The Spirit Catches You Exam

What does Fao say she misses about Laos?

"What I miss in Laos is that free spirit, doing what you want to do. You own your own fields, your own rice, your own plants, your own fruit trees. I miss that feeling of freeness. I miss having something that really belongs to me."

How was the author able to be accepted by the Lees?

"With May Ying at her side, she was not an official, not a threat, not a critic, not a person who was trying to persuade the Lees to do anything they did not wish to do, not even someone to be taken very seriously. Her insignificance was her saving grace."

E. pluribus Unum

"from many, one" -a matter of embracing a shared national identity

What did the Lees think the invasive test procedures were?

"sleeping shots"

Hu plig

"soul calling" -naming ceremony that takes place after birth

Quag dab peg

"the spirit catches you and you fall down" -Lia's parents recognized her epileptic symptoms as this

tsoy tom people

"tiger bite people" -Nao Kao thought of the doctors in the ER as this -because the tiger represented in Hmong folktales wickedness and duplicity, this was a very serious curse

hais cuaj txub kaum txub

"to speak of all kind of things"

What "type" of medicine did the doctors at MCMC conclude must be practiced with the Hmong?

"veterinary medicine"

Why does Fou feel that their escape from Laos was nowhere near as sad as after Lia went to Fresno and got sick?

"violence, starvation, destitution, exile and death were, however horrific, within the sphere of the known, or at conceivable tragedies. What had happened to Lia was outside that sphere."

What was Lia diagnosed with once transferred to the hospital in Fresno?

-"profound shock, probably of septic origin" -the septic bacteria had invaded her bloodstream, and her organs were now shutting down -The mortality rate for this kind of bacteria is between 40-60%

American doctors vs. Hmong shamans

-A shaman might spend eight hours in a Hmong home while an American doctor demanded the patient come to the hospital where the doctor might only see him for twenty minutes -Shamans never asked the rude questions American doctors did -Shamans could render an immediate diagnosis while the doctors had to run many tests and then sometimes didn't know what was wrong anyway -Shamans never undressed their patients; doctors even put their hands and fingers into body orifices -Shamans knew you had to treat the soul as well as the body -Shamans could not be blamed for their patients not getting well, because it was the fault of the spirits; doctors were blamed in America for the patient's death.

Dwight Conquergood

-An ethnographer who worked at the Ban Vinai refugee camp in Thailand. -live among the Hmong, learn their culture, and create educational campaigns that take into account their cultural beliefs. -

How did not administering Lia's medications affect her development?

-Lia was a victim of developmental delay. -She was showing a regression in the number of words she used -they saw a steady decrease in intellectual capacity if the parents didn't begin to follow directions in administering Lia's medications

What would Foua's experience of giving birth in Laos look like?

-Squatted on the floor and pulled the baby out with her own hands -labored in silence -husband would cut cord -husband would bury placenta -Foua would drink warm water to make the blood in the womb flow freely -eat steamed rice and chicken boiled in water with give postpartum herbs

Why do the Hmong believe that medical procedures were more likely to threaten their health than to restore it?

-The Hmong believe that there is only a finite amount of blood in the body, doctors are continually taking it. -When people are unconscious, their souls are at large, so anesthesia may lead to illness or death. -Surgery is taboo and so are autopsies and embalming. -The only form of medical treatment that was gratefully accepted by the Hmong was antibiotics. -They had no fear of needles and frequently practiced dermal treatments like acupuncture, massage, pinching, scraping the skin, heating a cup to the skin or even burning the skin.

Why were the Lees were non-compliant with the medical professionals' and their instructions?

-They didn't understand the instructions -They also didn't want to give the drugs. They had come to the conclusion that the medicines were causing the seizures and also Lia's fever.

How do the doctors have to handle the Lees' non-compliant attitude?

-They had to understand that if they pushed their western ideas too hard, they risked running up against the stubborn strain in the Hmong character that for thousands of years had preferred death to surrender -The key was to find a way to allow the parents to back down without loss of face.

Why was the Hmong people's deepest fear about life in the U.S. the doctors?

-medicine was religion, religion was society, and society was medicine. ---the Hmong preoccupation with medical issues was nothing more than a preoccupation with life and death and life after death

Why did Sukey (a psychologist at Merced Community Outreach Services) describe herself as a "fixer of hearts?"

-psychological problems did not exist for the Hmong, because they did not distinguish between mental and physical illness -Everything was a spiritual problem.

What (traditional medicine) measures did the Lees take to try to increase Lia's health?

-spent large amounts of their money on such things as amulets -tried every known cure in their medical library even to the point of changing Lia's name to Kou on the premise that the dab that stole her soul would be tricked into thinking she was someone else, and the soul could return -took her to a shaman in Minnesota for help.

What do the Lees believe is the reason for Lia's worsening sickness once she is in foster care?

-the Lees believed that Lia became even sicker, because she missed them so much.

