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...
He believed they intended to let her die to take her organs, and tried to flee the hospital with her.
Fadiman wrote out what the Lees would likely have said had they been asked, what kind of treatment she should receive. 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…
Spirit Catches You and You Fall Down by Anne Fadiman is a groundbreaking book about cross-cultural communication in health care. The book is about Lia Lee, who was the first in her Hmong family to be born in the United States. Her parents spoke no English. When Lia Lee was three months old, she had her first seizure. Due to misdiagnosis, a string of unfortunate events prevented Lia Lee from
The family would certainly have been more comfortable if the hospital made more of an effort to understand their culture and beliefs. The Lees were treated as if they were indignant and unresponsive to the needs of their child which was not the case at all. The hospital could have enlisted the help of affluent Hmong natives who have become more accustomed to American traditions. This person could have helped
Spirit Faidman, Anne. (1998) The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux. The title of Anne Fadiman's book on the implications of multiculturalism in modern nursing sounds more like a religious testimony than a textual asset to the modern nursing profession. However, Faidman tells a tale of Biblical proportions, and the emotional nature of The Spirit Catches You and You Fall Down is epic in its
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
Then, if the parents did not listen to the doctors, they assumed more of the responsibility of what happened. How could the doctors expect the medicine to be taken correctly when the parents did not read, did not know mathematical symbols and were given change after change. They were blindsided by their own diagnosis and the arrogance that everyone would follow their treatment exactly. Nor can the doctors be
They cannot ignore the socioeconomic issues of adversity so often present and, where necessary, need to act as advocates, mediators and social brokers (Compton, Galaway, & Curnoyer, 2005). The concern is that the issue of healthcare for culturally diverse individuals is so complex, there are no exact rights and wrongs. For example, in Fadiman's book, no person(s) can be said to be ultimately correct or incorrect in his/her behavior or