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The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman

While the subtitle captures the essence of the subject of this book, the content is far richer than a mere discussion of the clash of cultures. Although this book has been out for several years, it is worth a second look in light of our country’s ongoing issues as a nation of immigrants.

Lia Lee is a child of Hmong refugee parents, whose culture differs radically from that of the California community in which they live. In addition to language barriers, they also share a sense of community and religion that is far different from that of the people who live in their town of Merced. These differences create obstacles in their daily lives, but are particularly profound and destructive in a crisis.

Lia lives a life of crisis. Lia as a young infant develops epilepsy, which is treatable, but difficult to do so nevertheless and dangerous in that its progression leads so often to permanent brain damage. Compound that with a language barrier for the parents and a cultural barrier in treatment methods. Compound that with a suspicion her parents have of Western medicine and physicians. Compound that with the lack of proper interpreters of a language that is not widely known or understood. In this harrowing story, the reader sees Lia through the years descend into a maelstrom of chaos, as her pediatricians, medical emergency workers, nurses, social workers, and so many other support staff try to prevent her from suffering irreversible brain damage, while her parents see Western medicine as more harmful than helpful or simply do not understand the medical procedures and medicines used in Lia’s treatment.

Fadiman also reveals to readers something of the complexity of Hmong culture. She traces the history of the Hmong people and explains the predicament in which the Hmong find themselves when they agree to work for the U. S. government in Laos during the Vietnam War. This places them in dire straits when Laos falls to a communist government at the war’s end. They must then escape to Thailand and finally to the U. S. The Hmong, however, are not a group that integrates itself in the melting pot of America. And this is just part of Lia’s predicament.

Fadiman not so much places blame as reveals the inevitable results when very different people converge in a crisis. The results of such a convergence can be and usually is an unavoidable tragedy.

D. L. S.

Labels: Hmong, Hmong American children, Hmong Americans - medicine, medicical case studies, medicine