Cultural Competence and Health Care Lia Lee was a Hmong child living in California. The Hmong are an ethnic group from the Southeast Asian country of Laos whose culture is rooted in a rural way of life. When Lia was born in a California county hospital, her mother spoke no English, and the medical staff spoke no Hmong. At just three months old, Lia experienced fainting episodes, which doctors attributed to epileptic seizures. Over the next four years, Lia’s doctors struggled to control her symptoms by prescribing a dozen different drugs in dosages and combinations that changed more than twenty times. This dizzying array of treatments would have been confusing to anyone, but Lia’s family was especially ill-prepared to understand the process. Illiterate even in their own Hmong language, they were able to follow their doctor’s advice only intermittently. Instead, they turned for relief to their culture’s familiar religious beliefs about illness. According to that tradition, Lia’s fainting spells were caused by the temporary departure of her soul from her body, a condition whose name roughly translates as “the spirit catches you and you fall down.” Lia’s parents sent away to Thailand for sacred charms to protect her and changed the child’s name to fool the evil spirits (Underwood and Adler 2005). As U.S. society becomes ever more culturally diverse, health care workers are increasingly treating people like Lia and her family, whose beliefs about sickness and health differ dramatically from those of mainstream Western medicine. To treat these patients effectively, health care workers need to pay close attention to their cultural beliefs and traditions. Unfortunately, the Western doctors did not understand the Hmong culture, and Lia’s family did not understand the doctors’ efforts. As a result, the medical treatment was ineffective. Four years after her initial symptoms, Lia experienced a massive seizure that left her in a vegetative state for decades. She died in 2012 at the age of 30. Lia’s story is perhaps an extreme example, but dealing with gaps in communication between patients and health t h i n k i n g a b o u t c u l t u r e Do you belong to a particular subculture or know someone who does? What features of this subculture set it apart from the dominant culture? Do you think aspects of this subculture are likely to be incorporated into mainstream culture in your lifetime? Explain. 72 other segments of society were usually not entirely excluded, but they did tend to be marginalized. White, professional middle-class culture was often the norm from which other cultures deviated. We can see this dominance in action in commonly used phrases such as “the black community” or “working-class literature” or “women’s history,” each of which signals a deviation from the standard of white, professional men. Rarely, if ever, do we use terms such as “the white community,” “middle-class literature,” or “men’s history” because these are already the unspoken norm in the dominant culture. power, as well as a number of subcultures, cultures associated with smaller groups in the society that have distinct norms, values, and lifestyles that set them apart from the dominant culture. Political and educational institutions, major businesses, the mass media, and educational institutions, among others, mostly refl ect the dominant culture. For example, until quite recently (and some would argue, still today) the dominant culture in the United States was associated with the images, ideas, and values of white, often male, professional middle-class culture. Those in positions of power were disproportionately white, professional men. The cultures of care workers caused by cultural differences is a very real and growing challenge. The federal government, along with several universities, private foundations, and organizations representing health care providers, has launched a variety of public and private initiatives to promote and ensure cultural competence—the ability to understand and address the needs of people from different cultures (Rees and Ruiz 2003). For example, some states have enacted regulations that require medical facilities to provide culturally competent care to groups that make up a certain percentage of the community’s population. As one key element of this care, facilities are required to make interpreters available who are fluent in the language and cultural traditions of different groups. Organizations such as Resources for Cross Cultural Health Care (diversityrx.org) have stepped up to the challenge. One recent study found that medical interpreters, those who facilitate bilingual communication in hospitals, often act as an essential part of a medical team, becoming informal co-diagnosticians, even though these interpreters lack formal medical training (Hsieh 2007). As part of their training, medical students are also learning about the important role of culture in their patients’ lives. One book has become required reading in more than 100 medical schools. Titled The Spirit Catches You and You Fall Down, it’s the tragic story of Lia Lee (Fadiman 2012). think about it 1. Have you or your family ever had trouble communicating with a doctor or been uncertain about what is happening at a hospital? If so, do you think cultural differences help explain why? 2. How might cultural differences cause problems with communication in school or at work?
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