When Lia went four months with only one seizure, what did her parents attribute the success to?

-the Lees thought it was because of the Shaman they had taken her to in Minnesota -Jeanine attributed it to the use of Depakene and no other seizure medication

In what way did the complaints among the Hmong to the doctors pose an issue?

-their complaints had no organic basis though their pain was perfectly real -they were feeling somatization, emotional problems expressing themselves as physical problems

What did the Lees do when they got home with Lia?

-they boiled some herbs and washed her body -She had been sweating constantly in the hospital, but after washing Lia's body, the sweating stopped and she didn't die.

What does the history of the Hmong reveal about their people?

-they do not like to take orders or lose -they would rather flee, fight, or die rather than surrender -they are not intimidated by being outnumbered -they are rarely persuaded that the customs of other cultures are superior -they are capable of getting very angry

What did Fadiman's first interview with Lia's parents reveal?

A couple that was unlike anything the doctors had described: intelligent, talkative, energetic.

Why did Lia's father like her fat?

A plump Hmong child was perceived as healthy and especially well cared for

Roger Fife

A popular doctor among the Hmong in Merced - popular, in part, because he rarely performed surgeries and was happy to give patients their babies' placentas in plastic bags whenever they requested them.

What sickness did Lia end up having?

Bacillus- caused septic shock

What are two signs that indicate one's soul is pleased to take up residence in one's body?

Chickens' (dead and previously in the cooking pot) skulls are translucent and tongues are curled upward

In what country have the Hmong lived during most of their history?

China

Where would the father bury the placenta?

Girl-under the parents' bed Boy-near the base of the central wooden pillar of the house where a male spirit geld up the roof of the house and watched over its residents (more honorable)

What did Dwight Conquergood do that made his public health campaigns a success among Hmong refugees in Thailand?

He delivered information using characters from Hmong folktales.

Why did Nao Kao not trust Su Xiong (the interpreter)?

He didn't trust her, because she had married an American and the Hmong almost never married outside of their clan. -He also believed, because she scolded him, that she was not accurately translating what he said.

Why did Neil recommend that Lia be placed in foster care?

He felt that her parents were jeopardizing her health by not following her medical regimen.

What other problem contributed to Lia's epilepsy problem?

Her obesity -It made intravenous access difficult and threatened her life, as a result

What caused Lia to start having epileptic seizures?

Her soul was frightened out of her body and became lost after her sister slammed the front door of the Lee's apartment.

What Hmong word is the same as the word for placenta? Why?

Jacket The placenta is considered one's first and finest garment

Kleinman's 8 Questions: (2) WHAT HAS CAUSED THE ILLNESS (a) How would Hmong respond? (b) How would Merced doctors respond?

Kleinman's 8 Questions: (2) WHAT HAS CAUSED THE ILLNESS (a) How would Hmong respond? (b) How would Merced doctors respond? a. Soul loss. While doctors can fix sicknesses that involve the body and blood, for illnesses that are caused by "soul loss," spiritual healing is required. Spiritual healing is performed by a txiv neeb. Furthermore, too much Western medicine will diminish the neeb's healing efforts. b. No uniform cause -often associated with brain damage or other diseases and/or developmental disorders

When and how did Lia die?

Lia died at age 26 of pneumonia, outliving expectations by at least 20 years.

In what condition did Lia leave Fresno to be transferred back to MCMC?

Lia was effectively brain dead

What are the names of Lia's doctors at MCMC?

Neil Ernst and Peggy Phelp

May Ying

Served as translator for Anne Fadiman.

Tvix neeb

Shaman who was believed to have the ability to enter a trance, summon familiars, ride a winged horse, cross an ocean inhabited by dragons, and negotiate for his patient's he alt with spirits that lived in the realm of the unseen

Jeanine Hilt

She is the social worker who makes Lia her personal cause. She fights against the medical establishment whenever she can on Lia's behalf and truly cares for the Hmong as a culture.

What do the Hmong believe to be the most common cause of illness?

Soul loss

What did Dr. Hutchinson, Lia's doctor at the new hospital say about the septic shock?

That in all likelihood, the medicine Depakene set her up for it because it lowers immune system: both preserved her life and compromised it.

What do the Lees believed caused Lia's status epilepticus?

The Lees believed that the teacher had made her fall from the swing, and when she became afraid, her soul went away, and she became sick again

Why was asking the Lees questions involving time not helpful?

The Lees did not tell time in the same way hospital record-keepers did. Years were described as "when the spirits caught Lia and she fell down" or "the year Lia became government property." -They also had no calendar, but followed the lunar cycles and how they affected agriculture, their traditional work.

Why did Medi-Cal refuse to pay for a pediatric hospital bed?

The doctor who made the decision said the Hmong sleep on the floor anyway so they didn't need it. -Jeanie says this is racist

What caused Lia to regain a normal temperature, regular breathing, and gag reflexes?

The doctors attributed it to reduced swelling in her brain while her parents attributed it to the herbal infusion with which they bathed their daughter.

