The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame the miscommunication, cultural racism, and the western way of medicine.
Perhaps the greatest problem faced throughout this tale was that of miscommunication. The Merced Community Medical Center or MCMC for short was the place where Lia was being treated. This hospital was the Merced county's only hospital and unlike most rural county hospital it is state of the art, ."..42,000-square foot wing ... that houses coronary care, intensive care, and transitional care units; 154 medical and surgical beds...."3 This was a teaching hospital made up of interns mostly, but also with some great doctors like Peggy Philp and Neil Ernst. Peggy and Neil are married and have children. They graduated together at the top of their class, and have created quite a practice for themselves. Although MCMC is a great rural hospital, it also has the same problems as most rural hospitals do which is the health care crunch, where most of the money goes to the urban hospitals and then the leftover money is spread among th...
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...es, and the Hmong would be more likely to listen to them, because they had helped someone else in their community.
In conclusion, three things could have solved the cross-cultural problems between the Hmong and the American doctors. The doctors should have had more compassion toward the Hmong people, who have been discriminated and put down for very many years. They should have been more understanding toward the Hmong's belief and worked with and not undermine it. Lastly to compromise in all aspects in a relationship no matter what kind is a two way street, and if one party does not respect the other then the feeling will be reciprocated. You have to come to a middle ground or everything will fall apart like in Lia's case.
End Notes
1. Anne Fadiman, The spirit catches you and you fall down, (New York, Farrar 1997)
2. Ibid
3. Ibid
4. Ibid
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.
All informants and sources are listed according to the chapters in which they contributed. Her major helpers, such as her interpreter, the Lees, the doctors who treated Lia, and a few others, have a special thanks from the author at the beginning of this section. Fadiman consulted a vast array of sources from both perspectives of Lia’s story. She also read nearly all of the available literature about the Hmong at that time, which admittedly was not abundant compared to now. Overall, those she spoke to seemed to be open and willing to talk about what had happened. The doctors freely admitted mistakes they made or may have made, and showed an interest in learning where they went wrong so that they could avoid any future
2) Medical pluralism was used to treat Lia in Fadiman’s book as she was treated using both Western medicine and Hmong medicine. For example, she was taken to Merced County Hospital by her parents after she began to have seizures to get her looked at by Doctors and while there she was treated using western medication. At the same time though her family also treated her using Hmong medical beliefs which involved sacrificing animals in an attempt to bring her spirit back as well as visiting Twix Neeb, a Hmong shaman, in Michigan in an attempt to get professional help in curing their daughter.
In this book Anne Fadiman portrayed the ethnocentricity of the American culture, in which people of other cultures are judged based on the standard of American customs and tradition. This means that people are very skeptical about the things that they do not understand. A lot can be learned from the interactions that took place between the Western United States health care system and the more traditional Hmong culture. This book proved that in the end neither way of thinking was completely wrong or completely right. Compromise and understanding is the key to both cultures getting the outcome that they desire.
In the play And When We Awoke There Was Light and Light by Laura Jacqmin, she analyzes the ethical issues revolving around service in America. The main character Katie, struggles with this common ethical issue just like all other Americans when making a life decision that challenges one’s morals. Katie struggles with conflicting messages about service, not being fully committed to helping David, her pen pal from Uganda and then realizing in the end that David is more important than Harvard.
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...
In this case, communication and medications adoptions were the main difference in the treatment of a Lia. Though Lia’s parents and her doctors want best for her, but the above barriers were creating a hindrance in her treatment. They both were not understanding each other and interpreter was also not there, doctors want to transfer her to another best hospital because they were not getting with her disease but her parents misunderstood the situation and thought they were shifting her for their own benefit.
As our textbook states, “Communication includes the willingness of individuals to share their thoughts and feelings” (Purnell, 2103, p. 21). To that end, the Hmong people are primarily illiterate. For this culture, they have a belief that Americans are rude because direct eye contact is maintained when conversing, as well as asking direct questions. In order for there to be successful education regarding the risks of cupping or coining as well as needle pricks, it is important to know that when speaking to someone of the Hmong culture to use quick glances without starting and to initiate a light conversation prior to asking anything regarding their beliefs, health, etc. The Purnell Model of Cultural Competence states that the domain of high-risk behaviors is one area that healthcare providers can make a significant impact on a patient’s health status (Purnell, 2013, p. 30). Advice to the parents, under these circumstances along with other obstacles that could potentially be faced due to the very different cultural aspects, would best be given via one-on-one or through family counseling techniques. From what I have learned so far from our readings, spirituality plays a very important role in a cultures health and well-being. Knowing the beliefs pertinent to the culture you are treating allows you as the provider to better assist them to attaining better health and well-being. Trust is also paramount and it is very clear that to interfere with a person’s spirituality could possibly hinder their physical recovery and actually cause physical
...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.
Initially, when the refugees and their children first arrived in America, primarily California but also Minnesota and Wisconsin, the American educational system identified Hmong children as LEP and placed them in English as a Second Language classes. Very few schools offered academic programs to integrate Hmong students into the society of the school and those that do, have not had any flourishing success. Due to the resulting segregation, both socially and academically, the teaching methodology for these students suffered; become haphazard and improvised. During the initial years of integration, there were very few Hmong bilingual teachers. Hmong students were placed in classes based on an expectation that they would not go on to a higher education and that their ma...
I could also excel beyond the typical limit and I could figure out a different way to communicate with the Lee’s, maybe through hand signals or taking the initiative to learn the common phrases of the Hmong language.
Cobb, Torry Grantham, DHSc, MPH,M.H.S., P.A.-C. (2010). STRATEGIES FOR PROVIDING CULTURAL COMPETENT HEALTH CARE FOR HMONG AMERICANS. Journal of Cultural Diversity, 17(3), 79-83. Retrieved from http://search.proquest.com.ezp-01.lirn.net/docview/750318474?accountid=158556
For as long as man has walked the earth, so has evil. There may be conflicting moral beliefs in this world, but one thing is universally considered wrong: serial killers. Although some people may try to use insanity as an explanation for these wicked people, they cannot explain away the heartlessness that resides in them. As shown in The Stranger Beside Me, infamous serial killer Ted Bundy is no exception to this. Even though books about true crimes may be considered insensitive to those involved, the commonly positively reviewed book The Stranger Beside Me by Ann Rule handles the somber issue of Ted Bundy’s emotionally destructive early life and the brutal crimes he committed that made people more fearful and aware of the evil that can exist in seemingly normal people well.
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The Hmong culture is evidence that health worlds exist. Health worlds exist in which health is understood in terms of its social and religious context (SITE BOOK). Spiritual beliefs in the Hmong culture are strongly connected to their view and description of health and illness (SITE 6). Illness in the Hmong culture is believed to be caused by evil spirits, a curse from an unhappy ancestor, or a separation of the soul from the body (California Department of Health Services, 2004). Paja Thao, the shaman in “The Split Horn” emphasizes his belief that a soul can separate from its body and the failure to return back to the body is a sign that the individual will become ill. Like the Chinese concept of ‘Ying and Yang’, Hmong people believe that the balance between the body and soul determines perfect health. Paja Thao believes that a body is attached to seven souls, and when there is a loss in a soul, illness occurs. In contrast to this holistic concept that the Hmong’s believe in, the Western culture is not able to predict when illnesses will occur. Instead, the dominant biomedical model of health focuses on preventing depression through a healthy life style, such as exercise and nutrition