Should doctors deal with Hmong patients?
While most patients accept the fact that their doctor is doing his or her best to treat them, doctors dealing with the Hmong cannot take this attitude for granted. If they continue to force compliance with a regimen that patients believe to be harmful, they may run up against Hmong stubbornness.
What has history taught the Hmong about hospitals?
Indeed, history has taught them to mistrust outsiders and large impersonal institutions, i.e. hospitals. (An Important History Note: Due to their support of the CIA’s efforts in Laos during the Vietnam War, the Hmong had to flee retribution when the communists gained power in that country after the US military pulled out.
Why did the Hmong migrate to America?
Since the mid-1980s, a large portion of Hmong refugees have immigrated to the US. In the relocation process, efforts are made to keep the nuclear family intact, but not necessarily the extended family. Because the Hmong give such importance to the extended family, many "secondary" migrations have occurred in order to reunite that extended family.
Why didn't the Hmong understand what diabetes was?
The Hmong also did not possess the same conceptual background knowledge as most other patients. They couldn't understand that diabetes was caused by a faulty pancreas, for instance, because they didn't have any idea what a pancreas was.
What were the names of Lia's primary doctors?
Ms. Lee's primary doctors, Neil Ernst and Peggy Philp, said the girl and her family profoundly changed medicine. “Lia's a game changer,” Ernst said. “She's altered so many people's approaches to dealing with patients with different beliefs.”
What was Lia's diagnosis by her American doctors?
Lia Lee was born July 19, 1982, in Merced. When she was 3 months old, she had her first seizure. American doctors eventually diagnosed epilepsy.
Who does Jeanine use as an interpreter?
. She knew the names of all their children, and her size at five feet one was less pretentious than that of Peggy and Neil who were both quite tall. She was able to make house calls and this kept the lines of communication open, and she used May, the Lees' most Americanized daughter, as her interpreter.
What difficulties does the Merced medical Center face treating the Hmong community and Lia specifically?
What were problems with the way Lia's parents were treated in the Merced hospital? - failure to work within the traditional Hmong hierarchy of male/elders making decisions lead to confusion because information was being relayed to people that could not act on it.
Is Lia Lee alive?
Lia Lee died in Sacramento on Aug. 31. (Her death was not widely reported outside California.) The immediate cause was pneumonia, Ms.
What does Lia's family believed happened during the door slamming mentioned in chapter three?
Despite the careful installation of her soul during the hu plig ceremony, the noise of the door had frightened out of Lia's body, and it became lost. The resulting symptoms they recognized as qaug dab peg or “the spirit catches you and you fall down.” This is, of course, translated as epilepsy.
Why did the Lees leave Laos?
For the next three years, the Lees lived under the oppression of the communist Vietnamese, who viewed the Hmong as traitors for having sided with the United States. In 1979, they lost another child to starvation—not long afterward, they joined four hundred other Hmong in another attempt to leave Laos.
What did you learn from the spirit catches you and you fall down?
The Spirit Catches You and You Fall Down is a moving story that highlights the importance of acknowledging and respecting people's beliefs as part of their health care — in other words, cultural competence. And thanks in part to this book, cultural competence is now a required lesson in many medical schools.
Who is Jeanine hilt in the spirit catches you?
Jeanine Hilt: a social worker who makes Lia her personal cause and fights on Lia's behalf. She is presented as one of the few members of the American medical establishment willing to acknowledge Hmong tradition and tailor treatment to Lia's case.
What do traditional Hmong consider their most important duties and obligations What do American doctors consider their most important duties and obligations?
What do American doctors consider their most important duties and obligations? It is very clear that the Hmong value their family and cultural and spiritual beliefs to be the most important in their life. The Hmong look to heal in spiritual ways while American doctors look to heal in medical ways.
Why did the doctors at MCMC fail to correctly diagnose Lia with epilepsy at first?
Why did the doctors at MCMC fail to correctly diagnose Lia with epilepsy at first? Lia's seizures had stopped by the time she got to the hospital, and there was no interpreter to explain what had happened.
What did Lia do when she sensed a seizure?
Foua and Nao Kao knew when a seizure was coming on, because Lia knew. The aura, a sense of premonition common to all epileptics, could be seen in Lia in a strange, scared expression, and they would pick her up and gently lay her down on a mattress in the living room, placed there just for that purpose.
In Western medicine, what is "quag dab peg"?
wy did lees trust, Jeanine? why did Jeanine succeed where so many had failed.
Who filed a report about Lia to Child Protective Services?
n April 1985, after receiving word that the Lees were once again modifying Lia's medical treatment, Neil sent a note to Child Protective Services r...
Why was Lia transferred to a different hospital in Chapter 11?
MCMC didn't have a children's Intensive Care Unit, so they transferred her to Valley Children's Hospital in Fresno.
What did Neil and Peggy feel about the Lees?
