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The Spirit Catches You And You Fall Down Summary Essay Example

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures is a 1997 book by Anne Fadiman that chronicles the struggles of a Hmong refugee family from Houaysouy, Sainyabuli Province, Laos,[1] the Lees, and their interactions with the health care system in Merced, California. In 2005 Robert Entenmann, Ph.D., of St. Olaf College wrote that the book is "certainly the most widely read book on the Hmong experience in America."[2]

On the most basic level, the book tells the story of the family's second youngest and favored daughter, Lia Lee, who was diagnosed with a severe form of epilepsy named Lennox-Gastaut Syndrome and the culture conflict that obstructs her treatment.

Through miscommunications about medical dosages and parental refusal to give certain medicines due to mistrust, misunderstandings, and behavioral side effects, and the inability of the doctors to develop more empathy with the traditional Hmong lifestyle or try to learn more about the Hmong culture, Lia's condition worsens. The dichotomy between the Hmong's perceived spiritual factors and the Americans' perceived scientific factors comprises the overall theme of the book.

The book is written in a unique style, with every other chapter returning to Lia's story and the chapters in-between discussing broader themes of Hmong culture, customs, and history; American involvement in and responsibility for the war in Laos; and the many problems of immigration, especially assimilation and discrimination. While particularly sympathetic to the Hmong, Fadiman presents the situation from the perspectives of both the doctors and the family. An example of medical anthropology, the book has been cited by medical journals and lecturers as an argument for greater cultural competence, and often assigned to medical, pharmaceutic, and anthropological students in the US. In 1997, it won the National Book Critics Circle Award for General Nonfiction.[3]

Major characters[edit]

Lia Lee (Romanized Popular Alphabet: Liab Lis,[4] July 19, 1982 – August 31, 2012.[5]): She was born in Merced, CA, and she was a Hmong child. She had seizures due to epilepsy.

Anne Fadiman: She is an author and narrator of ‘The Spirit Catches You and You Fall Down’. She wrote about her experience with Lia and her family. Through this experience, she learned the importance of understanding about diversity of culture between doctor, patient, and family.

Neil Ernst and Peggy Philp: They are Lia’s doctors at MCMC. There is conflict between them and Lia's parents because of Hmong shamanism culture versus western medicine. This leads to great misunderstandings between each other.

Foua Yang and Nao Kao Lee: They are Lia’s parents, and they love Lia very much. They only believe in their traditional approach to medical treatment, with a strong influence from shamanism.

Jeanine Hilt: A social worker who makes Lia her personal cause. She fights against the medical establishment on Lia’s behalf and cares for the Hmong as a significant culture.[6][7]

Summary[edit]

Lia experienced her first seizure at three months of age, but a resident at Merced Community Medical Center misdiagnosed her condition, and the hospital was unable to communicate with her parents since the hospital had no Hmong interpreters. Anne Fadiman wrote that Lia's parents did not give her medication as it was prescribed because they believed that Lia Lee's state showed a sense of spiritual giftedness, and they did not want to take that away. The American doctors did not understand the Hmong traditional remedies that the Lee family used. The doctors treating Lia Lee, Neil and Peggy Ernst, had her removed from her home when she was almost three years of age, and placed into foster care for one year, causing friction with her parents. By age 4½ Lia Lee had been admitted to hospital care 17 times and had made over 100 outpatient visits.[8]

The worst seizure Lia had put her onto the verge of death. She went to the emergency room and Dr. Neil Ernst could not do anything. He talked to Lia's parents about transferring her to Fresno, California because Lia would need further treatment that Dr. Ernst could not provide. Lia's parents ". . . believed their daughter was transferred not because of her critical condition but because of the Ernst's vacation plans". Lia Lee slipped into a coma after suffering from a grand mal seizure in 1986, when she was four years of age. Lia Lee's doctors believed she would die, but Lia Lee remained alive but with no higher brain functions.[8]

Research[edit]

This section needs expansion. You can help by adding to it.(July 2014)

Fadiman's sources for information about the history of the Hmong include Hmong: History of a People by Keith Quincy. She stated "Were I citing the source of each detail, Quincy's name would attach itself to nearly every sentence in the pages on the Hmong in China."[7] Fadiman's book cited the Quincy theory that the Hmong people originated from Siberia.[9] Entenmann wrote that because of the reliance on Quincy's book, Fadiman's book propagates the idea that Sonom was a Hmong king, a concept that Entenmann says is inaccurate.[2]

