In the Field: Hospice Team Targets Manhattan’s Chinatown
Together, the New York City metropolitan area’s Chinatowns constitute the heaviest concentration of Chinese outside Asia. The oldest and largest is the 24-block Chinatown neighborhood in Manhattan, where registered nurses and other clinicians from the Visiting Nurse Service of New York’s Asian Hospice team care for patients and their families.
Comprised of interdisciplinary nursing professionals, the group reaches out to neighborhood physicians and the community. With a combination of specialized skills, extensive experience, and cultural familiarity, the team brings a unique blend of strengths to their Chinatown practice. Their fluency in Mandarin, Cantonese, and other dialects builds rapport and reduces cultural barriers to quality care. Just as essential is the team’s cultural sensitivity, particularly toward end-of-life issues.
Reaching the community
In Chinese culture, discussion of dying is taboo. The color white and the number four are associated with death and considered inauspicious. Death is viewed as a harbinger of more bad luck for the families of the deceased, so elderly Chinese sometimes try to avoid dying at home. To deal with the matter in a culturally appropriate way, the Asian hospice team collaborates with VNSNY’s broader Asian Program, the Chinatown Community Center, and the Neighborhood Naturally Occurring Retirement Community (NNORC) to reach community leaders and organizations like the Chinese Consolidated Benevolent Association. Team members also grant interviews about hospice issues to Chinese radio, TV, and newspapers, in an effort to make the subject more accessible.
“Patients and families feel comfortable talking to me not only about physical but also spiritual problems,” says Hsiao Hui-Chen, R.N., a Taiwan-born coordinator of care who brings culturally relevant experience from her work in oncology and the fi rst-ever hospital hospice unit in Taiwan.
Another member of the team, Heidi Chan, R.N., draws on her Chinese roots when administering care. She is a Chinese-American after-hours RN with 20 years of hospice experience, and she conducts in-service seminars at a major city hospital and elsewhere regarding culturally informed home care for Chinatown’s end-of-life patients and families. Her Buddhist faith enhances her ability to comfort patients and families.
But not all of the team’s members are fl uent in Chinese dialects. Charles G. Meys, R.N., a highly experienced hospice nurse, has cared for patients in Chinatown for five years, with support from his escort/translator, Fong Fai Chow. “My escort not only translates but also interprets everything from moods and circumstances to clinical, emotional, and fi nancial concerns,” he says. “Mr. Fong builds a bridge to our Asian patients.”
Nurses collaborate with the team physician, Dr. Leonard Bakalchuk, a former Hong Kong resident who speaks both Cantonese and Mandarin, a rarity in a Caucasian American. He coordinates with VNSNY’s Asian Program in meetings with the New York Department of Health, doctors practicing in Chinatown (particularly oncologists and cardiologists), and the Chinese American Independent Practice Association to build awareness of hospice care in the neighborhood.
From a psychological perspective, Pamela Yew Schwartz, Ph.D., a Chinese-American bereavement counselor, gives follow-up care to surviving relatives. Last April, Dr. Yew Schwartz and other team members organized the region’s fi rst presentation on improving end-of-life treatment for Chinese Americans, co-sponsored by a major hospital. Serving as a panelist at that presentation was an additional team member: Kei Okada, a spiritual care counselor who relies on his upbringing in Japan to offer culturally sensitive support. Gui Loo, L.C.S.W., a Chinese- American social worker, rounds out the team, led by nurse Alice Palatnick, R.N., B.S.N., M.S.W., also a social worker.
The team’s current initiatives include translating hospice brochures, consent forms, and Advance Directive forms and cooperating with the Asian Program and Chinatown MDs to give community presentations on Advance Directives. Last summer, they joined with VNSNY’s Chinatown NNORC to organize an Advance Directive Task Force. They held their first workshop on health care proxies (HCP) earlier this year at Confucius Plaza in the heart of Chinatown, attended by several city agencies and 150 residents. To expand on their community outreach, the team also provides cultural sensitivity hospice training at a nursing home on Manhattan’s Lower East Side, in-service presentations at a major hospital and settlement house, and ongoing work with community organizations and senior centers to promote hospice care in Chinatown.
Other examples of culturally competent care include supporting the patients’ surviving relatives in their practice of traditional rituals (such as displaying photographs of the deceased). Dr. Yew Schwartz notes that sometimes her work involves counseling family members on their experiences and “encounters with ghosts” in the wake of bereavement.
Perhaps the most meaningful facet of their work is the connections the team RNs and other clinicians have made with patients and their families. One patient’s daughter, an oncology nurse in Hawaii, kept in touch with Hsiao Hui-Chen by phone, enabling her to travel home when the end was near. The wife of another of Hui-Chen’s patients went from resisting hospice care to appreciating having her spouse pass away peacefully at home.
History of service
VNSNY’s outreach and service in Chinatown stretches back to the agency’s founding in 1893, when they began caring for poor immigrants on the adjacent Lower East Side. In 1910, founder Lillian Wald went to Asia and chose the Chinese character “bao” (meaning “We are all one family.”) as an agency symbol still in use today. VNSNY has photos and footage from the 1920s when a Chinese RN named Zing Ling Tai made her rounds in Chinatown. Ten years ago, Liu Fang Mien, R.N. (now retired), launched VNSNY’s Community Center. After 9/11, the center helped residents cope with the terror attack and has since provided thousands of free flu shots; cholesterol, diabetes, and blood pressure screenings; health classes; and other services.
RNs on the Asian hospice team join fellow clinicians in bringing awareness of the benefits of end-of-life care to Chinatown. Thousands of residents have been exposed to information on Advance Directives and end-of-life issues through the NNORC and Community Center efforts, in addition to ongoing outreach in hospitals and nursing homes. Dr. Bakalchuk reaches out to local doctors as well as the New York State Department of Health. Other team members partner with neighborhood pharmacies and local, state, and national organizations like the Charles B. Wang Community Health Center, the American Cancer Society Eastern Initiatives, and the Taiwan-based international Buddhist nonprofi t Tzu Chi Association. Through VNSNY’s Asian Program, the team also reaches out to Asian nurses and patients in New York City’s other Chinatowns in Queens and Brooklyn and beyond.
The nurses and their teammates measure outcomes one patient at a time, while continuing their progress in bringing hospice care to Chinatown.