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The importance of understanding cultural differences in the medical environment
The importance of understanding cultural differences in the medical environment
Cultural Differences Among Patients in the Medical Field
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Communication is cited as a contributing factor in 70% of healthcare mistakes, leading to many initiatives across the healthcare settings to improve the way healthcare professionals communicate. (Kohn, 2000.) As part of my Culture, Health and Illness class, I undertook a critical analysis of the book “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures” by Anne Fadiman. This book was published in 1997, and documents the struggle of a Hmong family from Laos in communicating with and understanding the American health system. The Vietnam War caused great destruction in Laos, and so the Lee family migrated to America, after spending a short time in refugee camps in Thailand. After settling in America, Foua gives birth to Lia, who unbeknownst to them will suffer from epilepsy soon after she is born. For four years, little Lia is admitted to hospital seventeen times, after suffering both grand and petit mal seizures. Through miscommunication and a failure to understand each other’s cultural differences, both the parents of Lia, and her American doctors, are ultimately at fault for Lia’s tragic fate, when she is left in a vegetative state. Within this critical analysis, I hope to show that the lack of communication and compromise between the Hmong family and the American doctors, was the defining blow to Lia’s ill health. I hope to do this by addressing the following three main points of interest in relation to this miscommunication; the views held by the American healthcare professions on the causes of Lia’s illness, contrasted with the opinions of Lia’s parents. I will then discuss the health-seeking strategies of Lia’s parents and how they were influenced by different resou... ... middle of paper ... ... Lia Lee will never be repeated. “The soul-caller in Lia’s healing ceremony, began to chant, “Where are you? Where have you gone? . . . Come home to your house. Come home to your mother . . . Come home. Come home. Come home.” Ironically and tragically, Lia would never come home, because her brain had been lost forever. References: Balzer Riley, J. 2012. Communication in Nursing. 7th Ed. United States: Elsevier Fadiman, A. 1997. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux. Kleinman, A. 1980. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. University of California Press. Kohn, L. et al. 2000. To err is human: building a safer health system. Washington D.C. National Academies Press.
In their pursuit of assimilating and calling the US home, they had forged a new identity of Hmong Americans. (Yang, 203) Being Hmong American meant striving to move up the economic ladder and determining one’s own future. They understood that for them to realize their American dream and their “possibilities”, it could only be done so through “school”. (Yang, 139) Yang realized her dream by attaining a Master’s of Fine Arts from Columbia University and publishing books about the Hmong story.
This book addresses one of the common characteristics, and challenges, of health care today: the need to achieve a working knowledge of as many cultures as possible in health care. The Hmong population of Merced, California addresses the collision between Western medicine and holistic healing traditions of the Hmong immigrants, which plays out a common dilemma in western medical centers: the need to integrate modern western medicinal remedies with aspects of cultural that are good for the well-being of the patient, and the belief of the patient’s ability to recuperate. What we see is a clash, or lack of integration in the example of the story thereof. Lia, a Hmong child with a rare form of epilepsy, must enter the western hospital instead of the Laotian forest. In the forest she would seek out herbs to remedy the problems that beset her, but in the west she is forced to enter the western medical hospital without access to those remedies, which provided not only physical but spiritual comfort to those members of the Hmong culture. The herbs that are supposed to fix her spirit in the forest are not available in the western hospital. The Merced County hospital system clashes with Hmong animist traditions.
The Hmong people, an Asian ethnic group from the mountainous regions of China, Vietnam and Laos, greatly value their culture and traditions. The film “The Split Horn: Life of a Hmong Shaman in America” documents the seventeen year journey of the Hmong Shaman, Paja Thao and his family from the mountains of Laos to the heartland of America. This film shows the struggle of Paja Thao to maintain their 5000 year-old shamanic traditions as his children embrace the American culture. Moreover, the film shows that one of the major problems refugees like Paja Thao and his family face upon their arrival to the United States is conflict with the American medical system. Despite the dominant biomedical model of health, the film “The Split Horn” shows that
As she travels from a metropolis to the tiny town of Bethel, Alaska, for her first experience with patients. Among the heavily Yupik Eskimo population, she begins to glimpse the depth of the challenges that physicians juggle. She discovers that the social and cultural context is vital to understanding the patient's story, a story that she, as a physician, needs to know in order to help relieve suffering, especially when it comes from a place that is foreign to her own
The Spirit Catches You and You Fall Down by Anne Fadiman is a nonfiction book that brings to light the clash of Hmong culture and Western medicine in Merced, California. Anne Fadiman tells the story of a Hmong immigrant family, the Lees, and the unfortunate condition of epilepsy that their daughter Lia suffers from. Throughout the book the reader sees great conflict inflicted on medical practitioners due to the Lee’s own cultural beliefs and the frustration suffered by the family due to miscommunication. Anne develops the story by giving a detailed background of the Hmong peoples’ lifestyle in their indigenous land of Lao, how it contributes to their beliefs, and their struggle to understand and accept Western practices.
The book titled “The Spirit Catches You and You Fall Down” is not only an interesting narrative to read just because but it serves as insight into the culture of the Hmong’s and not only how but also a why the Lee’s struggled to adapt and agree with Western medical practices for her daughter’s health.
