MHA 516 Phoenix Policy Change, Interacting with patients Please, read carefully each topic and answer the topic individually with no plagiarism or from oth

MHA 516 Phoenix Policy Change, Interacting with patients Please, read carefully each topic and answer the topic individually with no plagiarism or from other sources such as course hero, etc. Please use the book of Fadiman, Anne. (1998). The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.New York, NY: Noonday Press.

Fadiman, Anne. (1998). The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.New York, NY: Noonday Press.

Topic 1

Assignment Content

Review your leadership structure and identify the process by which you can propose a policy change and how that proposal would navigate through leadership to get approved.

Identify a policy in your organization that you think could be created or amended to improve organizational governance, operations, or compliance with federal or state regulations.

Write a 700- to 1,050-word paper that outlines your policy proposal ideas in which you do all of the following:

Provide an analysis of how your policy change would improve the organization.
Evaluate what changes in the organization would need to be made to implement the policy change.
Explain how you would advocate for your policy change while using the approval processes in your organization.

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Topic 2

Write a 175- to 265-word response to the following:

Was Lia’s life ruined by cross-cultural misunderstandings? Explain your thoughts.

Substantive messaging requires offering your own thoughts and ideas relating to the discussion question supported by citation(s) from two scholarly resources. All posts within this course must reflect scholarly quality.

Topic 3

Selecta health care facility or service (e.g., hospital, physician practice, long-term care facility, ambulance service, pharmacy, or skilled nursing facility)

Selecta culture, religion or ethnicity that requires specific health care accommodations.

In this scenario, you are administrators at a hospital that has seen an increase in the number of patients coming in for treatment that requires specific health care accommodations. As a result, hospital staff have repeatedly asked for more training to know how to more effectively interact with these patients.

Createa 3-5-minute speech to assist hospital staff with how best to interact with these patients. Cover the following in your speech: Cover each topic separately inside of the 3-5 minutes.

Review any policies that inform on this population
Cite any previous cases regarding the interaction between the health care industry and the culture, religion or ethnicity
Review best practices typical for an organization that you selected.
Identify internal resources that would be available at the organization you selected.
Identify organizations that can assist with the population you selected.

