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Combining aspects of both traditional Hmong care and Western medicine may be beneficial 

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Combining aspects of both traditional Hmong care and Western medicine may be beneficial 

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Similar to the New medicine movie about alternative means to medical care (non-clinical)

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"Sorrows of motherhood cut through all cultural barriers." (252) Neil 

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"Sorrows of motherhood cut through all cultural barriers." (252) Neil 

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Neil facing his own inability to place IV during an intense seizure 

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Neil facing his own inability to place IV during an intense seizure 

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Like it is associated with defeat or shame

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Doctors approaching Dee and Tom Korda instead of Lia's real parents when they visited

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Doctors approaching Dee and Tom Korda instead of Lia's real parents when they visited

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"It was awful..They doctors wouldn't even look at Foua and Nao Kao...They saw us as smart and white, and as far as they were concerned the Lees were neither." (151) Dee Korda

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"The doctors made Lia stay so long in the hospital, and it just made her sicker and sicker." (116) Nao Kao

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In her own country and within her culture, Foua feels independent and empowered, but out of place in America, she feels naïve and frustrated. 

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In her own country and within her culture, Foua feels independent and empowered, but out of place in America, she feels naïve and frustrated. 

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No distinction between physical or mental illness among Hmong

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No distinction between physical or mental illness among Hmong

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No need for specialization like we see in Western Medicine (ie psychology)

Hmong is non cartesian

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What are the ethical implications of this? 

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What are the ethical implications of this? 

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Is providing suboptimal care going against the Hippocratic oath?

What are the ethical implications of not considering one's preferences or cultural values in treatment?

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"I have the same standard of care for the Hmong as I have for everyone else...My hands are just tied to provide it. So I give them suboptimal care. Sometimes you can find a middleground and try to understand where they are coming from" (75) - Raquel Arias

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"I have the same standard of care for the Hmong as I have for everyone else...My hands are just tied to provide it. So I give them suboptimal care. Sometimes you can find a middleground and try to understand where they are coming from" (75) - Raquel Arias

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Shaman: Hmong culture as doctor: medical culture

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Shaman: Hmong culture as doctor: medical culture

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Highly regarded

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Bill Selvidge, Jeanine Hilt, Blia Yao Moua  

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Bill Selvidge, Jeanine Hilt, Blia Yao Moua  

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Cultural bridges

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Peggy assumes that Foua was stupid and incompetent because she was not administering the medication properly or adhering to Lia's treatment schedules

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Healthcare providers could have altered their approach to treatment to accommodate the Lee's capabilities and cultural values 

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Healthcare providers could have altered their approach to treatment to accommodate the Lee's capabilities and cultural values 

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Simpler care is better than no care...

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Complicated medical regiment for Lia's parents to follow just highlights the lack of understanding from the Drs

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Complicated medical regiment for Lia's parents to follow just highlights the lack of understanding from the Drs

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Did not consider illiteracy issues or that there was no interpreter available at some points in the care (for example when Lia's mom was trying to find the lab for bloodword)

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Do you think Fadiman did a good job of remaining relatively neutral while depicting the Lee's story? 

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Do you think Fadiman did a good job of remaining relatively neutral while depicting the Lee's story? 

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Were there any times you felt that Fadiman was favoring one side or doing a better job of portraying one side?

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Fear of the unknown with both sides since they providers had little control over what happened to Lia outside the hospital and the Lee's had little idea of what was happening inside the hospital

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Cultures clash when they do not seek to understand one another

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Cultures clash when they do not seek to understand one another

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Neither were asking the right questions to bridge the divide, but how could they with the language barrier ?

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Lack of adequate staff to interpret Hmong population

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Lack of adequate staff to interpret Hmong population

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Despite their cultural beliefs about western medicine, the Lee's bring their child to the hospital 

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Despite their cultural beliefs about western medicine, the Lee's bring their child to the hospital 

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Supports that they put their child before their beliefs

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Delayed soul-calling ceremony -----> first onset of epilepsy 

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Delayed soul-calling ceremony -----> first onset of epilepsy 

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Soul-stealing Dabs

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- Healthcare center burns Lia's placenta 

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- Healthcare center burns Lia's placenta 

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- Spinal Tap
- too much medicine

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Considering cultural values & spiritual beliefs

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Considering cultural values & spiritual beliefs

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Where two cultures can meet and not clash

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Where two cultures can meet and not clash

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Two cultures can work harmoniously if each works to avoid misunderstandings and assumptions about the other

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What kind of cultural or clinical implications does the combining of body and mind in healthcare that we discussed last week sustain?  

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What kind of cultural or clinical implications does the combining of body and mind in healthcare that we discussed last week sustain?  

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Lee's not taking the threats of the disease seriously 

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Lee's not taking the threats of the disease seriously 

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When Neil and Peggy notice developmental delays, their concern for compliance spikes

Discussion about spiritual 'benefits' to epilepsy concern the providers

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Medical model of Epilepsy vs. Hmong beliefs of annointment and enlightenment

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Medical model of Epilepsy vs. Hmong beliefs of annointment and enlightenment

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Once again, we see cultural influences in the historical separation of body and spirit (plig) or mind. We can see how the Hmong idea of Soul loss has influenced the Lee's behaviors and beliefs within the medical treatment of Lia

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Many Hmong believe that doctors' procedures seem "more likely to threaten their patients health than to restore it." (33)

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Many Hmong believe that doctors' procedures seem "more likely to threaten their patients health than to restore it." (33)

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What dangers exist when we misinterpret mistrust for misunderstanding?
(Relating to the Lee's noncompliance)
And how does culture play a role in this relationship?

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What happens to medical care when there is trust missing from both sides?
How do we repair this system if it is not working?
Besides the hospital acquiring better interpreters, what else could the providers have done to improve compliance and trust?

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"It was foreign to me that they had the ability to stand firm in the face of expert opinion." (53) - Dan Murphy

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"It was foreign to me that they had the ability to stand firm in the face of expert opinion." (53) - Dan Murphy

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Relates to our discussion last week on knowing our own bodies sometimes better than experts and needing to trust oneself

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The Lee's were standing up for something they believed in, which contradicting medical 'expertise'

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The Lee's were standing up for something they believed in, which contradicting medical 'expertise'

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Lee's did not trust their doctors many times, even stating that they thought the treatments may have been causing the seizures (despite medical evidence supporting elsewise)

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"The best thing I could have given Lia's mother was compassion, and I wasn't giving her any and I knew that I wasn't giving her any...there was just too much aggravation" (56)

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"The best thing I could have given Lia's mother was compassion, and I wasn't giving her any and I knew that I wasn't giving her any...there was just too much aggravation" (56)

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Despite providing hundreds of hours of free care, the Lee's did not seem appreciative, which angered even Neil and Peggy

Feeling resented by the parents

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Whether this was purposeful or accidental noncompliance, much of the frustration from the medical team stemmed from the Lee's inability to keep track and adminster Lia's medications