In America the clashing of cultures is inevitable due to the different backgrounds that make up the country --- especially when it comes to treating patients medicinally or through more traditional ways. The conflict occurs in The Spirit Catches you and You Fall Down By Anne Fadiman, when the culture of western medicine collides with Hmong practices. A daughter of a Hmong family, Lia, suffers from epilepsy and is brought to the Merced Community Medical Center (MCMC) to seek treatments that will alleviate the symptoms of her seizures. While the doctors and parents try to find ways to help Lia, they encounter cultural barriers such as their differences in practicing medicine that inhibit their ability to help her efficiently. The MCMC doctors and the parents are both responsible for the increasing cultural conflicts because of their negative biases towards each other long before they meet.These negative biases were later enforced by their lack of trust and respect as the book progressed.
Going to a different country or area of the world can open up anybody’s eyes to see that culture makes a huge impact on the understanding and practices of healthcare that seem to be so common to other areas of the world. When a person lives in one country their whole life, that person may not realize how different the life they live is from someone in a foreign country. If a person is going to receive treatment from someone with a different cultural background, they should be expected to get treatment to respects their own culture. Massachusetts College of Pharmacy and Health Sciences having such a diverse variety of students has their own cultural competency definition that states “effectively and comfortably communicate across cultures with patients of differing backgrounds, taking into account aspects of trust in order to adopt mutually acceptable objectives and measures”. In the book Dancing Skeletons: Life and Death in West Africa by Katherine Dettwyler, the issue of culture and healthcare are greatly prevalent. Katherine Dettwyler herself goes to West Africa as an anthropologist and her horizons are broadened when during her research she comes in contact with how much culture has an impact on healthcare and everyday life.
Through showing the different definitions of health, the authors explain how those different understandings affect patterns of behavior on health depend on different cultures. In addition, an analysis of the models of health demonstrates even western medical approaches to health have different cognitions, same as the Indigenous health beliefs. The most remarkable aspect is a balance, a corresponding core element in most cultures which is an important consideration in Indigenous health as well. From an Indigenous perspective, health is considered as being linked, and keeping the connection is a priority to preserve their health. Consequently, health is a very much culturally determined. Health practitioners should anticipate and respect the cultural differences when they encounter a patient from various cultures. In particular, this article is good to understand why the Indigenous health beliefs are not that different than western medicine views using appropriate examples and comparative composition, even though the implementation the authors indicated is a bit abstract, not
She clearly portrayed the Hmong beliefs and their origins through her detailed explanation of the Hmong customs and history. She also uses keen details to explain the medications and medical procedures over the course of Lia’s treatment. It was evident that Fadiman entered the case with an open mind and avoided cultural/religious misunderstanding. While her explanation of the Hmong culture using the “fish soup” method laid a foundation for which the novel would build upon, I believe that maintaining aroused on the subject was slightly difficult. Fadiman also uses her knowledge of medical education to explain that blame for the culture clash cannot be assigned to the doctors since they were not educated on that matter (Fadiman, 61). Even though Fadiman attempts maintain an unbiased position on the issue, I believe her claim regarding doctor was biased. The author states, “Medicine, as it is taught in the United States does an excellent job of separating students from their emotions. … Dissociation is part of the job. … Neil Ernst avoided Lia Lee after she returned from Fresno with irreplaceable brain damage(he couldn’t bear it) (Fadiman, 275, 276). In the beginning of the novel the author explained how doctors Neil Ernst and Peggy Philp were some of the only people to provide satisfactory treatment for Lia (Fadiman, 42). With this being said, I believe that
The main coping mechanism, then, became suppressing of the memories and emotions attached to the traumas of the Vietnam Wars. Their home served as the host of these demons, but the demons impacted parenting styles. Thi acknowledges that her parents taught her and her siblings many lessons, some intentional but others, quite the contrary. It was the “unintentional ones [that] came from their unexorcised demons and from the habits they formed over so many years of trying to survive;”(“The Best We Could Do,” 295) these lessons were indeed unintentional because just like the suppressed communication, they derived weak communication between the parents and the children. In Min Zhou’s article “Are Asians Becoming ‘White’?” she concludes by including a picture of a Vietnamese family celebrating the 1998 Lunar Year, looking happy. This happy family in the article is much like the Bui family because on the outside, they appeared happy, but inside their home and their hearts, a darkness
In the US., the therapeutic group seldom has approaches to correspond with individuals of societies so drastically unique in relation to standard American society; even a great interpreter will think that it troublesome deciphering ideas between the two separate societies' reality ideas. American specialists, not at all like Hmong shamans, regularly physically touch and cut into the collections of their patients and utilize an assortment of capable medications and meds.
...ation could have been improved between doctors and patients in simple ways. Interpreters were used and children went to school and helped translate for family members. These helped communication somewhat, but it wasn’t enough. There may not have been any other way to help, but some people tried to and doctors tried to be patient with the Hmong to understand what they wanted and to make them understand what was going on.
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures shares the journey of cultural illiteracy from the Hmong and American side. Fadiman states, “In 1995, for the first time, the national guidelines for training psychiatry residents stipulated that they learn to assess cultural influences on their patients’ problems,” (Fadiman 270). Though the unfortunate events that occurred were definitely able to avoid now, at the time, there was no standard set of actions and procedures to take in order to provide the best health care to different cultures. Fadiman truly succeeded in showing the reader that good intentions and compassion must be weighed more heavily when analyzing events and the consequences must be met with an objective eye.
There are many main ideas and themes in the book “The Spirit Catches You When You Fall” by Anne Fadiman. I and my group discussed three themes and specific main points that we all thought was important to take from the book. Some of the main points that we discuss is Hmong culture/family, language barriers, and epilepsy. I will talk about the main points, a brief reflection on the doctor’s take on this situation and the theme sometimes you can’t control the outcome of situations.