Culturally Competent Care: A Hmong Child and Her American Doctors

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Table of Contents

Introduction
Differences between Western and Eastern Medicine’s Approach to Health
Overview of the Book
Dynamics of Difference and Underlying Issues
What Went Wrong in the Process?
Who is Responsible?
The Clash of Cultures’ Impact on the Final Outcome
Critical Analysis and Alternative Approaches
References

Introduction

The importance of culturally competent care in the contemporary healthcare system, as well as academic literature on the topic, is highly recognized. One of the most important factors, which contribute to the significance of the problem, is that health appears to be largely determined by the cultural traditions, values, and beliefs of a particular nation. Thus, health could be defined as a socio-cultural construct.

Accordingly, health services treatment and preventive interventions delivery appears to be problematic when patients and doctors come from different cultural backgrounds. The book by Anne Fadiman (2012), which is the primary referencing point for this essay, explores socio-cultural issues related to culturally competent care. Based on the events depicted in the book as well as theoretical and practical perspectives provided in the contemporary nursing literature, this paper aims to answer several questions about the impact of traditional health beliefs on the process of treatment and caregiving.

Differences between Western and Eastern Medicine’s Approach to Health

First of all, it is important to dwell upon providing some preliminary observations about differences between Western and Eastern medicine along with their approach to health. Traditionally, Western culture understands humans as a duality of body and soul.

This dualistic approach manifests itself primarily in processes related to caregiving and medical treatment. On the contrary, Eastern medicine tends to perceive body and soul holistically, understanding and treating them as one complex entity. Thus, healing practices in Western and Eastern cultures differ significantly. It is essential to notice that in recent decades a more diverse and comprehensive understanding of caregiving led to the development of a culturally competent care approach in the U. S. healthcare system, which pays significant attention to spiritual aspects of care delivery (Bauer & Bai, 2018). However, in the book by Fadiman (2012), a different situation is depicted.

Overview of the Book

As the previous section overviews general differences between Western and Eastern medicine and how they impact the process of caregiving, it is appropriate to provide a short summary of the book by Fadiman (2012) in order to put further reasoning in a more extensive context. It could be stated with certainty that the importance of culturally competent care appears to be the most prevalent topic of the book.

The narration focuses primarily on the story of Lia, the daughter of Hmong refugees Nao Kao and Foua Lee, who is diagnosed with epilepsy. Due to the fact that the girl’s parents do not speak English and thus are not able to communicate with doctors, Lia is taken to a foster home. Despite the fact that she is cared about in her new place of residence, Lia’s condition starts getting worse as soon as she is separated from her family. Ultimately, it leads to more frequent and severe seizures, and, finally, one of the seizures leaves the girl brain-dead.

Nao Kao and Foua Lee are deeply shocked by the experience. Despite the fact that they were able to keep their daughter alive for a significantly longer time than it was expected, they largely blame American doctors for Lia’s treatment outcomes. Fadiman (2012) provokes various questions with her book, and the following sections tend to investigate particular aspects of the story in the context of culturally competent care.

Dynamics of Difference and Underlying Issues

It is apparent that the story of Lia’s treatment represents the situation of a collision between two cultures and their approaches to the concept of health. It is possible to state that dynamics of difference between cultural perceptions of health practiced by Lia’s parents and her doctors are the most important aspect of the book’s narration. It could also be stated with certainty that there are considerable underlying issues that determined future problems in the process of the girl’s treatment.

Firstly, it is possible to mention that the Hmong are largely distrustful of American medicine in general. Secondly, the refugee status of Lia’s parents might have been the factor that influenced their cautious perception of American doctors. Thirdly, epilepsy in the Hmong culture is widely associated with the involvement of spiritual forces, and Lia’s doctors did not consider it to be the case due to their health beliefs. Additionally, it is possible to mention that Lia’s parents regarded their participation in the process of treatment as one of the most important factors since illnesses in the Hmong culture are usually treated within the family while American doctors were perceived as strangers.

