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The Underlying Issues
The main underlying issues in this book involve the clash of Eastern and Western cultures in the medical profession. The lack of cross-cultural communication stands out clearly as one of the events that led to the death of Lia Lee, a girl born with epilepsy. The patient had the first seizure following the slamming of the door by her older sister. Her parents diagnosed her with quag dab peg by believing that her soul had been forced to flee by the noise coming from the door (Fadiman, 2012). Even though the parents were concerned about the safety of their daughter, they considered her special because, according to their culture, most epileptics were chosen to be shamans. Therefore, while the girl was taken for treatment at the Merced Community Medical Center, traditional healing methods were also used together with engaging in this neeb to recall her soul (Fadiman, 2012). Additionally, the parents wanted just a little medicine because they believed that too much of it would compromise the effectiveness of spiritual healing.
What Went Wrong
When Lia was taken to the hospital for the first time, she was not diagnosed with epilepsy due to the lack of interpreters. The correct diagnosis was made after a few months, and this aspect could have contributed to the escalation of the condition. After it was discovered that she was suffering from epilepsy, the doctors approached and treated the condition purely as a neurological disorder. Due to the complicated regimen of the drugs that Lia was supposed to take, her parents did not follow the doctors’ instructions. They did not like or understand the side effects of the drugs. Additionally, it is important to note that the parents were skeptical of using a lot of medications as they would interfere with spiritual healing. Consequently, the patient was caught between two opposing sides – that of the doctors and her parents. As a result, her condition deteriorated.
Who was to Blame?
The healthcare practitioners were to blame in this case. First, there was a delayed diagnosis caused by a lack of interpreters when Lia was taken to the clinic. According to Shen (2015), the language barrier is one of the main challenges facing healthcare professionals when providing services in a multicultural set-up. Additionally, understanding the history of a patient plays an important role in the process of making the correct diagnosis. Therefore, the healthcare practitioners are to be blamed in this case for their failure to request an interpreter before attending to the patient. Additionally, after the doctors discovered that Lia was epileptic, they should have tried to understand the cultural implications of the disorder and offer the necessary patient education to ensure adherence to the drug regimen that was prescribed. Salmond and Echevarria (2017) argue that healthcare practitioners should be actively engaged in educating their patients to ensure positive care outcomes. However, in Lia’s case, the parents were not educated on the importance of taking anticonvulsants for an epileptic patient and the need to adhere to the given instructions.
Impact of the Cultural Clash on the Final Outcome
The cultural clash between the doctors and Lia’s parents affected the final outcome adversely. As mentioned earlier, the parents were not fully convinced about the need for complex medication regimens as such would affect their spiritual healing practices embedded in their culture. On the other hand, the doctors did not offer the necessary guidelines and education to ensure adherence to the prescribed drugs. Consequently, Lia suffered devastating consequences. She had frequent seizures due to noncompliance with medication and eventually started showing signs of mental retardation. Ultimately, one of Lia’s primary physicians alerted the Child Protective Services (CPS) after it became evident that the patient was not getting the requisite care from her parents. Therefore, she had to be separated from her parents, and this experience was traumatizing.
Analysis of the Events and Alternative Approaches
The events that led to the health condition and eventual death of Lia underscore the complexity of issues involved in offering care services in a multicultural context. Additionally, the events highlight the role of culture in health care provision. After Lia had the first seizure, her parents diagnosed her condition as quag dab peg. According to Chinese culture, when someone is caught by this spirit, he or she falls down. The parents believed that Lia was a special kid, and thus she would probably become a shaman later in life. Therefore, the social importance of this condition explains why the parents were quick to employ spiritual healing practices to call her spirit back.
After getting to the clinic, the doctors did not diagnose Lia with epilepsy because they did not have a translator to explain the patient’s medical history. The ensuing language barrier led to the delayed diagnosis, and thus the condition was identified after several months. This scenario points to the importance of effective communication between patients and health care practitioners. Shen (2015) posits that medical practitioners and patients should be in a position to understand each other for meaningful care to take place. For an accurate assessment of a new patient, effective communication plays a critical role in ensuring that the health care practitioner understands relevant health history and other related information.
The alternative approach that the doctors could have taken is to request a translator. According to VanderWielen et al. (2014), translators act as a bridge between patients and healthcare providers to ensure that the involved parties understand each other comprehensively. With an interpreter, the primary care doctors handling Lia would understand her medical history and make the correct diagnosis immediately. Consequently, the situation would have been addressed early enough before aggravating.
After the correct diagnosis was made, the patient has prescribed a complicated drug regimen as the treatment process progressed. However, the parents were either unwilling or unable to follow adherence instructions to ensure that Lia had the right drugs at the appropriate time in the specified dosages. The unwillingness to comply with the prescription instructions emanated from the parents’ beliefs that drugs would interfere with the spiritual healing that they were applying concurrently. On the other hand, the parents did not understand the need to take anticonvulsants for patients suffering from epilepsy. This scenario presents different loopholes that facilitated the unfolding of events as recorded in the book. First, the doctors approached Lia’s condition purely from a neurological disorder perspective. Consequently, they forgot or ignored to address the cultural aspects associated with this condition, which would have paved the way for holistic care.
According to Shen (2015), cultural connotations play an important role in the way people from different cultures view medical care. For instance, Lia’s parents were convinced that she was a special child due to her condition. They also believed that only a ‘little’ medicine was required to supplement the spiritual healing that they were administering to their daughter. On the other hand, from a medical perspective in the western culture, epilepsy is a neurological health condition that can be managed using drugs. This scientific and medical approach clashed with the traditional Chinese perception of the disorder. Therefore, the differing views concerning the condition created a disconnect between Lia’s parents and the doctors. Ultimately, the parents’ failure to adhere to prescription led to the aggravation of the condition and the lifelong suffering of the patient with a dead brain.
The first alternative approach goes back to the need to have an interpreter. If a translator was involved, probably he or she could have pointed to the cultural issues surrounding this disease. Consequently, the involved doctors would have taken the appropriate steps to address the situation satisfactorily. Second, even in the absence of an interpreter, the doctors should have endeavored to understand the cultural implications of their actions. Shen (2015) notes that health care practitioners working in a multicultural set-up should be aware of the various beliefs that patients associate with different diseases. After gaining cultural awareness of the issues surrounding this condition, the doctors would have noted the possibility of non-adherence to the medication regimen. Consequently, they would have acted appropriately to resolve this problem and ensure a positive patient outcome. Patient education would have played a central role in this case by ensuring that Lia’s parents understood the necessity of taking anticonvulsants and following the prescription instructions carefully for the best patient outcome.
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.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12-25.
Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in nursing: A literature review. Journal of Transcultural Nursing, 26(3), 308-321.
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VanderWielen, L. M., Enurah, A. S., Rho, H. Y., Nagarkatti-Gude, D. R., Michelsen-King, P., Crossman, S. H., & Vanderbilt, A. A. (2014). Medical interpreters: Improvements to address access, equity, and quality of care for limited-English-proficient patients. Academic Medicine, 89(10), 1324-1327.