ningerbil (ningerbil) wrote in 50bookchallenge,

Book 37- The Spirit Catches You and You Fall Down

37. The Spirit Catches You and You Fall Down, by Anne Fadiman. This is a must-read for anyone who works with different cultures. This one deals a lot with the Hmong culture. The book focuses on one family, the Lees, and their second youngest child Lia, who was diagnosed with severe epilepsy. Her parents took her for treatment at a county hospital in Merced, but the clash between Hmong culture and the western/medical culture, coupled with significant language barriers, led to multiple misunderstandings and deep distrust on both sides. At one point, Lia was even taken into state custody when her parents didn't giver her the proper medications (due to a combination of suspicion and not comprehending the complicated and changing regimen the doctors wanted them to follow). That move -- which even the foster family condemned and even the doctor who started the process said he regretted -- created a further rift in relations. The antipathy on both sides was at least partially responsible for Lia's final two grand mal seizures, which put her in a vegetative state at age 4. This is not in the book, but she lived for 26 years in a vegetative state, dying two years ago. Fadiman includes a lot of interviews from the Lees, the doctors at the county hospital, others in the Hmong community and those who work with Hmong. On one hand, you do feel bad for the American doctors; trying to work with Hmong, whose customs and language are worlds different from American culture, would be difficult, especially at the end of a 30+ hour shift. But it also highlights the hubris of American culture and Western medicine. I am glad to say, according to this book, that steps were taken by the hospital after what happened to Lia to make sure that not only interpreters but cultural brokers in the facility when communicating with Hmong patients. It's sad, however, it took such a tragedy to do what should have been done in the first place. If a facility knows that it has a sizable immigrant population, then efforts should be made to at least have a rudimentary understanding of that culture. My knowledge of Hmong culture is limited, but even I knew things about the culture that the doctors then were clueless on. Fadiman covers the family every other chapter, with the other chapters dedicated to Hmong culture and the Vietnam war; the U.S. withdrawal was the impetus for the Hmong to immigrate to the United States. I do wonder if the author's speculation that Lia might have had (and the author does say "might") a normal life, with the simplified medicine regimen (which the parents did follow), had her doctors done more effective communicating to begin with, is a stretch. To be sure, better understanding would not have created the deep distrust felt not only by the Lees but their entire family (and Hmong families are very close-knit). But Lia had her first seizure at 3 months old, and she often had multiple seizures a day, which eventually had an impact on her language skills and abilities. The window between the consistent medicine regimen and no seizures to the final two that left her nearly brain dead was a scant few months. When you look at any condition - whether it be dementia, cancer, Parkinson's, or another disorder- striking at an atypically young age, the prognosis is never good. We will never know, however. Only other nit I have is specific dates are scant; a part of this could very well be that the Hmong concept of time and date is very different from the American view.

Currently reading: Just My Type, by Simon Garfield, and The Devil's Teeth, by Susan Casey.
Tags: non-fiction

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