“The Spirit Catches You and You Fall Down” the book by Anne Fadiman is an interesting book that contains different situations where different cultures and traditions clashes as a result of different barriers. In this brief work I tried to shed light on some of these barriers that could exist in our clinical practice and how these barriers could be understood in different cultures.
On the other hand, there is no doubt that cultural differences play an important role in problems analysis as well as the illness differential diagnosis, that is why it is important for policy makers and legislatives to set goals that help in including people from diverse cultures into health care systems such as the one of the United States of America. Finally, better understanding of these barriers would help health care providers to overcome cultural diversity barriers.
I did enjoy reading this book as it painted a detailed picture of a specific incidence of cultural collisions with the doctors of Mercy Medical Center of Merced (MCMC) and Lee’s family in addition to similar collisions occurs across the world and the United States of America as a result of misunderstanding between families and health care givers (Paterson, 2013). There is a vast difference between the Hmong people culture to that of western and eastern cultures.
Reading this book teaches us as healthcare providers that there are social interactions and common gestures that could be considered inappropriate to the Hmong people. When doctors maintain friendly eye contact to the patient or the family, this is could be translated as a disrespectful or an invasive gesture. Nelson (2010) discussed that when a doctor looks in patient’s eyes, this would help understanding the patient’s level of stress or discomfort. However, eye contact that is continues for 10 seconds or more could make the patient feel uncomfortable.
Another incidence that physical therapists and other health care providers could fall into is touching the patient’s head without permission or beckoning with a crooked finger, which might be considered grossly insulting. The Hmong people believe that there are alive spirits watches them and involves their daily lives as well. For such cultures, it is important not to complement a child’s beauty out loud as the evil spirit overhear and be unable to resist snatching the soul.
Anne Fadiman book exposed to an important issue when th family was desperate for a translator not only for the language, but also for a cultural translation to guide them through the western culture. Moreover, liaisons were required to educate people from the western culture about the Hmong traditions and culture. It is essential for physical therapists and other healthcare providers to establish a strong understanding of patients’ background and culture to support them and enable them to be more attentive and active participants in the treatment.
Saha, Beach, and Cooper (2008) discussed this issue and concluded that it is important for healthcare providers to consider patients diversity, perspectives and values when interacting with patients from different cultures. On the other hand, to provide a better health care services for the patients from diverse cultures, it is important to incorporate other health team members and social workers to decrease the possible barriers for a better outcome. One important thing to be learned from Anne Fadiman book is that health care providers could be excellent practitioners, but they could be imperfect healers.
In the United States, and in a diverse city like New York there are many immigrant families who struggles with the American health care system, so in my own practice I try to articulate the most single fundamental source of contention among patients, today’s medical establishment in addition to those who entrust themselves to its care to overcome such barriers. One of the challenges that faces the United States health care system is to respond to the continues changes and to the reality of that these changes might result in consequences that often ignored or underestimated.
Health care providers should be aware that patients from diverse cultures do not present at the doctor offices with their illness only, but they bring their lives that include their cultures, traditions in addition to their families’ history. The training period for health care professionals mainly concentrates on instructing professionals how to clinically manage the patients’ diseases as seen from the point view of doctors. However, illness is the problem that is seen from the point view of the patient (Gerrard & Vernon, 2008).
The United States health care system incorporates many organization partnerships in order to improve the clinical decision making between the health care professionals and the families. The family-centered care (FCC) is one of those partnerships, which is considered the standard of children health care by many health care groups, hospitals and clinical practices (Kuo et al. , 2012). FCC role is to describe the families’ experiences with the optimal health care and the health care delivery process. The main principles of the FCC is to: • Share the related health information. Respecting the cultural diversity. • Respecting the linguistic traditions. • Respecting the care preferences. • Providing medical decisions that fit needs and strength values of practitioners and families at the level they desire. • Negotiating about the desired outcome of the medical care plans. • The medical care should reflect children within their context that include home, school and their community (Kuo et al. , 2012).
The United States health care system is evolving. Many changes have been made since the writing of this book to transform it to a managed care system from being a system ith an indemnity plan that based on the patients’ needs. The cultural beliefs and values are not the only factors that drove this change. However, the economic factors and the related health care expenditures required the United Sates government to take measurement to improve the health care outcome by increasing the access to health care services and make it affordable to more people. One of these reforms is “Obama care”. The aim of this health care reform was to make health insurance and health care services available to wide range of Americans with less cost (Riesman, 2015).
However, many legislatives were not satisfied with Obama’s affordable care act that was signed in 2010, and this is because of many reasons that include incompatibility with religious liberty and personal freedom in addition to other reasons such as the heavy taxation, enormous spending and the relatively higher cost (Riesman, 2015). Another recent legislative change that occur in the United States of America regarding physical therapists who wish to become practitioners in the United States.
The federation of the state boards of physical therapy (FSBPT) (2015) has made few reforms for foreign physical therapists including a mandatory test of English language exam prior to taking the licensure test beginning of January 2018. These legislative efforts were made to improve Foreign Educated Standards in order to improve competency and decrease the possible language barriers that might encounter therapists in their licensure examinations and in their clinical practice.
Many efforts have been made to improve health care for the immigrant populations in the United States to help in expanding the health care access for those people beyond the Affordable Care Act. The city of New York (2015) discussed in their website that the barrier to health care access for immigrants relies on health care providers and these related factors: • Inadequate linguistic competency. • Inadequate cultural competency. • Lack of knowledge. • Lack of access to high-quality interpretation services. • Lack of language understanding and translation services available to immigrants.
In order to overcome these obstacles, many measures should be adopted such like: • Health care access programs that include uninsured immigrants should be implemented incoordination with the preventive and primary health care services. • The health care system should expand to include linguistically and culturally preventive and primary health care services for immigrants. • Public education should be conducted on the coverage options and health care outreach for immigrants.. The access to medical interpretation services should be increased.
This book is a real eye-opener to the Hmong culture with its exposure to epilepsy treatment and the different views of caregivers and medical staff. The various viewpoints of different cultures and approaches to treatment might not be always recognized. However, cultural awareness among caregivers and medical staff is essential for the benefit of both patients and their families. As a physical therapist I did find correlations to my experiences even within the local community, where many people doubt the medical community intentions in addition to the people who are trying to help genuinely, but frequently end up doing more harm than good.
