The primary goal of AAPCHO’s Story Bank is to generate awareness about the importance of providing access to culturally and linguistically appropriate care to all people. We feel that both the patient and provider perspectives are an important part of the national dialogue surrounding health care issues in our country.
Our hope is that these stories will give voice to the insights of our nation’s under-served and help educate policy makers at both the state and national levels.
Cultural Diversity in Hawaii - Winning Essay, Youth CHC Patient Category
Michelle Galvez (Kalihi-Palama Health Center, Honolulu, Hawaii)
Michelle Galvez (right) with Emmanuel Kintu, Executive Director, Kalihi-Palama Health Center. Photo by Jay Hubert
I was only 3 years old at the time, when I heard we were about to embark on an epic journey. I was born and raised in the Philippines, and the thought of leaving pained my young mind. I knew nothing of this foreign land, nor its culture, language, or precinct. I felt uprooted from my home as my mother packed our belongings, our life, and our future. We were on our way to Honolulu, Hawaii.
My first several years in Hawaii were the most challenging, yet exciting. I was new to almost every aspect of Hawaiian culture at first, but soon adapted and adored this new land we now call our home. Coming from the Philippines, my main language was Tagalog. I was alien to the English language. My mother, on the other hand, was very fortunate to have previously learned English. Through her knowledge and further research we were able to find a health care provider that suited our needs.
Kalihi-Palama Health Center made me feel at home. It was as if I had never left the Philippines. We were greeted with smiling faces and helpful hands that showed us the way through the clinic. The clinic was unique, but wholly expressed, diverse. They kept health posters throughout the offices printed in different languages, making it easier for people who were not familiar with English. It felt good to know I was welcome in a place that was so foreign to me.
I was sent to a pediatrician at Kalihi-Palama, one that spoke my language and understood my culture. It was easier to express my feelings when I could actually understand what was being said. Whenever I was sick, we simply gave the clinic a call and scheduled an appointment. Their times were flexible and the people were nice enough to make sure we got immediate attention when necessary.
Today, I stand as a healthy individual representing the effort and care my pediatrician has given me. Every year I go in for physical check ups, vaccinations, and prescription medicine. I really appreciate the help my health care has given me as I was growing. Up till now, they continue to support my health and encourage me to do well. Getting settled in Hawaii would be a completely different story without the great diversity of languages. When I was sick, I could easily relate to my pediatrician how I felt and what I was going through. I wish that everyone can experience this opportunity, to be able to have health care providers that help you accordingly, giving you the help and support you need in a language you can understand.
Hawaii is a diverse melting pot of cultures that provides for the needs of each nationality. I for one have definitely benefited from the multi-cultural diversity. Kalihi-Palama Health Center helped me grow and develop as a young child to a teenager today. They have inspired me to one day become a multi-lingual pediatrician.
Health and Wellness in AAPI Community - Winning Essay, Adult CHC Patient Category
Sunly Lao (Lowell Community Health Center, Lowell, Massachusetts)
Sunly Lao (center) with Dorcas Grigg-Saito, Executive Director, Lowell Community Health Center (left) and Yul Kwon (right). Photo by Jay Hubert
My name is Sunly Lao. I am from Cambodia. I have been here in the United States since July, 2000.
In 1975 when the Khmer Rouge took over Cambodia, I was in sixth grade, and my education stopped. I learned some English in a refugee camp in Thailand. Later, I got my high school equivalency in Cambodia, but I was never taught essay writing. I continued studying English in the U.S., and now I will try to write an essay for the contest.
After I arrived in the United States, everything seemed completely different in terms of culture, language, food, different ethnic groups, etc. At first, it was hard for me to communicate due to my accent and insufficient vocabulary. I really needed an interpreter.
I was pregnant, and I asked myself where I could receive health care appropriate to my culture and language. I met a Cambodian woman who urged me to come to Lowell Community Health Center (LCHC). Once there, I asked the people at the front desk if I was eligible since I was uninsured. Although I had no money, I was very welcome at LCHC. I felt much better when I saw that staff were friendly and cordial. They provided me with an interpreter. That made me feel confident to talk to the doctor through someone with language expertise.
I saw Doctor Dystar who encouraged me to come back even if I had no money to pay. LCHC staff applied for Free Care for me. I felt excited because one part of my problem was solved. Later, Doctor Dystar left to care for her sick mother. I miss her greatly.
A social worker referred me to WIC for supplemental foods for baby and mother. Then, I was referred to someone who helped me apply for Food Stamps.
