The Hmong: Mistrust Western Medicine And Practices

“Between the ages of eight months and four and a half years, Lia Lee was admitted to MCMC seventeen times and made more than a hundred outpatient visits to the emergency room and to the pediatric clinic at the Family Practice Center.” The Lee family was a regular visitor at the hospital but it did not make thing between the Lee family and the hospital any easier. There was many issues between Lia’s family and the Merced hospital staff. Many of these issues steamed from many different areas of things. Between the Lee’s a Hmong family and the American doctors at Merced Hospital there were several cultural differences on what both parties wanted. Cultural difference was not the only thing they did not see eye to eye on there was also a huge language barrier between the Lee family and the workers at Merced hospital.

“She had never said it was love. Neither had he. They were shy. They had been unsure. Now, there would be no time for love. It was in the moment of parting that she knew she loved him” (21).

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

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

III. (Credibility Statement): You guys are probably like why should I listen to this guy, “he 's probably making this up or something” but hey why would i lie about my culture.

I believe there was a clear miscommunication in the message and the Hmong did not entirely understand Dr. Ernst’s actions. I think they thought that if they got on the doctors “bad Side”, they will attempt to take control of your child, which is not the case. Neil and Peggy come off as helping and caring to me. One of the greatest sorrows of the situation is that this message was never truly communicated. However, Neil's message has elements of arrogance. While it is likely true that the doctor's understanding better the health problems and consequences of the issue, the idea that these American doctors could better understand the needs of their children is horrifying. All loving parents believe that they want and know what is best for their

“It felt as if there was this layer of Saran Wrap or something between us….So we couldn’t really accomplish what we were trying to do, which was to take care of Lia” (47-48). The cultural barrier between Lia Lee’s parents and the medical staff at Merced Community Medical Center (MCMC) was recognized equally by both parties throughout the many interactions they had. From Lia’s birth to her final release from MCMC a recurring theme has been reproduction, specifically its difference between Hmong and American traditions. The several occurrences between pregnant Hmong women and the medical staff at MCMC are demonstrative of the language and custom barriers between the two cultural groups. Standards of parental care are also different within the two cultures and both Hmong and American standards affected Lia’s health. Emotions and understandings towards children born or obtaining disability had both parties treat Lia differently throughout her varying stages of being medically treated. The different cultures pertaining specifically to reproduction are main factors that shaped Lia’s overall medical treatment through miscommunication, varying standards of parenthood, and viewpoints towards disability.

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.

Most Hmong fear western medicine because of a lack of understanding, and a refusal to try to understand. The Lees had the importance of the medicine that was given to them explained to them many times, but they still believed that their thoughts about medicine and disease were far superior. In contrast, the Americans also refused to even attempt to understand the Hmong culture; even though slightly adapting to their medicine would have likely made the Lees much more compliant. This general misunderstanding of the other culture is best summarized by Fadiman, saying,

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,

Before moving to Saint Paul, Minnesota, two and a half years ago, I lived in Storm Lake, a small rural town located in northwest Iowa. There was no big Hmong population there, only a few family friends. I was very hesitant to share my culture at school because I did not know how to explain the elaborate traditions and its purposes. For example, sacrificing animals to ancestors is an outdated practice and not understood by many people. Traditions like this only exist in historical textbooks. I was scared of being judged and looked on as weird. I did not know the purpose of dressing up in traditional clothing for new years, or what was the purpose of celebrating Hmong new year. I envied other cultures, for they had a history that was widely known and written down in text. I had no appreciation for my culture.

The doctors assuming the Lee were giving their daughter her medications, were surprised to not see levels of the medications in her blood. Dan Murphy who was one of Lia’s doctor questioned the parents and he learned that due to their cultural beliefs, Lia’s parents have not been administering her with the proper medicine. Where Lia’s mother believes she is doing the right thing for her daughter, Murphy has sympathy for the mother and told Fadiman “I remember having a little bit of awe of how differently we looked at the world”. A key feature of the Hmong is that they have no interest in being rule, do not like to be told what to do, and are rarely persuaded by the customs of other culture. The mistrust and open hostility between the medical staff and the Lee family seemed to overshadow Lia’s disease. Both side obviously loves Lia and wants her healthy but neither was willing to compromised and meet half way.

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

Throughout time, mankind has persistently been seeking ways to maintain their health and to cure those that had not been so fortunate in that task. Just about everything has been experimented with as a cure for some type of illness; whether physical, spiritual or mental. There has always been evidence of spiritual healing and it will continue to be an important part of any healing process, large or small.

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.