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Lia Lee was born in 1981 to a family of recent Hmong immigrants, and soon developed symptoms of epilepsy. By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, overmedication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty--and their nobility."
Book Description
Winner of the National Book Critics Circle Award for Nonfiction
When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.
Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.
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When three-month-old Lia Lee arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while the medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness qaug dab peg - the spirit catches you and you fall down - and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices. The Spirit Catches You and You Fall Down moves from hospital corridors to healing ceremonies, and from the hill country of Laos to the living rooms of Merced, uncovering in its path the complex sources and implications of two dramatically clashing worldviews.
Customer Reviews:
A Paradigm of the Complexities of Modern Medicine in Relation to Cuture and Ethnicity.......2007-09-30
I read "The Spirit Catches You, and You Fall Down" as a required reading for a Sociology course on Health and Ilnness in Society. This is simply put, an amazing piece of work, that not only is thorough, but has a great deal of emotion and you really are able to sense the pain, frustration, and joy, of both the Lee family and the medical community that cared for her. This work is also a testiment to the Hmong people and culture, who are often grealty overlooked in US Asian American culture. Anne Fadiman goes into great detail describing their culture, from it's language, history, and religion both here and in Loas, and to their unfortunate and tragic involvement in the US war in Vietnam which landed them in refugee camps in Thailand. My opinions vacillated at times from anger to empathy for her parents and their inability and refusal to follow the doctors advise, that could've saved their daughters life. I encourage this book to be read by anyone going into the medical field where you will encounter a myriad of ethnicities, that often fly in the face of conventional US medicine. This is nonfiction that reads with the excitement and personality of a well crafted novel.
The Spirit Catches You and You Fall Down .......2007-09-26
exceptional book for those involved in anything dealing with human relationships. gives unbiased information from all sides of the issue (language & cultural barriers resulting in medical "errors")
this book smacks you in the face with your own preconceptions about what families know about their child, and what professionals know about their field, and how sometimes those two don't mesh, resulting in the child being put in the middle.
oh yeah, and every once in a while you will want to yell out about "the guy hiding behind the rock." because hindsight is so clear!
Great introduction to cross cultural communication.......2007-09-04
I was assigned this book as a supplement to a Cross Cultural Communication class. It's a very interesting read about a young girl who gets caught between Eastern and Western medicine. It makes a good read to see how CCC can be so important in our daily lives. It has a good lot of medical jargon and even more characters. There are a lot of doctors that are important for various reasons. It is certainly not a light beach read. Once you read it though you'll want someone else to read it to have someone to talk about. You can get in long discussions over who is "right" and if there is a right.
Oh so predictable..........2007-08-07
Detailed, researched look at the Hmong people of Vietnam in America through the experiences of one family in the medical/hospital system as they try to help their epileptic child. Although the action takes place in California, the story would probably have been similar no matter where the family lived. Non judgemental author keeps reader engaged. Structure of the book with alternating chapters detailing the history of the Hmong and then the specific family works well. Cross cultural misunderstandings seem inevitable given language and cultural differences. Sad without being depressing.
The Spirit Catches You and You Fall Down.......2007-08-01
An excellent book. A powerful and moving true story of a cultural east/west clash, especially concerning medical care. I couldn't put the book down. Enlightening also when it comes to the drugs used in treating status epilecticus, specifically in children under three. I also appreciated learning about some of the political history regarding the beautiful people of Laos. My heart goes out to the Hmong people.
Average customer rating:
- Great Informational Book
- It is always good to read the text before...
- Not a good resource for this important area of inquiry
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Cultural Diversity in Health and Illness, Sixth Edition
Rachel E. Spector
Manufacturer: Prentice Hall
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Caring for Patients from Different Cultures
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Ethics and Issues in Contemporary Nursing
ASIN: 0130493791 |
Book Description
The sixth edition of this best-selling resource continues to teach nursing, health professions, medical and social science readers the importance of cultural competence and cultural awareness in the health care industry. The new edition will include revised organization to create a better flow of content, new content on gererational differences, updated chapter on health care delivery system, updated illustrations and tables and MediaLink icons. For undergraduate and graduate courses in patient care and basic health related profession programs, as well as medical, social work, and other health disciplines.
