Author Anne Fadiman combines multiple narratives in her fabulous ethnography The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Most importantly, it’s both an immigration and a medical story of one Hmong (pronounced MUNG) family in Merced, CA. Their infant daughter is stricken with seizures, and thus begins the Lee family’s rocky introduction to the U.S. medical system. It’s also the story of the medical professionals treating young Lia, most of whom have no significant knowledge of Hmong culture and beliefs. The clash between the two groups is dramatic and Fadiman tells the complex story with ease.

Fadiman builds a narrative structure that includes Hmong history reaching back in time. They originated in China but are fundamentally nomadic. Thus, they later moved to Laos where they were living during the Vietnam War. At that time, they helped the U.S. and South Vietnamese armies. So, after the fall of Saigon, many Hmong emigrated to the U.S. with the blessing of the government.

Even so, the Hmong people’s situation in the 1970s wasn’t simple. They aren’t naturally prone to assimilation. Thus, they chose immigration to the U.S. over assimilation in Vietnam or return to Laos. Once in the U.S., they wanted to congregate and create their own distinct community as they’d done for generations. However, our immigration policy worked against that instinct and Hmong people were sent all over the country. As time went on, they moved into communities together as they did in Merced.

Medical aspects

Fadiman intertwines the Lee’s family story with the broader Hmong story. The two narratives complement each other and explain the Lee’s reaction to the doctors’ care. Hmong have distinct religious beliefs, including connections to spirits active on our physical plane. They believe that animal sacrifice appeases those spirits. And they’re incredibly mistrustful of U.S. medicines and medical care.

As you can imagine, the medical professionals and institutions involved in Lia’s care wanted the Lee family to follow complicated instructions. Yet, they didn’t speak English and certainly didn’t understand medical terminology. And the doctors had no knowledge of the Hmong language either. Because of cultural differences, finding a competent translator was extra difficult.

As a result, frustration levels ran high on both sides. Lia’s parents thought the medicine to control her seizures was actually making her sick. Lia’s doctors just wanted the parents to be compliant, since they knew the toddler’s life was at stake. Again, Fadiman balances both perspectives and obviously gained the trust of everyone involved.

My conclusions

Fadiman published this book in 1998 about events in the 1980s, so many things have changed. But the edition I listened to has an epilogue reflecting the anniversary. In it, Fadiman reminds us that immigrants are still struggling to balance retention of their culture with assimilation. And although much has changed in the medical community’s acceptance of cultural individualities, we still have a long way to go.

Despite being about 350 pages, this book is dense with facts and information. I could easily read it again and learn new things. Additionally, in the book Fadiman describes her multi-year process gathering the information, including the relationships she develops. This is a small window into a writer’s life.

Interestingly, I learned that my semi-rural county outside Philadelphia is home to the largest concentration of Hmong in Pennsylvania. And yet, I knew virtually nothing about them, their history, and culture. So glad that’s now changed for me.

If you want to learn about cultural sensitivity, especially in medical settings, this is a must read. I highly recommend it!

Pair with something else about immigration or about navigating medical challenges. Miracle Creek by Angie Kim combines both aspects. Alan Brennert’s Moloka’i books also describe otherness because of medical conditions.