The Spirit Catches You And You Fall Down

With the increasing immigrant population a third barrier affecting access to health care is a cultural barrier. Culture barriers can include values and beliefs, language and race and ethnicity. Health beliefs and behavior can become a barrier when patients decide not to seek medical treatment and instead turn to home remedies and healers when treating illnesses. Approximately 10% of Americans speak a language other than English and can be classified ad being limited in their proficiency. For these patients language becomes a barrier and they are less likely to receive optimal medical treatment (Flores, 2006). Horton and Johnson (2010) stress the importance of communication in reducing disparities and increasing the trust of patients in the health care system. As reported by the American College of Physicians, evidence reveals that racial and ethnic minorities are more likely to receive inferior care when compared with non-minorities. This occurs even when minorities have access to insurance and adequate income (Racial and ethnic disparities in health care, 2010).

Directions: Read the captioned book. Then answer the questions contained in this study guide. Post your completed document to the appropriate assignment box on the course website.

The Spirit Catches You and You Fall Down or quag dab peg is said to mean “a soul stealing dab; peg means to catch or hit; and quag means to fall over with one’s roots still in the ground, as grain might be beaten down by wind or rain” (Fadiman, 1997). The Lee family belonged to the Hmong tribe, which was the basis of their differing beliefs in comparison with modern medicine. Lia’s parents believed that when she was three months of age, she had been startled when her older sister, Yer, slammed the door of the Lee family’s apartment. This resulted in Lia’s first seizure which her parents believed made Lia particularly fit for divine office. The Hmong believed epileptics became shamans or medicine men and

“Medicine was religion. Religion was society. Society was medicine” (Fadiman, 1997). To the Hmong’s, this is a way of life. Everything in their culture is interrelated and represents a holistic view. As Americans, we try to incorporate the holistic approach into our health care system, but heavily rely on medications and science to treat illness.

The Spirit Catches You and You Fall Down (1997) is an ethnography written by Anne Faidman. It tells the story of Lia Lee, a Hmong girl with severe epilepsy, and her family’s journey with managing the condition and the cultural barriers that posed great challenges in Lia’s care. Lia was diagnosed with epilepsy at age 1. It was her family’s opinion that the condition was a spiritual gift. Lia’s parents, Nao Kao and Foua, were wary of the American medical system, preferring to treat Lia in the Hmong way. Under the more spiritually focused care of her parents, Lia continued to have severe seizures; at the age of 4 ½, she slipped into a coma that would last the rest of her life. This book serves as a testament to the importance of cultural competency

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.

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.

The Spirit Catches You and You Fall Down is a story that portrays the life of a young Hmong girl named Lia Lee and her battle with heritage and the medical profession. The novel displays two interchanging story lines. One story line exhibits the life of a young girl named Lia Lee and her family as they live as immigrants in the U.S, and the other story line displays the Hmong heritage history. Both of these storylines come together and the novel shows how the two are interchangeable.

Although the United States is a leader in healthcare innovation and spends more money on health care than any other industrialized nation, not all people in the United State benefit equally from this progress as a health care disparity exists between racial and ethnic minorities and white Americans. Health care disparity is defined as “a particular type of health difference that is closely linked with social or economic disadvantage…adversely affecting groups of people who have systematically experienced greater social and/or economic obstacles to health and/or clean environment based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (National Partnership for Action to End Health Disparities [NPAEHD], 2011, p. 3). Overwhelming evidence shows that racial and ethnic minorities receive inferior quality health care compared to white Americans, and multiple factors contribute to these disparities, including geography, lack of access to adequate health coverage, communication difficulties between patients and providers, cultural barriers, and lack of access to providers (American College of Physicians,

Commonly, culture is considered large and extravagant events and holidays, such as Diwali, a wedding, or the Fourth of July. Each event and holiday have specific traits and rituals that occur to distinguish the event from everyday life, but culture isn’t exclusive to lavish events such as these and include everyday activities such as watching a football game and listening to a speech. Every belief, behavior, and symbolic system that a person shares with another is an example of culture. Authors Anne Fadiman and Joshua Reno explores the different aspects of culture and ethnography in their two books, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, and Waste Away: Working and

The Spirit Catches You and You Fall down, by Anne Fadiman, illuminates the issues that arise when constructive collaboration cannot be accomplished between two conflicting parties. The conflict between Western beliefs and Hmong ideology is illuminated through a young epileptic Hmong named Lia Lee, and her tragic experience due to cultural differences. Ultimately, the conflict between parent and doctor beliefs thwarted medical advancement, eventually leaving her in a vegetative state and a premature death. In order to fully understand her predicament, we must establish the bounds of each culture. Largely defined by science, Western culture approaches things in technical terms, with decisions being based on measurable evidence. Western advocates argue that individuals must understand and accept scientific reality over their religious views. Non-Western beliefs, such as the Hmong culture, are largely defined by religion and pseudo-science practices. Those that oppose strict Western ideology, such as Francesca Farr, propose, “our view of reality is only a view, not reality itself” (p 276). In other words, reality is relative to the respective individual. Legitimate claims on both sides create a large grey area of misinterpretation. On the contrary, health does not have margin for misinterpretation. The lack of understanding can prevent Western doctors from providing certain aspects of treatment. Even worse, the patient may reject treatment entirely. This dilemma in cultural

1. Do you think the author was evenhanded in her presentation of Hmong culture and medical culture?

In The Spirit Catches You and You Fall Down, there are many different intercultural misunderstandings. A Hmong girl’s life was forever changed because of these misunderstandings and some things could have easily been avoided, had each side taken the time to better understand the other.

The book titled The Spirit Catches You and You Fall Down: Talks about a Hmong Child, Her American Doctors, and the Collision of Two Cultures written by Anne Fadiman. Anne Fadiman is an American essayist and reporter, who interests include literary journalism. She is a champion of the National Book Critics Circle Award for Nonfiction, the Salon Book Award, and the Los Angeles Times Book Prize for Current Interest. In the book, Anne Fadiman explores the clash between a county hospital in California and a refugee family from Laos over the health care of Lia Lee. Lia Lee is a Hmong child diagnosed with severe epilepsy, whose parents and the doctors wanted the best treatment for her, but the lack of communication cause a tragedy. The essay paper will state and explain what went wrong between Lia’s family and the doctors. The central point is a lack of understanding between them leads to Lia’s tragedy.

I have to admit when I first read “The spirit catches you and you fall down” I thought it would be pretty boring turns out its one of the most interesting books I have ever read. The cultural conflicts can apply to anyone and knowing a little bit more now what the Hmong people have actually gone through can make everyone develop a great amount of respect for the culture. The Lee family continuously went full force colliding with the American ways in order to protect their traditions so they could preserve their culture. Unfortunately, in the end it didn’t help them but that was all they knew considering the fact that that the doctors at MCMC hospital didn’t really go out of their way to explain procedures it only makes sense for the Lee family to revert back to what they know in their traditions.