NY: Farrar, Straus and Giroux; 1997. ISBN: 0-374-52564-1. 352
pages; $15.00 |
The
Spirit Catches You and You Fall Down: A Hmong Child, Her American
Doctors, and the Collision of Two Cultures |
to pdf >>
By
Anne Fadiman
Review by Carol A Redding, MA
|
The Spirit
Catches You and You Fall Down is a stimulating adventure for any
intelligent reader whose heart and mind are open to reaching beyond
that which is familiar and understood. Against a backdrop of cultural
mystery, tales of nations at war, an epoch of human misery, and a thundering
clash of two worthy, well-intentioned cultures, a baby girl has epilepsy,
and all who know her struggle to help her.
The child--Lia
Lee--is the 13th born to mother Foua and father Nao Kao Lee, residents
of Merced County, California. The Lees "... are among the 150,000
Hmong who have fled Laos since their country fell to communist forces
in 1975."1:p5 Like many Hmong, the Lees were a fiercely
independent family of self-sufficient farmers who, chased by war and
political strife, in 1980 arrived in California, a land of foreign customs
and languages where the Hmong would save their lives but lose their
treasured identity as respected, productive people.
Lia was
the first Lee child to be born in a hospital--a surreal experience for
Foua, all of whose other children were delivered by Foua, unattended
and in silence so as not to alert the evil spirits (dabs) to
each new child's presence. Nao Kao had dutifully buried the placentas
of the first 12 children under the hut's dirt floor so that their souls
could find their way back home after death.1:p5 (And by the
time the Lees arrived in California, half of their children had already
died.)
The book's
title is a literal translation of qaug dab peg, the Hmong phrase
describing a seizure.1:p20 Fadiman shows how the Hmong view
of epilepsy is similar to views expressed in other periods and cultures--for
example, by the ancient Greeks, who viewed epilepsy as a "sacred
disease" of supernatural origin.1:p21,28 Given both
their natural concern for the health of their daughter and their reluctance
to interfere with things supernatural, the Lees were burdened with an
unwieldy internal struggle that would only worsen as they tentatively
brought their seizing baby daughter repeatedly into the hospital's emergency
department.
There,
unable to communicate with the child's parents, the kind, well-intentioned
medical staff endured the unspeakable frustrations of having to practice
"veterinary medicine" on the seizing Lia. Despite everyone's
best efforts, the unavailability of translation services, combined with
profound cultural differences, resulted in Lia being undermedicated,
overmedicated, and mis-medicated. Lia's seizures were increasingly severe,
and her physicians knew that onset of an uncontrollable grand mal seizure
was inevitable. Said one of Lia's physicians, "It was so haunting.
I started to have nightmares that it was going to happen, and I would
be the one on call, and I couldn't stop it and she was going to die
right before my eyes."1:p118
The Hmong
are superior parents in general,1:p22 and Fadiman illustrates
the outstanding care the Lees provided to Lia. Nonetheless, the complexity
of Lia's medical regime would have befuddled even the most literate,
American-born parents: "By the time she was four and a half, Lia's
parents had been told to give her, at various times, Tylenol, ampicillin,
amoxicillin, Dilantin, phenobarbital, erythromycin, Ceclor, Tegretol,
Benadryl, Pediazole, Vi-Daylin Multivitamins with Iron, Alupent, Depakene,
and Valium"1:p46 and that these drugs were to be administered
only at certain times and under specific conditions.
Lia's father
said, "Sometimes the soul goes away but the doctors don't believe
it. I would like you to tell the doctors to believe in our neeb
[healing spirit] .... The doctors can fix some sicknesses that involve
the body and blood, but for us Hmong, some people get sick because of
their soul, so they need spiritual things. With Lia it was good to do
a little medicine and a little neeb, but not too much medicine
because the medicine cuts the neeb's effect. If we did a little
of each she didn't get sick as much, but the doctors wouldn't let us
give just a little medicine because they didn't understand about the
soul."1:p100
The reciprocal
frustration of the parents and of the clinicians are compounded by arrival
of the grand mal seizure. Fadiman's tale of the events leading up to
and following this event make this modern tragedy---in which everyone
fights for the good, yet no one wins---an opportunity for greater wisdom.
Fadiman provides extraordinary insight into how vital is a thorough
understanding of cultural diversity to successful practice of the medical
arts.
