Spirit Catches You the Makeup

Spirit Catches You

The makeup of the world is undergoing a major change in demographics. In the next twenty to thirty years, the American population will be significantly different, with the number Hispanics and Asians growing at a much faster pace than the African-Americans and white, Anglo Saxon. The white population accounted for about 18% of the U.S. population increase in the years 2000 to 2004, but the Hispanics make up 14% of the population and nearly one half of the increase during these four years. Similarly, between these same years, African and Asian-Americans added approximately 29% to the American population increase, but the Asian immigration contributed a much greater proportion of population expansion. Despite this, America continues to lag behind in its preparation for a demographic change. The book the Spirit Catches You and You Fall Down by Anne Fadiman, demonstrates, for example, how the U.S. does not have any process in place to meet the needs of special population groups who require care, in this case, for healthcare in medical institutions.

Fadiman's book tells the tragic story of a Laotian three-month-old girl named Lia who was the victim of cultural misunderstanding and lack of communication. Fadiman, a freelance journalist, heard about Lia's story through her friend who worked at hospital in California. It took a number of months before the leaders of the Hmong community were willing to talk with Fadiman about Lia's story. The book is not only valuable because Fadiman heard the story firsthand from those in Lia's community, but because she also kept to the facts, presenting two sides of a very difficult and painful story. The Hmong people and the hospital both cared about Lia and did what they thought was best. However, sometimes that is not enough. Life situations, especially in this case, can be very complicated. Fadiman writes about the difficulties, disappointments and confusion from both of these perspectives, so that it has become a learning tool for the medical field and others who are not part of the mainstream American culture.

When a family brings a loved one to the emergency ward or goes through a period of a serious or chronic illness, it is usually a harrowing time for everyone involved. Often, decisions have to be made quickly and without much input by both the family and the medical staff. Communication becomes even more paramount in such situations. When someone from the staff cannot speak the language of the patient or his/her family or, even worse, does not understand the cultural behavior and values, a difficult situation becomes all the more complex.

Unfortunately, Lia was the result of such a major linguistic and cultural understanding. When she had an epileptic seizure when she just a baby, her parents brought her to the hospital. Having arrived in the U.S. only a short time before, the Lees did not know how to speak English, especially enough to explain their cultural differences and to understand the doctors' directions for pharmaceuticals. It was not until the medical staff actually observed Lia having an epileptic fit that they began to understand her needs. Yet the nightmare continued, because the communication problems were not resolved.

During the next four years, her anticonvulsant medicines were changed about 25 times, which would have been hell for any family. The Lees questioned the value of so many prescriptions, especially with their Hmong mindset, and did not follow directions. Of course, this was exacerbated by the fact that they did not understand the dosages. The doctors inaccurately concluded that the Lees were endangering their child and placed Lia in foster care. She had a massive seizure several months later and was left brain dead. She continued to live, being cared for by her parents, despite doctors' expectations.

A major reason for this terrible situation was that the hospital did not have the right people on staff from the very start of the problem. The Lees should have been told what was being done and why and what would happen if their directions were followed incorrectly or not at all. The hospital should have learned about the cultural changes and the reason for the Lees behavior.

In some cases, some good comes out of a bad situation. In this case, when Lia's story in the Spirit Catches You was published it encouraged a number of medical schools and healthcare facilities to investigate what they were doing in similar situations. Since then, studies show that much progress has been made. A number of American medical schools are addressing this issue in their curriculum and hospitals are hiring or having individuals on call who can communicate with patients of different cultures and with different languages. The U.S. government, private and public foundations and organizations have given grants for better service delivery. For example, the U.S. Health Resources and Services Administration created the Centers for Excellence to implement an educational program for the purpose of integrating cultural and linguistic improvement approaches and assessment.