Thank you for inviting me to speak to you today about the importance of social anthropology and its importance in the medical community.
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Many of you as health care providers have had difficult experiences explaining Western medical technology to your Hmong patients. Either the treatment program was not followed appropriately or the parents removed the children from the hospital before treatment began. The Hmong have a very well devolved fight or flight response that has been keenly honed over generations. America is their new home and while they have begun the process of assimilation with changes in religion and language they still strongly believe in the shamanistic rituals for healing. By understanding those rituals and finding ways to integrate them with Western medicine there will be less frustration and more meaningful treatment.
To understand the Hmong you need to have at least a brief history of the regions in which they have lived and their long history of migration.
Their last migration was their relocation as refugees to the United States. The history of migration began when 2700 and 2300 B.C. when they lived between the planes of the Yellow and Yangtze Rivers. The multiple conflicts of the region helped to develop the fight or flight response.
The Hmong were affected by the Indo-China war. The death toll was largely due in part to the fighting and also the starvation and diseases that were prevalent during the forced migrations with the country. After Laos fell in 1975 thousands of the Hmong fled to Thailand where they lived in refugee camps until they were resettled in various countries including the United States. Their relocation was primarily to urban areas with an increase in technology that was unfamiliar to the Hmong which resulted in further changes in their lifestyle and traditions.
When the Hmong immigrated to the United States they had a wide range of ideologies to alter social relationships and to create access to secondary social and economic resources. By becoming Christians and changing some aspects of their medical practice the Hmong gains access to economic resources including literacy and material practices but lost some of their traditional ritual practices. Christianity provided a means for the Hmong to reinforce their cultural identity in their churches while appearing to be absorbed by mainstream society.
Another way the Hmong have attempted to assimilate with American culture is by including practices from Western medicine in their lives. The difficulty arises because the Hmong believe that their medical practices are superior for several reasons one of which is they enhance their sense of membership in their own culture. This membership is important to people that have undergone significant change and trauma as refugees.
While the Hmong have begun to adapt to Western medicine they have also kept their medical traditions. These two very distinct medical traditions resulted in miscommunication between doctors and the Hmong which can be seen very clearly in the case of Lia Lee. During the treatment of Lia Lee, she was being treated for epilepsy which in the Hmong tradition is known as quag dab peg or the spirit catches you and you fall down the miscommunication between the doctor and parents resulted in the removal of Lia from her parents and her eventual neurologically impaired status.
To fully understand different cultures and provide adequate care, doctors and nurses need to be able to have a dialogue with their patients and a good way to start that conversation is with eight simple questions.
These questions if asked and the answer listened to and taken into account of the medical treatment significantly better treatment can be provided.
These questions are:
- What do you call the problem?
- What do you think caused the problem?
- Why do you think it started when it did?
- What do you think the sickness does? How does it work?
- How severe is the sickness?
- Will it have a short or long course?
- What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
- What are the chief problems this sickness has caused?
- What do you fear most about the sickness?
Had these questions been asked with the Lee’s the medical staff would have had a better understanding of their understanding of the illness and could have proceeded with a better course of treatment.
Assuming that Western medicine is superior to any other is arrogant and causes damage that could very well be irrevocable.
In Western medicine, a medical mistake is difficult to rectify. The septic infection that caused Lee Lee’s brain to shut down can not be fixed and when the doctors involved are asked about her case they refer to her as if she has died while she still lives.
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By asking these questions the healthcare providers can attempt to create a treatment plan that answers the spiritual concerns of the Hmong as well as the medical needs of the patients.
While some of the answers received might be odd or different from a Western standpoint when interpreted by a member of the Hmong community a valid treatment plan can be formed. The medical staff also needs to understand that in the Hmong religion reincarnation will happen and protecting the spiritual life of an individual is more important to them than preserving this life.
The body must be whole at death so that the spirit can move throughout its existence in a complete state. In Western medicine saving the life is more important than spiritual existence and as such decisions are made to remove damaged parts through surgery. These plans need to be made with the full support and understanding of the necessity of the surgery so the patient does not leave the hospital to never be seen again.
I have an example of a male patient who was admitted to the hospital with lower abdominal pain and an inability to engage in anything more strenuous than complete relaxing. A Hmong shaman was consulted who performed the necessary rituals to solve the problem if its cause had been a spiritual problem. When the ritual failed to heal him he agreed with the doctor that it was not a spiritual problem and that Western medical intervention was required.
He had gall balder surgery and the problem was resolved. By working in harmony with the shaman both the medical and spiritual aspects of the case were resolved with a little amount of aggravation to both the patient and the medical staff.
Patients do not arrive at the hospital in a bubble. They come to you with a diverse culture and traditions that must be taken into account to provide effective treatment. While it can be difficult to work within the traditions, consulting the shamans can lessen the difficulty. Perhaps it would be beneficial to the hospital to have a shaman on staff as a consultant as well as translators that are easily available to both the medical staff and the Hmong patients.
It is my sincere belief that while Western medicine can heal many illnesses and diseases the educational system that we have in place creates healthcare providers with very ethnocentric viewpoints. Since the medical expertise that they have been taught supersedes all other traditions there is no need for the health care professional to consider their patient’s spirituality or personal beliefs and by doing so neglects the patient. To fully treat patients their background, beliefs, and religious orientation must be considered and a treatment plan created that will allow all aspects of the patient to be healed not only the illness that brought them to Western medicine in the first place.
Fadiman, Anne. The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux, 1997.