By Josh Brustein
Everyone knows what its like to ask a doctor a question and
have them answer it in what seems like a different language. For
New Yorks immigrants, many of whom dont speak English
well, health care can be even more confusing and frustrating.
But the language barrier is not the only obstacle preventing New
Yorkers from other countries from getting effective medical care.
Attitudes about health care differ in different parts of the world,
and many immigrants see doctors, hospitals, and medicine in different
ways than do many American health care professionals. Some of New
Yorks hospitals have made it their primary mission to deal
with these challenges.
According to Brian Palmer, associate executive director of Coney
Island Hospital, part of being an effective hospital for an immigrant
population is "being open to the medical practices that people
used before coming here."
The hospitals first experience with cross-cultural care
came in the 1970s, when a wave of Russian immigrants settled in
Brooklyn, forming what is now the largest Russian community in the
United States. By staffing itself with members of the Russian community,
Coney Island Hospital was able to keep connected to the people it
Then a surge of Pakistani immigrants moved into the area, and
the hospital was forced to start over once again.
Coping with Shifts
Quickly changing populations, characteristic of New York, provide
a major challenge for many New York City hospitals. Once a hospital
has developed a relationship with a community, it shifts. "Normally
you would see [a demographic shift] around every twenty years or
forty years," said Lata Vasconcellos, public affairs director
for Elmhurst Hospital. "Our shift is somewhere around five
years," she said. "Just when youre feeling a bit
comfortable youre having to change again."
and Hospitals Corporation has been trying to create a centralized
data base, so that when a population shifts from one part of the
city to another, the insights of one hospital will not be lost.
"In a city like this, where people move around so fluidly,"
says Palmer, "its the only way to do it."
Coney Island Hospital responded to its new role as a provider
of health care for Pakistanis the same way that it had before
by changing the staff to be more like the people they were serving.
"In order to promulgate effective care, one needs to speak
or understand the language, which obviously I cant,"
said Dr. Edwin Bronstein, head of the obstetrics and gynecology
department at Coney Island. Coney Island Hospital does have a telephone
interpretation service that offers interpreters in over 100 languages.
The obstetrics and gynecology clinic at Coney Island Hospital,
which now includes two Pakistani health educators, developed a distinct
procedure for Pakistani childbirths, such as allowing mothers to
remain in their own modest clothing instead of hospital gowns during
the early stages of labor, and playing Pakistani music throughout
labor, are common. Also, since the Pakistani community is almost
exclusively Muslim and prefers to have female doctors treat women,
the hospital provides an all-woman delivery team.
One night, however, a woman needed an emergency caesarian. "When
you have an emergency in the middle of the night," said Bronstein
"it is impossible to provide ten women [to perform the surgery]."
Bronstein then went to the neighborhood mosque and explained the
situation to over a thousand members of the local Muslim community.
Because he made the effort to make this connection, he said, "we
formed a good relationship" with the community, "with
the understanding that we try our best [to respect their wishes]."
According to Molly McNees, a medical anthropologist who is working
on a study of how health care is provided to Mexican immigrants
in New York City, cultural differences can not only strain relations
with the community as a whole, but can lead to miscommunication
when a patient and doctor are talking one on one - even if
they are speaking the same language.
The field that is most difficult for people from a range of countries
to deal with is mental health. In her study, McNees found that traditional
beliefs and practices can prevent people from accessing mental health
services. Palmer, from Coney Island Hospital, has found the same
thing to be true.
"Theres a lot of shame," with Russian patients
who have to deal with mental health services, Palmer said. "In
the former USSR, admittance to a mental health facility was a form
Back to The Citizen Page