The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman, Anne Fadiman (Preface by)

From the Publisher

Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.

Carole Horn

Superb, informal cultural anthropology — eye-opening, readable, utterly engaging. —The Washington Post Book World

Sherwin B. Nuland

I cannot think of a book by a non-physician that is more understanding of the difficulties of caring for peoplke. . .or of the conditions under which today's medicine is practiced. —The New Republic

Publishers Weekly

When two divergent cultures collide, unbridgable gaps of language, religion, social customs may remain between them. This poignant account by Fadiman, editor of The American Scholar, of the clash between a Hmong family and the American medical community reveals that among the gaps yawns the attitude toward medicine and healing. The story focuses on Lia Lee, whose family immigrated to Merced, Calif., from Laos in 1980. At three months of age, Lia was diagnosed with what American doctors called epilepsy, and what her family called quag dab peg or, 'the spirit catches you and you fall down.' Fadiman traces the treatments for Lia's illness, observing the sharp differences between Eastern and Western healing methods. Whereas the doctors prescribed Depakene and Valium to control her seizures, Lia's family believed that her soul was lost but could be found by sacrificing animals and hiring shamans to intervene. While some of Lia's doctors attempted to understand the Hmong beliefs, many interpreted the cultural difference as ignorance on the part of Lia's parents. Fadiman shows how the American ideal of assimilation was challenged by a headstrong Hmong ethnicity. She discloses the unilateralness of Western medicine, and divulges its potential failings. In Lia's case, the two cultures never melded and, after a massive seizure, she was declared brain dead. This book is a moving cautionary tale about the importance of practicing 'cross-cultural medicine,' and of acknowledging, without condemning, differences in medical attitudes of various cultures.'

Library Journal

Award-winning reporter Fadiman has turned what began as a magazine assignment into a riveting, cross-cultural medicine classic in this anthropological exploration of the Hmong population in Merced County, California. Following the case of Lia (a Hmong child with a progressive and unpredictable form of epilepsy), Fadiman maps out the controversies raised by the collision between Western medicine and holistic healing traditions of Hmong immigrants. Unable to enter the Laotian forest to find herbs for Lia that will 'fix her spirit,' her family becomes resigned to the Merced County emergency system, which has little understanding of Hmong animist traditions. Fadiman reveals the rigidity and weaknesses of these two ethnographically separated cultures. In a shrinking world, this painstakingly researched account of cultural dislocation has a haunting lesson for every healthcare provider. -- Rebecca Cress-Ingebo, Fordham Health Sciences Library, Wright State University, Dayton, Ohio

School Library Journal

A compelling anthropological study. The Hmong people in America are mainly refugee families who supported the CIA militaristic efforts in Laos. They are a clannish group with a firmly established culture that combines issues of health care with a deep spirituality that may be deemed primitive by Western standards. In Merced, CA, which has a large Hmong community, Lia Lee was born, the 13th child in a family coping with their plunge into a modern and mechanized way of life. The child suffered an initial seizure at the age of three months. Her family attributed it to the slamming of the front door by an older sister. They felt the fright had caused the baby's soul to flee her body and become lost to a malignant spirit. The report of the family's attempts to cure Lia through shamanistic intervention and the home sacrifices of pigs and chickens is balanced by the intervention of the medical community that insisted upon the removal of the child from deeply loving parents with disastrous results. This compassionate and understanding account fairly represents the positions of all the parties involved. The suspense of the child's precarious health, the understanding characterization of the parents and doctors, and especially the insights into Hmong culture make this a very worthwhile read. -- Frances Reiher, Fairfax County Public Library, Virginia

Richard Bernstein

Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different.--The New York Times

Carole Horn

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 . . . Fadiman's book is superb, informal cultural anthropology--eye-opening, readable, utterly engaging.--The Washington Post Book World

Melvin Konner

This fine book recounts a poignant tragedy. . . It has no heroes or villains, but it has an abunance of innocent suffering, and it most certainly does have a moral. . .[A] sad, excellent book. -- The New York Times Book Review

Sherwin B. Nuland

I cannot think of a book by a non-physician that is more understanding of the difficulties of caring for peoplke. . .or of the conditions under which today's medicine is practiced. -- The New Republic