What about the move from Laos to the US was hard for Foua?

The fact that none of the skills she had translated into American life. The one thing that did, parenting, had been contradicted by the government when Lia was placed in foster care - *involuntary migrants*

What was the most important part of the Lee home?

The parking lot where Foua grew her medicinal herbs.

What does one's soul do after death?

The soul travels back place to place, retracting the life's geography, to the house where its placenta is buried. It then puts on this garment and continues on the dangerous journey until it is reunited with its ancestors from where it can be reborn as a new baby. If it can't find its placenta, it is condemned to an eternity of wandering naked and alone.

Hmong view of epilepsy

They acknowledge that it is potentially dangerous and life threatening, but they also consider it to be an illness of some distinction, an illness in which a healing spirit enters the body. -The Hmong saw it as divine, because many of their shamans were afflicted with it. As a result, it conferred a great deal of social status in their community and marked the victim as a person of high moral character since a healing spirit would never choose someone of no -account.

Niel and Peggy Philp

They are Lia's main doctors at the Merced Community Medical Center and unlike most of the physicians there, are open to understanding the Hmong culture. However, they never understand the concept of the soul in healing illnesses and for them, the bottom line is always about life.

When Lia was having a terrible seizure, why did Nao Kao have his nephew come over and call 911 instead of running three blocks to the hospital?

They feared if they took her to the ER themselves, they wouldn't be taken as seriously -However, an ambulance was always taken seriously

Kua quav

a beef stew made from cow's intestines, heart, liver, and lungs, finely chopped and boiled with lemon grass and herbs; literally translated as "liquid excrement"

status epilepticus

a condition in which seizures continue one after another with no intervals of consciousness, instead of spontaneously stopping after a few minutes

septic shock

a potentially fatal medical condition resulting from severe infection and sepsis, in which chemicals released into the bloodstream to fight infection trigger inflammatory responses throughout the body which can lead to organ failure

What is a "tvix neeb"?

a shaman who can negotiate with the spirits for his patients' health

hu plig

a soul-calling ceremony, in which a baby's name is officially conferred

paj ntaub

a traditional Hmong textile art comprised of geometric or organic designs worked in embroidery, applique, and reverse applique; literally translated as "flower cloth"

Kleinman's 8 Questions: (4) HOW DOES THE ILLNESS WORK -WHAT DOES IT DO? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Lia's parents attribute to a spirit called a dab. Lia's parents believe that the sickness makes Lia shake and fall down. The shaking and falling down are caused by a spirit called a dab that is catching her and shaking her. b. Abnormal discharge of electrical activity in the brain.

Kleinman's 8 Questions: (3) WHY AND WHEN DID THE ILLNESS START? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Lia's sister, Yer, slammed the door, causing Lia's soul to be frightened out of her body. b. October 24th, but by the time the Lees got her to the MCMC ER the seizure had stopped. She was misdiagnosed with bronchopneumonia -wasn't able to be directly diagnosed until her 3rd visit because of language barrier on March 3rd when Lia was 8 months old

Kleinman's 8 Questions: (8) WHAT DO YOU FEAR MOST ABOUT THE ILLNESS? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Lia's soul would never return. Most of their actions involved trying to protect her (feeding her herbal remedies through the nasogastric tube b. Death.

Kleinman's 8 Questions: (6) WHAT KIND OF TREATMENT SHOULD THE PATIENT RECEIVE? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Medicine to take for a week but no longer. After she is well, she should stop taking the medicine. Long-term treatment should be spiritual and involve restoring her soul (ex. Tried to change her name do that the dab would be tricked into thinking she was someone else. Plan was foiled because doctors continued to call her Lia) b. Anticonvulsants, anaesthetics, steroids such as prednisone, immunoglobulins, and various other pharmacological agents that have been reported to work in individual patients. Because the these types of seizures are treatment resistant, a variety of drugs should be tried to find the best treatment for the individual.

Kleinman's 8 Questions: (1) WHAT DO YOU CALL YOUR ILLNESS (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Quag dab peg. A dangerous problem but also an illness of honour if it leads to becoming a txiv neebs. b. Lennox syndrome- a severe and difficult to treat form of childhood-onset epilepsy

Kleinman's 8 Questions: (7) WHAT ARE THE CHIEF PROBLEMS THE ILLNESS HAS CAUSED? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Saddness at Lia's condition and anger at her sister, Yer. b. Neurological and development delays on top of the injuries caused by the seizures

Kleinman's 8 Questions: (5) HOW SEVERE IS IT? WILL THE ILLNESS HAVE A SHORT OR LONG COURSE? (a) How would Hmong respond? (b) How would Merced doctors respond?

a. Why are you asking us those questions? Doctors should know the answers. b. Quite severe, it is a life-long condition that is resistant to medication. However, through trial and error doctors can usually develop a good treatment plan which includes a laundry-list of anticonvulsants, anesthetics, steroids etc.