Legacy[edit]

Marilyn Mochel, a nurse and clinical educator at Sutter Merced Medical Center (now Mercy Medical Center Merced), who heads the hospital's cross-cultural program, said in 1999 that "The book has allowed more dialogue. There's certainly more awareness and dialogue than before. Both sides are teachers and learners."[10]

Lia Lee lived in a persistent vegetative state for 26 years. She died in Sacramento, California, on August 31, 2012 at the age of 30.[5] At that age she weighed 47 pounds (21 kg) and was 4 feet 7 inches (1.40 m) tall; many children with severe brain damage have limited growth as they age.[11] Outside of the State of California Lia Lee's death was not widely reported. Fadiman said that pneumonia was the immediate cause of death. Margalit Fox of The New York Times said "[b]ut Lia’s underlying medical issues were more complex still" because she had lived in a persistent vegetative state for such a long period of time. As of 2012 most individuals who go into that state die three to five years afterwards.[5]

Reception[edit]

Ralph Jennings of The Modesto Bee said "Hmong, including some among the 2,000 in Modesto, say the book typified conflicts between their culture and American institutions. But some say it didn't capture the complexity of the Hmong culture."[10]

Cheng Lee, a brother of Lia Lee, said that his father and mother liked Fadiman's book.[10]

“Compellingly written, from the heart and from the trenches. I couldn’t wait to finish it, then reread it and ponder it again. It is a powerful case study of a medical tragedy.” - David H. Mark, Journal of the American Medical Association

Anne Fadiman's essay "Hmong Odyssey," adapted from the book, was published in the March–April 1998 Via. The Hmong community leaders in Fresno, California praised the essay, saying that it was thoughtful and accurate.[12]

See also[edit]

Notes[edit]

  1. ^Fadiman. "Foua and Nao Kao." The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux. 1997. 103. "[...]I asked her to describe a typical day in Houaysouy, the village in the northwestern province of Sayaboury where the Lee family had lived."
  2. ^ abEntenmann, Robert. "The Myth of Sonom, the Hmong King." (Archived 2014-07-11 at WebCite) Hmong Studies Journal, Volume 6, 2005. p. 1. Retrieved on July 11, 2014.
  3. ^National Book Critics Circle - past awards
  4. ^Fadiman, Anne. "Note on Hmong Orthography, Pronunciation, and Quotations." The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux. 1997. 292.
  5. ^ abcFox, Margalit. "Lia Lee Dies; Life Went On Around Her, Redefining Care." The New York Times. September 14, 2012. 1. Retrieved on October 23, 2012.
  6. ^Clapsaddle, Diane (20 Mar 2015), "The Spirit Catches You Study Guide02", TheBestNotes.com, retrieved 12 Apr 2016 
  7. ^ abFadiman (September 30, 1998), The Spirit Catches You and You Fall Down(PDF), ISBN 9781429931113 
  8. ^ abFox, Margalit. "Lia Lee Dies; Life Went On Around Her, Redefining Care." The New York Times. September 14, 2012. 2. Retrieved on October 23, 2012.
  9. ^Pfeifer, Mark E. (Hmong Cultural and Resource Center). "Overview of Recent Scholarship on Premodern Hmong History" (Archived 2014-07-11 at WebCite). Hmong Studies Journal at Hmong Studies Internet Resource Center. Presentation at the "“Building on Hmong Women’s Assets: Past, Present, and Future” September 16-17, 2005, St. Paul/Minneapolis, MN" (Archive).
  10. ^ abcJennings, Ralph. "MERCED HOSPITAL FILLS CULTURAL PRESCRIPTION." The Modesto Bee. Sunday March 21, 1999. B3. Retrieved on March 12, 2012.
  11. ^Fox, Margalit. "Lia Lee Dies; Life Went On Around Her, Redefining Care." The New York Times. September 14, 2012. 3. Retrieved on October 23, 2012.
  12. ^"ESSAY VS. APOLOGY DIVIDE HMONG * FRESNO LEADERS SAY AUTOMOBILE ASSOCIATION SHOULD APOLOGIZE ONCE MORE, AND MORE DIRECTLY." Fresno Bee. Wednesday March 4, 1998. Telegraph A1. Retrieved on March 12, 2012.

