Multicultural Medicine : Patients want doctors and nurses who speak their language--and know their fears. Hospitals try to keep pace by providing everything from sushi and salsa to CPR seminars in Spanish.
When Takehiko Kobayashi of Gardena underwent surgery in December at Torrance Memorial Medical Center, he was surprised to find that many nurses spoke his native Japanese.
“To me, that makes a lot of difference,” said Kobayashi, 58. “When you are sick, you’re not in the mood to try to communicate things in a foreign language.”
Spurred by that same feeling, Lisa Torres of San Pedro scoured her health plan physicians’ list for a Latino name.
She and her husband chose Dr. Andres Jimenez, a young family physician with ties to San Pedro Peninsula Hospital, and she turned to him last month when her 6-month-old son, Rudy, fell sick with a stomach virus. Even though she and Jimenez communicated in English, she felt reassured that he understood her concerns.
“It’s not that I’m prejudiced or anything. I just felt comfortable with a Latino physician,” said Torres, 27, a local cable company employee.
This desire for a cultural common ground in medicine--a nurse who speaks the same language, a doctor who understands one’s heritage--is helping forge changes at some hospitals in the South Bay.
In a medical world that can seem harsh and impersonal, even when patients and doctors speak the same tongue, new attention is being paid to the barriers that can be posed by language and culture. Such concerns helped create the hospital wing where Kobayashi recuperated, a wing that will formally open this month as the East-West Pavilion, the South Bay’s first inpatient hospital unit designed for Asians.
Here, nurses speak Japanese or Chinese, and meal trays have chopsticks, Japanese garnishes such as shredded cabbage or radish, and, of course, the traditional warm towels. Pavilion planners even designed a sushi assortment nicknamed “the Torrance pack” that contains tuna, shrimp, whitefish, eel and California roll.
This wing is perhaps the most ambitious example of how some local hospitals are retooling their services amid the sweeping demographic changes in Southern California.
Asians accounted for nearly 10% of the patients treated at Torrance Memorial in 1991, up from 5% eight years earlier. Another 69% were white, 14% were Latino and 8% were black.
“The South Bay demographics have changed and are going to continue to change. That’s what we’re responding to,” said Carlene Reuscher, senior vice president for patient services at the 340-bed nonprofit hospital.
She described the East-West Pavilion as a starting point and says the hospital is planning other changes, such as more materials in Spanish. “Our first desire is to meet (patients’) needs better. Our second hope is that patients will prefer to come here.”
Some say this trend toward multiculturalism is simply good medicine; others call it good business sense. But since the South Bay’s Asian and Latino communities have grown dramatically in recent years, other hospitals have begun trying to appeal to a more diverse patient market.
Little Company of Mary Hospital in Torrance is expanding a program that provides physicals for executives of Japanese companies.
The same hospital now sends new mothers home with a baby-care video in English, Spanish or Japanese.
Dishes such as fajitas , tacos and menudo were added last year to the patient menu at Robert F. Kennedy Medical Center in Hawthorne, where the Latino community nearly doubled in the 1980s to account for more than 30% of the city’s population.
And Inglewood’s Daniel Freeman Memorial Hospital and the Great Beginnings for Black Babies program are opening a clinic targeted at African American and Latino patients in a Hawthorne shopping mall this week. Those two groups comprised 68% of the hospital’s patients in 1991.
Some say these changes are long overdue. One Latino doctor, for instance, said hospitals have ignored the Latino community too long in favor of patients considered more likely to have private health insurance.
“There’s not always been a willingness on the part of the provider to treat (patients) on an equal basis,” added Virginia Apodaca, regional manager of the Office for Civil Rights for the U.S. Department of Health and Human Services. “I’m seeing improvement now, because providers are taking steps to communicate with patients.”
In many cases, those steps are being taken because Los Angeles County has evolved into the Ellis Island of the late 20th Century, where residents come from 140 countries and read more than 50 foreign-language newspapers published here.
Just four months ago, California created a new Office of Multicultural Health, explaining that the state’s African Americans, Native Americans, Asians and Latinos experience a disproportionate share of disease, disability and early death.
But more than humanitarianism is helping kindle this interest in patients from diverse cultures.
In the turbulent world of health-care economics, some hospitals have concluded that marketing to racial and ethnic groups makes economic sense--and may be a key to their survival.
Badly bruised by the recession, a steep drop in patients and insurance changes, 60% of the regions’s hospitals were in the red last year. Many are cutting staffs, discussing mergers or reassessing their marketing strategies.
“Hospitals can no longer be all things to all people, and so they are specializing,” said David Langness, vice president of the Hospital Council of Southern California.
