This study guide uses the edition, which includes an afterword updating the book 15 years after its original publication. The doctors at MCMC struggle to understand the Lees, as there is no Hmong translator on staff to provide more information.
Ernst and Dr. Philip diagnose Lia with Lennox-Gastaut Syndrome, a serious neurological disorder that causes frequent seizures. They prescribe anticonvulsants for Lia, but her parents do not understand the necessity of giving Lia the medication and are wary of the side effects.
The more seizures Lia has, the more she suffers. She begins to show signs of significant brain damage and developmental delays as a result of the seizures. After Lia returns home to her parents, social worker Jeanine Hilt teaches Foua how to give Lia her medication, satisfying CPS requirements for reuniting Lia with her family.
Unfortunately, four months after Lia returns home, she has a grand mal seizure. Medical professionals discover she is brain dead and suffering from septic shock. In addition, they meet a doctor named Dan Murphy , who is curious about Hmong culture. This is unusual; at MCMC, most of the doctors are annoyed by the number of Hmong patients they see who are unwilling to accept proper treatment. Although Nao Kao and Foua are resistant, Dan eventually convinces them and he is able to stabilize Lia.
Totally unaware that the Lees have already diagnosed their daughter with the spiritually-charged quag dab peg , Dan diagnosis her with epilepsy. Wanting to monitor her condition, he keeps her in the hospital for several days before discharging her and giving Nao Kao and Foua directions to administer a specific medicinal regimen they have no way of understanding or following.
As previously mentioned, the Hmong attitude toward Western medicine is one of relative skepticism. In some cases, Hmongs believe that hospitals and certain medicines are capable of making people even sicker than they already were.
This is not a malicious perspective, but rather the direct result of their spiritual practices and commonly held beliefs. Despite these misgivings, Nao Kao and Foua continue to take Lia to MCMC when she has major seizures, which happens many, many times; in fact, between the ages of eight months and four and a half years, she is admitted to MCMC 17 times and makes over visits to the emergency room.
During this period, the Lees meet Neil Ernst and Peggy Philp , two head pediatricians at MCMC who are fiercely intelligent, inquisitive, quick to admit their mistakes in the name of problem solving, and, strangely enough, married to one another. At first the doctors believe that this is due to a lack of comprehension.
Thus, the complex cocktail of various medications proves difficult to follow, which leads Lia to continue to have seizures that threaten her brain development. Not one of these nurses, however, is able to get through to Nao Kao and Foua, who nod along to directions but fail to follow through with the regimen when left to their own devices.
It comes as no surprise, then, that the Lees stop giving Lia any medication at all for three months. The next time Dan sees Lia, she is being rushed into the hospital in the middle of a serious grand mal seizure.
Struggles continue between the doctors and the Lees. Neil Ernst grows increasingly frustrated that Foua and Nao Kao refuse to give Lia all the necessary medication, a decision he believes is eroding her brain capacity. Shortly after Neil writes this note, Lia is placed in foster care for two weeks, after which she returns home in order to give Nao Kao and Foua one final chance to properly administer the medications.
Still, though, blood tests reveal that Lia is not taking the prescribed amounts, and she is once again taken away—this time for a minimum of six months, a period during which her parents are expected to prove themselves capable of caring for her needs. Lia is placed into the custody of Dee and Tom Korda , two loving and generous caretakers who become close with Foua and Nao Kao, encouraging them to visit and, eventually, even officially suggesting to the government that they regain custody of their daughter.
The Hmong's tenacity and unwillingness to surrender helped them to survive for thousands of years. However, it also made them wary of submitting to doctors' orders.
A compounding factor in Hmong noncompliance was their taboo against many western medical procedures. For instance, they believed that the body has only a finite amount of blood and that frequently taking one's blood can be harmful or fatal.
They thought surgery might lead to disfigurement not only in this lifetime but also in subsequent ones, and that autopsies could prevent souls from being reborn. For this reason and others, western doctors frequently struggled with their Hmong patients. Fadiman suggests that acknowledging other belief systems could go a long way in improving the outcomes of patients from different cultures.
She cites examples of successful cross-cultural programs, such as one in which shamans are encouraged to work alongside western health care providers. Her work has had a lot of influence, as it is frequently read in medical training programs and "cultural competence" is now recognized as an important trait. What were the Lees hoping to find in the United States? Chapter one.
Foua delivered each child with her own hands, without a birth attendant, keeping silent to avoid thwarting the birth with noise. She then washed each baby with water she had carried from the stream. Her husband helped by bringing her hot water to The Spirit Catches You and You Fall Down study guide contains a biography of Anne Fadiman, literature essays, quiz questions, major themes, characters, and a full summary and analysis.
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