How did you feel when Child Protective Services took Lia away from her parents? Do you believe it was the right decision? Was any other solution possible in the situation?
Were you surprised at the quality of care and the love and affection given to Lia by her foster parents? How did Lia’s foster parents feel about Lia’s biological parents? Was foster care ultimately to Lia’s benefit or detriment?
How did the EMT’s and the doctors respond to what Neil referred to as Lia’s “big one”? Do you think they performed as well as they could have under the circumstances?
How does the greatest of all Hmong folktales, the story of how Shee Yee fought with nine evil dab brothers, reflect the life and culture of the Hmong?
Discuss the Lees’ life in Laos. How was it different from their life in the United States? Foua says, “When we were running from Laos at least we hoped that our lives would be better. It was not as sad as after Lia went to Fresno and got sick”. What were the Lees running from? What were they hoping to find in the United States?
When polled, Hmong refugees in America stated that “difficulty with American agencies” was a more serious problem than either “war memories” or “separation from family.” Why do you think they felt this way? Could this have been prevented? If so, how? What does the author believe?
The Hmong are often referred to as a “Stone Age” people or “low-caste hill tribe.” Why is this? Do you agree with this assessment of Hmong culture? Does the author?
What was the “role loss” many adult Hmong faced when they came to the United States? What is the underlying root cause? How does this loss affect their adjustment to America?
What are the most important aspects of Hmong culture? What do the Hmong consider their most important duties and obligations? How did they affect the Hmong’s transition to the United States?
What does Dan Murphy mean by, “When you fail one Hmong patient, you fail the whole community”?
The author gives you some insight into the way she organized her notes. What does it say about the process of writing this book? She chooses to alternate between chapters of Lia’s story and its larger background—the history of the Lee family and of the Hmong. What effect does this create in the book?
The concept of “fish soup” is central to the author’s understanding of the Hmong. What does it mean, and how is it reflected in the structure of the book?
It is clear that many of Lia’s doctors, most notably Neil Ernst and Peggy Philp, were heroic in their efforts to help Lia, and that her parents cared for her deeply, yet this arguably preventable tragedy still occurred. Can you think of anything that might have prevented it?
What did you learn from this book? Would you assign blame for Lia’s tragedy? If so, to whom? What do you think Anne Fadiman feels about this question?
Other Books of Related Interest
Virginia Barnes Lee, Aman: Story of a Somali Girl; Michael Bérubé, Life as We Know It; Robert Olen Butler, The Deep Green Sea; Lan Cao, Monkey Bridge; Temple Grandin, Thinking in Pictures: And Other Reports from My Life with Autism; Jamaica Kincaid, My Brother; Maxine Hong Kingston, Woman Warrior; Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales; Esmeralda Santiago, When I Was Puerto Rican; Susan Sheehan, Is There No Place on Earth for Me?; Abraham Verghese, My Own Country: A Doctor’s Story.
Farrar, Straus and Giroux
19 Union Square West, New York 10003
Copyright © 1997 by Anne Fadiman
All rights reserved
Published in 1997 by Farrar, Straus and Giroux
The Library of Congress has cataloged the hardcover edition as follows: Fadiman, Anne, 1953-
The spirit catches you and you fall down : a Hmong child, her American doctors, and the collision of two cultures / Anne Fadiman.
p. cm.
Includes bibliographical references and index.
ISBN: 978-1-4299-3111-3
1. Transcultural medical care—California—Case studies. 2. Hmong American children—Medical care—California. 3. Hmong Americans—Medicine. 4. Intercultural communication. 5. Epilepsy in children. I. Title.
RA418.5.T73F33 1997
306.4'61—dc21
97-5175
www.fsgbooks.com
* These phrases are pronounced, roughly, “kwa ntshwa” and “ntsha tya.” For an explanation, and a basic guide to pronouncing the other Hmong words and phrases in this book, see “Note on Hmong Orthography, Pronunciation, and Quotations,”.
