Hmong

“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.

In this case study on cross cultural medicinal beliefs and practices, Anne Fadiman addresses the rift between Hmong spiritual and medicinal customs and the culture of American biomedicine by telling the story of a young Hmong child, Lia Lee. Lia’s journey started when she was three months old and she suffered her first of many epileptic seizures. Over the next few months she continued to suffer from her seizures and made at least three emergency room visits. Like most cases of epilepsy, the cause of her grand mal seizures was unknown, however, her parents, Nao Kao and Foua Lee, believed it to be the result of her elder sister slamming the door and scaring Lia awake, allowing a dab, or evil spirit, to steal her soul. After her first visit to the Merced Community Medical Center, it became clear that the language barrier would not allow for an accurate patient history to be recorded. As Lia’s condition worsened, this barrier would further prevent the Lee’s from understanding exactly what was happening to their daughter as well as follow the treatment the doctors were implementing. This eventually lead to the doctor’s believing that Nao Kao and Foua

What would it be like to come to a country and not understand anything about its health care system? In The Spirit Catches You And You Fall Down, Anne Fadiman brings to light the conflicts between a Hmong family’s cultural beliefs, and that of the traditional western medical beliefs of the American doctors they come into contact with. Fadiman shows the consistent tug of war between the Hmong culture and the Western American medical practice. The Lee family comes from a culture that believes in holistic healing. They have an animalistic view in regards to health and medicine. The cultural barriers between the two eventually leads to the detrimental fate of the Lee’s daughter Lia.

In The Spirit Catches You and You Fall Down, Lia’s health complications could have been prevented or alleviated if the doctors had taken the cultural differences, cultural belief and practices of the Hmong community into account. While doctors in this book had received a Western type of foundation in terms of their medical preparation, this book demonstrated that how the life of a patient could have been improved when he/she is examined holistically.

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

The health care providers didn’t understand the Lee’s culture. The doctors never took the time to understand the Hmong culture and instead assumed that their practices may have been what was negatively affecting Lia’s recovery. According to Fadiman (2003), in the hospital they would call the shaman “witch doctoring” (p. 35). Many times the Lees wouldn’t understand the instructions of the doctors and I believe this also impacted the way that they thought of medicine. The doctors loved Lia and so did her parents, but they just had different ways of thinking. The Lees thought that sickness comes from the soul, and the doctors believed that there was a physiological cause for the sickness. The doctors were not open minded about the Lee’s

Anne Fadiman's “The Spirit Catches You and You Fall Down” documents the continuous struggles faced between Western medicine in a California county hospital and traditional beliefs of the Hmong within a refugee family from Laos. Lia Lee, a Hmong baby, suffers from epilepsy and has many episodes of grand mal seizures. To medical professionals, seizures are episodes of abnormal neuronal brain activity. They are often caused by trauma, drug use, hypoglycemia, and hypoxia, but can also be triggered by unidentifiable internal and external causes. To the Hmong, seizures and their associated symptoms are described as qaug dab peg, or “the spirit catches you and you fall down.” This is also the Hmong translation for epilepsy, which, in chapter 3, is described as a disease that holds mystical and spiritual properties for its sufferers. The Hmong believe that epileptics can see things that other people cannot, as they are allegedly able to see into the spirit world. Chapter 4 discusses the perceptions the Hmong held of American doctors and Western medicine. The mistrust the Hmong had in Western medicine was based on a variety of factors, from doctors being

In addition, relying on a doctor who does not share the same beliefs as one does can become fearful. Trusting the doctor for full treatment is necessary but when from a different cultural background it can prevent them on trusting them. According to a research article, Cross- Cultural Medicine a Decade Later, clearly states “when the basic belief structure of biomedicine and another set of health beliefs differs radically, problems and frustrations almost inevitably arise” (Barker, 1992, p.249). The central purpose of the research was to show whether or not health beliefs between patient and doctor differs will they find it difficult to interpret the symptoms and treatment variations to accommodate their beliefs. However, the doctor having faith in one’s health beliefs can sometimes be beneficial for the patients because they’ll be fully understood and not misjudged as being crazy. As stated by the author, for the article Chinese Health Beliefs of Older Chinese in Canada, “the findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intergroup socio-cultural diversity that health practitioners should acknowledge in their practice” (Lai, 2009, 38). Like the Chinese, Hmong’s too first go to their shaman for traditional treatment rather than going to the doctor; to them an illness and their healing is more of a spiritual thing that

