Cindy Copeland The Spirit Catches You and You Fall Down Chapter 1 “Foua never thought to ask, since she speaks no English, and when she delivered Lia, no one present spoke Hmong. ” (pg 6) I cannot imagine being somewhere where no one spoke the same language – let along receiving medical care and/or delivering a baby without anyone speaking the same language. That must have been not only a scary experience, but a lonely one too. To have no one there and no one there that spoke my language – I would have been terrified!
I also cannot imagine not having an interpreter available. I was not aware that this was, or even could be, an issue in America (naive of me). Foua first experience giving birth “Western” style must have been terrifying – completely different than what she was accustomed to, unable to communicate, and receive/follow directions. How difficult and frustrating for Foua and her family and for the medical staff. With the apprehension of the Hmong of Western medicine, it is no wonder that lack of communication and direction can precipitate this belief. Chapter 2 The history of the Hmong’s yields several lessons that anyone who deals with them might do well to remember. Among the obvious ……do not like to take orders, that they do not like to lose, that they would rather fight, flight, flee, or die than surrender; that they are not intimidated by being outnumbered, that they are rarely persuaded by other customs of other customs ….. , and they are capable of getting very angry. ” (pg 17) This should be common knowledge for most people. Common courtesy – who in their right mind likes to be ordered around? There is a right and wrong way in approaching and dealing with people.
Nice and not so nice – unfortunately for the Hmong, it sounds as if most people were either annoyed, arrogant, or too busy to listen to and learn about the Hmong culture. It is essential to remember the fundamentals of humanity. Listen; be courteous, empathetic, and helpful. No one likes to be bossed around as well as being intimated or demand into something they don’t want to do. I don’t understand people who don’t remember this once they obtain a degree (or big accomplishment). It seems to go to their head and they don’t remember how to relate to others (more times than not).
It is essential to remember where you have come from, how you’ve gotten there, and know that everything can be lost in an instance. Life is precious and others should be treated as you want to be treated. Chapter 3 “Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia’s parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells. ” (pg 28)
So much miscommunication – it is so sad to read! Each person wanted only the best for Lia, but ended up brings out the worst in each other. The miscommunication, the cultural barrier, as well as the misunderstanding – neither side ever thought to ask the other their thoughts, ideas, or questions on Lia’s condition. If that had happened – who could say if the outcome would be different? I would have thought a doctor would ensure that a patient’s family would fully understand the condition of their child, regardless of race/gender/origin.
I thought it was part of the Hippocratic Oath that they take. I really do see the need for cultural competency classes now – to ensure that situations like this does not happen. However, situations like this probably happens more than we would like to think about and know about. Chapter 4 “In his opinion, the physicians and nurses at Ban Vinai failed to win the cooperation of the camp inhabitants because they considered the relationship one-sided, with the Westerners holding all the knowledge. As long as they persisted in this view……what the medical establishment was offering would ontinue to be rejected, since the Hmong would view it not as a gift but as a form of coercion. ” (pg 37) This view that Conquergood stated was very true to form and continued over into the United States. So many Americans seem to think that we know everything and our country is the greatest. We can learn so much from so many others if we would just open ourselves up to the possibilities that we do not have all the answers to everything. Conquergood really made a difference within the refugee camp.
He immersed himself into the culture by trying to understand the Hmong and become not one of them but friends with them not “to” them. Treating others as you would want to be treated really needs to be remembered for everyone – but it seems that society does not do this. We must learn we cannot push an agenda off onto others, especially if they are from a different culture. It may be with the best of intentions with great benefits, but it is essential for each side to understand the intentions of each. Coercion and helpfulness can be misunderstood, but are two very different things.
Chapter 5 “The worst aspect of the case was that as conscientious physicians and dedicated parents, they found it agonizing to watch Lia, as it would have been for them to watch any child, fail to receive the treatment they believed might help her lead a normal life. ” (pg 57) I am not a parent yet, but I cannot stand to watch anyone, especially a child, suffer. I can’t imagine what Lia’s parents and physicians went through when treating her. There were so many thing mishandled, and it so easy to see it now when hindsight is 20/20.
