If you are a lover of non-fiction, then perhaps you can overlook my lack of stars. This particular story is truly fascinating and is told in a wonderful manner. I have gained a wealth of knowledge from it. The author has the remarkable ability to evoke emotions within me. When she intended to make me angry, I found myself seething, and when she aimed to make me sad, my heart ached.

While narrating a sweet and yet heartbreaking tale, she has also exposed the significant cultural divide that exists between Hmong and Western medicine. This has made me reflect upon and examine my own cultural biases. The topic is indeed highly thought-provoking. It has all the elements that one could hope for in a good non-fiction book. I anticipate that the majority of people would take great pleasure in reading this book.

However, there is one aspect that slightly dampens my reading experience. Anytime I come across a footnote that is not there for comical purposes, a great deal of the joy seems to drain away.

It's not your fault, non-fiction books with never-ending titles. It's just me. I have truly learned a great deal from you, and I have no regrets. We both understand that you are probably better off without me. But that doesn't mean we can't still be friends. In fact, I even know the perfect reader for you, and I'll do my best to set you up with them.

I really liked this book a great deal.

Before reading it, I had no knowledge whatsoever about the Hmong people and their rich history.

The author's approach was truly engaging. They took the captivating story of Lia and then skillfully wove in all the surrounding background and historical details of the Hmong people.

This made the entire narrative extremely interesting and informative.

Moreover, just when the book seemed to be getting a little long-winded and repetitive, it came to a timely end.

This was a great relief as it kept the reader's attention intact until the very last page.

Overall, it was a wonderful read that not only entertained but also educated me about a culture and people I previously knew nothing about.

Journalist Anne Fadiman's 1997 work, "The Spirit Catches You and You Fall Down," is a captivating and nuanced medical and intercultural drama that centers around the crucial theme of communication.

Fadiman dedicated years to delving into the story of Lia Lee (1982 - 2012), a first-generation Hmong child. Her parents had fled Laos for the US in the 1970s. Lia developed epilepsy at an early age, which unfortunately led to significant conflicts. The Lee family's cultural and spiritual understanding of her illness clashed with the interventions of the Western medical system. In the 1980s, this communication gap seemed insurmountable. Lia was even temporarily taken away from her parents' custody before being returned. Tragically, at around four years old, Lia developed septic shock and brain death. She then existed in a persistent vegetative state under her family's care until her other organ systems failed at the age of thirty.

As a physician, I can empathize with the challenges that many members of the medical care team faced when dealing with the Lee family. Although Fadiman's 2012 afterward was optimistic, suggesting that medical schools were incorporating formalized cultural training in the 2010s, this wasn't always the case in my own medical school experience during that decade. Similar to the 1980s doctors Fadiman wrote about, our training mainly came from practical experience and trial and error. Even when patients' languages, cultures, socioeconomic, and ancestral backgrounds seem similar to ours, there are always gaps, and sometimes these can be as deep as chasms.

Further reading:
When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri | my review
Being Mortal: Medicine and What Matters in the End by Atul Gawande

My statistics:
Book 100 for 2025
Book 2026 cumulatively

A poignant and beautifully written narrative unfolds, shedding light on the detrimental effects of miscommunication and the presence of culture and language barriers in the medical field. In a hospital setting, patients from diverse backgrounds often find themselves at a disadvantage due to these obstacles. The inability to effectively communicate symptoms, concerns, and medical history can lead to misdiagnoses, inappropriate treatments, and a general sense of frustration and fear for the patients.

Culture plays a significant role as well. Different cultures may have varying beliefs and attitudes towards health, illness, and medical procedures. These cultural differences can sometimes clash with the Western medical model, further complicating the communication process. For example, some patients may be reluctant to ask questions or express their doubts, believing it to be disrespectful to the medical professionals.

Language barriers are perhaps the most obvious challenge. When patients do not speak the same language as their doctors and nurses, it becomes extremely difficult to convey important information accurately. This can result in misunderstandings and errors that can have serious consequences for the patient's health.

In conclusion, it is essential for the medical field to address these issues and find ways to improve communication and bridge the culture and language gaps. This could involve providing interpreter services, training medical staff in cultural competence, and using more patient-friendly communication techniques. By doing so, we can ensure that all patients receive the best possible care, regardless of their background or language.

Subtitle: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

The 150,000 Hmong refugees who came to the United States in the late 1970s found themselves in a completely foreign land and culture. The Lee family, having fled their native village in the hills of Laos, settled in Merced, California. In July 1982, Foua Yang gave birth to her fourteenth child, Lia. She was adored and pampered as the "baby" of the family.

However, when Lia was about three months old, she had a seizure. Her parents believed it was caused by her older sister slamming the front door, attracting a spirit that caught Lia's soul. The Hmong call this condition quag dab peg and consider it an honor, as the child might grow up to be a shaman. But the frequency and severity of the seizures worried Foua and Nao Kao, so they took Lia to the Merced County Medical Center Emergency Room. There, the lack of a common language and trained interpreters, along with the clash of cultures, led to disastrous results.

