Cross- Cultural Differences in the World of Biomedicine Samantha Linnett ANT 185 Professor Van Hollen TA: Sean Reid Section M003

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1 Cross- Cultural Differences in the World of Biomedicine Samantha Linnett ANT 185 Professor Van Hollen TA: Sean Reid Section M003

2 Cross-cultural differences and miscommunications between immigrated peoples and citizens of the United States have caused numerous, and many avoidable, conflicts, especially in the medical field. If one were to type cross-cultural medical conflicts into Google or another database search, the results would seem endless. Examples of these conflicts happen every day in the melting pot that is America, when involuntary migrants, with their respective cultures intow, subsequently don t melt (Fadiman 2012: 183). One example of an immigrant population that hasn t smoothly conformed to the American society is the Hmong. The Hmong people have had many of such encounters and cross-cultural misunderstandings within the biomedical community. With such a different view on medicine and illness, one might expect that the Hmong culture would clash in the biomedical setting of the United States. This makes it all the more important for medical students and training practitioners to be made aware of the cultural context of the patients they will be caring for. The Hmong people practice a form of healing known as shamanism. They believe that illness derives from soul loss. The shaman in the Hmong society, known as a Txiv Neeb (tsi neng), is greatly respected and revered for his or her ability to perform both physical and spiritual healing. To be chosen to be a shaman by the ancestor spirits is thought of as a divine gift. Shamanic healing not only attempts to recapture the lost soul of the ill, but in doing so restores the cosmic balance of the whole society (Van Hollen Lecture: 9/16/13). Many things can cause the soul to separate from the body. The soul is believed to have its own agency its own desires and feelings and responds to its environment (Van Hollen Lecture: 9/16/13). Sensations such as anger, grief, fear, curiosity, or wanderlust can pull the soul away (Fadiman 2012: 10), such as is the case of Lia Lee s soul being scared away by her sister slamming the door, which caused Lia to have epilepsy, or according to her family, the 2

3 illness of the spirit catches you and you fall down (Fadiman 2012: 20). The soul can also be stolen away by evil spirits called dabs, especially during vulnerable stages of life, such as early childhood (Van Hollen Lecture: 9/16/13). This makes it very important for the Hmong to keep the soul satisfied. Young girls often wear large, silver necklaces, and babies wear traditional hats on their heads to keep the soul happy and to disguise them from any lurking dabs (Fadiman 2012: 11). If the soul is lost or stolen, the Hmong have many rituals that they perform to call the soul back to the person who is ill, all of which incorporate some sort of sacrifice. The sacrificed animal s often a chicken, pig, or cow soul is made as an offering to the ancestors or the dab that stole the soul in order to get back the lost soul. The Hmong then have a huge feast in which they utilize almost every part of the animal in the meal (Seigel: 2001). With all of this in mind about the Hmong culture of sickness and healing, it is also important to understand how the Hmong view the culture of biomedicine. They do not understand it in the way that any other American citizen might. Most of the Hmong s earliest experience with biomedicine was with fast-acting antibiotics in the refugee camps in Thailand (Fadiman 2012: 36-37). They have little understanding of a chronic illness and of having to take medicine for the rest of one s life. The Hmong critique the biomedical culture for its brevity and rudeness. Doctors in the United States only spend about twenty minutes with a patient, compared to the full day worth of ritual that the Hmong shaman performs. In those twenty minutes, the doctors ask rude, intimate questions about sexual behaviors and other private matters. Doctors also perform invasive procedures, such as taking blood and surgery (Van Hollen Lecture: 9/23/13), which are strictly taboo in the Hmong culture and could have severe consequences on the soul (Fadiman 2012: 33). 3

4 Many Hmong also have little, if any, understanding of English. Many are unable to read, write, or speak it (Fadiman 2012: 50). Many times, Hmong children who have been primarily or completely raised in the United States and educated in American schools will have a better understanding of the English language, but they are usually not the best option as translators. In the Hmong culture, men are held higher than women, elders are held higher than all those younger than them, and all Hmong ever care about is family (Siegel: 2001). Therefore, using the young, Americanized much to the discontent of their parents (Siegel: 2001) children to translate for the family can be a sign of disrespect to the parents and creates a sensation of role loss, where the parents become elementary school children and the children become the educated (Siegel: 2001). It is extremely important to have a respective Hmong translator on call at all times to aid communication and understanding in the doctorpatient interaction. This lack of the ability to understand each other s cultures and absence of proper communications between Lia s doctors and family is the main reason for her parent s noncompliance with her medicine regiment. As explained previously, Lia s family had no conception of long-term medication. Even if they did, they wouldn t have been able to read or understand the directions for the prescribed medication (Fadiman 2012: 50). In the end, Lia s parents were convinced that the medicine was making her more ill (Fadiman 2012: 213), and wanted a little medicine and a little neeb (Fadiman 2012: 110). The reaction of the Hmong to the doctors and the biomedical culture is one that could have been expected. The Hmong, throughout history, have never conformed, or melted, into the society that they were in (Fadiman 2012: 183). They hold strong to their cultural values. The Hmong are highly resistant to authority and do not adhere to being told what to do. They have a 4

5 long history of persecution for this resistance, from China to Laos and now in the United States. In every situation they have had a fight or flight reaction, either resisting whoever was trying to make them conform against their will or migrating somewhere else to avoid it (Van Hollen Lecture: 9/9/13). This is exactly the reaction the Lee family had to the doctors who were treating Lia. They saw the doctors as authoritative figures, and wanted to resist giving in on what they believed to be right that more neeb and less medicine was necessary or run out of the hospital with their daughter as Nao Kao did when he thought he was signing a paper that said his daughter would die in two hours rather than she would be released from the hospital in two hours (Fadiman 2012: 178). The fact of the matter is that it is of the upmost importance that medical students who are likely to be working with the Hmong population in the United States, or with any culture outside of their own, need to understand that culture in order to effectively treat their patients. They need to give respect to the patient s culture in order to gain respect and trust from their patient. And they need to have a good translator so that understanding isn t lost in communication, or lack thereof. Most importantly, they need to understand that the profession they are practicing is part of a larger biomedical culture. It is not just scientific fact. Once they view their own practices as part of a culture, they will better be able to realize their own biases and limitations of sight based on that culture, and from there be able to better understand other cultures as well. 5

6 Works Cited Fadiman, Anne The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux Siegel, Taggart The Split Horn: The Life of a Hmong Shaman in America. 56 min. PBS. Washington, D.C. Van Hollen, Cecillia The Spirit Catches You and You Fall Down. Lecture delivered on 9/9/13 at Syracuse University Shamanism and Soul Loss. Lecture delivered on 9/16/13 at Syracuse University Collision of Cultures. Lecture Delivered on 9/23/13 at Syracuse University. 6