The Lees

In Anne Fadiman’s book, The Spirit Catches You and You Fall Down, two cultures clash with each other in the struggle to save Lia Lee, a Hmong child refugee with severe epilepsy. Although Lee and her family live in the United States, and thus receive medical care from Westerners, her family believes that Lee’s condition is sacred and special. The following miscommunications, both culturally and lingually, between the American doctors and the Lee family leave Lia Lee in comatose at the end of the book. However, Lia Lee could have been saved if the Lee’s had a better understanding of the American doctors’ intentions, and the American doctors understood the Hmong culture. Essentially, the tragedy of Lia Lee can be attributed to the clash of American and Hmong cultures at both the surface and sub-surface level.

The Spirit Catches You and You Fall Down by Anne Fadiman, explores cultural competence, ethics in medicine, and the provision of culturally competent health care in the United States by following a family of Hmong culture in their struggles with mainstream U.S. society and healthcare. Fadiman has implemented her studies to highlight the differences between Hmong and Western practices and perspectives on health care, illness, spirituality, and the body. Through her extensive research, Fadiman is able to express cultural differences and the impact ignoring this crucial piece can have. Healthcare in the U.S. is described as the best in the world, but Fadiman is able to highlight the weaknesses this healthcare system has in regards to culturally

Cross-cultural methods and approaches should be taken to accommodate for the diverse patient population in our communities. I will introduce the culture clash by first describing the Hmong point of view on health and illness. Then, I will proceed my analysis by comparing it with the Western perspectives and practices on healing. Social stigma will also be emphasized as another negative factor

The Spirit Catches You and You Fall is a novel based on the clash of two cultures---the Hmong culture and the American culture. A little Hmong girl is diagnosed with epilepsy which her parents believe is caused by spirits. Because of this belief, they try to cure her illness not with western medication but their own Hmong ways. There is a huge misunderstanding between the parents and the doctors that Anne Fadiman explores. Anne Fadiman provides readers with a vivid, detailed history of the Hmong in Laos to their involvement in the Vietnam War to their struggles in America that explains this clash.

Book Review: The Spirit Catches You and You Fall Down Tim Merlino Drexel University November 2017 The patient-doctor relationship recognizes transference affects as a bi-directional relationship which affects the way a health care provider treats a patient and the way the patient responds to treatment (Zinn, 1990). Fadiman’s book examines different problems in the culture of American medicine by highlighting a tragedy centered around a Hmong immigrant family and their sick child, Lia, in California (Fadiman, 2012). The story also highlights some important lessons to be learned by the American health care system to avoid future incidents like described by Fadiman and to ultimately apply cultural competency in public health (Fadiman, 2012).

As a result, all these factors played a major role in the tragic death of her patient. If Jasmine took the time to professionally handle the situation correctly by taking care of her well-being by getting the proper sleep and paid closer attention like she should have the outcome of the situation could have turned out drastically

However I do believe the practices with the placenta are a bit peculiar, but who am I to judge it may stand true since Lia was the only one out her siblings to have any complications growing up. When Lia was taken away from her parents that was a tear jerking moment. Ultimately, I have mixed emotions about if it was the right decision to take Lia away. Dr. Neil, saw his job as to practice good medicine.

The different ways one can look at Paja’s illness is by acknowledging the Hmong culture and by looking at the perspective of the biomedical world.

Over the progression of the book the view points and relationships between the Lees and the doctors develops slightly. The medical staff was not prepared with a translator or a cultural understanding of the Hmong and how their beliefs would not match up with their medical practices. “Not only do the Hmong fail resoundingly to improve the payer mix- more than eighty percent are on Medi-Cal- but they have proved even more costly than other indigent patients, because they generally require more time and attention, and because there are so many of them that MCMC has to hire bilingual staff members to mediate between patients and providers” (Fadiman 25). This theme in the story was immensely eye opening for all of the cultural gaps that exist throughout the United States. The solution to this problem is for both sides standing on opposite sides of the gap to take the time to bridge the gap together.

As I listened to the Riverbend scenario I thought of my own cultural competence and how at one time I knew very little of the Hmong culture. Working in a city where Asians make up only 3% of the population, this is a population I knew little about. I have learned that most Hmong are from the mountainous region of Laos, and are granted preferred refugee status by the U.S. (Cobb, 2010). From 2000 to 2010 the number of Hmong grew 40%, there are currently 260,073 Hmong people living primarily in California, Minnesota, and Wisconsin. Even though the Hmong people seem to be prospering after thirty years in the U.S., there are still challenges with communication, understanding of cultural beliefs, and use of traditional medical practices (United States Census Bureau, 2013)

This is an important issue because by trying multiple techniques to get Vivian’s heart pumping again, such as CPR and electric shock paddles, he violates the ethical principle of autonomy. He refuses to respect what the patient has decided is best for her mind, body, and soul and instead steals her right to that decision away from her. It is clear that this was a deliberate act because Susie exclaims that the order was put in a day before and he even looked at it himself (Bosanquet & Nichols, 2001). He was not lazy and forgot to check her chart, he knew the order was there and made a methodical choice not to abide by it. His motivation to revive her is to keep her alive because she aids his research.

Over the past four months, this course has been one of the most eye-opening experiences I have had during my first year of college. Although I have always realized the importance of being culturally competent in daily life, specifically healthcare, I was unaware of the many ways that cultural competence can be obtained. This class gave me the opportunity to view situations from a different perspective, especially through the weekly discussion boards and peer responses. Learning from classmate can teach more valuable lessons than listening to boring lectures or reading hundreds of pages in a textbook because it is easier to relate to experience rather than hypothetical situations. For example, one of the discussion boards asked us to detail

One of it is the proper way of upholding patient 's rights when it comes to medical research. As a nursing major, I am aware that it is one of my ethical responsibilities to ensure that utmost care and treatment are provided to my patient 's advocate which means that we should stand and do something when we see malpractice being done to our patients. The doctors used Vivian as a research subject, but her nurse Susie struggles to guarantee the most beneficial care and treatment is provided for her. This film depicts the significance of advocating and fighting for patients as well as their rights in order to ensure that they are receiving optimal medical treatment.

I watched her face knot up like a thread and then she let go. It fell in a splash, floated for a while, and then sank. And quickly after that she jumped in too” (23). Celianne went through terrible experiences in her past, but her desire for her baby and a better future supported her to keep persisting. However, once this spark of ambition dimmed, she felt as if she had no choice except to give up on living.

Josie’s death shouldn’t have happened, and would’ve probably been avoided if someone took the time to truly listen to her mother’s concerns. Reading Josie’s story opened my eyes to the dire need of communication between the medical team and patients and/or family members. Sorrel, Josie’s mother, tried numerous times to alert the medical team of the changes observed in her daughter, yet no one listened. She highlights the severe breakdown in communication and the necessary steps needed to rectify our medical