This story has innumerable examples of how culture affects the psychology and behavior of the parents and community of one sick Hmong child.
- beliefs about what causes sickness
- epilepsy is when the soul flees the body, or is stolen.
- causes concern but also pride
- medication was causing sickness
- can't give medicine forever
- beliefs about what cures sickness
- treat the soul and the body
- ceremonies
- rituals
- Western medicine seen as disrespectful
- finite amount of blood (but repeated blood tests)
- can't take out organs without messing up next life
- misconceptions about what the doctors were trying to do lead to fear
- the rituals required for being and then for un-being (living and dying)
- attaching the soul to the body
- burying the placenta under the home
The behaviors and beliefs of the US medical community are painfully illuminated by this collision
- Epilepsy has a natural cause just as other diseases have
- not asking the family what they thought was causing the seizures
- The shamanistic rituals might be harmful
- not allowing Hmong mothers to take home their placentas
- cutting off spirit strings for fear that they were fomites
- Westerners hold all of the medical knowledge
- medicine not as exchange, but as gift
- Communication is not as important as are objective laboratory results
- little effort to secure translators
- 5-month delay between medical presentation and diagnosis of epilepsy
- translating just language instead of having a "cultural broker" (95)
- Failure to understand why dilantin was not being given at home, and resorting to CPS to intervene.
- Viewed taboos against blood tests, spinal taps, surgery, anesthesia and autopsies as "self-defeating ignorance" (61).
- Episiostomies one decade but not the next
- Inability to compromise, to give up the "medically optimal" treatment in exchange for one that was more acceptable to the family (257).
- Not a single word in Lia's entire medical chart "dealt with the Lees' perception of their daughter's illness" (259).
The political, social, and economic determinants of this Hmong family's situation include:
- The long history of genocide attempts by the Chinese and other groups.
- "they would rather flee, fight, or die than surrender"
- The Hmong fight against French colonialism in
- The Hmong alignment with US interests against the socialist Pathet Lao party throughout the Laotian civil war, and then when the US and Hmong were defeated and the Vientiane government fell in 1975, yet another attempted genocide of the Hmong.
- The Lees' time in a Thailand refugee camp Ban Vinai.
- Immigration and placement in Merced, CA.
- Racism, misunderstanding
- Each side expected the other to be grateful.
- US success measured in economic terms
The medical system of the US
- No payment for cognitive work or time spent with interpreters
- Practice is responsible for paying for interpreter
- "Evidence based"
- Little training in cultural medicine
- little training in cognitive errors. "If it had been a brand-new kid walking off the street, I guarantee you Neil would have done a septic workup and he would have caught it. But this was Lia. No one at MCMC woul have noticed anything but her seiaure. Lia was her seizures" (256).
- The idea of "compliance" (261) "implies moral hegemony".
What have I learned from this book? What questions remain?
- Arther Kleinman's cross-cultural medicine questions (260).
- What do you call the problem?
- What do you think caused the problem?
- Why do you think it started when it did?
- What do you think the sickness does? How does it work?
- How severe is the sickness? Will it have a short or long course?
- What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
- What are the chief problems that this sickness has caused?
- What do you fear most about the sickness?
- Model of mediation instead of coercion. Negotiate with another Hmong or a medical anthropologist. Compromise must come from both sides.
- "If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" (261)
- Mindfulness of my own emotions and reactions can improve my ability to be a healer.
- Which is more important? Life or Soul? (277)
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