“The Spirit Catches You and You Fall Down” as an Example of Conflicts in Healthcare Based on Cultural Differences

Patients are unique individuals and differ in several ways. Some examples of differences that may be seen are illness, personality, socioeconomic class, or education, but one major difference may be cultural. Many health care professionals treat patients the way they would want to be treated but often times do not take cultural preferences into consideration.

While I was working as a nurse on a busy medical surgical floor, there was a patient that was from India. My patient was fasting due to a cultural belief but the physician taking care of that patient had no knowledge of the culture nor did they think that might be why the patient wasn't eating. Instead, the physician thought the patient had something wrong with them medically as to why they were not eating. There ended up being several tests ordered, which were all negative. It took a family member of that patient coming in to tell the physician why the patient wasn't eating. Reflecting back on the situation, not only do I believe the physician should have investigated further but I should have too.

Having cultural knowledge will not only avoid misunderstandings between the health care provider and patient but it will promote better care and compliance. The Spirit Catches You And You Fall Down is a great example of how cultural preferences need to be considered when caring for patients.

Conflicts

In the nonfiction book The Spirit Catches You And You Fall Down, Anne Fadiman describes conflicts that arise between a Hmong family's cultural beliefs and traditional Western medical beliefs of Americans. Nao Kao and Foua Lee are a Hmong family that moved to California as refugees from Laos. Their youngest daughter, Lia suffered from epilepsy and as a result of the cultural barriers between the Hmong family and the Americans, Lia never got the full appropriate treatment and eventually passed away. Lia's physicians believed her seizures were caused by a neurological illness within her brain while Lia's parents believed her seizures were caused by soul loss. Although the health care providers and the Lee's both wanted what was best for her, cultural differences interfered with Lia's treatment.

Ethical Issues

"Unethical behavior is anything someone says or does that is morally wrong" (Morelli, Trepal, & Udell, 2015). In The Spirit Catches You And You Fall Down the healthcare professionals fail to learn the Hmong culture and therefore they do not care for Lia in the way the Lee's thought was culturally right. How the healthcare providers acted was morally wrong, they should have determined how the Lee's wanted to be cared for in order to ensure happiness and compliance. When the physicians were asked why they never asked the Hmong patients how they treated their illnesses they stated, "because the Hmong dressed at least approximately in American clothes, had driver's licenses, and shopped in supermarkets" (Fadiman, 1997, p. 112). It never occurred to the healthcare professionals that the Hmong patients would practice something other than western medicine. According to Mendes (2017), "the patient remains the single most important part of the health care equation-when determining what is right, their views must always come first and foremost. " The author of this paper believes if the healthcare providers would have taken the time to learn what the Lee's cultural preferences were, the Lee's would have been more receptive to their care and may have been more open to Western medicine as well.

Cultural Issues

The Spirit Catches You And You Fall Down has cultural issues throughout the book. One cultural issue is the failure to understand cultural preferences. Like it was mentioned above, the Lee's fail to understand the American culture and the health care professionals treating Lia do not understand the Hmong culture that is practiced by the Lee's. It seems as though the health care providers didn't agree with the Hmong culture so they did not want to understand it. Health care providers may not agree with a patients beliefs but they must respect them and honor their choices (Cultural diversity, 2018). An example of the physicians not respecting the Lee's beliefs is when Lia was born they did not let the Lee's keep the placenta, instead they incinerated it. The physicians believed the Hmong culture was going to eat the placenta however, that was not the case (Fadiman, 2007). The Hmong believed the placenta was a jacket that was to be worn into and out of the world (Fadiman, 2007). They would bury the placenta under the dirt floors of their homes for the dead to travel to and reunite themselves (Fadiman, 2007). It was thought that if there wasn't a placenta jacket to return to then the soul of that person would wander the Earth for forever (Fadiman, 2007). Other cultural issues related to health care presented in the book were the Hmong culture did not believe in repeated blood sampling, it was believed to be fatal especially if it was from small children (Fadiman, 2007). Hmong's also believed when an individual was unconscious their souls were at large therefore they didn't want anesthesia because it may lead to illness or death (Fadiman, 2007).

Another significant cultural issue presented in the book was the language barriers. Nao Kao and Foua Lee did not speak or read English. This lead to a lot of misunderstanding between the Lee's and the healthcare providers. Not only did the Lee's not understand the directions on how to administer Lia's seizure medication, they could not read the labels. The Lee's were also presented with consents and discharge paperwork that they were unable to read or understand. If there was interpreters available, they were not competent and they barely had knowledge of the Hmong culture. Without an effective way to communicate, the misunderstandings and differences in opinions continued to grow throughout The Spirit Catches You And You Fall Down.

Spiritual Issues

Fadiman (2007), indicates that the Hmong believe "everything is a spiritual problem" (p. 95). Throughout The Spirit Catches You And You Fall Down, this belief is very apparent. As it was mentioned above, the Lee's believed Lia's seizures were caused by "soul loss" while the health care professionals believed the seizures were caused by "an electrochemical storm" inside Lia's head (Fadiman, 2007, p. 28). The Lee's wanted to use Twiv neeb ("person with a healing spirit") while physicians wanted to use medications (Fadiman, 2007, p. 21). The Lee's felt the medications were making their daughters symptoms worse and that they would interfere with her spiritual healing.

Nursing Practice

Reflecting back on The Spirit Catches You And You Fall Down, the author of this paper believes a dilemma that occurred in the book is the healthcare professionals failed to learn the Hmong culture. Orenstein (n. d. ), states "when physicians understand the cultural backgrounds of their patients and themselves, they can engage patients more effectively and provide better care. " If I were to experience taking care of a patient from a different cultural background and I did not know anything about it I would start off by asking the patient their preferences using the FICA Model. Dameron (2005), describes the FICA Model as an assessment tool that is easy to use and can be adjusted to fit the patients needs. The FICA Model stands for Faith/Beliefs, Importance and Influence, Community, and Address (Dameron, 2005). Some examples of the questions that I could ask to get a better background on my patients culture and prefereces are "What are your spiritual beliefs?"for Faith/Beliefs, "Is spirituality important to you?" for Importance and Influence, "Are you affiliated with a spiritual group within your community?" for Community, and "What can I do to help you spiritually while you are in the hospital?" for Address. I believe if the health care professionals that were taking care of the Lee's would have taken the time to learn their culture, then the Lee's would have been more accepting of Western medicine as well as the physicians would have been more accepting of the Hmong culture. The two could have came together and developed a more effective plan.

Conclusion

As the United States population continues to grow, the diversity will too. It is important for healthcare professionals to respect other cultures and tailor their treatment plans based on what the patient prefers. It is also important for the physician not to assume something else is wrong and start ordering procedures based on assumptions. If the healthcare provider does not know the culture, it is imperative that they obtain the knowledge that is needed to effectively treat the patient. Not only will this improve the compliance rate, it will also make the patient feel more involved in their care.