External sources[edit]

New England Journal of Medicine article 1 [1]

  • Fox, Renée C., Ph.D. "Cultural Competence and the Culture of Medicine." New England Journal of Medicine. 2005; 353:1316-1319. September 29, 2005. DOI: 10.1056/NEJMp058066

New England Journal of Medicine article 2 [2]

  • Malina, Debra, Ph.D. "Compliance, Caricature, and Culturally Aware Care." New England Journal of Medicine. 2005; 353:1317-1318. September 29, 2005. DOI: 10.1056/NEJMp058064.

External links[edit]

  • The Spirit Catches You and You Fall Down at Macmillan Publishing
  • "Ann Fadiman: 'Go to the Edge of Your Culture'." Inside Chico State. Volume 32, Number 4. October 25, 2001
  • Yang, Yeng. "Practicing Modern Medicine: "A little medicine, a little neeb"." (Archive." (Archive) Hmong Studies Journal. v2n2. northern hemisphere Spring 1998.
  • Ernst, Neil T. and Margaret "Peggy" Philp. "Bacterial Tracheitis Caused By Branhamella Catarrhalis." Pediatric Infectious Disease Journal. June 1987. Volume 6, Issue 6. Page 574.
  • Lilly, Amy. "Influential Author Discusses How Culture Clash Became Tragedy." Seven Days. February 17, 2010.
  • Lammert, Kathy. "When Epilepsy Goes By Another Name." Epilepsy.com. September 15, 2003.
  • Chrismer, Ellen. "Fadiman visit stirs emotions, understanding." University of California-Davis. December 6, 2002.
  • Chiu, Monica, PhD (University of New Hampshire). "Medical, Racist, and Colonial Constructions of Power: Creating the Asian American Patient and the Cultural Citizen in Anne Fadiman’s The Spirit Catches You and You Fall Down" (Archive" (Archive). Hmong Studies Journal 2004-05, Volume 5.
Mercy Medical Center Merced, previously the Merced Community Medical Center; this is a new building and not the previous building where Lia Lee was taken

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Essays

Example Research Essay

English 1A
Research Paper

Assignment: After substantial research, make an argument concerning what should be done to resolve a specific conflict between the cultural or religious traditions or values of a particular community, and the rules and expectations of the larger Anglo/Christian dominated American society. The conflict could occur in connection with medicine, transportation, education, the legal system, penal system, or another area that interests you.

[Instructor comments appear in bold, italic font within brackets below.]

The Need For Cultural Sensitivity

In the nonfiction text The Spirit Catches You And You Fall Down, Anne Fadiman brings to light the conflicts between a Hmong family’s cultural beliefs, and that of the traditional western medical beliefs of the American doctors they come into contact with. The cultural barriers between the two groups prevent any positive outcome in the health care of the Hmong family’s youngest daughter, Lia. This unfortunately results in a tragic end to the young girl’s life. Fadiman does not blame anyone for the unfortunate events that occur; after all, there is no one to blame. Each was only doing what they believed was best for the young Hmong girl. It was the lack of communication and understanding of what those beliefs were, that helped destroy any hope of providing effective health care for the Hmong child. This is not an isolated case that just happened in the small town of Merced, California. [Good way to use the text we read in class as a springboard into your subject and argument.] It is a prevalent problem all over the world. It stems from the lack of cultural sensitivity being sufficiently taught in medical school. [Strong claim – a good thesis statement.] Teaching medical students how to be culturally sensitive is not easy in the least, but there is a tremendous need for it. The United States is a hugely diverse country, and becoming ever more so by the decades. There are cultures from all over the world in the United States, and these cultures carry extremely different beliefs from that of the larger Anglo/Christian American society. In the United States, the doctors are taught traditional Western medicine. The problem is, Western medicine is not accepted or practiced in all cultures, and conflicts can arise if doctors are not sensitive to others’ cultural beliefs that are different from their own.

Not only does cultural sensitivity need to be better taught in medical school, there needs to be a lot more value put on it than there currently is. [Good topic sentence to focus the paragraph.] An article in the Medical Education journal stated that “although some medical training is beginning to prepare doctors to work in an ethnically diverse society, there is a long way to go. Research suggests many practicing clinicians are inadequately equipped to provide appropriate intercultural care” (Kai et al). Some doctors believe that there will never be enough training to better prepare them for being culturally sensitive to everyone. They say that there is not enough time in their already hectic schedules to be culturally sensitive all the time. [Nice way to introduce a counterargument, so that you may then address it or refute it.] But, doctor Michele Borgeson at the University of California San Francisco, believes that cultural sensitivity does play an extremely important and crucial part in helping to make health care more effective and appropriate for all patients, from all cultural backgrounds. In order for this to happen, there needs to be a change in the curriculum currently being taught in medical school. If the American doctors in Merced, California would have been better trained in medical school to be aware of, and sensitive to the Hmong’s cultural beliefs, the outcome of the young Hmong girl might have been different.