I still come regularly to see the doctor for my baby and myself. Bunachi was my baby doctor. She is gentle, smart, outgoing, and friendly. And after the arrival of my two children from Cambodia in 2005, they were scheduled for health assessments at LCHC as well. We all see Doctor Miller regularly. She is kind and generous.
LCHC has skilled staff who speak many languages such as Cambodian, Spanish, Lao, and Vietnamese. Most of them are aware of cultural beliefs, foods, and traditional medicine, and they listen to patients’ needs. One thing that I like the most is that the doctor allows people to use traditional medicine in combination with modern medicine. For instance, Tiger Balm is allowed to be used for relief of ailments such as abdominal pain, dizziness, and headache.
I always tell Cambodian women who are newcomers, don’t hesitate to come to LCHC. LCHC is a valuable resource for Southeast Asians and other ethnic groups. LCHC impacts my health and well-being through appropriate health care and other services such as financial support, cultural awareness, and linguistic facilitation. For your health and well-being, do come to LCHC.
Metamorphosis - Winning Essay, CHC Employee Category
Christina Ng, M.D. (Asian Health Services, Oakland, California)
Dr. Christina Ng (center) with Yul Kwon (left) and Sherry Hirota, Executive Director, Asian Health Services (right). Photo by Jay Hubert
Ling was a young Chinese woman who came to our clinic for prenatal care just four months after immigrating to the United States. Like many of our patients, she came straight from a rural farming village where traditional herbal medicine was practiced and prenatal care was non-existent. Consequently, our protocol of drawing multiple tubes of blood, asking very personal questions, and having her undress completely for a pelvic exam on the first visit was completely foreign to her. Luckily, I became her family physician, and her face relaxed when she learned that we both spoke the same Chinese dialect.
As I explained that we tried to do more preventive medicine here in the United States, she started to understand the reasoning behind all of our tests and inquiries. When her tuberculosis skin test turned positive, she initially felt that a chest X-ray was not necessary or safe during pregnancy. Nevertheless, she eventually consented to having the X-ray in her second trimester, after I explained the consequences of reactivation TB in terms that she could understand, drawing on examples from our shared cultural beliefs, and dispelling myths with education regarding methods of disease transmission.
Another foreign concept for Ling was to openly discuss sexuality. She giggled because these issues were rarely discussed with family, let alone with strangers. Nevertheless, we had to broach the subject because she had tested positive for chlamydia. She stated that of course she and her husband were each other’s only lifetime sexual partners, yet didn’t seem perturbed to be diagnosed with a sexually transmitted disease! After a long discussion using basic, non-medical terminology, both Ling and her husband got treated. He also came in for further screening, since Ling was anemic and a hepatitis-B carrier.
Ling eventually delivered a healthy baby girl, who immediately received the hepatitis-B vaccine and antibody. Ling was happy about this because her brother had died of liver cancer and she did not want to pass the virus on to her child. Unfortunately, Ling’s husband and family blamed her for not producing a male child to pass on the family name, so her husband started beating her again. (Ling had not reported the previous episodes and even denied any domestic violence during our first prenatal visit.)
Only after gaining trust in a place where she felt safe and understood did the true story come out. Apparently, all the men in her husband’s family abused their wives. Those women told Ling that it was her duty to submit to her husband, especially because she was unemployed and had no other relatives in the U.S. When he tried to strangle her because the baby kept crying, however, Ling mustered the courage and self-respect to finally leave him. Her visits to our clinic had given her the emotional support of a loving family and a glimpse of the possibilities the larger world had to offer. Ling and her baby daughter successfully relocated to a shelter across the bay, taking their first steps toward a brighter future ahead.
Asian Pacific Health Care Venture: The difficulty of medical interpretation
Grandchild of Patient, Asian Pacific Health Care Venture, California
“Explain to your grandmother that she has arthritis in her hands,” says the blue-eyed doctor.
“Uhh, how do I say “arthritis’ in Cantonese,” I think to my eight year-old self. “Ah-mah, the ee-sun says you have painful bones,” I manage to muster in my language, hoping she’d understand.
“I don’t understand,” my grandmother says to me, looking startled.
From a young age, I remember my grandmother deprecating me for being unable to translate specific medical terms. I knew her anger was out of frustration. I witnessed my grandma struggle to relate to the unfamiliar doctor; however there existed a cultural and language barrier. Every time I went to clinical check-ups with her, I saw other indignant Asian people who could not speak English.
