Cultural conflict in Hmong and Western medical approaches to epilepsy

¶ … cultures work: that what is considered abnormal and almost impossible to achieve in one, is considered routine in another. For instance, the description of Foua's birthing procedure was amazing to me -- her strength and the ability that she could break off and continue with 'regular' life as before.

I especially appreciated the amount of knowledge and detail that went into description of the Lee's life. The author's apparent scholarliness and insight in their life as well as empathy is admirable.

I was confused however, by the extent to which relative ethics and beliefs can be taken. Dilemmas can sometimes be caused, as was shown in these chapters, by cultures professing their ways of life to be superior to another. There may be cases when no superiority obtains, but sometimes one model may deliver better -- or safer -- results than another. The western medical model, for instance, is premised on the long-tested scientific history of testing and disproving. Although it may be culture biased and specific, nonetheless certain principles that have been tested internationally do apply. In these instances, I wonder whether some cultures, such as the Hmong, who fall in these areas may not benefit by following these strictures?

I was impressed by the depth of attention that the Hmong accord their children with far more attention and care shown than Western parents generally do.

What I can learn from the whole is to realize that other cultures may be totally different from mine in each and every detail; that people are suffused by their cultural experiences; and that, to best understand them, I have to read up on their culture -- better still -- experience it first hand before judging.

Chap 4-5

I was struck by the huge difference in terms of Western culture and perspectives of the Hmong culture and how individuals at heart seem to want to do well and are, generally altruistic but perimeters of their different culture may trip them up. For instance, perceived as an honorable condition, the epileptic individual is obligated, by his or her culture, to use these phenomena in order to help others. In fact, many Hmong shamans are epileptics, and achieve acclaim as physical and spirit healers for the physically and emotionally sick individuals of their cultures. As a result of their belief in this process, Hmong individuals would certainly be against western medical interventions that seek to cure epilepsy in any which way or manner. The Western doctors, on the other hand also wanted to do good and saw their medicine as a way of doing so. The problem was that miscommunication and utterly converse cultures turned good into destruction.

I was upset by Neil's steps of relocating Lia. Her parents obviously cared for her. This was no abusive environment. Alternate steps could have first been taken such as providing social work service in the Hmong language to the parents and teaching them how to care for the child. They were obviously eager. Cultural impediments needed to be breached.

On the other hand, I was struck by the dedication and efforts of the overworked and underpaid physicians and nurses to help the child. There are few medical practitioners like this today who put the patient before their needs. Neil and Peggy emerge shining from these chapters, as do most of the hospital personnel in general. .

Chapters 6-7

These two chapters are a mix of both heartening and disheartening factors.

I found the Dee family to be inspirational: the fact that the woman had children of her own and yet adopted a range of foster children from troubled families and the cheerfulness and solidity with which she ran her 'family' was astounding. I could certainly learn from her.

On the other hand, I was upset by the situation of the policeman who misunderstood a Hmong's protest to his taking away the child and that the case proceeded in an incorrect manner. Some may have seen this as bias on the official's part. I think it was more cultural miscommunication and uncontested acceptance of stereotyping of another's culture. Yet the ramifications could have been huge. People may have, and almost did, kill themselves.

We see that, over and again, the Hmong were stereotyped as with the doctors who saw them as a 'dirty' people. I wondered how Peggy and Neil (and the rare others like them) could get past their own cultural leanings and see them in the objective way that they did.

I also wondered why someone like Jeanine had not been called in beforehand. Much expense and suffering would have been avoided had this been the case.

Chapters 8-9

I was struck by my discomfort in terms of the animal sacrifices that the Hmong perform yet upon reflection realized that I myself am quite comfortable with the killing of animals in other ways, such as for food. The basis of the Hmong slaughter of animals is for human healing. What, then, is the differnce between that and kilign for food..