What is cultural sensitivity, and why is it important in the delivery of health care? Cultural sensitivity is the respect, and the valuing of differing cultural identities. It is important because there are few places in the world where the delivery of health care takes place in mono-cultural contexts (Prideaux). The United States is continually becoming more culturally diverse. In an increasingly diverse society, doctors and medical staff must learn to value ethnic diversity in order to deliver effective health care to everyone. It would also help providers to better understand others’ beliefs to some extent [This feels a little repetitive, although I think you’re saying doctors need to not only value diversity, but be educated about it, and apply their knowledge, yes?], which would aid in building a strong doctor-patient relationship. The American Academy of Pediatrics agree that physicians need to “...take into account the beliefs, values, actions, customs, and unique health care needs of distinct population groups. Providers will thus enhance interpersonal and communication skills, thereby strengthening the physician-patient relationship....” The relationship between the doctor and the patient, including the patient’s family, is extremely important. In the case of The Spirit Catches You And You Fall Down, we see that the relationship between the American doctors and the Hmong family was weak because of the lack of communication, understanding, and respect. Anne Fadiman shows the lack of communication when she stated that “Dan had no way of knowing that Foua and Nao Kao had already diagnosed their daughter’s problem as [soul loss]. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy...” (28). [Good specific example to illustrate your point.] Neither knew, because no one had bothered to ask. This may seem like a small miscommunication, but it is actually the whole reason why Lia Lee didn’t receive the optimal care she deserved, thus resulting in the tragic end of her young life. If Lia’s doctors would have had some sort of cultural sensitivity training in medical school, the relationship between the American doctors and the Lees might have been different, which would have possibly resulted in better health care for Lia.

How does one effectively teach medical students to be culturally sensitive? What some experts suggest is that in order to understand and appreciate another’s cultural beliefs and practices, students need to first look at their own cultural beliefs and practices. Professor David Prideaux states that there are at least three key elements in teaching cultural diversity:
Students should have opportunities to discuss and reflect upon their own cultural identities. They should interact with others who will represent and explain their own differing cultural identities. Finally they should be prepared for the delivery of health services in a manner which values, respects and enhances the cultural identities of those under their care.

Training at some point, should also look critically at each student’s assumptions and attitudes about people different from themselves. This would involve teaching the students to recognize stereotyping, prejudice and racism (Kai et al). Students also need to be able to understand the strengths and weaknesses of their own culture and cultural identity. When this is achieved, only then can students begin to understand that one culture is not normal or dominant, stronger or superior than the other. Most doctors agree that prejudice and racism have no place in the medical field, yet they appear frequently (Borgeson) [A specific example would help make your argument stronger here]. Only when these issues are addressed will their there be any progress in the training of cultural sensitivity in medical school.

Although medical schools seem to lack sufficient cultural sensitivity and cultural diversity training, there are some effective teaching strategies out there. [Great transition sentence. Your essay flows smoothly from paragraph to paragraph.] A nurse from Sequoia Hospital in Redwood City felt well enough prepared through the nursing school she attended. She recalls an assignment where she had to pick a culture different from her own and learn about it. She then needed to represent that culture in a skit that accurately portrayed ways in which the cultural beliefs of the group might be properly accommodated in the hospital. Nurse Jones also remembers being taught things about certain cultures’ religious beliefs, their birth and death rituals, and beliefs that might be different from her own. She claims that this helped her to be more open and more respectful to people that were different from herself. Doctor Michele Borgeson at the University of California San Francisco, also felt well prepared to handle cultural issues. She felt that there was a lot of value given to cultural sensitivity in her medical training. But, she also says that “growing up in a culturally diverse society, attending medical school at the University of Miami, doing [her] residency at the University of California San Francisco, and marrying a man of a different culture, might have something to do with [her] being culturally sensitive as well, but never the less, [she] realize[s] the importance of respecting others’ cultural beliefs when caring for [her] patients” (Borgeson). This positive aim in teaching student to be culturally sensitive is not just being done in the major metropolitan cities located in the United States. A study done at the University of Leicester Medical School in the United Kingdom, showed that most students were aware of their responsibility to consider cultural issues in caring for patients (Dogra) [Quality research – the personal interviews as well as the research study]. This is good news, and shows that the issue of delivering culturally effective health care is on the right path [The issue is on the right path? Awkward metaphor]. Had any of this training been given to the American doctors described in The Spirit Catches You And You Fall Down, the delivery of the health care they gave Lia would have been different. As Fadiman explains: “All of them had spent hundreds of hours dissecting cadavers...but none of them had had a single hour of instruction in cross-cultural medicine” (61). [Great way to wrap up the paragraph, showing the significance of your argument.]

