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The cases about the two Hmong children whom went to the
doctors and had fevers were similar but different in some ways.
With the case about Daisy, the six month old girl, the parents
had taken her daughter to her primary care physician because
she had a fever of 103°F but had no other symptoms. The
parents tried to treat the fever with Tylenol but the fever got
worse. There was no interpreter so the physician spoke to the
parents in English. The physician was concerned that Daisy
might have had bacterial meningitis. The parents asked little
questions about the procedures and tests the physician wanted to
do to confirm bacteria in the blood stream. The parents agreed
to keep Daisy at the hospital. The grandparents came and stated
that they wanted a khawv koob ritual. The doctor had allowed
the ritual to happen in the hospital but had said that the healer
could not burn incense because of oxygen Daisy was being
given. Unfortunately Daisy did not get better and died from
cardiac arrest.
If I was the physician I would have made sure that there was an
interpreter present and translating for me what I had to say to
the parents. This is very important because so many details of
Daisy’s condition could get lost in the conversation between
Daisy’s parents and me. With the interpreter, all options could
be informed effectively and the parents could be warned of
repercussions. It would also be important for me to be
competent about this cultural and the values it has. It’s evident
that the Hmong culture believes in Khawv Koob healers and
value this practice. I would know what the benefits of this
practice are and use my knowledge to be empathetic towards
what this family was asking for. I would make sure that the
nurses tending to the patient and their families were also
competent about the Hmong culture.
This case was hard to determine whether the daughter was going
to die with or without the ritual. Unlike the other case, Daisy
was not getting better, instead she was getting worse. In my
opinion, there was probably nothing that could have been done
to save her life.
The case about Neng Song was different than Daisy’s case
because the fever Neng had was not persistent and the doctors
had no real proof of bacterial infection because no test was
done. Neng’s parents refused any treatment or test to determine
with there was bacteria in the blood stream and the doctor was
concerned that the baby would die if not being treated. So, the
doctor tried to get a court order and held the family at the
hospital but by the end of their hold the baby’s fever had went
down to 100 °F and the baby was not fussy anymore. The family
somehow escaped and the baby had gotten better with khawv
koob ritual.
In this case there was a Hmong interpreter but it’s obvious that
the doctor was not competent of the Hmong culture. The doctor
did not allow the Khawv Koob to be in the hospital and did not
offer that. I would allow the khawv koob be in the hospital and
allow the ritural to happen if that meant that I could perform the
test needed to make sure that the baby did not have bacterial
meningitis. Either way, if the family wanted to leave, I’d allow
them to leave after communicating to them the possibilities of
bacterial meningitis to make sure they are okay with the
decision they are making of leaving the hospital.
When practicing medicine in an intercultural environment, the
importance of a translator cannot be underestimated. In a
scenario where I was the practicing physician in a community
that worked with (specifically) Hmong refugees, my first and
primary concern would be to have a staff of interpreters at hand
during all hours of operation. As I am not wholly familiar with
Hmong society, practices and belief systems, it would be
important to me to have an interpreter who was familiar with
the culture, as well as the language. Aware of my ignorance, I
would be open to cultural education on how to pursue medical
matters with patients and families in a sensitive and sympathetic
manner.
In the case studies, the parents of little Daisy acted on the
suggestion of the physician, who was sensitive to the needs of
the family and allowed them to perform ceremonies essential to
their own medical practices. However, Daisy did not survive,
and both sides of the cultural gulf blame them for their
misapplied trust.
The parents of baby Neng had a much different story to tell.
While Daisy’s parents encountered a physician who was
sensitive to their input, Neng’s parents encountered a physician
who felt it her responsibility to “save Hmong infants from their
parents”[1]. The assumption on the part of the physician that
Hmong parents were irresponsible and did not care about their
children-while blatantly ethnocentric- resulted in traumatic and
unnecessary police intervention and the subsequent flight of the
family.
It is difficult to simply provide clear-cut solutions to complex
social dilemmas. As a physician, I would imagine that my first
priority-especially in intercultural environments-would be to
educate myself on local attitudes toward Western medicine, as
well as the traditional medicine practiced by the community.
