"The Spirit Catches You and You fall down", what is this book about and how is it relevant to Applied Medical Anthropology?
This book eloquently explains the clash or 'miscommunications' between two cultures: Western medicine and Hmong traditions. Differences not only between languages but ideas, culture, religion, beliefs, concepts, theories, and medicine in general. These differences were focused around a young Hmong epileptic girl, whose care was explicitly exposed to the western society. Were these differences a result of cultural incompetence, would this child's care been changed if these differences resolved or more importantly if applied medical anthropology were utilized? These are questions in which could never be answered completely, but does reiterate the importance of applied medical anthropology.
Applied Medical Anthropology has many times in the past been used to understand why a certain culture was reluctant to a new health policy, this same concept could have been used in Lia Lee's case. In the beginning, applied Medical Anthropology could have been used to understand why Lia's mother was noncompliant with the medications. Understanding this would have prevented possibly the unrelenting seizures that lay ahead of her, the eventual involvement of child protective services, and the resultant foster home placement of Lia. What if a medical anthropologist had investigated a little more into how Lia's parents viewed her illness, how they viewed the doctors and their care, how they viewed her prescribed medications, would Lia's care been improved? Would her brain death which occurred during a status epilepticus episode been something that could have necessarily been avoided? If not, could it have been prolonged? We are not certain if even applying medical anthropology would have changed Lia's morbid future, but we are confident that exploring the parents religion and beliefs would have helped many other situations, and possibly lessened the amount of seizures that Lia had suffered from. Lets take for example the initial medication regimen that the physicians had prescribed for Lia.
Lia's family was Hmong, spoke very little english and had never even seen numerical symbols before. This country was new and foreign. In the Lee's country, epilepsy is not necessarily seen as a bad medical condition, as many whom do possess this, become shaman. To the Hmong, a shaman is a religious leader, one who can fly in the sky, argue and negotiate with spirits. To the Lee's, Lia's condition made her 'special'. In their country, disease and illness is not treated with medications, but with a shaman to help negotiate with the spirits. Western medicine, to say the least, was completely foreign, odd and new to them, they didn't truly understand it. Even the concepts in which western medicine operate were so foreign and bizarre to them. Taking too much blood was dangerous because they were unaware of the concept that blood indeed regenerates, but if you had no knowledge or concept of this, wouldn't you be afraid of too much blood being taken from your child? Also numerical symbols, such as time, was a completely new concept to the Hmong people. Applying medical anthropology to this case would have helped shed light onto these thoughts and beliefs and would allow the physicians to see medicine in their eyes. Lets take for example the initial medication regimen that the physicians had prescribed for Lia.
Although there were many factors in this situation that prolonged appropriate care, such as prolonged correct diagnosis of her condition, there was also another huge factor which was the constant changing of medications. "By the time she was four and a half, Lia's parents had been told to give her, at various times, Tylenol, ampicillin, amoxicillin, Dilantin, phenobarbital, erythromycin, Ceclor, Tegretol, Benadryl, Padiazole, Vi-Daylin Multivitamins with Iron, Alupent, Depakene, and Valium. Because these medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescriptions changed twenty-three times in less than four years" (Fadiman, 1997). Even for a colloquial American individual, this would have been confusing and frustrating. Not to mention the fact that the Lee's spoke little english and have no familiarity to numbers. They could not read the labels! Applied and critical medical anthropologists could have taken time to try and understand this. Try to see why there was noncompliance with medications. This frustration and confusion just built a wall between the Lees and the physicians at the hospital. Would Lia's care from the very beginning changed the rest of her life?? I think it would have, and definitely think that medical anthropology was not utilized in the slightest bit and was detrimental to this young child's life.
Applied and critical medical anthropology in todays news!
