The Spirit Catches You and You Fall Down by Anne Fadiman changed my perspective on medicine and culture. The story of an epileptic Hmong child, her American doctors, and the collision of two cultures changed Merced, CA in more profound ways. Merced is an agricultural town in California’s Central Valley where many Laotian refugees – US allies during the Vietnam War – settled in the late twentieth century. The saga of a toddler with a disease that Western medicine wants to treat aggressively, but is considered a mysterious gift among the Hmong, is a tragic epic of well intentioned people working at cross purposes.

The book raised awareness of medical / cultural dissonance across the country. In Merced, the book led to changes in medical protocol, integrated Hmong Shaman into the local hospital, and triggered the formation of Healthy House, a non-profit organization that provides education and translation services to Hmong and other non-English speaking groups, as well as cultural training for clinicians. Candice Adam-Medefind has been Director of Healthy House for five years.

Healthy House’s foundational work is providing medical translation in fourteen different languages to patients across the Central Valley. “Any provider who receives federal funding must provide translation services. Family members can provide translation, but we discourage it.” Translating within the family, usually younger generation to older, creates problems in comprehension; children often don’t understand the medical terms. It also violates cultural norms. Older people will not disclose personal issues, especially about their bodies, through their children. Professional translators are more effective.

Since the last group of Hmong refugees arrived in 2005, Healthy House’s work has expanded beyond direct medical services to include cultural and language classes for young Hmong. “We want to give them the tools to appreciate Hmong values – like respect for elders – in the context of the United States.

As second, and third generation Hmong live in Merced, they are becoming more integrated in the community. “A Hmong is leading our local redistricting effort. We have the first Hmong judge and a city councilwoman. Hmong are very community minded. The Kiwanis youth group is almost all Hmong kids. And my kids tell me they are really good a math, which makes it harder for everyone else.”

Healthy House’s challenges are becoming more refined. Living in a country with a different diet and less exercise, Hmong have developed adult-onset diabetes, a disease they call ‘sweet blood’. Healthy House has started an initiative to stem that trend. They also work with other minority communities in the Valley with culturally selective medical issues. “Right now we’re doing an African-American disparities project to increase breast feeding among new mothers and provide more breast cancer care among older women.”

Although Healthy House values integrating Hmong culture, sometimes the dissonance is so great they try to adapt Hmong values to American ones. “Powerful men in the Hmong community often practice polygamy. Sometimes they neglect the older women who are left. Late in life abuse of women is common.” Healthy House has started an ‘Honor Human Rights’ initiative to extend the respect Hmong children show their elders across the entire community, including elder males.

How will we live tomorrow?

“We will live in more diverse communities. We will have more multicultural conditions through marriage and shared culture.

“We have to act less like victims. Identity politics can be divisive as well as empowering. We have to be culturally sensitive yet not take offense so easily about cultural snubs. Look at the issues of men, boys, and race versus the police. We have to be comfortable about being uncomfortable. As director of a cultural program, I appreciate our need to be sensitive, but not to the point of being victims.

“People have abdicated our free speech rights. Students don’t value or even know what we’re entitled to under our free speech. Too many people take offense and then limit what’s acceptable speech.”