The Spirit Catches You and You Fall Down by Anne Fadiman Essay
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The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame…show more content…
Merced's population was a one fifth Hmong and since MCMC offered the Medi-Cal plan which was a government funded service for people who couldn't afford health insurance, which most Hmong could not. More than eighty percent of the Hmong who obtained care were receiving free health care. The government only pays for so much, so the hospital has to pick up the rest of the bill. MCMC didn't have the money to hire interpreters, so as a makeshift they hired bilingual Hmong as lab assistants, nurse's aides, and transporters. Sometimes even these people weren't around and the Hmong children who attended English school were used as the translators. Even if the children and the makeshift workers could translate it would never be perfect for most medical English terms have no equal in Hmong, and it is awkward for children to ask such questions as "Do you want to take him of life support?" Questions like that should never have to be asked by a child. Foua and Nao Kao were illiterate and spoke only Hmong, so there problems were destined from the very beginning. They never understood what the doctors told them unless there was some sort of translator available. When a translator wasn't available they would sign without knowing what for, because they believed that in America if they didn't sign they would be deported or punished. Lia's parents were farm people they didn't know anything about
Chapter 13: Code X
Despite everything they had been through in Laos, Foua and Nao Kao considered the worst time in their lives to be after Lia had her big seizure. However horrible death, starvation, violence, and exile were, they were known tragedies. What happened to Lia was completely different.
Lia returned to MCMC on December 5, 1986. She was hot, breathing irregularly, and moving her arms. Peggy Philp noted that she seemed to be in pain. Neil avoided seeing her for a few days, as it was so emotionally difficult to witness her in a vegetative state.
The family brought a shaman to the hospital; he rubbed Lia's body with a white ointment that smelled like vodka and herbs. Foua sat by Lia's bed and learned to apply Vaseline to her lips, rub ointment on her diaper rash, cool her forehead with a cloth, suction her secretions, and feed her through a tube inserted through her nasal cavity. Peggy let them pour a herbal remedy through the tube, certain that Lia would die anyway.
The Hmong New Year fell during this time, normally the most important of all the Hmong holidays, in which families banish dabs, ask benevolent spirits for help, summon the souls of dead ancestors, dance, sing, and play courting games. They dress in their finest embroidered clothes, which often takes months to prepare. Lia's clothes were the nicest in her family, but nobody celebrated that year. Instead, the Lees brought funeral garments to the hospital to dress their daughter: a black hat, a black jacket, and an appliqued skirt. The nurses told Foua that Lia couldn't wear the jacket because they needed to access her upper body, but Foua dressed her in it regardless.
Lia's room was always full of visitors. Most were family members, but Dee Korda and Jeanine Hilt also came frequently. Jeanine was thankful that this tragedy hadn't happened while Lia was in foster care, or the Hmong community would have blamed her and CPS for Lia's death.
On Lia's second day at MCMC, Nao Kao demanded that the doctors remove Lia's IV and discontinue all medications. Peggy believed the parents wanted to let Lia die in peace rather than artificially prolonging her life. In fact, they believed it was the medicines that were killing her.
Foua and Nao Kao wanted to take Lia home, but the physicians wanted to make sure they had everything they needed to care for her before letting her go. When they were almost ready to discharge her, Nao Kao was asked to sign something that he believed meant that Lia was going to die in two hours. (It is likely that it actually said she would be released in two hours, at which point he could take her home to die.) Nao Kao decided that if she were going to die anyway, he might as well bring her home immediately so the older children could see her. He was particularly angry, perhaps because in Hmong culture, it is taboo to foretell a death, especially with such specificity. In response, he grabbed Lia and started running down the stairs. One of the nurses called a Code X, an emergency code for security breaches. The security guards caught him and brought Nao Kao and Lia back to her room. The attending resident, Dave Schneider, already overly stressed, angrily noted that Lia's nasogastric tube had been ripped out and wouldn't let her go until a new one had been inserted and X-rayed.
