Hmong Case Analysis

“Between the ages of eight months and four and a half years, Lia Lee was admitted to MCMC seventeen times and made more than a hundred outpatient visits to the emergency room and to the pediatric clinic at the Family Practice Center.” The Lee family was a regular visitor at the hospital but it did not make thing between the Lee family and the hospital any easier. There was many issues between Lia’s family and the Merced hospital staff. Many of these issues steamed from many different areas of things. Between the Lee’s a Hmong family and the American doctors at Merced Hospital there were several cultural differences on what both parties wanted. Cultural difference was not the only thing they did not see eye to eye on there was also a huge language barrier between the Lee family and the workers at Merced hospital.

Other doctors who wants to be accepted by the Hmong could use a little to this philosophy.

Anne Fadiman wrote this book to document the conflict between cultural barriers and how they affect medical issues. In this book, Lia Lee is a Hmong child was has epilepsy and battles cultural medical differences. The main struggle in this story is the conflict between the doctors and parents because they cannot seem to get on the same page. While writing the book, Fadiman stated that there was a “clash of cultures”. (Fadiman, preface) Meaning, there are two different sides to the story and the problem has not be solved.

Lia Lee born and raised in America, but brought up as a Hmong, faced health issues specifically epilepsy. Her parents who practice the Hmong culture had a different view on how to handle Lia critical condition. Hmong did not believe in traditional medicine but believed in Txiv neeb, person with a healing spirit. Not only do they believe in a person with healing spirit to help cure their illness but also consider epilepsy as power; “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (Fadiman, 1998, p.21). Right at this moment is where you can tell conflict is going to occur.

Many years ago, an epileptic Hmong girl named Lia Lee entered a permanent vegetative state due to cross-cultural misunderstanding between her parents and her doctors. An author named Anne Fadiman documented this case and tried to untangle what exactly went wrong with the situation. Two key players in her narrative were Neil Ernst and Peggy Philp, the main doctors on Lia’s case. As Fadiman describes, “Neil and Peggy liked the Hmong, too, but they did not love them… [W]henever a patient crossed the compliance line, thus sabotaging their ability to be optimally effective doctors, cultural diversity ceased being a delicious spice and became a disagreeable obstacle.” (Fadiman 265) At first glance, this statement seems to implicate Neil and Peggy as morally blameworthy for a failure to be culturally sensitive enough. However, upon further inspection of the rest of the book, it becomes clear that Neil and Peggy’s failure to be more culturally sensitive to their Hmong patients was caused by structural issues in the American biomedical system. To prove this point, this paper will first present a background to Lia’s case, then discuss possibilities for assigning blame to Neil and Peggy, then show evidence for the structural issues in American biomedicine, before finally concluding.

     The Hmong Culture of South Asia is a very interesting ethnic group. Between 300,000 to 600,000 Hmong live in Southeast Asian countries, such as Vietnam, Laos, Thailand, and Myanmar. About 8 million more live in the southern provinces of China. Since the Vietnam War ended in 1975, Hmong refugees from Southeast Asia have settled in Australia, France, Canada, and the United States. The largest Hmong refugee community lives in the United States with a population of about 110,000. The U.S. Department of state has tried to spread Hmong refugees out across the country to reduce the impact on any one region. Because Hmong families tend to be large in numbers, the community grows rapidly.

To begin with, a cultural difference between Hmong and Americans are their opinions about Lia’s medical condition. “When Lia was about three months old, her older sister Yer slammed the front door of the Lee’s Apartment” (Fadiman 1997:20). After slamming the door Lia’s eyes rolled in the back of her head and she

It is not always easy to decide about the care of a patient, because the patient’s cultural beliefs do not always coincide with the beliefs of the nurse. Ephesians 4:2 in “Be completely humble and gentle; be patient, bearing with one another in love” (English Standard Version). God has loved us unconditionally from the beginning of time, and has always been patient with us. It is time that humans show the love that God has for us onto others and respect one another no matter the differences. This paper will discuss the importance of respecting another person’s culture, what stigma is and whether if Lia’s family viewed her that way, brief history of the Hmong, the preventions that could have taken place, and how to incorporate

Many live under the assumption that those who come to the United States want to become Americanized and assimilate to the melting pot our culture has formed into. This is the populations ethnocentric belief, which is the belief that the ways of one’s culture are superior to the ways of a different culture, that wants others to melt into the western ways. In Ann Faidman’s The Spirit Catches You and You Fall Down, Faidman fails to completely remain objective when demonstrating how cross-cultural misunderstandings create issues in the healthcare field, specifically between the Hmong and western cultures that created dire consequences between the Lee’s and their American doctors. Faidman uses her connections with the Hmong and the doctors who cared for them in order to disclose the different views, beliefs and practices the Hmong and Western cultures practiced. With her attempt to be culturally relative to the situation, Faidman discusses the series of events and reasons as to why the Lee’s faced the fate that they did and how it parallels to the ethnocentrism in the health care system.