Although the cultural training that is currently being provided in some medical schools and nursing schools is effective to a certain extent, understanding a person’s culture is not enough. [Another excellent transition sentence.] An article in the Medical Education journal stated, “Although many curricula may include some reference to culture, few training programs appear to have implemented any comprehensive multicultural health care component...” (Kai et al). Cultural sensitivity needs not only to be taught in medical school, but residency training and continued medical education as well. Both Nurse Jones and Doctor Borgeson admit that issues such as stereotyping, prejudice, and racism were never addressed in their medical training. And, nothing at all is mentioned about culture in their continued education training. [Interesting] A public health nurse from Oakland, California admits that she was not prepared at all to deal with people from other cultures that were different from her own. She found it very hard to be culturally sensitive at first. She assumed that the people she was going to serve in her community would accept the care she had been taught to give them (Quinn).

Students also need to realize that an individual’s idea of what his or her culture is might not be the same as the cultural group’s idea; therefore addressing the patient as an individual is very important. Medical staff should encourage patients to describe their cultural characteristics and health beliefs during encounters. This is exactly what the doctors in The Spirit Catches You And You Fall Down did not do. Fadiman explains that the reason why the doctors never asked the Hmong how they treated their illnesses was because the Hmong dressed in American clothes and had driver’s licenses (112). Assuming what the patient’s cultural beliefs are, based on the way they dress, how they live, or how they appear to be, is stereotyping, and can lead to ineffective health care for the patient. It is very clear that there needs to be much more done in training students how to be culturally sensitive than what is currently being done in medical school today, especially if doctors and health professionals recognize the fact that being culturally sensitive has a positive effect on the patient’s outcome.

Although some doctors and health care professionals realize that being culturally sensitive is important in the delivery of health care, most say it’s not as easy as it sounds. [Good – you’re returning to an opposing argument to address it fully.] There are many reasons why medical schools are hesitant in teaching medical students to be culturally sensitive. Medical schools argue that integrating cultural sensitivity into an already over packed curriculum is going to be a challenge in itself. Doctor Borgeson says that “doctors that practice Western medicine are taught in medical school that figuring out the cause of the illness, which is always biological, is their number one priority.” Doctors usually don’t have the extra time in their hectic schedules to learn about a person’s cultural beliefs. As it is, doctors only have fifteen minutes to: gather information on the patient’s medical history, diagnose the patient, and either give medication or come up with a treatment plan. If the patient does not speak English, a translator must be found. Language barriers often cut into precious time when trying to get to the root of a problem (Borgeson). Doctors in rural parts of America argue that their local communities have few ethnic minority groups, so the training of cultural sensitivity would be irrelevant (Kai et al). Tala Montoya, a long time nurse and nursing instructor, admits that “the current medical system in the United States is not tolerant of all cultural issues. There are laws that need to be followed here, and some of the things that are done in other cultures are considered against the law in the United States.” [As an example,] In The Spirit Catches You And You Fall Down, Dr. Neil Ernst reported Lia’s parents to Child Protective Services because they were not giving Lia the prescribed medication properly, which was considered child abuse, which is against the law (58). All medical staff are required by law to report any suspicion of child abuse, or their medical license could be put in jeopardy. So, regardless of how culturally sensitive a doctor or nurse is trained to be, there are laws and values that are supported by the people that practice Western medicine in the United States. [An important paragraph – you outline all the major arguments against more cultural sensitivity training, and they’re serious arguments. Now you can counter them or concede partially, but returning to your thesis.]

