The first chapter of Anne Fadiman's The Spirit Catches You and You Fall Down sets the stage for the frustrating cross-cultural conflicts that took place in Merced, in Central California. Language barriers and belief system differences prevented Lia from receiving optimal care, even though both her family and the doctors did their absolute best to help her epilepsy. Although Fadiman focuses on the Hmong and their encounters with the Western medical system, The Spirit Catches You and You Fall Down describes a universal phenomenon. Not far into the book readers can see that what Fadiman presents is more than the story about Lia Lee. The lessons learned from Lia's story can and should be applied universally. Lia's story simply provides an extreme example of what occurs everyday in health care. Doctors and other health care practitioners assume a lot about their patients and their patients' families. In many cases they presume ignorance, assuming a paternalistic attitude toward patient care plans. In other situations, health care practitioners fail to explain adequately the decisions faced by the patient, the ramifications of each decision, and the potential alternatives to established procedures. The Lee's story is not necessarily about non-compliance, although non-compliance is an underlying theme in the book.
             One of the most important and also most obvious communication barriers Fadiman describes in The Spirit Catches You is language. Hmong language is so rare that translation was often impossible. Body language and facial gestures provided some of the only means by which the Lees and the medical staff at the Merced Community Medical Center could communicate. Because the Hmong community grew so large in California greater attention was paid to the need for translation during such critical situations. Successive patients and generations were able to communicate more effectively with their health care staff. What the Lees encountered co...