Imagine you are Foua Lee, a Hmong woman who lives with her husband; Noa Koa Lee and twelve children. Your ancestors and Hmong neighbors escaped persecution in China by moving to a small village in the hills of northwest Loas.The Chinese viewed themselves as being superior to the Hmong. The Chinese often referred to the Hmong as "Miao" which means "barbarians" (Fadiman, 1997, p. 21). While living in Loas you and your family were forced to move due to the destruction from the Vietnam War. You and your husband made the drastic decision to move to Merced, California in hope of a better life. When the Lee's moved to Merced, Foua gave birth to Lia Lee in Merced County Medical Center. At only three months old Lia was taken to MCMC for seizures, which embarks the beginning of the cultural tug-of-war between Hmong traditional medicine and modern Western medicine. "The spirit catches you and you fall down" is the story of an emotional rollercoaster and hardships dealt with by the Lee family after moving from Loas to California. Not only does this story portrays the difficulties the Lee's and many other families faced due to cultural differences, it sheds light on many of the multicultural issues encountered in the fields of speech-language pathology and audiology.
A multicultural society consists of a society of various racial and ethnic backgrounds, socioeconomic groups, age groups, geographic regions and individuals of other cultural differences come together to form a diverse whole. Considering the United States is referred to as the melting pot, there are many diverse cultures here.
Individuals who have an ethnocentric view towards other cultures tend to describe other cultures as weird or wrong and view their culture to be superior. Hmong culture is quite different compared to the modern American culture, but that does not make either culture “weird”. The Hmong often did not agree with Western medicine practice. Hmong believed a person becomes ill when they are visited by a malevolent dab and that a txux neeb or Shaman had the power to cure it (Fadiman, 1997, p.113). The only medicine the Hmong’s approved of was antibiotics because they were fast acting. At Mercer hospital one doctor noted that the Hmong felt deceived or discriminated when not given antibiotics but if given any other medicine they would not take them (Fadiman, 1997, p. 81). Many of the Hmong did not like the American doctors for several reasons. One reason, a doctor is extremely different from a shaman; a shaman does not touch people and only uses natural remedies. According to the Hmong it was invasive for doctors to make friendly eye contact with them and it was insulting for doctors to touch the head of a patient without permission. It was important for doctors to never compliment a baby’s physical characteristics out loud because a dab would hear. It was also very crucial for a doctor to act like an authority figure or the Hmong would lose respect (Fadiman, 1997, p.77). Overall, Hmong culture differentiates vastly compared to
American culture, which led to the many conflicts between the staff at Mercer and the Hmong as they tried to improve the health of the Lee’s second youngest daughter, Lia.
As healthcare providers, it is their job to develop cultural competence; the ability of service providers to recognize, honor, and respect the beliefs, interaction styles, and behaviors of the individuals and families they serve. In order to develop cultural competence, members of the healthcare field must learn about the cultural background of the client and family, develop awareness of their own biases and preconceptions, and build on the unique strengths, values and experiences of the clients and families (Coleman & McCabe-Smith 2000).
Lia began having seizures at two months old and progressively worsened as she got older because of the cultural differences between the Hmong and medical professionals at Mercer. When Lia was not even a year old she began having grand mal seizures. Neil Ernst and Peggy Philp, Lia’s primary physicians at Mercer prescribed Lia several medicines to stop the seizing. In order to communicate with the Lee family an interpreter was used when available, but often there was not one present. After Ernst and Philp prescribed the medicine, the Lee’s repeatedly brought Lia to the hospital from seizures. The doctors later found out that Lia’s parents had not been giving her the correct dosage of medicine, which was causing her to seize and later suffer from brain damage. Lia was given more attention than any of the other Lee children and was obviously loved by her parents, so the doctors wondered why she was not being given the medicine. To ensure the Lee’s gave Lia the right dosage of medicine, MCMC sent a nurse and a translator to the Lee’s home three times a day, but Lia still was not given the correct amount. Neil Ernst believed he had the legal right to tell Child Protective Services about the situation with the Lee’s and Lia was placed in foster care for a year until she returned home. Over the course of the year that Lia was living with foster mother, Dee Korda, Lia’s parents endeavored a very emotional year. Lia’s father Noa Koa, told the case worker he had contemplated suicide and how he came home to his wife with a knife to her chest. Hmong’s are known for their very close relationships with their children so for a Hmong to be accused of child abuse was a very big deal.
During the Lee’s time at Mercer Hospital, the doctors and Lia’s family struggled to agree on a method of practicing cross-cultural medicine, but several doctors found techniques to agree to the Hmong taboo. According to highly respected psychologist among the Hmong and MCMC, Sukey Walker believed the keys to earning Hmong trust is to be respectful and using a good translator (Fadiman, 1997, p.105). When working in any medical field it is extremely important to have an interpreter or some form of communication with the patient. Medical professionals n the field of Speech-Language Pathology and Audiology often cannot directly conversate with their patient by talking but use various technology to communicate with them. For example, a patient with aphasia has lost the ability to speak so they use an AAC to communicate with others. Without a form of communication, a doctor is unable to identify important information. Not only is it difficult for health care professionals to assess a patient without a translator or form of communication, it can be very dangerous without knowing personal information about them. In 1991 MCMC was given a federal grant to hire interpreters but the grant expired after a year, so the only translators available were the Hmong staff working at the hospital at that time (Fadiman, 1997, p.98). Many doctors at MCMC did not agree with the differences in the Hmong traditional medicine practice but found methods to please the Hmong. MCMC obstetrician Raquel Arias explained she was successful in working with the Hmong even though she used the same standard of care for them as she did with every patient. Arias stated, “sometimes you can find middle ground
and try to understand where they are coming from, which is hard, but not impossible” (Fadiman, 1997, p.86). When working in not only the field of speech-language pathology and audiology but in any medical field it is beneficial for both parties to try to understand the beliefs of the other.
The story of "The spirit catches you and you fall down" illustrates the cultural conflicts endeavored by the Hmong and the medical professionals at MCMC. This tragic story reveals how cultural differences can cause various conflicts between medical personnel and families. Lia’s many visits to Mercer Hospital prove that American doctors need to be more accepting of other cultures and their beliefs. Professionals in the field of Speech-Language Pathology and Audiology deal with any patients who have completely lost the ability to hear and speak but are still able to communicate with them. Furthermore, the Lee’s experience shows how damaging it can be whe