Lee family
• Live in the city of Merced, California.
Lia Lee
• Born on July 19, 1982.
Lia Lee
• When Lia was three months old, her older
sister Yer slammed the door of the Lee’s
apartment.
• Moments later, Lia’s eyes rolled up, her
arms jerked over her head, and she fainted.
• Despite the hu plig ceremony, the noise was
so scary that Lia’s soul fled her body and
became lost.
• A dab stole Lia’s soul.
Qaug Dab Peg = Epilepsy
Epilepsy
• A neurological disorder (a physical
condition) which causes sudden bursts of
electrical energy in the brain.
• These discharges produce sudden, brief
seizures.
Epilepsy
• Hmong feel ambivalent toward this
condition.
• It is seen as both dangerous and as a sign of
distinction.
• Hmong epileptics often become txiv neeb
Txiv Neeb = Shaman
• Literally: A person with a healing spirit
Txiv neebs
• Act toward their patients in ways that are
culturally acceptable, and in general, more
pleasant than the ways of Western doctors.
Txiv neebs
• Know how to treat illnesses with herbs.
• The only medicines Hmong gladly accepted
from Western doctors were antibiotics.
Foua and Nao Kao Lee
• Highly attentive and caring toward Lia.
Two-Pronged Approach
• Services of Western doctors at Merced
Community Medical Center (MCMC) and
• Services of Hmong shamans.
Jeanine Hilt
• A social worker.
• Only person, out of 40, who asked Lia’s
parents what they thought was the cause of
her illness.
• Despite the fact that 20% of Merced’s
population is Hmong, the State has not
funded interpreters to help communication
between doctors and patients.
• On the first time that Foua and Nao Kao
carried Lia to MCMC’s emergency room,
there was nobody available for translation.
• Since seizures had stopped, they could not
explain to doctors what had happened.
• Residents identified bronchial congestion,
which was caused by aspiration of saliva
during the seizure, and prescribed an
antibiotic.
• Nao Kao was told to sign a paper, where he
supposedly acknowledged receipt of
instructions for administering the medicine,
and agreed to call for a follow-up
appointment.
• He had no idea what he had agreed to.
• The third time, the Lees were accompanied
by a cousin who spoke some English.
• The Lees were instructed to give Lia 250
milligrams of ampicillin twice a day, and
twenty milligrams of Dilanti, an
anticonvulsant, twice a day, to suppress
further seizures.
Lia’s condition was severe
• Between the ages of eight months and four
and a half years, she was admitted to
MCMC seventeen times and made more
than a hundred outpatient visits.
Grand Mal Episodes
• Full-blown seizure attacks characterized by
long periods of loss of consciousness.
• When the brain is deprived of oxygen, as is
the case with prolonged seizures, significant
brain damage occurs.
• Lia’s disorder was much more severe than a
case of classic epilepsy.
Paediatricians:
Neil Ernst and Peggy Philip
• Lia was overweight.
• This made it very difficult to find her veins
and insert the intravenous needles necessary
to administer her medicine.
• Doctors had a hard time getting Lia to take
her medications.
• The Lees had an even harder time, because
they didn’t like to restrain her or force
anything down her throat.
• Over time, Lia’s drug regimen became so
complicated and was revised so many times,
that it would have been very confusing even
for a family that could read English.
• For the Lees, it was just incomprehensible.
• Prescriptions changed twenty-three times in
less than four years.
• Foua and Nao Kao could not read medicine
labels, neither in English nor in Hmong.
• They couldn’t read markings on droppers or
measuring spoons.
• They weren’t able to read temperature in a
thermometer.
• Lia’s parents never really understood the
connection between a seizure and what it
did to the brain.
• Drugs had different and significant sideeffects, such as diarrhea and hyperactivity.
• For Nao Kao and Foua, the treatment was a
crisis, not the epilepsy. They understood
that not everything is in our control.
• Doctors began to see signs of
developmental delay in Lia.
• Neil and Peggy found this situation tragic,
because they thought it was preventable.
• Neil wrote to the Health Department and to
Child Protective Services.
• What the doctors viewed as the basic tools
of modern medicine (blood tests, spinal
taps, surgery, anesthesia, and autopsies), the
Hmong saw as practices that threatened the
seat of their identity, in fact, of their souls.
Questions:
1) Dr. Dan Murphy said, “The language
barrier was the most obvious problem, but
not the most important. The biggest
problem was the cultural barrier. There is a
tremendous difference between dealing with
the Hmong and dealing with anyone else.
An infinite difference” (p.91). What does he
mean by this?
2) Dr. Neil Ernst said, “I felt it was important for
these Hmongs to understand that there were
certain elements of medicine that we understood
better than they did and there were certain rules
they had to follow with their kids’ lives. I wanted
the word to get out in the community that if they
deviated from that, it was no acceptable behavior”
(p. 79). Do you think the Hmong understood this
message? Why or why not? What do you think of
Neil and Peggy?
3) How did you feel about the Lees’ refusal to
give Lia her medicine? Can you understand
their motivation? Do you sympathize with
it?