Fadiman, A. (1997). The spirit catches you and you fall down:
a hmong child, her American doctors, and the collision of
two cultures. New York, NY: Farrar, Straus and Giroux.
Question 1:
Week 3
The author says, "I was struck . . . by the staggering toll of stress that the
Hmong exacted from the people who took care of them, particularly the
ones who were young, idealistic, and meticulous" (p. 75). Why do you think
the doctors felt such great stress?
I think the doctors feel great stress because of not being able to understand how
this culture believed or valued things. I remember in one of classes on cultures I
learned that the value put on certain things help to define that culture. I have
noticed during our reading of the first two books each book had its own set of
cultures. The people in both books put different values on different things.
Another reason I think the doctors felt stressed was do to them being young. The
idea of being young means being fresh from medical school. During this time
they would have learned the newest and latest ways to provide modern medical
care. They were taught to be through and to provide the best care to all people.
Plus this was not only the latest and newest but was the best. Never taking into
account what the person wanted or even their culture.
Next, when thinking about being idealistic; one can not help but think these
doctors felt that they would be different and would make a difference. Their
cutting edge ideas would prove to be the ones to make a difference or change for
everyone. Once again not thinking of anyone other than what they felt to be the
best. To listen and communicate with these people and learning about what is
important was not even considered.
Lastly I feel most doctors try to be meticulous and appear to others as all
knowing. I think this would be especially true if the language and communication
was a great barrier for all involved. I believe that great pains on the doctor's part
were probably given because they wanted to show these people they cared. This
was done to articulate through nonverbal communication that this doctor really
cared and was going above the call of duty.
All of these ideas would put stress not only on the part of the doctor but also on
the Hmong people. I think stress for all was involved when a person from this
culture had to visit the hospital. The way these doctors' felt was summed up
pretty well by Dan Murphy when he stated, "People in the early years of their
medical careers have invested an incredible amount of time and energy and pain
in their training, and they have been taught that what they've learned in medical
school is the only legitimate way to approach health problems. I think that is why
some young doctors go through the roof when Hmong patients reject what we
have to offer them, because it intimates that what Western medicine has to offer
is not much” (p.76). Murphy's statement sums up all the stress they felt. I think
that the one thing that caused all of this was the lack of interpreters aiding in
helping not only with the language but also to help shed light on culture. I feel
that a lot of the problems could have been avoided if the talking and sharing of
information were more readily available to both the doctors and the Hmong
people.
Question 2: How did you feel about the Lees' refusal to give Lia her medicine? Can
Week 3
you understand their motivation? Do you sympathize with it?
When the Lees' refused to give Lia her medicine on a regular basis I was mad. I
thought that here was another group of individuals who receive free medical care
and then did not follow through with the treatment. I could not help but think that
if they had followed the treatment that Lia would not have had the grandma
seizures that led to her demise.
Then, when Lia became an award of the court system and Fadiman talked with
Kathleen Ann Culhane-Pera and she summarized the Hmong attitude toward
medical care concerning their children; I was better able to understand their
motivation (p.83-84). I think too often we are quick to judge without knowing all
the facts or in this case the language barrier presented became the major
obstacle. I think the motivation in this case was best summarized by CulhanePera when she stated, "The differences are no longer about beliefs. The
differences are about power. Doctors have the power to call the police and to
access state power which Hmong parents do not have (p. 84)." This totally
broke my heart. I think the Lees' were going with their belief in dealing with Lia
and her medication; but above that they were feeling some of the same power
struggles they had faced in the past when dealing with power of the government.
I totally could understand their motivation; it was left up to them to decide how to
treat their daughter based on the information presented by the doctor.
I had great sympathy for the Lees. I can not imagine the confusion and
uncertainty of the situation. I do not feel that Dr. Neil took in to consideration
anything about the culture or beliefs of this culture. He did not at any time make
reference to trying to find out about their belief system. I found that to be odd
considering the amount of Hmong living in that area. One of the first things, as
teachers, we are told is that we need to get to try to know our students and their
beliefs. I was waiting on each page to see that the doctors had finally
researched the culture and their beliefs; but to my chagrin they never did. I was
really disappointed. My heart cried for not only the Lees, but for this entire
community. I totally saw the power being wielded by the doctors in the
statement made by Culhane-Pera.
I feel this book provided me with a real life lesson when dealing with any
situation/problem. I need to gather all the facts before making a decision that
may have long lasting consequences.
Question 1: What does Dan Murphy mean by, “When you fail one Hmong patient, you
Week 4
fail the whole community” (p. 253)?
The statement meant that because the Hmongs living in the Merced area had
heard of how the treatment or lack of treatment had caused Lia’s brain death.
These people had a strong bond among themselves. The Hmong community
had naturally been forged together in their common belief system and that this
would have influenced their feelings on the medical care given them. The fact
that the doctors took Lia from Foua and Nao Kao would have added to this failing
opinion of the medical institute. I believe that the statement continued to hold
true especially in the Lee and Yang clans. According to Fadiman both sides had
bad feelings for one another. She says, “Everyone in the Merced’s Lee and Yang
clans knew that what had happened to Lia (those bad doctors!), just as everyone
on the pediatric floor at MCMC knew what had happened to Lia (those bad
parents!). Lia’s case had confirmed the Hmong community’s worst prejudices
about the medical profession and the medical community’s worst prejudices
about the Hmongs” (p. 253). I have found this statement to be one of the truly
amazing and frustrating problems throughout the book; that is the very definition
of prejudice, which is an adverse judgment or opinion formed beforehand or
without knowledge or examination of the facts. This failure was actually just the
fact that neither party had been given enough information about the other party.
This type of failure could have totally been eliminated if only the ability to
communicate had been available to the parties involved. This led to an entire
community that failed the community in which Lia and her family lived.
Question 2: What was the “role loss” many adult Hmong faced when they came to the
Week 4
United States? What is the underlying root cause? How does this loss
affect their adjustment to America?
The reference to the “role loss” is that many adult Hmong faced when they came
to the United States was the fact that in their families the elder or grandfather was
the leader of the family. When they came to the United States this role loss was
do to the fact that the children learned English quickly and had learned to read it.
This led to many children leading the parents and grandparents in their family.
Fadiman illustrates this role loss when she talks about going to a Southeast
Asian mental health conference given by Evelyn Lee. She uses a phrase that
touches the heart of the reader when referring to this loss; “Full of both past
trauma and past longing, the Hmong have found it especially hard to deal with
present threats to their old identities (p.205).” Fadiman recognized that the
traumas the Hmong experienced were related to loss of identity in their family
structure. While attending this conference the presenter Lee called members of
the audience up for a role-playing exercise. She had them line up according to
their status in the old country and then according to their status after coming to
America. Fadiman states; “As the family reshuffled, I realized that its power
structure had turned completely upside down, with the youngest girl now
occupying the head of the line and the grandfather standing forlornly at the tail
(p.206).” This added great stress to the families. The Hmong had maintained
their culture for many years in stressful situations.
The underlying root cause was the fact that “Hmong workers over thirty-five, the
majority are immovably wedged at or near entry level. They can’t get jobs that
require better English, and they can’t learn English on their current jobs (p.199).”
Fadiman goes on to say that the role loss “may be the most corrosive to the ego
(p.206).” This inability to learn English had major affect on the ability to adjust to
America. They did not understand all the procedures and customs of America.
The parents relied heavily on their children for help to make decisions and help
them determine the direction of their family. This may have made some of the
parents question their own knowledge and how to decide what was best for the
family.