Carole Horn

Superb, informal cultural anthropology -- eye-opening, readable, utterly engaging. -- The Washington Post Book World

Kirkus Reviews

A vivid, deeply felt, and meticulously researched account of the disastrous encounter between two disparate cultures: Western medicine and Eastern spirituality, in this case, of Hmong immigrants from Laos. Fadiman, a columnist for Civilization and the new editor of The American Scholar, met the Lees, a Hmong refugee family in Merced, Calif., in 1988, when their daughter Lia was already seven years old and, in the eyes of her American doctors, brain dead. In the Lees' view, Lia's soul had fled her body and become lost. At age three months Lia had had her first epileptic seizure—as the Lees put it, 'the spirit catches you and you fall down.' Lia's treatment was complex—her anti-convulsant prescriptions changed 23 times in four years—and the Lees were sure the medicines were bad for their daughter. Believing that the family's failure to comply with his instructions constituted child abuse, Lia's doctor had her placed in foster care. A few months after returning home, Lia was hospitalized with a massive seizure that effectively destroyed her brain. With death believed to be imminent, the Lees were permitted to take her home. Two years later, Fadiman found Lia being lovingly cared for by her parents. Still hoping to reunite her soul with her body, they arranged for a Hmong shaman to perform a healing ceremony featuring the sacrifice of a live pig in their apartment. Into this heart-wrenching story, Fadiman weaves an account of Hmong history from ancient times to the present, including their work for the CIA in Laos and their resettlement in the U.S., their culture, spiritual beliefs, ethics, and etiquette. While Fadiman is keenly aware of the frustrations ofdoctors striving to provide medical care to those with such a radically different worldview, she urges that physicians at least acknowledge their patients' realities. A brilliant study in cross-cultural medicine.

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Reading Group Guide

Lia Lee was born in the San Joaquin valley in California to Hmong refugees. At the age of three months, she first showed signs of having what the Hmong know as qaug dab peg (the spirit catches you and you fall down), the condition known in the West as epilepsy. While her highly competent doctors saw the best treatment in a dizzying array of pills, her parents preferred a combination of Western medicine and folk remedies designed to coax her wandering soul back to her body. Over the next four years, profound cultural differences and linguistic miscommunication would exacerbate the rift between Lia's loving parents and her caring and well-intentioned doctors, eventually resulting in the loss of all her higher brain functions. Fadiman weaves this personal tragedy, a probing medical investigation, and a fascinating look at Hmong history and culture into a stunningly insightful, richly rewarding piece of modern reportage.

Questions and Subjects for Discussion
1. What do you think of traditional Hmong birth practices (pp. 3-5)? Compare them to the techniques used when Lia was born (p. 7). How do Hmong and American birth practices differ?

2. Over many centuries the Hmong fought against a number of different peoples who claimed sovereignty over their lands; they were also forced to emigrate from China. How do you think these up-heavals have affected their culture? What role has history played in the formation of Hmong culture?

3. Dr. Dan Murphy said, "The language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier. There is a tremendous difference between dealing with the Hmong and dealing with anyone else. An infinite difference" (p. 91). What does he mean by this?

4. The author says, "I was struck . . . by the staggering toll of stress that the Hmong exacted from the people who took care of them, particularly the ones who were young, idealistic, and meticulous" (p. 75). Why do you think the doctors felt such great stress?

5. Dr. Neil Ernst said, "I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids' lives. I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior" (p. 79). Do you think the Hmong understood this message? Why or why not? What do you think of Neil and Peggy?

6. Dr. Roger Fife is liked by the Hmong because, in their words, he "doesn't cut" (p. 76). He is not highly regarded by some of the other doctors, however. One resident went so far as to say, "He's a little thick." What do you think of Dr. Fife? What are his strengths and weaknesses? The author also speaks of other doctors who were able to communicate with the Hmong. How were they able to do so? What might be learned from this?

7. How did you feel about the Lees' refusal to give Lia her medicine? Can you understand their motivation? Do you sympathize with it?