febrile seizure

an epileptic seizure associated with a high body temperature, occurring most often in children between 6 months and 5 years of age

nyias

apron-shaped baby carrier -Lia was carried on Foua's back in one of these

When and where did Lia officially receive her name?

at a soul-calling ceremony about a month after her birth

Why did seeing Lia have a spinal tap distress Nao Kao?

because he believed that by sucking her backbone like that they had lost Lia

Why did the doctors never ask the Hmong how they treated their illnesses?

because they dressed in American clothing, had American driver's licenses and shopped in supermarkets, it never occurred to the medical staff that they might practice unconventional healing arts

How would a pregnant hmong woman assure the health of her baby?

by paying close attention to her food cravings

what method do Hmong use to cure disease?

ceremonies conducted by a shaman dermal treatments herbs

Status epilepticus

condition in which her seizures continued one right after the other -Lia went into status epilepticus after falling off a swing in 1986 -There were no intervals of consciousness -She was found to have adequate levels of Depakene in her system so non- compliance was not the issue.

What do the hmong believe are the source of deformities?

deformities are the consequences of past transgressions on the part of the parents and this must be borne with equanimity and treated with kindness as a means of expiation

Somatization

emotional problems express themselves as physical problems.

What are Bliatout's suggestions for doctors working with Hmong patients?

female doctors should treat female patients and vice versa; involve the patient's families; use bilingual or bicultural interpreters; enlist the support of family and community leaders; minimize blood drawing; allow relatives and friends in the room; allow shamans to perform ceremonies; encourage Hmong traditional arts; acknowledge the Hmong contribution to US military operations in Laos; promote clan reunification, never undercut the father's authority; give refugees more opportunities; fuss over them less; and most importantly, integrate Western medicine with traditional healing arts. -Bliatout actually felt that the shaman was the ideal collaborator. No one was better qualified to span the gap between the medical and spiritual. He would always recognize the patient as a victim of an assault from outside powers or of an accidental separation from one part of his self. When this situation has identified and overcome by the shaman, health is recovered.

What did Nao Kao do when forced to sign a piece of paper that said his daughter was going to die?

he did what the Hmong have done for centuries: he fled -saying that his daughter was going to die was an offensive comment and was perceived as threatening

A shaman ties cords around a baby's wrist, because

he wants to bind the soul to the body

neeb

healing spirit shamanic ritual

What was one of the side effects of Lia's medication?

high blood pressure hyperactivity memory loss

qeej

hmong musical instrument, 6 bamboo tubes

What is the name of the ceremony that gave lia her official name

hu plig, or soul calling

What produced the quarter-sized round lesions on the abdomens and arms of the Hmong children that prompted Neil and Peggy to call Children's Services?

lesions were the result of dermal treatments like cupping, a treatment common among Southeast Asian ethnic groups

Dab

malevolent spirit

Why didn't the hmong fight back when they were abused in the US

nothing in US is worth defending

too much medicine would

reduce the neeb's effect

What does the author conclude Fao meant when she says she is stupid?

she meant that none of her former skills were transferable to the United States except for the ability to be an excellent mother to nine surviving children.

What was Lia's condition at age 7?

she was quadriplegic, spastic, incontinent, and incapable of purposeful movement. Her condition was termed a 'persistent vegetative state.'

Plig

soul

plig

soul

neeb

soul -Fao believed that Lia needed a little medicine and a little neeb in her encounters with malevolent dabs

Hmong folktale of the Orphan

the Orphan, a young man whose parents have died, leaving him alone to live by his wits. He is usually clever, energetic, brave, persistent, and a virtuoso player qeej (Hmong instrument). Though he lives by himself on the margins of society, reviled by almost everyone, he knows in his heart that he is actually superior to all his detractors. This character is a symbol of the Hmong people.

Why did the Hmong women in the United States refuse to have their babies at home?

they believed the children would then not be an American citizen -they often gave birth in the parking lot or the elevator

How was "You can take Lia in two hours so she can die at home" interpreted by Nao Kao?

As a threat that Lia would be dead in two hours.

Why was nao kao angry at the interpreter sue xiong

Didn't translate statements, came with CPS worker to get lia, married to nao kao's nephew

What war were the Hmong recruited into and by who? Why did the Hmong agree to fight? What happened to the Hmong as a result of the war?

- Quiet War: Armee Clandestine (as part of the Vietnam War 1960-70s) - recruited by the CIA - agreed to fight because they knew that communism was a larger threat to their autonomy; however, many were also coerced - the Hmong became "internal refugees" due to bombing, displacement, and human loss; *they lost their self-sufficiency* - evacuated to Thailand but only a few were airlifted... the rest were forced to move on foot --> dangerous and many lives were lost

Dwight Conquergood

- designed environmental health program for the refugee camp Ban Vinai - used productions to communicate significance and importance of cerain interventions in a way the Hmong would understand --> promote dog inoculations and sanitation - understood that he wasn't the only party with something to offer and that the Hmong were also knowledgeable, if in a different way. - instructions interpreted as malleable suggestions (changed dosage to get better faster or if they were worried that it was meant for larger Americans)

Vang Pao

- general - cornerstone of the war, and its most cryptic figure - asked for land from the US government, just enough so the Hmong could live. Rejected because thought to be too expensive and unfair to other refugees, even though Fadiman notes it might actualy have been less expensive considering all the subsidies going to welfare dependent Hmong

What were Kleinman's suggestions to Lia's physicians?

