MIXING EAST AND WEST

To maintain a good balance of yin and yang, Chinese culture also dictates the importance of keeping a healthy flow of chi, or "vital energy", in the body in order to "maintain health and prevent illness or injury" (Olson, 29).  Physicians are able to help people with an imbalance of chi restore their balance through a variety of Eastern practices, such as "acupuncture, acupressure, and moxibustion (the laying of hot coins on certain parts of the body)" (Olson, 29).  Herbal medications can also be prescribed in order to correct the flow of chi within a patient.

In many cases involving an elderly Chinese immigrant and Americanized children and grandchildren, it seems likely for the elder to gravitate more towards using traditional Chinese medical practices while their children urge them to consult Western doctors and prescription medicines.  While both parties are simply more comfortable with what they know and what they grew up with, the constant disagreement between the elder and their progeny could result in a blending of both Eastern and Western practices.  

In some instances this would be fine; in fact, many Western doctors are finding benefits in combining Chinese traditional treatments with Western techniques.  In an interview with the director of the University of California, Los Angeles Center for East-West Medicine, Dr. Ka-Kit Hui, Hui supports the idea of "complementary medicine".  He believes that the main difference between the two styles of medicine is that the Western style examines disease in a very detailed, micro way, ultimately striving to "locate where the organs, cells and molecules are in trouble".  However, the Eastern practices view disease in a very macro scale, trying to understand problems in a more holistic sense.  By combining the two, for example, by pairing Western prescribed medicine with tai chi exercises for back pains, one is able to combine a very examined medicine with a more natural healing.  

However, there can be problems resulting from the combination of Eastern and Western medicines.  Reports of Chinese elderly using a combination of Western medicines and Chinese herbal medicines at the same time are not uncommon. (Hessler et al.)  This can be dangerous, especially in consuming the two different types of medicines, because of the risk of "drug interactions and toxic substances" (Olson, 29).  Because the two prescriptions are not coming from the same source, rather coming from two different parts of the world and two radically different styles of thinking, there is no way to know if taking both prescriptions together would bring about negative results within the patient.  Serious side effects resulting from poisoning could occur as a result of the interaction between Chinese herbal treatment and Western prescribed or over-the-counter medication.  (Yee and Weaver)

Thus, it is important to be aware of the risks in combining Chinese and Western medical practices.  Due to the different styles of perceiving disease and treating it, the most important thing is to be conscious of what is being consumed.  While more and more Western doctors are beginning to see the positive effects of Chinese practices, this does not mean that any an all herbs can be taken alongside pills and other Western prescribed medicines.  Attempting to compromise between the elderly Chinese customs and modern American practices could come to fatal results without a proper knowledge of both styles of healing.

SOURCES:

Chelan, David. "Multicultural Health: Eastern Medical Practices Augment Western Techniques." Smart Business Los Angeles (2006): Web. 23 Apr 2011. <http://www.uclahealth.org/workfiles/documents/insights/UCLA_LOS_0206.pdf>.

Hessler, Richard M., M. F. Nolan, B. Ogbru, and Peter K.M. New. 1975. "Intraethnic Diversity and Health Care of Chinese Americans." Human Organization 34, no. 3: 253-362.

Olson, Laura Katz. 2001. Aging Through the Ethnic Lens: Caring for the Elderly in a Multicultural Society. Lanham, MD: Rowman & Littlefield Publishers, Inc., 2001. 29. Print.

Yee, Barbara W. K., and Gayle D. Weaver. 1994. "Ethnic Minorities and Health Promotion: Developing a 'Culturally Competent' Agenda." Generations 18, no.1 (Spring): 39-44.

CREATING BALANCE THROUGH DIET

The traditional Chinese view of health, both physical and mental, resides in the belief of balance and equilibrium of the yin and yang energy forces.

"Yin (the female element) represents the passive principle or bodily forces described to darkness, cold, wet, and emptiness.  Yang (the male element) is equated with the active principle, characterized by light, heat, warmth, dryness and fullness." (Olson, 29)

By living a balanced life, it is the Chinese belief that good health and prosperity will naturally follow.  However, the Chinese concept of a balanced life does not necessarily mean eating well-rounded meals and exercising, as would be the American way of thinking.  According to the Chinese, certain foods are considered to be "warmer" or "cooler", and consuming such foods would ultimately affect a person's internal balance of yin and yang.  While foods like ginger and hot tea are thought to affect the yang element, foods such as bananas, watermelon, and most vegetables would cool the body, affecting the yin element (Koo, 759).

For the Chinese elderly to believe so strongly in the concept of yin and yang, practices that seemed to make perfect sense to them could go against Western styles of thinking.  For example, because elderly people are seen to possess more yin element "because of their age and physical conditions", according to the yin and yang food beliefs they should refrain from eating most fruits and vegetables (cold foods), which would affect the imbalance of yin and yang in the body (Olson, 29).