This would not be difficult. A simple Google search could have
helped Neng’s physician to understand the potential hesitations
the family might feel, and perhaps she could have better worked
toward a satisfying solution.
When faced with the dilemma that Neng’s parents encountered
with regards to the possibility of a life-threatening infection, I
cannot say that I know exactly what I would do to care for the
infant. If I felt his life were in danger, I would probably get the
courts involved, however, that would be my last recourse, not
my first. This action both frightened and alienated Neng’s
parents, and weakened any influence that physician would have
in that community.
If a child of Hmong parents were presented to me, feverish with
no other symptoms, I would first communicate-via interpreter-
with the family, to ensure that both parties sufficiently
understand the situation. I would explain my fears, and what I
wanted to do, and why I wanted to do it. I know enough about
Hmong culture to realize that this is a family issue, and thus
more people would have to be consulted. If the matter were
urgent, I would encourage-at the very least- fever-reducing
medicine in the meantime. During the time taken to collect the
family, I would possibly inquire about any other medical
consults, or cultural healers that the family trusts. It could help
to involve them, in order for the family to feel more
comfortable with the proceedings.
Above everything else, it would be my duty to treat the child,
and I realize that sometimes things simply do not go as planned.
While I recognize the occasional need for drastic action, I think
that most people just want what is best for their child, and are
willing to collaborate with the doctor, if they feel that the
doctor is willing to listen to them. This is not just an
intercultural application. It is easy for a patient of any culture
to walk into a Western hospital or medical facility, and feel
powerless. The fact that there is a system in place that can be
activated to remove parental right from a child’s treatment-
however justified- indicates that parental rights are not
paramount, and that is a risk that some are simply unwilling to
incur. It would be my aim to work to prevent the need for this
type of power-struggle and to work with parents for the health
of their child.
This process unquestionably takes a great deal of time, overall.
Doctors these days have rosters of thousands of patients and
don’t generally have the time to sit down for a Hippocratic heart
to heart. However, this is perhaps the necessary difference
between what Western medicine currently is, and what Western
medicine could possibly become. The LEARN model (Listen,
Explain, Acknowledge, Recommend and Negotiate) is an
excellent practice for physicians, not only because it is simple,
but because it serves as a gentle reminder that even doctors
have something left to learn.
[1]Healing By Heart P.121

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The cases about the two Hmong children whom went to the doctors an.docx

  • 1. The cases about the two Hmong children whom went to the doctors and had fevers were similar but different in some ways. With the case about Daisy, the six month old girl, the parents had taken her daughter to her primary care physician because she had a fever of 103°F but had no other symptoms. The parents tried to treat the fever with Tylenol but the fever got worse. There was no interpreter so the physician spoke to the parents in English. The physician was concerned that Daisy might have had bacterial meningitis. The parents asked little questions about the procedures and tests the physician wanted to do to confirm bacteria in the blood stream. The parents agreed to keep Daisy at the hospital. The grandparents came and stated that they wanted a khawv koob ritual. The doctor had allowed the ritual to happen in the hospital but had said that the healer could not burn incense because of oxygen Daisy was being given. Unfortunately Daisy did not get better and died from cardiac arrest. If I was the physician I would have made sure that there was an interpreter present and translating for me what I had to say to the parents. This is very important because so many details of Daisy’s condition could get lost in the conversation between Daisy’s parents and me. With the interpreter, all options could be informed effectively and the parents could be warned of repercussions. It would also be important for me to be competent about this cultural and the values it has. It’s evident that the Hmong culture believes in Khawv Koob healers and value this practice. I would know what the benefits of this practice are and use my knowledge to be empathetic towards what this family was asking for. I would make sure that the nurses tending to the patient and their families were also competent about the Hmong culture. This case was hard to determine whether the daughter was going to die with or without the ritual. Unlike the other case, Daisy was not getting better, instead she was getting worse. In my
