I spent 12 hours at a hospital in the heart of Brooklyn — and saw what the future of medicine could look like


BI Graphics_Undividing America_800x100_Post


the_building
Maimonides Medical Center
in Brooklyn, New York.

Lydia
Ramsey


“This hospital wasn’t always like this,” says Douglas Jablon, the
senior vice president of patient relations at Maimonides Medical
Center.

Today, when he walks around this Brooklyn hospital, he hears as
many as 70 languages. When he arrived 41 years ago, diversity
meant having Orthodox Jews and other Jews in the same space.
Jablon, who is Jewish, said his main job was to get them all to
get along.

Then the hospital decided to encourage people from outside the
Jewish community to come through its doors, and Jablon took on
the challenge. At his first stop — St. Finbar’s, a Catholic
church in Brooklyn with a heavily Italian-American congregation —
he was met with questions like “why should I come to that Jewish
hospital?” Jablon recalls.

That’s all changed. Maimonides is located Brooklyn’s Borough
Park, a neighborhood that’s still home one of the largest
Orthodox and Hasidic Jewish populations in the US, but also new
immigrants from China and the Arab world. Adjacent communities
served by the hospital are predominantly Latino or home to
European immigrants.


BI Graphics_Diverse Hospitals 2
Maimonides and its cancer
center are located in south Brooklyn amid ethnic and religiously
diverse neighborhoods.

Skye
Gould/Business Insider


I went to Maimonides to learn about how ethnic and religious
diversity affects healthcare and what doctors and hospital
administrators need to think about as the populations they serve
change.

It’s not just about dealing with language barriers. Our cultural
backdrop affects how we talk about illness and death, and our
ethnicity can make us more prone to develop diseases like
diabetes or certain cancers, and the doctors at Maimonides have
to think about every way they engage with new or different
communities — all the way down to how they decorate.

I also learned about a concept called community-based healthcare,
the whole point of which is to consider a person’s individual
circumstances — whether you’re talking about ethnicity or
language barriers or poverty.

New York, of course, is unique in its degree of diversity, but
the lessons here will be relevant nationally one day as the US
undergoes a massive demographic shift. In 50 years, the country
is expected to have no majority population. By then, the
Pew Research Center
estimates, 24% of the US population will
be Hispanic, while 14% will be of Asian descent, compared with
18% and 6% as of 2015.


BI Graphics_Diverse Hospitals 1Skye Gould/Business Insider

Right now, most of the country is getting it wrong, says Keith
Chan, a professor of social welfare at the University at Albany
who focuses on immigrant health, particularly among the
Asian-American community.

Minority populations are disproportionately hurt because they’re

more likely to delay
going in for care, waiting until their
conditions progress to a point that can make them harder to
treat.

And while it’s true, as one surgeon told me, that once patients
are on the operating table the doctors don’t see any difference
in them, people like Chan are focused on changes that will keep
them off the table in the first place. Those efforts, he said,
could make everyone’s health better — not just minority
populations’.

The case of breast cancer in Chinese-American women


IMG_0640.JPG
A pediatric patient named Ethan Gallardo with Dr. Hanna
Siddiqui, a pediatrics resident.

Courtesy Maimonides

Even what’s on the walls can matter. One problem Maimonides
encountered at its cancer center — about a mile from the main
hospital — was the huge “four” painted on the wall outside an
operating room.

“Four” in Chinese sounds similar to the word for “death,” and —
sort of like the number 13 in the West — it’s an ominous sign.
That had to go.

That is low-hanging fruit, though, compared with the medical
challenges doctors encountered as they treated more Chinese
patients. They’re seeing cancers that aren’t normally common in
the US and tumor sizes that are different — both of which can
affect proper diagnoses.

“Tumors that are supposed to be rare we see frequently,” Dr.
Patrick Borgen, the chief of surgery at Maimonides, said.

According to a 2012 study of
breast-cancer patients
from China and the US, as well as
Chinese-Americans, Chinese-American patients with stage 1 cancer
tended to have bigger tumors than patients from the US but
smaller ones than patients in China. Women in China on average
also tend to get breast cancer 13 years earlier than women in the
US.

And the very diagnosis is viewed differently between the two
cultures. Dr. Yiqing Xu, the associate director of hematology
oncology at Maimonides, said communication was especially
important, as some Chinese patients, if not given prompt guidance
over treatment options, would opt to fly to China to get a
mastectomy, a procedure in which the whole breast is removed.

“They come back with horrible mastectomy down to the bones,” Xu
said. The procedures in China often use older techniques that
remove more of the breast than American doctors would consider
necessary.

Building communities


IMG_0647.JPG
Dr. Jacob Shani with a cardiac patient named Guo Ren
Zhen.

Courtesy
Maimonides


While a hospital built for the future American population may
have the added challenge of navigating different backgrounds,
religions, and languages, there are some basic principles that
will remain unchanged. Those in the hospital are there with a
singular purpose: to get better.

That removes divisions that may be prominent outside the
hospital.

During a group conversation of breast-cancer patients and their
family members, Fatema Khatun, a Bengali woman who learned she
had breast cancer in February, broke down when discussing the
experience of going through treatment while losing her mother and
caring for a child.

The other women nodded along sympathetically and handed her
tissues. “You are so strong,” the sister of an Arab-American
patient named Amal Omar told Khatun. “If you can face this alone,
that means you are strong.”

“I don’t know how people who don’t have faith … survive,” said
an Orthodox Jewish woman who declined to tell me her name because
she hasn’t shared her diagnosis with many people.

“We are a community, and we serve people who elsewhere on the
planet today are killing each other literally. Here, they’re
not,” Maimonides CEO Kenneth Gibbs told Business Insider. “I
think part of that is about the moment at which we come together
is those who need and those who provide healthcare. It’s about
that service that vulnerability and that sense of purpose that
allows for humanity to emerge rather than all the things that we
can find to disagree about.”

What others can learn

When I asked what other hospitals could learn from Maimonides and
its work expanding into other areas culturally, Gibbs spoke of
the hospital’s position as one piece of what’s called a community-based
healthcare system
— an approach that makes health and
prevention an important conversation outside traditional
healthcare settings like the doctor’s office or a hospital.

The hospital is there for an emergency or extreme situation, he
said, and very good at handling those situations. IMG_0653.JPGShani and Anton Tomilson, who had a heart procedure in
the morning. After a “stress test” during a primary-care visit
earlier in the week, he was sent to Maimonides for the
procedure.
Courtesy
Maimonides

But the real point of understanding diversifying communities is
to do a better job of keeping people out of the hospital in the
first place.

That’s still where the healthcare disparities happen, Chan said.
That’s in part because outreach to minority communities hasn’t
historically worked as well.

Community-based healthcare, though, considers what’s going on in
patients’ everyday life, such as whether patients have access to
food or childcare. It can change the way doctors approach
patients. It could lead to more preventive actions, like
heart-health screenings or setting up new dietary habits because
of a higher risk of diabetes.

Chan said there had been a shift in the conversation toward
setting up community-based healthcare systems, though hospitals
have yet to do it fully. If that transition were to happen, it
would benefit all Americans, not just minority populations.

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