Customer Reviews:
Great Informational Book.......2007-02-24
The chapters are long and detailed and filled with statistics and charts that physically show the information being presented. Overall it is a well put together book that remains uniform throughout.
It is always good to read the text before..........2005-11-27
The book is based on some solid quantitative studies and it is important that we read the text first before inclining to accept any particular views invoked by reviews. I suggest that you read the text first and then make your mind based on your reading.
Not a good resource for this important area of inquiry.......2005-05-10
This review updated by author on March 21, 2006:
I recently (Spring 2005) used this text in an undergraduate health professions course titled "Diversity in Health and Illness". The author addresses a broad scope of cultures, issues and responses to cultural needs in health care. Although the book contains much that is useful, my students found it to be, on balance, confusing and disorganized.
I believe much of this response can be attributed to poor editing. We identified numerous spelling and grammar errors throughout. Poorly edited content is also evident in several chapters. Example: "...this chapter has introduced the dominant culture's perception of health and illness through countless lenses" (pp. 67). Similarly, "...countless letters are displayed attesting to the healing powers of this statue" (pp. 106). Isn't there a more accurate word to use in place of `countless'? More importantly, ethnic and race labels are not used consistently. "Hispanic" and "Latino" are used as though they are strictly interchangeable; ditto for "Black" and "African American." Term consistency would enhance clarity.
My concerns with the text are more fundamental and numerous but I will limit myself to a few examples:
USE OF SOURCE DATA AND REFERENCE MATERIALS
Although the text is heavily laden with descriptive statistics, comparative data is often not included, thus limiting interpretations. For example, the discussion of rising expenditures for unconventional therapies in the U.S. (pp. 96) includes expenditure estimates for 1990 and 1997. Without companion statistics for conventional therapy expenditures, readers are unable to asses the magnitude of the trend. Similarly, the description of the African American population as young (54.4% are under 18 - pp. 233) is not very enlightening in the absence of corresponding percentages for the white population and the overall American population. Figure 10-3 adds little additional information.
References for culture group descriptions are often either very old (1950's - 1970's), not the definitive works, or are not sufficiently academic (encyclopedias and web pages), and should be replaced with citations for newer research reported in more rigorous formats. Several important sections contain insufficient or no reference citations. The "Health/HEALTH Care Choices" section (pp. 85) contains numerous historical claims but only a single reference to the American Heritage Dictionary.
OUT OF DATE THEORIES
Some of the sociological and anthropological concepts presented do not represent current theoretical stances. I was especially interested in exploring citations for the "Cycle of Poverty" discussion in Chapter 2, as this blame-the-victim concept has fallen out of favor in sociological circles because it ignores structural realities that are beyond the control of individuals. This conflation of structural problems with cultural phenomena inadvertently creates a situation where the subtle racist beliefs we all learn through our socialization is reinforced in the classroom. Sadly, the only citation provided in this section, (Spector 1979, pp. 148-152), refers to an earlier edition of this book. Original references should be provided.
The Chapter 3 discussion of the sick role is limited to functionalist models presented by Talcott Parsons (1966) and Edward Suchman (1965). As our society ages we are experiencing increasing levels of chronic illness and more patients cannot expect to fully recover. More recent examinations of the illness experience would be appropriate.
CULTURAL MISUNDERSTANDINGS
The discussion of historical background for Native American cultures (pp. 186-188) is particularly dismal. While somewhat correct in broad outlines, the text reads like a less-than-distinguished freshman research paper, and includes various repeats. The discussion of traditional health beliefs and practices is limited to those of the Navajo and Hopi - important southwestern groups - but not representative of all Native Americans. Sources cited are limited to a few 1960's and 1970's references. Strains of the Noble Savage are also evident, particularly with reference to the discussion of "True Indian love" and domestic violence (pp. 200).
The role of voodoo in African American traditions is somewhat overstated (Chapter 10), and is presented as an explanation for present-day underutilization of the allopathic system (pp. 239). At the same time, more realistic explanations are omitted. Chief among those are the disproportionate poverty experienced by the community as well as recent and historical sources of distrust between the African Americans and the largely white medical establishment (e.g., antebellum forced medical experimentation, Tuskegee Experiment, Holmesburg Prison Experiments).
