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Evocative and empathetic narrative medicine work that examines cross cultural barriers between the Hmong community and the Western medical community. A must-read.

Imagine becoming seriously ill in a foreign country, and having to deal with doctors who don't speak your language. Now, imagine that the doctors practice techniques that you find offensive and sometimes horrifying. And finally, imagine being treated as inferior by the doctors because of your beliefs. This is what happened to the Lee family, Hmong immigrants living in Merced, California. Foua and Nao Kao were forced to leave their homeland (Laos), and came to the United States as refugees. In 1982, Foua gave birth to a daughter, Lia, and early on it was determined she had a severe form of epilepsy. In this nonfiction book, Anne Fadiman chronicles the experiences of both Lia's family and those in the health and social services professions who provided care.

The cultural divide was huge. The Hmong believe in shamans and healing rituals, many involving animal sacrifice. Refrigerators, televisions, and even toilets were unfamiliar. Foua and Nao Kao were illiterate, and therefore unable to comprehend the complex and varying medicines prescribed for their daughter. The American doctors were well-educated, confident, and caring, but clearly considered themselves and their beliefs as superior to the Hmong. This chasm proved disastrous for Lia and her family.

Fadiman presents a very objective portrait, showing the good and bad sides of both the Americans and the Hmong involved. She dissects the case, ultimately identifying the point where a simple wrong turn set Lia on a course from which she could not recover. Fadiman weaves into the narrative educational segments on Hmong history, culture, and traditions. The result is a very informative and yet emotional story, that ultimately comes down to a collision of two cultures. As Harvard's Arthur Kleinman told Fadiman, "You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. 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?" (p.261) ( )

http://amiralace.blogspot.com/2008/12... ( )

Anne Fadiman takes a very rare look into a fairly unknown culture, the Hmong. Tracing the people's unusual and exuberant independence back several centuries, examining attempts by the Chinese and the French to assimilate them, Fadiman is able to examine the Hmong's current plight in a modern, American society. Refugees, uprooted from everything that makes any sense to them, Hmong people face difficulties with the most simple things that American's daily take for granted - the use of a refrigerator or a phone, for instance. But the largest obstacle they face is in the clash of their cultural and religious beliefs with modern Amercian life.

Focusing on the Lees, a typical Hmong family, who migrated to Merced, CA, the book follows their long battle with Western medicine and doctors in treating their daughter, Lia, who is struck with epilepsy as an infant. Originally diagnosed with pneumonia, Lia begins a long spiral downward as her condition worsens and the doctors who treat her grow more and more intolerant of her parents care. Lia is even removed from her home and placed with foster parents based on a doctor's report that her parents have failed to adequately medicate her, even though the only family members who can read, write, or understand English are minors and the doctors only infrequently use the hospital janitor to interpret their instructions. To be fair, the doctors who treated Lia were well-meaning, caring, and earnest people. But their inability to connect with Lia's parents exposes a more disturbing and wider barrier between our Western focused systems and the ever growing immagrant population.

Fadiman is seldom judgemental of any of the players in the story, even when it would be easy to slip into such an attitude. The book is really an excellent examination of the clash of cultures in general and the Hmong people specifically. My primary criticism is that the book seemed too focused on garnering sympathy for the Lee's. They are an extraordinary family who suffered through a great many trials and mostly succeeded. However, I tend to agree with Fadiman's doctor firend whose opinion she exhibits in the closing chapters. He makes clear that, while respecting and using the Lee's cultural and religious perspectives might have helped serve the goal of treating Lia, the doctor's here were right to proceed with whatever means necessary to treat the girl in a way that saved her life. It would be silly to withhold or subjugate medical treatment in favor of Hmong holistic treatment simply to exhibit respect for the Lee's beliefs. Indeed, the doctors here failed in their duties to understand the Lee's and, in so doing, better understand their patient's condition. But, they could have overcome the gaps in understanding with an interpreter and a little more creative thinking about how to verify Lia's medicine was administered.

A good read, especially the portions of the book which highlighted the history of the Hmong people.

Four bones!!!! ( )