The Spirit Catches You and You Fall Down is a book by Anne Fadiman about a Hmong family from Laos living as refugees in California and their dealings with the American healthcare system. Their daughter, Lia Lee, is diagnosed with epilepsy and, through a series of incidents of mistrust, misunderstanding and lack of cultural understanding, she does not receive the necessary medications and her condition worsens. The book deals with the clash between cultures, their customs and science, and argues for cultural competence in the field of medicine.
Lia experienced her first seizure at three months of age, but a resident at Merced Community Medical Center misdiagnosed her condition, and the hospital was unable to communicate with her parents since the hospital had no Hmong interpreters. Anne Fadiman wrote that Lia's parents did not give her medication as it was prescribed because they believed that Lia Lee's state showed a sense of spiritual giftedness, and they did not want to take that away.
The American doctors did not understand the Hmong traditional remedies that the Lee family used. The doctors treating Lia Lee, Neil and Peggy Ernst, had her removed from her home when she was almost three years of age, and placed into foster care for one year, causing friction with her parents. By age 4½ Lia Lee had been admitted to hospital care 17 times and had made over 100 outpatient visits.
The worst seizure Lia had put her onto the verge of death. She went to the emergency room and Dr. Neil Ernst could not do anything. He talked to Lia's parents about transferring her to Fresno, California because Lia would need further treatment that Dr. Ernst could not provide. Lia's parents ". . . believed their daughter was transferred not because of her critical condition but because of the Ernst's vacation plans". Lia Lee slipped into a coma after suffering from a grand mal seizure in 1986, when she was four years of age. Lia Lee's doctors believed she would die, but Lia Lee remained alive but with no higher brain functions.
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