This goes against the American view of having a balanced diet in order to lead a healthy life.  The conflict could arise between elderly Chinese who still hold on to their cultural beliefs and their acculturated children and grandchildren; while the younger generations see a balanced meal as being important, the elderly would see it as being imbalanced for them to consume foods that would add to their yin element rather than trying to balance it out with "warmer" foods.  The elderly could even begin to believe that, upon their posterity's insistence to eat a more balanced diet from the American standards, their family would be trying to poison them and prevent them from restoring the balance within their own bodies.




SOURCES:

Koo, Linda C. 1984. "The Use of Food to Treat and Prevent Disease in Chinese Culture." Soc. Sci. Med., p. 759.

Olson, Laura Katz. 2001. Aging Through the Ethnic Lens: Caring for the Elderly in a Multicultural Society. Lanham, MD: Rowman & Littlefield Publishers, Inc., 2001. 29. Print.

LOSING FACE AND FILIAL PIETY

Filial Piety is an important aspect of Chinese culture.  It describes an "[emphasis on] respect, honor, loyalty, and obligations within the parent-child relationship" (Tsai, 1999).  Children are expected to take care of their aging parents, almost to a point of obeying without questioning.  They must: 1) support their parents, either financially or morally; 2) continue the family line; 3) obey and respect their parents, even after death; 4) self-sacrifice; 5) attend to parents at all times, especially when old or sick; and 6) honor parents and ancestors through good achievements.

This concept of filial piety, however, can prove to be detrimental to the elderly Chinese.  Since the elderly believe so strongly in filial piety and the fact that their children should be taking care of them in every aspect of their lives, they might be too ashamed or prideful to seek help from doctors or other healthcare professionals on their own.  Since filial piety states that children must attend to their parents at all times, they might feel that they would be losing face to discuss their own health problems with strangers; instead, they could feel that their children should be the ones to tend to them rather than professionals they do not know.

With the combination of filial piety and loss of face, children must be even more attuned and aware of their parents' health issues.  However, as younger generations become more Americanized, concepts such as filial piety become less of an importance; families where both parents have full-time jobs could mean that less time is spent tending to the elderly's every need.  As the children and grandchildren live their own lives, they would be less aware of the needs of their elderly parents and grandparents, so even when the elderly still believe so strongly that it should be their progeny who take care of them, if they do not voice their pain the busy family might not be able to pick up on the fact that they are in need of medical help.



SOURCES:

Tsai, Jenny Hsin-Chun. 1999. "Meaning of filial piety in the Chinese parent-child relationship: Implications for culturally competent health care." Journal of Cultural Diversity 6.1, p. 26-34

Olson, Laura Katz. 2001. Aging Through the Ethnic Lens: Caring for the Elderly in a Multicultural Society. Lanham, MD: Rowman & Littlefield Publishers, Inc., 2001. 24, 27. Print.

PERSONAL EXPERIENCES WITH LOSING FACE

I interviewed a family friend, who wished to remain anonymous, in order to get personal experiences with the Chinese elderly and their belief in losing face in terms of refusing to receive medical attention.

She immigrated to America in the mid-60's with her parents at a young age, so while she is more Americanized, her parents and the people of that same generation did not assimilate the American culture as easily as the immigrant youth, therefore holding on to such beliefs as losing face.  As they grew older, the concepts they held on to from their homeland proved to be detrimental, and in many cases, fatal.

Are you familiar with the concept of losing face?

Yes, in terms of bringing shame to a person or their family, right?

Correct.  Do you know of anyone, particularly from the first generation Chinese immigrants, who  refused to go to the doctor because they did not want to discuss their problems with others?

Yes, as a matter of fact, my husband's father died because he did not want to go to the doctor.  For the longest time his father was constipated and couldn't use the bathroom.  In fact, I think he couldn't use the bathroom for about a month but he wouldn't talk about it and wouldn't go to see the doctor about it.  He didn't know that he had cancer, all he knew was that he couldn't use the bathroom.  He was more willing to endure the physical pain than to actually go for help.  The cancer spread very quickly, and by the time he eventually went to the doctor the cancer had spread to his liver and he died.  

Do you think that he would have been able to live had he been willing to see a doctor sooner?

I think he would have been able to live a longer life but because of his stubbornness and because he didn't want to show that he was hurting, the cancer couldn't be helped.  I think if he had gone to the doctor right away something could have been done, but because he waited so long the situation became too much to treat.  The family even told him that he needed help, my husband told him that he needed to see a doctor about it but he kept saying that he was fine and that he didn't want to go to the doctor.  In the end, its what killed him.