INTERPRETATIONS
My graduate degree is in anthropology, and although I expected some level of disconnect between my training and the nursing orientation of Spector, I found myself admonishing my students several times over to ignore specific passages and sections in this text as irrelevant or just plain wrong.
For example, in the section titled "Cultural Phenomena Affecting Health", in Chapter 1, subheadings include "Biological Variations" and "Social Organization". Confusion between biology and culture appears in other places as well, and was especially troublesome for my students with their limited previous exposure to the concept of culture.
The "Social Organization" subheading precedes a disjointed (but brief) discussion of childhood socialization, family organization, and barriers to health care access. Perhaps the first two could be combined in a section "Socialization". Regarding the barriers to health care access (e.g., unemployment, poverty and lack of health insurance), these could be better characterized as economic barriers rather than social barriers. Diminished economic resources are correlated to large extent with particular demographic groups, but one should avoid essentializing the availability of resources as a series of ethnic or cultural traits. Conceptualizing these issues as cultural phenomena obscures the contributions of racism, xenophobia, and unequal distribution of wealth to the problems of unequal access. Spector draws these categories from a previously published article, and the uncritical use of other people's published materials is apparent throughout the book.
Spector's background is nursing, and on balance, I am not sure that this provides one with the appropriate skills necessary to summarize the fundamentals of culture and cultural diversity. Theorising culture and society is (and should remain) the domain of anthropologists and sociologists (and perhaps psychologists). Like nursing and most other applied and academic fields of inquiry, understanding culture requires a great deal of specialized education.
On my initial reading I suspected a functionalist interpretation of the intersection between health care and culture, but on further examination this book is more like an online encyclopedia where everything (including the kitchen sink) is thrown in. What is missing is a critical evaluation of the usefulness and theoretical implications of others' data and interpretations. The result is conflicting content and a great deal of confusion.
A final example: Spector rejects the WHO health definition but does not suggest a better alternative. Instead she seems to think that health is indefinable: "I would define health as an undefined term" (pp. 50). I agree that students should maintain an open mind, but perhaps a series of limited definitions addressing a variety of situations would be more useful in the classroom. Social science practitioners and researchers struggle with variability in human behavior as a matter of course, but that struggle is mitigated through a realization that definitions are often necessary heuristic devices rather than complete summaries. Put simply, if we can't know a thing, aren't we just wasting our time?
I have reviewed a number of alternate texts over the past year and have found the problems discussed here to be present in several other texts. Perhaps the academic pursuit of cultural care is still in its nascent stage.
In any case, I have found "Culture in Rehabilitation: from Competency to Proficiency" edited by Royeen and Crabtree (Pearson 2006) to be a much better text for my class. The authors represent a variety of health professions and the text was reviewed by a similarly diverse panel of ten. Most of the contributions present robust bibliographies, rely on up-to-date social science research, and avoid the culture-as-checklist approach. I will review the text in detail sometime in May 2006.
Book Description
Vulnerability is explored from the prespective of individuals, groups, and communities. The chapters address the many private faces of vulnerability and the implication of that vulnerability for nurses, and nursing care.
Customer Reviews:
It's about time!.......2004-10-31
A book like this should have come out long ago! When I was taking my "Vulnerable Populations" course in my BSN program we did not even have a textbook. Now nursing students can benefit from the experiences and research in this book.
Average customer rating:
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Transcultural Health Care: A Culturally Competent Approach
Betty J. Paulanka
Manufacturer: F. A. Davis Company
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Cultural Diversity in Health and Illness, Sixth Edition
ASIN: 0803610572 |
Customer Reviews:
Good Reference Book.......2006-12-30
Provides a wealth of information on many cultures that are useful for practicing nurses. Students wll also find this book useful.
Book Description
This essential text assists health care students and practitioners in delivering skilled and appropriate care to all patients, no matter their ethnicity, country of origin, cultural history, or access to services. Presenting need to know and often hard to find information on differences in access to heath-care, immunization histories, disease prevalence, attitudes about health and provision of care, and much more, this resource provides practical, authoritative and specific guidance.