With the major communication barriers, I cannot imagine that the doctor’s would not think that the orders, explanations, and medication would be understood. With virtually no communication with the Lees, the doctors should have known that they don’t speak English, and if they don’t speak English, they probably can’t read it either. I understand that in an emergency room, doctor’s see many patients. But the Lees were in and out of the ER consistently. Should that not have been a warning sign after the first couple of times? Why had no one thought to ask if the parents had questions, concerns, or ideas for treatment.
The doctors knew they dreaded seeing Lia, they should have known the parents did not want this for their child either! She had been in and out so much; it wasn’t as if the hospital staff did not know their faces. It just a break down of communication that is sad to read about and it is hard to think that this actually happened within the US. Chapter 6 “This is a different kind of tension because they don’t know that they are doing something bad. ” (pg75) It is very difficult trying to express and explain something when someone does not understand.
I cannot even imagine what it was like for doctors treating Lia, trying to help her, when explaining the importance of certain procedures. However, it must have been equally frustrating for the Lees because they did not understand this new way of medicine. Being open to all possibilities is essential when treating someone – your way may not be the best way and it may take a patchwork of treatments to work. It is important for each party involved to be able to express themselves and explain why they are doing what they are doing – communication is the key!
That is what is lacking here, communication and tolerance of each other’s different culture. Tolerance and patience is the key. When something is not understood, people react and act out in different ways. If this had been caught, maybe Lia could have been saved. Chapter 7 “I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior. ” (pg 79) “We are just refugees but we are human beings like any doctor too. ” (pg 84) Respect is the key issue here. We must respect everyone in order to receive it back.
Everyone deserves to be treated equally, regardless of race/color/sex/origin/culture. Why some individuals feel superior to others is beyond me. We all deserve the same opportunities in life. We all experience the same basic needs and wants. Although doctors may have a wealth of knowledge in the medical field, other individuals may have street smarts and succeed further in different circumstances; thus, proving the need for respect and equality for all. Everyone is unique and special in his or her own way. Commanding, domineering, arrogant, behavior is unacceptable behavior regardless of position.
With this type of behavior, respect will be earned nor granted. Chapter 8 “Ever since they had arrived in the United States, the Lees had been meeting Americans who, whether because of their education, their knowledge of English, or their positions of relative authority, had made them feel as if their family didn’t count for much. Being belittled is the one thing no Hmong can bear. ” (pg 96-97) Feeling inadequate is an easy feeling to feel. Knowing how to overcome it is difficult. Family is so important. The possibility of someone putting my family down or belittling me would upset me.
It would upset me more if my family was involved. This is a trait I believe everyone has, not just Hmong. Who likes to feel belittled, unworthy, or inadequate? This goes back to the respect issue. Respect for others, regardless of culture is so very essential to make for good relations. Without it, lines of communication will never be open. The first impression really does matter. Chapter 9 “The Hmong have a phrase, yuav paim quav, which means that the truth will eventually come to light. ” (pg 108) “Neil and Peggy had no idea what the Lees were doing to heal Lia because they never thought to ask. pg 112) I believe these two quotes go together. The truth did eventually come out. Two worlds and cultures collided and tragically, a child was caught in the middle. Doctors never thought to ask the parents what they believed would heal their child. Parents never thought to ask the doctors if they thought they could heal their child. Neither worked together for the good of Lia – each were opposing forces that collided together and Lia suffered the negative effects from both. The truth does eventually come to light in everything, it just takes time. However, I believe time was not Lia’s friend.
Caring for your patient isn’t enough – knowing that there is a clear line of communication is essential. Chapter 10 “The Hmong also impressed the Americans with their adaptability. ” (pg 131) During the war, the Hmong was able to adapt to virtually every aspect that was thrown to them: making homes out of rice sacks, improvising supplies to hunt with, and relocating themselves and their families. How sad that not even 30 years later, the Hmong are looked upon with disdain and annoyance. The Hmong had nothing but patience and loyalty for Americans during the war in their homeland.