Please do not plagiarize and use valid citations. Praise for
The Spirit Catches You and You Fall Down
“Fadiman describes with extraordinary skill the colliding worlds of
Western medicine and Hmong culture.”
—The New Yorker
“This fine book recounts a poignant tragedy…It has no heroes or villains,
but it has an abundance of innocent suffering, and it most certainly does
have a moral…[A] sad, excellent book.”
—Melvin Konner, The New York Times Book Review
“An intriguing, spirit-lifting, extraordinary exploration of two cultures in
uneasy coexistence…A wonderful aspect of Fadiman’s book is her evenhanded, detailed presentation of these disparate cultures and divergent
views—not with cool, dispassionate fairness but rather with a warm,
involved interest that sees and embraces both sides of each issue…
Superb, informal cultural anthropology—eye-opening, readable, utterly
engaging.”
—Carole Horn, The Washington Post Book World
“This is a book that should be deeply disturbing to anyone who has given
so much as a moment’s thought to the state of American medicine. But it
is much more…People are presented as [Fadiman] saw them, in their
humility and their frailty—and their nobility.”
—Sherwin B. Nuland, The New Republic
“Anne Fadiman’s phenomenal first book, The Spirit Catches You and You
Fall Down, brings to life the enduring power of parental love in an
impoverished refugee family struggling to protect their seriously ill
infant daughter and ancient spiritual traditions from the tyranny of
welfare bureaucrats and intolerant medical technocrats.”
—Al Santoli, The Washington Times
“A unique anthropological study of American society.”
—Louise Steinman, Los Angeles Times
“Some writers…have done exceedingly well at taking in one or another
human scene, then conveying it to others—James Agee, for instance…
and George Orwell…It is in such company that Anne Fadiman’s writing
belongs.”
—Robert Coles, Commonweal
“When the Lees hedged their bets in 1982 in Merced by taking Lia to the
hospital after one of her seizures, everybody lost. Fadiman’s account of
why Lia failed to benefit over the years from Western medicine is a
compelling story told in achingly beautiful prose.”
—Steve Weinberg, Chicago Tribune
“A deeply humane anthropological document written with the grace of a
lyric and the suspense of a thriller.”
—Abby Frucht, Newsday
“Fadiman’s meticulously researched nonfiction book exudes passion and
humanity without casting a disparaging eye at either the immigrant
parents, who don’t speak English, or the frustrated doctors who can’t
decipher the baby’s symptoms…The Spirit Catches You and You Fall
Down conveys one family’s story in a balanced, compelling way.”
—Jae-Ha Kim, The Cleveland Plain Dealer
“Fadiman’s sensitive reporting explores a vast cultural gap.”
—People Magazine
“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
“The Spirit Catches You and You Fall Down is Fadiman’s haunting
account, written over a nine-year period, of one very sick girl in Merced,
California…What happens to Lia Lee is both enlightening and deeply
disturbing.”
—Kristin Van Ogtrop, Vogue
“Fadiman gives us a narrative as compelling as any thriller, a work
populated by the large cast of characters who fall in love with Lia. This is
a work of passionate advocacy, urging our medical establishment to
consider how their immigrant patients conceptualize health and disease.
This astonishing book helps us better understand our own culture even as
we learn about another—and changes our deepest beliefs about the
mysterious relationship between body and soul.”
—Elle
“The other day, I picked up a book I had no intention of buying. Eight
hours later, having lifted my head only long enough to pay for the book
and drive home, I closed Anne Fadiman’s The Spirit Catches You and You
Fall Down and started calling friends…This is an important book.”
—Wanda A. Adams, The Honolulu Advertiser
Contents
Preface
1 / Birth
2 / Fish Soup
3 / The Spirit Catches You and You Fall Down
4 / Do Doctors Eat Brains?
5 / Take as Directed
6 / High-Velocity Transcortical Lead Therapy
7 / Government Property
8 / Foua and Nao Kao
9 / A Little Medicine and a Little Neeb
10 / War
11 / The Big One
12 / Flight
13 / Code X
14 / The Melting Pot
15 / Gold and Dross
16 / Why Did They Pick Merced?
17 / The Eight Questions
18 / The Life or the Soul
19 / The Sacrifice
Note on Hmong Orthography, Pronunciation, and Quotations
Notes on Sources
Bibliography
Acknowledgments
Index
Preface
Under my desk I keep a large carton of cassette tapes. Even though they
have all been transcribed, I still like to listen to them from time to time.
Some of them are quiet and easily understood. They are filled with
the voices of American doctors, interrupted only occasionally by the
clink of a coffee cup or the beep of a pager. The rest of the tapes—more
than half of them—are very noisy. They are filled with the voices of the
Lees, a family of Hmong refugees from Laos who came to the United
States in 1980. Against a background of babies crying, children playing,
doors slamming, dishes clattering, a television yammering, and an air
conditioner wheezing, I can hear the mother’s voice, by turns breathy,
nasal, gargly, or humlike as it slides up and down the Hmong language’s
eight tones; the father’s voice, louder and slower and more vehement; and
my interpreter’s voice, mediating in Hmong and English, low and
deferential in each language. The hubbub summons a whoosh of sensememories: the coolness of the red metal folding chair, reserved for
guests, that was always set up as soon as I arrived in the apartment; the
shadows cast by the amulet that hung from the ceiling and swung in the
breeze on its length of grocer’s twine; the tastes of Hmong food, from the
best (quav ntsuas, a sweet stalk similar to sugarcane) to the worst (ntshav
ciaj, congealed raw pig’s blood).
I sat on the Lees’ red folding chair for the first time on May 19, 1988.
Earlier that spring I had come to Merced, California, where they lived,
because I had heard that there were some strange misunderstandings
going on at the county hospital between its Hmong patients and its
medical staff. One doctor called them “collisions,” which made it sound
as if two different kinds of people had rammed into each other, head on,
to the accompaniment of squealing brakes and breaking glass. As it
turned out, the encounters were messy but rarely frontal. Both sides were
*
*
wounded, but neither side seemed to know what had hit it or how to avoid
another crash.
