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Running head: A RESPONSE
The Spirit Catches You and You Fall Down: A Response
Sarah Brick
Research Methods III
Northwest University
Response 2
The Spirit Catches You and You Fall Down: A Response
“The Spirit Catches You and You Fall Down” written by Anne Fadiman describes
the clash between Hmong and American culture. As Fadiman puts it “Hmong people
were transplanted from the stone age to the space age.” In great detail, Fadiman
distinguishes traditional Hmong health care practices, and how they differ from the
Westernized standard of care. Fadiman provides a detailed account of a Hmong child
named Lia and her parents, Nao Kao and Foua Lee. Fadiman walks us through the
horrific story of cultural barriers and life experiences while paying special attention to the
care in which Lia received. The story ends in tragedy due to cross culture
misunderstanding.
Nao Kao and Foua Lee wanted only the best for their children, they loved them
very much and would have died for them if it meant life for their children. Foua had
thirteen children and Lia was their prize child. She was special from the start. Lia was
sick with qaug dad peg (in English translated as “the spirit catches you and you fall
down”) otherwise know as epilepsy. Lia’s spirit was lost when Lia’s sister Yer slammed
the door so hard that it scared Lia’s soul right out of her. The Lee’s believed that Lia’s
illness was gift, and perhaps the beginning of becoming a txiv neeb, or a shaman believed
to have the ability to enter a trance and retrieve the soul that was snatched by the dab (or
evil spirit). Additionally, the Hmong believed that a tix neeb had special powers and the
ability to cure illness.
In the Hmong culture, shaking is noble and curing her was not their goal.
However they wanted to minimize injury to the child so they brought her to MCMC.
Ideally, the Lee’s would have liked Lia put on medication for about a week, and when
she was well to discontinue medication. The Lee’s did not want the doctors to perform
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blood transfusions, surgeries, or spinal taps (all of which happen anyway). The Lee’s
wanted to treat Lia in the safety of their home. The Lee’s did not receive this treatment
because it conflicted with the American standard of care. The Lee’s did not understand
why and became furthermore suspicious of American doctors.
The Lee’s brought Lia to the hospital several times before her illness was
detected. The epilepsy was undetected due many factors. First, by the time Lia arrived at
the hospital, the seizing at stopped, and the doctors treated her for respiratory illness,
which was really a side effect of epilepsy. Secondly, the Lee’s spoke only Hmong, and
could not communicate otherwise. They were as some put it, “fresh off the jet” (for
most of their life) and were clueless of American medical practices (or anything
American for that mater). Even if they could speak English, they were unable to describe
Lia’s condition in terms that the American doctors could understand. They did not know
how to describe pain, it just “hurts.” Additionally, the Hmong culture does not
differentiate between physiological illness, psychological distress and everything is a
spiritual problem, which complicates an accurate description of the illness. In addition,
the translator, often times the hospital janitor (who spoke a related language, but very
different from Hmong), only made matters worse and caused more confusion for the
Lee’s
The Lee’s (and most Hmong) were suspicious of Americans and their evasive
medical techniques. The Hmong relied on herbs, animal sacrifices and the talents of a
txiv neeb. They did not believe in surgery, spinal taps, or prolong medicine use. They
were insulted when the doctor poked and prodded at their little Lia, as the txiv neeb never
even touched the suffering one. They were fearful that her spirit would never return
because her spirit would not recognize a body that has been altered. Additionally, the
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Hmong culture is set in their ways, and the Lee’s were no different. Sure they took her to
“the doctors” but they did not follow their instructions. They believed that the prescribed
medicine was actually making her sicker, so they did not give it to her (the doctors
discovered much too late that the medication may have been making Lia sick after all). If
the Lee’s did give it to her, they were giving her the wrong dosage. Because they did not
understand how to measure out the prescribed amount, they guessed which furthermore
complicated Lia’s medical condition.