* These phrases are pronounced, roughly, “kwa ntshwa” and “ntsha tya.” For an explanation, and a basic guide to pronouncing the other Hmong words and phrases in this book, see “Note on Hmong Orthography, Pronunciation, and Quotations,”.
* Savina was not intentionally insulting the Hmong when he called them by the offensive term “Miao.” “Meo” and “Miao” were widely used until the early 1970s, when the scholar Yang Dao successfully campaigned for the general acceptance of “Hmong.”
* Despite this early attempt by Hippocrates (or perhaps by one of the anonymous physicians whose writings are attributed to Hippocrates) to remove the “divine” label, epilepsy continued, more than any other disease, to be ascribed to supernatural causes. The medical historian Owsei Temkin has noted that epilepsy has held a key position historically in “the struggle between magic and the scientific conception.” Many treatments for epilepsy have had occult associations. Greek magicians forbade epileptics to eat mint, garlic, and onion, as well as the flesh of goats, pigs, deer, dogs, cocks, turtledoves, bustards, mullets, and eels; to wear black garments and goatskins; and to cross their hands and feet: taboos that were all connected, in various ways, with chthonic deities. Roman epileptics were advised to swallow morsels cut from the livers of stabbed gladiators. During the Middle Ages, when epilepsy was attributed to demonic possession, treatments included prayer, fasting, wearing amulets, lighting candles, visiting the graves of saints, and writing the names of the Three Wise Men with blood taken from the patient’s little finger. These spiritual remedies were far safer than the “medical” therapies of the time—still practiced as late as the seventeenth century—which included cauterizing the head with a hot iron and boring a hole in the skull to release peccant vapors.
* Most Hmong women, though more Americanized now, still avoid prenatal care until at least the second trimester of their pregnancies. Several studies suggest that their pregnancies usually have good outcomes nonetheless, with babies delivered at term, at normal weight, and without complications. Several cultural factors—low rates of drinking and smoking, nutritious diets—work in their favor. In addition, as obstetrician Raquel Arias explained to me, “Hmong women have proven pelves. If you had an inadequate pelvis back in Laos, it was lost to evolution. There was no one available to do a C-section for disproportion, so those women died, and their pelves died with them. Also, Hmong don’t marry Swedes. They marry people who are genetically similar to them, so they are likely to have babies that are the right size for their bodies.”
* In 1996, the Supreme Court declined to review the civil case of McKown v. Lundman, in which an eleven-year-old diabetic named Ian Lundman slipped into a fatal coma after his mother, his stepfather, and two Christian Science practitioners prayed for him instead of administering insulin. The boy’s father, who was not a Christian Scientist, had won a damages award of $1.5 million, the first ever obtained against Christian Scientists after a child’s death. By refusing to overturn this award, the Supreme Court signaled its lack of sympathy for faith healing. Although popular opinion favored the Supreme Court and condemned the Christian Science Church, an interesting dissent was expressed in a New York Times editorial by Stephen L. Carter, a Yale law professor. Carter pointed out that according to a recent Gallup poll, four out of five Americans believe that prayer can cure disease, and nearly half say they have been healed by prayer themselves. He concluded sardonically, “By refusing to intervene in McKown v. Lundman, the Supreme Court has reinforced
a societal message that has grown depressingly common: It is perfectly O.K. to believe in the power of prayer, so long as one does not believe in it so sincerely that one actually expects it to work.”
* For more than three decades, historians have debated the question of whether the United States broke any international agreements by sending American troops into Vietnam. The 1954 Geneva Accords included a declaration “prohibiting the introduction into Viet-Nam of foreign troops and military personnel as well as of all kinds of arms and munitions.” The United States and South Vietnam refused to join in that declaration, but the U.S. stated that it would “refrain from the threat or use of force” to disturb the provisions of the Accords. According to the historian John Lewis Gaddis, “The [1954] Geneva Accords were so hastily drafted and ambiguously worded that, from the standpoint of international law, it makes little sense to speak of violations of them by either side.” The 1962 Accords, however, which dealt only with Laos, were unambiguous.
