The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures The Spirit Catches You and You Fall Down question


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"a little medicine and a little neeb."
Daniel Daniel Mar 16, 2013 04:59AM
March 3, 1983, Lia was brought into the emergency room still seizing and diagnosed with epilepsy five months after its onset. The cause of Lia's epilepsy was construed differently by the Lees and her doctors. The belief of Lees was that Lia's disorder is "qaug dab peg," an dab that owes its inception to the act of loosing one's soul and rejuvenated best with pacification of the soul and restoration of the spiritual order which was a believe in Hmong culture. Lia's doctors, however, challenge that epilepsy is a neurological abnormality that makes the neurons, brain cells, to fire uncontrollably. The doctors believe that such a condition is managed best with antiepileptic medications; also, it can be completely or partially controlled in most cases by ant-convulsant drugs.
Lia's parents felt honored because, in the Hmong culture, epileptics often become shamans or spiritual healers as the seizures are thought to be proof that they have the power to see things other people can’t see, as well as help their entry into trances. The medical staff had learned in medical school the only legitimate way to approach heath problems and they couldn’t hardly comprehend the concept of soul loss much less acknowledges and understands the Lee's needing animal sacrifice with the help of a txiv neeb to negotiate for Lia's soul (P.76). Her seizures maintained to be unmanageable despite changing anticonvulsant medications many times.
Lia’s doctors Neil states that Lia needs to be removed from the parental home to preserve the life of Lia. There was a substantial danger to the physical health and she could not be protected without removing the from the parents’ physical custody (p.81). He supports his decision by saying “I felt that there was a lesson that needed to be learned …. I felt it was important for the Hmongs [sic] to understand that there were certain elements of medicine that we [biomedical doctors] understood better than they did and that there were certain rules they had to follow with kids’ lives. I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior” (p. 79). From this two statements Neil conveys this two important claims, that the westerners holding all the knowledge as long as they persisted and that his culture is more superior to the Hmongs. The Spirit Catches You and You Fall Down is essential and applicable to the practices of culturally inclusive medicine. It makes obviously clear the need for Neil to reexamine the way he delivers medical care. Western medicine is often biased and claims to be right the majority of the time. As a doctor in a multicultural nation, he cannot and should not be so rigid in enforcing his authority and expertise on the Hmong patients. Neil was trained in the Western medicines, which is practical scientific based medicine, the statement he makes refer to religion and culture differences as the main impediments of effective healing, he means other cultural and religious practices seem to compromise the practice of medicine except for prayer. Prayer is not high and dry in science but in faith, much like that of the Hmong's soul calling ceremonies, yet it is an interlinked part of medicine, healing and spirit world in the western culture. I have the same opinion as Dan Murphy, Family Practice resident at MCMC, when he did that despite all that he learnt in medical school and residency, he had to rely on the patient's beliefs and cultural practices to compliment the western medicine.
Language barrier was the most obvious problem, which was filtered through interpreters of dubious competence, but not the most important; the biggest was the cultural barrier (p.69). Perhaps learning that he too Neil had his own prejudice and skeletons of reference, including the mysterious faith we all have in our respective religions, which he bring to each encounter with the Hmong patients, he could be more effective and compassionate healer if he open up to new culture believes. The conflicting paradigms that each member of these relations that lead to Lia being a government property brings to their interactions are at the core of a great misunderstanding as each culture holds its convictions as fact. Foua and Nao Kao were becoming increasingly reluctant to give medications which they believed shouldn’t be given forever because they felt that the medications were causing the seizures as well as the fever that they mentally conceived the medications harmed her more than they helped (P.50). The Lees often express dissatisfaction at medical facilities with the medical staff that made decisions for the daughter, they asked too many questions with the aide of an interpreter and neglected to follow instructions. The root of this dissatisfaction stems from the Lee’s experience with the practice of rejuvenating with a txiv neeb. A txiv neeb might spend as much as eight hours in a sick person’s home while doctors forced their patients, no matter how weak they were, to come to the hospital, and then might spend only twenty minutes at their bedsides (p.33).
One night, on November 25, 1986, Lia, at four years of age, suffered a truculently belligerent seizure and went into status epileptics, a state of prolonged seizures that put her in the intensive care unit of a nearby hospital, Valley Children’s Hospital, on a ventilator. She was eventually diagnosed with septic shock, a state of multiple organ failure secondary to circulatory failure from an infection. With Lia’s complicated hospitalization, there was no more disagreement between Lia's parents and her doctors on whether to give her medicines or not since her epilepsy were controlled. Lia became more too easy to care for; in fact, the Lees took such good care of her that she seemed to glow beautifully although in a sedulously diligent vegetative state.
The western specialized health care system has been acknowledged to have the best technology in the world and as a result, has lost touch with its patients. In the midst of dividing and subdividing the specific roles of medical staff, they have lost what it signifies to be a true healer. Possibly, they have become more like mechanics of the human body and abandoned the soul of patients thus resulting in the difficulties that they face in connecting with Hmong patients. The Hmong have always had a holistic approach to rejuvenating. They give a new lease of life the soul and then the flesh, each one is not equally exclusive just as culture and religion they are entangled and any distinction is strictly subjective. The Hmong believe that when the soul is not well, this is often manifested as physical illness. The doctors’ probe and treat a particular disease entity, and often failing to identify what the patient perceives as illness. The medical institution think westerners hold all the knowledge as long as they stick with in their medical training they often forget that each individual patient walking into their offices has their worldviews and most often have their own agenda for seeking their care.
Fadiman has shows the degree of obscurity that many compassionate and devoted medical staff face in working with Hmong patients. The culture, the religion, and the way life are valued and how decisions are made are strange to western trained health professionals. In critical situations, when medical decisions have to be made quickly, the way Hmong patients and their families arrive at decisions often becomes an impediment to good medical care; patients and parents of patients often have to discuss with many members of the family. Being a Hmong patient in the American health care system also takes a vigorous sense of faith in the Hmong culture. A faith that the Hmong culture shall persist despite seeking and accepting what western medicine has to offer. In the ending, perhaps the most important message of all was verbally expressed by Nao Kao Lee, "a little medicine and a little neeb."



I have a great job. I am a nurse and I speak a few languages. I try to prevent cultural & language barriers from occurring. I visit patients in their homes which is so much better than doing it all in a clinic.


deleted member Mar 22, 2013 10:57AM   0 votes
What you have said was exactly correct,the Lee's could not read,write or speak english and so many American Dr.s did not try to help.It was such a cultural barrier.


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