I have always felt that the action most worth watching is not at the
center of things but where edges meet. I like shorelines, weather fronts,
international borders. There are interesting frictions and incongruities in
these places, and often, if you stand at the point of tangency, you can see
both sides better than if you were in the middle of either one. This is
especially true, I think, when the apposition is cultural. When I first came
to Merced, I hoped that the culture of American medicine, about which I
knew a little, and the culture of the Hmong, about which I knew nothing,
would in some way illuminate each other if I could position myself
between the two and manage not to get caught in the cross fire.
Nine years ago, that was all theory. After I heard about the Lees’
daughter Lia, whose case had occasioned some of the worst strife the
Merced hospital had ever seen, and after I got to know her family and her
doctors, and after I realized how much I liked both sides and how hard it
was to lay the blame at anyone’s door (though God knows I tried), I
stopped parsing the situation in such linear terms, which meant that
without intending to, I had started to think a little less like an American
and a little more like a Hmong. By chance, during the years I worked on
this book, my husband, my father, my daughter, and I all experienced
serious illnesses, and, like the Lees, I found myself spending a lot of time
in hospitals. I passed many hours in waiting rooms gnawing on the
question, What is a good doctor? During the same period, my two
children were born, and I found myself often asking a second question
that is also germane to the Lees’ story: What is a good parent?
I have now known the people in this book for much of my adult life. I
am sure that if I had never met Lia’s doctors, I would be a different kind
of patient. I am sure that if I had never met her family, I would be a
different kind of mother. When I pull a few cassettes from the carton
beneath my desk and listen to random snatches, I am plunged into a
pungent wash of remembrance, and at the same time I am reminded of
the lessons I am still learning from both of the cultures I have written
about. Now and then, when I play the tapes late at night, I imagine what
they would sound like if I could somehow splice them together, so the
voices of the Hmong and the voices of the American doctors could be
heard on a single tape, speaking a common language.
A.F.
1
Birth
If Lia Lee had been born in the highlands of northwest Laos, where her
parents and twelve of her brothers and sisters were born, her mother
would have squatted on the floor of the house that her father had built
from ax-hewn planks thatched with bamboo and grass. The floor was dirt,
but it was clean. Her mother, Foua, sprinkled it regularly with water to
keep the dust down and swept it every morning and evening with a broom
she had made of grass and bark. She used a bamboo dustpan, which she
had also made herself, to collect the feces of the children who were too
young to defecate outside, and emptied its contents in the forest. Even if
Foua had been a less fastidious housekeeper, her newborn babies
wouldn’t have gotten dirty, since she never let them actually touch the
floor. She remains proud to this day that she delivered each of them into
her own hands, reaching between her legs to ease out the head and then
letting the rest of the body slip out onto her bent forearms. No birth
attendant was present, though if her throat became dry during labor, her
husband, Nao Kao, was permitted to bring her a cup of hot water, as long
as he averted his eyes from her body. Because Foua believed that
moaning or screaming would thwart the birth, she labored in silence, with
the exception of an occasional prayer to her ancestors. She was so quiet
that although most of her babies were born at night, her older children
slept undisturbed on a communal bamboo pallet a few feet away, and
woke only when they heard the cry of their new brother or sister. After
each birth, Nao Kao cut the umbilical cord with heated scissors and tied it
with string. Then Foua washed the baby with water she had carried from
the stream, usually in the early phases of labor, in a wooden and bamboo
pack-barrel strapped to her back.
Foua conceived, carried, and bore all her children with ease, but had
there been any problems, she would have had recourse to a variety of
remedies that were commonly used by the Hmong, the hilltribe to which
her family belonged. If a Hmong couple failed to produce children, they
could call in a txiv neeb, a shaman who was believed to have the ability to
enter a trance, summon a posse of helpful familiars, ride a winged horse
over the twelve mountains between the earth and the sky, cross an ocean
inhabited by dragons, and (starting with bribes of food and money and, if
necessary, working up to a necromantic sword) negotiate for his patients’
health with the spirits who lived in the realm of the unseen. A txiv neeb
might be able to cure infertility by asking the couple to sacrifice a dog, a
cat, a chicken, or a sheep. After the animal’s throat was cut, the txiv neeb
would string a rope bridge from the doorpost to the marriage bed, over
which the soul of the couple’s future baby, which had been detained by a
malevolent spirit called a dab, could now freely travel to earth. One could
also take certain precautions to avoid becoming infertile in the first place.
For example, no Hmong woman of childbearing age would ever think of
setting foot inside a cave, because a particularly unpleasant kind of dab
sometimes lived there who liked to eat flesh and drink blood and could
make his victim sterile by having sexual intercourse with her.
Once a Hmong woman became pregnant, she could ensure the health
of her child by paying close attention to her food cravings. If she craved
ginger and failed to eat it, her child would be born with an extra finger or
toe. If she craved chicken flesh and did not eat it, her child would have a
blemish near its ear. If she craved eggs and did not eat them, her child
would have a lumpy head. When a Hmong woman felt the first pangs of
labor, she would hurry home from the rice or opium fields, where she had
continued to work throughout her pregnancy. It was important to reach
her own house, or at least the house of one of her husband’s cousins,
because if she gave birth anywhere else a dab might injure her. A long or
arduous labor could be eased by drinking the water in which a key had