* The yellow rain charges can be summarized as follows: Starting in 1975, after the Pathet Lao victory in Laos, Hmong refugees who had escaped to Thailand reported that while in Laos they had suffered from dizziness, skin rashes, blisters, diarrhea, stomach cramps, nausea, and bleeding from the nose and mouth. Some had died. They said these symptoms had begun after clouds of droplets—usually yellow, but sometimes white, black, blue, or red—fell from the sky, delivered by (according to various and sometimes conflicting reports) jets, prop-driven aircraft, helicopters, artillery shells, grenades, or land mines. The Hmong believed that what came to be called “yellow rain” was a communist reprisal against their continued resistance; anti-Hmong reprisals in other forms had already been well documented. In 1981, Secretary of State Alexander Haig announced that the Soviet Union and its communist allies in Southeast Asia were using chemical weapons in the form of trichothecene mycotoxins, a fungal poison. This was a serious charge, as chemical and biological weapons had been banned by both the 1925 Geneva Protocol and the 1972 Biological and Toxin Weapons Convention. Haig’s accusations were called into question in 1983, when Matthew Meselson, a professor of molecular biology at Harvard, noted that every sample of “yellow rain” residue on leaves, twigs, and stones that had been turned in by Hmong refugees contained a high proportion of pollen. When Meselson examined some samples under an electron microscope, he found that the pollen grains were hollow, indicating that they had been digested—that, in fact, these samples were actually bee feces, which fall in yellow clouds when bee colonies take mass defecation flights. One sample even contained a bee hair. Meselson pointed out that most of the Hmong-provided yellow rain samples contained no trichothecenes, and that in those that did, the level was too low to be toxic. He postulated that the Hmong were getting sick from natural causes—perhaps moldy food—and misattributing the source of their symptoms. (Many of Meselson’s critics misunderstood his theory, mistakenly believing he had claimed that bee feces, which are harmless, had poisoned the Hmong.) Other yellow rain skeptics emphasized the potency of rumor in Hmong culture; some suggested that yellow rain was not mycotoxic poison but a conventional weapon, possibly American-made CS tear gas left by U.S. troops in Vietnam and appropriated by communist Vietnamese. A 1985 federal chemical-warfare team concluded that “information regarding the use of ‘yellow rain’ against the Hmong in Laos remains too incomplete or implausible” to justify any conclusive claims about its existence. I would agree. It is noteworthy that the extensive press coverage of yellow rain has frequently divided along political lines, with the more conservative Wall Street Journal and Reader’s Digest affirming its existence and the more liberal New York Times and New Yorker challenging it.
* Neo Hom is a controversial organization. It is financed almost entirely by refugees from Laos. (The U.S. Council for World Freedom, a right-wing group chaired by retired Major General John Singlaub, contributed clothing, medicine, and advice during the late 1980s.) At its height, in the early 1980s, an estimated eighty percent of all Hmong in the United States were donating regularly to Neo Hom—typically, a $100 down payment followed by $2 a month for each family member. Vang Pao promised that their donations would be used “to carry out guerrilla activities and the eventual overthrow of the communist government presently controlling Laos.” (“He may as well believe in the tooth fairy,” Phillip Hawkes, who was then the director of the federal Office of Refugee Resettlement, said in 1984, “but his people want to hear it.”) Those who donated $500 received a certificate promising free airfare back to Laos after the liberation. Others have said they were promised important military and government jobs in the “imminent” Lao democracy—as army officers, mayors, police chiefs, and so on—if they contributed large sums. Some Hmong who had recently arrived in California reported that they were told their contributions were a condition of receiving welfare assistance. (Several county welfare offices had contracts with Lao Family Community, a state-financed mutual assistance organization founded by Vang Pao. Most branches of Lao Family Community were not involved in the Neo Hom scheme.) In 1990, when the California Department of Social Services conducted an investigation of the alleged extortion, several Hmong witnesses received death threats from other Hmong, though none were harmed. There have also been charges that not all of the money donated to Neo Hom has actually reached the guerrilla army, but has instead been diverted to the pockets of Hmong resistance leaders in America.
