Anne Fadimans book is so engaging, and touches on so many sensitive subjects, that its more like a dialogue between author and reader. They took Lia to Merced Community Medical Center, a county hospital that just happened to boast a nationally-renowned team of pediatric doctors. From this initial collision different languages, different religions, different ways of viewing the world sprang a dendritic tree of problems that resulted in a medical and emotional catastrophe for Lia, her family, and her doctors. When Lia first came to the hospital, the language barrier an inability to take a patient history caused a misdiagnosis. For a variety of reasons (both spiritual and practical), the Lees did not follow the treatment plan, and Lia didn't receive the specific care her doctors ordered. By the time the final seizure came for Lia Lee, her family actively distrusted the people working at the Merced Community Medical Center. Fadiman intercuts her narrative of Lia Lees care with sections on the history of the Hmong in general and the journey of the Lees in particular. The Lees left northwest Laos, spent time in a Thai refugee camp, and eventually ended up in California, where Lia was born. Fadiman explores the complicated system of rituals and beliefs that govern traditional Hmong life. The Lees, like many Hmong, are animists, with a belief in a world inhabited by spirits. Judging from other reviews Ive read, this is a book that angered people. Much of the vitriol is aimed at the Hmong who are accused, among other things, of being welfare mooches (this book was published right before Clinton signed the Personal Responsibility and Work Opportunity Act, gutting welfare); of ingratitude for the millions of dollars of free medical care they received; of parental negligence; and for their refusal to assimilate into American society. Or the doctors, who never took the time to understand their patient, her family, and the context in which they lived their lives? The time she spent allowed her to see the Lees as fully formed people, not the seemingly-ignorant, oft-mute other that presented at the hospital. There are moments where I think that Fadiman is rather a bit too hard on some of her non-Hmong interview subjects. At the same time, I recognize the need for doctors to better remember their patients are people. If I couldnt get a doctor to give me five minutes of uninterrupted time, I can only imagine the experience of an indigent, non-English speaking patient who walks into the hospital with a life experience 180-degrees different from his or her physician. One of the books final chapters, The Eight Questions, provides a nice roadmap for doctors. It shouldnt be a binary question of the life or the soul, with the doctor standing in for God. When I love a book, I talk to people about it. (Final aside: The Spirit Catches You and You Fall Down was researched in the 80s and published in the 90s, meaning that the Hmong experience in America has changed.
I knew a little about this case, and before I read the book, I was certain Id feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well. This is a great book to read if you want to try to understand any people who are different from you in any way.
This is the heartbreaking story of Lia, a Hmong girl with epilepsy in Merced. It is intended to be an ethnography, describing two different cultural approaches to Lia's sickness: her Hmong parents' and her American doctors'. The book is so beautifully and compassionately written - you feel for absolutely everyone in the story.
The edition I read had a new afterword by the author providing some updates and discussion of the impact of the book.
Sadly, and not surprisingly, those who would probably most benefit from a book like this would probably be the ones least likely to read it.
This was recommended to me in a cultural literacy course and it certainly delivered. It makes you want to listen more, forgive more, learn more about people, and allow for more realities.
The Hmongs presumed non-separation of any of the dimensions of life (least of all the physical) is a good contrast to the western notion of categorization and separation of the physical, emotional, spiritual and mental. In contrast, the Hmong view control quite differently. Western medicine seems to not only classify problems into different aspects of the overall human physical, mental, emotional and spiritual, it tends to also over-categorize different physicians for different organs or diseases, specialization etc. On the other hand, according to Fadiman, the Hmong dont even bother with the separation of these different aspects; they do not even have a concept of organs making up a human body. By categorizing people according to gender, class and race we try to assign people different roles and duties, further illustrating societys desire to control individual lives - to maintain order.
Having just learned that Lia, the subject of the book, passed away within the last week I'd like to express sheer admiration to her family, and especially her parents, for loving and caring for her for so many years. It is heartening to learn that this book is being used in educational settings.
Fadiman spent hundreds of hours interviewing doctors, social workers, members of the Hmong community--anyone who was somehow involved in Lia Lee's medical nightmare. What she found was that the doctors' orders, prescribed medications, hospital care, etc., were all based on a number of Western assumptions that did not take the family's (and child's) best interests into consideration. Fadiman's book is a difficult read, not because of specialized vocabulary or lofty philosophical concepts, but because there comes a point when the reader realizes that the barriers faced by those involved were much more cultural than they were linguistic.
She has won National Magazine Awards for both Reporting (1987) and Essays (2003), as well as a National Book Critics Circle Award for The Spirit Catches You and You Fall Down.