Within this clash of cultures, the Lee family did not know how to cope with the medical system in place to help Lia and her epilepsy. When they refused to give her the medications, Lia was removed from the home and placed in foster care. When the foster care parents gave her the prescribed medication, her condition worsened in several important ways. The foster parents believe that Lia's parents realized that, and that this is why they did not give her the medication, but did not have the cultural and language skills to communicate this to the medical staff.

Fadiman points out through example after example that the medical staff looked at Lia only as her illness, not as an individual, and certainly not as an individual part of a strongly developed culture that was markedly different than the hospital culture within which the doctors worked. Through a translator, a doctor wants to just order a woman to take her tuberculosis medication even though she is pregnant. The translator coaches the doctor that the conversation must open with the doctor expressing good wishes for the man and his family. So the doctor says she "wishes that his children would never be sick, that their rice bowls would never be empty, that his family would always stay together, and that his people would never be in another war." (p. 264). With this opening, the Hmong man relaxed and listened to what the doctor had to say, had his very serious concerns addressed, and then announced that his wife would take the medicine.

By comparison, when Lia's father was told she was probably going to die, the staff asked him to sign an organ donation form. He believed they intended to let her die to take her organs, and...

They would likely have suggested... medicine for a week but no longer... after she is well she should not take the medicine any longer. You should not treat her by taking her blood or the fluid from her backbone... we hope Lia will be healthy, but we are not sure we want her to stop shaking forever because it makes her noble in our culture, and when she grows up she might become a shaman." (p. 260). It is hard to imagine a system of beliefs more at odds with how the medical staff thought Lia's epilepsy should be managed.
Fadiman presents both sides with sympathy. She understands the Lee family, their Hmong culture, and the anguish they feel over their daughter's illness. However, she recognizes that the Lees actually have no rational reason to believe that the doctors know more than they do about how to help Lia. The doctors, however, function in an ethnocentric way, and just expect the Lees to do whatever they tell them to. When the Lees fail to follow through, they are labeled "noncompliant," and the medical reaction is to take steps to force them to comply, not to try to understand the problems the cultural differences make.

Fadiman's book puts real faces on the difficulties the United States faces as it becomes the new home to people whose backgrounds, beliefs and cultures are radically different than the European roots other immigrants either possessed or at least had some knowledge about. The Hmong in the book are truly fish out of water, and for the Lees, there was no one around to help them bridge the differences.