Spirit Catches You and You Fall Down

¶ … Spirit Catches You and You Fall Down is a book by Anne Fadiman about cross-cultural communications, or lack thereof, in the American health care system. The book is about a child named Lia Lee. Lia Lee was the first in her family to be born in the United States. Her parents are Hmong, which is a hill tribe that was settled mainly in Laos and which helped the American government during the War in Vietnam. The Hmong were displaced and persecuted, and thus afforded refugee status. This book is about how the immigrants spoke no English, had different values toward health care, and were therefore excluded from receiving the quality of care needed. As a result, their daughter was taken away from them and eventually Lia Lee became a vegetable and recently died.

When Lia Lee was an infant, she had her first epileptic seizure. However, doctors misdiagnosed the disease at first. Their misdiagnosis could have been a serious problem. Therefore, the book is also about medical malpractice to a certain degree, although the author focuses more on cultural issues. The Spirit Catches You And You Fall Down is now widely read and appreciated by many health care workers and others who care about cultural concerns.

Epilepsy is called qaug dab peg in the Hmong culture. Qaug dab peg is relatively common and treated as a spiritual condition by the Hmong (p. 21). The title of the book comes from the phrase quag dab peg, which is translated as "the spirit catches you and you fall down," (p. 21). This is because the disease is related to a bad spirit that steals a person's soul, and the person has a seizure as a result. The author of the book tries to get the readers to understand that the Western model is not the only way of viewing a disease. It is equally as valid to think that the spirit is taken by an evil spirit. However, it is something different altogether to deny a child treatment. The family is shown as being too afraid of the Western medical system to allow their daughter to use surgical procedures. This is why the state took control of the child and put her in foster care. Had the family been able to understand the doctors were trying to help her, the outcome might have been different.

The Lee family did not like knowing their daughter was not being seen by a shaman and was seeing doctors instead. It is remarkable that even though there was a large Hmong community, no one found a translator for the family. Drugs like ampicillin and Dilantin were recommended to control seizures but the family did not want to use these or other drugs to counteract symptoms. Lia Lee's seizures became more frequent and the family could not ignore the problem. After the parents took the child back to the hospital, the health care team tried to do the right thing but it ended poorly. Lia Lee went to several different foster homes. A few of them were good to her, but many were not. It was her last foster home that was the best one, as the foster mother made ties with the parents and encouraged cross-cultural communication.

It is important to point out that the Lee family had a long and difficult life prior to coming to the United States. They had lived in refugee camps in Thailand. They lived at a waypoint before making it to Merced, California. The author explains how the Hmong people have resisted cultural assimilation throughout their history. They were persecuted in China before moving to Southeast Asia. Their resisting assimilation is a pattern perpetuated in the United States. Americans expect immigrants to assimilate, while many immigrants prefer to retain their culture and traditions.

This book makes it clear that communication would have alleviated the fears about the interventions used in Western medicine. When Lia Lee is placed in foster care, the parents also believe that the government is stealing their child. The author of the book does a good job showing how problematic health care can be when there are cultural barriers. The Lee family is angry, until the foster mother named Dee Korda comes to the rescue and genuinely cares for the entire family. Lia Lee starts to take her medication, but it is too late. Jenine Hilt is a small woman who the Lees also start to like, and who helps the Lees see that Western medicine is only trying to help make their daughter healthier. Unfortunately, the interventions come too late.

The Spirit Catches You And You Fall Down is a good book about how to improve cross-cultural communications in health care. The story is about the Hmong girl and her family. It is important to analyze this book, in light of the need for American health care to improve. The stories told in this book are only one of a million people who go through similar problems with a system as broken as the one in the United States. Many people dislike doctors because of the way they control health care and disrespect patients and their families.