9Txiv Neeb = ShamanLiterally: A person with a healing spirit
10Txiv neebsAct toward their patients in ways that are culturally acceptable, and in general, more pleasant than the ways of Western doctors.
11Txiv neebsKnow how to treat illnesses with herbs.
12The only medicines Hmong gladly accepted from Western doctors were antibiotics.
13Foua and Nao Kao LeeHighly attentive and caring toward Lia.
14Two-Pronged ApproachServices of Western doctors at Merced Community Medical Center (MCMC) andServices of Hmong shamans.
15Jeanine Hilt A social worker. Only person, out of 40, who asked Lia’s parents what they thought was the cause of her illness.
16Despite the fact that 20% of Merced’s population is Hmong, the State has not funded interpreters to help communication between doctors and patients.
17On the first time that Foua and Nao Kao carried Lia to MCMC’s emergency room, there was nobody available for translation.Since seizures had stopped, they could not explain to doctors what had happened.
18Residents identified bronchial congestion, which was caused by aspiration of saliva during the seizure, and prescribed an antibiotic.
19Nao Kao was told to sign a paper, where he supposedly acknowledged receipt of instructions for administering the medicine, and agreed to call for a follow-up appointment.He had no idea what he had agreed to.
20The third time, the Lees were accompanied by a cousin who spoke some English. The Lees were instructed to give Lia 250 milligrams of ampicillin twice a day, and twenty milligrams of Dilanti, an anticonvulsant, twice a day, to suppress further seizures.
21Lia’s condition was severe Between the ages of eight months and four and a half years, she was admitted to MCMC seventeen times and made more than a hundred outpatient visits.
22Grand Mal EpisodesFull-blown seizure attacks characterized by long periods of loss of consciousness.
23When the brain is deprived of oxygen, as is the case with prolonged seizures, significant brain damage occurs.
24Lia’s disorder was much more severe than a case of classic epilepsy.
26Lia was overweight.This made it very difficult to find her veins and insert the intravenous needles necessary to administer her medicine.
27Doctors had a hard time getting Lia to take her medications.
28The Lees had an even harder time, because they didn’t like to restrain her or force anything down her throat.
29Over time, Lia’s drug regimen became so complicated and was revised so many times, that it would have been very confusing even for a family that could read English.For the Lees, it was just incomprehensible.
30Prescriptions changed twenty-three times in less than four years.
31Foua and Nao Kao could not read medicine labels, neither in English nor in Hmong. They couldn’t read markings on droppers or measuring spoons.They weren’t able to read temperature in a thermometer.
32Lia’s parents never really understood the connection between a seizure and what it did to the brain.
33Drugs had different and significant side-effects, such as diarrhea and hyperactivity.
34For Nao Kao and Foua, the treatment was a crisis, not the epilepsy For Nao Kao and Foua, the treatment was a crisis, not the epilepsy. They understood that not everything is in our control.
35Doctors began to see signs of developmental delay in Lia. Neil and Peggy found this situation tragic, because they thought it was preventable.
36Neil wrote to the Health Department and to Child Protective Services.
37What the doctors viewed as the basic tools of modern medicine (blood tests, spinal taps, surgery, anesthesia, and autopsies), the Hmong saw as practices that threatened the seat of their identity, in fact, of their souls.
38Questions:1) Dr. Dan Murphy said, “The language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier. There is a tremendous difference between dealing with the Hmong and dealing with anyone else. An infinite difference” (p.91). What does he mean by this?
392) Dr. Neil Ernst said, “I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and there were certain rules they had to follow with their kids’ lives. I wanted the word to get out in the community that if they deviated from that, it was no acceptable behavior” (p. 79). Do you think the Hmong understood this message? Why or why not? What do you think of Neil and Peggy?
403) How did you feel about the Lees’ refusal to give Lia her medicine 3) How did you feel about the Lees’ refusal to give Lia her medicine? Can you understand their motivation? Do you sympathize with it?