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When The Spirit Catches You And You Fall Down Essay

The Spirit Catches You and You Fall Down by Anne Fadiman Essay

1868 Words8 Pages

The Spirit Catches You and You Fall Down by Anne Fadiman is about the cross-cultural ethics in medicine. The book is about a small Hmong child named Lia Lee, who had epilepsy. Epilepsy is called, quag dab peg1 in the Hmong culture that translates to the spirit catches you and you fall down. In the Hmong culture this illness is sign of distinction and divinity, because most Hmong epileptics become shaman, or as the Hmong call them, txiv neeb2. These shamans are special people imbued with healing spirits, and are held to those having high morale character, so to Lia's parents, Foua Yang and Nao Kao Lee, the disease was both a gift and a curse. The main question in this case was could Lia have survived if her parent's and the doctors overcame…show more content…

Merced's population was a one fifth Hmong and since MCMC offered the Medi-Cal plan which was a government funded service for people who couldn't afford health insurance, which most Hmong could not. More than eighty percent of the Hmong who obtained care were receiving free health care. The government only pays for so much, so the hospital has to pick up the rest of the bill. MCMC didn't have the money to hire interpreters, so as a makeshift they hired bilingual Hmong as lab assistants, nurse's aides, and transporters. Sometimes even these people weren't around and the Hmong children who attended English school were used as the translators. Even if the children and the makeshift workers could translate it would never be perfect for most medical English terms have no equal in Hmong, and it is awkward for children to ask such questions as "Do you want to take him of life support?" Questions like that should never have to be asked by a child. Foua and Nao Kao were illiterate and spoke only Hmong, so there problems were destined from the very beginning. They never understood what the doctors told them unless there was some sort of translator available. When a translator wasn't available they would sign without knowing what for, because they believed that in America if they didn't sign they would be deported or punished. Lia's parents were farm people they didn't know anything about

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English 1A
Research Paper

Assignment: After substantial research, make an argument concerning what should be done to resolve a specific conflict between the cultural or religious traditions or values of a particular community, and the rules and expectations of the larger Anglo/Christian dominated American society. The conflict could occur in connection with medicine, transportation, education, the legal system, penal system, or another area that interests you.

[Instructor comments appear in bold, italic font within brackets below.]

The Need For Cultural Sensitivity

In the nonfiction text The Spirit Catches You And You Fall Down, Anne Fadiman brings to light the conflicts between a Hmong family’s cultural beliefs, and that of the traditional western medical beliefs of the American doctors they come into contact with. The cultural barriers between the two groups prevent any positive outcome in the health care of the Hmong family’s youngest daughter, Lia. This unfortunately results in a tragic end to the young girl’s life. Fadiman does not blame anyone for the unfortunate events that occur; after all, there is no one to blame. Each was only doing what they believed was best for the young Hmong girl. It was the lack of communication and understanding of what those beliefs were, that helped destroy any hope of providing effective health care for the Hmong child. This is not an isolated case that just happened in the small town of Merced, California. [Good way to use the text we read in class as a springboard into your subject and argument.] It is a prevalent problem all over the world. It stems from the lack of cultural sensitivity being sufficiently taught in medical school. [Strong claim – a good thesis statement.] Teaching medical students how to be culturally sensitive is not easy in the least, but there is a tremendous need for it. The United States is a hugely diverse country, and becoming ever more so by the decades. There are cultures from all over the world in the United States, and these cultures carry extremely different beliefs from that of the larger Anglo/Christian American society. In the United States, the doctors are taught traditional Western medicine. The problem is, Western medicine is not accepted or practiced in all cultures, and conflicts can arise if doctors are not sensitive to others’ cultural beliefs that are different from their own.

Not only does cultural sensitivity need to be better taught in medical school, there needs to be a lot more value put on it than there currently is. [Good topic sentence to focus the paragraph.] An article in the Medical Education journal stated that “although some medical training is beginning to prepare doctors to work in an ethnically diverse society, there is a long way to go. Research suggests many practicing clinicians are inadequately equipped to provide appropriate intercultural care” (Kai et al). Some doctors believe that there will never be enough training to better prepare them for being culturally sensitive to everyone. They say that there is not enough time in their already hectic schedules to be culturally sensitive all the time. [Nice way to introduce a counterargument, so that you may then address it or refute it.] But, doctor Michele Borgeson at the University of California San Francisco, believes that cultural sensitivity does play an extremely important and crucial part in helping to make health care more effective and appropriate for all patients, from all cultural backgrounds. In order for this to happen, there needs to be a change in the curriculum currently being taught in medical school. If the American doctors in Merced, California would have been better trained in medical school to be aware of, and sensitive to the Hmong’s cultural beliefs, the outcome of the young Hmong girl might have been different.

