The Spirit Catches You and You Fall Down

by Anne Fadiman
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Discuss specific strategies to improve the collaboration and effectiveness of all the agencies and staff involved with the Lee family. How would you measure effectiveness?

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In The Spirit Catches You and You Fall Down, the clash of Western and Hmong cultures hinders Lia Lee's access to sufficient medical care, with devastating results. Any solution must focus on cross-cultural understanding and collaboration, with an assessment metric of increased medical access for Hmong patients.

Initially, the Lees cannot follow Lia's doctors' instructions due to the language barrier. Because Merced has a large Hmong population, the hospital should have employed sufficient interpreting staff. Access to interpreters could prove even more effective if language interpreters functioned as cultural interpreters as well, explaining to each side the basis for the other's beliefs. Effectiveness could initially be measured on the spot, with the interpreter verifying that the patient or caregiver understands the treatment plan. Assessment would continue at follow-up appointments or with phone calls, where the interpreter would check in regarding how the treatment plan was being carried out.

When a language and cultural interpreter is not sufficient, or follow-up indicates treatment is not being carried out in a medically effective manner, social services could get involved. Indeed, this is the case in The Spirit Catches You and You Fall Down, when Lia Lee is removed to foster care because her parents have not properly administered her medications. Eventually, the family is reunified as their social worker helps them to understand Lia's treatment plan. Involving social services at an earlier stage, as soon as interpreter services prove insufficient, would save money and resources by addressing the problem before foster care became necessary. This would also save the family from the pain of separation. Because follow-up visits are built in to the current social services model, checking in to ensure interventions were effective would be a natural part of social services' involvement.

While these types of safeguards within the treatment process are necessary when misunderstanding arises, the most sustainable solution would be to avoid such misunderstandings in the first place. This could be accomplished through mutual cross-cultural education. In 2009, following the tragic events of The Spirit Catches You and You Fall Down, Merced's Mercy Medical Center implemented a program called Partners in Healing, in which Hmong shamans are educated in the basics of Western medicine, and doctors in what cultural beliefs to expect from Hmong patients. Shamans encourage their patients to seek medical treatment in conjunction with shamanic care. Shamans, interpreters, and doctors now explain medical procedures in terms that mesh with the way the Hmong understand illness; for example, an interpreter in the program explains a CAT scan as the doctor finding where disease resides in the body, just as a shaman discovers the location of spirits believed to cause illness. Whereas the Lees were not allowed to conduct shamanic rituals in the hospital, shamans now provide traditional services in conjunction with Western medicine within hospital walls. Effectiveness could be concretely measured in the increased number of Hmong patients seeking and complying with Western medical treatment. Additionally, since the program's inception, shamans have noticed a cultural shift in the Hmong community toward greater trust in Western medicine.

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