Anne Fadiman

In the 1980s, a young Hmong child – whose people fought for the Americans during the Vietnam War – had epilepsy after her parents were relocated to California as refugees. Tragically, her parents never adapted to the American medical system, and equally tragically, the American medical system never adapted to them either. The child Lia Lee’s case resulted in a negative outcome, and the Lee family’s difficulty appears utterly humane upon further investigation. In this classic book, Anne Fadiman tries to learn lessons to instruct us all how to avoid such outcomes in the future.

This book fortunately received many accolades when first published in the late 1990s and has brought about significant change across the American medical system. It taught us – and continues to teach us – to be mindful of culture’s role in medical encounters. Medicine itself is a culture, and those new to Western medicine have their own culture with their own integrity. Learning to effectively mediate between cultures, for some patients, is at least as vital as the right diagnosis and treatment.

In a less heralded contribution, this book highlights the need for cultural brokers, especially among refugees. Refugees are people without a home. Unlike most immigrants, they come to America not as a goal but merely as an act of survival. They seek to leave a substandard refugee camp to anyplace else because they no longer have a home. Unlike other immigrants, they do not run to American culture and its Western medicine; indeed, they may harbor some suspicions of it. Refugee and other social organizations need to be mindful of this dynamic when refugees encounter foreign medical systems. Education and support are certainly required for those new to any land.

With the rising challenge of climate change and continuing wars around the globe, the problem of refugees will likely rise throughout this century. Cultural attitudes towards medicine is but a part of this complex problem, along with aspects like nativism, racism, international law, and homophobia. This book eloquently depicts what this looks like. It does not take sides but rather extrapolates both sides’ full practical and ethical ramifications. It concludes that this is an utter tragedy, one that must be learned from.

My wife has dedicated her career to educating refugee children, and having spent time on medical wards, I work in the healthcare arena. Thus, my family is familiar with both sides that this saga addresses. Let’s all hope this story is a “worst case scenario.” It seems that American healthcare has grown as has the communities supporting refugees. Reading this book can remind us of why we cannot go back but must push forward.… (more)