The woman, who was in her 50s, had thyroid cancer, and scans suggested it had spread to her lungs. But her doctor, Michael Fratkin, knew there were options. “It’s like, well, what a bummer you have metastatic cancer, but we have a sort of magic missile for that kind of cancer, and it can be controlled,” he thought to himself. “All you have to do is swallow three iodine capsules.” The woman, a Hmong immigrant, spoke little, if any, English. Through an experienced interpreter, Fratkin explained the protocol and told her she would need a lung biopsy to confirm the diagnosis. After the procedure, he told her he felt confident the protocol he had described would cure her. The woman, though, was incensed. “Something about how we explained what we were doing didn’t match her way of thinking about things,” Fratkin recalled. “She thought we gave her cancer in the chest.” Thousands of Hmong emigrated from Southeast Asia after the Vietnam War, when the CIA recruited them to fight or spy on the United States’s behalf, only to face harsh repercussions after U.S. forces withdrew.
Many Hmong understand physical illness in mystical terms: an evil spirit, or “dab,” can enter the body if a person is badly startled, for instance, or if a baby’s placenta is not properly buried. A dab might depart only if a person takes specific actions, like drinking an herbal remedy while also leaving a cup of the remedy for the dab to drink. The Hmong’s beliefs about medicine and illness, combined with hard-earned suspicions about American institutions, can mix poorly. Even from the start, she was cool toward him, and inscrutable. “Never ever did I get a glimpse of something I recognized,” said Fratkin, who has practiced in Northern California for two decades. Still, he persuaded her to accept the cancer treatments. Then, at the last minute, she refused — for reasons Fratkin could not understand, even with his interpreter’s help. He contacted a social worker with experience with the Hmong community, and helped pay for the social worker’s visit.
His patient agreed to try. Again, she backed away at the last minute.