The Spirit Catches You and You Fall Down PDF

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HSCI-135 Professor Chris Yen Writing Assignment 2 The Spirit Catches You and You Fall Down I am fortunate enough to have never faced any issues with the healthcare system in the United States. My parents have always been hard working people, who have provided health care insurance to my sisters and me. From my own experiences, I have easy access to my doctor, however I realize that at my age of 20, I haven’t faced the realities of the healthcare system since I am still under my parent’s insurance. I have taken Health and Healing Systems: Cross-Cultural Perspectives (HSCI-164) course at DVC and it really broadens the spectrum of different types of healing systems because it doesn’t just focus on western medicine being the only type of correct medicine. I really enjoyed taking this class because we discussed about Persian medicine, Chinese medicine, and Greek medicine, and was exposed to learning all different kinds of healing methods. In “The Spirit Catches You and You Fall Down”, there is a language barrier that makes it difficult for Nao Kao and Foua to understand the doctors. Because of this language barrier, Nao Koa and Foua have troubles with understanding the treatment for their daughter, Lia, who is suffering from epilepsy. “Since Foua cannot read and never has learned to recognize Arabic numerals, it is unlikely that she followed these instructions” (8), Foua, being unable to even recognize numbers, will have tremendous difficulties trying to read words. This difficulty makes it impossible for them to communicate with Lia’s doctors, “Except during that brief hiatus, there have been often no Hmong-speaking employees of any kind present in the hospital at night” (25). Not only does Lia’s parents have no understanding of English, the hospital has no Hmong-

speaking employees. The language barrier leads eventually to misinformation, since the Hmong family cannot understand English, false assumptions are made, “After you die, why do American doctors try to open up your head and take out your brains? Do American doctor eat the livers, kidneys, and brains of Hmong patients?” (32). However, we see more language barriers when Lia is treated at the hospital and due to the lack of interpreters and a misunderstanding, she is falsely diagnosed with “early bronchopneumonia or tracheobronchitis” and was incorrectly given antibiotics. Not only was she misdiagnosed, the doctors were not making it any easier for her parents to understand what was going on. This incorrect diagnosis of Lia by her doctors should have been deemed as completely unacceptable. Her doctors didn’t try to really figure out what was wrong with her, and it just seemed like the doctors were trying to avoid the cultural confrontation of discussing the real origins and symptoms of Lia’s illness. I feel that this language barrier is important to emphasize, personally for me because I have elderly Filipino grandparents that do not understand much English. In some ways, I can understand that the language barrier between doctors and patients can be different, but it isn’t an excuse for a doctor to not give his/her 100% effort into treating the patient. Because my grandparents have difficulties fully understanding their doctors, usually my auntie, who is fluent in English, has to accompany my grandparents to their doctor appointment. Although my grandparents do understand most English, we always ask for a family member to attend their appointment with them in case my grandparents don’t have a full understanding of what the doctor is trying to say. My grandparents also don’t communicate back that well in English, and instead prefer to speak in Tagalog and have my auntie translate it to the doctor in English. Unfortunately, like in Lia’s case, not everybody has an English-speaking family member, which then allows for the language barrier to occur between the doctor and patient. Lia’s situation

brings light to the language barrier and shows us why it is important for our health that we have multilingual doctors in order to accommodate for patients who do not speak English. This leads us into the discussion of cultural differences between the Hmong people and Americans. The Hmong people do not believe in Western medicine, and have many differences with the doctors, Peggy Philp and Neil Ernst. Part of these differences have to do with Peggy and Neil misunderstandings and cultural biases associated with the Hmong culture. Because Neil and Peggy have no knowledge about the Hmong culture, it becomes even a bigger problem than the language barrier. The Hmong family believes more of the traditional healing methods that they were taught by tvix neeb. The parents of Lia don’t necessarily reject western medicine, but they just don’t understand it. We see this during Lia’s first seizure, and instead of calling it a seizure, Foua and Nao Kao believed that noise of the slamming door caused Lia’s soul to flee, “… the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as quag dab peg, which means ‘the spirit catches you and you fall down’” (20). The family doesn’t make a medical diagnosis of seizure, and instead call it an illness called quag dab peg. The cultural beliefs that Lia’s parents have led them to believe that the ellipsis is of a spiritual origin, and her doctor considers her illness to be caused by neurological disorder. This indifference makes it difficult for her parents to comply with the doctors because they were scared that too much medicine would interfere with the spiritual healing. Her parents also do not understand the treatment or have no knowledge on western medicine at all.

