Role of Cross-Cultural Misunderstanding in Ruining Lia's Life

Nao Kao and Foua had been conflicted with abiding with the Hmong ways to not seek physician help. Certain parts of Hmong culture, such as taboos against procedures, beliefs of disease origins, and power structures within the family and Hmong clan often conflict with western culture of medicine. But when the Lee’s had not taken one of their children to the hospital, his soul was lost, and he died. Considering this incident and their lack of knowledge of Lia’s condition, the Lee’s had to involuntarily comply to western culture and take Lia to the doctors, as their last line of defense. It is important to note here that as a provider, I must be aware of my own assumptions of care. The doctors’ goal of treatment was to use medication and procedures to find out what caused her seizures and treat it with various medications. Lia’s parents considered her disease a blessing as a chance to become a shaman and a curse that caused great stress over the family. This often resulted in misunderstandings between the physicians and the Lee family as the Lee’s perceptions of Lia’s illness were not in line with the doctors.

What happens when two very different or even mutually exclusive cultural perspective are forced into contact with one another? In Anne Fadiman’s The Spirit Catches You and You Fall Down, there is a division between the shamanistic insubordinate cultural of Hmong refugees in Merced, California and the cold analytical approach of western medicine. In the early 1980s, the child of a Hmong refugee family in Merced, California is born with epilepsy, her name is Lia Lee. Anne Fadiman traces the interaction between these two cultures and Lia’s disease, she reviews that misunderstanding and miscommunication can have calamitous consequences for all involved. The author introduces many characters throughout the book and they all

Kind of like in the book “the spirit catches you and you fall down,” by Anne Fadiman. Fadiman described how the Hmong’s and the doctors had different point of views; because of their differences in culture and the language barrier they had trouble communicating and understanding one another. In the Banes family, Jackie was responsible for understanding and pursuing treatments for her grandmother. These treatments were not so easy for Jackie to understand, and often there has been a lack of communication

The doctors clear the family to take Lia home and be with her during her last days. Although Lia’s family devoted themselves to making Lia as comfortable as possible, and keeping her alive for decades longer than the doctors expected, her parents blame Lia's doctors for their daughter's prognosis.

This kind of cultural conflict led to Lia’s tragedy. Foua felt that it was important that there was a combination of western medicine and neeb. Knowing the history behind the Hmong could help a nurse better their care, by including their beliefs within their plan. The Hmong already felt that the United States had betrayed them by only choosing a select people, followed by not automatically taking those from the Thai camps, finding out they had no veteran benefits, Americans condemning them for taking all the welfare, and then taking it away from them. At this point they had little trust for people inside of the United States, so if the bedside nurses include their beliefs in some way, they could build a greater trust with them (Fadiman,

With the loud noise of a slamming door the family believed that Lia’s spirit had been frightened and left the body causing the sickness she was experiencing. The family saw the seizures as an illness of some distinction. In the Hmong culture epileptics often become shamans. The chapter goes on to tell the child’s story about multiple trips to the Hospital Emergency Room. It speaks about the lack of communication surrounding the child’s symptoms. The family is unable, and the medical team unaware of the lack of communication about medical dosages. The doctors have no idea about parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects. The doctors do not attempt to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme.

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.

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

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.

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

In Anne Fadiman’s book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1997), a Hmong family was faced with having to deal with westernized practices. Foua and Nao Kao, parents of Lia Lee, are forced to take Lia to Merced Community Medical Center, (MCMC), when she has a seizure. Lia’s parents believe that her seizure was the result of her soul being scared from the door slamming, thus escaped and became lost. MCMC has no Hmong interpreters to offer the Lees, so

A vital foundation for a high-quality care delivery is an efficacious communication between the patient and the healthcare providers (Gengler & Jarrell, 2015). Fadiman (1997) recounted the conflict between a refugee family from Laos and a small hospital in California over the care of Lia Lee, a Hmong girl with severe epilepsy, in her book The Spirit Catches You and You Fall Down. Despite both sides wanting the best care for Lia, the lack of cross-cultural communication between her Hmong family and her American doctors, lead to her tragedy (Fadiman, 1997). Awareness regarding the disparities in culture and language of our patient with ours and how to address them should be taken into account when providing healthcare since the life of a

We can see that there was a misunderstanding between the Lee’s and the doctor. Both parties explained the view on Lia’s case but from a biased perspective within their own culture. Lia's doctors strongly opinionated to treat her disease with medication, however her parents felt that being given medication would restrict with the spiritual healing given by a Hmong shaman.