Lia's Case Study

Comparing quag dab peg and epilepsy is all a matter of perspective. We can diagnose what Lia is going through as either a disease or a blessing, depending if our mindset is that of a MMC medical staff or a Hmong, respectively. Before I begin I must answer the question and say that all though both sides describe almost the same symptoms, it’s a matter of perspective, your red is not the same as my red. So no quag dab peg and epilepsy are not the same thing. For the Hmong having quag dab peg is a blessing. Yes they acknowledge that being quag dab peg is potentially life threatening but also quag dab peg means your body is considered clean enough for the “Soul of Health” to enter your body. They consider quag dab peg or “The spirit catches you and you fall down” a symptom associated with the highest levels of purity. For example, being quag dab peg means your body is clean enough for the healing soul to enter your body, since this spirit is never wrong in choosing the pure. A quag dab peg individual is considered a highly respected person in the community and is most likely candidate to become a Shaman. Being quag dab peg means you have the ability to go between both worlds say heaven and earth. In contrast, being epileptic as defined by the medical staff at Merced is a neurological disorder marked by sudden recurrent episodes of sensory disturbance. In conclusion, the Merced Medical staff want to cure the disease while the Hmong are grateful Lia is qua dab peg. To the 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.

The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame

The Lees, a Hmong family, came to the United States in the 1970s as refugees from Laos, and lived in Merced, California. Unlike most immigrants, the Hmong population was less amenable to assimilation. The traditional health beliefs and practices of the Hmong population were disputed by the practices of Western medicine. This became very event when the Lees took their three-month-old daughter, Lia Lee, to the emergency room in Merced. Lia was diagnosed with epilepsy a disease that had two different meaning among the Hmong population and Western medicine.

1. The client system, in this case the Lee family, defines Lia’s seizures as both a spiritual and physical ailment. According to Fadiman (1997), “…the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as qaug dab peg, which means ‘the spirit catches you and you fall down’”(p.20). To the Lee family, Lia’s condition was as revered as it was frightening. While a person with qaug dab peg was traditionally held in high esteem in the Hmong culture, it was also terrifying enough that the Lee’s rushed Lia to the emergency room more than once in the first few months

Due to such challenges, some people have sought to provide cross-cultural solutions. One such person is Arthur Kleinman, a medical anthropologist, psychiatrist, and chair of the department of social medicine at Harvard Medical School who developed a set of eight questions that were “designed to elicit a patient’s ‘explanatory model’” (260). In other words, the Eight Questions are a set of questions to ask a patient and/or the patient’s family member(s) and/or twiv neeb (I will call these last two “relevant relaters”), and by hir answers, a doctor can better understand how ze sees hir illness and how ze sees healing. Specifically, the questions ask what the answerer calls the problem, what ze thinks has caused the problem, why ze thinks it started when it did, what ze thinks the sickness does and how it works, the sickness’s severity, whether it will have a short or long course, what kind of treatment ze thinks the patient should receive, what the most important results ze hopes the patient receives from this treatment are, what the chief problems the sickness has caused are, and what ze fears most about the sickness. I think questions like these are a good start for cross-cultural understanding by the American medical community because they are open-ended questions, thus the way the questions are answered will give more information. The answers will be in the patient (or relevant relater)’s own words, which will allow more insight into hir personality, values, and personal

Epilepsy shows no racial, age, gender or geographic boundaries[1]. Social class has however been indicated as an associated feature by some studies [4] [5]

In Hmong culture seizures are not recognized much as a physical illness as it is spiritual in nature and quab dab peg which translates to, the spirit catches you and you fall down, describes the group of symptoms experienced by Lia in the Hmong culture. The Lee’s were both happy and sad about Lia’s seizures. In Hmong culture seizures are considered to have special powers and usually become Shamans, but at the same time the Lees were worried about their child’s health.

I do find the cultural differences in healthcare interesting, but I am not sure if any of them are “useful” than the other--the examples given all seem to hinder medical diagnoses by the doctor. In Kleinman’s example, Mrs. Flowers ignored (most of her decisions were unchangeable by her lifestyle choices, but she didn’t have to drink the pickle juice; that was entirely due to her culture) her doctor’s advice. In one of Macklin’s examples, the Mien burned her baby because that was what her culture did; all these examples are surely interesting, but detrimental in someone’s well-being.

After reviewing the different cultures and diving into the different points of views on treatments, the 1st and 3rd world treatments should be compared as there tends to be controversies; 1st world treatment tends to rely on technological advances whereas 3rd world treatments tends to rely on past down wisdom. Comparing the two should assist in the understanding of epilepsy treatment.

Certain cultures, such as the Hmong’s, adapt to this terror by placing it in a positive light such as a blessing to explain something they do not understand, this is known as biological reality in communities. The Hmong’s, within the novel The Spirit Catches You and You Fall Down by Anne Fadiman, is proven difficult to treat because of their unique views on illness. They view illness in general as spiritual interventions to lead their souls astray. For example, they viewed epilepsy as qaug dab peg, or as “the spirit catches you and you fall down” (Fadiman pg.20). Although they recognize this as an illness, they view it as a blessing, honoring one to become a shaman. It is viewed as so because it is believed that when seizing episodes occur you’re in touch with the spiritual

With the quote “for the secret of the care of the patient is in caring for the patient,” Dr. Verghese implies and emphasizes the importance of human touch and interaction in the treatment of patients. Dr. Verghese suggests that a physician must aspire to understanding how the illness is felt from the patient’s perspective. This requires that the physician step out of his ethnocentrism and look beyond his beliefs and cultural values in order to truly understand and sympathize with patient in their illness. Although it may difficult to imagine the suffering the patient is going through, simply trying or showing the willingness to engage with the patient and making the effort to see their fears, vulnerability, and need for reassurance can go a long way in providing the type of health care they desperately need. In other words, physicians should strive to preserve the capacity to imagine the suffering of their patients. Often times the lack of communication and cultural competency in health care settings leads to a wide array of health related issues including, poor adherence to medication, miscommunications, misunderstanding, and patient dissatisfaction. The importance of a cultural sensitivity and awareness amongst physicians towards a patient’s suffering can go a long way in helping patients recover from illnesses and preventing them.

Dr Stan Moloabi, executive healthcare manager at the (GEMS) says that epilepsy impacts hundreds of thousands of people of all races and backgrounds in South Africa. For this reason, he urges everyone to learn about this medical condition and what to do in the event that someone they know has a seizure, as this condition makes it difficult some to hold down a job and live a normal life.

Western health care professionals and Middle Eastern are often clashed as both parties have different views of mutual misunderstanding on culturally values and communication styles. Ethnically, Middle Easterners may be vary, but they share common values and behaviour including attitudes toward illness. Middle Easterners’ family may be very demanding people to obtain client’s sickness. Moreover, they have conflicting beliefs about planning and differing patterns of communicating grave diagnoses. Therefore, individual approach and continuous care by the same health care professional can help to bridge the gap between both parties. In addition, using cultural interpreters often can reduce some intense cultural

There are many cultures out in the world today that practice beliefs different than those in the United States. America is based off Western Culture and traditional medicine practices which focus on preventative and curative medicine. Most cultures around the world practice folk medicine, which focus more on the person as a whole with remedies and ceremonies rather than medicine and treatment. Even though each one believes in a different practice, all medical professionals should have the knowledge and awareness of each culture’s health beliefs to properly treat their patients in a respectful and kind