- get rid of the word "compliance" - look at model of mediation rather than coercion - her life was probably ruined by cross-cultural misunderstanding - conjoint treatment: doctors cure the disease but indigenous healer heals the illness - for better or worse, Western medicine is one-sided; but it's not to much to ask doctors to acknowledge their patients' realities - what if the medical enterprise was bent around hearing and treating a story rather than a condition?

What were problems with the way Lia's parents were treated in the Merced hospital?

- paperwork was never translated so they had no idea what they were agreeing to - don't understand why Lia was restrained instead of letting them coddle her (needed to prevent more veins from being lost) - couldn't read dosages or labels on the meds but understood that there were side effects and thought medicines were causing the seizures; they didn't hesitate to modify her dosages based on what they believed was best for her in terms of side effects - Hmong feel practiced on instead of helped - failure to work within the traditional Hmong hierarchy of male/elders making decisions lead to confusion because information was being relayed to people that could not act on it.

Sukey Walker

- psychologist - most respected American in the Hmong community - knew the importance of cultural brokers - "consensual reality is better than facts"

what was apart of the soul calling ceremony?

-Live chickens were slaughtered and their bodies examined for signs that Lia's soul was happy to reside in her body and her name was a good one. -Lia's parents and elders tied strings around her wrists to bind her soul to her body. -Lia's father sacrificed a pig to invite the soul of one of her ancestors to be reborn in her body.

What are challenges faced by the Merced Community Medical Center (MCMC)?

-The majority of patients are on public assistance and lack private insurance to pay for treatment. -Doctors have a hard time taking medical histories of Hmong patients due to language barriers. -the hospital has a large number of Hmong patients, yet it has no budget for interpreters.

what are reasons the Hmong do not like Western doctors?

-They require blood tests and cannot make an immediate diagnosis. -They ask rude and intimate questions. -They require patients to take off their clothes.

Why did Neil and Peggy feel angry with the Lees?

-They showed no deference to the doctors' many years of schooling, awards, and time spent educating themselves about the Hmong. -They didn't seem to appreciate what the doctors were doing for them. -It was hard to watch them fail to give Lia the medication they felt she needed to live a normal life.

What is a characteristic of the Hmong, according to their history?

-They would rather fight than take orders or surrender. -They tend to believe their own customs are superior. -They have a lot of courage.

Dan Murphy

-he family practice resident on call the third time the Lees brought Lia to the emergency room at MCMC. -Dan was the first doctor to realize that Lia had epilepsy, as the first two times Foua and Nao Kao brought Lia to the hospital there were no interpreters present and her seizures had already stopped.

Vang Pao

-leader of hmong forces in Laos -ruthless to enemies, but provided to hundreds of war orphans and widows -considered himself modern reformer who supported education -critisized slash and burn ag. -encouraged assimilation in Lao -employed tvix neebs -believed in the fortune telling power of chicken bones -indirect reason Hmongs moved to Merced

Power

Another theme is the lack of power afforded to Hmong refugees. Whereas in Laos they had been free to follow their culture and to live independently, in the United States their freedom was curtailed. Welfare made them dependent upon others for sustenance, with few jobs available that did not require English proficiency and other skills they didn't have. They feared the American penal system, which punished crimes far differently than they had done in Laos. Most importantly for the Lees, they were no longer considered the ultimate decision makers for their children. A Minnesota physician summarized this view: "Once the police are called and court orders are obtained... the differences are no longer about beliefs. The differences are about power. Doctors have the power to call the police and to access state power which Hmong parents do not have

Why does Lia's father believe she went into a coma (was lost)?

Because the new hospital performed a spinal tap before he could get there. Didn't understand why she was comatose or any of the highly invasive procedures she underwent. - disappointed in the hospital

Love

Clearly, Foua and Nao Kao loved their daughter Lia very much, and it may be their love (and subsequent care for her) that prolonged Lia's life. Others who showed love also met with success. Jeanine Hilt, the social worker assigned to Lia when she was placed in foster care, grew to love the family, and in return, they loved her too. She alone among Lia's caregivers thought to ask Foua and Nao Kao about their beliefs about Lia's epilepsy and to learn about their customs. Because of the love she showed them, Foua accepted her help and learned to administer Lia's medication, which led to regaining custody. Another social worker was able to persuade a patient with tuberculosis to take her medication by working within the family's belief system; like Jeanine, she loved her clients. In Fadiman's opinion, Lia's doctors, Neil Ernst and Peggy Philp, liked the Hmong, but they didn't love them. It may have been this lack of love that hindered them from considering their patients' points of view and adjusting their methods accordingly.

