An American medical doctor, unlike a tvix neeb, does need to enter the body. Many of the necessary procedures that doctors perform are actually considered dangerous by the Hmong, and more likely to make the patient worse. What doctors fail to understand is that ?medicine was religion. Religion was society. Society was medicine. Even economics were mixed up in there somewhere? (Fadiman 60). The complex interplay in Hmong society makes treating them outside of their culture impossible. In fact, Dan Murphy, the doctor who diagnosed Lia, claims ?the language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier? (Fadiman 69). Recognizing that culture plays an integral part in medicine, it is important to take the values of the patient's culture into consideration when treating them, for the best possible result. At that time, however, respect for cultural differences had not yet made its way into American medicine, nor did it play a part in Hmong medicine. The two systems worked independent of each other, and also in direct contrast with each other. It can never be known if they had worked in harmony, if Lia would have been cured.



The cultural differences between the Hmong and the doctors in Merced were huge: different languages, different backgrounds, and different beliefs. There was no system in place to help them learn about one another, nor did either group take the time to try and understand the other. The few times there was understanding, it was through exceptional effort by one side or the other. Sadly, the result was devastating for one little girl.

While the doctors in Merced blame the family for not medicating Lia correctly, and following hospital orders, Lia's family blames the hospital for not understanding her disease, and for not treating her soul along with her physical body. Is either really to blame for what happened to Lia? Yes, and no. Lia represents a fatal break in communication and a lack of effort from either side to work in harmony for her cure. The differences between the two cultures medical practices are so different, that it was impossible for either group to find a common starting point.

The Spirit Catches You and You Fall Down is the story of a little girl named Lia, who is sick. Or can commune with spirits. It is the story of miscommunication between medical communities, and of the need for mutual respect and understanding between groups whose medical practices are different. But mostly, it is the heartfelt story of a little girl named Lia, who was trapped between cultures, those of her community, the Hmong, and her country, the United States.

This book was absolutely fabulous, and really does highlight the problems facing Western medicine, especially when it comes across cultures that look at health very differently. One thing I have really learned from this book that I can take with me in my career is that every person really needs to be respected, and that I as a health care professional need to do everything possible to learn about other cultures and their beliefs, so that I can respect and honor them in the work that I do. In this case especially, it is horrible how many things have gone wrong, but nobody is to blame. I believe Fadiman agrees, as she points out where both parties had erred, as well as where both had been correct. It was cultural miscommunication. While they should have tried to find a cultural interpreter, or someone who could have helped the two groups understand each other, it was not common at the time, and the two groups did try to work together. As a health care professional, I know that I need to keep in mind that I will not always understand other cultures, and that as a professional, I need to be respectful, honest, kind, and open to learning about my patients and their cultures.