Reaching Out to Asian Patients
At Garfield Medical Center, elderly patients rehabilitate their dexterity with games of mah-jongg. In the kitchen, the staff prepares meal trays for patients brimming with braised tofu, soy sauce chicken and sweet and sour beef ribs. For breakfast, Chinese rice porridge is more popular than oatmeal.
The nurses, meanwhile, are friendly but watchful as families visit patients, keeping an eye out for those sneaking in an acupuncturist late at night or some old-world herbal remedies.
The Monterey Park hospital is located in the heart of one of the nation’s largest Chinese American communities and has generated much attention for its effort to blend Western medicine with Eastern attitudes about medical care.
Its owners have made a concerted effort to turn their medical center into a laboratory of sorts -- a place that tries to adapt its services to the culture of the surrounding community. The model has become so successful the owners have purchased a second facility, Whittier Hospital Medical Center, and are rebuilding it in the same mold.
Garfield is stocked with the latest medical technology, but its staff also tries to be sensitive to the tastes and needs of the predominantly Asian patients. Nurses and doctors speak not only Mandarin and Cantonese, but more obscure Chinese dialects like Hakka, Shanghainese, Taiwanese and Toisanese.
They try to guide immigrants, some of whom are used to hospitals where families themselves provide food and some medicines.
William Bao, a family practitioner based in Rowland Heights who also sees patients at Whittier Hospital Medical Center, said the hospitals provide needed services to people who might be uncomfortable in a regular hospital.
“I can read their prescriptions and test results from China. They don’t have HMOs over there, so I can explain the system here,” he said.
He said part of his job is dispelling questionable treatments that are popular in China. Patients have asked him to “wash their blood,” a process in which an IV drips fluid that is supposed to rid the body of toxins.
“I had a person call in a couple months ago to see if we could do it,” Bao said. “I have to tell them that there’s no evidence that supports that it works.”
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Veteran nurse Shirley Tang casts a watchful eye over her 28-bed floor at Garfield.
“I’ve seen families sneak in acupuncturists,” said Tang, the rehabilitation unit’s nursing director. “They don’t tell us. They say they’re a family member and close the door. We have to tell them, ‘Don’t do that here, it’s not part of the treatment. It can be harmful.’ ”
The last time Tang dealt with such a situation was a year ago when a Mandarin-speaking family revealed to a social worker that they had brought an acupuncturist in to look at a family member who had suffered a stroke.
“They believed the acupuncture would unblock the chi -- or energy -- and circulate it around the body to take the feeling of weakness away,” Tang said. “They felt bad about it after we spoke to them. They said they didn’t mean to do it behind our backs and that they didn’t know it was that significant.”
Tang and other nurses are also trained to sniff out pungent Chinese herbal medicines, which are also smuggled in by family members, usually during the night shift. The powerful elixirs, made of such things as dried roots and flowers, have the potential to clash with prescribed diets and medications, Tang said.
“It probably happens every three or four weeks,” Tang said. “They usually tell the nurses that it’s just tea or chicken soup. I usually don’t stop them if they’re on a normal diet. I just tell the physician. We don’t discourage all alternative medicines. We just want to be informed.”
Conflict stems from how Asians view the role of health workers and family. In Asia, parents and children are seen as the frontline for care-giving. As a show of love, family members are expected to do all they can to nurse their loved one back to health. At times, this comes across as overbearing when family members oppose standard procedures such as feeding patients through stomach tubes, because many Chinese consider it invasive and unnecessary.
“The good side is the patients feel loved and have more hope,” said Tang, who speaks both Cantonese and Mandarin. “But sometimes it’s a drawback.”
“For example,” she said, “we want patients to feed themselves, not their family, so that they can learn to take care of themselves again. In Chinese culture, feeding your family is a sign of love. So we sometimes have to send family home and say, ‘You’re doing too much.’ ”
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Signs and forms are all written in English, Spanish and Chinese. A 24-hour Mandarin news channel is available in patients’ rooms.
In Garfield’s expansive kitchen, cooks slice open a Chinese winter melon the size of a basketball to boil for soup. In the pantry, dried shiitake mushrooms, shredded dried pork and rice wine share shelf space with cans of cream of mushroom soup and Uncle Ben’s rice.
Ingredients arrive from Hong Kong supermarket, a short walk away on Garfield Avenue. Wooden chopsticks are packaged in paper wrapping that bears the hospital name in both English and Chinese.
“We had consultants come in and research what we should serve,” said Jerry Miller, director of food and nutrition services. “We found out that Asian patients want home-style cooking. They want more porridges and stews, something a mother would serve her child.”
Upstairs in an L-shaped therapy room outfitted with exercise equipment, beds and a karaoke machine, four elderly Chinese patients in wheelchairs sit around a four-cornered table playing mah-jongg -- a Chinese game in which participants stack white and green tiles and move them according to the roll of two dice.
Doctors use the game to exercise patients’ motor skills.
“I was never able to play mah-jongg at other hospitals,” said Shao Y. Feng, a 92-year-old Monterey Park resident who was recovering from a hip fracture after a fall on Christmas Day.
Moments earlier, Feng was arguing with a Vietnamese-Chinese patient over which rules to play by: the Taiwanese or Cantonese version, a difference that affects how many tiles to start the game with, among other rules.
“I used to play regularly,” said Feng, slightly frustrated that his opponents were not as skilled. “But I can’t sit down that long anymore.”
Downstairs is Garfield’s obstetrics unit, which saw a surge in births in 2000 because it was the popular year of the dragon in the Chinese calendar.
Chinese women in labor are never offered ice chips or cold water -- as is custom at other hospitals -- because Chinese custom frowns upon shifting the delicate internal balance of hot and cold, said Erik Jiang, director of business development.
Not all of the hospital’s efforts to introduce Chinese culture have worked. Folk dances in the obstetrics unit, replete with a dragon mask and a floor drum, were nixed after too many patients complained about the noise.
Administrators said contributing to Garfield’s credibility in the Asian community are its Asian physicians. More than 75% of the hospital’s 539 medical staff members are Asian. Half of the 180 patients that visit the hospital each day are Asian.
“You need a Chinese physician in every specialty,” Jiang said. “It took Garfield a good decade to do that. Chinese doctors need to grow into leadership roles. You can’t just say one day, ‘I want a Chinese hospital.’ ”
The owners of Garfield, health group AHMC, are now working on transforming the Whittier hospital.
Bao, the doctor with the private practice in the City of Industry, now roams the hallways of the 210-bed hospital. Bao had previously worked in Montebello at Beverly Hospital, but heard through colleagues about Whittier’s interest in adding Asian physicians.
“I went because they had more Chinese doctors and patients,” he said.
Assemblywoman Judy Chu (D-Monterey Park) praised the efforts to better serve Chinese Americans who find themselves in the hospital.
“And the food! That’s really critical,” Chu said. “Especially for an older person who just suffered a stroke or has cancer. They need to have something familiar to them like Chinese food.”
