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Hmong (Posted: May 13)
The Spirit Catches you and you Fall down written by Anne Fadiman gave me a chance to think about intercultural communications barriers. While reading the beginning of the book I was enthralled at the fact that there were so many Hmong patients in MCMC hospital. With the increase in population of Hmong residents in the areas I could not see how more extreme measures were not taken if no other reason that to prevent a lawsuit on the hospitals behalf.
To reduce the chances of that happening and to increase the patient survival rate there are a number of things I think that should have been done. The most obvious would be to get the government to fund the hiring of translators. I also would have suggested that some of the instructions given to patients should have been in Hmong/English similar to our Spanish/English in health settings. As I read further however, I realized that most Hmong speakers are illiterate not only in English but in Hmong as well.
There also could have been a community based effort to teach Hmong residents to speak, read and write basic English or if it would be easier to teach the already speaking Hmong people to read and write in that language. This could have been used in a combined effort to introduce the dual language literature and instructions for the patients. It also occurred to me that after so many Hmong residents started to be seen at MCMC hospital then why wasn’t the already employed medical staff required as part of their training to undergo a seminar or program for learning the basics of Hmong health care communication skills were they could learn to speak enough of the language to find out what was wrong with the patient and for how long almost basic asked questions when someone is seeking medical attention. It would also benefit the employees that were taking the program or seminar to learn a little about the Hmong cultural and social norms in their societies because this aside from the basic language barrier was another cause for misunderstanding leading to anger and lack of trust in the medical procedures and staff. A basic understanding that the Hmong people generally feel comfortable taking care of their own children might have eased a little tension while Lai was receiving medical care. They (the medical staff) could have allowed the parents to participate in giving the medications to her in the hospital so that the staff could see if they were doing it right and understood the directions as clearly as they could. It’s confusion on both parts of the medical staff and the parents and they both want what is best for their children but they didn’t know how to get that across to the other party. In the beginning of the book the writer says that their was a mistrust because the Hmong after having children bury the placenta so that the spirit or soul can find their way home and from that lack of understanding, (the medical staff assumed they wanted to eat it) refused because they thought it would spread illness among the residents. That was the first step in mistrust because the staff took away something the Hmong have been practicing for decades.
There was not that many things they could have done in the beginning to better understand their patient’s problems, but what little they could have done was lost because it wasn’t in their budget. It was good that they had Dr.’s there like Ernst and Philp’s that went to the wire to try and figure out a way to help them even through the barrier of language and culture.