In Anne Fadiman's book, "The Spirit Catches You and You Fall Down", the practices of critical and applied medical anthropology are failed to be used in finding the best healthcare treatment plan for Lia. There was a very obvious clash of two cultures in which created problems in the care taking of Lia. Neither the bio-medical healthcare perspective nor the Hmong healthcare perspective saw eye to eye, leading to some major controversies in her care.
From the American bio medical care standpoint, the doctors were culturally incompetent to the Hmong culture in general, and specifically their healthcare beliefs. From the very beginning of the book, the cultural incompetence was evident. Often times there weren't translators to help the doctors understand what the Lees were saying, procedures were done that invaded Lia's body too much and threatened her soul in her parents eyes, and in general the healthcare providers never really tried to get their perspective on what care would be the best for Lia.
This cultural incompetency lead to some major downfalls in Lia's care including drug regimes that varied constantly, tensions between the Lees and the pediatricians Neil and Peggy, and the intervention of child protective services in which took Lia away from the Lees.
Through all this Lia continued to decline consistently after being put back into the Lee's care, even with a more consistent drug regimen. She kept having her seizures, leading up to her biggest seizure ever, which had put her in complete vegetative state. Lia couldn't do anything for herself and was completely dependent on her parents for everything until she passed away at the age of 30.
"I have come to believe that her life was ruined not by septic shock or non compliant parents but by cross cultural misunderstanding" (Fadiman 1997: 262)
How could this situation have been avoided using medical anthropology?
Critical Medical Anthropology: If the members of the American healthcare system caring for Lia had taken more of an approach in this sense, they would have known why a lot of the problems between the parents and doctors in Lia 's care occurred and how to prevent them to make Lia more comfortable.
For example, had Lia's doctor had better understood how the Lee's perceived and understood the numerous prescriptions Lia had, then many problems could have been avoided. The doctors didn't understand that the Lee's felt that these made her condition worse at times, so they wouldn't give her the regimine right. The doctors didn't understand that giving so much medications that they had no knowledge of whatsoever due to their culture, would need a lot more education on their part to the Lees than just telling them what to give Lia. Also, they didn't understand that there were some spiritual beliefs that contributed to their lack of medicinal care to Lia. The Hmong believe that a condition such as epilepsy could signify a spiritually superior child. Therefore, the Lees may have thought the drug regime wasn't necessary all the time due to this.
Applied Medical Anthropology: Had the healthcare providers working on Lia, had more knowledge of the Hmong background through critical anthropology, they could have provided more educational interventions with the Lees to inform them of what this practice of giving Lia a drug regimen was all about. They could have explained the side effects of the medications to them in detail, so the Lee's wouldn't have perceived the side effects as Lia's condition worsening due to the medications. There would certainly be some communication barriers, but continuous educational reinforcement and Hmong translators could have gone a long way.
Another medical intervention they could have done when administering the drug regimen was to do a weekly session with the Lee's where they could have expressed their concerns and difficulties in administering the drug regimen. Had the medical providers followed with the Lee's consistently in this sense, they could have seen exactly what problems may arise with the drug intervention, prior to anything actually happening to Lia.
Cultural Competence: In Lia's story cultural competence was definitely lacking on part of the American medical personnel. Due to this, there were major communication barriers between the Lees and the doctors, and ultimately there was no compromise in ideas of how to care for Lia, which is what should happen when there are 2 different cultural healthcare beliefs.
The pediatricians Neil and Peggy Ernest, seemed to only think that what was best for Lia was what they deemed important in the bio-medical perspective. They never really took into consideration what the Lees deemed important in their spiritualistic healthcare culture.
Had the Hmong spiritualist healthcare perspective been understood better, compromise could have been made, and most importantly Lia could have been a lot more comfortable in the caring of her condition.
Conclusion
Ultimately, through this site I hope one can take away how a better understanding of what critical and applied medical anthropology, along with its relation to cultural diversity. With a better understanding of these particular fields, one can get a good perspective on why cultures have certain medical practices, based upon their specific cultural roots. Understanding these roots to which make their medical practices, helps in applying the best possible medical interventions to improve a healthcare practice or a healthcare system as a whole.
