Interestingly, for all of the author’s anthropological acumen, she never directly addresses the ostensible paradox of why the Lees kept taking Lia back to the emergency room in spite of their mistrust of the medical community (see p. 25 for a description of the first ER visit). This question is also unaddressed in the academic literature (see ME Warner. “The Hmong and Health Care in Merced, California.” Hmong Studies Journal. 1998. Pp. 10-12). However, Fadiman obliquely addresses the topic, and in doing so, provides a number of partial frameworks for answering the question. In this essay, I will discuss three frameworks. First, the Lees considered the optimal treatment to be “a little medicine and a little neeb [a type of traditional Hmong medicine literally translated as healing spirit]” (100; also, chapter 9). Second, Hmong cultural beliefs, conflated with Lia’s placement in governmental custody, likely made the Lees feel coerced into accepting what may have otherwise been unacceptable treatment. Third, the Lees and other Hmong had witnessed the power of fast-acting antibiotics, so Western medicine was in some cases preferred to traditional Hmong medicine. For all of these reasons, taking Lia to the emergency room was sometimes viewed as a legitimate strategy. The author's statements notwithstanding, assessing this paradox through individual and interpersonal theoretical frameworks sheds further light on the Lees' actions.
For a time, the Lees believed that a combination of Western and traditional Hmong medicine was optimal for Lia (Aubrey, Innocence and Kathryn also make this point). As Nao Kao noted (100):
The doctors can fix some sicknesses that involve the body and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb, but not too much medicine because the medicine cuts the neeb’s effect. If we did a little of each she didn’t get sick as much, but the doctors wouldn’t let us give just a little medicine because they didn’t understand about the soul.
In this respect, interpersonal relationships were a key factor in compliance: the Lees trusted their American social worker Jeanine, who was able to train them on Depakene (112-116). Therefore, one could feasibly argue that there were times in Lia’s life when their choice of treatment for her may have improved her quality of life, the putative goal of any Western or “traditional” system of medicine.
Fadiman writes that many Hmong, including the Lees, felt coerced to accept unwanted medical treatment. Other Hmong reported that: “if you want to stay here you must let doctor [sic] examine the [sic] body” and “I already sign [sic] everything and the doctor going [ sic] to send me to jail if I change my mind.” (62). In addition, “most Hmong women did go the hospital to give birth, erroneously believing that babies born at home would not become US citizens” (72). After Lia was placed into temporary foster care, she “was to be reunited with her family after six months only if the court was persuaded that her parents would comply with her medication regimen” (85). It is bittersweet that the power of the state, perceived and real, held a great sway over the Lees and was one factor that may have helped give Lia “one of the richest [times] in her life” (106).
Antibiotics, which provided a quick, noticeable fix to some infections, were the “only form of medical treatment that was gratefully accepted by at least some of the Hmong in the Thai camps” (34). Similarly, “Hmong patients might not understand the doctors’ diagnoses, but if they had summoned the courage to visit the clinic, they wanted be told that something was wrong and to be given something, preferably a fast-acting antibiotic, to fix it” (69) (italics in original) (Erika, Min-Young and Jessica also points this out). More specifically, Foua “informed [Dr. Dan Murphy] that she didn’t think you should ever have to give a medicine forever.” Here, Fadiman opines that “it is likely that the only Western drugs Foua and Nao Kao had encountered in
Asia were fast-acting antibiotics” (53).
Viewing this question through the lenses of individual and interpersonal behavioral models, it is fair to question the degree of autonomy the Lees actually had in “choosing” to take Lia to the emergency room. Here, the theories of reasoned action and planned behavior are useful, and their practical differences become muddled. Contrary to the health belief model, these two models stress that subjective norms meld people’s beliefs and actions, arguably more so than our perceived individual autonomy or self-efficacy. To extend these models a bit more broadly (or extremely), the notion that someone can function with more than a modicum of autonomy is debatable. Given the aforementioned three primary influences (empiricism, coercion and culture), the Lees may have been effectively constrained in their actions, as other Hmong were, and in practice forced to utilize the American medical system despite viscerally strong objections, which sometime even included a fear of eternal damnation. Thinking diagrammatically with respect to the theory of planned behavior, the “subjective norms” circle becomes so large as to encompass the remaining whole. Conceptualizing the individually-oriented theories of reasoned action or planned behavior as such essentially rehashes Berkman and Glass’ model of interpersonal social networks and the environment as the principle determinants of individuals’ “choices.”
In conclusion, it is incorrect to say the Lees’ actions represent a “traditional” practice, because it is fundamentally empirical. (See, for example, page 56: “The Lees had now decided that they liked Phenobarbital, disliked Dilantin, and were ambivalent about Tegretol” or pp. 90-91 for a description of the positive effect of Depakene and the Lees’ recognition of it). The Lees’ fears that the doctors were making Lia sick (213) were justified and ultimately correct (255). Thus, through a combination of empiricism, coercion and culture, the Lees “chose” to take Lia to the emergency room.