I admired the Lees for their persistence in trying Western medicine despite their unfamiliarity with that way of life and despite the increasing sickness of their child. More so, cultural myths of shamanistic animism was rife in their culture, and many of them disallowed invasive medical surgery due to their belief that doing so will enable human souls and the spirits sometimes invading these souls of escaping. Lia's family was nonetheless ready to question this tradition in their overriding desire to help Lia

I pitied their confusion with the variability and characteristics of the medical regimen (with drugs being changed frequently) and the fact that their lack of English literacy hampered them from following instructions. I wondered at the fact that the doctors were not aware of this and that it took a Jeanine to recognize this fact. Above all, I was impressed at Neil and Peggy's scrupulous honesty to assess their failures and to see how they could improve.

I wondered how a second generation Hmong could merge so successfully in American culture -- despite the deep-rooted differences -- as May, for instance, seemed to do.

Chapter 14

What I was most struck by in this chapter was the different connotations of the word 'productivity'. According to the American government, the Hmong were generally not productive because they did not contribute to the American nation in the way that the American nation expected -- i.e. according to American norms and conventions. Part of this, incidentally, was due too to the fault of government itself that failed to provide them with the land, which the Hmong could have fertilized.

I realized that even thoguh America has gone a long way in attempting to appreciate other cultures and in refraining from foisting their own way of life on cultures other than they; they still do so to a certain extent.

I also wonder why people found it so hard to understand that others coming from lives so different than they would need time to acclimate and learn their 'language'.

Most of all I was impressed with the steadfastness, courage, and resilience of the Lees to resolutely cling to her traditions and way of life despite recrimination and hardship.

There are some things that are better in the Hmong culture than in the Western culture, such as the man's devotion to his wife, faithfulness, marital stability, and family functionality. America can learn much from these, and similar aspects.

Chap 15-16

I was impressed with the way that the family viewed Lia. A Western / American family may have seen her as 'unproductive' and therefore as barely worth attention and as a drain on their time and money. America, it seems to me, views individuals in terms of their consumption-value (i.e. how much they can produce to society). The Lees, however, saw Lia as a person even thoguh she no longer seemed to have mental acuities and was a hardship on them.

I wondered too whether it might be cultural perspectives and beliefs that lead to respect of an individual. Amerce that views in terms of dollar-value may readily shift aside an individual who does not fulfill his or her expectations. A religion that perceives a person as created in the image of God, may accordingly respect the person. The Hmong who see a spirit as inhabiting individuals may likewise respect the individuals for the very essence of who he/she is.

I discovered too that Western values had left their impact on me when I found myself feeling frustrated at Foua's spending so much time on Lia at sacrifice of her own and her family's life.

Chap. 17-18

The enduring question in these two chapters was the responsibility of a hospice nurse or actually the responsibility of anyone to people at the end of their life.

Medical personnel try to cure people at all costs, but sometimes, the most human thing is simply to let them die.

I realized that, however, difficult it may be, sensitivity to the individual, compassion to the patient and to his or her family and caregivers, as well as attempts to understand and help the other according to their cultural beliefs and circumstances may, ultimately, be the most helpful thing.

The ethical dilemma that still exists and that I would not know how to answer is what do when prescriptions f your own culture and that of the other conflict. Doctors have to be humane and bring culture into the equation, but there may be times when culture has to be overruled for the safety and protection of the individual (such as when withdrawing blood when necessary for the other's protection, even thoguh a culture may forbid blood-letting.)

Chap 19

The last chapter is a repeat and synopsis of the cultural shaking impact that the entire book has on the way that I saw life. The Lees were a poor family; yet they spent much of their resources on a pig sacrifice that they believed was important for Lia's spirit. Some Americans may have scorned the irrationality of that performance and the amount of expense spent on it. Yet I think that the expense points to the Lee's love for their child. Some Hmong, likewise, may have been perplexed at many of the items that we spend enormous cost on.

The Hmong believes in the efficacy of certain rituals. This belief makes it his reality. We believe in certain rituals of our own and this creates our reality. The lesson that I learned from this chapter in particular and from the book as a whole, is that it is very difficult to rate realities and challenging to stop different realities from battering one another and attempting to understand that multiple realties may exist.

Reference

Fadiman, A. The spirit catches you and you fall down. Farrar & co., 1997