8. How did you feel when Child Protective Services took Lia away from her parents? Do you believe it was the right decision? Was any other solution possible in the situation?

9. Were you surprised at the quality of care and the love and affection given to Lia by her foster parents? How did Lia's foster parents feel about Lia's biological parents? Was foster care ultimately to Lia's benefit or detriment?

10. How did the EMT's and the doctors respond to what Neil referred to as Lia's "big one"? Do you think they performed as well as they could have under the circumstances?

11. How does the greatest of all Hmong folktales, the story of how Shee Yee fought with nine evil dab brothers (p. 170), reflect the life and culture of the Hmong?

12. Discuss the Lees' life in Laos. How was it different from their life in the United States? Foua says, "When we were running from Laos at least we hoped that our lives would be better. It was not as sad as after Lia went to Fresno and got sick" (p. 171). What were the Lees running from? What were they hoping to find in the United States?

13. When polled, Hmong refugees in America stated that "difficulty with American agencies" was a more serious problem than either "war memories" or "separation from family." Why do you think they felt this way? Could this have been prevented? If so, how? What does the author believe?

14. The Hmong are often referred to as a "Stone Age" people or "low-caste hill tribe." Why is this? Do you agree with this assessment of Hmong culture? Does the author?

15. What was the "role loss" many adult Hmong faced when they came to the United States? What is the underlying root cause? How does this loss affect their adjustment to America?

16. What are the most important aspects of Hmong culture? What do the Hmong consider their most important duties and obligations? How did they affect the Hmong's transition to the United States?

17. What does Dan Murphy mean by, "When you fail one Hmong patient, you fail the whole community" (p. 253)?

18. The author gives you some insight into the way she organized her notes (p. 60). What does it say about the process of writing this book? She chooses to alternate between chapters of Lia's story and its larger background-the history of the Lee family and of the Hmong. What effect does this create in the book?

19. The concept of "fish soup" is central to the author's understanding of the Hmong. What does it mean, and how is it reflected in the structure of the book?

20. It is clear that many of Lia's doctors, most notably Neil Ernst and Peggy Philp, were heroic in their efforts to help Lia, and that her parents cared for her deeply, yet this arguably preventable tragedy still occurred. Can you think of anything that might have prevented it?

21. What did you learn from this book? Would you assign blame for Lia's tragedy? If so, to whom? What do you think Anne Fadiman feels about this question?

Other Books of Related Interest
Virginia Barnes Lee, Aman: Story of a Somali Girl; Michael Bérubé, Life as We Know It; Robert Olen Butler, The Deep Green Sea; Lan Cao, Monkey Bridge; Temple Grandin, Thinking in Pictures: And Other Reports from My Life with Autism; Jamaica Kincaid, My Brother; Maxine Hong Kingston, Woman Warrior; Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales; Esmeralda Santiago, When I Was Puerto Rican; Susan Sheehan, Is There No Place on Earth for Me?; Abraham Verghese, My Own Country: A Doctor's Story.

About the Author
Anne Fadiman is the editor of The American Scholar. Recipient of a National Magazine Award for Reporting, she has written for Civilization, Harper's, Life, and The New York Times, among other publications. She lives in New York City.

Read a Sample Chapter

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. The 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-barred 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 hill tribe to which her family belonged. If a Hmong couple failed to produce children, they could call in 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.

One 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 weighted 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 Lia's delivery, that her date of birth was October 6, 1942, or, more frequently, October 6, 1926. Not a single admitting clerk ever appears to have questioned the latter date, though it would imply that Foua gave birth to Lia at the age of 55. Foua is quite sure, however, that October is correct, since she was told by her parents that she was born during the season in which the opium fields are weeded for the second time and the harvested rice stalks are stacked. She invented the precise day of the month, like the year, in order to satisfy the many Americans who have evinced an abhorrence of unfilled blanks on the innumerable forms the Lees have encountered since their admission to the United States in 1980. Most Hmong refugees are familiar with this American trait and have accommodated it in the same way. Nao Kao Lee has a first cousin who told the immigration officials that all nine of his children were born on July 15, in nine consecutive years, and this information was duly recorded on their resident alien documents.