What is cultural sensitivity, and why is it important in the delivery of health care? Cultural sensitivity is the respect, and the valuing of differing cultural identities. It is important because there are few places in the world where the delivery of health care takes place in mono-cultural contexts (Prideaux). The United States is continually becoming more culturally diverse. In an increasingly diverse society, doctors and medical staff must learn to value ethnic diversity in order to deliver effective health care to everyone. It would also help providers to better understand others’ beliefs to some extent [This feels a little repetitive, although I think you’re saying doctors need to not only value diversity, but be educated about it, and apply their knowledge, yes?], which would aid in building a strong doctor-patient relationship. The American Academy of Pediatrics agree that physicians need to “...take into account the beliefs, values, actions, customs, and unique health care needs of distinct population groups. Providers will thus enhance interpersonal and communication skills, thereby strengthening the physician-patient relationship....” The relationship between the doctor and the patient, including the patient’s family, is extremely important. In the case of The Spirit Catches You And You Fall Down, we see that the relationship between the American doctors and the Hmong family was weak because of the lack of communication, understanding, and respect. Anne Fadiman shows the lack of communication when she stated that “Dan had no way of knowing that Foua and Nao Kao had already diagnosed their daughter’s problem as [soul loss]. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy...” (28). [Good specific example to illustrate your point.] Neither knew, because no one had bothered to ask. This may seem like a small miscommunication, but it is actually the whole reason why Lia Lee didn’t receive the optimal care she deserved, thus resulting in the tragic end of her young life. If Lia’s doctors would have had some sort of cultural sensitivity training in medical school, the relationship between the American doctors and the Lees might have been different, which would have possibly resulted in better health care for Lia.

How does one effectively teach medical students to be culturally sensitive? What some experts suggest is that in order to understand and appreciate another’s cultural beliefs and practices, students need to first look at their own cultural beliefs and practices. Professor David Prideaux states that there are at least three key elements in teaching cultural diversity:
Students should have opportunities to discuss and reflect upon their own cultural identities. They should interact with others who will represent and explain their own differing cultural identities. Finally they should be prepared for the delivery of health services in a manner which values, respects and enhances the cultural identities of those under their care.

Training at some point, should also look critically at each student’s assumptions and attitudes about people different from themselves. This would involve teaching the students to recognize stereotyping, prejudice and racism (Kai et al). Students also need to be able to understand the strengths and weaknesses of their own culture and cultural identity. When this is achieved, only then can students begin to understand that one culture is not normal or dominant, stronger or superior than the other. Most doctors agree that prejudice and racism have no place in the medical field, yet they appear frequently (Borgeson) [A specific example would help make your argument stronger here]. Only when these issues are addressed will their there be any progress in the training of cultural sensitivity in medical school.

Although medical schools seem to lack sufficient cultural sensitivity and cultural diversity training, there are some effective teaching strategies out there. [Great transition sentence. Your essay flows smoothly from paragraph to paragraph.] A nurse from Sequoia Hospital in Redwood City felt well enough prepared through the nursing school she attended. She recalls an assignment where she had to pick a culture different from her own and learn about it. She then needed to represent that culture in a skit that accurately portrayed ways in which the cultural beliefs of the group might be properly accommodated in the hospital. Nurse Jones also remembers being taught things about certain cultures’ religious beliefs, their birth and death rituals, and beliefs that might be different from her own. She claims that this helped her to be more open and more respectful to people that were different from herself. Doctor Michele Borgeson at the University of California San Francisco, also felt well prepared to handle cultural issues. She felt that there was a lot of value given to cultural sensitivity in her medical training. But, she also says that “growing up in a culturally diverse society, attending medical school at the University of Miami, doing [her] residency at the University of California San Francisco, and marrying a man of a different culture, might have something to do with [her] being culturally sensitive as well, but never the less, [she] realize[s] the importance of respecting others’ cultural beliefs when caring for [her] patients” (Borgeson). This positive aim in teaching student to be culturally sensitive is not just being done in the major metropolitan cities located in the United States. A study done at the University of Leicester Medical School in the United Kingdom, showed that most students were aware of their responsibility to consider cultural issues in caring for patients (Dogra) [Quality research – the personal interviews as well as the research study]. This is good news, and shows that the issue of delivering culturally effective health care is on the right path [The issue is on the right path? Awkward metaphor]. Had any of this training been given to the American doctors described in The Spirit Catches You And You Fall Down, the delivery of the health care they gave Lia would have been different. As Fadiman explains: “All of them had spent hundreds of hours dissecting cadavers...but none of them had had a single hour of instruction in cross-cultural medicine” (61). [Great way to wrap up the paragraph, showing the significance of your argument.]