Lia left that night in her mother's arms. Her parents took her home, took off her funeral clothing, placed her on a shower curtain on the floor, boiled herbs, and washed her body. They believed her body gave way at the hospital because she had too much medicine inside of her. At home, she stopped sweating and didn't die.
Chapter 14: The Melting Pot
The Lee family - two parents and six children - had arrived in the US in December 1980, taking with them only a few clothes, a blanket, and a wooden mortar and pestle. Upon their arrival they spent a week with relatives in Portland, where they learned about electricity, refrigerators, televisions, toilets, grocery stores, and stoves. They didn't realize the cans and packages in the store had food in them, and they were afraid to use the stove in case it exploded.
Foua and Nao Kao now use American appliances, but they still speak only Hmong, practice only Hmong customs and religion, and know more about current events in Laos and Thailand than in the US. Unlike immigrant workers in the early 1900s who were given compulsory "Americanization" classes and wanted to assimilate into American society, the Hmong came to the US because they were trying to resist assimilation. They are what sociologists call "involuntary migrants." What they most wanted was to be left alone to be Hmong and allowed to be self-sufficient and agrarian.
While many among the first waves of Vietnamese and Cambodian refugees received vocational and language training when they arrived, the Hmong new arrivals were sent directly to their new homes. The logistics were arranged by VOLAGs (‘national voluntary resettlement agencies’) and associated local sponsors. New arrivals had to deal with dozens of bureaucrats from various agencies, something they were historically loath to do. Many also had to deal with Christian ministers, as many VOLAGs had religious affiliations. These refugees tended to have a higher likelihood of having psychiatric problems.
Despite having lived their lives in the mountains of tropical countries, most Hmong were resettled in urban areas with flat topography in the colder regions, as this is where most of the refugee services were concentrated. To avoid overly burdening any one area, the refugees were dispersed over fifty-three cities in twenty-five different states. In some places clans were broken up; in others, there were members of only one clan in a region, making it impossible for young people to find local marriage partners. A few nuclear families were placed in rural areas, where, isolated from their community and traditional supports, they suffered from an unusually high level of anxiety and depression. Refugee coordinators have since admitted how poorly the Hmong resettlement was handled.
Many Hmong found the new language, the strong emphasis placed on literacy, and the many new customs they were expected to learn overwhelming. They had to learn how to use telephones, refrigerators, garbage disposals, toilets, sinks, and stoves, and avoid doing things offensive to Americans such as picking their nose or spitting in public. The task was enormous, as reflected by some of the newcomers' "mistakes": they washed rice in the toilet, stored blankets in the refrigerator, ate cat food, and even hunted pigeons.
Americans, for their part, found the Hmong equally mystifying. The media used phrases such as "Stone Age" or "emerging from the mists of time" in their descriptions of the refugees. Articles were full of inaccuracies, such as postulating that the Hmong have no folk tales, that they don't make the connection between a drawing of a tree and a real tree, and that they are killed by their own nightmares. Americans were also perturbed by the fact that the Hmong were selective about what they adopted from the majority culture. For example, many learned to use telephones and drive cars, which helped them to keep in communication with one another, but they failed to learn English. Few people knew anything about the Hmong, even how to pronounce the name of the tribe, or that they had played such a large part in the war. Unaware of their rich history and complex culture, many Americans projected their own fantasies onto the Hmong, spreading rumors such as that the men sell their daughters and buy their wives, that women think speed bumps are washers for scrubbing clothes, and that they all eat dogs.
The Hmong were not only victims of slander; they also suffered from violence. One reason is simply that they were easy targets, unused to guarding against theft. However, some perpetrators were motivated by resentment over what they erroneously thought was preferential welfare treatment. The Hmong were mugged, beaten, stoned, and even shot and killed. Their tires were slashed, windows smashed, and property vandalized. Despite their history of fighting back against their oppressors, few took revenge; they may have known that doing so would have invited further violence, felt ashamed fighting back, or felt that they had little here worth defending.
