Female obstetricians are always on duty overnight at the hospital's maternity ward in case a Muslim woman arrives in labor and does not want to be treated by a male doctor.
At the diabetes nutrition classes, where participants are mostly from Latin America, diet plans incorporate items like guava paste, plantains and chayote squash.
Ruth Rooney, a registered nurse who has been running the classes for 15 years, said she had struggled to figure out why blood sugar levels among her Latino patients remained so high. So one day she asked them to bring in samples of the foods they ate at home.
"I realized I had been telling them to avoid white bread," Ms. Rooney said, "but I never mentioned tortillas, which is really a staple of their diet."
As more immigrants crowd its waiting rooms, Elmhurst Hospital is joining a growing number of hospitals in New York and across the country that are going beyond hiring interpreters and offering translated paperwork and are adopting practices intended to improve care for an increasingly diverse patient population.
Doctors and nurses are interviewing religious leaders, visiting cultural centers and even traveling abroad to better understand their patients.
The lessons are redefining traditional notions of health care not just in immigrant hubs like New York, California and Texas, but also in places like Storm Lake, Iowa, a city of 12,000 that has been transformed by an influx of Hispanics who work in the area's meatpacking plants.
"We can't just say, 'You're different,' call an interpreter and consider our job done," said Candi Castleberry-Singleton, chief diversity officer at the University of Pittsburgh Medical Center, which operates 15 hospitals and clinics throughout Pennsylvania. "What we have to say is, whatever cultural beliefs you have, they're going to be acknowledged and respected."
At Mercy Medical Center in Merced, Calif., shamans tend to the spiritual needs of the hospital's many Hmong patients. Memorial Hermann Southwest Hospital in Houston has a floor devoted to Asian patients, where the menu offers a selection of Chinese and Vietnamese comfort food, like chicken congee soup and steamed dumplings.
In Harlem, the Medina Clinic opened in May 2009 inside Harlem Hospital Center to cater to the many West African immigrants arriving in the neighborhood. Since many immigrants are devout Muslims, the clinic provides a prayer space. Medical appointments can last an hour or more because many patients with limited or no access to health care in their home countries often have chronic illnesses, like heart disease or diabetes, said Dr. John M. Palmer, executive director of Harlem Hospital.
The doctors at the clinic have seen more than 700 patients since it opened, providing treatment and helping them navigate an unfamiliar and complex health care system. Patients with no insurance often miss follow-up appointments, believing they will be asked to pay for something they cannot afford.
"It takes them time to get the idea of pay scales and subsidized care," Dr. Palmer said.
Finding ways to make immigrants feel more at ease is not just a good-faith effort at cultural sensitivity but can also translate into improved health outcomes, health care providers say. Patients who trust their doctors are less likely to end up in emergency rooms because they have waited too long to deal with an ailment. And the emotional difficulties often experienced by patients recovering from surgery or extended hospital stays can be made more palatable.
Some hospitals, for example, place no restrictions on visiting hours to accommodate the varied work schedules of many immigrants.
"One thing you don't learn in medical school is how to interpret cultural cues, but they're key when you're dealing with a diverse population," said Dr. Braden Hexom, who works in the emergency room at Elmhurst Hospital.
Todd Hudspeth, the chief executive of Buena Vista Regional Medical Center in Storm Lake, which has the most diverse public school system in Iowa, knew he had a problem when he started getting complaints about his hospital from Mexican and Central American immigrants at a Spanish Mass he attended a few years ago.
The hospital had no interpreters and no Spanish speakers on its staff, Mr. Hudspeth said.
So he took several doctors and nurses with him on a trip to Mexico in 2004 to learn about the health care system; some of the hospital's doctors have made repeated visits. The hospital also created a training program that covers attitudes among people from Mexico and Central America toward issues like birth, illness, dying and death.
"A lot of it is just raising people's awareness that not everybody does things the way we do in the Midwest," Mr. Hudspeth said.
The accommodations hospitals make can be subtle but meaningful. At a hospital that is part of the University of Pittsburgh Medical Center, a Muslim woman admitted for gastric bypass surgery a few months ago was placed in a bed facing east so she would be in the proper direction during her daily prayers.
Mercy Medical Center in California has banished pens with red ink from patient rooms because some Hmong believe the color red is a sign that a person has been cursed, said Robert C. Streeter, vice president of medical affairs for the hospital.
In the neighborhoods surrounding Elmhurst Hospital, including Jackson Heights, Corona and Elmhurst, 56 percent of the residents are foreign-born, according to the city's health department.
To better understand patient attitudes, lactation consultants at the hospital surveyed new mothers last year to figure out what women from different countries thought about breast-feeding. They asked, among other things, whether they knew the importance of their first milk, which is called colostrum, and if breast-feeding was promoted in their native country.
They found out that in Bangladesh colostrum is considered impure and is usually discarded and that Bangladeshi women had no idea that it is, in fact, highly nutritious. Chinese women planning to send their children to be raised their first few years by relatives in China, a common practice, will not breast-feed. And though breast-feeding is common in rural Mexico, Mexican women here are often eager to give their babies formula.
"They come across the border, they see bottles and they think, 'That's American, that's the way to go.' It's kind of a status thing," said Patricia de Lima, director of a breast-feeding initiative at Elmhurst.
The survey helped shape the way lactation consultants approach mothers from different countries. In much the same way, Ms. Rooney, the nurse who runs the diabetes classes, adjusted the diets of her immigrant patients after reviewing the food they ate at home.
Dr. Jasmin Moshirpur recalled how different it was when she started working at Elmhurst Hospital 40 years ago, as the sole female obstetrician-gynecologist on the staff.
The issue of treating immigrants goes well beyond the challenges posed by linguistic diversity, said Dr. Moshirpur, regional director of the Queens Health Network, which includes Elmhurst Hospital. The very notion of health differs depending on where a patient is from.
"A good part of the mentality is still to provide what our patients need," she said. "Health needs come first, of course, but there's no question we can be better doctors if we're also mindful of patients' cultural needs."
http://www.nytimes.com/2010/09/07/nyregion/07hospital.html?th&emc=th