When Lia Lee was released from MCMC, at the age of three days, her mother was asked to sign a piece of paper that read:

I CERTIFY that during the discharge procedure I received my baby, examined it and determined that it was mine. I checked the Ident-A-Band[R] parts sealed on the baby and on me and found that they were identically numbered 5043 and contained correct identifying information.

Since Foua cannot read and has never learned to recognize Arabic numerals, it is unlikely that she followed these instructions. However, she had been asked for her signature so often in the United States that she had mastered the capital forms of the seven different letters contained in her name, Foua Yang. (The Yangs and the Lees are among the largest of the Hmong clans; the other major ones are the Chas, the Chengs, the Hangs, the Hers, the Kues, the Los, the Mouas, the Thaos, the Vues, the Xiongs, and the Vangs. In Laos, the clan name came first, but most Hmong refugees in the United States use it as a surname. Children belong to their father's clan; women traditionally retain their clan name after marriage. (Marrying a member of one's own clan is strictly taboo.) Foua's signature is no less legible than the signatures of most of MCMC's resident physicians-in-training, which, particularly if they are written toward the end of a twenty-four-hour shift, tend to resemble EEGs. However, it has the unique distinction of looking different each time it appears on a hospital document. On this occasion, FOUYANG was written as a single word. One A is canted to the left and one to the right, the Y looks like an X, and the legs of the N undulate gracefully, like a child's drawing of a wave.

It is a credit to Foua's general equanimity, as well as characteristic desire not to think ill of anyone, that although she found Lia's birth a peculiar experience, she has few criticisms of the way the hospital handled it. Her doubts about MCMC in particular, and American medicine in general, would not begin to gather force until Lia had visited the hospital many times. On this occasion, she thought the doctor was gentle and kind, she was impressed that so many people were there to help her, and although she felt that the nurses who bathed Lia with Safeguard did not get her quite as clean as she had gotten her newborns with Laotian stream water, her only major complaint concerned the hospital food. She was surprised to be offered ice water after the birth, since many Hmong believe that cold foods during the postpartum period make the blood congeal in the womb instead of cleansing it by flowing freely, and that a woman who does not observe the taboo against them will develop itchy skin or diarrhea in her old age. Foua did accept several cups of what she remembers as hot black water. This was probably either tea or beef broth; Foua is sure it wasn't coffee, which she had seen before and would have recognized. The black water was the only MCMC provided food that passed her lips during her stay in the maternity ward. Each day, Nao Kao cooked and brought her the diet that is strictly prescribed for Hmong women during the thirty days following childbirth: steamed rice, and chicken boiled in water with five special postpartum herbs (which the Lees had grown for this purpose on the edge of the parking lot behind their apartment building). This diet was familiar to the doctors on the Labor and Delivery floor at MCMC, whose assessments of it were fairly accurate gauges of their general opinion of the Hmong. One obstetrician, Raquel Arias, recalled, "The Hmong men carried these nice little silver cans to the hospital that always had some kind of chicken soup in them and always smelled great." Another obstetrician, Robert Small, said, "They always brought some horrible stinking concoction that smelled like the chicken had been dead for a week." Foua never shared her meals with anyone, because there is a postpartum taboo against spilling grains of rice accidentally into the chicken pot. If that occurs, the newborn is likely to break out across the nose and cheeks with little white pimples whose name in the Hmong language is the same as the word for "rice."

Some Hmong parents in Merced have given their children American names. In addition to many standard ones, these have included Kennedy, Nixon, Pajama, Guitar, Main (after Merced's Main Street), and, until a nurse counseled otherwise, Baby Boy, which one mother, seeing it written on her son's hospital papers, assumed was the name the doctor had already chosen for him. The Lees chose to give their daughter a Hmong name, Lia. Her name was officially conferred in a ceremony called a bu plig, or soul-calling, which in Laos always took place on the third day after birth. Until this ceremony was performed, a baby was not considered to be fully a member of the human race, and if it died during its first three days it was not accorded the customary funerary rites. (This may have been a cultural adaptation to the fifty-percent infant mortality rate, a way of steeling Hmong mothers against the frequent loss of their babies during or shortly after childbirth by encouraging them to postpone their attachment.) In the United States, the naming is usually celebrated at a later time, since on its third day a baby may still be hospitalized, especially if the birth was complicated. It took the Lee family about a month to save enough money from their welfare checks, and from gifts from their relatives' welfare checks, to finance a soul-calling party for Lia.