This book has had an effect on the initiation and application of medical anthropology. Although Lia Lee's case was heart breaking, it was beneficial in that it opened up the importance of medical anthropology along with cultural competence. The very essence of the patient and physician understanding each other is the bolster for appropriate and effective care. Without this understanding or knowledge the results can be lethal. Today we can utilize medical anthropology in current issues that we hear about today. There are an increasing amount of refugees and immigrants that migrate to this country every year. Exploring the cultural differences among these cultures and establishing cultural competence should be a goal in which facilities incorporate to avoid miscommunications. Another hot topic which is in the new today is the spread of Ebola within the United States. It is important to investigate culturally acceptable public interventions that will be effective immediately to void a pandemic. Investigating where the virus originates and how it is spread is part of epidemiology but how cultures view this epidemic is medical anthropology and how we can develop interventions that will be effective among the source of where this virus originates.
In Africa, it is suspected that Ebola is underreported by 75% according to the World Health Organization (Biello, 2014). There is an epidemic fear of those transmitting Ebola (Biello, 2014). People in Africa will hide their dead ones, in fear that the health care workers in "space suits" are coming in to harvest organs or murdering sick ones with various treatment protocols, such as spraying them with chlorine solutions (Biello, 2014). People are viewing the treatment centers as death sentences and whatever trust there was in health care officials has completely evaporated (Biello, 2014). Some Africans are even bribing health officials so that the dead person's can be given a proper washing, according to their culture, upon death, which is dangerous as well, because Ebola is spread even in death (Biello, 2014). This is a serious problem and the cultural miscommunication can cause serious harm to many people. It is important we figure a way in which interventions can be made culturally clear and lucid. That somehow trust can be re-established. However, this is easier said than done. Applied and critical medical anthropology is definitely a useful tool that should be utilized in this dire situation. The goal should be to improve trust in the healthcare officials and prove that reporting illness and seeking treatment will only benefit the patient, if not, the spread of this virus could become exponential (Biello, 2014).
Conclusion
It is important to understand the importance of cultural competency especially in such a diverse world. Cultural competency has been shown to be such an important part of delivering efficient care to all individuals. The lack of cultural competency, as illustrated by the book "The Spirit Catches You and You Fall Down". It is important to be able to apply medical anthropology as well as challenge it or question it. It was discovered what applied medical anthropology is as well as what critical medical anthropology is. Both fields are necessary in providing efficient and holistic care to patients. Along with creating pragmatic interventions, applied and critical medical anthropology can not be done without cultural competency as well. These concepts all go hand in hand. What happens when these concepts are lacking? Well this is evident in the book "The Spirit Catches You and You Fall Down", misdiagnosis, unnecessary prolonged diagnosis of a life-threatening disease, or fatal consequences. It was also discussed how all these concepts apply to what we hear in the news today and how we can apply cultural competency, applied and critical medical anthropology. Epidemics are such a serious situation and one in which these concepts can be used to help control! We must be knowledgeable of how to understand patients, situations and how to plan the appropriate interventions to prevent an even more exacerbated situation.
References:
Biello, D. (2014, October 30th). Ebola Exacerbates West Africa’s Poverty Crisis. Scientific American. Retrieved October 9, 2014 from
http://www.scientificamerican.com/article/ebola-exacerbates-west-africa-s-poverty-crisis/.
Brown, P.L. (2009, September 20). A Doctor for Disease, a Shaman for the Soul. NYTimes.com. Retrieved from
http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=1&adxnnl=1&pagewanted=pri.
Fadiman, Anne. 1997. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two
Cultures. New York: Farrar Stratus, and Giroux.
Joralemon, Donald. 2009. Exploring Medical Anthropology, 3rd Edition. Upper Saddle River, NJ: Prentice Hall.
Image #1. Peterson, M. (2012). Medical Anthropology [Online Image]. Retrieved October 4, 2014 from
http://www.slideshare.net/medianth/medical-anthropology-14253752
Image #2. Ortiz Asenita Fernandez, Olivia. (2012). Creative Commons Paularps [Online Image]. Retrieved October 2, 2014 from
www.weebly.com.