Although the cultural training that is currently being provided in some medical schools and nursing schools is effective to a certain extent, understanding a person’s culture is not enough. [Another excellent transition sentence.] An article in the Medical Education journal stated, “Although many curricula may include some reference to culture, few training programs appear to have implemented any comprehensive multicultural health care component...” (Kai et al). Cultural sensitivity needs not only to be taught in medical school, but residency training and continued medical education as well. Both Nurse Jones and Doctor Borgeson admit that issues such as stereotyping, prejudice, and racism were never addressed in their medical training. And, nothing at all is mentioned about culture in their continued education training. [Interesting] A public health nurse from Oakland, California admits that she was not prepared at all to deal with people from other cultures that were different from her own. She found it very hard to be culturally sensitive at first. She assumed that the people she was going to serve in her community would accept the care she had been taught to give them (Quinn).

Students also need to realize that an individual’s idea of what his or her culture is might not be the same as the cultural group’s idea; therefore addressing the patient as an individual is very important. Medical staff should encourage patients to describe their cultural characteristics and health beliefs during encounters. This is exactly what the doctors in The Spirit Catches You And You Fall Down did not do. Fadiman explains that the reason why the doctors never asked the Hmong how they treated their illnesses was because the Hmong dressed in American clothes and had driver’s licenses (112). Assuming what the patient’s cultural beliefs are, based on the way they dress, how they live, or how they appear to be, is stereotyping, and can lead to ineffective health care for the patient. It is very clear that there needs to be much more done in training students how to be culturally sensitive than what is currently being done in medical school today, especially if doctors and health professionals recognize the fact that being culturally sensitive has a positive effect on the patient’s outcome.

Although some doctors and health care professionals realize that being culturally sensitive is important in the delivery of health care, most say it’s not as easy as it sounds. [Good – you’re returning to an opposing argument to address it fully.] There are many reasons why medical schools are hesitant in teaching medical students to be culturally sensitive. Medical schools argue that integrating cultural sensitivity into an already over packed curriculum is going to be a challenge in itself. Doctor Borgeson says that “doctors that practice Western medicine are taught in medical school that figuring out the cause of the illness, which is always biological, is their number one priority.” Doctors usually don’t have the extra time in their hectic schedules to learn about a person’s cultural beliefs. As it is, doctors only have fifteen minutes to: gather information on the patient’s medical history, diagnose the patient, and either give medication or come up with a treatment plan. If the patient does not speak English, a translator must be found. Language barriers often cut into precious time when trying to get to the root of a problem (Borgeson). Doctors in rural parts of America argue that their local communities have few ethnic minority groups, so the training of cultural sensitivity would be irrelevant (Kai et al). Tala Montoya, a long time nurse and nursing instructor, admits that “the current medical system in the United States is not tolerant of all cultural issues. There are laws that need to be followed here, and some of the things that are done in other cultures are considered against the law in the United States.” [As an example,] In The Spirit Catches You And You Fall Down, Dr. Neil Ernst reported Lia’s parents to Child Protective Services because they were not giving Lia the prescribed medication properly, which was considered child abuse, which is against the law (58). All medical staff are required by law to report any suspicion of child abuse, or their medical license could be put in jeopardy. So, regardless of how culturally sensitive a doctor or nurse is trained to be, there are laws and values that are supported by the people that practice Western medicine in the United States. [An important paragraph – you outline all the major arguments against more cultural sensitivity training, and they’re serious arguments. Now you can counter them or concede partially, but returning to your thesis.]