There were a few exceptions, such as when several Hmong sent death threats to the Social Services Department after hearing rumors their welfare might be cut off because they owned cars, or when a father and son hit an American driver over the head for honking at them rudely. In general, however, they avoided the American penal system. In Laos, they administered punishments that fit the crime; for instance, a thief might be forced to repay more than he had stolen and to be brought to the village chief with his hands tied while the community jeered, thus shaming the criminal without depriving his family of a breadwinner. The Hmong had heard that any wrongdoing in the US would land them in jail, and they would do nearly anything to avoid that fate.
Rather than fighting back, many Hmong engaged in their time-honored tradition of flight. From 1982 to 1984, three quarters of the Hmong population of Philadelphia left the city, and around a third of all Hmong in the country relocated. They typically left en masse, without notifying their sponsors. This "secondary migration" thwarted the government's plan to evenly disperse the Hmong throughout the population.
The Hmong had other reasons for migrating besides escaping violence. Some states offered more welfare benefits than others, so many refugees moved to more generous states (such as California) once they stopped receiving Refugee Cash Assistance. Thousands also moved to California because they had heard they might be able to farm. The most important reason, however, was to reunite with other members of their clan.
Unfortunately, the most popular areas for secondary resettlement also had high unemployment rates, driven higher by the economic recession of 1982. Hmong had to compete with unemployed Americans for even the least skilled jobs. Few succeeded even in agriculture, as the skills they had developed in the highlands of Laos did not adequately prepare them for the type of farming used in California. By 1985, at least eighty percent of the Hmong in Merced County and the surrounding areas were on welfare. Even so, the Hmong continued to migrate, motivated by a desire to reunite with family members and strengthen their community.
The federal Office of Refugee Resettlement, concerned that the Hmong were becoming an economic burden on their new communities, tried to encourage Hmong to stay in their original communities by offering vocational training, English classes, and other incentives; however, the migration to California was pretty much unstoppable. The fact that most new refugees were being sponsored by family members already in the US rather than by organizations meant that the government could no longer control their placement. Unable to curb the influx of refugees to these areas, one program worked on encouraging those already there to leave, offering to pay moving expenses, subsidize a month or two of rent and food, and provide job placement to about 800 unemployed families who moved to areas with more unskilled, low-wage jobs. These families have fared well, with 95% becoming self-sufficient.
Hmong have found a variety of jobs, including as factory-workers, grocers, carpenters, welders, mechanics, teachers, nurses, and interpreters. Some younger Hmong have become professionals such as lawyers, doctors, dentists, engineers, computer programmers, and accountants. They serve as mentors for other Hmong and share information via the Internet. Older Hmong, however, are mostly stuck in entry-level positions, as they can't get jobs that require better English and they can't learn English at their current jobs. Cultural barriers have also held them back; for instance, one man quit rather than accept a promotion that would have put him above his Hmong coworkers.
In high-unemployment areas, the Hmong typically have no jobs at all. They are therefore often called the "least successful refugees" in the US, although this label refers only to their economic status and not to social indices such as rates of crime, child abuse, or divorce. A large percentage is on welfare (almost half in California), with the welfare system making it almost impossible for an average family to become financially independent. A man with a large family, for example, would have to work over 80 hours a week at a minimum-wage job to equal his welfare stipend and food stamp allowance. In addition, until the mid-nineties, welfare recipients in most states would lose all benefits if they worked more than 100 hours a month.
The 1996 welfare reform bill promised to deny benefits to legal immigrants, prompting some Hmong to apply for citizenship. However, many find the English language requirement an insurmountable obstacle. Some will move to states with more jobs, some will rely on relatives, and some will rely on welfare provided by individual states.
The Hmong get upset whenever they are criticized for accepting welfare, as they believe they deserve the money in exchange for risking their lives and losing their homes in the "American War." After doing so much for the US, they expected a hero's welcome. Instead, the US betrayed them multiple times: when American airlifts rescued only officers from Long Tieng, when not all Hmong who wanted to come to the US from the Thai refugee camps were automatically admitted, when they were ineligible for veterans' benefits, when Americans condemned them for taking welfare, and finally when the US announced that the welfare would stop.
