The New York Times
June 4, 2006 Sunday
Late Edition – Final

Spoonfuls of Culture Help Medicine Go Down

By NICHOLAS CONFESSORE

When officials at Brooklyn’s Maimonides Medical Center were preparing
a new clinic in Sunset Park in April, everything was ready for the
big opening day except the big opening day itself.

”One of our staff members told us it was an unlucky date,” said
Pamela S. Brier, the hospital’s chief executive. ”We had to change
it.”

So the ribbon-cutting, originally scheduled for April 24, was moved
to the following day. It was a difference of only 24 hours, but all
the difference in the world to the Chinese immigrants the clinic was
largely built to serve, who believed the 25th to be a more auspicious
date.

It was one of the many ways in which the $1 million clinic was
carefully designed to cater to Sunset Park’s fast-growing Chinese
population, one of the largest in the city.

Because the color white is associated with death in China, the walls
are mostly painted in yellow and pink tones. And because Chinese
immigrants have high rates of tuberculosis infection, every patient
is tested for it. The chefs in the main hospital’s kosher kitchen
have learned to prepare rice porridge, a beloved Chinese comfort
food. ”Language, culture, food — it’s all tremendously important,”
Ms. Brier said.

The new clinic is Maimonides’s most ambitious effort to respond to a
growing and increasingly diverse population of immigrant patients. It
also reflects a broader national shift in health care as urban
hospitals move beyond the translation services that started becoming
common in the late 1990’s and acknowledge that language is not the
only barrier they face in treating people from all over the globe.

Some come from cultures that are broadly skeptical of Western
medicine, and prefer the herbs and poultices of traditional healers,
”cures” that in some cases can retard the effects of prescribed
medicines or produce dangerous interactions. Others come from
cultures where they are expected to hide sickness from strangers, or
where it might be offensive for male doctors to examine female
patients.

”It’s been a slow trend to develop because it’s not always clear to
a hospital how big a certain community might be, and sometimes it
takes a couple of years to manifest,” said Rick Wade, a senior vice
president of the American Hospital Association. But now, he said,
programs are appearing everywhere, to strengthen what hospitals call
”cultural competency.”

At Oakwood Hospital in heavily Arab Dearborn, Mich., nurses are
trained to point the beds of Muslim patients toward Mecca. In
Glendale, Calif., which had a rapid influx of Armenian immigrants
during the 1990’s, one hospital sponsors a popular health-related
call-in show that is broadcast in Armenian on cable-access
television.

But challenges can be more varied and daunting for hospitals in
places like Brooklyn, home to insular communities of Orthodox Jews,
Muslims from conservative Arab countries, recent immigrants from
rural China and Hispanics from Central and South America, among many
others.

”In each culture that we’re dealing with, there are different ideas,
family values and beliefs, whether about medicine or life in
general,” said Virginia Tong, a vice president at Lutheran Medical
Center, one of south Brooklyn’s largest health care providers.
”Let’s say you had an Hispanic godparent who brought a patient in to
see a doctor. In this country, we would say, ‘That’s not a parent;’
there might be legal issues. But in their culture, godparents are
almost as important as parents.”

Lutheran’s main hospital has a mosque on site; it also runs clinics
aimed at Caribbean and Korean immigrants. In 2001, Lutheran opened
its own Chinese clinic, on Eighth Avenue in Sunset Park, after a
survey showed that most Chinese immigrants in the area were going to
Chinatown in Manhattan for medical care.

Maimonides, long known as ”the Jewish hospital,” in Ms. Brier’s
words, has in recent years customized the care at many of its 15
clinics, which are around southwest Brooklyn, based on the cultures
and needs of the patients each serves.

The doctors at the hospital’s Newkirk Avenue clinic, for example, see
many Indian immigrants, who have disproportionately high rates of
hypertension. Its pediatricians also see many children born in
Bangladesh. Because infants there are often not immunized against
measles, as most babies are in the United States, that means more
effort devoted to vaccination and extra care in reporting cases to
public health officials to contain any outbreaks.

But the hospital’s outreach to Chinese immigrants is its biggest,
driven by what its officials believe will be continued population
growth in south Brooklyn. ”We go where the patients are,” Ms. Brier
said.

Maimonides opened its first Sunset Park clinic in a brownstone
building in 1996. Within three years, doctors there were seeing 9,000
patients a year, including a growing number of Chinese. The number of
patients has doubled since, prompting the latest move from a
storefront space to a 10,000-square-foot building on Seventh Avenue
and 64th Street.

The attending doctors there speak Mandarin or Cantonese, two major
Chinese dialects. About 70 percent of the patients are Chinese,
according to Dr. Bing Lu, the clinic’s medical director, and a
significant number are recent arrivals to the United States. Many
hold the traditional belief, he said, that drawing blood for tests
drains a person’s life force, and they are reluctant to allow it.

”We teach them that they need it,” he added, relying on the staff
members’ language skills and familiarity with Chinese culture to
reduce patients’ suspicion. ”Generally speaking, Chinese people
don’t believe in preventative care.”

Such an attitude can be deadly. A few years ago, doctors at the
clinic found early signs of liver cancer in a man in his 30’s who was
infected with hepatitis B. The man left the clinic, Dr. Lu said, and
did not return the clinic’s phone calls. When he finally came back
six months later, he was jaundiced and underweight, with a severely
enlarged liver. The cancer had advanced beyond the possibility of
life-prolonging surgery.

It was ”a fatal mistake,” said Dr. Lu, who believes the man at
first sought out traditional healers instead of returning to the
clinic.

Several patients praised the doctors’ warmth and staff members’
willingness to help them with paperwork. Susan Lin, 31, who emigrated
from China’s Fujian Province five years ago, said, through an
interpreter: ”Sometimes we’re afraid to ask questions, to ask how to
follow up. Here, they always smile, they are always welcoming. You
feel very comfortable asking questions.”

Recently, an 80-year-old woman arrived at the clinic just before
closing time, asking to see a doctor. She said it was urgent, but
when examined she would say only that she had been unable to sleep
for about a week.

Under careful questioning, Dr. Lu said, she eventually revealed that
her husband had died the previous week, and that she had been crying
and having anxiety attacks, details that a Chinese woman her age
might consider inappropriate to admit.

”When you know the culture, you know it’s normal, but if you don’t,
as a practitioner, you can miss a significant problem,” Dr. Lu said.
”She could easily have been turned away from the clinic that day.”

URL:

GRAPHIC: Photos: At a new Brooklyn clinic, Dr. Jason Wu, top,
examines William Hung, 4, as his father, Rong Hung, demonstrates
saying ”ah.” Sue Ng, a clinic translator, talks with Chikwan Hui, a
patient, in a waiting room decorated with Asian art. (Photographs by
Ruby Washington/The New York Times)