Educacion

Book Review by Lucia Q Sumner

The Spirit Catches You and You Fall Down by Anne Fadiman: Closing the Gap between Cultures.


Anne Fadiman shares with the reader the story of a Hmong family, the Lees, and their beloved child Lia. Lia suffered epileptic seizures from the time she was 3 months of age to the time she was four and a half years of age. The diagnosis given by the doctors wasepilepsy but the Lees believed that Lia’s condition was caused by qaug dab peg, or “the spirit catches you and you fall down.” During her first four and a half years of life “Lia Lee was admitted to MCMC seventeen times and made more than a hundred outpatient visits to the emergency room...”(p. 38). Finally, after two prolonged epileptic seizures, Lia fell into a vegetative state. The writer alsodescribes the Lee family’s trip from Laos to the refugee camp, and ultimately to America. Throughout the book the author flashes the reader back to Hmong history. However, the author’s main objective is to illustrate the abysmal cultural divide between American heath care providers and the Hmong. The cultural gap in the book was created by the following factors: language barriers, cultural barriers,ethnocentrism and lack of cultural sensitivity and empathy.
An essential part of providing responsive healthcare is the communication that occurs between provider and patient. Without it, treating a patient can become a difficult task at the very least and a treacherous proposition at its worst. The doctors and the Lees had a communication gap because MCMC did not have trained medicalinterpreters on staff. Medical interpreters are not just bilingual individuals. They need to undergo rigorous training and examinations and require certification to practice in their field. Interpreters need a firm grasp of medical lingo and colloquial terminology in both languages. Doctors at MCMC placed patients at risk by routinely using unqualified interpreters. Hospital personnel that were bilingual(such as the janitor) and/or patients’ relatives (including children) were used to convey sensitive medical and personal information. One of the patients put at risk by this practice was Lia. She was wrongly diagnosed with pneumonia as an infant because her parents couldn’t explain her symptoms to her doctors. None of the medical interactions with the Lees took place in the presence of aprofessional medical interpreter. In all the times they met with the Lees, Drs. Neil Ernst and Peggy Philp never tried to find out the reasons for their uncooperativeness and never opened the lines for real constructive communication through the use of a medical interpreter. Drs. Neil Ernst and Peggy Philp were unaware to the function of a tvix neeb and the dangers of a Dab.
The use of trainedmedical interpreters sometimes is not enough and the help of a cultural broker may be required. Cultural brokering is “…bridging, linking or mediating between groups or persons of different cultural backgrounds to effect change” (Jezewski, 1990). The cultural broker minimizes cultural misunderstandings due to lack of cultural competency. May Ying acted as a cultural broker (although untrained) forthe author, aiding her in reaching the Lees. It is important to note that interpreters can also be trained as cultural brokers, thus being able to transmit information in a manner that make sense to people of a different cultural background. For example, an interpreter trained as a cultural broker could have explained to the doctors at MCMC that the reason families wanted the placenta after a birthwas to protect their new born child in the afterlife. Unfortunately, several doctors refused to give the Hmong families the placenta because they though they wanted to eat it. For the Hmong, the placenta needs to be buried in the family home because after death the soul travels back retracing its live journey to
the house where the placenta is buried. If the placenta is not found the soul is...