Image #3. N.A. (2012). Medical Anthropology [Online Image]. Retrieved October 5, 2014 from http://www.canstockphoto.com/images-
photos/medical-anthropology.html#file_view.php?id=11804700
Image #4. Wilce, J. (2011). Medical Anthropology and Bioethics [Online Image]. Retrieved October 4, 2014 from
http://jmaib.iea.ras.ru/englishversion/issues/001/publications/wilce.html
Image #5. 53Kevin. (2010). Creative Commons [Online Image]. Retrieved October 7, 2014 from www.weebly.com
Image #6. Goldman, J.S. (2012). The-Spirit-Catches-you-and-you-fall-down [Online Image]. Retrieved October 8, 2014 from
http://judystonegoldman.com/wp-content/uploads/2012/09/The-Spirit-Catches-you_jpeg.jpg
Image #7. Backstrom, C.C. (2011). Creative Commons [Online Image]. Retrieved October 8, 2014 from www.weebly.com
Image #8. Castro, D. (2013). The Spirit Catches You and You fall down [Online Image]. Retrieved October 9, 2014 from
http://blogs.christianpost.com/ambassador-of-reconciliation/the-spirit-catches-you-and-you-fall-down-16290/
McElroy, A. 1996. Medical Anthropology. In Encyclopedia of Cultural Anthropology. (pp. 170-191). New York, NY: Henry Holt.
Singer, M. 2004. Critical Medical Anthropology: Health and Illness in the World's Cultures. In Encyclopedia of Medical Anthropology.
(vol 1, pp. 23-30). doi: 10.1007/0-387-2905-X_3.
Video #1. Nolfo, T. [Online video]. (2012, July 13). What is cultural competence and why is it important? [Education]. Retrieved October
4, 2014 from http://www.youtube.com/watch?v=MTh3pe8N3DQ.
Video #2. Mell. C. [NeuroKultur]. (2013, June 20). Cultural Competence - A key competence of the 21st century. [News and Politics-Video
file]. Retrieved October 4, 2014 from http://www.youtube.com/watch?v=zsbRMMAyZ0U. (Video #2)
Video #3. Adams, E. [aboriginalhealthVCH's channel] (2014, January 31). What is Cultural Competency? [Education-video file]. Retrieved
October 4, 2014 from http://www.youtube.com/watch?v=xw9BBb8LhYw.
This book eloquently explains the clash or 'miscommunications' between two cultures: Western medicine and Hmong traditions. Differences not only between languages but ideas, culture, religion, beliefs, concepts, theories, and medicine in general. These differences were focused around a young Hmong epileptic girl, whose care was explicitly exposed to the western society. Were these differences a result of cultural incompetence, would this child's care been changed if these differences resolved or more importantly if applied medical anthropology were utilized? These are questions in which could never be answered completely, but does reiterate the importance of applied medical anthropology.
Applied Medical Anthropology has many times in the past been used to understand why a certain culture was reluctant to a new health policy, this same concept could have been used in Lia Lee's case. In the beginning, applied Medical Anthropology could have been used to understand why Lia's mother was noncompliant with the medications. Understanding this would have prevented possibly the unrelenting seizures that lay ahead of her, the eventual involvement of child protective services, and the resultant foster home placement of Lia. What if a medical anthropologist had investigated a little more into how Lia's parents viewed her illness, how they viewed the doctors and their care, how they viewed her prescribed medications, would Lia's care been improved? Would her brain death which occurred during a status epilepticus episode been something that could have necessarily been avoided? If not, could it have been prolonged? We are not certain if even applying medical anthropology would have changed Lia's morbid future, but we are confident that exploring the parents religion and beliefs would have helped many other situations, and possibly lessened the amount of seizures that Lia had suffered from. Lets take for example the initial medication regimen that the physicians had prescribed for Lia.
Lia's family was Hmong, spoke very little english and had never even seen numerical symbols before. This country was new and foreign. In the Lee's country, epilepsy is not necessarily seen as a bad medical condition, as many whom do possess this, become shaman. To the Hmong, a shaman is a religious leader, one who can fly in the sky, argue and negotiate with spirits. To the Lee's, Lia's condition made her 'special'. In their country, disease and illness is not treated with medications, but with a shaman to help negotiate with the spirits. Western medicine, to say the least, was completely foreign, odd and new to them, they didn't truly understand it. Even the concepts in which western medicine operate were so foreign and bizarre to them. Taking too much blood was dangerous because they were unaware of the concept that blood indeed regenerates, but if you had no knowledge or concept of this, wouldn't you be afraid of too much blood being taken from your child? Also numerical symbols, such as time, was a completely new concept to the Hmong people. Applying medical anthropology to this case would have helped shed light onto these thoughts and beliefs and would allow the physicians to see medicine in their eyes. Lets take for example the initial medication regimen that the physicians had prescribed for Lia.
