The Spirit Catches You And You Fall Down Case Study

Cultural competency aids in closing the “disparities gap” in health care. ("OMH," 2012, para. 2) In doing so, health professionals and their clients are better able to discuss concerns without cultural differences getting in the way of effective communication and problem solving. Being respectful of and sensitive to the client’s health beliefs, culture, values, and diverse needs can bring positive outcomes within treatment and patient care. After all, is it not the main job of the health care provider to ensure patient trust? Open forms of communication when dealing with client issues can only be provided if the patient is comfortable with his provider and believes his

Introduction: Cultures, social, ethnicity, English proficiency are factors that my significantly affect the quality of healthcare. Patient’s perspective, values, beliefs and behavior are highly influenced by the sociocultural background pf the patient (1-5). These factors can affect dealing with patient’s symptoms, seeking care, pain toleration, care adherence, preventive measure, and health care expectations.

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 Spirit Catches You and You Fall Down, portrays two themes. First, the text refers to Hmong history and the destabilization of the region of Vietnam forcing Hmong refugees to migrate to other parts of the world but mostly the United States. Within the text is another story of a Hmong refugee family and their daughter named Lia Lee who settle in Merced California. Lia is tormented by a misfortunate diagnosis of epilepsy and faced by cultural inequality by her American doctors. Health care providers wrote Lia Lee off as a complex patient with severe communication barriers. Almost all of her admission notes contained the phrase” language barrier” (Fadiman, 2012). As she bounced back and forth between healthcare providers within the Emergency Room and pediatric visits, her doctor, Neil Ernst concurs that her parents are responsible for the communication barrier and non-compliance with prescribed treatment. Dr. Ernst deemed this as neglect and had Lia placed in a foster home but after being separated from the only people she knew, her conditioned rapidly deteriorated. Her seizures progressed in intensity and duration until one

Critically analyse one of the main challenges, barriers, and enablers for cultural competence in health care when working in a cross-cultural environment.

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.

Cultural competence can be defined as using the ability of one’s awareness, attitude, knowledge and skill to effectively interact with a patient’s many cultural differences. Madeline Leininger, a pioneer on transcultural nursing describes it this way; “a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs, values and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people” (Barker, 2009, p. 498). The importance of cultural diversity in healthcare allows for the delivery of appropriate cultural autonomy. Showing respect for others will lead to trust between nurse and

In America, the number of federally identified tribes is 562 with every tribe having its own culture, belief system and practices. That is why there seem diverse type of behaviors among this population related to healthcare seeking and healthcare attitudes. Amongst the most common components that lead to this diversity in healthcare seeking behaviors is the role of culture which affects healthcare intervention, prevention, and care. So, it is very important to understand the diversity of culture in particular

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.

Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and to understand culturally influenced health behaviors. However, becoming culturally competent is a much more daunting task. Culture (and ethnicity) often influences a patient’s perceptions of health and illness. Therefore, if healthcare providers appear insensitive to cultural diversity, their actions may negatively affect the quality of the healthcare that they provide.

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.

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

Lia Lee was a Hmong infant born with epilepsy. Lia’s parents were immigrants to a Western nation. However, the parents held tightly onto traditional beliefs from their native country. The incongruent belief structure of the East and West created difficulty when the two systems collided in an effort to care for Lia Lee. Specifically, when the drug therapy prescribed for Lia Lee was not followed by her parents. Subsequently the child’s medical team contacted child services, which lead to Lia’s removal from her family. The result of the cultural misunderstanding was fragmented family. In addition to fueling the distrust of the western healthcare system by an already marginalized community.

Insuring that the patient fully understands what is being done to them is of great importance. As patients, they have the right to understand what is being done and why. Informed consent must be given; the patient should be able to repeat what they have been informed of before the procedure is done. Currently “only 33 percent of U.S. hospitals have quality improvement efforts underway to improve the quality of their language access programs.” (Armand and Hubbard, 2010). The goal of the interpreter is to assure that the LEP patient has no doubts or concerns and totally understands what is going to happen, why, and any options they may have.

It is important to approach the patient in the appropriate manner to prevent jeopardizing the nurse-patient relationship. The first step a nurse should take is to eliminate any communication barriers. Most Arabs can speak fluent English, but it may be necessary in some cases to facilitate an Arabic interpreter. The nurse should then document the interpreter as an intervention in the patient’s chart (Khalifa, 2012). In the case of the patient not speaking fluent English, the nurse should be aware of nonverbal cues and implement strategies to successfully