Sitting down and putting her feet up at the end of a lengthy
working day
at the Child Health Clinic at the Long Branch County Health Department,
Linda Gorman, a public health nurse, silently ruminated on the hovering
psychological discomfort she was experienceing. She knew she was troubled
because of an encounter early in the afternoon with her patient Marie's
mother, Mrs. Saeto. "Am I just being culturally insensitive?" she
wondered to herself, "or did I really miss the boat on this one?"
Mrs. Saeto had brought Marie, her youngest child, to the clinic
for a
well-child check and her six-month immunizations. They had been referred
to Child Health Clinic by the Woman, Infant, and Children (WIC)
Supplemental Feeding Program when Marie was a newborn and had come for
regular visits since that time. The Saeto family had emigrated from Laos,
and although Marie's father worked full time the family had no health
insurance and little money for health care. Mrs. Saeto and Linda had
developed a comfortable relationship over the months that Marie had been a
patient at the clinic. Linda looked forward to Mrs. Saeto's visits and had
learned a lot about the Saeto's lu Mien culture from their
conversations. Mrs. Saeto's English was excellent and her willingness to
share information about Mien cultural practices had permitted Linda
to understand better the many Mien living in Long Branch County who
used the clinic for some of their health care needs.
Mrs. Saeto was born in Laos, but at the end of the Vietnam War
she
left with friends and what remained of her family. She settled in the
United States with her grandparents when she was fourteen. Mrs. Saeto had
talked with Linda about how difficult her first year in America had been.
When she became more comfortable with her new environment, she went
through what she now called a "rebellious stage." She refused to speak
Mien except with her grandparents, and only then because they had
never learned English. A part-time job provided money and independence,
enabling her to feel less like an outcast in school. She told Linda that
she didn't really have the opportunity to enjoy her new life as an
American high school student. She became pregnant before graduating and
left school to take care of the baby. The father of the baby was an
American high school student who quickly lost interest in the infant and
finally drifted away. Mrs. Saeto had no support except for her
grandparents and the lu Mien community who welcomed her home
without reservation.
Mrs. Saeto later married a Mien man. When Linda met her
they
were living with his mother and their four children, one of whom was the
child she had before they were married. She described herself to Linda,
saying proudly, "Now I am a Mien woman." It seemed to Linda that
she found great value in her sense of belonging. She took pride in her
expanded knowledge of Mien traditions and beliefs. Once she sensed
Linda's interest, she had eagerly discussed Mien beliefs regarding
spirits, ceremonies, and cures during each of her daughter's clinic
visits.
On this day, when Linda entered the exam room, she noted that
Marie
appeared to be developing normally. She smiled, vocalized, was able to
sit without support, and was quite responsive to Linda. Linda plotted the
weight and height measurements taken by the clinic nurse on a growth chart
and showed Mrs. Saeto that Marie fell into the 65th percentile for both
height and weight for her age and that her growth was proceeding normally.
However, when Mrs. Saeto undressed Marie for the physical examination,
Linda immediately noted five red, blistered, quarter-inch round markings
on the child's abdomen.
"What are those?" she asked, concerned by what she saw.
Not hesitating, Mrs. Saeto explained that the marks were
burns.
"Burns?" Linda asked, shocked by this admission.
"Yes," Mrs. Saeto told her. "This is from a Mien cure for
pain that I used two days ago. My mother-in-law and I both suspected that
Marie had a case of Gusia mun toe. She went on to explain that
Gusia mun toe is an illness seen, although infrequently, among
Mien babies and is characterized by restlestness, agitation,
constipation, and loss of appetite. "We knew that Marie had it," Mrs.
Saeto continued, "because she kept throwing her head back when held.
Babies who have this illness always act so," she concluded.
"The cure we used was a 'string' of inner pulp from a special reed
that my mother-in-law got from a Mien neighbor who specializes in
traditional cures. The pulp was dipped lightly in pork fat and then lit.
My mother-in-law passed the flame quickly over the skin of Marie's
abdomen, in the area where pain seemed to be located. The flame raised a
blister that popped like popcorn." Mrs. Saeto went on, "The blisters
meant
that the illness was not related to spiritual causes. If blisters had not
developed, we would have had to hire a shaman to conduct a spiritual
ritual in order to cure Marie."
Mrs. Saeto proceeded with enthusiasm, "My mother-in-law said that
only five burns were necessary to cure Marie. The number of burns needed
depends on severity of illness and it can take three, five, seven, or even
eleven burns before a person is cured. Before the flame is put out, it is
used to burn a spot on a wall of the room, or a block of wood, a process
that transfers the pain. The person performing the cure says 'The wall
doesn't feel, so let the wall suffer instead of this person.' After this
part of the cure is completed, the burns are covered with Tiger Balm, a
cream that we use for many purposes."
"How did Marie respond to what you did?" Linda asked, trying to
keep her revulsion at what the child had suffered out of her voice.
"Marie cried for a while but the pain did not last very long,"
Mrs. Saeto said. "The pain lasts maybe for half an hour or an hour at
most. With most babies the burns heal with no problems. Sometimes there
are some scars, but since these are identified as the result of the cure
they are not of any worry to anyone from the Mien culture."
"Weren't you concerned that the burns could be serious?"
"I know that this method of cure can be dangerous for children,"
Mrs. Saeto replied.
Linda said emphatically, "I coudn't agree more." However, she
soon realized that their ideas about the dangerousness of burning children
did not correspond.
"The cure must be done by someone skilled in burning, like my
mother-in-law," contonued Mrs. Saeto. "If the burn is placed too near to
the line between the baby's mouth and her belly-button, the baby could
become mute or even retarded. We knew that Marie's cure was successful
because she soon became calm. She has been eating well, she is no longer
constipated, and she is sleeping all night."
Linda completed the physical examination and was forced to
conclude that, other than the burns, the baby appeared to be completely
healthy. She administered Marie's six month immunizations, noting to
herself that the injections made Marie cry and, at least temporarily,
affected the baby's formerly calm and cheerful disposition. She wondered
to herself - and not for the first time - about the pain she routinely
inflicted upon children in the course of her practice. Perhaps she was
neither more civilized nor more compassionate than Mrs. Saeto and her
mother-in-law in her approach to health care delivery. Linda informed
Mrs. Saeto of possible side effects of the immunizations, suggested that
she call with any questions or problems that arose, and asked that she
bring Marie back to the clinic in three months for her next well-child
examination.
Linda did not mention her misgivings about the practice of burning
the baby to any of her colleagues. However, as the afternoon went by, she
became increasingly concerned and wondered if she shouldn't have said
something. "After all," Linda thought, "it is cruel and dangerous to burn
babies." She admitted to herself that she didn't know much about the
danger of the cure performed by an unskilled healer, but she knew well
that burns cause pain, possible infection, and scarring. She also knew
that most people would consider burning infants as child abuse and
allowing the act would be seen as criminal neglect, regardless of the
rationale. Finally she thought about the fact that, as a licensed health
professional, she was mandated to report suspected child abuse.
Linda knew that she was in the middle of a situation with no easy solutions. She couldn't dispel her uneasiness and she noted, for the first time that day, that she was beginning to feel a bit angry. "How far am I supposed to go with this cultural sensitivity, anyway?"