Neo-liberalism of today is a tag for economic laissez-faire that explains government policies intended to endorse liberated competition between trade firms inside market, particularly liberalization and monetarism, which is distinct from Globalization, which generally refers to greater international cultural exchange, dissemination of multiculturalism, and enhanced individual access to cultural diversity. Under such parameters it is obvious that medical practitioners are more inclined to come across patients of different cultural backgrounds in the process of providing healthcare. As a result, modern approaches to healthcare should consider the influences of the above – community, family, gender, culture, health, geographical and regional beliefs and language on the healthcare perspective of the patients.
These aspects are subjected to learning procedures and the healthcare practitioners should be aptly prepared to accept and execute these challenges. This paper would advocate this issue and argue that Cultural sensitivity training program for all healthcare providers is an important procedure for proper and effective healthcare system. For the purpose the case of the rigid medicine training of western doctors that contributed to the bad outcome of Lia Lee presented in the text The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures by Anne Fadiman would be considered and evaluated to argue in behalf of essential need of Cultural sensitivity training program for all healthcare providers as it would be established that rigid medicine training of western doctors that contributed to the bad outcome of Lia Lee.
“If Lia Lee had been born in the highlands of northwest Laos, where her parents and twelve of her brothers and sisters were born, her mother would have squatted on the floor of the house that her father had built from ax-hewn planks thatched with bamboo and grass.” (Fadiman, 1998, 3) But owing to the ongoing war in Laos the family had to immigrate to the United States and settled at Merced in California and this was a whole new world for the family with a completely different way of life and outlook based on scientific deductions rather than humanistic perceptions. This family belonged to the Hmong culture and they brought their heritage with themselves in form of beliefs and customs. The girl, Lia Lee, was suffering from severe epilepsy which the Hmong believed to be caused by spirits. Here the major problem came up with the assimilation complexes developed by the means of moving into the mainstream of American values and outlook. The author presented the perspectives of both the sides and is deemed to be sympathetic towards the family even though the point of views of the medical helps was also documented.
There are several occasions documented in the text that indicate that the cultural heritage and beliefs of the Hmong family made them object to the medical proceedings. In return, the doctors also argued on these issues with trying to understand the value system of the family. One such issue came up when the doctors “started squeezing formula into her mouth with a baby bottle. This worked perfectly, even though the doctors had predicted that without the tube Lia would choke to death”. (Fadiman, 1998, 212) This was done as the family was not interested with the use of tube and objected to the medical proceedings. It was achieved after many arguments and it is obvious that such delay is only detrimental for the patient’s health. If the doctors showed more understanding of the cultural background of the Hmong family then the delay could have been avoided.
On the other hand, the Hmong family was dissatisfied with the proceedings all the same. The author documents that “When I asked Foua about that encounter, all she said was, ‘Lia’s doctor really hurt for her’. Nao Kao scowled and remained silent.” (Fadiman, 1998, 213) In time to come the situation worsened with continuing arguments and counter arguments on several such issues that could have been easily solved with better humane approach and understanding of the situation. The problem was mutual and the perceptions were rigid on the part of the both parties that their views were correct and the other party was to be blamed. “Everyone in Merced’s Lee and Yang knew what had happened to Lia (those bad doctors!), just as everyone on the pediatric floor at MCMC knew what had happened to Lia (those bad parents!)” (Fadiman, 1998, 253)
The ill results were showing with lack of faith on the Healthcare professionals. ”Foua and Nao Kao were fairly sure, but not certain, that transgression on the part of American doctors, not on their own part was responsible for Lia’s condition.” (Fadiman, 1998, 216) This dilemma reached its zenith at the loss of the girl and then the family openly stated that “My child is lost because of those doctors!”(Fadiman, 1998, 218) Thus it is certain that none of the parties, the doctors or the patient, were satisfied with the proceedings and all these happened because there was lack of knowledge about the other’s point of view among the parties. In such conditions the doctors should have been more responsible as they are far more educated and knowledgeable and as they are in a favorable position to judge matters, it is the doctors’ responsibility to understand the cultural significance of the matter.
