In these recent chapters from The Spirit Catches You and You Fall Down, we learn more about the progression of Lia Lee’s epilepsy and the negative light Hmong people continue to shed on Western medicine. While reading through Chapters 3 and 4, we start to get a since of how frustrating treating Hmong patients can be for both the doctors and families. Lia Lee’s symptoms of epilepsy continue to increase in severity, partly due to her parents not wanting to give her the medication prescribed by her doctors, Neil and Peggy. Despite the doctors impressive credentials, Foua and Nao Kao continue to express their displeasure with giving Lia Lee certain medication, like Dilantin. This puts doctors, like Neil and Peggy in a hard place. If they are trying their best to treat a sick child, but the parents are constantly questioning their methods and by default negatively affecting their daughters health, what are they to do? It is hard to get anywhere with Hmong patients, because of the difficulty with communicating in an understandable manner. The lack of verbal & cultural understanding about Hmong people makes treating them very difficult. They have an intense distrust of Western medicine, which is spurred on by rumors passed along in refugee camps.
It seems like the only time they even go to a hospital is as a last resort. Doctors and physicians alike sometimes do not know what to do with these people they perceive as stubborn and exasperating. It is difficult to make these people see what we in the Western world would think of as common sense. If the doctor prescribes you medication, you take it. No questions asked. If the doctor recommends having a certain condition, you accept it without any doubt. For the Hmong people, it is not that simple and in a way their apprehension makes a degree of sense. There are many times when doctors suggest a harsh treatment to a patient without any consideration for less intrusive measures. It seems though that many at MCMC seem to care a great deal for their patients. In the case of Lia Lee, Neil and Peggy only wanted the best for her and it proved increasingly difficult to get Foua and Nao Kao to understand reason. I must admit, if I was in Neil’s position I probably would have called Child Protective Services. I can only imagine how hard it must be to see a child go without medication that could make them better. For me, sitting idly by while a child so young is neglected of necessary medication would be impossible. However, given the examples of Hmong peoples’ extreme actions when their children are taken from them, I would need to think twice before I made a decision.
I show extreme empathy for the doctors who try their best to meet patients needs. It has to be especially difficult when your patients are from a culture you or any of your colleagues have encountered before. Cultural competence is an important facet that should be taught in every school and hospital, but even with that education there are still challenges.