Sunday, October 4, 2009
The Spirit Catches You and You Fall Down
I've started reading one of the two books I purchased at the conference on cultural competency called, "The Spirit Catches You and You Fall Down: A Hmong child , her American doctors and the collision of two cultures." The other book was about medical missions. Spirit catches you is the well written assessment of what happens when a non-English speaking refugee family intercepts with the American healthcare system. It is a riveting story, though the author at times becomes bogged down in clinical analysis. I remember the Hmong refugees. I was a young teen in the 1980s when they seemingly 'invaded' the housing project where one of my aunts lived. They were quiet solitary people who kept to themselves. I could only imagine how foreign our world must have seemed to them. Could anyone have possibly chosen two more unalike populations to put together- Hmong refugees fresh from the mountains placed in the urban core housing projects with low income Americans, mostly African-American? Each group kept to themselves and there were few clashes, but only because there was no interaction. Each eyed the other suspiciously as I recall. In the book, the Hmong parents of the story present to the emergency room with a child afflicted by seizures. Since they don't speak English and this is prior to the time of having interpreters on staff- the doctors don't know what the problem is. It takes several visits, until the child is brought in still in the throes of a seizure, for them to figure it out. The book goes on to catalog the highs and lows of treatment for this child with all miscommunication and misunderstanding that accompanies their interactions. It is a fascinating read- amusing in some places, heartbreaking in others. It makes me want to work harder to impress upon my students the importance of taking the time to understand the health beliefs of the person for whom you are caring. It's also changed my mind about another thing. It is not enough to seek patient compliance as the highest goal for the nurse's efforts, but rather client collaboration. The healthcare consumer has to have buy-in. Clinicians and consumers must work together to create and individualized plan of care- this is the only way, in fact, that it can be individualized- the individual has to help create it. We in our authoritative cloak cannot arbitrarily decide what is best for someone else. For true healing, rather than merely curing, to take place, we need to involve the body, mind, and spirit of the client. All of these aspects of the person are embraced by culture. In the book, progress begins to be made, when a few astute clinicians, inadverdantly begin to ask some of Kleinman's Questions, such as what the child's illness means to the parents. I can't wait to finish this book.