The Political Power of Medicine
The political power of physicians directly confronted Lia Lee's parents. This began with home visits from public health nurses who tried to ensure the family's adoption of the recommended treatments. Their assessments characterized the parents as noncompliant and unable to effectively administer the medications to their child even with the help of colored labels and lines on the liquid bottles. Outdated medications were mute evidence of their failure to appropriately administer the medications necessary to prevent seizures and address bronchial infections. The side effects were a primary reason her parents resisted the pharmaceutical regimen. Lia Lee's emotionless facial expression after taking her medication convinced her parents that the drugs were harming her rather than helping her. Later one of her physicians concluded much the same.
The doctors came to conclude that they were not going to be able to get Lia's parents to administer the medication needed to effectively treat her. The resultant convulsions and periods of oxygen loss were apparently causing a developmental delay and portended permanent mental retardation. Her physician eventually wrote a letter to Child Protective Services (CPS) accusing the parents of failure to comply with the administration of required medicines for their child. Such failure, he argued, was both child abuse and child neglect because it could result in further seizures causing brain damage and possibly death.
The physician's recommendation that the child be placed temporarily in a foster home to assure proper medication was immediately granted by the court, which ordered that Lia Lee be removed from her parent's custody. Without advance notice, social workers arrived to remove her
To resist medicalization, critical medical anthropology calls for community organization and involvement in the public dimensions of health decisions. Community involvement is dependent on both organizational change in health institutions and the development of community coalitions that can participate in this planning process. Achieving this community participation requires health professionals with the cultural competence to foster institutional change in their organizations, stimulating them to facilitate the formation of community health coalitions. These community coalitions can have greater power to influence health behaviors of people and exert political influence to effect institutional changes, such as new programs for alcohol education or tougher drunk-driving sentences. Anthropologist-advocates are involved in the politics of health, making efforts to influence policymakers, bureaucrats, and government officials to change conditions that affect access to health resources. Cultural perspectives can be employed on behalf of individuals and communities when anthropologists give expert witness testimony, create community input through community coalitions, or provide policy analysis regarding needed programs.
Not all groups have equal access to resources for health. One of the principal foci of critical medical anthropology is the issue of health disparities: the adverse health consequences for the underprivileged, poor, and marginalized. Who speaks on their behalf? Medical anthropologists have often felt a moral obligation to speak out on behalf of these from her home and took her to an undisclosed location. Her parents did not see her or learn of her location for weeks. In a court hearing in the following days, Lia Lee's father Nao Kao was present. There is no record of an interpreter present, but the father is recorded as assenting to the foster placement, contrary to what he in fact desired. Lia had become government property and the rights of her parents superseded by the demands of biomedicine.
Lia's initial foster placement was in a home operated by Mennonite sisters. They strapped Lia Lee into a car seat to control her behavior. Later she was placed with a foster family that cared for six other children with special needs, but they spoke no Hmong, the only language Lia understood. The foster family soon decided, for the first time as foster parents, that a placement child—Lia—should be with her parents, but CPS did not agree. A visitation period back at home was arranged, however, as a test of whether she could be returned to the parents. A test done afterward indicated that they had not provided Lia with her medication, confirming the CPS conclusion that she should not be returned to her parents. In the foster home, Lia was forcibly medicated on the prescribed schedule, but her seizures increased rather than subsided.
In retrospect, her physician reflected that there might have been other options: arranging daily home nurse visits or seeking assistance from other members of the Hmong community to assure Lia's proper medication. The doctor's retrospective comments also revealed the political agenda behind his actions: teaching the Hmong community the lesson that they had to follow the rules laid down by doctors.
less fortunate communities and to directly confront the political power of biomedicine to intervene in people's lives.
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