DECEMBER 2002

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Translating Vital Signs

By Josh Brustein

Everyone knows what it’s like to ask a doctor a question and have them answer it in what seems like a different language. For New York’s immigrants, many of whom don’t 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 York’s 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 hospital’s 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 was serving.

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 you’re feeling a bit comfortable you’re having to change again."

The Health 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, "it’s 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 can’t," 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]."

Cultural Differences

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.

"There’s 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 of punishment."

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