In addition to the logistical complications cited in the Immigrant Health Care post, immigrants face social barriers that prevent them from receiving adequate health care. Instead of viewing immigrants as one group, each group’s ethnicity, age, language, and culture must be taken in to account to understand an immigrant’s approach to western health care. These socioemotional conflicts are overlooked by empirical research, but become painfully obvious when viewed through an individual experience. The Spirit Catches You and You Fall Down explores the clash between two cultures through a Hmong family and small county hospital in California to keep Lia Lee alive. Anne Fadiman delicately presents two sides that both want their respective idea of what is “best” for Lia. Faced with language and cultural barriers in addition to mutual distrust, American doctors and the Lee family led to Lia’s deterioration of health.
Amidst the Vietnam War, the United States created the Hmong Armee Clandestine. Half of the Hmong population in Laos died in the “Quiet War.” By 1970, forced to adapt their migratory habits to wartime, more than a third of the Hmong in Laos had become refugees within their own country. In the provinces of Hous Phanh and Xieng Khouang, the war has reached into every home and forced every individual to make the agonizing choice of flight or death. Today, more than 200,000 people live in settlements and military bases, confined to a mountainous strip of only 50 to 90 kilometers. The rest of the provinces are in total desolation. After the U.S. signed the Paris Agreement pledging to withdraw its forces from Vietnam, the Pathet Lao crossed the cease-fire line and announced the extermination of the Hmong. In a matter of a decade, half their population was killed in war, 3,000 were displaced, and over 10,000 were left at the hands of the Pathet Lao. The Lee’s distrust of America began here.
Lia Lee was the Lee’s first child born after arriving in the United States. She was birthed in a small county hospital in Merced, California with doctors who had no regard for spiritual practices that the Lee family felt would determine her soul’s presence, and therefore, their daughter’s reason to live. Three months later, Lia’s sister slammed the front door, and as the Lees believed, frightened the soul out of Lia’s body. The American doctors diagnosed her with epilepsy. The Hmong regard it as divine, because many of their shamans were afflicted with it. They have been chosen as the host to a healing spirit, allowing them to communicate and negotiate with the spirit realm in order to act as public healers to the physically and emotionally sick. In addition to these beliefs, Hmong also have many customs and folkways that are contradicted by those of the American mainstream and medical communities. For example, some Hmong traditionally perform ritual animal sacrifice, and because of very specific burial traditions and the fear of each human’s many souls possibly escaping, the traditional Hmong beliefs do not allow for invasive medical surgery.
Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust and misunderstandings, and the inability of the doctors to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia’s condition worsened. The dichotomy between the Hmong’s perceived spiritual factors and the Americans’ perceived scientific factors compromised Lia’s health. Ultimately, in a climax of miscommunication leading to Lia being seen as an illness rather than a complete person, Lia suffered a detrimental seizure that left her in a vegetative state. After suffering through language barriers, cultural misunderstandings and judgments, pre-conceived notions, and removal from her parents’ care, Lia Lee became the casualty in the battle of two cultures.
Anne Fadiman’s book turns a tragedy into a case study that has been used for medical patient reform throughout the country. The understanding that culture affects health just as much as the patient’s access to health is crucial in understanding the future of our nation and its people, regardless of documentation. Immigration is an undeniable mixing of cultures, and this cannot be forgotten once inside an emergency room.
Fadiman, Anne. 1998. The Spirit Catches You and You Fall Down. New York: Farrar, Straus, and Giroux.