue, the idea that these American doctors could better understand the needs of their children is horrifying. All loving parents believe that they want and know what is best for their

With the loud noise of a slamming door the family believed that Lia’s spirit had been frightened and left the body causing the sickness she was experiencing. The family saw the seizures as an illness of some distinction. In the Hmong culture epileptics often become shamans. The chapter goes on to tell the child’s story about multiple trips to the Hospital Emergency Room. It speaks about the lack of communication surrounding the child’s symptoms. The family is unable, and the medical team unaware of the lack of communication about medical dosages. The doctors have no idea about parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects. The doctors do not attempt to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme.

This prejudice is another strong concept, as the American doctors continued to underestimate, disrespect, and undermine Foua Yang (mother) and Nao Kao Lee (father) and their Hmong way of life. Vice versa, the Lees would refuse doctors’ orders in administering medicines. Ruane and Cerulo hit it right on the nail when describing prejudice,(20) which is a prejudgment directed towards members of certain social groups, as a feeling associated with immigrant groups, those that contain individuals who have left their homelands in pursuit of a new life in a new country. There is a clear indication of an in-group vs. an out-group, as it is noted from Second Thoughts, “an in-group carry unrealistically positive views of their group. At the same time…share unrealistically negative views of the out-group.” The cultural barriers are built due to “the one-sided relationship,” of knowledge only found in the unyielding West, with the prominent racial discrimination found among the white, English-speaking doctors and their intimidate dismissal of the existence of any Hmong medical practices/knowledge. The application of assimilation (20) is important to the in-group, as they simply believe that the immigrants will come to embrace the same values and customs of their new ‘homeland.’

The Lees, a Hmong family, came to the United States in the 1970s as refugees from Laos, and lived in Merced, California. Unlike most immigrants, the Hmong population was less amenable to assimilation. The traditional health beliefs and practices of the Hmong population were disputed by the practices of Western medicine. This became very event when the Lees took their three-month-old daughter, Lia Lee, to the emergency room in Merced. Lia was diagnosed with epilepsy a disease that had two different meaning among the Hmong population and Western medicine.

The doctors assuming the Lee were giving their daughter her medications, were surprised to not see levels of the medications in her blood. Dan Murphy who was one of Lia’s doctor questioned the parents and he learned that due to their cultural beliefs, Lia’s parents have not been administering her with the proper medicine. Where Lia’s mother believes she is doing the right thing for her daughter, Murphy has sympathy for the mother and told Fadiman “I remember having a little bit of awe of how differently we looked at the world”. A key feature of the Hmong is that they have no interest in being rule, do not like to be told what to do, and are rarely persuaded by the customs of other culture. The mistrust and open hostility between the medical staff and the Lee family seemed to overshadow Lia’s disease. Both side obviously loves Lia and wants her healthy but neither was willing to compromised and meet half way.

4. There were many people affected by the Lia’s seizures and the cultural clashes that ensued. I will focus on the two that seemed most significant. The first people who were affected were her family, namely her parents. Nao Kao and Foua were obviously distressed that their youngest daughter was having these seizures. The Hmong in general are excellent parents, providing their children with an extraordinary amount of love and attention (Fadiman, 1997, p. 22) and I can’t even imagine the amount of grief the Lees dealt with as they watched Lia’s soul slip away during those several tumultuous years of her life. Because the Lees blamed the medical system for the end result of Lia’s vegetative state, they became increasingly angry people, Nao Kao in particular. Fadiman tells us how angry he was several times in the book, angry enough to try to steal Lia away from the hospital (p. 213). While Foua more evenly tempered than her husband, she did show severe signs of depression and even suicide when Lia was first taken away from them and placed in

The Native American culture is the original culture of the United States. Members of Native American tribes live throughout the country. “There are an estimated 4.9 million persons, in 565 federally recognized tribes who are classified as American Indian or Alaska Native (AI/AI), alone or in combination with one or more other designated racial classifications. This demographic group compromises 1.6% of the U.S. population” (Horowitz, 2012). Wisconsin is home to the Ho-Chunk (Winnebago), Ojibwa (Chippewa), and the Potawatomi tribes (“American”, 2014). It is important for nurses within this state, as well as any other state, to understand the Native American belief system in order to provide a quality healthcare experience. Nurses are the primary point of contact in the healthcare setting. Client advocacy is one of the nurse’s major roles. Therefore, the nurse should have the highest level of diversity understanding for the cultures within the local region.

One vigorous situation she went through was during Chinese New Year and the two children of her stepmother’s were treated like royalty while the other five children were treated almost worst than servants. A months and

Native American traditional medicine and spiritual healing rituals go back for thousands of years, these traditions often focus on different variations of alternative medicine. This knowledge is passed on throughout generations, many of the tribes learn that by mixing natural plants such as herbs and roots they can make remedies with healing properties. It is believed that being healthy is when people reach a state of harmony not only spiritually, mentally but physically. To be able to overcome the forces that cause illness people must “operate in the context of relationship to four constructs —namely, spirituality (Creator, Mother Earth, Great Father); community (family, clan, tribe/nation); environment (daily life, nature, balance); and self (inner passions and peace, thoughts, and values)” (Portman & Garret, 2006, p.453). In this research paper I am going to show evidence of the tremendous influence that Native American medicine and spiritual healing have over modern medicine in the course of healing