Medicine, to the modern day world, is a way of healing the sick and helping people experience life to their full potential. It is an ingredient of a culture that allows the culture to survive through decades and centuries at a time. But what if the medicine that we know as helpful is actually harmful? When a child cuts their knee the first thing an adult would do is check the scrape and then assess the damage. After assessing the damage, the adult would normally plan a course of treatment to ensure the child would not lose a limb in the near future. After treating the child with a mixture of antibacterial wipes, bandages and ice cream, what if the child is not better, but actually worse? That is what happens when you compare the medical practices of the Hmong to the medical practices of the Americans, both cultures believe that the others will cause more damage than good in respect to healing the soul and body.

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive, yet problems do arise and it affects the quality of care the patient receives. Language barrier, poor socioeconomic status, and poor health literacy also contribute to health care disparity. For Lia, it was more than her skin color, it was all of the above, her parents did not speak English and they were illiterate. They had trouble understanding the American healthcare system, had trouble or little interest in adjusting to or understanding the American culture. They didn’t work, which in addition to cross cultural misunderstanding, helped contribute to animosity between the Hmong and the host community, because some in the Merced area did not like or appreciate the fact that some Hmong did not work and relied on welfare to make ends meet. All these factors, contributed to the poor quality of

At birth, the Hmong view their newborns as a gift and extremely special. At birth, it is called “Mus Thawj thiab, “go become again” or more simple, “reincarnation,” is a traditional Hmong belief (Bankston 2000). When a child is born, they are automatically seen as a gift and reborn as a reincarnated soul. Though, if a child dies after three days of living there are “no funeral ceremonies…since the child did not have a soul yet” (Bankston 2000). The Hmong believe if the child lives past three days, their soul is present though if they die, the infant never had a soul to begin with. If the child lives past day three, then a shaman is brought in and he “evokes a soul to be be reincarnated in the baby’s body” (Bankston 2000). This is considered

Language barrier was a major factor that served to extend the boundary existing between the two cultures. Some of the utterances made by the doctors were interpreted right but were understood wrongly (Swartz 2). This resulted in a worsened discernment of the American doctors by the Lees and Hmong as an entity alike. In the case of an emergency, the Lees needed to contact an ambulance, but could not communicate with the hospital. This necessitated the involvement of their learned nephew, who would call an ambulance. The interpretation process would at times limit the effectiveness of the message intended by either party. For instance, when Lia was undergoing critical care in MCMC, the Lees needed to be comforted, a process which had to be done by an interpreter. Before the final discharge, miscommunication between Lia’s mother and the doctors had her think that the nurses disconnected medicine tubes off Lia in order to give it to some other patient; a mean act. In the same incident, Lia’s father was made to sign a letter of discharge for Lia, which would happen in two hours. However, he understood this as a letter to guarantee death in two

“In the Spirit Catches You and You Fall Down”, Anne Fadiman explores the subject of cross cultural misunderstanding. This she effectively portrays using Lia, a Hmong, her medical history, the misunderstandings created by obstacles of communication, the religious background, the battle with modernized medical science and cultural anachronisms. Handling an epileptic child, in a strange land in a manner very unlike the shamanistic animism they were accustomed to, generated many problems for her parents. The author dwells on the radically different cultures to highlight the necessity for medical communities to have an understanding of the immigrants when treating them.

Hmong or Miao people usually lived in places such as hills and mountain areas, mostly in the southern part of china. During this time the Hmong people struggled with the Chinese government, even at one point killed the Hmong King for not surrendering. After several attempts of rebellion, they reached no luck against the Chinese government even after tensions grew after being heavily taxed after the Chinese government loss against the British. Many Hmong migrated to southern Asia in places such as Vietnam and Thailand