Customer Reviews:
Be careful...........2007-09-09
I felt that this book had a tendency to make very subjective, generalized, unsupported assumptions. I offer an example: in the chapter about Mexicans, it says something to the effect of: being overweight is viewed as a good quality in Mexican culture. Ok, we know that there does tend to be widespread obesity among Mexican populations, but how do you come to the conclusion that being overweight is a desirable state among Mexican people? I am a Mexican American and I have never known a single Mexican person who viewed being overweight as a coveted position. I would not advise taking this book as gospel truth. Exercise caution when referencing this book in the clinical setting.
Wonderful tool.......2007-05-29
We use this with our nursing students. It is an easy-to-use tool that helps them to write papers and to deliver culturally competent care.
Average customer rating:
- APPALLING book ! Full of insulting stereotypes & little insight!
- tough topic
- Loved it!
- Fascinating read...
- High School Biology Teacher
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Caring for Patients from Different Cultures
Geri-Ann Galanti
Manufacturer: University of Pennsylvania Press
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Culture & Clinical Care
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Cultural Competence in Health Care: A Practical Guide
ASIN: 0812218574 |
Book Description
""A must-read for any healthcare professional.""--Caregiver Journal ""An important addition to any hospital library or reading room.""--Disabilities Studies Quarterly What happens when a Cherokee patient summons a medicine man to the hospital,
Customer Reviews:
APPALLING book ! Full of insulting stereotypes & little insight!.......2006-05-14
I have a long-standing interest in cultural issues in healthcare and so I eagerly bought this book. It's in the 3rd edition--I figured it must be good.
It is appalling! You can turn to almost any page and find a portayal of a person from a minority culture that is presented in such a way that it makes the person sound like an idiot. Not just immigrant and ethnic minority patients--immigrant medical professionals, too.
In addition, she does not modify her gross generalizations by saying, "HIGHLY OBSERVANT Muslims" or "LESS-ACCULTURATED Mexicans" or even "SOME Chinese." No, for Galanti, she generalizes about Muslims, Mexicans and Chinese, with no gradations according to people's country of origin and degrees of orthodoxy (e.g. Muslims), generations in this country, fluency in English, etc.
I am afraid this volume will perpetuate stereotypes. Yes, it may be "fun reading" for people who know nothing about the topic, but they will end up with a view of "how weird those people are!" rather than either any true cultural understanding or a better sense of how to adapt their own practice to meet their patients' needs.
i have never returned a book in my life--this is going to be the first.
For alternative choices on related topics consider:
Culture & Clinical Care (Lipson & Dibble)
Ethnicity & Family THerapy (McGoldrick)
Child Abuse & Culture: Working with diverse families (Fontes)
The spirit Catches You and YOu Fall Down (Fadiman).
Stay away from this one!
tough topic.......2005-10-28
Did not find this to be all that much different informationwise than the other healthcare culture sensitivity books out there
Loved it!.......2004-12-14
I bought this book to do research for a class and from the time I opend it I could not put it down. What a facinating read into different cultures. Highly reccomend to anyone who is intersted in their medical care of people from other cultures or religious groups.
Fascinating read..........2003-10-01
This book is the definitive work on this subject, one that is sorely ignored by the medical community in general. I'm a physician and specialize in children's diseases and treatment. I have given a copy of Ms Galanti's book to every colleage I know. A must have for any physician or other medical professional, in particular those who practice in urban centers.
High School Biology Teacher.......2002-01-11
My students loved the real life situations in this book!
I recommend that teachers use this to incorporate multiculturalism in a very meaningful way in biology classes, and welcome ideas about how others use it. The way I did it was to present the problem, have students brainstorm what they might do, and then reveal the resolution (or lack of one) from the book. I am so glad I found this while browsing the medical section. You are not likely to find a used copy for sale because the stories are so interesting to everyone.
Book Description
This book analyzes the debate surrounding cultural diversity and its implications for ethics. If ethics are relative to particular cultures or societies, then it is not possible to hold that there are any fundamental human rights. The author examines the role of cultural tradition, often used as a defense against critical ethical judgments, and explores key issues in health and medicine in the context of cultural diversity: the physician-patient relationship, disclosing a diagnosis of a fatal illness, informed consent, brain death and organ transplantation, rituals surrounding birth and death, female genital mutilation, sex selection of offspring, fertility regulation, and biomedical research involving human subjects. Among the conclusions the author reaches are that ethical universals exist but must not be confused with ethical absolutes. The existence of ethical universals is compatible with a variety of culturally relative interpretations, and some rights related to medicine and health care should be considered human rights. Illustrative examples are drawn from the author's experiences serving on international ethical review committees and her travels to countries in Africa, Asia, and Latin America, where she conducted educational workshops and carried out her own research.