The doctors tried to be culturally sensitive with the Lee’s, but they were all too
familiar with the Hmong culture and knew that the Lee’s were not fit to give medication
as prescribed. They understood that the Lee’s loved Lia, and wanted to help her, but the
doctors decided that Lia would be better off with a caregiver that could follow the
doctor’s orders. CPS became involved and, essentially placed the Lee’s on probation to
dispense medication correctly. When the review period was up, the Lee’s failed
miserably. The Lee’s never understood the severity of Lia’s health condition as viewed
by the American doctors, but did what traditional Hmong culture did- they loved her and
treated her with herbs and animal sacrifices.
Lia was placed in a foster home and became “government property.” The Lee’s
were devastated. At one point, Nao Kao walked in on his wife pointing a gun at herself,
she was about to commit suicide. Fortunately, Nao Kao was able to convince her not to
kill herself. The two were overwhelmed with sadness. Fortunatley, the foster mom and
Foua developed a trusting a relationship and were able to visit regularly after the first
three weeks. In fact, the foster mom often left her children with Foua to watch her kids.
Foua was an amazing mom, and showed unrelenting love and compassion. The foster
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mom realized the tragedy of removing Lia from her home, and fought to get her placed
back with her family.
The Lee’s had suffered greatly. They dodged bullets, were forced into exile, they
lost three children in three years, experienced famine and mass destruction. Why did
Foua attempt suicide this time and not the previous deaths of her children? The answer is
simple, Lia being placed in a foster home was outside of normal occurrences. Back home
in the mountains of Laos, children were never removed from the home- the idea was
never even considered. The Hmong values togetherness, and tightly knit clans. An old
Hmong proverb states “a stick can not cook a meal or build a fences, but if either needed
to be cooked or built, they would need to bundle together.”
About a year or so had passed before CPS returned Lia home. When she did
return home, the Lee’s recognized that their little girl was not the same. When Lia was
living in the foster home, she had a severe epileptic episode, which caused brain damage.
The Lee’s were certain that had Lia been at home with them, she would not have had that
incident and the resulting brain damage.
The doctors at MCMC knew Lia all too well. The attending feared that they
might be the one on-call when Foua and Nao Kao would come busting through the doors
hold their seizing child. Lia was not the easiest of patients. She was a very plump child,
which made inserting an intravenous line, at times, impossible. The doctors would
frantically look for a vein, knowing that precious time was ticking. This pattern
continued for much of Lia’s life, and the doctors feared that one day they wouldn’t be
able to help her. Well, they were right. The doctor’s refereed to it as “the big one.” Lia
started seizing one night and the Lee’s recognized that it was unusually aggressive so
they ambulanced her to MCMC (this was the first time they had ever use the ambulance).
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The doctors at MCMC recognized that they did not have the facility needed to care for
Lia so they ambulanced her to Fresno, a state of the art hospital 60 minutes away. The
doctors tried and tried to stop the seizing, but could not. They packed her little body with
more and more medicine, but it did not stop the seizing. When they were able to stop the
seizing, the damage had been done. A CAT scan evidenced that Lia was basically brain
dead. She soon after she developed infections, explosive diarrhea, and respiratory failure
to name a few. The Lee’s were set on bringing her home, regardless of the doctor’s
opinion. She wanted Lia to die in her home, not in some state of the art, cold textile
facility. Lia was sent back to MCMC to die basically. The Lee’s convinced MCMC to
allow them to take Lia home. She was given hour maybe days at the most to live off the
life sustaining equipment. Foua took her hurting child back home, washed her and
performed her own medicine on her. Lia did not die that night, nor did she die the
following night, in fact, Lia lived several years after that night.
Reading this book was very frustrating. I was frustrated with MCMC for
allowing the Lees to sign off on documents that they did not understand, for not using
more culturally sensitive measures, for not using a Hmong translator (especially since
85% of the total hospital consisted of Hmong patients), for not taking the time to
understand what the Lee’s wanted, and for assuming that because they dressed like
Americans they must want all the usual things that American’s want. Additionally, I was
frustrated knowing that early prevention and consistent medication could have lessened
the severity of the disorder. I am sympatric to the Lee’s situation; I can not imagine the
hardship they endured. I am amazed how the Lee’s are able to love like they do, despite
all the horror they have been through. Additionally, I can’t hardly believe that in 1995
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students only then began cultural diversity training in medical schools and other
universities, it seems a little late coming.