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The Spirit Catches You and You Fall Down

Family’s History

In the book, the author Anne Fadiman, describes a drama behind a collision of epistemologies, depicted by Lee’s family. They are refugees in Merced, California, United States. The Lee family came from a clan of Hmong people, originating in Laos. They arrived in Merced, California by the way of a refugee camp in Thailand. While in Merced, Lee’s wife, Foua Yang, went into labor for her fourteenth child Lia. She was born in the Merced Community Medical Center, and this is where controversies of the clash of Hmong and Western cultures begun. During her development, Lia becomes sick and epileptic. She suffered from a severe grand mal seizures and eventually becomes vegetative for the rest of her life. Treatment compliance becomes the origin of a tug-of-war for Lia’s life between her parents and her doctors.

Outline

This paper analyzes the clash between the Lee family’s culture and interaction with the doctors Merced Centre. In part one, it describes the roles played by the social and medical services in creating barriers to Lia’s treatment. A discussion of cultural dissonance is then analyzed to show the need for the understanding of different cultures. In part two, a discussion of the theories of formal organizations is analyzed. The need for development of social services in healthcare set up is then addressed in relation to Lee’s family case. Finally, a summary of the need for development of social services will be addressed.

Part one

Lee’s family and the values of the medical organization

There are several community and family issues in the book, that occur due to differences in culture and lack of understanding between the two sides of spectrum. For example, during the postpartum period, Lia’s mom was customary restricted to specific foods, which were criticized by the medical staff. After the birth of Lia, the medical staff refuses to give the placenta to Lao, as they thought that the Lee’s family was going to eat the placenta if they took it home. After the Lee’s family went home, they celebrated her birth by performing cultural rituals which included ‘huplig’- a celebration which includes a sacrifice for ancestral soul to entice/invite a soul into Lia’s body. When Lia is sick, the Lee family is seen to be trying their best to care for her while holding to their cultural beliefs. They believe in the use of shaman and herbs to try and return her soul to her, while on the other hand, the doctors in the medical organization were trying to use western medication to take care of the seizures. Lee’s family saw this as something that was making Lia sicker and not returning her soul at all.

The medications provided by the western doctors are considered not to be used by Lee’s parents, because they believe in the use of herbs and other holistic methods that is coining, cupping, and use of shaman. Lia’s parents’ decision of not giving her medication is considered by the doctors as a form of child abuse. They are considered to have even suggested of Lia’s removal from the household. This is a big form of cultural disparity, but the doctors don’t take time to find out and understand why Lia is not getting the medication. In the Hmong culture, it is a common to mourn, celebrate, or seek help on sickness by sacrificing an animal. This is something that Lee’s family still observe, but the American culture does not support.

Another clash in cultural values is where Hmong views illness as a physiologic response. They consider illness as purely a physical component where the soul and the body of a person are intertwined. Therefore, when Lee’s family presents the physical symptoms to the doctor, they correlate it with the illness of the soul. The routine practice of taking a patient blood samples was considered by the Hmong culture to be counterintuitive and barbaric. In their perspective, they viewed the body to produce only a finite amount of blood, and removing it would cause death. This became problematic to the doctors, as they believe in blood sample testing in the diagnosis of the disease.  

Cultural dissonance

Cultural dissonance is a sense of discord, conflict, and confusion, resulting from cultural displacement. The Lee family’s story illustrates how cultural dissonance and misunderstanding affects social inequities in health care. First, the language barrier between Lee’s family and the medical staff makes it difficult for them bridge each other. Fadiman portrays the situation very well: “Doctors on the late shift in the emergency room had no way of taking a patient’s medical history, or of asking such questions as where do you hurt?” (Fadiman, 1998). During the diagnosis, the doctors misdiagnosed Lia of having bronchial infection, yet she was epileptic. Even after Lia had received the right diagnosis, her brain was harmed due to her parent’s inability to administer drugs to her as prescribed. Unfortunately, this lack of communication caused Lia to reactive subpar medical care.

Secondly, the Western and Hmong cultures didn’t allow doctors and the Lees with enough openness to the perspectives of the other culture to offer Lia the aid she needed. Of all of their beliefs about the soul and Western medicine, included in them are: “Most Hmong believe that the body contains a finite amount of blood that it is unable to replenish, so repeated blood samplings, especially from small children, may be fatal. When people are unconscious, their souls are at large, so anesthesia may lead to illness or death” (Fadiman, 1997, p. 33). On the other hand, doctors thought that their medical, rationalistic worldview was the only legitimate way of approaching healthcare because of their advanced training and education. Another instance is where the doctors views Lee’s condition as epilepsy, while her parents understood it as soul loss. These cultural discords led to severe consequences for Lia.

