Response Paper : Mother And The Medical Staff At Merced Community Medical Center ( Mcmc )

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

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.

This prejudice is another strong concept, as the American doctors continued to underestimate, disrespect, and undermine Foua Yang (mother) and Nao Kao Lee (father) and their Hmong way of life. Vice versa, the Lees would refuse doctors’ orders in administering medicines. Ruane and Cerulo hit it right on the nail when describing prejudice,(20) which is a prejudgment directed towards members of certain social groups, as a feeling associated with immigrant groups, those that contain individuals who have left their homelands in pursuit of a new life in a new country. There is a clear indication of an in-group vs. an out-group, as it is noted from Second Thoughts, “an in-group carry unrealistically positive views of their group. At the same time…share unrealistically negative views of the out-group.” The cultural barriers are built due to “the one-sided relationship,” of knowledge only found in the unyielding West, with the prominent racial discrimination found among the white, English-speaking doctors and their intimidate dismissal of the existence of any Hmong medical practices/knowledge. The application of assimilation (20) is important to the in-group, as they simply believe that the immigrants will come to embrace the same values and customs of their new ‘homeland.’

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.

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

The case study of Lia Lee is interesting and serves as a cautionary tale as it explores the consequences of cultural misunderstanding. In this case both the parents and medical staff sought the same thing; they both wanted Lia to have a positive outcome. Unfortunately, both groups had distinct ideas regarding how to achieve the common objective. This division was rooted in each sides individual cultural beliefs.

Anne Fadiman struggles to find the answer to who is responsible for Lia Lee’s health in her book, “The Spirit Catches You and You Fall Down.” The book describes the clashing of both the medical community within Merced, California, and a Hmong refugee family, the Lees, cultural beliefs. The Lees daughter, Lia Lee, is plagued with a severe case of epilepsy, or qaug dab peg in Hmong, as a child and is administered to the Mercy Medical Center Merced, or MCMC, a hospital in Merced, California. The doctors there go through many struggles in order to work with the Lee family, as they are faced with cultural and language barriers that they must overcome in order to ensure Lia is in good health. The Lees do not feel that they are in the wrong, for their

“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.

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.

When caring for a Native American patient, it is imperative that the nurse provide culturally competent care. In this scenario, there are two main dimensions along which cultural tensions between the patient and the nurse can arise. The first pertains to the actual practices and values of Native American culture, which may be at odds with the practices and values of dominant healthcare institutions. The second is both broader and more subtle: it pertains to the historical relationship of the Native American people and the

The intercultural misunderstandings start at birth. When a child is born, Hmong women want their placenta, so that they may bury it. In Laos, this is perfectly normal, but in the United States, most doctors find this strange. Since this is not something regularly practiced in the U.S., when a Hmong woman asks for her placenta, most doctors say no. The few that do agree to give them the placenta pack it in a plastic bag or some other container that degrades the importance of the Hmong culture. Many doctors assumed that the women wanted to eat the placenta. This is wrong, but they would never know because they never took the time to ask. If the doctors had asked why they wanted the placenta, they would easily find out that it’s important to the Hmong culture because their soul and afterlife depend on it.

The book titled The Spirit Catches You and You Fall Down: Talks about a Hmong Child, Her American Doctors, and the Collision of Two Cultures written by Anne Fadiman. Anne Fadiman is an American essayist and reporter, who interests include literary journalism. She is a champion of the National Book Critics Circle Award for Nonfiction, the Salon Book Award, and the Los Angeles Times Book Prize for Current Interest. In the book, Anne Fadiman explores the clash between a county hospital in California and a refugee family from Laos over the health care of Lia Lee. Lia Lee is a Hmong child diagnosed with severe epilepsy, whose parents and the doctors wanted the best treatment for her, but the lack of communication cause a tragedy. The essay paper will state and explain what went wrong between Lia’s family and the doctors. The central point is a lack of understanding between them leads to Lia’s tragedy.

The Hmong are a clan based, patriarchic culture. Within the clans there is much diversity, with each clan having its own group identity and traditions. The language has a long oral history and very new, 1095’s, written form. The family structure consists of multiple generations in one household, with the elder male being the main dissension maker. The nurse must be familiar with generalities of the Hmong culture and be able to ask patients and their families of the cultural beliefs and decision making.

The growth in presence of midwives in both Indigenous and non-indigenous communities is increasing, indicating the overall difference in experience between what would be defined as “natural” birth and what western medicine dictates as “normal” birth. Though, this does not include the use of “assisted” birth during emergency situations, which is sometimes the case even with midwife patients (Green, 2017). But, this experience gives the mother an ally especially through emergency situations, which is related through both Dorothy Green and Kim Anderson’s experiences; Anderson whose first pregnancy needed to be terminated was assisted by an Indigenous birthing center to ensure that she would be able to bury the remains of her child, which is needed for both closure and ceremony (2006). Similarly, Green had to fight to make Indigenous medicine and options known in the hospital, to ensure that her patients were returned the pieces of their birthing process they needed to move forward and perform ceremony (2017). The use of traditional teachings, especially in an event as sacred as birthing, helps to heal Indigenous communities and families, and a healthy community leads to healthy identities of mothers.

Cultural Competence based on the Purnell Model can provide a comprehensive, systematic, and concise structure for learning and understanding the Palauan culture. Based on the previous paper regarding my Palauan friend, S.S., I will be discussing five areas where I can further improve my transcultural care pertaining to this specific community. These areas are in communications, high-risk health behaviors, nutrition, pregnancy and the childbearing practices, and death rituals (Purnell, 2014). Furthermore, I will present a reassessment of my culture competency to evaluate my learning that can positively affect the nursing care of individuals from diverse cultures represented by the Palauans.