* The most celebrated case involved a respected Hmong leader named Vue Mai, who was persuaded to repatriate in 1992 as an example to other Hmong. In 1993 he disappeared from Vientiane and has not been heard from since. According to the U.S. Committee for Refugees, more than 700 members of the Vue clan living in a Thai camp, who had intended to join their leader in Laos, changed their minds after his presumed death and requested admission to the United States. The Thai government and the United Nations High Commissioner for Refugees rejected their request.
* The only place where Vang Pao’s plan has actually been carried out is French Guiana, on the northern coast of South America. In 1977, the French government arranged for about 500 Hmong to emigrate from Thai refugee camps to an uninhabited jungle site near the Comté River. Two other colonies were later established to the northwest and east. The original colonists were accompanied by French missionaries, one of whom, Father Yves Bertrais, had worked with the Hmong in Laos since 1948 and was one of the inventors of the most widely used system of Hmong writing. The settlers cleared land, built Lao-style houses, and within two years were economically self-sufficient. Although some of the original settlers decamped to France, the three colonies, with a current combined population of 1,400, are still prospering, producing more than seventy percent of all the vegetables sold in French Guiana. The colony where Father Bertrais serves as an adviser has also become an internationally known center for the publication of Hmong-language books.
* Sudden Unexpected Death Syndrome, which until the early 1980s was the leading cause of death among young Hmong males in the United States, is triggered by cardiac failure, often during or after a bad dream. No one has been able to explain what produces the cardiac irregularity, although theories over the years have included potassium deficiency, thiamine deficiency, sleep apnea, depression, culture shock, and survivor guilt. Many Hmong have attributed the deaths to attacks by an incubuslike dab who sits on the victim’s chest and presses the breath out of him.
* Like most false rumors, these all grew from germs of truth. The white-slavery rumor originated in press accounts of Vietnamese crimes in California, most of which were themselves probably unfounded. The car rumor originated in the Hmong custom of pooling the savings of several families to buy cars and other items too expensive for one family to afford. The insurance rumor originated in the $78,000 that a Hmong family in Wisconsin was awarded after their fourteen-year-old son died after being hit by a car. The daughter-selling rumor originated in the Hmong custom of brideprice, or “nurturing charge,” as it is now sometimes called in the United S
tates in order to avoid just such misinterpretations. The speed-bump rumor originated in the many nonlethal domestic faux pas the Hmong have actually committed. The dog-eating rumor, which, as I’ve mentioned elsewhere, is current in Merced, originated in Hmong ritual sacrifices.
* Like all low-income refugees, newly arrived Hmong were automatically eligible for Refugee Cash Assistance. The RCA program enabled Hmong who would otherwise have been ineligible for welfare in some states—for instance, because an able-bodied male was present in the home—to receive benefits. But it did not enable Hmong families to receive more money than American families. In a given state, Refugee Cash Assistance payments were always identical to benefits from AFDC (Aid to Families with Dependent Children, the most common form of public assistance before the 1996 welfare reform bill).
* The Hmong Channel is accessed almost exclusively by Hmong users. The Hmong Homepage and the electronic mailing lists also have an audience of Americans with an academic or professional interest in Hmong culture, as well as a number of Mormon elders who have been assigned missionary work in Hmong communities.
* At the request of local public assistance agencies, the infamous “100-Hour Rule,” which prevented so many Hmong from becoming economically self-sufficient, was waived in the majority of states, starting with California, between 1994 and 1996. “Basically, it required people not to work,” explained John Cullen, who directed Merced’s Human Services Agency during the last years of the rule’s sway. The 100-Hour Rule was replaced by a formula of gradually decreasing benefits based on earnings.