Cancer Case Ignites Culture Clash : Medicine: Hmong parents refuse to agree to court-ordered chemotherapy for teen-age daughter. They fear treatment by doctors will make her infertile and unmarriageable.

Green leaves sprinkled outside the shabby apartment by a Hmong shaman warned neighbors that no one but the immediate family should cross the threshold.

Inside, Chong Chang Lor and his wife, Yia, began a three-day ritual, hoping to summon the good spirits this weekend to protect their 15-year-old daughter, Lee. The girl ran away from home three weeks ago after a Fresno judge overruled the family and ordered chemotherapy to treat Lee’s ovarian cancer.

The short, chunky 10th-grader filled her backpack with herbal medicine and Hollywood teen-idol posters and seemingly disappeared, one step ahead of authorities. “I don’t want you guys to cry, it’s not your fault,” she wrote her parents. “If I stay, there is so much trouble for me.”

The unusual case has unleashed passionate feelings among the tens of thousands of Hmong refugees who have settled in the San Joaquin Valley, and pitted their 16th-Century tribal customs against modern American medicine.

When police first removed the girl from her parents’ custody for an initial round of chemotherapy, they were pelted with stones and had to wrest a knife from the father, who threatened to kill himself.

Lee’s parents, like most Hmong who came here from the mountains of Laos, argue that they have the right to seek herbal and spiritual remedies for their daughter before opting for Western medicine--procedures that they believe desecrate the soul and block reincarnation.

Authorities now question whether Lee has run away or if the Hmong community is hiding her in the belief that she does not have cancer and that doctors were simply using her as a “guinea pig.”

Her parents say they have not seen or heard from their oldest daughter since the night of Oct. 28 when she fell asleep in the living room with several of her eight siblings. The family shaman, a diviner of spirits who counsels Hmong on all matters, had a vision of Lee in an unknown location “out in the open but OK.”

“This case is about a big misunderstanding,” said Shur Vangyi, a liaison between the city of Fresno and the Hmong community. “The doctors and the social service people don’t understand our culture.”

Family and community leaders said Lee may have seemed a timid girl struggling with her high school studies, but to the Hmong community she was a prime candidate for marriage and motherhood--cherished rites that would honor her parents and fetch a fine dowry.

When doctors discovered that the pain in her stomach wasn’t appendicitis but ovarian cancer, they threatened the only future Lee knew by removing an ovary and Fallopian tube and ordering chemotherapy, the Hmong community felt.

At the upcoming Hmong New Year, where boys and girls will toss balls to each other in a colorful act of courtship, a bald and infertile Lee would be considered damaged goods. “Maybe her hair will grow back, but her fertility, that is gone,” Vangyi said. “And if she cannot have children, she will not have that worthiness.”

Authorities acknowledge that they may have underestimated the fervency of the fertility issue in the Lor case. It is a highly charged question in the Hmong community, where the average family such as the Lors receives welfare and numbers nine children, one of the highest fertility rates in the world.

Doctors at Valley Children’s Hospital said they informed the Lors that the surgery would only slightly decrease their daughter’s ability to conceive a child and that chemotherapy would have temporary side effects but no long-term effects on her reproductive life.

But the Lors were never completely assuaged.

“At 12 years old, Hmong girls begin to marry,” said Cheng Vang, Lee’s uncle and the family spokesman. “When the parents find out that they removed ovary and not just appendix, they didn’t trust the doctors anymore.”

Stephen Stephenson, a pediatric oncologist at the hospital, said the surgeon had no choice once the eight-inch tumor was found. “It was a matter of life and death,” the doctor said. “To do otherwise would have been malpractice.”

Two decades after the first Hmong arrived here from refugee camps in Thailand, authorities have grown familiar with the challenges of absorbing a proud and sometimes defiant people with almost no modern skills. Until missionaries converged on their mountain huts three decades ago, the Hmong had no written language.

While growing numbers are attending college and entering the professions, the vast majority of the 30,000 Hmong in Fresno County are basically lost in America and mired in welfare dependency.

Many of the refugees regard welfare as their due for serving as an underground force in the CIA’s secret war against the Viet Cong in the early 1970s, officials say. Nearly 70% of the Hmong receive Aid to Families with Dependent Children, the highest welfare rate of any ethnic group in the country.

Attempts to reduce that number through job training and workfare programs have been met with deep resistance and even death threats. “I’ve had to carry a gun, and we’ve had some caseworkers whose houses have been shot at,” said Ernest Velasquez, head of Fresno County social services.

“The Hmong say, ‘This is my check. The CIA promised me this check.’ We’re talking about a second generation of welfare recipients who weren’t even alive during the Vietnam War.”

The clash of cultures resounds everywhere here. Only a few funeral homes will accommodate the Hmong, who chant over their dead for three days and burn paper money and slaughter chickens and sometimes cattle in the parking lot for a departing feast. One funeral home burned to the ground a few years ago in the midst of high mourning.

Authorities have undertaken education programs to dissuade Hmong men from kidnaping young teens to be their brides and from growing opium. Fresno police have hired several Hmong officers to help bridge language and cultural gaps.

But the issue of caring for sick and crippled children has continued to vex officials. Because the Hmong worship their ancestors, there is a belief that diseases and handicaps are the sins of a dead relative being visited on a new generation or the sins of a child’s past life.

Many Hmong have allowed American doctors to treat their children once a shaman has performed the proper Hmong ceremonies. At Valley Children’s Hospital, for instance, shamans are allowed to burn incense and perform small rituals with water in a patient’s room.

“We treat them like any other priest,” said Cris Monahan-Bremer, the hospital spokeswoman. “Last year, we saw 5,300 Southeast Asian patients and there was rarely a problem.”

In 1990, nine Hmong children died of measles after their parents consulted with shamans and waited until the children were in cardiac arrest before bringing them into the hospital. That same year, in a highly publicized case, a Hmong family went to court to stop doctors from surgically repairing their son’s clubfeet. Ultimately, a judge ruled that the handicap was not severe enough to remove the child from the home and force surgery against the parents’ will.

Unlike that boy, officials point out, Lee Lor needed to begin chemotherapy within weeks of her Sept. 26 cancer surgery or her chances of survival would drop from 80% to 10%. But the Lors say they don’t believe the numbers or even that Lee suffers from cancer, a word that does not exist in their language.

They say they will never trust American doctors again, not after being told that their daughter suffered appendicitis only to discover--three days after the surgery--that one of her ovaries and a Fallopian tube were gone.

Hospital and welfare officials, including two Hmong translators, say the family was informed of the cancer right after the surgery. Velasquez, the head of county social services which sought and won the court order forcing chemotherapy, acknowledged that officials might have done a better job communicating with Hmong leaders and the family.

“Maybe we could have avoided some of this mess if we had done a better job paving the way,” he said.

The Lors say their daughter ran away from home once before. Last summer, angry that she couldn’t stay out later, she disappeared for a few days. She called from a local hospital with a bad headache.

“She’s a nice girl,” said her 16-year-old cousin, Angie Vang. “She always says she wants to go to Los Angeles. I think she was just afraid that if she didn’t have any hair, everyone would make fun of her.”