Spirit Catches You PDF

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full study guide of Spirit for AMCS3283 Exam 2...

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GLOBAL HEALTH EXAM 2 PREP 

The Spirit Catches You and You Fall DOwn ➢ Spirit Catches, p. 3-11, 20-59 - A  nne Fadiman ○

Subject: L  ia Lee ■

Mother - Foua;  Father - Nao  Kao

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Hmong hilltribe ●

If Hmong couple failed to produce children, call in in t xiv neeb ○

Shaman believed to negotiate for parents’ health with spirits

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May be able to cure infertility

Hmong woman of childbearing age would set step inside a cave, as an unpleasant dab  lived there who liked to eat flesh and drink blood and make his victim sterile

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Born in M  erced Community Medical Center

Lia had an epilepsy  when she was 3M old ■

Family interpreted as q  aug dab peg ●

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“The spirit catches you and you fall down”

Thought epilepsy was setting her up for a life as a txiv neeb

Merced ■

County hospitals have reputation for being crowded, dilapidated, dingy ●

Merced’s county hospital not like this

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Accepts all patients whether or not they can pay

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Only 20% privately insured, most receive aid from Medi-Cal  (x>80%), Medicare, Medically Indigent Adult programs

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Area started to be mainly composed of Southeast Asian refugees

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Hmong patients are more expensive b/c they require more time and attention, and translation services are needed 

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Lia kept Seizing, MCMC kept on misdiagnosing her as she kept on arriving post-seizure ■

One time, came with cousin who spoke some English, and doctor on duty was D  an Murphy

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One of the more knowledgeable about Hmong people

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Consulted Peggy  Philp - supervising pediatrician that helped Lia a lot

Blood sampling in US believed to be fatal as they believe the body contains a finite amount of blood

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Aura people would get before they had an epileptic seizure ■

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Angor animi =  soul anguish

Compliance - were Lees being noncompliant about administering drugs or did they not understand instructions?

 ➢ Spirit Catches, pp. 61 - 118 ○

Doctors have no training in c  ross-cultural medicine ■

Upon examination, some doctors believe child  abuse is at play - but really, just an alternative form of medicine

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A doctor jokes that high-velocity  transcortical lead therapy is the best therapy for Hmong (shooting them in the head, because they are so difficult)

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Fear of dab  and snatching away souls ■

Western doctors prescribe as psychosis

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Hmong believe they get sick because of encounters with dabs

Some families/patients prescribed hyper-cultural remedy (seeing a t xiv neeb), but unable to follow through because of laws/customs in America (don’t sacrifice  animals in homes)

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How doctors view compliance ■

Job of doctors: practice good medicine

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Job of patients: to comply  ; noncompliance → child endangerment → child abuse

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Somatization - incidence in which emotional problems present as physical

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Yes (meaning of “yes” in clinic, during examination) 

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  ■ ○

Yes = means politely listening

Neeb = healing spirit; shorthand for ritual performed by a txiv neeb, in which an animal is sacrificed and soul bartered for that of a sick person

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tegretol & phenobarbital ■

Parents gave Lia less than prescribed dose of t egretol

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Worst combination of drugs for Lia

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Changed to depakene   as drug of choice ●

Liquid that tastes like cherries - easier to administer

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fixer of hearts

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holism

 ➢ Spirit Catches, p. 119-209 ○

Really good at farming o  pium ■

Used as cash crop - used for ceremonial trances, dull pain, etc.

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Grown as a s lash and burn c rop ●

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Usage of Hmong in Vietnam War → impression that they were “primitive”  ■

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Recruited Hmong soldiers by force

In US, conflict in Laos called the Q  uiet War ■

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“Skilled in the savage techniques of ambush and night assault”

General Vang Pao - CIA-supported Hmong leader of Armee Clandestine ■

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b/c of this, moved from land after it was all burned

War displaced lots of locals and caused a “flight or death” situation ●

Internal refugee  crisis;

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Created lack of sufficiency

Americanization classes (Ford Motor) ■

“I am a good American”

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But Hmong came to resist assimilation & wanted to save their identity

Lia goes into a big seizure & suffers from s eptic shock ■

Neil & Peggy leave soon after to vacation & transfer to Fresno b/c they weren’t specialists

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Nao Kao thought it was because there wasn’t any doctor there so they had to send her away 

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  ■

Also thought spinal tap was unfair b/c it “sucked out her soul”

 ➢ Spirit Catches, p. 210-261 ○

In Lia’s vegetative state, doctors also felt like something was missing besides the neurotransmissive capabilities of her cerebral cortex, - maybe p  lig (soul)

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Hmong medicine seen to have cured her ■

With this, her condition improved and her parents miraculously transformed from child abusers to model caregivers

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Believed transgressions on part of american doctors → responsible for Lia’s condition

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Types of Hmong medicines that Lia was treated with ●

Teas from powdered roots from Thailand, herbs they grew for her in the parking lot

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Txiv neeb placed a steel mixing bowl hung with twine from the ceiling to lure Lia’s errant soul ●

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Hmong are not unethical or ethical, but d  ifferently ethical ■

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Twice a year, txiv neeb would come to home to sacrifice a pig

For them, what was unethical was leaving their relatives behind

Some want to establish H  mongtown ■

Meant to boost morale & foster community and culture

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Will help them become more economically self-sufficient

 ➢ Spirit Catches, p. 262-288 ○

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Francesca Farr - w  oman who worked well with Hmong, social worker ■

Example of success with Hmong in realm of western medicine by working within the family’s belief system

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Bruce Thowpaou Blitout - H  mong medical administrator who wrote about mental health problems as traditional ailments of the liver ■

Suggestions for how better to take care of Hmong patients

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Arrange for doctors of the same sex to treat corresponding patients

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Use bilingual, bicultural i nterpreters

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A little medicine and a little neeb

Conjoint treatment b  eneficial for Hmong, especially if txiv neebs were not hurting anyone. In many cases, this proves to be beneficial for the patient

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MCMC ■

If they employed interpreters instead of assistances and nurse’s aides who translated on the side, would hospital stays be shortened and costs reduced?

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Move to bring back w  hole doctor-whole patient model ■

Doctor brings full humanity to the hospital, and patient is viewed as a complete person

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“Counseling” and “social work” alienate parents; “noncompliance & difficulty” ■

Doctors thought Lia’s parents wanted her to die w/o medicine

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Parents thought meds were sapping her energy and making her sick

 ➢ General Notes (Hmong) ○

Powerful sense of cultural identity

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Egalitarian farming society

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Lack of assimilation in China, Laos… and, the United States

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Assimilation or marginalized? Aspects of difference

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Why don’t I assimilate to her?

Hmong community center to retain cultural identity (considered lack of assimilation in western world) ■

For Hmong - agency, power, community, togetherness

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Merced ●

Celebrating New Year → ability to enjoy both American and Hmong culture

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History as a solution has to do w/ stories

Vietnam war & Hmong participation

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  ■

Widespread land loss, loss of self-sufficiency, need to migrate as refugees, and strengthening of cultural identity

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Largest Hmong settlement in history: no electricity, running water, and sewage disposal

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Refugees are seen as a burden

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Camp officials held Hmong responsible for dependence, poor health, and lack of cleanliness

 6...