The Spirit Catches You and You Fall Down by Anne Fadiman is about a refugee Hmong family who resettled in Merced, California in the 1900s. The Lee’s gave birth to Lia, who was diagnosed as a child with severe epilepsy in which we learned and read the many difficulties the Lee’s had with Lia, this disorder, and in communicating with the Doctors and staff at the Hospital. The language barrier was the most obvious problem, but it wasn’t the only problem, I think that the biggest problem was the cultural barrier. Communication among the characters at the beginning of Lia’s Hospital visits were minimal with little to no words exchanged amongst the staff/Providers. I find it very interesting that small efforts were made to get an interpreter to communicate and to get something so important from the patient such as the “History”.

Still appalled that Lia was discharged and given medications in ENGLISH, I suppose the staff thought the Lees’ would suddenly know how to read. Finally, it wasn’t until Lia’s third trip to the Hospital that a Doctor was able get a diagnosis for Lia’s symptoms, not because there was an interpreter but because during this trip to the Hospital, Lia was presently seizing. In which I question, before the third trip to the Hospital whose fault would it have been if something would’ve happened to Lia? I believe the Hospital would have been liable because not having “funds” to provide an interpreter doesn’t suffice. Explanations behind some of the Hmong beliefs about disease causation or origins of diseases, are usually what they believe come from a spiritual cause. They do things such as drawing disease out with an egg, rubbing the skin with coins which Foua (Lia’s mother) did and using a cotton soaked in alcohol in a form of a vacuum as traditional forms of healing, not including other rituals such as animal sacrifices. They believe that shaman, and tvix neeb have higher power in healing (more than Doctors) to get rid of evil spirits, which the book describes as “dabs”.

The power structure within Hmong families (clan) and going against medical procedures often created misunderstandings and conflict between their culture and western medicine. Peggy and Neil are Lia’s Primary Care Physicians at MCMC and are responsible for most of the medical decisions for her. When they found out the Lees were making decisions about Lia’s medication they felt enormous rage and I don’t blame them because I too felt some rage when reading some of the things the Lees did or did not do. Saving Lia’s life was a priority to them (PCPs) so when Lia wasn’t getting better and the Lees were not complying with the medication treatment, Neil decided to have Lia legally removed from their custody. I felt the frustrations of Peggy and Neil, all they wanted was for that loving, caring, chubby little girl to get better. I must admit that the rage I initially felt quickly diminished after Lia wasn’t getting any better in the custody of the Kordas (Lia’s foster parents). The Kordas stated that some of the medication did in fact make Lia worse, just as the Lees tried to tell the Providers.

I learned the importance of being culturally competent in healthcare because we all have attitudes or stereotypes that affect our understanding, action, and decisions in an unconscious manner called implicit bias. The need for cultural competence is essential in the health care because there are many changes in the structure of health care delivery systems and the changes in the cultural composition of our nation’s population. Understanding distinct cultural backgrounds, languages, and knowing how to meet the needs of the population the organization serves, is extremely important. In conclusion, though many might believe it was unjust for Doctor Neil to take the custody from Lia’s parents, but he did what he thought was optimal for her health. I hope Lia’s health stabilizes but also serve as a lesson for her parents to put effort in learning how to properly give and follow her Doctor’s orders and treatment. Thus far, I have been culturally shocked!