The Spirit Catches You and You Fall Down, by Anne Fadiman

One of the more interesting and informative books I've read lately (and a nice break from my contemporary theology kick) has been The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures, by Anne Fadiman.

Lia Lee is a Hmong (pronounced with a silent "H") girl born shortly after her parents immigrated to the US as refugees after all the warring and fighting that went on in Vietnam and Laos. As an infant, Lia began having seizures (known in the Hmong culture as "the spirit catches you and you fall down") which bought her regular visits to the local ER at the Merced Community Medical Center (MCMC) in Merced, CA, a town where thousands of Hmong refugees have settled since the war during which Hmong soldiers fought on the US's side by the way.

With these visits brought the clashing of modern western medicine with ancient Hmong spiritual and medical practices. Over the course of several years the staff at MCMC got to know Lia Lee and her case very well as well as the cultural barrier or rather world-view barrier between them. More than a simple language barrier, the Hmong people have an understanding of health care so different than our own that both sides can talk though an interpreter but neither is able to hear the other. The two sides talked past each other.

For instance, at one point the doctors feared they had to give the worst news to Lia's parents by saying there's nothing more to be done and Lia will die within a week. Lia's father, Nao Kao, grabbed Lia (still a toddler at the time) disconnected everything from her and ran out of the hospital! Code Pink! Why did he do this? Because, in Hmong culture, the doctor stating that Lia will die soon is communicating that he is planning on killing her soon. Because, who in their right mind could even begin to try and predict the future. Yet this is something doctors love doing. (And, isn't it a little silly when you think about it?)

Fadiman has sure done her homework. Though the backbone of the book is the story of Lia Lee and her medical journey, being admitted some 16 times into the hospital in her first 3 years of life, the book as a whole is a treatise of, or rather a window into, the Hmong culture. Packed with information, she artfully takes you through Hmong history, customs, war time troubles, immigration instances, their adaptation (or lack thereof) to American culture, and so much more. And after over 300 pages and information overload, I still felt like I had only scratched the surface.

The writing style is somewhere in the funky space between novel and documentary. Fadiman walks this thin line very well. Not only does the reader develop an attachment to the Lee family, but also to the Hmong culture. My heart went out to their struggle in refugee camps in Thailand and Cambodia, I learned to understand their resistance to conforming to American culture (one of the defining characteristics of Hmongs), and I chuckled at some of the stunts they pulled that are documented in this generous book.

A few Hmong men went fishing in a nearby pond marked with signs that read "No fishing." Even if they could've read the sign, the concept of a "no fishing" pond is untenable to them, because how else are you supposed to find food? A police officer approached them to ask them to stop, and they all dropped to their knees ready to be executed. This is very telling of the environment they left when coming to the US.

Police were once called on a Hmong apartment because at a birthday celebration they were slaughtering a live cow. This freaked out the nearby Americans, but really, where do you think the meat in the super Walmart comes from? It's also common place for Hmong to slaughter their own pigs, chickens and rabbits, oh my!

Fadiman wrote about driving into the parking lot of an apartment building full of Hmong and noticing that more of it was dedicated to growing vegetables, spices and fruits than to parking cars. They would fill shoe boxes, old buckets, shoes!, dish pans, anything they could put dirt into, and plant herbs in them out in the parking lot.

One American couple, who had a Hmong family living above them, noticed a drip in their apartment ceiling. They called maintenance who went upstairs to check things out. Entering the Hmong family's apartment, he found that they had covered the entire living room floor with a foot of dirt, planted crops, and watered them!

Is this crazy behavior? No. This is how you get food.

This is probably a book that every medical professional should read. Not because they necessarily need to understand Hmong culture, but as an example of the power of cultural barriers. Though she does not "die," the story of Lia Lee and her seizures is extremely tragic. Ultimately, a failure in communication on both cultures' parts.

There's so much more to say about this truly monumental work, but I cannot say it all here. There's a reason why this book won so many awards and is an international best seller. If you get a chance to pick it up, I promise you will be enlightened, informed and enriched.