Actually, I know another woman whose mother has been having some leg problems, I think she said that her mother had a growth in the heel of her foot.  When she went to the doctor, the doctor suggested that she use a walker, but her husband wouldn't let her use it.  When my friend wanted to put a rail in their shower so that her mother would be able to hold on to it instead of slipping, her father wouldn't let her put it in.  

Why do you think her husband was so against using aids to walk and to support themselves?

I think its just that generation in general, they don't want to be seen as growing old or being handicapped because its something so shameful.  Maybe when they were growing up they saw people who needed help walking or moving around and they saw that as being a shameful thing, so now when they are getting old they don't want to be viewed as being unable to walk because they think that other people would look down on them.  

I guess that ties in with the concept of losing face, how they see people who are old and in need of wheelchairs or walkers as being shameful.

Exactly.  

My brother-in-law, in fact, had a pinched nerve in his spine, so he had a lot of back problems but he won't see a doctor.  It hurt him to walk, sit and even sleep, and he had these pains for over ten years.  Finally when he went to see a doctor about it because he couldn't handle the pain anymore the doctor told him that he needed a surgery immediately.  My husband and I went to go see him after his surgery and he seemed better; he could sit up without pain.  

So even your brother-in-law, who isn't in the same generation as your husband's father and your friend's mother, showed signs in the belief of losing face.

Well, even though he is in the same generation as us he grew up in China until he was college-age.  So because he didn't grow up here he still has a lot of Chinese beliefs in him.  

I know that "losing face" has negative effects on the first generation of Chinese immigrants, but do you think this has any negative effects on the rest of the family, the younger generations who are more open about talking about their problems?

Yes, I think that because that generation is so against shaming themselves and their family, they don't want to talk about their problems to their doctors or even to their own relatives.  Even when they do tell their families, they don't want to mention it regularly or talk about it because they are embarrassed or they are ashamed.  

My niece, my brother-in-law's daughter, told me that she doesn't even know much about her family's health history.  She herself had to ask my husband (her uncle) how her grandfather died because her own father does not want to talk about things like that.  They never talk about it, but now she needs to know her family's medical history in order to be aware of what diseases may run in the family.  She has to know in order to be able to take care of herself and her own children.  

Losing face doesn't just affect the elderly generation; while it prevents them from receiving healthcare, it also proves to be detrimental to the future generations who don't know about their family's history of illness.  Thus, it becomes important not just for the younger generations to urge their parents and grandparents to go to the doctor when they feel pain, but to also actively seek answers as to why their family members have died and whether it was because of diseases that could possibly be passed on from generation to generation.  

LOSING FACE

The Chinese concept of "losing face" (mo meen in Cantonese) denotes the concept of bringing shame to oneself and ultimately to one's family.  Since the family is viewed to be more important than the self, personal mistakes and shortcomings "reflect badly on the entire family and cause shame or loss of face" (Braun and Browne, 1998).

Because loss of face is such an important concept to Chinese, and is taken more seriously in elderly Chinese than in more Americanized generations of Chinese, it is very likely for the Chinese elderly generations to withhold information regarding physical of mental ailments from the public eye and even from their own families.  The rationalization behind withholding information is that, by "avoid[ing] disclosing private concerns to outsiders" there is no way for others to look down on the family and therefore there is no loss of face (Braun and Browne, 1998).

However, for an elderly person to not discuss pain or sickness with one's doctor or even with one's family does not end well.  Since the elderly are more likely to still follow Chinese customs, they are more likely to see weakness as loss of face; it is the elderly who would most need the help of a doctor or physician in the event of an illness.

It is up to the younger generations to initiate conversations about disease and sickness with the elderly; because they would not speak openly about problems they may be having, the younger generations must be the ones to bring up the topics and help the elderly in receiving aid.



SOURCE:
Braun, Kathryn L., and Colette V. Browne. 1998. "Perceptions of Dementia, Caregiving, and Help Seeking among Asian and Pacific Islander Americans."  Health and Social Work 23, no 4:262-74.

"THE MENTAL BURDEN WAS HEAVIER"

Continuing from the previous post about PALS for Health, which is a non-profit language service program which provides translation services for English proficient residents of the Los Angeles County, Ms. Yong-Na Wu was interviewed in 2008 regarding her experiences with receiving medical care.

Ms. Wu, who learned she had breast cancer after coming to the United States, found it difficult to receive proper medical attention because she had trouble communicating with the doctor.  Whatever he said, she could not understand, but when she tried to ask questions, he could not understand her.  Because of this, Ms. Wu would find herself "wait[ing] [a] very long time just for a prescription".  With the help of PALS, she was able to communicate with the doctor through her translator, Ms. Yang, and was able to receive the proper treatment to cure her cancer.

