Wednesday, November 27, 2019
American health care Essays
American health care Essays American health care Essay American health care Essay Essay Topic: The Healers The Spirit Catches You and You Fall Down Refugees from Laos began immigrating to the United States in the 1970Ã¢â¬â¢s. Since then, over 100,000 Hmong have settled in the United States. Many came because they felt they had no other option. They could not return to their homes in Laos because they faced persecution, and they had to leave the refugee camps in Thailand due to closure. Anne FadimanÃ¢â¬â¢s book, The Spirit Catches You and You Fall Down, explores a Hmong family, American health care, and the disastrous encounters between the two disparate cultures. Lia Lee, born in 1981, developed symptoms of epilepsy. However, by 1988, Lia was brain dead after years of misunderstanding, over-medication, and culture clash. Fadiman states that what the doctors saw as clinical professionalism, the Lees viewed as arrogance and cold indifference. Additionally, Fadiman shows readers how each party blamed the other for LiaÃ¢â¬â¢s illness, yet the assumptions and beliefs that each group brought to the doctor-patient interactions were never explored. American doctors saw LiaÃ¢â¬â¢s epilepsy as a neurological abnormality, but the Lees perceived LiaÃ¢â¬â¢s illness as a loss of her soul. They believed only appeasement of the lost soul and the restoration of spiritual order would cure their daughter. Although, LiaÃ¢â¬â¢s parents and her doctors both wanted what was best for Lia, lack of understanding led to tragedy. Anne FadimanÃ¢â¬â¢s book, The Spirit Catches You and You Fall Down, reveals how the inability to communicate and the ignorance of cultural differences pr! ohibited the Lees and the medical staff from forming the cohesion necessary to save LiaÃ¢â¬â¢s Ã¢â¬Å"soul.Ã¢â¬ The field of Western medicine has a very distinct culture. Medical students and nurses are socialized into this culture while they are in training. Their view of clinical reality assumes that biological concerns are more basic, real, and clinically significant than psychological or sociological issues. The biomedical viewpoint does not accept alternative forms of healing or other healers. Western medicine is considered superior to other medical systems in the world, and because of this fact, other beliefs about causation, diagnosis and treatment of disease are disregarded and/or denigrated. This ethnocentric view is rigid and highly judgmental especially when treating patients from other cultures. Therefore, in the clinical setting, the applications of this theory includes the belief that patients should be prompt, comply with the doctorÃ¢â¬â¢s plan of treatment, subordination of health care workers to the doctors, and vigilant observation of the doctorÃ¢â¬â¢s instructions. If p! atients fail to comply with these expectations, doctors may feel personally and medically threatened and lash out at patients or health care workers. An example of a doctorÃ¢â¬â¢s frustration in treating Lia is apparent in the following excerpt: Ã¢â¬Å"People in the early years of their medical careers have invested anÃ incredible amount of time and energy and pain the their training, and theyÃ have been taught that what theyÃ¢â¬â¢ve learned in medical school is the onlyÃ legitimate way to approach health problems. I think that is why someÃ young doctors go through the roof when Hmong patients reject what weÃ have to offer them, because it intimates that what Western medicine has toÃ offer is not muchÃ¢â¬ (Fadiman, 76). American health care professionals focus on the disease rather than illness, and concentrate only on the individual and not on the individual as part of a much wider social environment. Medicine focuses on the germ theory of disease. Doctors reach their diagnosis by using blood tests, x-rays, and other procedures. However, most non-Western cultures do not depend on the germ model, but instead believe that illness is caused by spirit possession, soul loss or breach of taboo. Many Hmong immigrants seek the help of traditional healers before they turn to Western medicine. This is only natural since their healing traditions have served them well for thousands of years. They trust and have confidence in these rituals while