Hospitals' Staffs Adapt to Patients' Cultural Differences : Medicine: Training sessions and other educational services are helping doctors and nurses to understand ethnically based beliefs on health.


Some notes from the front lines of San Gabriel Valley health care:

* Think twice before you swaddle a newborn baby in a white blanket. If the child's parents are Chinese, they might take offense because white is the color of mourning.

* Don't be surprised if a Latino woman refuses to eat pork following childbirth. Some cultures believe that pork, a "cold" food, is a no-no following delivery, a "hot" experience.

* And remember that pork--and shellfish--are not welcome additions to hospital trays for some Muslim patients.

The Methodist Hospital of Southern California, in an effort to keep up with Arcadia's changing demographics, is compiling such tips to help nurses and doctors understand patients' ethnically based health beliefs.

"Cultural files" that list common beliefs were distributed to all nursing stations last month, said Marsha Jackson, head of the hospital's Multicultural Committee.

And pamphlets detailing folk medicine practices were distributed at a hospital fair in May, where half of the 30 booths featured information about diverse health beliefs.

The hospital is not alone in this type of effort.

Huntington Memorial Hospital in Pasadena conducts annual staff training sessions on cultural differences.

The role of hospitals is perceived differently by different peoples, said Toni Cooke, patient services supervisor at Huntington. For instance, when some women, particularly Latino women, check in to have a baby, "all the work is to be done by us," she said, as opposed to the idea of the mother playing an active role as is common in a Lamaze delivery.

"We tell our nurses to understand, not get frustrated," Cooke said.

Sometimes nurses should ask whether a patient has been seeing any other health practitioner.

"If we know a person lives in a large barrio and speaks Spanish, we specifically ask if he has ever seen a curandero, " or folk healer, Cooke said. Oftentimes, the healer's herbal prescriptions are harmless, she said, but the doctor needs to know.

Foothill Presbyterian Hospital in Glendora regularly offers Spanish classes to employees, and Queen of the Valley Hospital in West Covina produces baby care programs in Spanish for broadcast to patients' rooms via closed-circuit television.

David Langness of the Hospital Council of Southern California, a trade association, said hospital management teams are becoming increasingly aware of the importance of educating their staffs on different patients' expectations.

"It's really spreading through a lot of Los Angeles hospitals now that they have to deal with such diverse national and ethnic groups," he said.

For instance, at St. Vincent Medical Center in Los Angeles, an entire ward, the 16-bed Nikkei Pavilion, is set aside for Japanese patients with a preference for an ethnic menu--or for nurses able to speak their language.

Better service, rather than marketing, is the main objective of such endeavors, Langness said. "What compels hospitals to do it is they see a need and attempt to fill it."

At Methodist Hospital in Arcadia, a major goal is accommodating Asian patients.

"We were recognizing we had an increasing Chinese population in Arcadia," said Penny Brown, an instructor in the hospital's Education Department. "We'd see these patients, and we weren't sure we were always serving their needs."

In April, 1989, she organized the hospital's first staff seminar on concepts about illness in different cultures. She invited, among others, a physician from Los Angeles' Chinatown to explain the Asian concept of yin and yang: complementary forces in the universe that must be balanced to ensure good health.

Among some Asians, in contrast to beliefs held by many Latinos, childbirth is considered a "cold" experience after which "warm" fluids or foods should be taken. "When we give (patients) water, we usually put in ice," Brown said. "We were finding that these women were not drinking the water." Now nurses know to ask.

Even though some of these patients have lived in the United States for years or were even born here, cultural beliefs linger, perpetuated either by more recently arrived relatives or simply by respect for tradition.

Dr. Lucille Leong, a second-generation Chinese-American who was resting one recent evening in Methodist's maternity ward, recalled her Hawaiian-born aunt's offer of pigs' feet stew to reduce the duration of her bleeding after the delivery of her first child, Matthew, in 1988.

"She brought this whole humongous pot," enough to last her an entire week, recalled Leong, cradling her 8-hour-old daughter in her arms. Leong, an oncologist at another hospital, said she knew the concoction of soy sauce, ginger and vinegar probably wouldn't make any difference, but she downed the lovingly prepared brew anyway.

Arcadia's Asian population, including many recent immigrants, has grown in the last decade.

According to 1980 census figures, 88.2% of the city's population was Anglo, 6.9% Latino and 4% Asian. City officials have no current estimate, and the U.S. Census Bureau has no update yet, but Arcadia Unified School District records reflect a dramatic demographic change.

Of 7,769 students enrolled during the the 1989-90 school year, 54% were Anglo, 8.8% were Latino, and 36.4% were Asian, Pacific Islander or Filipino, said Arcadia school district spokeswoman Marilyn Daleo. In 1981, Asian and Filipino students made up only 10% of the district's enrollment.

Methodist Hospital officials are compiling statistics on the demographics of their patients.

Of the hospital's 1,300 employees, about 68.4% are Anglo, 15.7% are Latino, 11.8% are Asian and 4.2% are black, according to hospital spokeswoman Marilyn Morrison.

In addition to in-house efforts, Methodist's programs reach a diverse group outside the hospital as well.

On Sunday evenings from January to March, Chinese-speaking physicians and nurses at the hospital were featured on radio station KIQQ-FM in Mandarin language health education programs. The hourlong radio interviews covered topics from prenatal care to surgery, and they included time for call-in questions from listeners.

The programs resumed June 24 and will continue every other week through October, when the hospital will re-evaluate the idea, Jackson said.

Dr. Chris Leong, a Methodist hospital pediatrician featured on the radio show, said many of Arcadia's Chinese travel to hospitals in Monterey Park or Alhambra, where they can receive treatment in their own language.

Representatives of Garfield Medical Center in Monterey Park and of Alhambra Community Hospital said their facilities, situated in neighborhoods with large Asian populations, receive many referrals from Asian physicians practicing in the areas.

But patients "are slowly beginning to come to Methodist," said Leong, who is not related to Lucille Leong.

Born in Malaysia and with a medical degree from Yale, Chris Leong understands when 2-week-old babies are brought in for checkups by the father or grandparents. The new mother is supposed to stay home for up to a month to recover, he explained.

"You just have to observe the custom," Leong said.

In another facet of the hospital's Asian outreach effort, it launched a physician referral hot line this spring staffed by three Mandarin-speaking volunteers. The number is (800) 828-8986.

Adjustments have been made in the hospital menu as well. Since last summer, rice has always been available, as well a greater variety of Latin dishes. In the maternity ward, new parents who want something other than the steak and lobster that is usually served after delivery may choose from a special ethnic meal.

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