Although there were many factors in this situation that prolonged appropriate care, such as prolonged correct diagnosis of her condition, there was also another huge factor which was the constant changing of medications. "By the time she was four and a half, Lia's parents had been told to give her, at various times, Tylenol, ampicillin, amoxicillin, Dilantin, phenobarbital, erythromycin, Ceclor, Tegretol, Benadryl, Padiazole, Vi-Daylin Multivitamins with Iron, Alupent, Depakene, and Valium. Because these medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescriptions changed twenty-three times in less than four years" (Fadiman, 1997). Even for a colloquial American individual, this would have been confusing and frustrating. Not to mention the fact that the Lee's spoke little english and have no familiarity to numbers. They could not read the labels! Applied and critical medical anthropologists could have taken time to try and understand this. Try to see why there was noncompliance with medications. This frustration and confusion just built a wall between the Lees and the physicians at the hospital. Would Lia's care from the very beginning changed the rest of her life?? I think it would have, and definitely think that medical anthropology was not utilized in the slightest bit and was detrimental to this young child's life.
Applied and critical medical anthropology in todays news!
This book has had an effect on the initiation and application of medical anthropology. Although Lia Lee's case was heart breaking, it was beneficial in that it opened up the importance of medical anthropology along with cultural competence. The very essence of the patient and physician understanding each other is the bolster for appropriate and effective care. Without this understanding or knowledge the results can be lethal. Today we can utilize medical anthropology in current issues that we hear about today. There are an increasing amount of refugees and immigrants that migrate to this country every year. Exploring the cultural differences among these cultures and establishing cultural competence should be a goal in which facilities incorporate to avoid miscommunications. Another hot topic which is in the new today is the spread of Ebola within the United States. It is important to investigate culturally acceptable public interventions that will be effective immediately to void a pandemic. Investigating where the virus originates and how it is spread is part of epidemiology but how cultures view this epidemic is medical anthropology and how we can develop interventions that will be effective among the source of where this virus originates.
In Africa, it is suspected that Ebola is underreported by 75% according to the World Health Organization (Biello, 2014). There is an epidemic fear of those transmitting Ebola (Biello, 2014). People in Africa will hide their dead ones, in fear that the health care workers in "space suits" are coming in to harvest organs or murdering sick ones with various treatment protocols, such as spraying them with chlorine solutions (Biello, 2014). People are viewing the treatment centers as death sentences and whatever trust there was in health care officials has completely evaporated (Biello, 2014). Some Africans are even bribing health officials so that the dead person's can be given a proper washing, according to their culture, upon death, which is dangerous as well, because Ebola is spread even in death (Biello, 2014). This is a serious problem and the cultural miscommunication can cause serious harm to many people. It is important we figure a way in which interventions can be made culturally clear and lucid. That somehow trust can be re-established. However, this is easier said than done. Applied and critical medical anthropology is definitely a useful tool that should be utilized in this dire situation. The goal should be to improve trust in the healthcare officials and prove that reporting illness and seeking treatment will only benefit the patient, if not, the spread of this virus could become exponential (Biello, 2014).
Conclusion
It is important to understand the importance of cultural competency especially in such a diverse world. Cultural competency has been shown to be such an important part of delivering efficient care to all individuals. The lack of cultural competency, as illustrated by the book "The Spirit Catches You and You Fall Down". It is important to be able to apply medical anthropology as well as challenge it or question it. It was discovered what applied medical anthropology is as well as what critical medical anthropology is. Both fields are necessary in providing efficient and holistic care to patients. Along with creating pragmatic interventions, applied and critical medical anthropology can not be done without cultural competency as well. These concepts all go hand in hand. What happens when these concepts are lacking? Well this is evident in the book "The Spirit Catches You and You Fall Down", misdiagnosis, unnecessary prolonged diagnosis of a life-threatening disease, or fatal consequences. It was also discussed how all these concepts apply to what we hear in the news today and how we can apply cultural competency, applied and critical medical anthropology. Epidemics are such a serious situation and one in which these concepts can be used to help control! We must be knowledgeable of how to understand patients, situations and how to plan the appropriate interventions to prevent an even more exacerbated situation.