Cultural Collision

Culture plays a major role in The Spirit Catches You and You Fall Down. Every other chapter shares some aspect of Hmong history or culture: food, clothing, language, family structure, birthing rituals, and so on. The Hmong traditionally lived high in the mountains of Laos, where they practiced agriculture and subsisted primarily on rice, vegetables, herbs, and occasionally pork or chicken. They believe that most disease has a spiritual cause and can be alleviated through traditional forms of healing such as rubbing the skin with coins, creating a vacuum by igniting cotton soaked in alcohol under a tiny cup, or drawing disease out with an egg. A tvix neeb, or shaman, could conduct more powerful healing; such a figure is thought to be able to get rid of evil spirits called dabs and retrieve lost souls. Certain aspects of Hmong culture, such as taboos against medical procedures, beliefs about the origins of diseases, and power structures within the family and the clan often conflict with the culture of western medicine, resulting in misunderstandings between doctors and patients. Other aspects, such as utilizing animal sacrifice in shamanic ceremonies, have lead to conflicts between the Hmong and their American neighbors; for instance, some Americans believe the Hmong are kidnapping and killing neighborhood dogs. Lia Lee's tragedy is presented as the result of this cultural collision and highlights the need for a new model of cultural understanding and cooperation.

Why was it hard for Hmong families to become independent?

Cycle of dependence began with rice drops in Laos. They had few marketable skills and little English; minimum wage was not nearly enough to get by on when you could be getting welfare. Felt that they deserved welfare for fighting in the American war. Note that Hmong hate dependence and don't feel like real men when forced to depend upon the government to feed their families --> depression, *role loss*

Dan Murphy

Doctor that was interested in and knowledgeable about the Hmong.

Which is more important, life or soul?

Doctors will always answer life, but those outside the sphere of biomedicine more often than not say soul.

Cultural Compromise

Fadiman advocates for doctors to consider their patients' stories about their disease and to try to use a model of cooperation rather than coercion. For example, Foua explained to Fadiman that she felt it was important to use both western medicine and neeb, or shamanic ritual. The Hmong believe that sometimes people get sick due to something that happens to their soul, or because they encounter an evil spirit called a dab. Such illnesses require spiritual healing, which can be rendered less effective by medication. Foua felt that the doctors wouldn't let them give just a little medication because they didn't understand about the soul. Had they done so, they might have been able to engage in cultural compromise, inviting a tvix neeb to work alongside the doctors who might have been able to convince the family that the amount of medication prescribed was beneficial. Lia's former hospital has since successfully adopted similar practices

May Ying Xiong

Fadiman's "cultural broker," who taught her what to do among the Hmong as well as translate what people said. May Ying was a 20-year-old clerk at the Merced County Office of Refugee Services when she began working with Fadiman. Her father was a famous tvix neeb and a soldier who had trained with the CIA. -

Dee and Tom Korda

Lia's foster parents during the year she was placed in foster care. The couple spoke no Hmong, but they treated Lia with love and tried to comfort her with physical contact. -became friends with the Lee's

Dee and Tom Korda

Lia's foster parents for a period of six months. "She knew how to love and how to let people love her." - Korda and Lee families became close

Terry Hutchinson

Lia's neurologist at Valley Children's Hospital in Fresno, which was better equipped to deal with severe cases of childhood trauma than MCMC. Hutchinson believed that Foua and Nao Kao's lack of compliance with Lia's medical regimen probably had nothing to do with her final seizure. Her brain was destroyed by septic shock, and it was the septic shock that caused the seizures. -may have never been the Dapakene

Martin Kilgore

Lia's outpatient nurse whose best attempts at courtesy fail because he is viewed as an authority figure and therefore a threat.

Why did the doctors at MCMC fail to correctly diagnose Lia with epilepsy at first?

Lia's seizures had stopped by the time she got to the hospital, and there was no interpreter to explain what had happened.

Jeanine Hilt

Lia's social worker who was determined to educate the Lee's about medication so that they would not lose custody over Lia. - gained the trust of Foua - Lia eventually returns home thanks to Jeanine's interventions - one of the few Americans the Lees referred to by first name - incredible patient advocate but became slightly obsessed with Lia's case

Family

Lia's story reveals the strength of the family within Hmong culture. While most American families would have committed a daughter with brain damage to an institution, the Lees cared for Lia for 26 years, bathing her, dressing her impeccably, and even celebrating her birthday each year. Their care is likely what kept her alive for so long, when the doctors believed she would die within days. Hmong families tend to be large, with an average of 9.5 children per family among refugees in the United States during the mid-eighties. Children are cherished and ancestors revered; one of the hardest parts about fleeing Laos leaving older family members alone to die. They place great importance on the clan; for instance, one reason that Foua and Nao Kao accepted Fadiman and her interpreter, May Ying, is that May Ying's husband belonged to the Lee's clan. Fadiman notes that family obligations sometimes put enormous demands on people, such as Jonas Vangay, a community leader who lived with his wife, his three children, his two brothers and their wives, and his brothers' ten children. Vangay explains that for a Hmong, unlike an American, "it is never everyone for himself"

Why might Hmong rejection of Western medicine so infuriate some doctors

Medical students have been taught that what they learned is the only legitimate way to approach health problems. Hmong rejection intimates that Western medicine doesn't have much to offer.. despite all the pain and money the med students had to pay and go through.