Customer Reviews:
clearly written, closely argued.......2006-02-09
A friend who works in the area of human rights lent me this as a result of a conversation we had. Though perhaps not a book for the general reader, Macklin's writing is unusually clear for an academic. Most anthropology and sociology writing I have encountered is impenetrable, full of jargon and bloat.
Macklin presents a variety of problems facing human rights workers worldwide. Generally they demonstrate the difficulty of providing "universal" human rights to persons within cultures in which those rights conflict with traditional practice. A common argument against the application of a universal human right that conflicts with local tradition is that it is ethical imperialism--that you (ie the Westerner) have no right to impose your values on our culture--there is no "better" or "worse" set of values, only yours, and ours. You do not have the right to criticize the practices of a culture, from outside that culture. Thus do many customs considered abhorrent by the "west" find justification in this "relativist" rationale.
She discusses issues such as female genital mutilation, informed consent by doctors, the definition of death, organ transplantation, the reproductive rights of women, and the rights of individual women vs the rights of their families. Macklin describes each case in full context then carefully picks her way through, arriving at well-argued conclusions.
Excellent reading, even for a non-specialist.
Average customer rating:
- Book Purchase: Cultural Competence in Health Care: A Practical Guide
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Cultural Competence in Health Care: A Practical Guide
Manufacturer: Jossey-Bass
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ASIN: 078796221X |
Book Description
A manual written for health care professionals who care for patients from diverse religious and cultural backgrounds. First developed by doctors and nurses at Children's Hospital in Boston, it contains detailed, practical information for working with dozens of religious and cultural groups and is designed to help providers best meet needs of their ethnically diverse patients while satisfying stringent new regulatory standards for culturally sensitive care.
Customer Reviews:
Book Purchase: Cultural Competence in Health Care: A Practical Guide .......2006-11-10
Good Transaction, Thank you.
Book Description
South African nurses care for patients in London, hospitals recruit Filipino nurses to Los Angeles, and Chinese nurses practice their profession in Ireland. In every industrialized country of the world, patients today increasingly find that the nurses who care for them come from a vast array of countries. In the first book on international nurse migration, Mireille Kingma investigates one of today's most important health care trends.
The personal stories of migrant nurses that fill this book contrast the nightmarish existences of some with the successes of others. Health systems in industrialized countries now depend on nurses from the developing world to address their nursing shortages. This situation raises a host of thorny questions. What causes nurses to decide to migrate? Is this migration voluntary or in some way coerced? When developing countries are faced with nurse vacancy rates of more than 40 percent, is recruitment by industrialized countries fair play in a competitive market or a new form of colonialization? What happens to these workers—and the patients left behind—when they migrate? What safeguards will protect nurses and the patients they find in their new workplaces?
Highlighting the complexity of the international rules and regulations now being constructed to facilitate the lucrative trade in human services, Kingma presents a new way to think about the migration of skilled health-sector labor as well as the strategies needed to make migration work for individuals, patients, and the health systems on which they depend.
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- Whatever It Takes: A Journey Into The Heart Of Human Achievement (Gift of Inspirations)
- Whitethorn Woods
- Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder
Books Index
Books Home
Recommended Books
- Redoute's Finest Flowers in Embroidery
- I and Eye: Pictures of My Generation
- Crystals and Life: A Personal Journey
- Little Honey Bear And the Smiley Moon
- History: Fiction or Science
- Introduction to Permaculture
- History: Fiction or Science
- The Body Art Book: A Complete, Illustrated Guide to Tattoos, Piercings, and Other Body Modification
- Food in Painting: From the Renaissance to the Present
- Field Guide to the Wild Flowers of the Highveld: Also Useful in Adjacent Grassland and Bushveld
Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World
Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)
Mama Might Be Better Off Dead: The Failure of Health Care in Urban America
Understanding and Applying Medical Anthropology
Infections and Inequalities: The Modern Plagues