In Torrance, home to the U.S. headquarters of Japanese-owned Honda and Toyota, the Asian population grew 113% between 1980 and 1990. Similar increases were recorded in the affluent cities of the Palos Verdes Peninsula.
The number of Latino residents, meanwhile, grew 134% in Inglewood and 91% in Hawthorne, meaning that more Spanish-speaking patients are being treated at hospitals such as Daniel Freeman and Robert F. Kennedy.
And in a field such as medicine, where good communication is paramount, language invariably becomes the first stumbling block.
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The infant girl was admitted recently to Daniel Freeman Memorial. Her father spoke little English, so pediatrics nurse Patricia De Jesus stepped in to quiz him in Spanish: Had the baby been irritable, lethargic, vomiting?
De Jesus became a key link in the baby’s treatment for pneumonia, providing reports to the doctor, explaining to family members why the baby needed to stay another night at the hospital, why the antibiotics were stopped and started again.
“I’m able to relate to them, because I speak their language, and they’re more at ease with me than an Anglo nurse,” De Jesus said.
Such scenarios are commonplace in hospitals in Los Angeles County, where the 1990 Census found that one in seven residents did not speak English at home.
Seeking to close communication gaps, a new state law effective in 1991 requires acute-care hospitals to provide interpreters for patients who speak little or no English and whose language is spoken by at least 5% of the hospital or area population.
Most local hospitals subscribe to the AT&T; Language Line, which provides over-the-phone interpreters in more than 140 languages. Many have also developed lists of bilingual staff members who can interpret when needed.
Those lists provide a portrait of how diverse the hospital staffs have become.
The roster at Little Company of Mary, for example, shows employees speaking 32 languages, from Arabic to Finnish, Mandarin, Thai, Urdu and Vietnamese. The Daniel Freeman roster lists 28. The most prevalent languages at both hospitals: Spanish and Tagalog.
Some experts caution that medical interpretation is no easy task. A Van Nuys-based firm, Interpreting Services International Inc., has developed a program specifically for hospitals to screen and train employees to do interpretation.
Language is not the only cultural barrier that can separate patients from hospital workers.
Experts caution that health-care workers need to be aware of cultural differences in such areas as medication, child care, the value of folk remedies and the emotion-laden issue of terminal illness.
“Just because you can tell someone where the bathroom is doesn’t mean that you can tell a daughter that her father has a terminal case of cancer,” said Jean Gilbert, an expert in ethnic medicine and a management researcher at Kaiser Permanente, Southern California.
In certain Asian cultures, dying at home is considered far preferable to dying in a hospital, so a patient’s family might fight hard to have their relative discharged before death, said Gilbert.
“And it’s considered in very poor form in many cultures for a patient to be informed that they are dying,” Gilbert said.
Kaiser is preparing more programs to help its staff deal with cultural differences, and at least two South Bay hospitals, Torrance Memorial and Daniel Freeman, plan to offer training to employees.
Some hospitals have taken cultural sensitivity a step further: designing a program for a specific niche, or ethnic group.
Little Company of Mary led the way five years ago with its ningen dock project to provide annual physicals to executives of Japanese firms in the area.
The program grew 63% in 1992-93 and has outgrown its hospital quarters. It will move in the next few months to new offices in the Del Amo Diagnostic Center.
Little Company, a 374-bed nonprofit Catholic hospital, also started a Japanese help line, physician referral service and a Japanese menu.
Its chief rival, Torrance Memorial, took a different tack in designing an Asian program by enlisting the aid of Community Hospital of Gardena, a 58-bed for-profit facility where two-thirds of the patients in 1991 were Asian.
The Gardena hospital’s small size has hindered its efforts to get managed-care contracts, said its president, Raymond N. Smith. So the two hospitals produced the East-West Pavilion in a 20-bed wing on Torrance Memorial’s fifth floor. Community Hospital provides nursing services and management expertise.
That approach has its dissenters. “I find it very difficult to dedicate any one wing to one culture,” said Ursula Durity, administrator at Memorial Hospital of Gardena. “I think we are multicultural, and we should be able to satisfy everyone.”
Managers of the new pavilion hasten to explain that a Torrance Memorial patient of any ethnic group may choose to stay in the Asian wing, even if only because of a hankering for egg flower soup and steamed rice, and the same dishes can be ordered in other patient wings.
“We’re very careful that a white, red-haired person from Ireland has the option of going into the East-West Pavilion,” said Smith.
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When Lisa Torres scanned her physicians’ list for a Latino name, she illustrated the crucial role that doctors play in hospitals’ efforts to reach patients of diverse backgrounds. Torrance Memorial, for instance, hopes to attract a broad mix of physicians to its new Family Medicine Center.