They fought beside us, gave their lives for their country, and assisted the U. S. intelligence with whatever they could. Then they relocate as refuges to America and begin to be treated as lowly citizens because of different beliefs and culture. Chapter 11 “It was awful,” Dee recalled. “The doctors wouldn’t even look at Foua and Nao Kao. They’d only look at us and Jeanine. They saw us at smart and white, and as far as they were concerned the Lees were neither. ” (pg 151) Stereotyping is a terrible thing. This is a perfect example of stereotyping. Because the Lees were Hmong, the doctors assumed that they were dumb and uneducated.
They did not know what an opportunity they had to assist the Lees and help break down the communication and cultural barriers that remained between the Hmong and the medical-American community. For something that terrible to be happening and not understanding it would be awful! Snap judgments really must be avoided at all costs. Nothing good can come from stereotyping and assumptions. And to think the educated medical community would do such a thing is sad and terrible. So much to learn from this book! Chapter 12 “For as long as there have been Hmong, there have been ways to get out of tight spots. (pg 170) I think this is a commendable quality of the Hmong. The ability to persevere through demanding situations with nobility and the capability to preserve one’s integrity is extraordinary. Being ingenious with the ability to think quickly without yielding to pressure is remarkable. So many cultures have been lost because of the necessity to adapt. I believe this remark was made in a derogatory manner within the book, but I believe it is an admirable quality. The Lee’s specifically conformed to some of the American culture without losing themselves. Conformity does not mean coercion or intimidation.
I don’t think American would be the nation it is today without some conformity of many cultures into one. But not losing one’s identity is the key. I think the Lee’s were afraid of losing themselves, thus their souls. They were not able to be diplomatic about the fact that two cultures could meld together. If I was in their shoes, I don’t know if I could have either, though. Chapter 13 “When Nao Kao thought he was being forced to sign a piece of paper that said his daughter was going to die in two hours, he did what any Hmong in an impossible corner, starting with the legendary Shee Yee, might consider doing: he fled. (pg 178) I believe Nao reacted the way any protective father would react if faced in this type of situation. If my father would have thought someone was trying to kill me within two hours, he would do everything and anything within his power to remove me from that situation to prevent the death. Granted, Lia wasn’t going to die in two hours, it was a huge misunderstanding; basically the premise of this book –misunderstanding, miscommunication, and no tolerance of others cultural beliefs. So many things that could have been prevented, but wasn’t. Nao loves his daughter; there is no doubt in my mind in that.
He just wanted to protect his daughter. Love drives people to do silly and unpredictable things. Nao was just doing what he thought was best for him and his family. Chapter 14 “In America, we are blind because even though we have eyes, we cannot see. We are deaf because even though we have ears, we cannot hear. ” (pg 187) In 1987, when Senator Alan Simpson, then the ranking minority member of the Senate Subcommittee on Immigration and Refugee Affairs, called the Hmong “the most indigestible group in society. ” (pg189) The Hmong feel that they are blind and deaf even though they are capable of doing both.
They feel they have no voice and no vision because American culture is a different type of prison than they have ever known. Welfare is the only way of life because they do not know the language and do not understand the culture. The only way of life the Hmong has known has been lost and they feel helpless to figure out what else is possible. At least in the Lee’s case, this mentality has not been given to their children. It seems that their children are adapting well to the American culture. Maybe it is due to them having more opportunities with schooling and such.
It is sad that the Hmong feels this way. Each person has a voice. They just have to know how to use it. Chapter 15 But whenever I began to be lulled by this relatively rosy picture, I was drawn up short by an explosion of rage from Nao Kao (“My child is lost because of those doctors! ), or, more frequently, by a sudden seepage of grief from Foua. I love Lia too much (pg 218) It could look deceptively rosy. Lia’s epilepsy has been cured, she is well-taken care of and her parent’s never have to worry about medication nor social services taking her away from them again.
