Culturally Attuned Care

Hospitals are tough places to get around in for everyone. Generally large, multiwinged structures with few clear directions for a new patient, they can be like crossword puzzles that are nearly impossible to solve. Warm welcomes are rare. Does anyone greet you at the hospital entrance? Are the signs coherent in their meaning?

Getting people through the door is the easy part, says Susan Koch-Weser, an assistant professor at the Tufts School of Medicine whose specialty is the expansive field of what is known as “patient navigation.” Once patients are inside the hospital, she asks, “Can you care for them in a timely fashion in whatever system of care is appropriate?”

In part, says Koch-Weser, the answer involves being sensitive to each patient’s native culture. “It’s something that we’re missing in modern medicine—that’s falling through the cracks,” she says.

Chinese-American patients pose a special challenge. Susan Parsons, a professor of medicine who oversees much of the outreach that’s occurred between Tufts Medical Center and Chinatown, its host community, in recent years, cites America’s “war on cancer” as an example of the typically aggressive approach of Western medicine.

Eastern therapies, in contrast, stress a balance of elements where the goal is harmony, she notes. Koch-Weser agrees on the cultural chasm. “For our Chinese-American patients, it’s a big step for them to say they’re going to do this Western thing,” she says. (See related story, “East Meets West.”)

Perhaps surprisingly, the mesh of the two cultures has not been studied much. A recent search of the medical literature found just 12 studies examining patient navigation among Asian immigrants, says Parsons, and none of the funded federal grants in this general area has targeted Asian immigrants within their scope. “We’re doing some of the first studies that will look at this,” says Karen Freund, a professor of medicine who’s nationally known in the area of medical and cultural dynamics.

Listening Skills

Tufts has therefore embarked on a new frontier, driven by two critical realizations: Connecting with Chinatown is the right thing to do, and now is the time to do it.

Associate Professor Laurel Leslie, who heads up the community engagement effort for the Tufts Clinical and Translational Science Institute (CTSI), the organization charged with making laboratory work pay dividends in the wider world, sees all the moves occurring between Tufts and the Asian-American community as the start of a beautiful friendship. “We’re trying to build [that relationship] from the grassroots up,” she says.

Project ADAPT (Addressing Disparities in Asian Populations through Translational Research), a new program under the direction of Carolyn Leung Rubin within CTSI that includes researchers, administrators, medical providers and community partners, is key to the effort.

The Tufts participants at the monthly meetings of Project ADAPT are there largely to listen. Rather than have a medical investigator presume what the needs of a neighborhood might be and proceed from there—enacting what Leslie calls “the helicopter approach” to research—residents of Chinatown speak for themselves and say, “This is an issue in our community.”

A spirit of collaboration animates the ADAPT model, Leslie explains, “because, in the end, what good is research unless it’s going back into the community, into the streets and having an impact on people’s lives?” Casting the net wide extends the logic. Accordingly, ADAPT has offered a program called Building Your Capacity (BYC) that’s aimed at drawing more community-based organizations into the conversation. A recent BYC workshop held in Chinatown drew 18 participants representing 10 community agencies.

Much of the work to be done is reparative, Tufts people admit, coming as it does after times when the two communities were not always in step. When residents were surveyed at ADAPT’s formation about their prior involvement with Tufts research, many said they had found it to be a waste of time, says Sujata Ghosh, an ADAPT community partner who works on domestic violence programs in Chinatown. “They didn’t see anything coming back,” she reports.

Interpreters of Maladies

Language barriers remain. There is no single Chinese language, of course, but multiple regional dialects instead. Cantonese (linked to southern China) predominates as the main language of Chinatown, with Mandarin (common in more northern regions of China) on the rise.

Interpreters at Tufts Medical Center stay busy facilitating community/hospital interactions at every turn. Of 15 interpreters on staff, six speak Chinese. “We are jack-of-all-trades,” says Yoshie Ng, an interpreter who was born in Taiwan and has worked at Tufts for more than a dozen years. “We help with scheduling appointments, we call patients with reminders of their appointments, we relay messages to them from the doctors and nurses and we follow up on care.”

Ng’s involvement reaches beyond the routine demands of her job. She has volunteered to interpret for a weekly hour-long session every Friday (run by Marybeth Singer, a clinical instructor in anesthesiology) for Chinese-American patients undergoing chemotherapy, during which she fields any questions they may have. Ng also manages to teach a class in basic Chinese for first- and second-year Tufts medical students eager to connect better with the Chinese-speaking patients who may await them in their practices.

Knowledge of the other brings a closeness that builds on itself, preparing the ground for better days to come. Recently a Chinese-American man and his wife, newly arrived in this country, were out walking in Boston when the wife fell and broke her hip at a downtown subway station. When the couple was brought to the emergency room at Tufts Medical Center, staff and interpreters quickly gathered around the two to ask if there was anything they needed.

Soon after this traumatic incident, the husband was diagnosed with cancer and scheduled for treatment at Tufts. At that point he wrote a heartfelt letter to Eric Beyer, CEO of Tufts Medical Center, relating the couple’s positive earlier experience and concluding simply, “I have confidence in this hospital because I know they will take care of me.” One more connection had been made.

This article first appeared in the Winter 2013 issue of Tufts Medicine magazine.

Bruce Morgan can be reached at bruce.morgan@tufts.edu.