Incorporating Compassion into our Discussion on Cultural Assimilation

Understanding the Hmong’s political history with the United States is important because it is very reflective of how the Lee family experienced the US. The Lee’s distrust of the American medical system stems from a deep betrayal of the American government: the U.S. pulled out of Vietnam, despite promises of protection to the Hmong people who fought on the side of the Americans. The withdrawal of troops resulted in mass killings of Hmong people which forced them to leave their homeland to seek refuge. Many believed that by leaving their homeland and reestablishing themselves in the U.S. they could provide more stability in their cultural beliefs (Fadiman, 1997). The idea of America as a “cultural melting pot” seems far from reality as we track the Lee’s existence. Dealing with America’s medical system proved almost as frustrating as it was to read. The biomedicine of the west paid no cultural respect to the Lee family as they struggled with their daughter, Lia, and her diagnosis of severe epilepsy.

Thinking of the Hmong political history, it is easy to empathize with the Lee’s hesitance to trust their doctors. After experiencing a genocidal tragedy that stemmed from an unfulfilled promise of security, coupled with the sheer culture shock that the Hmong people experienced after moving to the U.S., must have created an even greater divide between the two societies. The Hmong people left behind their home, which was rooted in such deep tradition, and lost much of what they left. The dispute between Lia’s family and their doctor’s treatments was simply the “icing on the cake”. This book was truly about cultural understanding and learning how to “walk a mile” in another shoes.

In chapter 18 of Anne Fadiman’s book (The Spirit Catches You and You Fall Down) there is a wonderful passage that describes the anthropology of biomedical doctors, and how they become so separated from their human “subjects”. It goes into detail about the high demand of their job, which places such a large emphasis on not letting people die, that they dissociate to escape from becoming “overwhelmed by their chronic exposure to suffering and despair” (Fadiman, 1997). I found this similar to compassion fatigue that is experienced by many social work colleagues. They get into the business because they care so much about helping people, but they realize so fast that there is so much trauma in the world that they become almost desensitized from the horrors they intercept daily. According to a study in a Secondary Traumatic Stress journal, compassion fatigue is a large problem facing the U.S. and must be dealt with by therapeutic interventions that assist the professionals by helping them understand their feelings and allowing them to talk about their experiences. This “burnout” experienced by many health professionals could be a factor in the cultural discrepancies that happen between doctors and patients much like that of the Lee family (Figley, 1995). Educating our professionals to become more culturally aware and tolerant is important.  Fighting for policies that encourage an open and equal, trusting relationship between patients and doctors is important. However, to improve our medical field I believe that equipping our medical professionals with necessary therapies to help reduce the impact compassion fatigue could have on their practice would be widely beneficial to the whole medical field.


  1. Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux, 1997.
  2. Figley, Charles R., and Hudnall B. Stamm, Ed. “Compassion Fatigue: Toward a New Understanding of the Costs of Caring.” American Psychological Association. Secondary Traumatic Stress: Self-care Issues for Clinicians, Researchers, and Educators, 1995.

4 thoughts on “Incorporating Compassion into our Discussion on Cultural Assimilation

  1. Hi Lindsey, I really liked your post. I enjoy how you mentioned America as the cultural melting pot. While even I, a patriotic American, would love to believe that this country is as welcoming to other cultures as we like to say we are, that truly is far from realty. It is true that the journey of the Lee family shines some light on the issue. As an American born, it is hard to see other ways of life in other countries and think of it as more ideal that the American life I am so used to. The way I want to study the American medical field, the way it is glorified, the way that we all look up to doctors as leaders and intellectuals, it’s all very westernized. In other cultures, like Hmong culture, it is the Shaman’s that are looked up to and thought of as the intellectuals. Who are we to say that that’s not correct, or that they don’t know anything about medicine? They could say the same about us; they could frown upon our lack of connection with our patients, much like the Lee family discovered. Like you mentioned, our biomedical doctors become to separated from their patients so much so that they only see them as “subjects.” Embarrassingly enough, in the book we have been reading, Fadiman mentions that one doctor had completely disregarded his patient’s (Lia’s) sex, having called “her” a “he” for the longest time. I love the term you use, “compassion fatigue,” because it properly describes how a lot, not all, but a lot of our modern day healthcare systems treat their patients. I hate to agree because I am proud supporter of how far our technology and medicine has come, but I do empathize with the Lee family when they say that they can’t trust our health care system.

