Common Reading Project addresses cultural challenges in medicine
By Bruce Coleman
The inability of health-care professionals to understand and appropriately respond to a radically contrasting culture can have dire consequences on the quality of care they can provide.
This principle of medical ethics is poignantly illustrated in Anne Fadiman’s book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures. The award-winning book is the topic of the next Common Reading Project discussion, scheduled for noon on Friday, Jan. 25, in room R153 (lower amphitheatre).
The true story centers on the medical plight of the 13th child of a Laotian immigrant family in Merced, Calif. The first of her siblings to be born on American soil, Lia Lee suffered from epileptic seizures, a condition that carried religious significance in the Hmong culture in which she was raised.
The book’s title is a literal English translation of qaug dab peg, the phrase many Hmong use to describe epilepsy. In the Hmong culture, the disease is viewed as an honorable condition and those who have it have been specifically chosen to enter and journey through the spiritual realm to act as healers for others who are physically or emotionally sick.
Miscommunication by the medical team treating the girl, mistrust of Western medical practices by her family and the cultural divide between both parties resulted in the worst possible outcome for little Lia. Her condition worsened and she slipped into a coma before her fifth birthday. She lived in a persistent vegetative state until her death last August at the age of 30.
The cross-cultural collision and its unintended consequences can serve as a life lesson for all health-care professionals at the University of Mississippi Medical Center, according to Dr. Jasmine Taylor, associate vice chancellor for multicultural affairs.
“Research, training and quality patient care, all of what we do at UMMC is focused on improving the health care of our patients,” Taylor said. “This book is an example of what happens when we can’t hear, see or understand from the patient’s perspective. To give that perspective voice and to understand that their belief system is meaningful to them is important.
“This diversity dialogue session is an opportunity for the institution to come together and talk about how we think about our patients holistically; not just as a disease process, but as individuals with a history, a culture, a social circumstance – things which I think we must keep in mind when delivering top quality health care.”
Sponsored by the Division of Multicultural Affairs, the School of Medicine Student Affairs Office and Academic Office and the Center for Bioethics and Medical Humanities, the Common Reading Project will include an interactive discussion with experts on pertinent topics in medical ethics. Participants should read Fadiman’s book – available in the UMMC Bookstore – before the event.
Dr. Ralph Didlake, director of the Center for Bioethics and Medical Humanities, said the Common Reading Project will challenge participants to reflect on such issues as respect for cultural differences, decision-making autonomy and health-care justice.
“As the story unfolds, we are required to question the very definitions of health and disease and ask how these definitions are informed by different cultures,” Didlake said. “Even further, we are required to ask about the role of our health-care system across cultures and how that role might differ from one to the next.
“These are profoundly important questions for the UMMC community as Mississippi becomes a more diverse society and as we move toward new health-care delivery models in the 21st Century.”
The impact of culture upon medicine is especially important for students to understand, according to Dr. Jerry Clark, chief student affairs officer.
“Our students have developed a strong basic and clinical science fund of knowledge,” Clark said. “This Common Reading Project provides them a vehicle to exercise that fund of knowledge by exploring the ethical and cultural challenges faced by the little girl and her physicians.
“We may not have a strong Hmong community in Mississippi, but there are all sorts of other cultural groups here. The lessons learned are specific and broad, so they can help make our students more sensitive to cultural issues and, ultimately, they can make them become better physicians. And they can help our faculty, teachers and staff provide better support for our missions.”
Taylor said the discussion will reinforce the values of cultural competence, a concept necessary for health-care providers and organizations to effectively deliver health-care services that meet the social, cultural and linguistic needs of their patients.
“Patient-centered care requires us to recognize our bias, it requires us to put the needs of the patient first, it requires us to listen and it requires us to effectively communicate – not only with the patient, but also as a health-care team,” Taylor said.
“The key points are having a respect for the patient, having an ability to listen to the patient while being able to take their perspective into account when delivering care, the importance of working together as an interdisciplinary team and the importance of working together as team members while taking care of patients.”
Clark said everyone at the Medical Center could benefit from the Common Reading Project discussion.
“We’re all in one room – staff and students from all schools, faculty from all disciplines – and we’re discussing something that we all have an opinion about. In fact, the more people that participate, and the more diverse the participants, the better the intellectual exercise will be for everyone.
“It creates community, and that’s all fun.”
Lunch will be available to the first 100 in attendance. For more information about the Common Reading Project, call 4-5012 or 4-1339.
Among the Hmong
Perhaps few participants in the Common Reading Project discussion can appreciate the close examination of Hmong culture Fadiman's book provides than fourth-year medical students.
Earlier this year, Redmond served a clinical rotation in pediatrics at Central California Children's Hospital in Fresno, a city approximately 20 miles way from where the described events took place.
Redmond said he had several encounters with patients from the Hmong culture during his training.
"The physician I was working with spoke several times about how theirs was a unique culture of its own that you had to seal with sensitively because of their beliefs," Redmond said. "you have to approach them from a slightly different perspective."
Redmond is no stranger to cultural differences: he has traveled extensively throughout the world and has met people of many diverse beliefs. He said those experiences have helped him develop a strong sense of cultural awareness of patient needs.
"You have to always be aware that you may not know what a patient really or truly needs from a holistic standpoint," he said. "You can't read a book and expect to know a Hmong patient. But reading the book can cause you to second-guess yourself in a healthy way when you encounter patients from different cultures."