Miscommunication and disaster: lessons from Anne Fadiman

Anne Fadiman’s National Book Critics Circle award-winning book The Spirit Catches You and You Fall Down is the story of a young Hmong girl with epilepsy. Her parents speak no English and are completely unaware of anything related to modern medicine, and the doctors that treat her know almost nothing about the Hmong and their culture. Not surprisingly, the two parties constantly clash over her treatment. The parents see the doctors as endangering both their daughter’s life and her soul, the doctors see the parents as willfully ignorant and non-compliant. In the end, tragedy strikes.

Much of the book focuses on the cultural and religious divide between the family and the doctors, and how this leads to disaster. And while both of those factors certainly come into play, I was struck by a simpler matter that also played a role: miscommunication. Some of this is no doubt due to the cultural elements in play as well as the lack of a common language, but there are more basic examples of that. For example, when the girl is placed into foster care because of the parents’ noncompliance in giving her anti-seizure medication, her foster mother notices that her current medication combination created such disorientation that she couldn’t walk or move. She aptly notes that her parents might have refused to give her the medication because of that. But they had no way to communicate that, and the doctors had no way to know that was happening without a translator. Similarly, the girl’s seizures weren’t recognized for some time because every time she was initially taken to the ER she had stopped seizing and her parents weren’t able to communicate what had happened.

In any medical business that targets patients or the general public instead of medical professionals, the same miscommunication can happen. While in this case both parties are speaking English, the business leaders, who have been immersed in medical technical terms, may not realize that they are not communicating effectively. This leads to loss of sales and less room to grow.

Fadiman faces the same difficulties the doctors did when they attempted to communicate with the family. However, she is able to quickly gain a rapport with them and learns their version of the story. Like the doctors, she doesn’t speak their language or know anything about their culture. So what did she do? She looked for an interpreter, but she calls the woman she eventually worked with a “cultural broker.” The interpreter had connections to both Hmong society and what we think of as traditional American society, and she was able to bridge the gaps for Fadiman in ways the doctors could not.

A cultural broker sounds like a big role, but it wasn’t a matter of anything complex in the end; it was just a matter of knowing the ways of both sides and being willing to listen. A good medical business knows the best way to reach out is to find someone who speaks both languages and is comfortable in both worlds. And just like finding that broker involved asking the right questions, effective communication in the medical field means finding someone who knows the right answers.