Lastly, the rationalist doctors and the animist, spiritual Lees had portrayed different religious frameworks. Lees believed that sickness is caused by wicked spirit that steals a person’s soul and this can only be returned by ritual performance. Other Hmong traditional medicinal practices include the use of special herbs, animal sacrifice, name changing, and skin pinching. The doctors disagree with Lee’s believe of treatment, and they think that Lia’s condition was biological and could be treated with proper medication. Lia’s medical problems can be viewed by many to have been propelled by the cultural conflicts between doctors and Lia’s parents, hence the need for recognition of cultural and social issues in medical care.

Theories of formal organizations

The two theories of formal organizations addressed in this book are the different social set ups and the paradoxical dilemmas, exhibited by the two cultures (Helman , 2000). For example, the social difference in cultures between the Western and Hmong cultures brings out the need for the development of social services in the healthcare set up. It’s paradoxical that the use of herbs and other holistic methods that is coining, cupping, and use of shaman, can help treat a sick person.

The possible organizational changes required at Merced hospital is the creation of social services agencies (Galanti, 1997). The medical community should ensure that they offer greater understanding of how cultural differences affect the health care. The medical personnel should also ensure the existence of cultural diversities, and they should ensure they learn, are aware, have necessary skills, and meet and work with people of different cultures.

Part two

Hmong culture in relation to social work practice

From the article ‘Joining hands across the divide’, the Hmong community is described to have originated from the highlands of Northwest Laos, as well as from Thailand and Vietnam. They were then resettled by the U.S to Minnesota, Wisconsin, and North Carolina. The Hmong proverb, ‘one stick cannot cook a meal or build a fence’, portrays the Hmong culture as a collective identity, which contrasts to American individualism. The perceived intrusion of social government into their lives has resulted into frustrating tragic incidences for Hmong families. For instance, physical disciplining of children, allowing young children to babysit young ones, and cultural healing practices such as coining or cupping led to the investigations by the Child Protective Services and Department of Social Services. In Hmong community marriage contracts of young girls to adult males are culturally arranged, these in most instances lead to cases rape. Although American law regards women independence, Hmong community disregards these social practices. This has propelled the U.S to provide education to new immigrants, like for example the provision of the pamphlet ‘Your New Life to the United States’, so as to bridge the cultural divide.  Other cultural collaborations and social services were developed to focus on the standards of child abuse and neglect.

Importance of culture social practice

Culture can be describe as the integration pattern of human process, that entails customs, thoughts, beliefs, values, communications, religious, racial or social perspectives. Differences in culture seriously affect medical care delivery. Thus, cultural competency is required in all areas of healthcare set up, so as to curb these challenges. The constant changes, growth, and demands in the health care system have been considered to have had a serious viability and impact on the need for social workers in all health care settings and areas. The ever growing technology in the medical field has improved the quality of life, yet it has raised concerns in the legal, social, and ethical healthcare dilemmas for healthcare providers, families, and individuals. Social work is, thus, important in the handling of psychosocial health care implications. Social workers in the health care segment will ensure the provision of such services as crisis intervention, health education, case management, and supportive counseling. Thus, such cases like Lee’s, would have been addressed by the social workers. If the Merced staff and doctors had looked into Hmong beliefs and medical practices, Lia’s would have been handled promptly and maybe she would not have suffered as she did. Their refusal to understanding the people they were dealing with and discharging them, as savages eventually led to Lia’s final seizure.

Learning experience

Through analysis of ‘The Spirit Catches You and You Fall Down’, I have come to learn that illness is more than symptoms and pathologies. I view that people should accept and appreciate the cultural differences that exist in our society, and for this to happen, in any cultural set up, awareness should be created. In handling patients, I would advise the doctors to not only rely on written facts while accessing the patient, but learn how to reduce the resistance and interactive mistakes that can hinder communication. This brings in the importance of social workers in a medical care set up.

Conclusion

When handling any kind of a patient, trust should always be built. Like for instance the healthcare providers in this book seemed to be either frustrated or too busy to develop trust in the patient. If they would have had it, better results and smoother intervention would have been achieved. Another ethical issue that should be addressed is the barriers to communication. In a healthcare set up, the compliance connected to ethnocentrism and barriers to communication should be reduced, if not eliminated to bring the patient and the medics on the same platform. As globalization continues to grow, the medical community requires a higher level of understanding of how cultural boundaries affects healthcare. As depicted by Lia’s story, healthcare cannot be administered in a vacuum, without communication between patients, physicians, and patient’s families. It is an important process of medical care, as it necessitates a healing of a patient’s entire well being.