Thus, it is almost a certainty that rigid medicine training of western doctors that contributed to the bad outcome of Lia Lee. In the meantime, “Lia had cost the United States government about $250000.” (Fadiman, 1998, 254) Sure, this is just a financial rough balance and the cost of a life is much more than that but ramification of the situation resulted due to lack of cultural knowledge remains the same. However, even in the context of financial analysis it is obvious that the doctors should be held responsible and thus there is so much need for Cultural sensitivity training program for all healthcare providers.
When we talk about culture, we mean the values, customs, rituals, behaviors and beliefs which we share with others in order to create a relation being as a group. On the other hand culture deals with shared values though there also we find assumptions, beliefs and customs but here it creates a relationship with the other members. Hayward, (1997) while quoting Hofstede (1980) mentioned that culture is the collective programming of the human mind which makes one group different from the other.
Hofstede (1980) identified four cultural dimensions. First, Power Distance refers to social inequality and the amount of authority one person has over others. From a behavioral perspective, a strong Power Distance is observed which manifests in the form of reluctance to challenge the choices and activities of leaders regardless of their appropriateness. Second, Uncertainty Avoidance relates to how a culture deals with conflict, especially the creation of beliefs and institutions to deal with disagreements and aggression. Those cultures which score high in the dimension of Uncertainty Avoidance (Rules and Order) strongly believe that all rules and regulations must at any cost be abided, even in cases when it may be conflicting with a company’s interests or security circumstances. They also hold that well documented procedures should be in place for all circumstances and in addition, stringent time constraints must be applied to all activities. Low Uncertainty Avoidance score indicate that those cultures are more likely to transgress Standard Operation Procedures (SOPs). However, this may be advantageous when dealing with unprecedented circumstances by means of adopting new and innovative means to tackle the same.
Third, concept of Individualism & Collectivism denotes a bipolar construct wherein cultures tend to be towards the individualistic or collectivistic. Cultures which tend to be more individualistic in nature are formed by individuals who are more concerned only about themselves or their closely related associates. On the other hand, in cultures which are more collectivistic, it is observed that people tend to form in-groups or cooperatives wherein caring for others is valued and loyalty is expected in return. Those belonging to individualistic cultures pay more attention to self and individual gains whereas compliance with the group ideals is often observed in people belonging to collectivistic cultures. High Power Distance scores are often observed in collectivistic cultures, indicating disposed approval of unequal status and respect towards leaders. Lastly, Masculinity and Femininity stands for a bipartite construct which signifies two very dissimilar sets of social principles and this too changes with cultural background. Generally, from the masculine perspective, the most significant ideals are related to accomplishment and wealth. In the feminine standpoint, better quality of life and care and concern for others are looked upon as fundamental values. In the present case, the lack of this knowledge of the doctors along with the inability to understand and recognize the culture and values of the Hmong family led to the loss of the girl and it is already well established that rigid medicine training of western doctors that contributed to the bad outcome of Lia Lee.
The medication errors occur due to miscommunications of this very kind would grow with more close contact world and globalization. It is certain that by the term ‘Universal Procedures’ it is conveyed that certain processes or procedures are tested with time to yield positive results every or most occasions they are put into use. These universal procedures are not mere hypotheses or theories but could be regarded as law. These are dependable formats and could be followed without hesitation. Moreover, and this is the most important statement about the term universal procedure, these are followed all over the globe without many alterations. However, though the above is of much importance, the present problem lies on the fact that proper communication is equally important while treating a patient from an alien culture. As there are benchmarks for medical procedures on scientific grounds, there should be benchmarks for humane understanding too in the medical world. Thus, two specific deductions come out of the entire parameter of this paper. The first states that rigid medicine training of western doctors that contributed to the bad outcome of Lia Lee and the second statement is that Cultural sensitivity training program for all healthcare providers.
Fadiman, A. (1998). The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. NY: Farrar, Straus and Giroux.
Hayward, B. (1997). Culture, CRM and aviation safety. ANZASI: Asia Pacific Seminar.
Hofstede, G. (1980). Culture’s Consequences: International Differences in Work Related Values. Beverly Hills, CA: Sage.