Hmong Culture and Western Medicine

I have read this story about Lia in several classes before, yet I still find it interesting each time. Fadiman provides such a vivid and detailed description of what happens to Lia over so many tough years, and each time I find that I can sympathize more and more with each of the characters. However, I find that I am most interested in Neil and Peggy and the ways in which they treat Lia and her family.

Today in class I mentioned the idea of the LEARN model, and this is something that I wanted to discuss a little further. This model stands for Listen, Explain, Acknowledge, Recommend, and Negotiate. Each of the letters in this acronym becomes very important in the relationship that is formed between a doctor and his/her patient. Regardless of cultural, ethnic, or racial differences a relationship based upon trust must exist to ensure the most positive health outcomes. Fadiman points out in the story that a certain reluctance or ethnocentrism prevents this model from being put into use, and it becomes very tragic for Lia. Neither Neil and Peggy nor Lia's family care to learn more about the meaning of Hmong girl's condition. The worst part about the first section of the story is that the reader remains in the dark about what Lia's parents really should be doing. They hold their traditions and culture very close to their hearts, just as the doctors at Merced Hospital do, too.

I find that Neil and Peggy, as Western doctors, act in a particular way that is very indicative of American culture and its presence in this world. Neil's decision to place Lia in the custody of the state is extremely aggressive - I believe that this was an unjust decision. Although he frames his decision in the sense of non-compliance, Neil's behavior exactly reflects how many doctors practice Western medicine. Americans tend to consider only certain parts of a disease, are concerned only with diagnosis and treatment, and rely heavily on different forms of intervention; they are extremely aggressive. Also, western doctors are afraid of the litigious nature of American culture. Neil demonstrates all of these things.

Cultural competence and sensitivity become a major theme in Fadiman's first chapter. And although we don't exactly see how this can surface with Lia's situation, the reader quickly understands that they are absolutely imperative for the health of the child. Along with these two ideas, cultural humility becomes a very important idea. Because of the historical context of the Hmong people and the emphasis that we place on both science and innovation, Fadiman demonstrates that neither culture is willing to back down. Throughout the first section of the book we see many ways in which Lia and her family are affected by the structural violence that exists in our modern world. This is something we have certainly seen in some of our past readings; it applies directly to the readings about the Native Americans and also the audio clip about the Tuskegee experiment. Historical context and social structure are affecting the ways in which we deliver medicine and medical care in today's world to various groups of people. These effects are rarely ever positive.