The diagnostic testing that MCMC professional deemed necessary to assess Lia’s progress was continually challenged throughout her care. Foua Yang and Nao Kao believed most of the procedures were unnecessary and did not understand the importance of the testing. A challenge for healthcare professionals when dealing with disapproved medical procedures and methods in Lia’s situation is the repetitive testing needed to review Lia’s progress. The blood sampling that occurred at every medical visit was viewed as unnecessary and threatening to Foua Yang and Nao Kao because, “Most Hmong believe that the body contains a finite amount of blood that it is unable to replenish, so repeated blood sampling, especially from small children, may be fatal” (Fadima, 33). Medical professionals overlooked a very important aspect of the Hmong culture, which is the soul, and the wisdom of shaman Txiv. Prayer is often used in the United States as a healer and according to the Hmong culture,  “Txiv neebs knew that to treat the body without treating the soul was an act of patent folly” (Fadima,

Traditionally, a common Hmong’s custom is that a soul can separate from its body and a shaman possesses power to control spiritual forces. Therefore, a shaman is capable of healing illnesses at the spiritual level. The Hmong have a belief that ancestral spirits, including the spirits of shamans are reincarnated into the same family tree. The Hmong’s believe in their Shaman more than western doctors. They prefer to perform their treatment by hosting their rituals to save and cure their sicknesses. Unfortunately, the major problem that Hmong refugees encounter upon arrival to this country is conflict with the US medical system. This conflict arises from misunderstanding and mistrust from both health professionals and refugees patients. As a

The Spirit Catches You and You Fall Down, by Anne Fadiman, is the story of two very different cultures lacking understanding for one another leading to a tragedy due to cultural incompetence. Today in America there are very many different cultures. Health care providers need to be aware of cultural diversity and sensitivity when caring for patients. If a health care provider is not sensitive towards a patient’s culture it can cause a relationship of mistrust to form, lead to barriers in the plan of care, and increase health care cost. The current guidelines to promote cultural competence in the clinical setting include completing a cultural diversity self-assessment, identify the need of the population served, evaluate barriers in the community and practice, educate staff to cultural diversities, schedule longer appointments, clarify limitations, and identify alternatives offered (Cash & Glass, 2014).

The main purpose of this article is for the nurses to provide a successful caring for the minority. Hmong are one of the largest minority group to lived in the United States. In order for the health professional to provide care for them. As Torry Cobb said, they need to be aware of the “history, culture, social structure and belief systems” of the Hmong people. The health care providers need to respect the Hmong American medical practices because they believe in their own use of traditional medication and using the shaman will help heal their spirit and physical illness. They also do believe in the western medication, but sometimes they don’t have confidence in the health care system because of their beliefs and practices. In addition to that,

Even though I am a Hmong person, I still need to do more research about the Hmong Population in Minnesota. At the University of Minnesota, Morris, I took a class called Southeast Asian’s history, which the professor went over a brief history of Hmong people. In this class we had to do a presentation and write a paper at the end, so I chose to do my research on Hmong people. By doing this research I learned about their history and why they came to the United States. In addition, I learned about other Southeast Asian’s history from the dominant groups to the minority groups. At ILCM, I was not working with Hmong clients only, I helped other immigrants coming from Africa to Asia. “Minnesota is home to more than 400,000 immigrants and refugee”

From what I gathered from the literature research, my theory is approved. Hmong Children with disabilities receive lower expectation from their parents, and parents have different attitude toward those children. Hmong parents expected children who can learn fast and physical normal because they wanted their children to be successful, and parents are often sadden when found out about their child’s condition. Some parents have no education goal for their children with disabilities because these parents are not familiar with the American school system. This is supporting my hypothesis.

The Hmong population in the United States was estimated in 2009 by the American Community Survey (ACS) at around 236,000. (Pfeifer, Chiu, and Yang, p.54, 2013)The largest settlements were found in the Midwest with approximately 107,000 people. The West was second largest at approximately 94,000, the South third at approximately 23,000, and the Northeast with the lowest population at approximately 2,000. The remaining settlers were scattered throughout the United States. (Pfeifer, Chiu, and Yang, p.54, 2013) According to the 2009 ACS 41.6 percent of Hmong Americans speak English less than very well, with 90.4 percent speaking a language other than English. (Pfeifer, Chiu, and Yang, p.56, 2013) A high percentage of the Hmong to this day prefer