  • 2. opinion, there was probably nothing that could have been done to save her life. The case about Neng Song was different than Daisy’s case because the fever Neng had was not persistent and the doctors had no real proof of bacterial infection because no test was done. Neng’s parents refused any treatment or test to determine with there was bacteria in the blood stream and the doctor was concerned that the baby would die if not being treated. So, the doctor tried to get a court order and held the family at the hospital but by the end of their hold the baby’s fever had went down to 100 °F and the baby was not fussy anymore. The family somehow escaped and the baby had gotten better with khawv koob ritual. In this case there was a Hmong interpreter but it’s obvious that the doctor was not competent of the Hmong culture. The doctor did not allow the Khawv Koob to be in the hospital and did not offer that. I would allow the khawv koob be in the hospital and allow the ritural to happen if that meant that I could perform the test needed to make sure that the baby did not have bacterial meningitis. Either way, if the family wanted to leave, I’d allow them to leave after communicating to them the possibilities of bacterial meningitis to make sure they are okay with the decision they are making of leaving the hospital. When practicing medicine in an intercultural environment, the importance of a translator cannot be underestimated. In a scenario where I was the practicing physician in a community that worked with (specifically) Hmong refugees, my first and primary concern would be to have a staff of interpreters at hand during all hours of operation. As I am not wholly familiar with Hmong society, practices and belief systems, it would be important to me to have an interpreter who was familiar with the culture, as well as the language. Aware of my ignorance, I would be open to cultural education on how to pursue medical matters with patients and families in a sensitive and sympathetic
  • 3. manner. In the case studies, the parents of little Daisy acted on the suggestion of the physician, who was sensitive to the needs of the family and allowed them to perform ceremonies essential to their own medical practices. However, Daisy did not survive, and both sides of the cultural gulf blame them for their misapplied trust. The parents of baby Neng had a much different story to tell. While Daisy’s parents encountered a physician who was sensitive to their input, Neng’s parents encountered a physician who felt it her responsibility to “save Hmong infants from their parents”[1]. The assumption on the part of the physician that Hmong parents were irresponsible and did not care about their children-while blatantly ethnocentric- resulted in traumatic and unnecessary police intervention and the subsequent flight of the family. It is difficult to simply provide clear-cut solutions to complex social dilemmas. As a physician, I would imagine that my first priority-especially in intercultural environments-would be to educate myself on local attitudes toward Western medicine, as well as the traditional medicine practiced by the community. This would not be difficult. A simple Google search could have helped Neng’s physician to understand the potential hesitations the family might feel, and perhaps she could have better worked toward a satisfying solution. When faced with the dilemma that Neng’s parents encountered with regards to the possibility of a life-threatening infection, I cannot say that I know exactly what I would do to care for the infant. If I felt his life were in danger, I would probably get the courts involved, however, that would be my last recourse, not my first. This action both frightened and alienated Neng’s parents, and weakened any influence that physician would have in that community. If a child of Hmong parents were presented to me, feverish with no other symptoms, I would first communicate-via interpreter- with the family, to ensure that both parties sufficiently
  • 4. understand the situation. I would explain my fears, and what I wanted to do, and why I wanted to do it. I know enough about Hmong culture to realize that this is a family issue, and thus more people would have to be consulted. If the matter were urgent, I would encourage-at the very least- fever-reducing medicine in the meantime. During the time taken to collect the family, I would possibly inquire about any other medical consults, or cultural healers that the family trusts. It could help to involve them, in order for the family to feel more comfortable with the proceedings. Above everything else, it would be my duty to treat the child, and I realize that sometimes things simply do not go as planned. While I recognize the occasional need for drastic action, I think that most people just want what is best for their child, and are willing to collaborate with the doctor, if they feel that the doctor is willing to listen to them. This is not just an intercultural application. It is easy for a patient of any culture to walk into a Western hospital or medical facility, and feel powerless. The fact that there is a system in place that can be activated to remove parental right from a child’s treatment- however justified- indicates that parental rights are not paramount, and that is a risk that some are simply unwilling to incur. It would be my aim to work to prevent the need for this type of power-struggle and to work with parents for the health of their child. This process unquestionably takes a great deal of time, overall. Doctors these days have rosters of thousands of patients and don’t generally have the time to sit down for a Hippocratic heart to heart. However, this is perhaps the necessary difference between what Western medicine currently is, and what Western medicine could possibly become. The LEARN model (Listen, Explain, Acknowledge, Recommend and Negotiate) is an excellent practice for physicians, not only because it is simple, but because it serves as a gentle reminder that even doctors have something left to learn.