Cultural Variation in Medicine

It is not unusual for there to be differences in medicine from culture to culture. Sadly, these differences can often cause problems, especially when there is a language barrier between doctor and patient. For Lia, a young Hmong, these differences cost her her life.

The arrival of the Hmong people in the United States was precipitated by years of fighting to remain who they were. Indeed, “the Hmong came to the United States for the same reason they had left China in the nineteenth century; because they were trying to resist assimilation” (Fadiman 183). These are people who do not want to blend in, but want to be independent within their own cultural group.

Lia, the focus of the book, was a young Hmong girl born in the United States, with what American medicine calls severe epilepsy, and what Hmong medicine calls the spirit catches you and you fall down. For the doctors, epilepsy is a strange and horrible disease that must be heavily medicated to prevent any additional seizures. For the Hmong people, quab dab peg is both a disease, and a calling. In Hmong culture, seizures are seen as a sign that the person can communicate with the spirit world, and has the makings of a shaman. Even if they end up not being a healer, they have a mark of distinction in their society. Seizures are not medicated, (there are no drugs for that) but respected as a time the spirit seeks the spirit world to commune with others. This is the primary area of miscommunication between the Merced doctors and Lia’s family, which had a profound affect on her treatment.

The doctors at the Merced Community Medical Center (MCMC) were not much different then any other doctors in the 1980’s. Very little, if anything was known about alternative medicine and few doctors were willing to suggest that osteopathic medicine might actually have merit. While working to treat Lia, they were limited by their education. There were no translators to help the doctors and Foua and Nao Kao understand one another, and there were no statutes in place to help either group realize that they all had Lia’s best interests at heart.

When Lia was brought in seizing, the doctors immediately worked to stop the seizures. The doctors at MCMC had diagnosed Lia with severe epilepsy. Yet they had no way to communicate this to the parents, just as Foua and Nao Kao had no way of telling the doctors that they already knew what was wrong with Lia. Each had made their diagnosis independent of the other. Fadiman notes:

Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia’s parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells.

The doctors, bound by their own code to protect and cure their patients, had to do all they could with the science they had to stop her seizures. Their culture insists that medicine is to cure diseases of the body, and that the soul is not a part of this complex system. Instead, the body is treated at the symptom level, to the point where the disease is controlled. Their medicine requires careful analysis of the body, including samples of fluids, x-rays, cat scans, physicals, and in-patient monitoring, all thins which are foreign to Hmong medicine. While these doctors work to cure their patients, there is little time to be spent at the bedside, and much more time to be spent in the lab.

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Robert Smith was born in New York City in 1956. He has spent more than 12 years working as a professor of English at New York University. He is always ineterested in helping students writing essays and papers. Now he spends most of his time with his family and shares his Univesity experience in writing homeworks and assignments.

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