Although the Hmong believe that illness can be caused by a variety of sources--including eating the wrong food, drinking contaminated water, being affected by a change in the weather, failing to ejaculate completely during sexual intercourse, neglecting to make offerings to one's ancestors, being punished for one's ancestors' transgressions, being cursed, being hit by a whirlwind, having a stone implanted in one's body by an evil spirit master, having one's blood sucked by a dab, bumping into a dab who lives in a tree or a stream, digging a well in a dab's living place, catching sight of a dwarf female dab who eats earthworms, having a dab sit on one's chest while one is sleeping, doing one's laundry in a lake inhabited by a dragon, pointing one's finger at the full moon, touching a newborn mouse, killing a large snake, urinating on a rock that looks like a tiger, urinating on or kicking a benevolent house spirit, or having bird droppings fall on one's head--by far the most common cause of illness is soul loss. Although the Hmong do not agree on just how many souls people have (estimates range from one to thirty-two; the Lees believe there is just one), there is a general consensus that whatever the number, it is the life-soul, whose presence is necessary for health and happiness, that tends to get lost. A life-soul can become separated from its body through anger, grief, fear, curiosity, or wanderlust. The life-souls of newborn babies are especially prone to disappearance, since they are so small, so vulnerable, and so precariously poised between the realm of the unseen, from which they have just traveled, and the realm of the living. Babies' souls may wander away, drawn by bright colors, sweet sounds, or fragrant smells; they may leave if a baby is sad, lonely, or insufficiently loved by its parents; they may be frightened away by a sudden loud noise; or they may be stolen by a dab. Some Hmong are careful never to say aloud that a baby is pretty, lest a dab be listening. Hmong babies are often dressed in intricately embroidered hats (Foua made several for Lia) which, when seen from a heavenly perspective, might fool a predatory dab into thinking the child was a flower. They spend much of their time swaddled against their mothers' backs in cloth carriers called nyias (Foua made Lia several of these too) that have been embroidered with soul-retaining motifs, such as the pigpen, which symbolizes enclosure. They may wear silver necklaces fastened with soul-shackling locks. When babies or small children go on an outing, their parents may call loudly to their souls before the family returns home, to make sure that none remain behind. Hmong families in Merced can sometimes be heard doing this when they leave local parks after a picnic. None of these ploys can work, however, unless the soul-calling ritual has already been properly observed.

Lia's bu plig took place in the living room of her family's apartment. There were so many guests, all of them Hmong and most of them members of the Lee and Yang clans, that it was nearly impossible to turn around. Foua and Nao Kao were proud that so many people had come to celebrate their good fortune in being favored with such a healthy and beautiful daughter. That morning Nao Kao had sacrificed a pig in order to invite the soul of one of Lia's ancestors, which was probably hungry and would appreciate an offering of food, to be reborn in her body. After the guests arrived, an elder of the Yang clan stood at the apartment's open front door, facing East 12th Street, with two live chickens in a bag on the floor next to him, and chanted a greeting to Lia's soul. The two chickens were then killed, plucked, eviscerated, partially boiled, retrieved from the cooking pot, and examined to see if their skulls were translucent and their tongues curled upward, both signs that Lia's new soul was pleased to take up residence in her body and that her name was a good one. (If the signs had been inauspicious, the soul-caller would have recommended that another name be chosen.) After the reading of the auguries, the chickens were put back in the cooking pot. The guests would later eat them and the pig for dinner. Before the meal, the soul-caller brushed Lia's hands with a bundle of short white strings and said, "I am sweeping away the ways of sickness." Then Lia's parents and all of the elders present in the room each tied a string around one of Lia's wrists in order to bind her soul securely to her body. Foua and Nao Kao promised to love her; the elders blessed her and prayed that she would have a long life and that she would never become sick.