The atmosphere of [APHCV] was completely surreal to the both of us; for one thing, it felt like walking across the world when we went inside because of the plethora of languages the staff members spoke. As I glanced across the room filled with patients, I imagined these people had the same problems my family endured and now they embody a sense of hope being inside a multicultural clinic. The doctor gave my grandma even more relief when he perfectly greeted her, “Nay ho mah pawh pawh? (How are you, Grandmother?)”.
My grandma told me in Chinese on the ride back home, “I never felt so respected and understood since I moved to America.”
Charles B. Wang CHC: Inspired to Serve the Community
Mental health staff member, Charles B. Wang Community Health Center
As a care manager in the mental health department, I often interact with patients who need mental health care but are reluctant to accept these services. Many Asians, especially those who have recently immigrated to America, have a different perception of mental health. This is because of cultural differences and values. For the most part, the older generation feels that those who visit a mental health provider must be mentally insane. The Mental Health Bridge program at Charles B. Wang Community Health Center aims to break this barrier and educate Asian Americans about the importance and benefits of utilizing mental health services. Providing mental health services in primary care is convenient for patients. At the same time, health center patients are less reluctant to utilize such services because t hey are familiar and comfortable with the clinic’s setting.
The Mental Health Bridge Program is the first step in getting patients to accept mental health services. Through a collaborative effort, primary care physicians work together with the mental health department to provide optimal mental health care to patients. Depression screenings during patients’ annual physical examination provides serves as a preventive measure and encourage patients to seek mental health treatment when necessary. When primary care physicians refer their patients to the mental health department, some patients are initially skeptical about their need to see a therapist or psychiatrist. Patients often do not understand the terminology of “mental health.” However, after patients receive assurance and explanation of such services, they are more likely to utilize mental health treatment.
During the process of treatment, many patients deepen their knowledge of mental health and compliment on how the treatment has impacted their lives. For instance, after the mental health provider conduct several sessions and explained the importance of mental health care, patients who were initially resentful to treatment are able to agree to a higher level of mental health care in a specialty clinic. Our mental health providers are able to understand the patients’ cultural background and values. Because of the language capacity and cultural understanding, patients are more expressive to their mental health provider during their visits. Along with the aforementioned characteristics of mental health services in primary care, these aspects facilitate the improvement of patient’s mental health well being which is also a part of their overall health.
These experiences continue to deepen my desire to provide mental health services to the Chinese community. When interacting with patients, I have seen that there is increasing mental health need among Asian Americans. Sadly, there is a shortage of linguistically appropriate therapists to absorb the large demand. This demand and the effectiveness of the Bridge Program have encouraged me to obtain a master’s degree in mental health counseling. After my training, I would be able to provide a higher level of mental health care to patients. I hope to reach out to the Chinese community and provide therapy to patients at Charles B. Wang Community Health Center.
Kalihi-Palama Health Center: Serving those with Diabetes
Staff Member, Kalihi-Palama Health Center, Hawaii
It’s tough enough to have diabetes, but imagine how much harder it would be if you didn’t have medical insurance. Our weekly diabetes clinic at Kalihi-Palama Health Center has served a wide range of uninsured people since 1999. We see recently arrived Micronesians who can’t get Medicaid because they lost their I-93 forms, to disabled local folks who used to work and are in the waiting period for Medicare, to people in low wage part time jobs who would qualify for Medicaid but earn just a bit too much.
I’ve practiced as a nurse practitioner in community health centers on Oahu for 15 years, and it’s been great to see how our health center has evolved to be able to better serve the uninsured with diabetes. We’ve increased the ranks of our interpreters for Micronesians, we’ve got an in-house pharmacy with rock-bottom priced 340B drugs and lots of samples from the Medicine Bank. Our private lab donates free lab tests to uninsured patients seen at the diabetes clinic.
With the financial strain of care removed, our patients have been able to come in regularly and show great progress in controlling blood sugar, blood pressure and cholesterol. Interpreters serve as guides through the system to reassure about the new and strange experience of taking “all those pills”. We bring as many services as possible to the patient during the visit.
I feel blessed to have had a part in developing this clinic. This could not have happened without the team effort, and the private-public partnerships that have developed to remove financial barriers. The patients are so grateful and often say “Thank you for giving me Life!”
That’s why we are here, and that’s what keeps me here.
Waianae Coast Comprehensive Health Center: Once a patient, now a staff member
Staff Member, Waianae Coast Comprehensive Health Center, Hawaii
When my children had to start school, reality hit us like a ton of bricks. We had no medical care, no idea what the school required, and how we were going to get help with all the shots, medications, and so on.
