Cultural Competency
Cultural competency is defined as the ability to function effectively with individuals from different cultural backgrounds within the context of their beliefs, behaviors and needs. (US Dept. of Health and Human Services, 2013). Cultural competence is essential to closing the gap of health disparities. Healthcare teams collaborate with one another to make sure the concerns of diverse patients are met appropriately and are able to communicate with the despite cultural differences or barriers.
The book written by Anne Fadiman entitled The Spirit Catches You and You Fall Down provides a perfect example of what could happen from lack of cultural competence. Hmong people, originating from Laos, immigrated to areas in Merced County, California seeking political refuge. Lia Lee, daughter of a Foua and Nao Kao, started experiencing seizures at three months of age. (Fadiman 1997:19). The family brought her to Merced Community Medical Center for treatment but the healthcare system failed them due cultural barriers and inability to communicate with the family effectively. Initially, she was misdiagnosed delaying appropriate treatment for a potentially serious condition.(Fadiman 1997:25). She experienced more seizures and was brought back to the same facility for treatment. The doctors eventually diagnosed her with epilepsy and attempted to instruct the parents on how to treat this condition at home with a medication regimen. However, the Hmong culture teaches that epilepsy, also known as qaup dab peg, allows an individual to transcend the spiritual realm and regarded as a sacred calling. (Fadiman 1997:21). These individuals become Shamans of their community many times. The sacred nature of qaup dab peg caused the family not to fully comply with the treatment for epilepsy. Lia was placed in foster care at 11 months of age for a ten month duration. (Fadiman 1997: 80) Later on in the story, Lia suffered a grand mal seizure from septic shock at age four which left her in a vegetative state until she past away. (Fadiman 1997: 150).
Both sides, healthcare providers and the Hmong family, experienced a great amount of avoidable frustration and grief. The life of Lia Lee was altered tremendously as a result and unfortunately it was irreversible. Clearly, neither applied medical anthropology nor critical medical anthropology played a role in this situation. If in fact this was the case, Lia Lee’s life would not have been comprised due to cultural incompetency. Applied medical anthropology would have encouraged and established cultural understanding between both parties resulting in positive health outcomes. Dr. Arthur Kleinman, a psychiatrist and medical anthropologist in the book, gave Lia's pediatricians retroactive advice for the situation. "Second, instead of looking at a model of coercion, look at the model of mediation. Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate. " (Fadiman 1997: 261). Dr. Kleinman felt the method used by the healthcare staff to foster Lia's parents compliance to the medical regimen was an incorrect approach. If healthcare professionals sought out and utilized this medical anthropologic strategy as part of her early treatment, Lia could have grown up and matured to possibly become a Shaman healer as Hmong culture predicts. Unfortunately this never came to pass however this tragic story brought about positive changes in the medical community. Respect and understanding for all cultures in healthcare.
The book written by Anne Fadiman entitled The Spirit Catches You and You Fall Down provides a perfect example of what could happen from lack of cultural competence. Hmong people, originating from Laos, immigrated to areas in Merced County, California seeking political refuge. Lia Lee, daughter of a Foua and Nao Kao, started experiencing seizures at three months of age. (Fadiman 1997:19). The family brought her to Merced Community Medical Center for treatment but the healthcare system failed them due cultural barriers and inability to communicate with the family effectively. Initially, she was misdiagnosed delaying appropriate treatment for a potentially serious condition.(Fadiman 1997:25). She experienced more seizures and was brought back to the same facility for treatment. The doctors eventually diagnosed her with epilepsy and attempted to instruct the parents on how to treat this condition at home with a medication regimen. However, the Hmong culture teaches that epilepsy, also known as qaup dab peg, allows an individual to transcend the spiritual realm and regarded as a sacred calling. (Fadiman 1997:21). These individuals become Shamans of their community many times. The sacred nature of qaup dab peg caused the family not to fully comply with the treatment for epilepsy. Lia was placed in foster care at 11 months of age for a ten month duration. (Fadiman 1997: 80) Later on in the story, Lia suffered a grand mal seizure from septic shock at age four which left her in a vegetative state until she past away. (Fadiman 1997: 150).
Both sides, healthcare providers and the Hmong family, experienced a great amount of avoidable frustration and grief. The life of Lia Lee was altered tremendously as a result and unfortunately it was irreversible. Clearly, neither applied medical anthropology nor critical medical anthropology played a role in this situation. If in fact this was the case, Lia Lee’s life would not have been comprised due to cultural incompetency. Applied medical anthropology would have encouraged and established cultural understanding between both parties resulting in positive health outcomes. Dr. Arthur Kleinman, a psychiatrist and medical anthropologist in the book, gave Lia's pediatricians retroactive advice for the situation. "Second, instead of looking at a model of coercion, look at the model of mediation. Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate. " (Fadiman 1997: 261). Dr. Kleinman felt the method used by the healthcare staff to foster Lia's parents compliance to the medical regimen was an incorrect approach. If healthcare professionals sought out and utilized this medical anthropologic strategy as part of her early treatment, Lia could have grown up and matured to possibly become a Shaman healer as Hmong culture predicts. Unfortunately this never came to pass however this tragic story brought about positive changes in the medical community. Respect and understanding for all cultures in healthcare.