:Cultural competency is the consideration and factoring of cultures into health problems to achieve resolution or to make more effective delivery of resolution.  Understanding the need for cultural competency requires that one realize that the practice of medicine itself is a form of culture, whether one is practicing Western Biomedicine, Peruvian Shamanism, or Hmong Animism.  Western Biomedicine has its own set of beliefs, values, attitudes, and knowledge, just as foreign to non-Western Biomedicines practitioners as Peruvian Shamanism and Hmong Animism are foreign to Western health workers.  In order for health providers to bridge the gap between health care providers and their patient groups of different cultures, cultural compentency must be used to understand the social and cultural structures that support the medicine (Joralemon 2010:97).

 

In my view, cultural competency was the main lacking factor in Lia's case and the main conclusion as the root cause of Lia's tragic experience with the American healthcare system in Anne Fadiman's book.  This is actually elegantly summarized in the book's title, where it explicitly states the patient's culture (i.e Hmong), the healthcare providers' culture (i.e. American), and the fact that there was a "Collision of Two Cultures" (Fadiman 1997).  As the reader, we don't truly understand the meaning of the book's title until we complete the reading.   One primary example of this lack of cultural competency is the issue about medication compliance.  It is easy to misunderstand Lia's parents' non-compliance by focusing on their inability to read and understand English and inability to read numbers.  However, the fact was, they had school-attending children in the immediate household who could read English instructions and numbers.  If they truly believed in and wanted to give Lia the Western Biomedicine as instructed, they could have asked their children to assist them.  In fact, Anne Fadiman mentioned that the eldest daughter often served as their family's informal translator at the hospital and the Lee children did the grocery shopping, implying the children knew more (competent) English than their parents did.  The real reason Nao Kao and Foua did not comply with the medicine administering was because their viewpoint of Lia's epilepsy was not one of disease or brain damage, but of soul lost.  They believed the Western medicine wasn't useful for recovering Lia's soul.  The medical staff at Merced Community Medical Center and the social worker Jeanine Hilt mistakenly considered this cultural issue "as an obstacle to overcome" (Joralemon 2010:97) and spent much effort to translation of the medication instructions and teaching the parents on the proper use.  Tragically, it took the drastic motion of the Child Protective Services episode to force Lia's parents to actually administer medication to Lia properly, so that they could regain custody of her.  The fact that the Pediatric Depakene was actually effective, was just a bonus.

 

In the years following Lia's case, there has been a focus to introduce cultural competency to the healthcare systems, including in Merced, CA.  In 1996, the Multidisciplinary Approach to Cross-Cultural Health (MATCH) Coalition was started in Merced county, CA.  It provided, among other services, cultural brokering, cultural training, and culturally responsive interpreter services (Hmong Health Collaborative website).  This program provided and taught cultural competency to healthcare institutions in Merced, CA so that the healthcare system there could provide effective care to their multi-cultural patient groups.  Among the Hmong community, the Healthy House program within MATCH certified and registered Hmong Shaman for integration into the Western Biomedicine healthcare system.  At the Mercy Medical Center in Merced, Healthy House shamans received a seven-week training program at the hospital to foster mutual understanding, trust, and cooperation (Brown 2009: A20).  The hospital instituted modified versions of the Hmong Shaman rituals and healing ceremonies to be performed at patient bedsides to complement the Western Biomedicine.

 

Unfortunately for Lia and the Lee family, this cultural competency implementation occurred after Lia's medical case.  If the MCMC staff had undergone similar cultural competency training, then perhaps they could have resolved the medication compliance issue early on, and Lia's treatment might have taken a more positive turn.  I suspect that with more cultural understanding, the staff at MCMC probably would not have assumed that "the west is the best" (Joralemon 2010:91) in their approach to Lia's case. While it is impossible to predict Lia's health under a culturally competency healthcare, it surely would have prevented the collision of the Hmong health culture and the culture of Western Biomedicine.

 

Today, we llive in an inter-connected world where we interact with people of different cultures almost on a daily basis.  Whether we interact at work, in our private lives, in person with verbal communication, or via our smartphones or online, cultural diversity and understanding play primary roles in our lives.  Cultural competency then is a necessity for us to communicate effectively and should be integrated into our lives, both on a personal level and on a work level.  For our healthcare system to provide effective care, we must include cultural competency for our cultural diverse patient groups.