Lia’s doctors

• Did not have instruction in cross-cultural medicine.

• They say Lia’s parents refusal to accept the basic tools of modern medicine as ignorance.

Lia’s parents

• Saw Lia’s doctors attitude as arrogant.

Some Hmong medical practices

• Dermal treatments:– Acupuncture– Massage– Rubbing coins against the skin– Igniting alcohol-soaked cotton under a tiny

cup to create a vacuum

• Some of these practices left marks on the skin that Western doctors interpreted as abuse.

Dr. Roger Fife

• Not respected in the medical community

• One of the only doctors trusted by the Hmong, because:– “He doesn’t cut”– He didn’t force his patients to comply with

conventional American medical practices– He handed over babies’ placentas upon

request.

• Would Lia have been better off if she had been treated by Dr. Fife instead of Dr. Ernst? We don’t know.

• Dr. Ernst was uncompromising, and would not apply two different standards of care to his patients.

• Neil Ernst decided that he had no choice but to request that Lia be placed in foster care, so she could get her medications according to his instructions.

• Lia’s parents were not notified in advance that she was going to be taken.

• Her mother almost went crazy when she came home and found out that Lia had been removed. She cried every day.

• Her father was very angry.

• Every other doctor at MCMC disagreed with Neil’s decision when Anne Fadiman brought it to their attention.

• They all considered that Foua and Nao Kao were very good, loving parents.

• The Hmong emphasize that back in Laos, parents have 100% responsibility over the child, and that they cannot be taken away.

• Hmong parents, who are very loving and caring toward their children, are utterly confused and enraged when they are stripped of their power in a country to which they have fled because of its reputation for freedom.

Lia in Foster Care

• Lia had severe behavioural problems at the time she was placed in foster care:– Self-injurious behaviour– Aggressive and hostile when frustrated– Hyperactive– Resistive– Temper tantrums

• When Lia arrived at her foster parents’ place, she cried every day. She began to engage in more severe self-injurious behaviour such as banging her head.

• Dee Korda, her foster mom, soon realized it was a serious mistake that Lia had been placed in foster care.

• She even asked Foua to baby-sit her kid when she took Lia to the doctor.

• When Lia was allowed to spend time with her parents, instead of giving her the medications, they opted for traditional healing techniques.

• This prevented them from regaining custody.

• Lia did not return home at the 6 month mark.

• Parents had also refused to sign an agreement, demanding that she be returned immediately.

• Despite the fact that Dee followed the anticonvulsant prescriptions to the letter, Lia seized more frequently at the Korda’s than she had when she was living with her parents.

• Lia was taken to a different hospital, and this time doctors substituted all of her medications with Depakene.

• With the help of social worker Jeanine Hilt, the Lees were able to learn how to administer the new medication, which was much easier than the ones prescribed by Neil.

• This allowed them to regain custody of Lia.

• When Lia returned home, she was in damaged condition, presenting severe symptoms of delayed mental development.

• Her parents decided to try a little medicine and a little neeb.

Neeb

• Healing spirit

• Shorthand for ua neeb kho, the shamanic ritual, performed by a txiv neeb, in which an animal is sacrificed and its soul bartered for the vagrant soul of a sick person.

Animal Sacrifice

• Propitiates ancestors.

• Cures illnesses by offering the souls of the slaughter animals as ransom for fugitive souls.

• Is a sacred act performed with respect and reverence.

• The souls of sacrificed animals are precious and vitally connected to human souls.

• Animals are not considered to be as far removed from the human species ast hey are in our world view.

Lia’s Neeb

• A cow was sacrificed

• A txiv neeb performed the ritual chant that accompanied his journey to the realm of the unseen.

• Relatives were invited to have a large, festive meal, where all parts of the cow were consumed.