they are suspicious of the medical procedures, diagnostic tools, and treatment plans of Western medicine. Ã¢â¬Å"Most Hmong believe that the body contains a finite amount ofÃ blood that it is unable to replenish, so repeated blood sampling,Ã especially from small children, may be fatal. When people areÃ unconscious, their souls are at large, so anesthesia may lead toÃ illness or death. If the body is cut or disfigured, or if it loses anyÃ of its parts, it will remain in a condition of perpetual imbalance,Ã and the damaged person not only will become frequently ill but mayÃ be physically incomplete during the next incarnation, so surgery isÃ taboo. If people lose their vital organs after death, their souls cannotÃ be reborn into new bodies and may take revenge on living relatives;Ã so autopsies and embalming are also tabooÃ¢â¬ (Fadiman 33). American health care providers are unaware of the isolation and fear the Hmong feel when they are unable to communicate in their native language. The inability to discuss their beliefs about illness and expectations regarding treatment leads to frustration and poor adherence to treatment plans. LiaÃ¢â¬â¢s mother, Foua, explains her daughterÃ¢â¬â¢s illness and the desire for American doctors to understand their point of view: Ã¢â¬Å"Your soul is like your shadowÃ¢â¬ ¦[s]ometimes it just wanders off like aÃ butterfly and that is when you are sad and thatÃ¢â¬â¢s when you get sick, andÃ if it comes back to you, that is when you are happy and you are well againÃ¢â¬ ¦Ã but the doctors donÃ¢â¬â¢t believe it. I would like you to tell the doctors to believeÃ in our neeb [or healing spirit]Ã¢â¬ ¦the doctors can fix some sicknesses thatÃ involve the body and blood, but for us Hmong, some people get sick becauseÃ of their soul, so they need spiritual thingsÃ¢â¬ ¦it was good to do a little medicineÃ and a little neeb, but not too much medicine because the medicine cuts the neebÃ¢â¬â¢sÃ effectÃ¢â¬ ¦but the doctors wouldnÃ¢â¬â¢t let us give just a little medicine because theyÃ didnÃ¢â¬â¢t understand about the soulÃ¢â¬ (Fadiman, 100). The conflicting paradigms that each member of these relations brought to the interactions are at the core of these great misunderstandings. Each group holds their beliefs to be true. The Lees remained suspicious of American doctors and American doctors continued to consider the Hmong an ignorant and backward people. Along the way, there was a lack of trust and respect between the family and doctors, and both groups blamed each other for the tragic results- LiaÃ¢â¬â¢s severe mental and physical disabilities. In Stress Management for Wellness, Walt Schafer describes the components of coherence as a feeling of confidence that stimuli deriving from oneÃ¢â¬â¢s environment is predictable, structured and explicable, resources are available to meet the demands posed by the stimuli, and the challenges are worthy of investment and engagement (239). In addition, Schafer states that groups with a strong sense of coherence Ã¢â¬Å"experience significantly less burnout than those with a weak sense of coherenceÃ¢â¬ (240). The doctors never felt LiaÃ¢â¬â¢s treatment at home was predictable or structured, neither did they feel there were resources available to meet the demands of communicating with the Lees, and the challenges to understanding their culture were never explored. In reflection, a doctor describes the gap as a Ã¢â¬Å"layer of saran wrap or something between usÃ¢â¬ ¦we were reaching and reachingÃ¢â¬ ¦but we couldnÃ¢â¬â¢t touch them. So we couldnÃ¢â¬â¢t accomplish what we were trying to do, which was take care of LiaÃ¢â¬ (Fadi! man, 48). In comparison, the LeesÃ¢â¬â¢ experience with the hospital and doctors was unpredictable, and without familiar structure. The hospital norms prevented them from using their customary resources of ritual and healers necessary for coping and helping during the healing process, and they dreaded the use of prescribed treatments. Because the doctors and the Lees lacked the elements of cohesion, their relationship was strained, untrusting, and uncompromising. All the benefits that accompany cohesion and the distress-resistance it offers was out of reach to all the players involved in LiaÃ¢â¬â¢s care. In the end, everyone lost a little bit of his or her soul.