One statement that Ms. Wu made during this interview:

"Basically, what my condition was wasn't clear to me.  So whether things were good or bad, I didn't understand.  The mental burden was heavier."

really stuck out to me because of the fact that, for the patients, it isn't the sickness that is the worst part, it is the confusion of not knowing what is going on that weighs most heavily on them.  The fact that they really do not know what is going on scares them more than whatever pains they may be receiving from their illness.

The effects of the language barrier go much deeper than a lack of communication.  The language barrier causes patients to feel uneasy and can perhaps cause them to worry more (potentially making themselves even sicker) because they feel that they are sick but cannot express their pains or understand their symptoms when they go to the doctor expecting to be cured.

Therefore, the use of translators becomes more important than simply acting as a multilingual pony express relaying information from English to Chinese and back again.  The use of translators brings about a sense of mental stability and peace to the patients because they are able to understand their condition and know the reasons as to why they are feeling what they are feeling.  More than just language, it is the duty of translators to act as calm harbingers of clarity.  Through this clarity of understanding their symptoms and what they can do to get better, the patients are able to focus less on their lingual frustrations and instead focus more on the healing process.

TRANSLATORS: FRIENDS OR STRANGERS?

PALS for Health, a non-profit language service program that strives to "increase access to meaningful and quality health care services for limited English proficient residents of Los Angeles County", is one organization that provides translation services that Chinese Americans can use to overcome the language barrier that they face in going to an American doctor.  The translators, as described in the video, undergo a careful selection process and must complete a comprehensive exam and a rigorous training program in order to best prepare themselves for clearly relaying information from doctor to patient.

One point that the video brings up is the use of relatives or friends as interpreters.  While the patient may be more comfortable with having someone they know well with them, the interpreter most likely lacks the skill and medical terminology needed to accurately translate information to the patient.  This, in turn, is detrimental to the patient because he or she does not get the clear description of what is happening to them simply because the interpreter does not know how to give the exact medical translation.  Another downside to using a relative or close friend is that, because they have a personal bond with the patient, they may choose to downplay the severity of the diagnosis in order to spare the feelings of the patient.  Because of the relationship they have, a family member or a friend might let emotions get in the way of the doctor truly helping the patient.

While an interpreter, in this sense, would be the ideal choice, especially since they are more trained and skilled in medical terminology and could give a clear translation, would the patient be completely comfortable with a stranger knowing what is wrong with them?  The question that is raised with using a stranger is the idea of privacy, something that would not be such an issue if someone close and trusted were with the patient.  Also, with the emotional bond the patient and interpreter have, wouldn't the interpreter be more likely to be trustworthy in relaying all the information simply because they care about the patient?

Thus, the issue is this: is it better to have a family member or friend translate because the emotional bond will push the translator to do the best they can to make the patient better, at the risk of not having the technical skill to accurately relay complex medical terminology, or is it safer to employ the use of a stranger who may have the medical translation abilities but not necessarily have the will to speak the whole truth?

A LOOK AT THE LANGUAGE BARRIER

In February of 2006, the Joslin Diabetes Center (an affiliate with Harvard Medical School) released an article discussing the language barrier experienced by Chinese Americans, which is preventing them from clearly understanding the issues regarding their health.

Although they acknowledge the fact that translators and bilingual staff are being used, Joslin states that that is simply not enough; according to a study conducted by researchers in the Joslin Diabetes Center:

"these patients also need comprehensive patient education materials written in Chinese and a medical staff thoroughly versed in the customs and cultural issues that may impede their diabetes care" (Joslin Diabetes Center)

The researchers at the Joslin Diabetes Center conducted surveys of 52 Chinese American immigrants from ages 18-70, all of whom had been diagnosed with type II diabetes for at least a year and were taking medication.  Those surveyed were divided between their preference towards speaking English and Chinese, and were then quizzed on their knowledge of diabetes.  Of the 52 people, the Chinese-speaking group scored a 63% understanding of diabetes, while the English group scored 85%.  

The subjects were then given books, written in English and Chinese to comply with their specific groups, explaining diabetes.  After reading the books, the Chinese group reported having an increased understanding of diabetes.  

The issue that this study explored is that translating information from English to Chinese is not enough.  Because the Chinese culture is different from American culture, translating text from English to Chinese does not necessarily provide Chinese Americans with material they can understand and relate to.  The article gives the example of diet; a dietitian who is unfamiliar with Asian American food could prescribe their patient to eat foods that are not normally consumed, such as pasta and cheese, without ever addressing foods that are more central to the Asian diet.  

Thus, more needs to be done in order to better aid the Chinese American population.  Rather than just translating English text to Chinese, the text needs to be written in Chinese specifically geared to Chinese Americans so that they can understand what they are going through and can take better care of themselves.