By Lois De Leon

Undergraduate Research Assistant


Over the holidays I read the ground-breaking nonfiction book The Spirit Catches You and You Fall Down by Anne Fadiman, about the tension between a Hmong refugee family and the U.S. healthcare system over the care of an epileptic child, Lia Lee. This fascinating story chronicles the cultural and language barriers in healthcare treatment and demonstrates the potential of CORE grad student Julie Dinh’s Cultural Competency Training project, which aims to develop culturally sensitive healthcare providers. This narrative provides an insight to the practical applications of a successful project.

In Fadiman’s work, Lia’s primary physicians face nearly insurmountable barriers in their interactions with the Lee family. As Hmong refugees in Merced, California, the Lees speak no English and have no understanding of Western medicine. The Lee family has a unique notion of illnesses, believing them to be caused by spirits. In working with the Merced healthcare system, the Lees are caught in a spiral of mistrust and misunderstanding, and Lia’s doctors make little headway in getting the Lees to comply with their daughter’s medication regimen.

In spite of this, one extraordinary woman achieves remarkable success with the Lees: social worker Jeanine Hilt. Though Hilt herself is not a healthcare provider, her empathy is key to Lia’s treatment. Hilt earns the Lees’ trust because of her high regard for them and her genuine interest in Hmong healing practices. Of all the Americans who look after Lia, Hilt alone asks the Lees for their thoughts on her illness and treatment. Hilt finally convinces the Lees to administer Lia’s medicine.

How can healthcare providers today be more culturally aware like Jeanine Hilt? CORE’s Cultural Competency Training project explores this question by probing into cultural disconnects between patient families and providers at Texas Children’s Hospital to ultimately create a multicultural, diversity-related training program for doctors and nurses. CORE has collaborated with Texas Children’s critical care department to bring volunteers into the PICU to assess these cultural barriers. By analyzing the data on patient-provider interactions, Dinh and her team will develop a training program to impart cultural awareness to healthcare providers. Once the trainees understand their own culture, they will be able to apply their knowledge to other cultures. The goal is to enable patient families and providers to more effectively communicate and to achieve the most optimal outcome for patient health.

The Spirit Catches You and You Fall Down is extremely relevant to Dinh’s project because Texas Children’s PICU team faces many of the same challenges that Lia’s physicians did. Though Houston may not have very many Hmong, our diverse city has dozens of ethnic groups, each with its own language and customs. Today’s healthcare providers must take great care not to distress patients’ families the way Lia’s doctors once alienated her parents. Instead, they must actively work to comfort the patient and ensure the family’s ongoing trust. Clearly, cultural sensitivity is absolutely essential to both of these objectives.

In the words of cross-cultural medical expert Arthur Kleinman, “if you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?” (Fadiman, 1997, p.261) The cultural competency wisdom in The Spirit Catches You and You Fall Down will be a source of inspiration for me as I work with CORE’s Cultural Competency Training project in addressing cultural barriers at Texas Children’s Hospital.



Fadiman, Anne. The Spirit Catches You and You Fall Down. 19 Union Square West, New York 10003: Farrar, Straus and Giroux, 1997.