Neil and Peggy felt a lot of anger at the parents for their noncompliance , even though they recognized that what they really needed was compassion. It was difficult to work so hard and to face resentment rather than appreciation. Furthermore, the Lees hadn't paid for any of Lia's medical care, yet they didn't seem to appreciate the generosity either of the state insurance program, Medi-Cal, nor of Neil and Peggy's services, which Medi-Cal reimbursed at a very low rate. Lia's parents showed no deference to the doctors' many years of schooling, their awards, or even the hours they spent educating themselves about the Hmong. It was also agonizing for them to watch Lia fail to receive the treatment they believed would let her live a normal life.
Why did Lia have to be tied to her crib?
Lia was quite overweight, which compounded the problem of administering intravenous medications. Doctors had to cut open and tie off several of her veins in an attempt to place a needle. They would tie the limb with the needle to a board and sometimes even tie Lia to her crib so that the IVs would last longer.
What do Hmong believe about medical care?
When asked their opinions of medical care in Merced, educated Hmong expressed their beliefs that you must let doctors examine your body in order to stay in the United States, that the rich are treated right away while the poor have to wait, that they will get sent to jail if they change their mind about having surgery, and that the doctors look down on refugees, want to study them rather than cure them, and ignore their wishes. Some even believe the student doctors kill the poor. None of these beliefs are true, of course. Most of the doctors went into family medicine for altruistic reasons. They know the Hmong don't like them, though, and this upsets them - enough that some doctors jokingly suggested treating the Hmong with ‘high-velocity transcortical lead therapy’ -- i.e., shooting the patient in the head.
What is the power structure of the Hmong community?
These chapters bring up a second aspect of power: the traditional power structure among the Hmong community, in which wives defer to husbands, who defer to elder brothers, who defer to clan leaders, and so on. Doctors complain that the requirement to consult with so many people serves as an obstacle for good medical care when decisions need to be made quickly. However, physicians who have acquiesced to working with this power structure instead of trying to fight it have had far more success. For example, parents who were upset at the frequent drawing of blood of their child backed down when a Western-educated Hmong leader explained the necessity and safety of the blood tests, communicating this information through the family hierarchy. There is a clear lesson to be learned: if doctors wish for Hmong patients to respect their expertise and accept their instructions, they must be willing to respect the Hmong hierarchy.
What happened to Lia after she stopped taking phenobarbital?
After they stopped giving her medication for three months, Lia had a seizure so severe that the phenobarbital given in treatment caused her to stop breathing. The resident on duty, Dan Murphy, had to place a breathing tube down her throat and have her transferred to a better-equipped facility 65 miles away.
Why can't Lia be left alone?
She couldn't be left alone, as she could get out of anything and hurt herself even with tied wrists. At the same time, she was very affectionate and always wanted to be held. Lia disliked swallowing her medications, and her parents were also uncertain about what they were supposed to give her.
How long did Lia stay unconscious?
In the most serious episodes, Lia would remain unconscious for twenty minutes or longer as she seized, a condition labeled "status epilepticus.". She would remain in this state until she received large doses of anticonvulsant medication intravenously, which, in her convulsing state, was very challenging to do.
Why didn't Lia Lee's parents give her medication?
Anne Fadiman wrote that Lia's parents did not give her medication as it was prescribed because they believed that Lia Lee's state showed a sense of spiritual giftedness, and they did not want to take that away. The American doctors did not understand the Hmong traditional remedies that the Lee family used.
What is the conflict between Ernst and Lia's parents?
Throughout the story, they clash with Lia's parents, whose adherence to Hmong shamanism conflicts deeply with their own beliefs about Western medicine. Despite the good intentions of Ernst, Philp, and Lia's parents, significant miscommunication and disagreement cause Lia permanent harm.
How old was Lia Lee when she was removed from her home?
The doctors treating Lia Lee, Neil and Peggy Ernst, had her removed from her home when she was almost three years of age, and placed into foster care for one year, causing friction with her parents.
Which theory did Fadiman use to prove that the Hmong people originated from Siberia?
Fadiman's book cited the Quincy theory that the Hmong people originated from Siberia. Entenmann wrote that because of the reliance on Quincy's book, Fadiman's book propagates the idea that Sonom was a Hmong king, a concept that Entenmann says is inaccurate.
Why did Lia's condition worsen?
Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects, and the inability of the doctors to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia's condition worsens. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme of the book.
How tall was Lia Lee?
She died in Sacramento, California, on August 31, 2012, at the age of 30. At that age she weighed 47 pounds (21 kg) and was 4 feet 7 inches (1.40 m) tall; many children with severe brain damage have limited growth as they age. Outside of the State of California Lia Lee's death was not widely reported.
How did Lia Lee die?
Lia Lee slipped into a coma after suffering from a tonic clonic seizure in 1986, when she was four years of age. Lia Lee's doctors believed she would die, but Lia Lee remained alive but with no higher brain functions.
What is the treatment for physical illness?
Chicken must be boiled, not fried. Herbal medicines are added to the meal in small amounts. Other treatments for physical illness include cupping, coining, and moxibustion. Treatment for illness of a spiritual nature involves religious ceremonies, wearing amulets, or food/animal sacrifices.
What is the role of a father in a Hmong family?
Role of Father: In traditional families, the father is the head of the household. When healthcare professionals encounter a more acculturated Hmong family in the U.S., they will likely see more balance of power between mother and father.