Training students to become culturally sensitive is not going to be an easy task. Not only are there laws that need to be followed, but not everyone can be trained to be culturally sensitive. [Moreover,] Becoming culturally sensitive is an individual choice; no matter if it is taught in medical school or not. [Yet] Psychologists agree that although certain prejudices are hard to change, it can be done through extensive cultural and cross cultural training (Spector). One problem is, doctors usually assume that the patient has come to their hospital to seek their advice, and that the patient will automatically agree with the diagnosis and treatment plan the doctor prescribes. In The Spirit Catches You And You Fall Down, Fadiman explains that young doctors are frustrated by the lack of acceptance of Western medicine by the Hmong. Doctors have been taught in medical school that Western medicine is the only legitimate way to care for health problems (76). But, doctors need to understand that Western medicine is a culture in itself. How can other cultures be expected to respect the beliefs of Western medicine if the doctors of Western medicine don’t respect other cultures? There needs to be some sort of compromise. Like the obstetrician in The Spirit Catches You And You Fall Down says: “Sometimes you can find middle ground and try to understand where they are coming from, which is hard, but not impossible” (75). Dr. Borgeson says that “becoming culturally sensitive takes time and experience in the health care field. Over time you begin to realize that there isn’t just one way of doing things, and if you value your career as a doctor, you’ll realize that really quickly.”

In an increasingly diverse society doctors must learn to value and respect others’ cultural belief systems. This will allow them to deliver the most effective health care possible. Medical students need to accept that as future doctors they have a responsibility to be aware and respectful of their patients’ cultural beliefs. Teaching students the importance of being culturally sensitive when caring for their patients is a crucial step in helping them provide effective health care for everyone, regardless of their differing cultural identities. Culturally effective health care must also be integrated into all levels of medical training: both the curricular and clinical phases of medical school, residency training, and in continuing medical education. The lack of cultural sensitivity being taught in medical schools is the reason why there isn’t effective health care for people that have cultural beliefs different from that of the more dominant American society. Some in the medical field feel that there will never be enough training to better prepare them for the issues that surround differing cultural beliefs [Or, apparently, that training doesn’t help, or that there isn’t time to apply their training, or other training is higher priority…]. Others have a more optimistic out look, and are doing everything they can to change the current curriculum in medical schools and nursing schools around the world. An article in the Medical Education journal stated, “Change is needed in medical education. Gradual change is preferable to radical change, because it allows the medical schools to see the success in a series of small changes” (Kai et al). Although this will not be an easy road, and will take time for the training to show an impact in the delivery of health care, we can see that now is the time for change. Now is the time to begin providing culturally effective health care for everyone. Hopefully after this is achieved, there will be no more tragic cases like that of Lia Lee.

Works Cited

American Academy of Pediatrics. Committee on Pediatric Workforce. “Culturally
Effective Pediatric Care: Education and Training Issues.” Pediatrics 103 (1999):167-170 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Borgeson,Michele MD, University of California San Francisco. Personal Interview. 4 Nov. 2003
Dogra, Nisha., and David Stretch. “Developing a questionnaire to assess student awareness of the need to be culturally aware in clinical practice.” Medical Teacher 23 (2001) 59-64. Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Fadiman, Anne The Spirit Catches You And You Fall Down. New York: Farrar, Straus
and Giroux, 1997.

Jones, Marcy L. Nurse, Sequoia Hospital. Personal Interview. 28 Oct. 2003
Kai, Joe, et al. “Learning to value ethnic diversity-what, why, and how? Medical Education 33 (1999)616-623 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Montoya, Tala Nursing Instructor, College of San Mateo. Personal Interview. 1 Nov. 03.

Prideaux, David. “Cultural identity and representing culture in medical education. Who does it?” Medical Education 35 (2001): 186-187 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward,Ca. 30 Oct. 2003<http://search.epnet.com/>

Quinn, Julianna Public Health Nurse, Alameda County. Personal Interview. 10 Nov. 2003.

Spector, Rachel E. Cultural Diversity in Health and Illness. 4th ed. Stamford: Appleton and Lange, 1996

Instructor end comment:

[An impressive, thoughtful paper! Your research is excellent, and while you can’t expect to answer all the problems of Western Medicine in one paper, you make a strong case for the value of improving cultural sensitivity training in medical education. Your paper is exceptionally well organized, and you weave examples from our class text in beautifully with your evidence from other sources. I really enjoyed reading this.]

** Minor mechanical errors/typos have been corrected by the creators of CHARLIE

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