The Spirit Catches You and You Fall Down

Lia Lee (Romanized Popular Alphabet: Liab Lis, July 19, 1982 – August 31, 2012): a Hmong child born in Merced, California in 1982. Beginning in infancy, Lia experiences severe seizures due to Lennox–Gastaut syndrome, a rare form of epilepsy. Anne Fadiman: author and narrator of The Spirit Catches You and You Fall Down, writing about her experience with Lia and her family. Throughout the story, she stresses the importance of cultural competence in the doctor-patient relationship (and in the greater medical establishment). Neil Ernst and Peggy Philp: Lia’s primary care doctors at MCMC. Throughout the story, they clash with Lia's parents, whose adherence to Hmong shamanism conflicts deeply with their own beliefs about Western medicine. Despite the good intentions of Ernst, Philp, and Lia's parents, significant miscommunication and disagreement cause Lia permanent harm. Foua Yang and Nao Kao Lee: Lia’s parents who seek care for their daughter with complex medical needs, while navigating a foreign and unfamiliar medical system without language fluency and cultural familiarity Jeanine Hilt: a social worker who makes Lia her personal cause and fights on Lia’s behalf. She is presented as one of the few members of the American medical establishment willing to acknowledge Hmong tradition and tailor treatment to Lia's case. ==Summary==

, previously the Merced Community Medical Center; is a new building and not the previous building where Lia Lee was taken Lia experienced her first seizure at three months of age, but a resident at Merced Community Medical Center misdiagnosed her condition, and the hospital was unable to communicate with her parents since the hospital had no Hmong interpreters. Anne Fadiman wrote that Lia's parents did not give her medication as it was prescribed because they believed that Lia Lee's state showed a sense of spiritual giftedness, and they did not want to take that away. The American doctors did not understand the Hmong traditional remedies that the Lee family used. The doctors treating Lia Lee, Neil and Peggy Ernst, had her removed from her home when she was almost three years of age, and placed into foster care for one year, causing friction with her parents. By age 4½ Lia Lee had been admitted to hospital care 17 times and had made over 100 outpatient visits. The worst seizure Lia had put her on the verge of death. She went to the emergency room and Neil Ernst could not do anything. He talked to Lia's parents about transferring her to Fresno, California, because Lia would need further treatment that Ernst could not provide. Lia's parents believed their daughter was transferred because of Ernst's vacation plans. Lia slipped into a coma after suffering from a tonic-clonic seizure in 1986 when she was four years old. Lia's doctors believed she would die, but Lia remained alive with no higher brain functions. ==Research==

Fadiman's sources for information about the history of the Hmong include Hmong: History of a People by Keith Quincy. She stated "Were I citing the source of each detail, Quincy's name would attach itself to nearly every sentence in the pages on the Hmong in China." Fadiman's book cited the Quincy theory that the Hmong people originated from Siberia. Robert Entenmann wrote that because of the reliance on Quincy's book, Fadiman's book propagates the idea that Sonom was a Hmong king, a concept that Entenmann says is inaccurate. ==Legacy==

Marilyn Mochel, a nurse and clinical educator at Sutter Merced Medical Center (now Mercy Medical Center Merced), who heads the hospital's cross-cultural program, said in 1999 that "The book has allowed more dialogue. There's certainly more awareness and dialogue than before. Both sides are teachers and learners." Lia Lee lived in a persistent vegetative state for 26 years. She died in Sacramento, California, on August 31, 2012, at the age of 30. Outside of California, her death was not widely reported. Fadiman said that pneumonia was the immediate cause of death. Margalit Fox of The New York Times said that "Lia’s underlying medical issues were more complex" because she had lived in a persistent vegetative state for such a long period of time. As of 2012, most individuals in persistent vegetative states die within three to five years of the onset. ==Reception==

Hmong reactions to the book were mixed. Ralph Jennings of The Modesto Bee said "Hmong, including some among the 2,000 in Modesto, say the book typified conflicts between their culture and American institutions. But some say it didn't capture the complexity of the Hmong culture." ==See also==

• - Google Books citations lead to September 30, 1998 edition published by Macmillan, , 9781429931113. New England Journal of Medicine article 1 * Fox, Renée C., Ph.D. "Cultural Competence and the Culture of Medicine." New England Journal of Medicine. 2005; 353:1316-1319. September 29, 2005. DOI: 10.1056/NEJMp058066 New England Journal of Medicine article 2 [http://content.nejm.org/cgi/content/extract/353/13/1317 • Malina, Debra, Ph.D. "Compliance, Caricature, and Culturally Aware Care." New England Journal of Medicine. 2005; 353:1317-1318. September 29, 2005. DOI: 10.1056/NEJMp058064. ==External links==