What are the Hmong people?
Who Are the Hmong People in America? The Hmong (pronounced hmung with a very soft h) in the United States are a relatively small southeast Asian minority group who began living here at the close of the Vietnam war. Due to their unique cultural beliefs and indigenous practices, Hmong refugees settled in the United States often present a unique set of challenges to healthcare professionals. As a people, their adaptation to our western model of healthcare delivery is often slow, hindered by particularly strong traditional beliefs, culturally-based patterns of communication, limited English proficiency, and a deep distrust of governments. Their history as a marginalized people fleeing persecution as war refugees has made them an insular people. Indeed, history has taught them to mistrust outsiders and large impersonal institutions, i.e. hospitals.#N#(An Important History Note: Due to their support of the CIA’s efforts in Laos during the Vietnam War, the Hmong had to flee retribution when the communists gained power in that country after the US military pulled out. The United States finally gave the Hmong preferential refugee status in the early 1980s.1)
Where did the Hmong come from?
Many Hmong originally came from agrarian societies which tend to relate to time as cyclical, repetitive, and slowly advancing. Some Hmong individuals who are less acculturated to the U.S. may still be unaccustomed to functioning via American “clock time.”
Do Hmong accept blood tests?
Traditionally, both are unacceptable. Younger Hmong, however, are more accepting of these medical procedures.#N#Blood Tests: Hmong accept blood tests. But they may question why they have to have blood taken more than once in one visit or why a large volume of blood is needed.
Do Hmong believe in reincarnation?
Traditionally not acceptable. Hmong believe it is not a good idea to put something into their bodies. If a person is immunized or has surgery, he/she will be reincarnated with less than a complete body or a body with something foreign in it . However, most Hmong parents will have their children immunized once they know it is required for school or other activities.
Do Hmong people drink hot water?
Traditionally, someone who is sick is required to eat hot food and certain vegetables. Hmong prefer hot chicken and rice. They drink hot or warm water. Within 30 days of childbirth, Hmong mothers will usually only eat warm foods.
What is Yeng Her's dream?
Overcoming adversity, Yeng Her achieves his dream of being a physician and biomedical researcher. Yeng Her spent the first 10 years of his life in a refugee camp. When his family arrived in America, he did not speak English and had never attended a formal school. Motivated by early hardships, he was determined to make a better life for himself ...
How long did Yeng Her live in a refugee camp?
Yeng Her spent the first 10 years of his life in a refugee camp. When his family arrived in America, he did not speak English and had never attended a formal school. Motivated by early hardships, he was determined to make a better life for himself and his family.
What was the Hmong people's role in the Vietnam War?
During the Vietnam War, the United States recruited the Hmong, an indigenous people who had no country of their own, to combat communist forces in Vietnam and Laos. After U.S. troops pulled out of Southeast Asia in 1975, the Hmong fled persecution, settling in refugee camps in Thailand. Her’s parents met, married and raised four children in refugee camps.
What is IMSD in Mayo?
During the next two years, the Initiative for Maximizing Student Development (IMSD), another Mayo-NIH program geared toward helping students from underrepresented groups complete graduate school, provided a supportive environment for Her.
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Why did Hmong change his name?
successful Hmong who changed his name so it wouldn't sound so Asian
When did Hmong refugees come to the US?
family of Hmong refugees that came to the US in 1980s
Did Lees take Lia's help seriously?
lees took lia's help _ seriously than expected by americans
Why are Foua and Peggy able to resolve their differences?
They are able to resolve their differences because Foua and Peggy could relate on the fact that they both have sick children. I think Foua sympathized with her because she thought that Peggy now had a deeper understanding of this pain they went through watching Lia when she was really sick. I don't know if this could have happened earlier because it seemed like no matter what Neil and Peggy did, Foua and Nao Kao would still feel inferior to them because they were doctors.
What did Blia Yao Moua teach Fadiman?
Blia Yao Moua taught Fadiman about customs and beliefs. He was the director of an organization that helped refugees receive public assistance, apply for job training, etc.
What did Fadiman teach Fadiman?
They taught Fadiman that there are Hmong leaders who have successfully assimilated into the American culture.
What is the difference between the Hmong and the American doctors?
I have yet to learn about a culture that is so strong-willed in their beliefs. This was the difference amongst the Lee's and the American doctors; the Lee's didn't believe in Western medicine and actually believed it was making Lia worse, while the doctors relied on medicine and drugs to treat Lia and her seizures.
What does Fadiman say in Chapter 18?
In Chapter 18, Fadiman writes, "As William Osler said - or is said to have said - 'Ask not what disease the person has, but rather what person the disease has." How might have the events of this book unfolded if Osler's dictum were universally followed in the medical profession? How would your relations with your own doctors change?
What does Fadiman say about Foua?
In Chapter 8, after describing Foua's competence as a mother and farmer in Laos, Fadiman quotes her as saying, "I miss having something that really belongs to me." What has Foua lost? Is there anything that still "really belongs" to her?
What is the Osler model?
*Osler is focusing on the "whole doctor-whole patient" model, where the doctor brings his entire humanity to the hospital, and the patient is seen as a complete person and not just a disease.