This is a captivating medical mystery and a balanced exploration of two very different perspectives. No one had malicious intent; everyone wanted what was best for Lia. But there was no way for the two opposing sides - Lia's parents and community vs the doctors and social workers - to reach an agreement. And Lia was the one who suffered.

I thought the book could have benefited from more editing. Maybe Fadiman thought the reader needed a lot of repetition to understand the message, and she might be right. But I didn't really need to be told again that the Lees believed a spirit was the cause of Lia's problems, or that they thought the medicine made her worse, or that the doctors thought the Lees were difficult or bad parents.

Still, I was really engaged by the story and appreciated learning more about the Hmong culture. I'm looking forward to discussing this book in my face-to-face book club.

The parents of a small boy took an astonishing action. They emptied his intravenous bottle and refilled it with a green slime of unknown ingredients - a herbal home brew that had been made by the Hmong parents for ages.

Hmong patients also caused quite a stir in the hospital. They made a lot of noise, which greatly annoyed their American counterparts. Sometimes, they even wanted to slaughter animals in the parking lot or the hospital room of a sick relative. One resident vividly recalls that they would "bang the crap out of some musical instrument" while visiting sick relations, and the nearby American patients would complain. Eventually, the hospital staff had to have a serious talk with them and firmly tell them, "No Gongs and No Dead Chickens!"

Moreover, the customs they were supposed to follow were numerous and seemed rather peculiar. The rules and regulations were difficult to learn, and many Hmong people were simply overwhelmed. Some newcomers had rather strange behaviors. They wore nightgowns as street clothes, poured water on electric stoves to put them out, lit charcoal fires in their living rooms, stored blankets in their refrigerators, washed rice in the toilet, washed clothes in swimming pools, washed their hair with Lestoil, cooked dinner with motor oil and furniture polish, drank Clorox bleach, ate cat food, planted crops in public parks, shot and ate skunks, woodpeckers, porcupines, robins, sparrows, egrets, and even a bald eagle, and hunted pigeons with a crossbow in the city streets of Philadelphia.

These incidents highlight the cultural differences and challenges that arose when the Hmong community interacted with the American medical and social environment.

This is probably the first book that I have ceased reading not due to the fact that it offended me in some manner, whether it be the content or the poor writing. Instead, it is because I could clearly envision the direction it was headed, and it simply did not seem worthwhile for me to continue pursuing it.

In case you are contemplating reading this book, allow me to spare you the time. The central theme appears to be that doctors, particularly those in America, believe their knowledge to be vastly superior to that of under-developed countries or ethnicities, simply because it is founded on "science." They seemingly never take the time to inquire or attempt to understand how another culture might perceive things, despite generally having good intentions.

Yes, that essentially sums up the book. If this seems like an intriguing premise to you, and you would enjoy hearing it repeated in various forms and anecdotes over the course of a few hundred pages, then this is not a bad read. Apart from the rather biased "objective" tone that the author adopts, the writing is quite good, and the story progresses fairly smoothly. However, I simply was not overly interested in it.

A little Hmong girl forcefully slammed the front door just once, and her three-month-old sister had what the medical community refers to as an epileptic seizure. The Hmong family, however, called it quag dab peg, which means "the spirit catches you and you fall down". This incident marked the start of a long series of similar seizures and also the beginning of numerous difficulties between the Hmong and American cultures.

Lia Lee and her family were refugees residing in Merced, CA when the spirit first took hold of Lia in this manner. Lia soon became well-known at the medical center where she was taken every time she fell ill. But the medical community is vastly different from the Hmong culture, with a distinct set of beliefs, rules, and expectations. The physicians at the medical center aimed to treat Lia with medication right from the start. However, the language barrier made this a challenging task. Not to mention, the medications contradicted the Lee family's entire belief system. On the part of the Lee family, they met the doctors with distrust and suspicion. Meanwhile, on the physician side, they often met the Lees with disgust and accusations of non-compliance.

This was an extremely difficult book for me to read. I work in a medical environment and clearly witness the positive impacts of medication and surgery. But I can also understand the other side of this story. A family that doesn't speak English, seeing things being administered to their daughter with very little explanation, being told that if they don't do x then y would occur, and being told that everything they have practiced for years (which may seem to most Americans as simply naively superstitious). I can't fathom the fear that the family must have felt. Every culture believes they know best, that their practices are the most appropriate, and that everything else is inferior.

