Today, as I scanned through my basement’s bookshelf, my wandering eyes settled on this book: “The Spirit Catches You and You Fall Down”-a true story. All of a sudden, my mind flashed back to the time I read this book for a “Medical Anthropology” course. It caused such a compulsive stir in my life-it made me want to take immediate action. Enter Healthcare. Now that I am working in Healthcare in Canada, I have begun to scratch the surface of what lies underneath the complexity of such devastating stories. Understanding these complexities hasn’t helped me in any way. The feeling of helplessness continues, however.
Picture this: Lia Lee-a three month old girl. When she was three months old, her older sister slammed the front door of their apartment and Lia’s eyes rolled up, her arms jerked over her head, and she fainted. Lia’s parents believed that the loud noise had frightened her soul and that it had fled from her body and become lost. Next time Lia fainted, Lia’s parents were convinced that the spirit was catching her and she was consequently falling down.
Now picture this: When Lia goes to the hospital, her Doctors ask her “impolite” questions that go all the way down to her excretory and sexual habits and before declaring a diagnosis, the Doctors require several samples of bodily fluids. Finally, the Doctors diagnose her for Epilepsy-a neurological disorder that causes seizures.
Given the two contrasting perspectives of Lia’s parents and her Doctors, how should Lia be diagnosed? Should Doctors listen to Lia’s parents who believe that an evil spirit is taking away Lia’s soul and that she must be treated with a healing spirit, or should they prescribe her with an 10-12 pills that vary in frequency, number, amount with prescriptions changing 23 times in less than 4 years?. Lia’s parents dodn’t even understand how medicine works. Medicine is such a Western concept. Lia was born into a Hmong Family. There was no way they were going to administer the medicine to Lia-they would much rather prefer to treat her through what they believed was the root cause-her soul was lost. Giving her medicine, that was too large for Lia to swallow anyways, would interfere with her spiritual treatments -her parents were better of omitting the entire practice of administering the medicine and so they did.
Lia’s life ended-not because of her lost soul or due to a neurological disorder, but tragically due to a mere infection that was overlooked by all her healers in the midst of the culture clash.
The deeply rooted culture of medicine against the culture of the Hmong: two very strong, stubborn, uncompromising cultures. Can you imagine the onslaught of helplessness one would feel? Her doctors, her parents, her entire community?
Lesson learned: Understanding the importance of seeing a case from the patient‘s point of view. Even if the doctor’s knowledge exceeds the patient’s by an incalculably huge factor, that knowledge will do little good if the patient does not trust the doctor or if the doctor does not understand the patient. The best remedy for both those problems is for the doctor to look at things from the patient’s perspective (which may be culturally influenced).
Having worked in a hospital for the first time in my life, I can vaguely only imagine how such a case could be effectively handled. It kills me to know that such cases happen where it is nobody’s fault-everybody tries to help Lia to the fullest and ends up suffering. There is nobody to assign blame to-or perhaps everybody. This is where my frustration arises. Its nothing but a culture clash. A couple days ago I tweeted that “Curing your illness is about restoring your faith in your body”. If the Doctor doesn’t treat you for what you think was causing the problem, then they haven’t really treated you at all.
Ann Fadiman, the author of this novel discusses Kleinman’s 8 question approach that attempts to understand the cultural infleunce of a disorder: The questions in this framework are:
- What do you call your problem? What name does it have?
- What do you think caused your problem?
- Why do you think it started when it did?
- What does your sickness do to you? How does it work?
- How severe is your sickness? How long do you expect it to last?
- What do you fear most about your illness?
- What are the biggest problems that your illness has caused for you?
- What kind of treatment do you think you should receive? What are the most important results you hope to receive from treatment
- The spirit catches you and you fall down (amenaskhan.wordpress.com)
- New Roots for Refugees (communicatingacrossboundariesblog.com)
- What do you think caused your disease? (kevinmd.com)
- Futuristic Mood (lauraannanderson.wordpress.com)
- What You Believe Can Kill You (blogher.com)
- It’s All in Your Head: (brothersjuddblog.com)
- The Dark Side of the Placebo Effect: When Intense Belief Kills (theatlantic.com)
- The Future of Medicine is the Engaged Patient Who Makes Their Own Decisions (downtheavenue.com)
- Why you should not go to medical school (blogs.law.harvard.edu)
- The Ways We Talk About Pain (blogs.scientificamerican.com)