Question

The book titled The Spirit Catches You and You Fall Down, by Anne Fadiman, tells the story of Lia Lee, a Hmong child with epilepsy, who lived in Merced, California. When 3-month-old Lia Lee arrived at the county hospital emergency room in Merced, a chain of events was set in motion from which Lia, her parents, and her doctors would never recover. Lia’s parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the “Quiet War” in Laos. Her parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment were very different.

The Hmong see illness and healing as spiritual matters that are linked to virtually everything in the universe, but the U.S. medical community marks a division between body and soul and concerns itself almost exclusively with the former. Lia’s doctors attributed her seizures to the misfiring of her cerebral neurons; her parents called her illness “qaug dab peg”—the spirit catches you and you fall down—and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants

; her parents preferred animal sacrifices. The Spirit Catches You and You Fall Down moves from hospital corridors to healing ceremonies, and from the hill country of Laos to the living rooms of Merced, uncovering in its path the complex sources and implications of two dramatically clashing worldviews.

Lia’s doctors prescribed a complex regimen of medication designed to control her seizures. However, her parents believed that the epilepsy was a result of Lia “losing her soul” and did not give her the medication as indicated because of the complexity of the drug therapy and the adverse side effects. Instead, they did everything logical in terms of their Hmong beliefs to help her. They took her to a clan leader and shaman, sacrificed animals, and bought expensive amulets to guide her soul’s return. Lia’s doctors believed that her parents were endangering her life by not giving her the medication, so they called child protective services, and Lia was placed in foster care. Lia was a victim of a misunderstanding between these two cultures that were both intents in saving her. The results were disastrous: a close family was separated, and the Hmong community faith in Western doctors was shaken.

Lia was surrounded by people who wanted the best for her and her health. Unfortunately, the involved parties disagreed on the best treatment because they understood her epilepsy differently. The separate cultures of Lia’s caretakers had different concepts of health and illness. This example illustrates how culture and health influence each other and at times clash. To help ensure good care for diverse patients, health care providers must address cultural issues and respect the cultural values of each patient. There are several issues to consider about this case:

How can healthcare providers prepare for situations like Lia’s?

Should child protective services have been contacted?

Were Lia’s parents irresponsible?

How did the parents’ belief system affect Lia’s health care?

Were the parents’ decisions morally and legally wrong?

Answer 1

1. Health care providers should respect the cultural difference and would have addressed the cultural issue of the parents more sensibly and responsibly. They would have persuaded the parents appropriately with counseling.

2. Contacting the protective services should have been the last option, when all the other options to convince the parents would have failed.

3. Lia's parents were not irresponsible. They were doing their best for Lia according to be their traditions, belief, and culture.

4. The parents lack of undertsanding and belief in their traditional system of treatment delayed the appropriate medical intervention and treatment. This would have turned critical for Lia. Also, it put Lia in foster care separated from her parents.

5. Morality the parents decision was not wrong because they were doing their best according to the norms and values of their culture. Legally their decisions for Lia was wrong because they denied the appropriate treatment for Lia's condition.