References:
Biello, D. (2014, October 30th). Ebola Exacerbates West Africa’s Poverty Crisis. Scientific American. Retrieved October 9, 2014 from
http://www.scientificamerican.com/article/ebola-exacerbates-west-africa-s-poverty-crisis/.
Brown, P.L. (2009, September 20). A Doctor for Disease, a Shaman for the Soul. NYTimes.com. Retrieved from
http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=1&adxnnl=1&pagewanted=pri.
Fadiman, Anne. 1997. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two
Cultures. New York: Farrar Stratus, and Giroux.
Joralemon, Donald. 2009. Exploring Medical Anthropology, 3rd Edition. Upper Saddle River, NJ: Prentice Hall.
Image #1. Peterson, M. (2012). Medical Anthropology [Online Image]. Retrieved October 4, 2014 from
http://www.slideshare.net/medianth/medical-anthropology-14253752
Image #2. Ortiz Asenita Fernandez, Olivia. (2012). Creative Commons Paularps [Online Image]. Retrieved October 2, 2014 from
www.weebly.com.
Image #3. N.A. (2012). Medical Anthropology [Online Image]. Retrieved October 5, 2014 from http://www.canstockphoto.com/images-
photos/medical-anthropology.html#file_view.php?id=11804700
Image #4. Wilce, J. (2011). Medical Anthropology and Bioethics [Online Image]. Retrieved October 4, 2014 from
http://jmaib.iea.ras.ru/englishversion/issues/001/publications/wilce.html
Image #5. 53Kevin. (2010). Creative Commons [Online Image]. Retrieved October 7, 2014 from www.weebly.com
Image #6. Goldman, J.S. (2012). The-Spirit-Catches-you-and-you-fall-down [Online Image]. Retrieved October 8, 2014 from
http://judystonegoldman.com/wp-content/uploads/2012/09/The-Spirit-Catches-you_jpeg.jpg
Image #7. Backstrom, C.C. (2011). Creative Commons [Online Image]. Retrieved October 8, 2014 from www.weebly.com
Image #8. Castro, D. (2013). The Spirit Catches You and You fall down [Online Image]. Retrieved October 9, 2014 from
http://blogs.christianpost.com/ambassador-of-reconciliation/the-spirit-catches-you-and-you-fall-down-16290/
McElroy, A. 1996. Medical Anthropology. In Encyclopedia of Cultural Anthropology. (pp. 170-191). New York, NY: Henry Holt.
Singer, M. 2004. Critical Medical Anthropology: Health and Illness in the World's Cultures. In Encyclopedia of Medical Anthropology.
(vol 1, pp. 23-30). doi: 10.1007/0-387-2905-X_3.
Video #1. Nolfo, T. [Online video]. (2012, July 13). What is cultural competence and why is it important? [Education]. Retrieved October
4, 2014 from http://www.youtube.com/watch?v=MTh3pe8N3DQ.
Video #2. Mell. C. [NeuroKultur]. (2013, June 20). Cultural Competence - A key competence of the 21st century. [News and Politics-Video
file]. Retrieved October 4, 2014 from http://www.youtube.com/watch?v=zsbRMMAyZ0U. (Video #2)
Video #3. Adams, E. [aboriginalhealthVCH's channel] (2014, January 31). What is Cultural Competency? [Education-video file]. Retrieved
October 4, 2014 from http://www.youtube.com/watch?v=xw9BBb8LhYw.
Lia Lee and her mother. (image #9 above provided by www.bibliostar.tv)
Image #7 as Banner and #8 as picture of Lia Lee.
Image #7 as Banner and #8 as picture of Lia Lee.