Day 84: HCS – Hmong, Care and Society

Another Health, Care and Society. This time, we are assigned a book.
A Spirit Catches You and You Fall Down – Anna Fadiman

I am going to save the summary of the story because there are a panoply of cliff notes available online regarding this book. The book was chosen so that students could challenge their views on the balance between practicing medicine and understanding culture.

After reading the book and writing a response to three questions, my small group was ready to engage in some heated discussion. So the question, What would “you” have done in their (Dr. Neil Erst and Dr. Peggy Philp) shoes? That what the kindle placed on the table. Hands flipped up faster than Judas flipped on Jesus. Just like that, 11 other students burned both physicians at the stake. “They were culturally insensitive” “They should have been more patient with the family”
The dust settles…
While I agree with the idea behind these statements, I feel that there is more depth to the story than just “be more culturally sensitive”. In no way, am I belittling the idea though. Being culturally aware of your patients is a necessity in a world that is reaching closer to the pinnacle of global integration. But my ideas crawl from beyond the shadows and  nudge my hand up in the air. I know the “pleasing” thing to say in the room; the answers that continues the wave of the same idea – groupthink. And there are very few things that I hate more than groupthink.

So I begin to piece my side of the argument. The physicians did try to understand the Hmong culture. They collected National Geographic Magazines, they took out books at the local library. They made an effort to understand a patient, by trying to understand their culture. It is so easy to ridicule that they should have asked question x and question y; especially when you are reading this book and are able to see the Hmong point of view written out for you. “Oh, they view epilepsy in this manner” “Oh, these are their medical beliefs and hierarchy of care” I believe that one of the take homes is how questions are asked. And you can apply this strictly to understanding culture, but I believe that it goes much beyond this. Ask questions so that the patient talks. Do not assume much before entering in the room.

Furthermore, I feel that this book expresses one of the complications in our medical system. There was a language barrier between the physicians and the patient’s family. In order to overcome this barrier, the hospitals need to see this as a priority. They need to understand that quality of care is impacted. To solve this problem, the hospital should hire a translator in order to accommodate the patients. So for this case, the hospital should hire a translator that speaks the language of the Hmong people…but…there are three spoken dialects. Danashan (over half of the population), Hmong Daw and Mong Njua. Of course, this would only be practically effective for cases regarding continuity of care. This is because emergent cases could have people that are monolingual in 1 of the 6,500 languages estimated to exist on our planet. I feel that we live in a world now where technology has been able to close the language gap. So, now the medical community can focus on making connections with the patient that will yield the highest quality of care!

As always, here is a song that corresponds to this portion of my life:


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