The Explanatory Model

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.

This chapter focuses on some of the conflict between the Hmong healing traditions and the doctor’s practice in medicine. The Hmongs took the doctors prescriptions as advice not as orders, and they did whatever they wanted regardless of what the doctor prescribed, but at the same time if they left the doctor’s office without being prescribed something, they felt cheated. The doctors and the Hmong have many problems communicating because of the language barrier and cultural barrier. This makes it hard for the doctors to try and treat someone, and some of the Hmong’s healing techniques aren’t acceptable and considered abuse in America.

On the other hand, western medicine doctors diagnose the problem by observing the physical symptoms, screening the blood, and perform various other medical techniques that rely on advanced medical education and training. Doctors are concerned with the physical symptoms and disregard the “soul” which in turn conflicts with the Hmong culture because they believe in souls and higher mental processes. Fadiman’s proved that the central argument was the collision between the Hmong culture and the physical disease treatment of western medicine.

What makes a person a good person? John Proctor is a strong Puritan whose character traits symbolize the values of his community. John Proctor faced many problem including his reputation. John is honorable because he is hardworking, a man of integrity, in spite he cheated.

Asian cultures have a very strong family bond and this is very important to them and often surpasses that of an individual. The older family members are rarely questioned and therefore they are often the decision makers and will decide for themselves after being made to go to a hospital that they do not want treatment and all health care providers must respect this decision and be culturally competent in handling the situation. One must not make a patient or family feel bad due to their cultural decisions. We must look at our own beliefs as nurses in order to know what our beliefs are in order to understand those of our patients.

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

Through her research, Leininger established an outline to further explain the importance of culturally competent care and the challenges presented throughout societies and healthcare institutions. The most obvious need for cultural sensitivity is the ongoing immigration throughout the world. As more people from different parts of the world enter into one area, different cultures will be present. The people that migrate to a new region or country will have the expectation that respect will be shown for their beliefs, particularly in the healthcare setting. This includes the use of technological advances in medicine. Some cultures may not understand or trust the delivery of care that is based on new technology (Andrews & Boyle, 2016).

One is expected to precisely follow all medication directions and finish all the medication as prescribed. This was an issue when treating Lia Lee, though. Her parents thought that they could just change the prescription based on what they thought was right for their daughter. However, this was considered child abuse, which would require actions with the child protective services (Fadiman, 1997). Albeit, the American health care system strives to not just treat and prescribe medication but also “involve satisfying the communication gap, interpersonal relationship, counselling and education regarding the disease,” (Ganesh, A. & Ganesh, K., 2013, para. 1). In following this principle, several steps were taken to try to explain to Lia’s parents that they need to give Lia exactly what the doctors had prescribed for her. One nurse even goes as far as drying on lines and suns or moons to indicate how much is to be given and what time during the day (Fadiman, 1997). With Lia’s parents being so steadfast on their Hmong culture belief of self-medicating through the spirit, they refused on several occasions to give Lia medicines that they felt were unhealthy. After several methods of trying to explain the reasons as to why Lia should be given the medicine, the local MCMC doctors decided to transfer Lia so she could get the proper care within a larger, more specialized hospital.

The providers should not just ask a patient where do it hurt, they should also ask why, when, how and what next ( Kandula, 2013). I feel that my doctor, when he asked me what was my treatment plan was using the explanatory model. By doing so it empowered me to be proactive when it comes to my health. This way of thinking and practice will elicit a more complete picture of the individual and their problems. It will also help the provider to see how one’s culture ties into the picture. According to Kandula, 2013 the way a person perceives their life and health is deeply embedded in their culture and hold significant

Another interesting difference of the movie and the Bible were the miracles shown in the Book of Exodus. In the Bible, Moses uses a staff to perform the miracles God asks him to do. He even turns the staff into a snake. However, in the movie, he uses a sword to part the Red Sea. In the Bible, God orders Moses to go to the bank of the Nile and use his staff to stretch it out for the rivers and all the reservoirs of water to turn into blood.

One of the conflicts that arise in health-care from a conflict perspective is the focus of the provider and is the provider functioning as a scientist or a care giver. Are there objective versus subjective concerns for the patient and is the health care provider treating the disease or is the provider treating the person? The conflict that arises between health-care provider and patient is vastly influenced by the patient’s cultural and social beliefs.

Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)

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.

I have always had a passion for care and a desire to work in the healthcare field. However, I gained admission into the university for Development Studies in Ghana after high school to study BS in agriculture, and then majored in animal science. It was really an interesting experience and I enjoyed working with animals and seeing how they behaved amazed me. It was a tremendous experience and it got even more exciting when I got employed in a fishery firm after school, where I got the opportunity to see different kinds of fish and how they survive when they are out of the sea. Along the line I had given up my ambition of dreaming to work with humans and in the healthcare field until I went to

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