What Went Wrong in the Process?

The underlying issues, which were identified in the previous section, have a direct impact on the emergence of various problems that were prevalent in the process. It could be suggested that the most problematic event was the doctors’ decision to put Lia in the foster home, thus separating her from the family. Prior to this event, the inability of Nao Kao and Foua Lee to speak with doctors and keep the medication regimen (which was also influenced by their distrust in Western medicine) was another influencing factor that aggravated the girl’s condition.

One can suppose that if the cooperation between the Hmong family and doctors was more efficient and productive in the early stages of Lia’s disease, the outcomes could be significantly better. However, the factor that had the most impact on the situation was the girl’s separation from her family. In Hmong culture, family ties play a highly significant role in the process of treatment, and thus Lia was put in the situation when she did not receive culturally appropriate care.

Who is Responsible?

Another question that is worth discussing is the extent to which people involved in the situation are responsible for the ultimate outcome of the treatment process. Arguably, in situations when two cultural approaches to health collide it is difficult to state with certainty that only one party is responsible. Nevertheless, Fadiman (2012) expressed an opinion that implies that Lia’s doctors are largely responsible for the girl’s tragedy. Such extent of their responsibility is determined primarily by the fact that they had a considerably wider set of opportunities in terms of care delivery for Lia. Apparently, Nao Kao and Foua Lee are also responsible since they were too persistent in keeping their traditional health practices.

The Clash of Cultures’ Impact on the Final Outcome

One can preliminarily conclude that the clash of cultures is the most influencing factor on the final outcome of Lia’s treatment. It is possible to state that there are two aspects of this issue. First of all, it is the contradiction between Western and Eastern approaches to medicine and health in general. Secondly, it is the involved parties’ insufficient effort in achieving effective collaboration on the girl’s treatment. Therefore, it is essential to critically analyze the situation on the basis of the depicted event as well as to observe alternative approaches to Lia’s situation.

Critical Analysis and Alternative Approaches

Critical analysis of the story under discussion would largely benefit from approaching scholarly literature on the topic. According to Bauer and Bai (2018), education in the sphere of culturally competent care is one of the most important aspects of medical education. This assumption is reinforced by the results of the study by Mathias, Mathias, Goicolea, and Kermode (2018), in which the authors argue that healthcare professionals are largely responsible for the promotion of mental health competence in communities that do not have sufficient knowledge about it. Fekadu et al. (2016) also state that working with rural communities, whose health beliefs differ from traditional assumptions about health in Western culture, requires the development of a comprehensive plan.

Therefore, this provision could be applied to the story described by Fadiman (2012). As it was already mentioned, both parties are responsible for the final outcome, but it is argued that American doctors are more responsible. It is also of high importance to propose several alternative approaches that could facilitate the girl’s treatment. For example, doctors could find a translator that could help them to communicate meaningfully with the girl’s family. They should have also paid more attention to the cultural peculiarities of the Hmong. Concerning Lia’s parents, they could compromise on some aspects of the treatment and communication with doctors in order to be adequately involved in the treatment process. In conclusion, it should be stated that the story depicted by Fadiman (2012) exemplifies the immense significance of culturally competent care in the contemporary world.

References

Bauer, K., & Bai, Y. (2018). Using a model to design activity-based educational experiences to improve cultural competency among graduate students. Pharmacy: Journal of Pharmacy Education and Practice, 6(2).

Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York, NY: Farrar, Straus, and Giroux.

Fekadu, A., Hanlon, C., Medhin, G., Alem, A., Selamu, M., Giorgis, T. W.,… Patel, V. (2016). Development of a scalable mental healthcare plan for a rural district in Ethiopia. The British Journal of Psychiatry, 208(s56), s4-s12.

Mathias, K., Mathias, J., Goicolea, I., & Kermode, M. (2018). Strengthening community mental health competence—A realist informed case study from Dehradun, North India. Health & Social Care in the Community, 26(1), e179-e190.

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