Above is the Title of Ann Fadiman's book and the basis for this page of the website.
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The Spirit Catches You and You Fall Down is a book based on the true story of a Hmong family's journey through the American health care system from the country of Laos in Vietnam. While living in Laos the Lee's lived as many do in that country. They lived in houses with dirt floors and usually had many children. The Lee's had 12 children, each born by Foua Lee, their mother who delivered them all with no use of pain medication or help from certified doctors. Had there been a problem with birth or conceiving they would call a txiv neeb, a shaman who could help them with their problems. Most of the time the shaman would ask the parents and family to sacrifice an animal to cure the infertility (Fadiman, 1997). Once the child was born the father would dig a hole to bury the placenta. This was a ritual done to ensure that once the person died the soul would retrace its path through life until it reached the placenta and put it on as a "jacket" making them properly dressed for the afterlife (Fadiman, 1997). The Lee's fled to America in 1975 when communist forces took over Laos. Foua and her husband Nao Kao had there 13th child, even though only half of the children were alive, while living in America. She delivered Lia, an 8 pounds 7 ounce baby girl in Merced County Medical Center in Merced, California (Fadiman, 1997). Lia suffered from, what bio-medicine knows as Grand- Mal seizures but the Lees saw something else. They believed she was going into a trans each time she seized coming in contact with spirits. They thought she was being chosen to be a shaman. The medical doctors tried to explain what was going on but the Lee's did not fully understand. The doctors prescribed her medication for the seizures but the Lee's stopped giving them to Lia because they thought they were making her worse. The doctors saw this as the parents being negligible. Applied anthropology is not seen here, the doctors try to help Lia by introducing their own medical views and practices on to a family who is new to the American health care system without understanding Hmong ways. The Lee's were not used to this type of treatment. Instead of working together to achieve an optimal outcome for Lia they spent more of their time going back and forth between what was the right or wrong way to treat Lia. The doctors were not culturally competent to cultures other then their own. The Lees clearly practiced a different way of treatment, They wanted to use a shaman to heal their child but the doctors couldn't understand what that meant to them. They saw their treatment plans in a very ethnocentric way yet so did the Lee's.
Regardless of the poor compliance or understanding of treatment the Lee's returned to the hospital on multiple occasion seeking treatment for their daughter. Once the doctors realized that there was non compliance with the medication they had prescribed they called child protective services on the Lee's and Lia went into foster care with a Caucasian family. This family was compliant with the medications but Lia didn't improve much. Foua and Nao Kao went to visit Lia every chance they had, proving that they were not negligent parents it was just how the doctors were perceiving them. Anytime Lia's foster parents took her to the hospital the doctors listened to them, yet each time the Lee's came in they saw them as incompetent parents. This is a good example of cultural incompetence. No interpreter was used in these communications, they never asked Foua and Nao Kao how they felt about the treatment that was received and in the end the medication did more harm then good. Lia had a massive Grand Mal seizure and she became brain dead. According to the doctors she was in a full vegetative state with no brain activity (Fadiman, 1997). They found the cause of the seizures to be a result of an internal infection of the blood. This is why the medication was not working. The Lee's new that her soul was lost somewhere, they believed that once the person falls unconscious it means that the soul has fled the body. They still love Lia, they took her home and called in a shaman to try and bring her soul back but it didn't work. Her parents were told she would live only 2 day but she actually lived to be 30 years old. Had the doctors listened to the Lee's and took the time out of their practice to understand their culture, a more effective treatment plan could have been established. Although Lia may have died sooner had the Lee's still been living in Laos it was the point that the American health care system failed to recognize the cultural differences between them and this Hmong family. An example of where applied anthropology is not used in the book is when the doctors tried to heal Lia by forcing their treatment onto the Hmong family who, up until this time, had only small exposure to professional medical care while living in the refugee camps.
There was no mediation between the doctors and the Lee's. Both wanted to heal the child in their own way. Applied anthropology and critical anthropology didn't come into play until the end of the book when Jeanine Hilt was a social worker who actually listened to the Lee's, asking them what they thought about the care and how it could be altered to fit their cultural practices. One question she asked was how the Lee's what they called the problem that Lia had. They responded Qaug dab peg which means the spirit catches you and you fall down, usually being caused by the loss of ones soul. Jeanine Hilt became well respected among the Hmong people. The Lee's financial needs were also assessed when Lia became vegetative. They used critical anthropology to look as the financial situation impacting Lia's care and ultimately gave them free supplies such as a bed. This is also the part of the book when the medical staff become culturally competent of Hmong people and how they view health care (Fadiman, 1997).
There was no mediation between the doctors and the Lee's. Both wanted to heal the child in their own way. Applied anthropology and critical anthropology didn't come into play until the end of the book when Jeanine Hilt was a social worker who actually listened to the Lee's, asking them what they thought about the care and how it could be altered to fit their cultural practices. One question she asked was how the Lee's what they called the problem that Lia had. They responded Qaug dab peg which means the spirit catches you and you fall down, usually being caused by the loss of ones soul. Jeanine Hilt became well respected among the Hmong people. The Lee's financial needs were also assessed when Lia became vegetative. They used critical anthropology to look as the financial situation impacting Lia's care and ultimately gave them free supplies such as a bed. This is also the part of the book when the medical staff become culturally competent of Hmong people and how they view health care (Fadiman, 1997).