At the same time, few Hmong would willingly accept welfare if they had another choice. The group has scored lowest among Southeast Asian refugees in levels of happiness and life satisfaction, and they suffer from disproportionately high rates of depression, anxiety, and other mental illnesses. They miss their homeland terribly, and many live with the unrealistic hope of returning. Here they don't speak the language, often cannot drive, and must remain isolated; at home they could raise animals, harvest food, and feel at peace. Of course, this remembered homeland is prewar Laos, which no longer exists.
Another challenge has been termed "role loss." Grandfathers who in Laos held the highest status in their clan now have less power than their grandchildren, who speak English and may have attended university. Men who served as colonels, military communication specialists, or flight crewmen now hold low-status jobs such as janitors, if they work at all. Children have become Americanized, soaking up the culture in school and in their communities, and they no longer give elders the respect they did at home. They may refuse to drive their parents around, express little interest in Hmong culture, and even get involved with drugs or violence.
Although many elders feel as if they are losing their culture, however, it has actually remained impressively intact. Hmong still marry other Hmong, marry young, do not marry within their own clans, pay bride prices, and have large families. The ethic of group solidarity and mutual assistance remains, as do clan and lineage structure. Tvix neeb ceremonies are common, babies wear strings on their wrists to protect their souls from abduction by dabs, people tell fortunes by interpreting dreams, and animal sacrifices are common. Most importantly, the Hmong temperament remains.
Chapter 13 represents the falling action of Lia's story as the family adjusts to the reality of her fate. There is a moment of final suspense when Nao Kao tries to take Lia from the hospital before she is discharged. Yet again, however, the medical system has the power. Despite the fact that the doctors could not save Lia, they insist on following proper medical procedure and allowing her to be taken home only on the hospital's terms.
Ironically, Lia's final tragedy occurs during the Hmong New Year, a time at which families traditionally banish dabs and call on benevolent spirits. Perhaps these spirits did appear to intervene in Lia's fate, for it was a miracle that she didn't die. Western medicine could not save Lia, but her family's love, care, and herbal remedies prolonged her life for many years. One wonders what would have happened had the doctors never been involved and the Lees had cared for Lia entirely using traditional healing methods. Would her epilepsy have killed her, no longer controlled with anticonvulsives? Or would Lia's body, no longer weakened by so much medication, have been able to fight off the infections that took her brain?
Chapter 14 continues the story of the Hmong, examining what happened when the refugees were resettled from the camps in Thailand to their new communities in the United States. Again, there are parallels with Lia's story. Just as Lia's treatment by the western medical system was ultimately ineffective, the resettlement of refugees by American agencies was administered poorly, due to a lack of understanding of the Hmong culture and the needs of the new arrivals. Despite coming from tropical, mountainous regions, the majority of Hmong were placed in cold, flat regions. To avoid overburdening any one region, they were dispersed across the country; sometimes this broke up clans, while in other places there was just one clan, making it impossible for young people to find local marriage partners. Just as the Lees took Lia's care into their own hands, many Hmong resettled in new area, most often to reunite with clan members.
These parallel stories reveal that both doctors and resettlement agencies behaved in a patronizing manner. Both believed they knew what was best - treat Lia with medication, resettle Hmong in areas with many refugee services and scatter them so as not to overwhelm the system - and their position of power ensured that the Hmong would initially comply. In both cases, however, ignorance rendered their actions ineffective, and the Hmong proved that they could care for themselves better than the Americans could. What was truly needed was cooperation. Doctors and resettlement agencies did have a lot to offer; however, so did the Hmong themselves. Their mistake was in assuming that they had all the answers, not recognizing the agency and knowledge of the people they were supposed to serve.
Were Lia's doctors and the refugee resettlement agencies racist? Certainly some of the Hmong's new neighbors were; fueled by ignorance, they responded both by slandering the Hmong and by committing acts of violence. It seems that better cross-cultural communication would have been beneficial in multiple arenas, not just in the hospital.