Lia is quiet, yet growing. Foua is able to have Lia at home to care for her. Nurse’s call Lia “the perfect patient” now. But what everyone is forgetting is a huge factor – Lia’s EEG is flat, she is essentially brain dead, in a vegetative state. She will not get any better. Lia’s parents will always have to take care of her. There is a lot of grief, a lot of anger, and a lot of frustration because of Lia’s condition. Lia’s parent’s blame the doctor’s, the doctor’s blame Lia’s parents – neither side is willing to take responsibility for their part in this tragedy.
Lia’s parent’s love exudes from the pages of the book. My heart goes out to them. It’s a situation that could have been avoided if cultures understood each other and were tolerant. Chapter 16 All kinds of vessels can be plugged, but you can’t plug people’s mouths. (pg 226) This is so true. People always have something to say! People do not realize that what they say can either help or hurt. No one can stop the wagging tongue. Everyone seems to have an opinion on something and everything, and most don’t seem to think (or care) if it will hurt others.
Take the quote from Chapter 14 from Senator Alan Simpson calling the Hmong the most indigestible group in society. That quote cannot help the Hmong be accepted with the American society. It only creates more hostility, more hate, and more gossip to be dealt with. And that was a politician – someone who is supposed to have the best of American in mind! The America that was founded for equality and justice for all. We wonder why racism and bias still run amuck today – because of small minds like this. People need to learn when to keep their mouths shut! Chapter 17
Lia’s case had confirmed the Hmong community’s worst prejudices about the medical profession and the medical community’s worst prejudices about the Hmong. (pg 253) This quote really sums up the basis of the book: prejudices on each side of the culture. Stereotyping, prejudice, and bias is something that really needs to be banished, but I do not know how this is going to happen. I don’t have the answers, but this book shows the need for it. The damage that has happened to Lia may never fully recover within the Hmong community. As said before, you can’t plug people’s mouths!
Again, with the medical community with the Hmong; however, this book may help with that. I think every medical, healthcare, educational, and business individual needs to read this book to see the implications bias and miscommunication/misunderstandings can have on a family, community, and two cultures. It is definitely an eye-opening lesson that every student needs to learn so no other family has to endure it. Chapter 18 But love, unlike etiology and diagnosis of pediatric seizures, cannot be taught. It can only be granted. In its absence, is there anything else that doctors can do to take better care of their Hmong patients? pg 265) Love cannot be taught. It can only be felt and be given. The best parents give love unconditionally, which the Lee’s did willingly and without any reservation. The Lee’s, overnight it seemed, went from being the monster parents to angelic parents. Because of Lia’s condition, respect was given to the Lee’s. This respect should have always been there and given, and why it wasn’t I don’t understand. I have such a tremendous amount of respect for the Hmong culture because of everything they have endured and persevered, especially the Lee’s. Lia was always loved and her parent’s always wanted what was best for her.
It was just they didn’t know and understand Lia’s condition. I believe they would have never willfully put Lia into harms way. It is just a tragic situation that should have never happened. There should have been some type of interference that happened to help prevent this tragedy to occur. Cultural competency is definitely a must – especially since America is a melting pot of diversity. Chapter 19 “Come home through this door, Come home to your family, Come home. (pg 288) My heart aches for this family, for this child, for her parents, and for each life Lia touched.
The enduring power of parental love is transcends time. Lia’s parents are still searching for her soul, hoping and praying she will get better. I cannot even begin to write the words I am feeling right now. Sadness, grateful that someone wrote this story, disgust that this could happen within American, grateful that the Lee’s did have people in their lives that genuinely loved and cared for them. It is tragic yet endearing to know that Lia will never recover yet the Lee’s still love and appreciate her as a normal child. Why couldn’t the community do the same for them?
Why did this collision of two cultures and two different worlds not turn out better – why didn’t someone take the time and initiative to help the Hmong culture meld better into the American society? Was it anyone’s fault? It’s just a tragic story that could have been prevented in so many ways. And maybe now it can because the story has been told …. And history will not be repeated. Heidi, This was an awesome book that has changed me, my views, my perspective, and outlook on so many aspects on life, culture, humility, and tolerance of others — Thanks for giving us the opportunity to read it! Cindy