According to the Association of Academic Health Centers

Internationals, “By making a determined and conscious effort to return to their historical roots, physicians can excel at two traditional skills: (1) respecting the right of patients to make choices according to their values and understanding how these values impact care decisions; and

(2) having real and tested abilities to provide the uniquely human services than patients need, most notably empathy and compassion”. It can be argued that Neil and Peggy did not take cultural backgrounds into consideration when treating Lia. Besides the language barrier, Neil and Peggy fail to try and understand the spiritual origin that Nao Kao and Foua believed the ellipsis are originating from. Instead of trying to understand how spirituality is related to health in Hmong culture, Lia’s doctors completely disregard it and stick to their teachings of traditional western medicine. In “The Spirit Catches You and You Fall Down”, Fadiman reveals the difficulties of the U.S healthcare system and how it failed to understand what Lia’s culture was really about. The book is trying to present the cultural divide that is present in the healthcare system through telling Lia’s story. In the healthcare system, we don’t always account for all the different factors than can be affecting the patients, and physicians only account for physical factor. Doctors don’t put into consideration the language the patient speaks, or if they even understand what the doctor is trying to say. We see this when an invasive was done on Lia, and her parents were told after it was already performed, “I don’t know why they did it. I wasn’t there yet, and they didn’t give me any paper to sign.” (148). Without her parent’s knowledge or consent, the doctors decided to subject Lia’s body to this procedure. Fortunately, for my grandparents, my auntie always joins them to their appointments to avoid any miscommunication between my grandparents and the doctor. These are the flaws in the healthcare system and it something that must be addressed in healthcare. Medicine is supposed to be for primary care and traditional medicine is to help people maintain their health. However, physicians and doctors sometimes do not understand what needs to be treated and fail to realize that that spirituality and mental health are connected

with the overall physical health of a patient, “Medicine was religion. Religion was society. Society was medicine” (60). In the Hmong culture, medicine, religion and society are all intertwined in each other. Doctors do not have a cultural understanding of the backgrounds of their patients and would make better diagnostics or analysis of their patients if they did. Doctors do not have background on cross-cultural perspectives of health, disease and medicine, “To most of them, the Hmong taboos against blood tests, spinal taps, surgery, anesthesia and autopsies- the basic tools of modern medicine-… What doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance” (61). This brings us to the theme cultural humility that is present throughout the story. According to the American Psychological Association, “Cultural humility is one construct for understanding and developing a process-oriented approach to competency”. The doctors did not practice cultural humility in Lia’s case because they weren’t able to empathize with the traditional Hmong lifestyle or even bother to learn about the Hmong culture. The question of how we can improve our healthcare system arises from learning about Lia’s story. One thing is to realize that different cultures have different practices, so some things that we do in western medicine can be perceived unethical in other cultures. According to An introduction to cultural differences provided by the Western Journal of Medicine, “Knowledge of cultural customs can help avoid misunderstanding and enable practitioners to provide better care”. In regard to this week’s discussion, realizing the differences in health care systems between different countries is astounding. Most countries have successfully enacted universal health care and it is surprising that the United States doesn’t. According to the Unnatural causes video, In Sickness and In Wealth, despite the fact that nearly half the billionaires in the world are in the U.S, 40 million Americans have no healthcare coverage. Our average income in American is 20-25% higher than in Japan, the U.K and Sweden, but the wealth in the United States is still

unevenly distributed, creating an even bigger gap between the rich and poor. If the United States has half the billionaires in the world and is a wealthy country, I question why our healthcare system is completely broken. There needs to be more federal monies funded into the healthcare system, and in Lia’s case, there should have been more resources for her at the time. The government needs to invest monies into the federal health programs that provide health resources to all income levels and to all cultural backgrounds in order to reduce disparities. Citations (2000). An introduction to cultural differences. The Western journal of medicine, 172(5), 335-6. Wartman, S. A. (n.d.). Volume 2, Number 1. Retrieved from http://www.aahcdc.org/PublicationsResources/Series/Nota-Bene/View/ArticleId/20829/The-Role-of-the-Physician-in-21st-CenturyHealthcare...