The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures – By Anne Fadiman
Remember my list of great books from my law professor? Here is another off the famed book list (see the December review of The Immortal Life of Henrietta Lacks).
Anne Fadiman pens an eye opening book taking a mile deep plunge into Hmong culture, with intense focus on its intersection and collision with Western Medicine. This book should be a graduation requirement for ALL working in the health care industry. Beyond the exemplifying the Swiss Cheese model, the book highlights the immense impact culture beliefs and norms bring to definition and pursuit of health. Anne provides a very detailed desscription of Hmong culture and belief, all of which was new information for me, despite some misdrawn parallels between Hmong and Vietnamese (the hub’s story). She also provides a different view of several social issues that should be extrapolated beyond Hmong including foster care, child protective services, end of life, literacy, race, discrimination, family and immigration.
From personal experience, it is challenging to incorporate different ideas and cultures into Western Medicine, in part because of rules and regulations that make accommodation challenging if not a liability but also due to lack of scientific “rigor” around long held belief systems and practices, especially when they are so difference from our own. This book will definitely challenge your thinking and while I could wax poetic on the subject, I will spare you. Short of it: I still believe in the need and practice of evidence based medicine, in fact more scrutiny and value and less industry and money is needed, however, we as a system need to find a way to allow for some art, take time to step back and reflect if a plan/practice makes sense (example: antiseizure regimen for Hmong child) or if there is another way to achieve the same end and continue to work to meet closer to the middle with patients.
This book does have themes of handicrafts, urban farming and chickens, albeit as sacrifices, but as per usual, lead me to wonder what connection might be out there between the Hmong and bees? Well the internets do not disappoint, granted I was looking more for a legend. I came across the “Yellow Rain”. In the early 1980s, the US accused the then Soviet Union of supplying chemical warfare agents (t-2 mycotoxin) to Vietnam and Laos. Refugees from these countries, which include Hmong, reported a yellow liquid falling from the sky, presumably planes, hence yellow rain. The US purported thousands have been killed, yet the Soviets denied the allegation and the UN found it inconclusive evidence. Eventually samples made their way to some independent scientists who deduced that Yellow Rain, was in fact honeybee poop. Honeybees do not defecate in their hives, so some of the first days they are out and about, in particular after an extended stay in the hive, they take much needed “cleansing flights”. As a result, with my bee jacket to prove it, yellow rain falls. It is plausible that a large number of bees flying overhead could generate Yellow Rain and panic, consider the effects of warfare in Laos and Vietnam at the time.
Resources to learn a little more:
There is also mention of honey and beeswax as part of the funeral ceremony, a passage describing how the deceased is leaving this world.
[…]When the columns of life crumble, my veins and vessels sever.
My flesh disintegrates, melting away like honey and bee wax;
My bones decay, becoming as fragile and brittle as the stalks of dry hemp.
In this way, the road has opened up for me to be on the way.
Her V. Hmong Cosmology: Proposed Model, Preliminary Insights. Hmong Studies Journal, 2005, 6: 1-25.
So what else is on this great medical law and ethics reading/viewing list?