In these chapters, we see Lia taken away from her parents because they repeatedly failed to administer her seizure medication properly. Lia is placed in a foster home temporarily but is later allowed to return home. Lia’s case is rare, as children are generally not taken away from loving, non-abusive, attentive parents. Lia’s parents tried to administer her medication as directed, but failed to do so either due to miscommunication or misunderstanding. A CPS caseworker, committed to bringing Lia home, is the one responsible for Lia being reunited with her family. The caseworker works with Lia’s parents regularly to address their cultural concerns and explains the medication’s administration clearly to them.
Spirituality in the context of illness is also explored in this section. The Hmong do not distinguish between mental and physical illness, so their approach to all illnesses is spiritual. For example, in examining the etiology of a particular sickness, the Hmong identify a dab (malevolent spirit) as the cause, and would seek to sacrifice a dog to cure the spiritual illness, which cure the physical sickness. Though western medicine ath the time dismisses the mind-body connection (though this is increasingly not the case today), the Hmong, in contrast, see no distinction between the two. The body’s illnesses are caused by the spiritual, so it does not enter the Hmong consciousness to try and heal a physical ailment while neglecting a person’s spirituality.
Lia’s separation from her parents is the culmination of the clash between American medical culture and Hmong culture. Lia’s physician, acting out of his training from his American medical training and a sense of ethical obligation, decides the last option left is to have the state take Lia away from her parents. Lia’s parents are mistrustful of American medicine and physicians, and are unable to partake in animal sacrifices to heal her as they would if they still lived in Laos. Bound by American laws, they must work through American medical channels.
Christian physicians in particular can likely understand the desire to respect a patient’s spirituality in treating them. In this case, however, the patient’s parent’s spiritual beliefs fly in the face of conventional medical knowledge. I don’t agree with Lia’s doctor’s decision to have her separated from her parents. I did agree with the CPS caseworker’s insistent commitment to making her parents understand her medication and why it was so important to ensure that Lia took it properly. Both the CPS caseworker and Lia’s physician believe they are advocates for Lia’s best interests: the caseworker to bring her back home to her family, and her physician for Lia’s proper medical care.
The ethical question about the protection of minors takes a central role in this section. Lia’s seizures are increasing in their frequency and severity, signs her physician believes are indicators of her eventual death. Lia’s life hangs in the balance, yet the people who care about her cannot, despite their best efforts, seem to find a way to help her in the way that she needs. Her parents do what they know how to do, sacrificing a cow in her honor and working with Lia’s physicians and caseworker. However, it is simply not in their nature to fully trust western medicine. They comply with the doctor’s orders primarily out of legal obligation, and instead place their faith in Hmong spirituality to heal Lia. Lia’s physician tries to work with Hmong beliefs to get through to her parents and work alongside them to help Lia. So far, though, the situation is not improving.
It is frustrating and saddening to think that cultural and religious differences may be a causal factor in a child’s death. Her medical condition is obviously the real cause, but the idea that her parents and her doctors are unable to come to a functional common ground to save her life is difficult to contend with. I’ll be able to speak more on this topic as the story unfolds in the coming chapters. For now, all I can say is that I see how incredibly important it is for physicians to understand their patient’s spirituality/culture, especially as it relates to their medical care. In Lia’s case, as for many other patients, it could mean the difference between life and death. Lia’s physicians are doing their best, but Lia needed more. She needed the kind of physician who knows how to treat patients in a way that honors their bodies, their cultural backgrounds, their spirituality, and their humanity.
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