been boiled, in order to unlock the birth canal; by having her family array
bowls of sacred water around the room and chant prayers over them; or, if
the difficulty stemmed from having treated an elder member of the
family with insufficient respect, by washing the offended relative’s
fingertips and apologizing like crazy until the relative finally said, “I
forgive you.”
Soon after the birth, while the mother and baby were still lying
together next to the fire pit, the father dug a hole at least two feet deep in
the dirt floor and buried the placenta. If it was a girl, her placenta was
buried under her parents’ bed; if it was a boy, his placenta was buried in a
place of greater honor, near the base of the house’s central wooden pillar,
in which a male spirit, a domestic guardian who held up the roof of the
house and watched over its residents, made his home. The placenta was
always buried with the smooth side, the side that had faced the fetus
inside the womb, turned upward, since if it was upside down, the baby
might vomit after nursing. If the baby’s face erupted in spots, that meant
the placenta was being attacked by ants underground, and boiling water
was poured into the burial hole as an insecticide. In the Hmong language,
the word for placenta means “jacket.” It is considered one’s first and
finest garment. When a Hmong dies, his or her soul must travel back
from place to place, retracing the path of its life geography, until it
reaches the burial place of its placental jacket, and puts it on. Only after
the soul is properly dressed in the clothing in which it was born can it
continue its dangerous journey, past murderous dabs and giant poisonous
caterpillars, around man-eating rocks and impassable oceans, to the place
beyond the sky where it is reunited with its ancestors and from which it
will someday be sent to be reborn as the soul of a new baby. If the soul
cannot find its jacket, it is condemned to an eternity of wandering, naked
and alone.
Because the Lees are among the 150,000 Hmong who have fled Laos
since their country fell to communist forces in 1975, they do not know if
their house is still standing, or if the five male and seven female
placentas that Nao Kao buried under the dirt floor are still there. They
believe that half of the placentas have already been put to their final use,
since four of their sons and two of their daughters died of various causes
before the Lees came to the United States. The Lees believe that someday
the souls of most of the rest of their family will have a long way to travel,
since they will have to retrace their steps from Merced, California, where
the family has spent fifteen of its seventeen years in this country; to
Portland, Oregon, where they lived before Merced; to Honolulu, Hawaii,
where their airplane from Thailand first landed; to two Thai refugee
camps; and finally back to their home village in Laos.
The Lees’ thirteenth child, Mai, was born in a refugee camp in
Thailand. Her placenta was buried under their hut. Their fourteenth child,
Lia, was born in the Merced Community Medical Center, a modern
public hospital that serves an agricultural county in California’s Central
Valley, where many Hmong refugees have resettled. Lia’s placenta was
incinerated. Some Hmong women have asked the doctors at MCMC, as
the hospital is commonly called, if they could take their babies’ placentas
home. Several of the doctors have acquiesced, packing the placentas in
plastic bags or take-out containers from the hospital cafeteria; most have
refused, in some cases because they have assumed that the women
planned to eat the placentas, and have found that idea disgusting, and in
some cases because they have feared the possible spread of hepatitis B,
which is carried by at least fifteen percent of the Hmong refugees in the
United States. Foua never thought to ask, since she speaks no English,
and when she delivered Lia, no one present spoke Hmong. In any case,
the Lees’ apartment had a wooden floor covered with wall-to-wall
carpeting, so burying the placenta would have been a difficult
proposition.
When Lia was born, at 7:09 p.m. on July 19, 1982, Foua was lying on
her back on a steel table, her body covered with sterile drapes, her genital
area painted with a brown Betadine solution, with a high-wattage lamp
trained on her perineum. There were no family members in the room.
Gary Thueson, a family practice resident who did the delivery, noted in
the chart that in order to speed the labor, he had artificially ruptured
Foua’s amniotic sac by poking it with a foot-long plastic “amni-hook”
that no anesthesia was used; that no episiotomy, an incision to enlarge the
vaginal opening, was necessary; and that after the birth, Foua received a
standard intravenous dose of Pitocin to constrict her uterus. Dr. Thueson
also noted that Lia was a “healthy infant” whose weight, 8 pounds 7
ounces, and condition were “appropriate for gestational age” (an estimate
he based on observation alone, since Foua had received no prenatal care,
was not certain how long she had been pregnant, and could not have told
Dr. Thueson even if she had known). Foua thinks that Lia was her largest
baby, although she isn’t sure, since none of her thirteen elder children
were weighed at birth. Lia’s Apgar scores, an assessment of a newborn
infant’s heart rate, respiration, muscle tone, color, and reflexes, were
good: one minute after her birth she scored 7 on a scale of 10, and four
minutes later she scored 9. When she was six minutes old, her color was
described as “pink” and her activity as “crying.” Lia was shown briefly to
her mother. Then she was placed in a steel and Plexiglas warmer, where a
nurse fastened a plastic identification band around her wrist and recorded
her footprints by inking the soles of her feet with a stamp pad and
pressing them against a Newborn Identification form. After that, Lia was
removed to the central nursery, where she received an injection of
Vitamin K in one of her thighs to prevent hemorrhagic disease; was
treated with two drops of silver nitrate solution in each eye, to prevent an
infection from gonococcal bacteria; and was bathed with Safeguard soap.
Foua’s own date of birth was recorded on Lia’s Delivery Room
Record as October 6, 1944. In fact, she has no idea when she was born,
and on various other occasions during the next several years she would
inform MCMC personnel, through English-speaking relatives such as the
nephew’s wife who had helped her check into the hospital for…
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