Bridging the Cultural Gap

Anne Fadiman, in her book "The Spirit Catches You and You Fall Down", asked Arthur Kleinman, a psychiatrist and medical anthropologist, if he had any retroactive suggestions for Lia's pediatricians that they could follow to avoid the cultural misunderstanding between them and the Hmong family that led to Lia's tragic ending. He responded that he has three. "First, get rid of the term 'compliance.' It's a lousy term. It implies moral hegemony. You don't want a command from a general, you want a colloquy. Second, instead of looking at a model of coercion, look at a model of mediation. Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate. Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides. Decide what's critical and be willing to compromise on everything else. Third, you need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?" ( P. 261)

A Hmong healing ceremony.

The cultural gap between Lia's family and the western doctors, in Merced California, centered on the conflicting of the belief systems about the "cause" and the "treatment"of a disease. Hmong cultural beliefs explain the cause of illness to be soul loss. To address illness, they seek help from Hmong Shamans who heal their patients by sacrificing an animal in a ceremony to locate and retrieve the lost soul so the health can be restored. On the other hand, western biomedicine system holds that disease has a biological basis and can be treated with medicine or surgery. Because of the language and the cultural barriers neither party understood the other's beliefs, mutual distrust and hostility evolved. Ultimately, the cultural misunderstanding between the Hmong parents and the western doctors contributed to the brain-death of the little girl. To bridge the cultural gap, Kleinman called for: colloquy, mediator and better understanding of the importance of Hmong and biomedicine cultures.


Over the last two years, to address the cultural and linguistic barriers, the Merced Department of Public Health developed a "Health Certification Program for Traditional Healers" to teach the traditional healers "Shamans" about western medicine. In a report published in the San Francisco Chronicle on June 4, 2006, "A Matter of Respect, Training Hmong Shaman in the ways of Western Medicine is saving lives in Merced", Laurie Udesky reported " ... Hmong community leaders, including Shaman and health-care professionals, reasoned that teaching the culture's healers about western medicine could reduce fear with the community and help the shaman and doctors better understand how they can work together to heal people. Although hard to quantify, their efforts have paid off. To date, 89 shamans have graduated from a shaman-training program that requires forty hours of western medicine classes. After graduation, shamans are given hospital badges that allow them unrestricted access to the local hospitals to visit patients. It's now more likely, program leaders say, the doctors and shamans in Merced view each other with respect rather than bewilderment."

The hospital badge received upon graduation from a shaman training program in western medicine.

This training program reflects Kleinman three suggestions. The program opened a communication channel between the Hmong community and the Hospital doctors based on mutual respect and understanding of both cultures. By teaching the Shamans about the western medicine, this program is getting the most trusted mediators who can convince the Hmong community how the western biomedicine system is as powerful as the Hmong healing system.


Laurie Udesky's Report/Images 1&3 sources: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/06/04/CMGPOIP5CV1.DTL

Image 2 source: http://www.caremark.com/wps/portal/HEALTH_RESOURCES?topic=crossadhere