The Spirit Catches You

The January 27, 2011 edition of the CDC MMWR (Morbidity and Mortality Weekly Report) includes an interesting case history of childhood lead poisoning in a Cambodian family in New York City. Through follow-up investigation, it was found that the child was very likely poisoned by a string amulet adorned with leaded beads (see photo). The toddler had been wearing the amulet for several months and had been observed mouthing the amulet. These amulets are believed to confer protection to the child. Based upon this incident, the guidance given by the CDC to health department staff members, medical practitioners, and others was as follows:

Educational efforts are needed to inform Southeast Asian immigrants that amulets can be sources of lead poisoning for children. Health-care providers and public health workers should ask about this custom when seeking a source of exposure in Southeast Asians with elevated BLLs. Targeted educational efforts in Southeast Asian communities also should be considered. This case also underscores the importance of being aware of different cultural practices, such as wearing amulets, and highlights the need to assess and reassess the same risk factors and rephrasing questions using different words when communicating with immigrant families.

I would suggest that it will take more than a traditional educational campaign to convince Southeast Asian parents to discontinue the use of such amulets. After all, this is very possibly a tradition steeped with significant religious significance and/or with centuries of empirical evidence suggesting the protective value of the amulet. Education, patience and cultural insight are likely warranted on both sides in reducing this lead poisoning risk.

For further information about cultural tradition and illness, there is a classic book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman, that describes the misunderstanding, pain and confusion sometimes inherent in cross cultural health work. It’s required reading for anyone interested in cross cultural health and medicine.

-Doug Hirano, MPH, APCA Executive Director