Continuity of Care

A Chinese initiatives department helps provide continuity of care for this population, providing Chinese-speaking volunteers, interpreters and translators to anticipate and resolve any problems between and within outpatient and inpatient facilities and in the home.

A Living at Home program of Chinese providers, nurses and aides is "very helpful," according to Wang, to help Chinese-speaking elders remain at home and near their families.

In the hospital, troubleshooting began in the design of Coleman 15 East. Numerology, the study of numbers, plays an important role in Chinese culture. Therefore, all rooms on the unit were changed to the alphabet, starting with C15A, since, for instance, the number 4 means death.

This past year, 2008 - the Year of the Golden Pig - was a good year for babies and St. Vincent's Hospital Manhattan saw an increase in births.

"Eight is a good number for Chinese," Wang said, "so we gave money in a red envelope, which means lucky money, to babies born on Aug. 8, 2008."

New mothers find comfort in eating a combination of ginger, pig's feet and vinegar, Wang said. Chinese don't like to eat or drink anything cold when they are sick so congee (rice porridge) is popular with the patient population in general.

"We eat a lot of [congee] or just plain rice, but especially when we are sick," said Nip, who admits she likes the soupy rice, too. "I think congee is very comforting, and a lot of our Chinese patients request it. Sometimes we just automatically order it as part of the Chinese diet option on the computer."

Culturally Sensitive

Being sensitive to cultural differences means looking out for staff, as well as patients. The Chinatown clinic is always closed on the Chinese New Year, Gribbin said. "It's a day of being with family, like Thanksgiving in the U.S."

Family plays a strong role in helping patients heal. Adult children, educated in the U.S., "make a lot of decisions on behalf of their parents," Nip said "because they speak [Chinese]. In Chinese culture, we are very close as a family. We make decisions together, so parents rely on their children and the children are usually very helpful and supportive."

When a new baby is on the way, usually grandparents take care of the baby and the mother. "We encourage them to come together," to the clinic, Wang said, "so they can participate in discussions and can understand our treatment."

An express van, driven by a Chinese-speaking driver following a schedule posted in Chinese, provides free shuttle service between Chinatown and the main hospital, the O'Toole Clinic and St. Vincent's Comprehensive Cancer Center in Greenwich Village.

Changing World

Older grandparents who care for children while their parents work require ongoing nutritional education.

"We're finding the little kids want to eat at McDonalds," Gribbin said. "Consequently, we're noticing an increasing trend in childhood obesity. The Chinese diet traditionally favors more rice, fruit and vegetables. It takes more education to help them choose healthier foods in the Western diet. We see a prevalence of hepatitis B and TB with this patient population, as well as premenopausal breast cancer and stomach cancer."

Smoking is a problem with the older men, Gribbin said, "especially recent immigrants. You'll see it in Chinatown when you walk down the street. This is not as great a concern with teenagers or women."

Eastern herbs may counteract Western medicine. "Our nurses and providers must spend time investigating and explaining to patients that this combination may be harmful," Gribbin said.

Building Bonds

Issues of shame and fear of addiction may complicate pain management.

"A lot of Chinese patients are not really expressing [pain] fully," Nip said. "They either have a very high pain tolerance or they are afraid to ask people for medicine. They won't express it to their family either. We just have to teach them it is OK to express pain, and pain is not good for the body and we can [give them] something for it."

Wang acknowledged building a good relationship with [Chinese-speaking patients] creates trust and encourages patients to "talk about their concern and pain after a few visits."

The dedication that nurses and others at SVCMC show in caring for their Chinese-speaking population promotes patient satisfaction. When Chinese-speaking patients move to other parts of the U.S., Wang sees many of them return on a weekend to the clinic in Chinatown.

"Most of our patients are relieved someone understands them and knows the language," Nip said.

Kathleen A. Waton is a frequent contributor to ADVANCE.