During the mid-eighties, the Nationalities Service of Central California in Fresno received a short-term federal grant of $100, 965 to establish an integrated mental health delivery service. Their resulting project contained descriptions of eighteen healing ceremonies intended to help make the client amenable to recommended medical procedures. Unfortunately, the project died out for lack of renewable funding. So, immigrants, even if they can get to a hospital and have the money to pay for the medical services, may find mainstream health care inaccessible. Ten years ago, there were hardly any medical schools that included cross-cultural training. But about 1995, national guidelines for training psychiatry residents stipulated that they had to learn to assess cultural influences on their patient’s problems. For example, at San Francisco General Hospital, all family practice residents are required to do a rotation at the Refugee Center. However, the author wondered whether any of this would trickle down to a place like Merced. As it turned out, it did much more than she expected. For example, Hmong were considered as employees who could be cultural brokers rather than lab assistants or nurse’s aides.
Of course, change came hard. It was observed that residents were over-reliant on biomedicine. They regarded cross-cultural medicine as a form of political bamboozlement, an assault on their rationality rather than a potentially lifesaving therapy. They were the product of American medical schools which teach students how to separate themselves from their emotions. Stanford is trying to bring back the full humanity of the medical students. William Osler said , “ask not what disease the person has, but rather what person the disease has.” The author believes that if there were more Osler-type generalists around, the Hmong, among others would stand to benefit. For example, a Hmong man being referred to a specialist did not ask the referring physician to get one who was skilled or famous. Instead, he asked if he knew someone who would care for him and love him. The author acknowledges that Western medicine saves lives, but she asks if it would be too much for doctors to acknowledge their patients’ realities.
The author took Bill Selvidge and Sukey Waller to dinner one night, believing they would have a lot in common. They discussed many Hmong ideas over dinner where Bill insisted that he had to act on behalf of the most vulnerable person in the situation and that was the child. You had to do what was best for the child even if the parent opposed it, because if the child died, she wouldn’t get a chance twenty years down the road to decide if she wanted to accept her parents’ beliefs or reject them. Sukey responded with the question, “What if the parents see the medical procedure as a definite possibility of eternal damnation for their child if she died in surgery. So what was more important: the life or the soul? Bill said the life, but Sukey insisted it was the soul.
This chapter summarizes the definite cultural differences that might never be resolved in the United States. The medical establishment will always believe that the life of the patient takes precedence over anything else, while the Hmong will always turn to their cultural concept that the soul was all important.