Anne Fadiman
The Spirit Catches you and you Fall Down is a truly eye opening story on how cultural misunderstandings can play a downward spiral in a child's health. Fadiman tries show that the western world view on health can not be one-sided. The battle shown between the doctors and Lia’s parents emphasized, that as Americans, we need to be more sensitive to the various aspects of different cultures. We can't expect people from different cultures to come to this country and assimilate into our culture. We are no longer the melting pot we have always claimed to be. Fadiman describes the Hmongs as coming to this country to for the same reason they had left China in the 19th century, because they were trying to resist assimilation. Even though the US tried to spread out the the Hmong refugees "like butter" they were still true to their culture and no matter what pot they were thrown in they didn't melt.
The biggest factor in the story however, was how cultural barriers and obstacles led to the vegetative state a young child Lia. The proper treatment and compliance with medications became the basis of the tug of war between Lia's doctors and parents the Lee's. Fadiman uses this battle as a way of discussing Western and Eastern medicine and how each group views the patient in such different ways. Arthur Kleinman said it best, "Get rid of the term compliance. It implies moral hegemony. You don't want a command from a general you want a colloquy" (Fadiman, 1997, p 260). Kleiman also makes a good point by asking "if you can't see that your own cultural has its own set of interest , emotions and bias, how can you expect to deal successfully with someone else's culture?"
In my opinion I believe that applied medical anthropology and critical anthropology appeared more toward the end of Fadiman's book after the events that took place with Lia and her family. It took 3 months for the doctors just to diagnosis Lia correctly. Interpreters for the Hmong community were not always readily available. The doctors didn't understand the Lee's or the Hmong community all together. They were viewed as the difficult and non-complaint family/ patient. Fadiman mentions in her closing remarks that the complaint she most often hears from her Hmong friends is not that they would like to leave the US but that they wish they encountered less persistent ignorance about who they are and were they come from. There was not much room for trying to understand one another in the Lee's situation, to the point were the doctor's felt it was in the best interest for Lia to be removed from her home and become government property for 12 months. The doctor's were strictly just viewing the Lee's as non-complaint instead of understanding why they were not giving Lia her medication. Some characters I can say did do there best in trying and making a difference in the Lee's lives, for example, Jeanine Hilt CPS case worker who fought for them to get Lia back. She came to their home with an open heart and mind and came to understand the Hmong culture. If the doctors would have accepted the Lee family's beliefs they could have possibly compromised Lia's medical treatment as well as spiritual treatment and maybe Lia would not have had such a tragic outcome.
It really wasn't until after Lia's "Big One" that the doctors began to question what could have been done to prevent this. This was just one of the events/ situations that opened the door to cultural competency. Fadiman describes how in 2009 Mercy Medical center (were Lia was born & taken to the ER when her seziures occurred) instituted the country's first formal shaman policy, a systemic plan to integrate txiv neebs into patient care. Healthy house, a storefront social service agency also worked with the hospital to help the Hmong and minority patients feel less marginalized and launched a training program called Partners Healing (this is more of an example, of applied medical anthropology, however, occurring more recently than the events that took place with the Lee family and Hmong community).
""Cultural responsiveness" encourages doctors to listen to patients and respond to them both as members of their cultural and as stereotyped individuals;The ability to deal with patients from unfamiliar cultures should not be a political stance but a human stance as well as a strategy that saves lives" (Fadiman, 1997).
Below is a video that talks a little about the Hmong culture and the beliefs of Shamanism.
The biggest factor in the story however, was how cultural barriers and obstacles led to the vegetative state a young child Lia. The proper treatment and compliance with medications became the basis of the tug of war between Lia's doctors and parents the Lee's. Fadiman uses this battle as a way of discussing Western and Eastern medicine and how each group views the patient in such different ways. Arthur Kleinman said it best, "Get rid of the term compliance. It implies moral hegemony. You don't want a command from a general you want a colloquy" (Fadiman, 1997, p 260). Kleiman also makes a good point by asking "if you can't see that your own cultural has its own set of interest , emotions and bias, how can you expect to deal successfully with someone else's culture?"
In my opinion I believe that applied medical anthropology and critical anthropology appeared more toward the end of Fadiman's book after the events that took place with Lia and her family. It took 3 months for the doctors just to diagnosis Lia correctly. Interpreters for the Hmong community were not always readily available. The doctors didn't understand the Lee's or the Hmong community all together. They were viewed as the difficult and non-complaint family/ patient. Fadiman mentions in her closing remarks that the complaint she most often hears from her Hmong friends is not that they would like to leave the US but that they wish they encountered less persistent ignorance about who they are and were they come from. There was not much room for trying to understand one another in the Lee's situation, to the point were the doctor's felt it was in the best interest for Lia to be removed from her home and become government property for 12 months. The doctor's were strictly just viewing the Lee's as non-complaint instead of understanding why they were not giving Lia her medication. Some characters I can say did do there best in trying and making a difference in the Lee's lives, for example, Jeanine Hilt CPS case worker who fought for them to get Lia back. She came to their home with an open heart and mind and came to understand the Hmong culture. If the doctors would have accepted the Lee family's beliefs they could have possibly compromised Lia's medical treatment as well as spiritual treatment and maybe Lia would not have had such a tragic outcome.
It really wasn't until after Lia's "Big One" that the doctors began to question what could have been done to prevent this. This was just one of the events/ situations that opened the door to cultural competency. Fadiman describes how in 2009 Mercy Medical center (were Lia was born & taken to the ER when her seziures occurred) instituted the country's first formal shaman policy, a systemic plan to integrate txiv neebs into patient care. Healthy house, a storefront social service agency also worked with the hospital to help the Hmong and minority patients feel less marginalized and launched a training program called Partners Healing (this is more of an example, of applied medical anthropology, however, occurring more recently than the events that took place with the Lee family and Hmong community).
""Cultural responsiveness" encourages doctors to listen to patients and respond to them both as members of their cultural and as stereotyped individuals;The ability to deal with patients from unfamiliar cultures should not be a political stance but a human stance as well as a strategy that saves lives" (Fadiman, 1997).
Below is a video that talks a little about the Hmong culture and the beliefs of Shamanism.