Training students to become culturally sensitive is not going to be an easy task. Not only are there laws that need to be followed, but not everyone can be trained to be culturally sensitive. [Moreover,] Becoming culturally sensitive is an individual choice; no matter if it is taught in medical school or not. [Yet] Psychologists agree that although certain prejudices are hard to change, it can be done through extensive cultural and cross cultural training (Spector). One problem is, doctors usually assume that the patient has come to their hospital to seek their advice, and that the patient will automatically agree with the diagnosis and treatment plan the doctor prescribes. In The Spirit Catches You And You Fall Down, Fadiman explains that young doctors are frustrated by the lack of acceptance of Western medicine by the Hmong. Doctors have been taught in medical school that Western medicine is the only legitimate way to care for health problems (76). But, doctors need to understand that Western medicine is a culture in itself. How can other cultures be expected to respect the beliefs of Western medicine if the doctors of Western medicine don’t respect other cultures? There needs to be some sort of compromise. Like the obstetrician in The Spirit Catches You And You Fall Down says: “Sometimes you can find middle ground and try to understand where they are coming from, which is hard, but not impossible” (75). Dr. Borgeson says that “becoming culturally sensitive takes time and experience in the health care field. Over time you begin to realize that there isn’t just one way of doing things, and if you value your career as a doctor, you’ll realize that really quickly.”

In an increasingly diverse society doctors must learn to value and respect others’ cultural belief systems. This will allow them to deliver the most effective health care possible. Medical students need to accept that as future doctors they have a responsibility to be aware and respectful of their patients’ cultural beliefs. Teaching students the importance of being culturally sensitive when caring for their patients is a crucial step in helping them provide effective health care for everyone, regardless of their differing cultural identities. Culturally effective health care must also be integrated into all levels of medical training: both the curricular and clinical phases of medical school, residency training, and in continuing medical education. The lack of cultural sensitivity being taught in medical schools is the reason why there isn’t effective health care for people that have cultural beliefs different from that of the more dominant American society. Some in the medical field feel that there will never be enough training to better prepare them for the issues that surround differing cultural beliefs [Or, apparently, that training doesn’t help, or that there isn’t time to apply their training, or other training is higher priority…]. Others have a more optimistic out look, and are doing everything they can to change the current curriculum in medical schools and nursing schools around the world. An article in the Medical Education journal stated, “Change is needed in medical education. Gradual change is preferable to radical change, because it allows the medical schools to see the success in a series of small changes” (Kai et al). Although this will not be an easy road, and will take time for the training to show an impact in the delivery of health care, we can see that now is the time for change. Now is the time to begin providing culturally effective health care for everyone. Hopefully after this is achieved, there will be no more tragic cases like that of Lia Lee.

Works Cited

American Academy of Pediatrics. Committee on Pediatric Workforce. “Culturally
Effective Pediatric Care: Education and Training Issues.” Pediatrics 103 (1999):167-170 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Borgeson,Michele MD, University of California San Francisco. Personal Interview. 4 Nov. 2003
Dogra, Nisha., and David Stretch. “Developing a questionnaire to assess student awareness of the need to be culturally aware in clinical practice.” Medical Teacher 23 (2001) 59-64. Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Fadiman, Anne The Spirit Catches You And You Fall Down. New York: Farrar, Straus
and Giroux, 1997.

Jones, Marcy L. Nurse, Sequoia Hospital. Personal Interview. 28 Oct. 2003
Kai, Joe, et al. “Learning to value ethnic diversity-what, why, and how? Medical Education 33 (1999)616-623 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward, Ca. 30 Oct. 2003 <http://search.epnet.com/>

Montoya, Tala Nursing Instructor, College of San Mateo. Personal Interview. 1 Nov. 03.

Prideaux, David. “Cultural identity and representing culture in medical education. Who does it?” Medical Education 35 (2001): 186-187 Ebsco Host Academic Search Elite. Chabot College Lib., Hayward,Ca. 30 Oct. 2003<http://search.epnet.com/>

Quinn, Julianna Public Health Nurse, Alameda County. Personal Interview. 10 Nov. 2003.

Spector, Rachel E. Cultural Diversity in Health and Illness. 4th ed. Stamford: Appleton and Lange, 1996

Instructor end comment:

[An impressive, thoughtful paper! Your research is excellent, and while you can’t expect to answer all the problems of Western Medicine in one paper, you make a strong case for the value of improving cultural sensitivity training in medical education. Your paper is exceptionally well organized, and you weave examples from our class text in beautifully with your evidence from other sources. I really enjoyed reading this.]

** Minor mechanical errors/typos have been corrected by the creators of CHARLIE

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