American medicine preserved her life
and compromised it (Fadiman 1997: 258)
Lia Lee Story
A true story example of when medical anthropologists were not utilized and cultural competency not present at first due to communication and cultural barriers.
Anne Fadiman’s book, The Spirit Catches You and You Fall Down, is a compelling story about a Hmong child, American doctors, cultural clashing, and understanding the views of Western medicine and history of the Hmong culture. The story discusses how a Hmong family came from Laos to America, with no insight on the language or Western way of medicine. Their baby girl, named Lia, began to have seizure type activity at the age of four months. She was brought to the hospital receiving the initial diagnosis of pneumonia. The seizures were not diagnosed at this time due to the parents, Foua and Nao Kao, not being able to communicate what symptoms their daughter was having. Later, when Foua and Nao Kao returned to the hospital, after numerous times with her seizures, an eventual seizure diagnosis, known as epilepsy, was given. The Hmongs call epilepsy it qaug dab peg, which means the spirit catches you and you fall down, which refers to the term epilepsy. They considered the illness an honor (Fadiman 1997: 22). They also believe the disorder is caused by dab, or evil spirits. In order to help cure a person of disease a shaman, or spiritual healer, must be contacted and an animal must be sacrificed. Hmongs believe that when you get sick the spirit leaves your body and needs to be returned, animals are sacrificed to invite souls and are seen as the only way to cure certain illnesses with certain animals. For example, dab enters a soul, person gets sick and restless, American doctors give shots and medicine to help cure, anger in a Hmong arises since the cure is seen by sacrificing a dog (Fadiman 1997: 101). Throughout the rest of her life she had uncontrollable seizures with attempts to change medication regimens, which the parents failed to cooperate with.
Due to there not being a Hmong translator present at various times, the parents did not understand what doctors thought and why they did things. The American doctors did not understand how the parents viewed the illness, procedures, ways their culture thought to cure her, their rituals, or their way of medicine. Lia went into foster care for one year after a doctor, Neil Ernst, thought he was protecting her by removing her from her parent’s custody after numerous observations of her parents not giving her her medications as were prescribed. This was the view of the doctors, that not taking the medication was killing Lia, her parents viewed the medications as making matters worse and altered them as they saw fit. In Hmong culture the parents are viewed as being in charge of kids, some family members help with hard serious decisions, but "physicians are not family members, they cannot make decisions for the child” (Fadiman 1997: 83).
A social worker, Jeanine Hilt, made an outstanding patient advocacy effort to speak to Neil for the Lees, teach Foua how to administer the proper amount of medication, and eventually be known as a “large pain in the ass” to Neil (Fadiman 1997: 114). The efforts put forth by Jeanine resulted in medication compliance by the parents and Lia having her best seizure record since birth, one seizure in four months (Fadiman 1997: 116). Unfortunately further down the line Lia had “the big one,” the largest seizure in her lifetime, lasting two hours, resulting in septic shock and detrimental brain damage, leaving her in a vegetative state. At age 4, Lia’s parents took on sole responsibility of her cares in her Hmong community in this vegetative state. After 26 years in this state of health, at the age of 30 Lia passed away.
Psychologist, Sukey Waller, spoke of when understanding the Hmong community and culture, she found an interpreter but never calls her staff interpreters. She calls them “cultural brokers” and that they teach her during their work together (Fadiman 1997: 95). A cultural broker is a term to explain what a medical anthropologist’s job consists of as well. They mediate between biomedicine and cultural practices. Interpreters are widely known to translate the languages from one person to another. A medical anthropologist does a form of interpreting; they learn the meanings of the culture and beliefs.
A strategy that Arthur Kleinman, medical anthropologist and psychologist at Harvard Medical School, developed was a series of eight questions “designed to elicit a patient’s explanatory model” (Fadiman 1997: 260). Depicting how a culture views these 8 questions can open the medical personnel’s eyes on how to appropriately communicate and approach the disease or health problem at hand. The 8 questions are:
1- What do you call the problem?
2- What do you think has caused the problem?
3- Why do you think it started when it did?
4-What do you think the sickness does? How does it work?
5-How severe is the sickness? Will it have a short or long course?
6-What kind of treatment do you think the patient should receive? What are the important results you hope she receives from this treatment?
7- What are the chief problems the sickness has caused?
8- What do you fear most about the sickness? (Fadiman 1997: 260).
The understanding of the Hmong culture and practices assisted in the learning of the views and reasons for decisions of the Lees family with Lia Lee. If a medical anthropologist would have become involved with Lia’s situation earlier and these 8 questions were translated to the parents initially, her prognosis and outcome may have been dramatically different. The medical anthropologist would have been able to look into Hmong cultural views and rituals, understand what Foua and Nao Kao viewed Lia’s condition as, and how they thought to approach her condition. Cultural competency was attempted once ways of communication were made, which was not an easy task. Sadly, during those first few years no American doctor knew of how to approach Lia's situation with Western medicine and were not aware of any of the Hmong culture's beliefs about her medical situation.