I am now employed by the center and have been for the last 14 years and worked in the capacity of a social worker most of that time. As a result, I have come to witness first hand the passing of the people from Panepe, New Guinea, Samoa, Tonga, Hawaii, Fiji, Philippines, Micronesia, New Zealand, Tahiti, Guam, Laos and Australia. Most of these people come to us because they know that they will find a friend and acceptance instead of rejection because of social or financial difference….
Because we have helped many of our patients, they have encouraged others to come to be taken care of. If they don’t speak our language we try to get them interpreters and make sure they understand what the doctor is trying to have them do…the majority have become our friends. They pass the word onto the people in their homelands and as a result, the health of their whole community has improved and benefited. I’m proud to be a member of this community and an employee of Waianae Coast Comprehensive Health Center.
Waimanalo Health Center: "We just need a doctor who understands us."
Patient, Waimanalo Health Center, Hawaii
“Tayo ay hindi pipi, tayo makatarungan mangilangan a gamutin sino maintindihan sa amin.” ~Tagalog
“We are not dumb, we just need a doctor who understands us.”
I am a single, uninsured mother of three, working four jobs simultaneously: I substitute teach, offer free tutoring, volunteer as a translator at local hospitals, and I’m also a waitress.
I seemed healthy; when you have no health insurance, you convince yourself that will have to do. No mammogram, no pap for years. My children lost their father and begged me to seek a program that might help their uninsured mom. Thankfully, Waimanalo Health Center had a Breast and Cervical Cancer “Ola Haloa = The Sustaining of Life” program. Regardless of my inability to pay, I was given these lifesaving exams. Like most uninsured, underinsured and low-income women, I justified the delay because I felt fine, I felt healthy—I was wrong.
All I remember were two abnormal mammograms, a surgical consultation and an inconclusive diagnosis of “a small suspicious cluster of micro calcifications” in my right breast. With compassionate and unbiased advice from my CHC, I opted for surgery. Waiting for the results is always the hardest part and I vacillated between fear of a positive cancer diagnosis and gratitude for such a blessing of access to my CHC. Finally, I got ‘the call’ and with it, the greatest gift a mother could ever receive. I got a second chance a new lease of life, a humble voice—Mahalo Waimanalo Health Center!”
North East Medical Services: Comprehensive family care
Patient, North East Medical Services
I came to the United States thirteen years ago. I can vividly remember those difficult days. I was sad and depressed. As one can imagine, when a person leaves her home country and moves to a completely strange place,with no language skills, and encountering various adjustment problems, she is unable to make sound decisions. I was in that predicament. At that time, my daughter was only four years old. I did not know what to do. Later my relatives suggested that I look for a daycare center for my daughter, and that I look for employment. They also urged me to go to NEMS and apply for membership and receive health care.
I found out that NEMS card has sliding fees scale and level assignments, according to a person’ s financial situation and family size. The staff took time to explain the complicated medical care system to me. A few years later, I was expecting my second child. The staff at NEMS helped me apply for Medi-Cal, and I selected our NEMS family provider. From that time on, my children have been under the care of the NEMS providers. The doctor asked me to see the health educator, to take the hospital tour, and to get acquainted with the essentials of quality prenatal care.
I can’t believe it, that now my children are 17, 9 , and 7 years old. The two younger children continue to see the pediatrician at NEMS. All of us are NEMS members and receive excellent care. We are thankful to this agency, and hope that many more newcomers will benefit from NEMS services. I hope that NEMS will continue to improve and provide the much needed services to the people.
Kwajalein Atoll CHC: The future of culturally competent care
Child patient, Kwajalein Atoll Community Health Center
It is true that doctors give us medicine when we are sick. Now, if they do not understand our symptoms, will they be able to diagnose properly?
We have many doctors from other countries working on my island of Ebeye. Partly that is because we do not have many Marshallese doctors as many of the students do not study hard and work hard in schools to become doctors. I love doctors that take care of my grandparents when they suffer from Diabetes. They are helpless and because of the help of these foreign doctors, my grandparents are now healthy again. I am so happy about that and I am trying my best in school, so I could become a doctor. I pray everyday that I will do well in my classes and at the same time I am putting full effort to reach my goal to become a doctor. Hours, days, and months pass by but I still think about becoming a doctor simply because I see everyday what these foreign doctors can do.
I realize that many times the foreign doctors do not understand fully the diseases or problems my people are facing, and the more challenging issue is the foreign doctors not fully understanding my culture. That makes it very difficult for my people to approach the doctors. I think that learning my culture and language will help these important foreign doctors to be more effective in their works and in treating my people. Thank you.