Office on Disability
National Leadership Summit on Eliminating and Ethnic Disparities in Health: Pre-Conference Addressing the Healthcare and Wellness Needs of Women of Color with Disabilities, January 2006
Conference Presentation: Clinical Issues in Delivering Rehabilitation Services To Asian Chinese in NYC
by Victoria Zhang M.D.
Medical Director, Rusk Institute of Rehabilitation Medicine at New York Downtown Hospital
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Clinical Issues in Delivering Rehabilitation Services to Asian Chinese in NYC Chinatown
Presented By:
Victoria Zhang M.D.
Medical Director, Rusk Institute of Rehabilitation Medicine at New York Downtown Hospital
Clinical Assistant Professor, NYU Rusk Institute of Rehabilitation Med.
Mathew Lee M.D.
Professor Chairman, Rusk Institute of Rehabilitation Medicine at New York University Hospital
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Introduction
- 3 Disability Issues in Chinese American Women:
- 1) Osteoporosis
- 2) Osteoarthritis
- 3) Back pain
- Due to language barriers as well as cultural factors, Chinese American women do not know how to seek healthcare, preventions, and treatments leading to such consequences
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Case Study
- A 74 year old Chinese female with severe Kyphosis, lower back pain, and leg pain. She was unable to lie down in bed at night. The patient was treated with Fosamax and Oscal 500 with D for 1.5 years, but the pain persisted. The patient fell down and suffered a left hip fracture.
- The patient had ORIF and went to the Rehabilitation Center for 3 months. She is now able to ambulate with a walker at home.
- SH: She came from China 50 years ago. She lived in Chinatown most of her life.
- FH: Her mother and sister also had severe Kyphosis. Her mother died in a nursing home one year after a left hip fracture.
- Lab: DEXA T- score: -3.5 at the spine; -3.0 at the femoral neck 2 years ago
- Repeat T- score: -3.6 at spine; -3.2 at femoral neck now.
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Break Language Barriers
- Addressing these factors, our program focuses on education to improve cultural understanding of health care and common diseases. The programs are available in the participants own native language to better improve communication and understanding. Language barriers are prevented by the availability of interpreters 24/7 and having a >50% bilingual staff in every department. Assistance with transportation can be provided by Shuttle Buses offered by the hospital. Physical barriers are prevented by having Chinese signs in hospitals, Chinese menus in dining facilities, and Chinese registration forms. There are many advertisements relative to health care in Chinese newspapers and in addition, the radio broadcasts many information regarding healthcare daily.
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Cultural Understanding
- Research supports our choice of topics as Chinese patients showed an increased risk due to hard labor in farms, factory works, and long hours of working in restaurants. Many of these occupations lead to the abuse and overuse of the joints. They have a false belief that work is equivalent to exercise, therefore, this leads to the risk of getting osteoarthritis and back pain. Even though limitations in daily activities are associated with osteoarthritis, they do not seek for treatment because of the belief that it is a natural occurrence. Furthermore, they have no acknowledgment of treatments and preventions. That is why we have to approach them in our outreach programs, workshops, and health fairs for them to gain more knowledge of preventions and treatments. (Fig. 5)
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Work in the Community
- We participated in 8 community health fairs, 3 based at NYDH and 5 street fairs in Chinatown. (Figure 6.) It was another good way to reach out to the community elderly and we were able to present out our programs and rehabilitation services to over 250 people each time. Most of the patients were recruited through the educational workshops or the health fairs. (Figure 7)
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Figure 7. Street Fairs
- Cholesterol, glucose, blood pressure, Body Mass Index, height, weight, osteoporosis rehabilitation consultation were offered free of charge.
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Prevention Program
- The patients recruited through the workshops, health fairs, or through physician referrals are scheduled for initial screening by the geriatric outreach social worker. The physiatrist and the social worker see the patients at the Rusk Institute at NYU Downtown Hospital. The hospital setting is favorable because of its location (within walking distance from Chinatown), directories in Chinese, the Chinese health care staff, and the familiarity of the place, as well as the close relationship to physical and occupational therapy services. Referrals to medical specialty services are arranged within the hospital to encourage the elderly to join local senior centers, community dances, Tai- chi, and other physical and recreational activities. (Figure 8.)
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Conclusion
- The "Convalescence Care for Seniors of the Chinese Community" is able to reach out successfully to an underserved Chinese population in Chinatown. The location of NYU Downtown Hospital is very beneficial because of vicinity to Chinatown, familiarity among Chinese people, Chinese- speaking health care staff, and directories in their language. The interdisciplinary team is important for an excellent outcome of the program and consists of an physiatrist, geriatric outreach social worker, program/ research coordinator, and rehabilitation staff (physical and occupational therapists). Through educational workshops, health fairs, and physician referrals, the Chinese patients were able to get services and benefits from the functional approach of rehabilitation.
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- Existing Problems
- Future Studies
- Questions and Answers?
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Last Revised: July 24, 2006
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