Neil Ernst & Peggy Philp

Needed to figure out which was more discriminatory: to deprive Lia of optimal care that another child would have received, or to fail to tailor her treatment in such a way that her family would have been more likely to comply? - doctors often had their hands tied from providing what they believed to be optimal care - decided to have Lia removed as a ward of the state because evidence showed that parents were not giving her medications as prescribed; noncompliance

May Lee

One of Lia's older sisters. May was just three and a half when her family left Laos. She learned English at an American high school and served as interpreter for Jeanine Hilt, Lia's social worker.

Why did the Lee's believe that Lia was taken from them?

Out of anger, as punishment by the doctors rather than for her own protection.

Why was Lia misdiagnosed the first time she was brought to the hopsital?

Parents could not communicate what had happened so they had no way o knowing she had just been seizing; saw congested chest and prescribed an antibiotic.

Knowledge

Related to power is knowledge, and in particular, the matter of whose knowledge is privileged. Spirit reveals that Western doctors' knowledge is considered superior to Hmong beliefs. Even Fadiman, whose sympathies lie with the Lees, expresses this view: "Dwight Conquergood's philosophy of health care as a form of barter, rather than a one-sided relationship, ignores the fact that, for better or for worse, Western medicine is one-sided. Doctors endure medical school and residency in order to acquire knowledge that their patients do not have" (276). However, Lia's neurologist admitted that it might have been a medical error which caused Lia to lose her brain function, and that the large dosages of medication in her system may have made her more susceptible to the septic shock that caused the brain damage. Furthermore, the fact that the Lees kept Lia alive for 26 more years suggests that their love and care was more powerful than the doctors' medicine. The story therefore begs the question of whether it is in the patient's best interest to privilege Western knowledge.

What is something the Hmong are notorious for?

Resistance to assimilate into society. - growing opium poppy - slash/burn farming to grow opium in mountain terrain

What was Lia's condition after the "big one"?

She became effectively braindead and never had another seizure because there was no longer enough activity in her brain. Parents took immaculate care of her after she was released from hospital 2 years later and she recovers somewhat, when "white families would have institutionalized her in a second."

Anne Fadiman

She is the author and narrator of the book whose experiences with the Lia and her family are re-told in intimate and tragic detail. She learns while others do not the importance of understanding the culture of the patient in order to properly treat his illness.

What did Foua think about her experience giving birth at an American hospital?

She was impressed by the number of people there to help her and complained only about the food.

Why was Lia transferred to a different hospital? Why did her parents think she was transferred?

She was transferred for better care and stability. Parents believed it was because Neil was going on vacation, which he was, but only coincidentally.

"high velocity transcortical lead therapy"

Some doctors were so frustrated with the Hmong that they think the best way of dealing with them is a shot in the head.

Jeanine Hilt

The Child Protective Services (CPS) caseworker assigned to Lia when she was placed in foster care. -educated Foua and Nao Kao so that Lia would be allowed to return home, teaching them how to measure and administer Lia's medication -suffered asthma attack and became brain dead

Sue Xiong

The Hmong interpreter who came to the Lee's home with Child Protective Services (CPS) when Lia was taken from her parents to be placed in foster care. She was unpopular in the community, in part because she had married an American, and in part because she did not behave in a traditionally Hmong way. She once told Nao Kao that she had recommended to CPS that Lia remain in foster care. Nao Kao felt a lot of anger towards her and once nearly hit her with a baseball bat.

Dang Moua

The first Hmong to relocate to Merced, CA, paving the way for many others to follow. Dang used to live in Richmond, VA, where his family was the only Hmong and where he worked eighteen hours a day at minimum wage jobs. -heard that General Vang Pao was thinking of buying a fruit ranch near Merced.

Hope Amidst Loss

The majority of Hmong living in Laos lost both friends and relatives and their homes as a result of the Hmong involvement in the Vietnam War. They gave up nearly all their possessions; by immigrating to a country in which many had to rely on welfare, a large number of them gave up their independence. However, one thing the new arrivals held onto was hope. When resettlement agencies located them far from their clansmen, they relocated themselves to reestablish a sense of community. When faced with the challenge of taking a written driver's test, they used a "crib sheet" to pass and thereby earn the license they needed to stay close to relatives. Likewise, despite their loss, Lia's family never gave up hope that their daughter's soul would return.

