When Cultures Collide: A Heart-Wrenching Case History


In 1982, a 3-month-old Hmong girl with severe epilepsy was carried in her mother's arms to the county hospital in Merced, a San Joaquin Valley farm town where the Hmong, refugees from Laos, now make up a fifth of the population. The girl, Lia Lee, had stopped seizing but had breathed vomit into her lungs; the doctor on duty diagnosed her ailment as pneumonia. The mother, Foua, couldn't correct him. She spoke no English, and no interpreter was available.

Even if Foua had possessed the words, however, the cultural divide between her and the doctor still would have been formidable. To the Hmong, epilepsy isn't a matter of neurons misfiring in the brain. It's a matter of the patient's soul wandering off and being captured by a dab, or evil spirit.

"When the spirit catches you and you fall down," you have a seizure, which, though life-threatening, is also a sign that you may develop the powers of a txiv neeb, or shaman.

In the next three years, Lia had to return to the hospital dozens of times. Her epilepsy was soon properly diagnosed but, to the doctors' frustration, Foua and her husband, Nao Kao, often failed to administer the prescribed drugs.

At one point Lia was removed from her family and placed in a foster home--yet another traumatic event for the Lees, who had survived the U.S.-sponsored war in Laos, the deaths of other children, Thai refugee camps and resettlement in a place where none of their skills (slash-and-burn farming, the cultivation of opium) had any value and they were dependent on welfare.

Finally, in 1986, a massive bout of seizures left Lia brain-dead. When her parents took her home from the hospital, she was expected to survive for a few days at most. She was still alive, however--inert but painstakingly cared for--in 1988, when Anne Fadiman heard from a college friend on the staff of the Merced hospital about "some strange misunderstandings going on."

"One doctor called them 'collisions,' " Fadiman says, "which made it sound as if two different kinds of people had rammed into each other, head on, to the accompaniment of squealing brakes and breaking glass. As it turned out, the encounters were messy but rarely frontal. Both sides were wounded, but neither side knew what had hit it or how to avoid another crash."

Fadiman, now editor of the American Scholar, thought she had stumbled across good material for a magazine article. Instead, the story of Lia--who to this day has neither died nor recovered--occupied her attention for nearly a decade.

The result is this extraordinary book, which is not just a case history but also a history of the Hmong, a work of cultural anthropology and a guide for all of us who come in contact with other ways of seeing the world.

The saddest thing about Lia's story is that it has no villains. Like most Hmong parents, Foua and Nao Kao were loving and conscientious. The doctors and nurses who treated the girl spared no efforts. In the best traditions of Western science, Lia's pediatricians, Neil Ernst and Peggy Philp, when reviewing the case, never let their desire to look good interfere with a frank acknowledgment of their mistakes.

Perhaps inevitably, though, we sympathize more with the Hmong. Fadiman shows us how 4,000 years of resistance to Chinese assimilation made them stubborn, unwilling to abandon their culture, including holistic medicine involving shamanism and animal sacrifice. She shows us how cold, hurried and impersonal Western medicine seemed to them, and how natural it was for the Lees to distrust Lia's drug therapy.

Even with the best of intentions, this book illustrates, understanding between cultures is difficult--and how much goodwill is left in California today for immigrants, especially those, like the Hmong, who are in no hurry to adopt the majority's ways?

Fadiman's 20-20 hindsight about Lia's case persuades us that we can learn from it, but no two cases are alike, and our view at any given moment--such as the moment Lia first arrived at the hospital--is usually more blurred than clear.

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