Response Paper : Mother And The Medical Staff At Merced Community Medical Center ( Mcmc )

“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.

However, Dr. William seems to make an assumption about the origin of the Waleed family, who are Sudanese, but he thinks they are African American. This caused him to overlook the stress, which the Waleeds may have gone through in Sudan before migrating to the US, thereby turning them away because they do not have insurance. This behavior will have a far reaching ultimate health outcome on the Waleed’s child. In addition, he seemed to not totally understand the culture of Vietnamese, which made him totally do the contrary of the Phan’s family expectations (Core Concepts in Cultural Competence, 2012).

What would it be like to come to a country and not understand anything about its health care system? In The Spirit Catches You And You Fall Down, Anne Fadiman brings to light the conflicts between a Hmong family’s cultural beliefs, and that of the traditional western medical beliefs of the American doctors they come into contact with. Fadiman shows the consistent tug of war between the Hmong culture and the Western American medical practice. The Lee family comes from a culture that believes in holistic healing. They have an animalistic view in regards to health and medicine. The cultural barriers between the two eventually leads to the detrimental fate of the Lee’s daughter Lia.

The different ways they each interpret medicine and life itself. How difficult it could be when the Hmong have their own set or ways to follow in order to cure a person and the doctors have their own policy which they must follow. It’s difficult and frustrating to not be able to understand someone else’s language and not know what sort of questions they’re asking and the treatments one must

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.

Anne Fadiman struggles to find the answer to who is responsible for Lia Lee’s health in her book, “The Spirit Catches You and You Fall Down.” The book describes the clashing of both the medical community within Merced, California, and a Hmong refugee family, the Lees, cultural beliefs. The Lees daughter, Lia Lee, is plagued with a severe case of epilepsy, or qaug dab peg in Hmong, as a child and is administered to the Mercy Medical Center Merced, or MCMC, a hospital in Merced, California. The doctors there go through many struggles in order to work with the Lee family, as they are faced with cultural and language barriers that they must overcome in order to ensure Lia is in good health. The Lees do not feel that they are in the wrong, for their

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 Hmong are a clan based, patriarchic culture. Within the clans there is much diversity, with each clan having its own group identity and traditions. The language has a long oral history and very new, 1095’s, written form. The family structure consists of multiple generations in one household, with the elder male being the main dissension maker. The nurse must be familiar with generalities of the Hmong culture and be able to ask patients and their families of the cultural beliefs and decision making.

Anne Fadiman wrote this book to document the conflict between cultural barriers and how they affect medical issues. In this book, Lia Lee is a Hmong child was has epilepsy and battles cultural medical differences. The main struggle in this story is the conflict between the doctors and parents because they cannot seem to get on the same page. While writing the book, Fadiman stated that there was a “clash of cultures”. (Fadiman, preface) Meaning, there are two different sides to the story and the problem has not be solved.

The intercultural misunderstandings start at birth. When a child is born, Hmong women want their placenta, so that they may bury it. In Laos, this is perfectly normal, but in the United States, most doctors find this strange. Since this is not something regularly practiced in the U.S., when a Hmong woman asks for her placenta, most doctors say no. The few that do agree to give them the placenta pack it in a plastic bag or some other container that degrades the importance of the Hmong culture. Many doctors assumed that the women wanted to eat the placenta. This is wrong, but they would never know because they never took the time to ask. If the doctors had asked why they wanted the placenta, they would easily find out that it’s important to the Hmong culture because their soul and afterlife depend on it.

The growth in presence of midwives in both Indigenous and non-indigenous communities is increasing, indicating the overall difference in experience between what would be defined as “natural” birth and what western medicine dictates as “normal” birth. Though, this does not include the use of “assisted” birth during emergency situations, which is sometimes the case even with midwife patients (Green, 2017). But, this experience gives the mother an ally especially through emergency situations, which is related through both Dorothy Green and Kim Anderson’s experiences; Anderson whose first pregnancy needed to be terminated was assisted by an Indigenous birthing center to ensure that she would be able to bury the remains of her child, which is needed for both closure and ceremony (2006). Similarly, Green had to fight to make Indigenous medicine and options known in the hospital, to ensure that her patients were returned the pieces of their birthing process they needed to move forward and perform ceremony (2017). The use of traditional teachings, especially in an event as sacred as birthing, helps to heal Indigenous communities and families, and a healthy community leads to healthy identities of mothers.

The book titled The Spirit Catches You and You Fall Down: Talks about a Hmong Child, Her American Doctors, and the Collision of Two Cultures written by Anne Fadiman. Anne Fadiman is an American essayist and reporter, who interests include literary journalism. She is a champion of the National Book Critics Circle Award for Nonfiction, the Salon Book Award, and the Los Angeles Times Book Prize for Current Interest. In the book, Anne Fadiman explores the clash between a county hospital in California and a refugee family from Laos over the health care of Lia Lee. Lia Lee is a Hmong child diagnosed with severe epilepsy, whose parents and the doctors wanted the best treatment for her, but the lack of communication cause a tragedy. The essay paper will state and explain what went wrong between Lia’s family and the doctors. The central point is a lack of understanding between them leads to Lia’s tragedy.

When caring for a Native American patient, it is imperative that the nurse provide culturally competent care. In this scenario, there are two main dimensions along which cultural tensions between the patient and the nurse can arise. The first pertains to the actual practices and values of Native American culture, which may be at odds with the practices and values of dominant healthcare institutions. The second is both broader and more subtle: it pertains to the historical relationship of the Native American people and the

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive, yet problems do arise and it affects the quality of care the patient receives. Language barrier, poor socioeconomic status, and poor health literacy also contribute to health care disparity. For Lia, it was more than her skin color, it was all of the above, her parents did not speak English and they were illiterate. They had trouble understanding the American healthcare system, had trouble or little interest in adjusting to or understanding the American culture. They didn’t work, which in addition to cross cultural misunderstanding, helped contribute to animosity between the Hmong and the host community, because some in the Merced area did not like or appreciate the fact that some Hmong did not work and relied on welfare to make ends meet. All these factors, contributed to the poor quality of

Cultural Competence based on the Purnell Model can provide a comprehensive, systematic, and concise structure for learning and understanding the Palauan culture. Based on the previous paper regarding my Palauan friend, S.S., I will be discussing five areas where I can further improve my transcultural care pertaining to this specific community. These areas are in communications, high-risk health behaviors, nutrition, pregnancy and the childbearing practices, and death rituals (Purnell, 2014). Furthermore, I will present a reassessment of my culture competency to evaluate my learning that can positively affect the nursing care of individuals from diverse cultures represented by the Palauans.