A true story example of when medical anthropologists were not utilized and cultural competency not present at first due to communication and cultural barriers.
Anne Fadiman’s book, The Spirit Catches You and You Fall Down, is a compelling story about a Hmong child, American doctors, cultural clashing, and understanding the views of Western medicine and history of the Hmong culture. The story discusses how a Hmong family came from Laos to America, with no insight on the language or Western way of medicine. Their baby girl, named Lia, began to have seizure type activity at the age of four months. She was brought to the hospital receiving the initial diagnosis of pneumonia. The seizures were not diagnosed at this time due to the parents, Foua and Nao Kao, not being able to communicate what symptoms their daughter was having. Later, when Foua and Nao Kao returned to the hospital, after numerous times with her seizures, an eventual seizure diagnosis, known as epilepsy, was given. The Hmongs call epilepsy it qaug dab peg, which means the spirit catches you and you fall down, which refers to the term epilepsy. They considered the illness an honor (Fadiman 1997: 22). They also believe the disorder is caused by dab, or evil spirits. In order to help cure a person of disease a shaman, or spiritual healer, must be contacted and an animal must be sacrificed. Hmongs believe that when you get sick the spirit leaves your body and needs to be returned, animals are sacrificed to invite souls and are seen as the only way to cure certain illnesses with certain animals. For example, dab enters a soul, person gets sick and restless, American doctors give shots and medicine to help cure, anger in a Hmong arises since the cure is seen by sacrificing a dog (Fadiman 1997: 101). Throughout the rest of her life she had uncontrollable seizures with attempts to change medication regimens, which the parents failed to cooperate with.
Due to there not being a Hmong translator present at various times, the parents did not understand what doctors thought and why they did things. The American doctors did not understand how the parents viewed the illness, procedures, ways their culture thought to cure her, their rituals, or their way of medicine. Lia went into foster care for one year after a doctor, Neil Ernst, thought he was protecting her by removing her from her parent’s custody after numerous observations of her parents not giving her her medications as were prescribed. This was the view of the doctors, that not taking the medication was killing Lia, her parents viewed the medications as making matters worse and altered them as they saw fit. In Hmong culture the parents are viewed as being in charge of kids, some family members help with hard serious decisions, but "physicians are not family members, they cannot make decisions for the child” (Fadiman 1997: 83).
A social worker, Jeanine Hilt, made an outstanding patient advocacy effort to speak to Neil for the Lees, teach Foua how to administer the proper amount of medication, and eventually be known as a “large pain in the ass” to Neil (Fadiman 1997: 114). The efforts put forth by Jeanine resulted in medication compliance by the parents and Lia having her best seizure record since birth, one seizure in four months (Fadiman 1997: 116). Unfortunately further down the line Lia had “the big one,” the largest seizure in her lifetime, lasting two hours, resulting in septic shock and detrimental brain damage, leaving her in a vegetative state. At age 4, Lia’s parents took on sole responsibility of her cares in her Hmong community in this vegetative state. After 26 years in this state of health, at the age of 30 Lia passed away.
Psychologist, Sukey Waller, spoke of when understanding the Hmong community and culture, she found an interpreter but never calls her staff interpreters. She calls them “cultural brokers” and that they teach her during their work together (Fadiman 1997: 95). A cultural broker is a term to explain what a medical anthropologist’s job consists of as well. They mediate between biomedicine and cultural practices. Interpreters are widely known to translate the languages from one person to another. A medical anthropologist does a form of interpreting; they learn the meanings of the culture and beliefs.
A strategy that Arthur Kleinman, medical anthropologist and psychologist at Harvard Medical School, developed was a series of eight questions “designed to elicit a patient’s explanatory model” (Fadiman 1997: 260). Depicting how a culture views these 8 questions can open the medical personnel’s eyes on how to appropriately communicate and approach the disease or health problem at hand. The 8 questions are:
1- What do you call the problem?
2- What do you think has caused the problem?
3- Why do you think it started when it did?
4-What do you think the sickness does? How does it work?
5-How severe is the sickness? Will it have a short or long course?
6-What kind of treatment do you think the patient should receive? What are the important results you hope she receives from this treatment?
7- What are the chief problems the sickness has caused?
8- What do you fear most about the sickness? (Fadiman 1997: 260).
The understanding of the Hmong culture and practices assisted in the learning of the views and reasons for decisions of the Lees family with Lia Lee. If a medical anthropologist would have become involved with Lia’s situation earlier and these 8 questions were translated to the parents initially, her prognosis and outcome may have been dramatically different. The medical anthropologist would have been able to look into Hmong cultural views and rituals, understand what Foua and Nao Kao viewed Lia’s condition as, and how they thought to approach her condition. Cultural competency was attempted once ways of communication were made, which was not an easy task. Sadly, during those first few years no American doctor knew of how to approach Lia's situation with Western medicine and were not aware of any of the Hmong culture's beliefs about her medical situation.