What was the tradition of the placental jacket?

The soul must retrace its life geography until it finds the placental jacket so it may continue its dangerous journey to the place beyond the sky. In the US Foua didn't even know how to ask for the placenta from the doctor that delivered Lia. (language barrier and culture difference)

Foua Yang and Nao Kao Lee

They are Lia's parents who love her very much and become totally committed to her care even after she enters the vegetative state. However, they are partially to blame, but nowhere nearly as much to blame for their child's medical condition as the doctors who treated her.

Why do Hmong traditionally like to keep the placenta after a baby's birth?

They believe a person's soul returns to the placenta and puts it on before journeying to the place where it will be reborn.

How do the Hmong perceive epilepsy? What do they call it?

They consider it a serious medical disease but also one of distinction because those who have it are said to have a calling to become a *txiv neeb* (shaman) They call it "quab dab peg": the spirit catches you and you fall dwn

What did the Hmong expect after the war?

They expected to be embraced and celebrated as veterans by the American government and people. Instead, they were often confused with Vietnamese though they fought for the US, not against it. They felt betrayed. - in hindsight, officials recognize that Hmong resettlement was mishandled: splitting clans and leaving people without marriage partners, ignoring the cornerstone of the community: group solidarity.

Why did Thailand decide to close Ban Vinai in 1992? What did they do if they were rejected by US and forced to go back to Laos?

They realized the Hmong were not willing to leave... they would rather stay where they had a semblance of their culture than have to go back to Laos or a new country. They fled to Buddhist monastery north of Bangkok.

How did the Lees view Lia's epilepsy?

They were concerned for her health but also proud, as epileptics are often chosen to be shamans and can see things others cannot.

Why did the Chinese dislike the Hmong?

They were offended by the fact that the Hmong preferred to keep to themselves and maintain their own customs rather than assimilating.

Why didn't the Hmong fight back when they were the victims of petty crime?

They were too proud to lower themselves to that level. "Nothing here is worth defending."

Blia Yao Moua and Jonas Vangay

Two Hmong leaders who taught Fadiman about the Hmong. Blia Yao Moua arranged Fadiman's first meeting with Foua and Nao Kao. Fadiman spent many afternoons in his office, asking questions about Hmong religion, military history, medical practices, weddings, funerals, music, clothing, and other cultural practices. - Jonas Vangay, another well-educated Hmong leader, taught Fadiman about Hmong history and linguistics. -Both men were stretched thin by their many responsibilities to the community.

What incident triggered a seizure that changed her condition, making it seem inevitable that the next seizure would be the last?

When Lia fell off a swing at daycare. - harder and harder to intubate because Lia is fat and has lost so many veins.

When did the "big one" occur? - what went wrong? - what is this an example of - what was the secondary complication?

When Lia was 4 years old - precious minutes were wasted because parents thought that calling an ambulance would get Lia seen faster - tremendous muscular activity - compromised ability to breathe; didn't stop seizing until nearly 2 complete hours... and after tremendous amounts of medication - example of American medicine at its best and worst: patient reduced to analyzable collection of symptoms and physician is therefore able to keep her alive - secondary complication: septic shock because of an infection

How did news of Lia's "disappearance" affect the Hmong community?

When she was forcibly taken into a foster home, word spread throughout the Hmong community, reinforcing the idea that American doctors are not to be trusted. - both Foua and dad threaten to commit suicide in the period when Lia was in fostercare

When was Lia's first epileptic episode?

When she was three months old and her sister slammed the door. Blamed the loud noise for scaring away her soul.

What is "status epilepticus"?

a condition in which an epileptic remains unconscious for twenty minutes or longer as he or she has a seizure

grand mal seizure

a full-blown seizure in which electrical disturbance extends throughout a wide area of the brain and the patient loses consciousness for a long period of time

Jonas Vangay

another French-educated Hmong that was exhausted and over-worked by his responsibilities to his community.

nyias

cloth baby carriers -embroidered with soul-retaining motifs, such as a pigpen, which symbolizes enclosure

Blia Yao Moua

cultured, cosmopolitan Hmong man educated in France that came to merced to help his generation - work of getting out the word about different causes and legislative changes burnt him out

foua and nao kao lee had how many children

fifteen children, eight of whom survived

Which of the following is NOT a country where many Hmong have migrated?

india

What does the phrase quab dab peg mean

spirit catches you and you fall down

Bill Selvidge

the chief resident of family practice at the country hospital in Merced, MCMC. Bill shared how his Hmong patients were incredibly interesting but also very difficult, as they rarely complied with doctors' instructions and had taboos against many medical procedures

Hmong dermal treatments

traditional healing techniques such as: acupuncture; massage; pinching; scraping the skin with coins, spoons, silver jewelry, or pieces of bamboo; applying a warm cup to the skin; or burning the skin with grass or cotton wool