  2. You bring up a very interesting point about the compassion fatigue that many doctors and health professionals could potentially be feeling due to the stressful nature of their job. This was something that I did not think about when I was writing my post, but I think that this is a critical matter that needs to be addressed. A health professional who is experiencing compassion fatigue will not be able to function properly or carry out his or her duties to the best of their abilities. Due to this, their patients will not receive the level of care that they are expecting or deserve. This fatigue can also compound the already present issue of cultural differences, and add to the tensions that can arise when two different views clash. Not having compassion and being “burned out” will not allow the doctor or other health professional to be accommodating or make an attempt to understand the cultural perspective of their patient. Implementing the “necessary therapies”, as you stated, to teach medical professionals how to deal with the stress of their job and to help combat the occurrence of compassion fatigue will allow more successful integration of policies that facilitate a better working relationship between doctors and their culturally diverse patients.

  3. Lindsey,
    Your article was very well written. I also wrote about how America is viewed as the “cultural melting pot,” yet many people still face cultural insensitivity every day. The simulation video that we watched really put into perspective for me how the Lees and other Hmong people felt making the journey to the U.S. after already being betrayed by us once. We did not set them up for success coming in, rather we set them up for struggle in every way possible: culturally, emotionally, mentally and physically. That is hardly the protection that was promised for their people during the war, so how could they expect to come here and be taken good care of medically? There was no cultural respect in biomedicine, so there was no protection offered for Lia Lee’s soul while at the MCMC.
    The same passage that you mentioned from Chapter 18 of the book really hit me when I read it. The repeated exposure of doctors and nurses to patient suffering and despair can really overwhelm and wear a person down (Fadiman). As a person who works in the healthcare field, I’ve seen how the burnout affects the staff as they try to accommodate every patient. Twelve-hour shifts that are physically demanding are easy to drain a person of compassion, as tiredness outweighs every other feeling. I also researched the term compassion fatigue, and the numbers were not surprising. According to one study, almost 82% of emergency nurses at the time of the study had high levels of burnout, and 86% of the nurses were severely compassionate fatigued. Although, reading the results, ICU nurses have a higher risk for burnout compared to emergency nurses, and oncology experiences more frequent compassion fatigue (Hooper et al). This is not surprising though, as these are some of the hardest units to work in with higher rates of patient loss. Emergency nurses are constantly seeing a stream in of patients and must work fast to fulfill their needs, whereas ICU nurses must work quickly and effectively to keep the patient stable. Meanwhile, oncology staff experience compassion fatigue as an effort to distance himself or herself from the patient in order to leave emotions aside. Ultimately, I agree that therapeutic interventions would benefit both the patient and the health care staff in an effort to minimize their stress and maximize their practice of holistic care.

    Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux, 1997.

    Hooper, Crystal, Janet Craig, David R. Janvrin, Margaret A. Wetsel, and Elaine Reimels. Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties. 5th ed. Vol. 36. South Carolina: Journal of Emergency Nursing, 2010.

  4. Hey Lindsey, I really enjoyed reading your post! I really never thought about compassion fatigue being a factor for doctors and nurses and the effect that definitely would have on patients. I absolutely agree that doctors often dehumanize patients in an effort to deal with the demands of their job. This can have a drastic effect on patient care especially when dealing with refugee patients who really require the extra effort in order to be properly educated with their health. I really liked how you suggested therapy for doctors dealing with burnout, as the daughter of a physician, I think that would prove to be very beneficial. Doctors often work long hours and are not given the proper amount of resting time in between, I think that therapy would be something very interesting for hospitals to try. I also really feel that if doctors were properly educated on respecting cultures and traditions different than their own it would really improve patient care. Too often are walls put up between the patient family and the doctor when there is a difference in beliefs. It’s really up to doctors to move past this barrier and educate themselves to benefit the patient. Overall, I really liked your post and felt that you brought up some really unique points.

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