The Importance Of A Client Centered Approach

I cannot accept the Lee 's refuse to hive lia her medicine. But as Lia 's parents a traditional Hmong family, they belief in what they had known and learnt from the past and their culture. They believe medication should not be taken forever or doctors cannot be trused. No, I do not sympathize with it, because Lia should be taken by Dr. Ernst and let Dr. Ernst to help Lia.

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

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.

Lias final seizure was a horrifying yet blameless conclusion to her extremely short life. At only four years old she went into an extremely violent seizure that lasted for hours. Nurses and doctors were unable to stop her seizing due to her size (Fadiman 143). When they were finally successful in stopping her seizure she had almost no brain activity left, and was declared brain dead and sent home to die, (Fadima 211). Following all of the previous events of her life it can be easily assumed that the Lees did not give Lia her medicine, or the doctors and MCMC complicated her regime, causing her symptoms to worsen, but that is not the case. Lia had her final seizure due to sepsis, not because she was epileptic. (Fadiman 147). The fact that her organs were shutting down was hidden by a lack of symptoms. Despite everyone finally doing what they needed to do, Lia’s fate had already been sealed at that point. The ultimate cause of her brain death was nobody 's fault at all, and it had nothing to do with culture, it was just an unfortunate accident.

It is not always easy to decide about the care of a patient, because the patient’s cultural beliefs do not always coincide with the beliefs of the nurse. Ephesians 4:2 in “Be completely humble and gentle; be patient, bearing with one another in love” (English Standard Version). God has loved us unconditionally from the beginning of time, and has always been patient with us. It is time that humans show the love that God has for us onto others and respect one another no matter the differences. This paper will discuss the importance of respecting another person’s culture, what stigma is and whether if Lia’s family viewed her that way, brief history of the Hmong, the preventions that could have taken place, and how to incorporate

Even though Foua and Nao Kao never completely understood the reasons for why they had to administer Lia with so many prescription drugs, they eventually participated in proper medication trainings with the social worker in order to comply and appease the doctor’s demands. Over time, Foua and Nao Kao were able to develop a good relationship with Lia’s doctors, with the assistance of the family’s social worker, Jeanine Hilt, in order to regain custody and comply with the medication regimen. This was a difficult concept for them to grasp, as the methods of the doctors were completely foreign to them, and they felt they had no control in what was happening to Lia who they, according to their cultural values, wanted to take complete responsibility

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 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.

According to the Hmong culture a shaman helps to cure the soul. A doctor cures biological problems. As we learn throughout this class there is a difference between an illness and a disease. An illness or a disease may have the absence of the other. In most cases an illness can be present without a disease. In the case of Lia there was a presence of both Illness and disease. If txiv neb and the American doctor would have balanced their practices and learned from each other this would have affected the way the Lees thought about medicine. I believe that faith plays an important role in Lia’s case if the doctors would have understood the way that txiv neeb thought and vice versa the lees would have trusted American doctors and medicine more. Learning from txiv neeb would have also helped the American doctors in other cases when treating Hmong by understanding their culture. It is important for the doctors to understand the Hmong culture and specifically the way that a txiv neeb works because in Merced a third of the population were Hmong and used a tixv neeb as their main source of healing.

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.

The Lees believe that for an illness to be cured the soul has to be called back through the ritual sacrifice of animals such as chicken and pig. That is, they believe in the “Shamanistic ritual performed by a trix neeb in which an animal is sacrificed and its soul battered for the vagrant soul of a sick Person” (Fadiman, 1997, p.100). According to Lia's father Nao Kao “Sometimes the soul goes away but the doctors don’t believe it…The doctors can fix some sickness that involve the body and blood but for us Hmong some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb” (Fadiman, 1997,p.100). The medical care that the doctors at Merced were providing was without animal sacrifices therefore the Lee’s believe that it could not make their daughter well.

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.

The client has had a strong support system in the past and is open to creating another one. This is strength because it demonstrates that the client is open reaching out to others in times of need and is a resiliency factor.

D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for “extra support and someone to talk to.” D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for “hearing voices.” In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a variety of mental health settings, including hospitals, day programs, and outpatient treatment. The client has an extensive alcohol and drug use history that he believes impacted his Schizophrenia. In the early 1980’s the client would use alcohol every day “to avoid the voices,” drinking “anything he could get his hands on.” He was also heavily involved with drugs at that time and regularly used marijuana, PCP, cocaine, and heroine. In 2000, the client was sentenced to eight years in jail for four bank robberies. While in jail, D.D. received mental health treatment and alcohol and drug treatment, which was greatly beneficial. When the client was released from jail in 2008, he was drug and alcohol free and was taken off of Risperdal.