I had to read this book slowly, in small portions, because I would find myself getting frustrated with the Lee family in the same way the physicians were frustrated with them. I would find myself saying, "If you just gave Lia the medication as the doctors instructed, she wouldn't be so sick...", and then immediately I would feel disgusted with myself. At other times, I found myself saying, "American doctors have no idea - listen to your patients...", and I found myself questioning the things I say and do every single day at work. I found myself on both ends of the spectrum, and each time I had that overwhelming sense of frustration, I knew it was time to put the book down. This, I imagine, is what Anne Fadiman intended when she wrote this book. She wants her readers to be able to view both sides of the story, realizing that neither one is particularly right nor is either side particularly wrong. It's a fine and delicate line that must be walked, but who can say which is the correct way to walk it?

The original article is not provided, so I can't rewrite and expand it specifically. However, I can give you a general example of how to expand an article to about 300 words.

Let's assume the original article is: "The cat is sitting on the mat. It is a black cat. The mat is red."

Here is the expanded version:

The cat is sitting on the mat.

It is a beautiful black cat with sleek fur that shines in the sunlight.

The mat on which it is sitting is a vibrant red, adding a pop of color to the otherwise ordinary scene.

The cat seems to be enjoying the warmth and comfort of the mat, its eyes half-closed in a state of relaxation.

Perhaps it is thinking about its next adventure or simply taking a break from the hustle and bustle of the world.

As I watch the cat, I can't help but smile at its cuteness and the simplicity of the moment.

It is these small, ordinary scenes that often bring the most joy and beauty into our lives.

You can provide the original article, and I will rewrite and expand it according to your specific requirements.

The three stars is actually closer to four, but I don't think it quite deserved four.

While the book is very informative, I found the dreadfully long historical chapters rather detracted from it.

However, it was an excellent exploration of the struggles between vastly different cultures in a patient-doctor situation.

I found myself extremely annoyed and frustrated with the Hmong. Yet, it was difficult for me to truly hate or be angry at them because they did everything to the best of their knowledge to help Lia.

I badly want to say their culture is wrong, but that isn't true. In many ways, it is more pure than our own.

Still, I can't help but think how much their ignorance in medicine, logic, and reasoning hurts them and how many people have died because of their religious beliefs.

And then, in an ironic way, their strong superstitious beliefs bring out so many good aspects in their culture and even provide a psychological healing aspect.

It almost acts like a placebo where if they think they are being healed, they get better. And I would attribute that effect to all religions.

In the book, the question was raised: is it better to save the life or the soul? And that was what the struggle of the book was really about.

The doctors were trying to save a life, and the Lees were trying to save a soul. They failed to communicate this to each other, and as a result, Lia was the one who suffered.

This is an outstanding piece of journalistic nonfiction. It commences with a toddler named Lia Lee, who resided in California during the 1980s. The daughter of Hmong refugees, Lia started experiencing epileptic seizures as an infant. However, her treatment went awry as her parents and the American doctors failed to understand and respect each other. The book then expands, delving into the history and culture of the Hmong, their involvement in the U.S.’s secret war in Laos, and their subsequent refugee experiences. It also pertains to medicine, the goals of American medicine, and what it means for healthcare providers to be culturally competent.

Fadiman manages to pack an astonishing amount of content into just 300 pages (including the 2012 afterword, which is a must-read). And it is executed brilliantly. She conveys a wealth of information in an accessible and captivating manner, making the book a real page-turner. I breezed through it in just a few days. She is an excellent storyteller, constantly keeping the reader eager for more. At the same time, she shows humility and a willingness to engage with difficult issues. She presents arguments from multiple viewpoints, all empathetically. She is not afraid of facts that oppose her arguments, nor does she summarily dismiss opposing opinions. After grappling with the collision of two cultures herself, she emerges able to depict both worldviews, recognizing the merits in everyone's arguments and seeking better systems to solve problems rather than assigning blame to individuals.

Overall, it is an incredibly comprehensive, thoughtful, and engaging work that I would highly recommend, regardless of whether you are in the medical field (I am not). Fortunately, one can now also read memoirs by Hmong authors, such as The Latehomecomer, which closely tracks the experiences recorded in this book but from a first-person perspective.

Amazing book.

In my work dealing with people who have developmental disabilities and epilepsy, I have witnessed numerous instances of the disconnection between doctor and patient. This is the case even when both parties speak the same language and share a common cultural understanding of their respective roles.

This book presents the tale of an extreme example. Here, the patient's parents not only failed to understand the doctors but also did not trust them. Conversely, the medical system was equally unable to comprehend the family's perspective.

In telling this one story, the author delves into the history and culture of the Hmong people, both in Laos and the US. It is a narrative that is both captivating and heart-wrenching.

My one initial annoyance was with the author's consistent use of the term "epileptic". Currently, this term is highly unfavored, but it was not so at the time when she wrote the book. The preferred term nowadays is "people with epilepsy", as it emphasizes that individuals with the disorder are not defined solely by their symptoms.

However, as I progressed through the book, I became accustomed to her archaic terminology. I am certain that the author would be the first to concur with the spirit underlying this change.