“We want a balance of male and female physicians of many ethnicities that reflect the mix of the population in the community,” said Sally Eberhard, hospital vice president of planning and marketing. And, the doctors presumably would refer patients to Torrance Memorial when they need hospital care.
Most of the physicians at the Family Medicine Center are white, but a group of Asian doctors from Gardena will move in next month. So will a five-doctor group that includes two Latinos, one Chinese American and Dr. Rick Chavez, who is of Mexican and Japanese heritage.
Chavez praises Torrance Memorial for its efforts, but says most hospitals have been slow in addressing the needs of patients from different cultures.
“Hospitals in the past have viewed Hispanic patients as being poor and without insurance,” Chavez said. What those hospitals failed to realize, he said, is that many Latinos are insured and make up a sizable portion of the work force. A survey of eight South Bay hospitals found all of them offering some materials in Spanish. Three hospitals advertise in Spanish, and four are making plans to add Spanish directional signs in their buildings.
Memorial Hospital of Gardena has begun translating its patient menu into Spanish, and Robert F. Kennedy Medical Center plans to follow suit by February.
Little Company offers Lamaze, CPR and a Safe Kids U.S.A. course in Spanish. The Safe Kids, which has attracted nannies and housekeepers, is clearly pitched to the employers, using an advertisement in English that raises the stark question: “Your child starts choking while you’re at work. Does your housekeeper really know what to do?”
The program was designed for nannies and child-care providers, teaching them skills such as accident prevention, earthquake and fire preparedness and first aid, said Sandra Jansen, director of Safe Kids.
“One thing I like about this program is that the Hispanic women who take this course leave feeling good about themselves,” Jansen said.
Both Little Company of Mary and its affiliate hospital, San Pedro Peninsula, are considering a program that might include Latino menus and food for patients as well as more materials translated into Spanish, administrators said.
For hospitals, the value of such ventures cannot be underestimated, some experts say.
“If they’re interested in attracting patients and providing them the best service possible, making those changes--having interpretation services, having staff that reflects the patient population, having appropriate diet available--those are very important things,” said Calvin Freeman, chief of the state’s multicultural health office.
For some hospital employees, learning to serve new patients has been an education.
In the kitchen at Torrance Memorial, cooks are whipping up dishes such as egg flower soup and a cereal known as Okayu.
Although Japanese food had never appealed to food director Scott Freeman (“I was a meat-and-potatoes guy”), he has swiftly become a convert.
“I love it. I’m sold,” he said. The one dish he has not embraced, however, is sushi. “That’s because I’m letting my own culture get in the way.”
Cultural Mix
Patients by ethnic group in selected South Bay hospitals for 1983, the first year such statistics were collected, and 1991. Totals do not include newborns.
Daniel Freeman Memorial Hospital, Inglewood
1983
White: 50.3%
Black: 45.4%
Asian: 3.8%
Other / unknown: 0.3%
Hispanic: 0.2%
1991
White: 28.9%
Black: 61.3%
Asian: 2.7%
Other / unknown: 0.6%
Hispanic: 6.6
Little Company of Mary Hospital, Torrance 1983
White: 91.9%
Black: 2.1%
Asian: 0.7%
Other / unknown: 5.1%
Hispanic: 0.1%
1991
White: 76.7%
Black: 3.2%
Asian: 9.4%
Other / unknown: 3.7%
Hispanic: 7.1%
San Pedro Peninsula Hospital, San Pedro
1983
White: 88.8%
Black: 4.5%
Asian: 2.4%
Other / unknown: 0.5%
Hispanic: 0.1%
1991
White: 74.5%
Black: 6.6%
Asian: 1.9%
Other / unknown: 0%
Hispanic: 7.1%
Torrance Memorial Medical Center, Torrance 1983
White: 74.3%
Black: 3.6%
Asian: 5.1%
Other / unknown: 5.2%
Hispanic: 8.8%
1991
White: 68.6%
Black: 7.7%
Asian: 9.7%
Other / unknown: 0.2%
Hispanic: 13.8%
Source: Office of Statewide Health Planning and Development, patient discharge information.
On the Cover
When 6-month-old Rudy Torres got sick, his mother took him to Dr. Andres Jimenez, incoming chief-of-staff at San Pedro Peninsula Hospital. “I just felt comfortable with a Latino physician,” said Lisa Torres. As the South Bay’s population grows more diverse, some local hospitals are trying to practice a new kind of medicine that is more in tune with different cultures. Some have forged ties with doctors from varied backgrounds. Some have translated patient pamphlets and videos. In Torrance, two hospitals are even serving up Japanese food.
