Being laid up in a hospital bed is a trying enough experience without whiling away the hours in an unlucky room. To many people of Chinese and Japanese descent, receiving care in Room 4 or on the fourth floor bodes misfortune, because in their native tongues the word for the number sounds like the word for death.
Though some would scoff at such superstitions (and presumably the thousands of U.S. buildings without 13th floors as well), health care providers can treat patients more effectively if they're familiar with foreign folkways. On the heels of a number of legislated changes to make health services easier for the city's millions of immigrants and non-native English speakers to use, a new guide is available to help medical staff deliver care in a culturally informed manner.
Last month, EmblemHealth, the parent company of insurers HIP and GHI, published what it believes to be the first comprehensive guide to help physicians and medical professionals address the needs of patients making health care decisions based on a wide variety of religious and cultural beliefs. “The Medical Manual for Religio-Cultural Competence” appeared just before the City Council passed a bill (now awaiting the mayor's signature) requiring pharmacies in certain neighborhoods to translate medical instructions – something already required by state and federal law, but frequently lacking in local drugstores. And it comes a few years after immigrant advocates successfully pressured the state health department to adopt rules requiring all private and public hospitals in New York state to provide skilled interpreters, translate important hospital forms into commonly used languages, and ensure that patients awaiting care do not face excessive delays because of language issues.
But while advocates say they’ve seen improvements in translation services in hospitals and pharmacies since those provisions took effect in 2006, some say there are still major cultural hurdles to cross, both through training and policy changes. That's where the new manual comes in – a joint project between EmblemHealth and the Tanenbaum Center for Interreligious Understanding, a secular organization that promotes religious tolerance in healthcare settings and schools. Tanenbaum staff saw the need for a “toolkit” or guide when they began running trainings for health care providers in 2000 and saw that the workers were hungry for more information on how to be sensitive to patients’ religious beliefs.
The 200-plus page guide is broken down into chapters on 10 major religions, providing overviews of core beliefs, end-of-life customs, and areas where religion and health care intersect, such as modesty, birthing practices and nutrition.
Dr. William Gillespie, senior vice president and chief medical officer for EmblemHealth, said the company has provided free copies to some 6,000 providers in ethnically diverse neighborhoods. Practitioners in the network can download a copy from the Web for free. Tanenbaum is making the manual available to others in the fall.
According to Wayne Ho, director of the Coalition for Asian American Families and Children, religion and culture gaps can prevent patients from seeking and accessing health care, and can also lead to errors and harmful behaviors.
The Coalition in June released a report revealing that one in nine Asian Pacific American youth surveyed in New York frequently translate for doctors and nurses, even though state health department regulations mandate that an interpreter must be available within 20 minutes in non-emergency settings and 10 minutes in emergency settings.
This can be traumatic for children, Ho said, who may not have the technical medical vocabulary to translate effectively, and who are sometimes exposed to inappropriate situations, such as a mother’s physical exam or treatment after domestic violence.
The city’s Health and Hospitals Corporation has earned recognition for implementing a high-quality simultaneous translation system in Bellevue, Gouverneur and Kings County Hospitals, similar to the one used by the UN. However, funding for the system was cut in the last round of budget cuts. Ho said the quality of translation services still varies widely from hospital to hospital.
Aside from the language barriers, Ho said there are cultural factors that come between Asian American patients and health care providers. One issue is a cultural stigma in the Asian community against using government services, particularly among older immigrants. Some even avoid applying for benefits because they are afraid it will jeopardize their citizenship applications. Other nuances include the fact that in Chinese and some other languages, there is no word for depression, and mental health problems already carry a stigma in many immigrant communities.
Martha Chavez, membership coordinator at the Jackson Heights nonprofit New Immigrant Community and Empowerment (NICE), said she hears frequent complaints from members about the health care system. “There’s a lot of miscommunication about what are their options [and] if they can’t pay, what programs are there to help them,” Chavez said.
NICE member Miriam Perez, 50, recounted an ordeal she suffered because of miscommunication at a Queens hospital. “They took out my appendix, and I didn’t have appendicitis,” Perez said. She has felt dismissed at the hospital, and that some staff members are hostile towards her when she speaks Spanish. “I think this is what happens if you don’t speak English and you’re not white – they treat you differently,” she said.
While advocacy groups are continuing to push for institutional reforms and policy changes to improve access to health care, the creators of the manual for religio-cultural competency hope it can be a first step in educating health care providers about the issue.
Dr. Gillespie of EmblemHealth says New Jersey currently requires cultural-competency training for physicians to obtain or renew their license, and similar legislation has been introduced in New York.