From the American bio medical care standpoint, the doctors were culturally incompetent to the Hmong culture in general, and specifically their healthcare beliefs. From the very beginning of the book, the cultural incompetence was evident. Often times there weren't translators to help the doctors understand what the Lees were saying, procedures were done that invaded Lia's body too much and threatened her soul in her parents eyes, and in general the healthcare providers never really tried to get their perspective on what care would be the best for Lia.
This cultural incompetency lead to some major downfalls in Lia's care including drug regimes that varied constantly, tensions between the Lees and the pediatricians Neil and Peggy, and the intervention of child protective services in which took Lia away from the Lees.
Through all this Lia continued to decline consistently after being put back into the Lee's care, even with a more consistent drug regimen. She kept having her seizures, leading up to her biggest seizure ever, which had put her in complete vegetative state. Lia couldn't do anything for herself and was completely dependent on her parents for everything until she passed away at the age of 30.
"I have come to believe that her life was ruined not by septic shock or non compliant parents but by cross cultural misunderstanding" (Fadiman 1997: 262)
How could this situation have been avoided using medical anthropology?
Critical Medical Anthropology: If the members of the American healthcare system caring for Lia had taken more of an approach in this sense, they would have known why a lot of the problems between the parents and doctors in Lia 's care occurred and how to prevent them to make Lia more comfortable.
For example, had Lia's doctor had better understood how the Lee's perceived and understood the numerous prescriptions Lia had, then many problems could have been avoided. The doctors didn't understand that the Lee's felt that these made her condition worse at times, so they wouldn't give her the regimine right. The doctors didn't understand that giving so much medications that they had no knowledge of whatsoever due to their culture, would need a lot more education on their part to the Lees than just telling them what to give Lia. Also, they didn't understand that there were some spiritual beliefs that contributed to their lack of medicinal care to Lia. The Hmong believe that a condition such as epilepsy could signify a spiritually superior child. Therefore, the Lees may have thought the drug regime wasn't necessary all the time due to this.
Applied Medical Anthropology: Had the healthcare providers working on Lia, had more knowledge of the Hmong background through critical anthropology, they could have provided more educational interventions with the Lees to inform them of what this practice of giving Lia a drug regimen was all about. They could have explained the side effects of the medications to them in detail, so the Lee's wouldn't have perceived the side effects as Lia's condition worsening due to the medications. There would certainly be some communication barriers, but continuous educational reinforcement and Hmong translators could have gone a long way.
Another medical intervention they could have done when administering the drug regimen was to do a weekly session with the Lee's where they could have expressed their concerns and difficulties in administering the drug regimen. Had the medical providers followed with the Lee's consistently in this sense, they could have seen exactly what problems may arise with the drug intervention, prior to anything actually happening to Lia.
Cultural Competence: In Lia's story cultural competence was definitely lacking on part of the American medical personnel. Due to this, there were major communication barriers between the Lees and the doctors, and ultimately there was no compromise in ideas of how to care for Lia, which is what should happen when there are 2 different cultural healthcare beliefs.
The pediatricians Neil and Peggy Ernest, seemed to only think that what was best for Lia was what they deemed important in the bio-medical perspective. They never really took into consideration what the Lees deemed important in their spiritualistic healthcare culture.
Had the Hmong spiritualist healthcare perspective been understood better, compromise could have been made, and most importantly Lia could have been a lot more comfortable in the caring of her condition.
Conclusion
Ultimately, through this site I hope one can take away how a better understanding of what critical and applied medical anthropology, along with its relation to cultural diversity. With a better understanding of these particular fields, one can get a good perspective on why cultures have certain medical practices, based upon their specific cultural roots. Understanding these roots to which make their medical practices, helps in applying the best possible medical interventions to improve a healthcare practice or a healthcare system as a whole.