Japanese patients get culturally competent care in Novi, Mich.

February 15, 2016


Nobuko Nishida, a homemaker and mother of two, came to the Detroit area in 2011 when her husband accepted a five-year, intercontinental transfer with his Japanese company. The move to the United States was challenging, to say the least. Though her husband's employer had provided him with English lessons, Nishida knew very little about either the language or culture.

Nurse Coordinator Eiko Sterchele, at right, translates a medical office questionnaire for Hideyo Mosumoto, a patient of St. John Providence — Providence Park Hospital. Sterchele supports Japanese patients of the hospital.

Negotiating the American educational and health care systems was particularly difficult, she says. That's why she was relieved when her family settled in Novi, a suburb with a large and growing Japanese population, attracted there because of the many Japanese businesses located nearby that service the auto industry. There the Nishida family found both the Japanese School of Detroit, which their children could attend from kindergarten through high school, and St. John Providence-Providence Park Hospital, which had begun offering the services of a Japanese nurse coordinator, Eiko Sterchele, in 2010 to help Japanese patients manage their medical concerns.

Emotional support
Those services proved to be of the utmost importance when Nishida was diagnosed with breast cancer in 2013. A relatively rare disease among Japanese women, Nishida, who had been seen regularly at the hospital as part of the executive physical program offered through her husband's company, says that when she first found a lump in her breast, she didn't know what to do.

"I was so afraid about what was going to happen to my body, and what my future would be," she says, speaking through an interpreter.

Nishida called the Japanese program office, which arranged for a mammogram and biopsy, and provided translation services, both oral and written, to make certain Nishida understood her treatment options. Then Sterchele helped her navigate the health care system through surgery, chemotherapy and radiation treatments.

"I was so thankful to have the program's services," says Nishida. "It gave me so much comfort to be able to express my thoughts and be confident that I knew what was going on. They did more than schedule appointments, translate and help educate me about my care. They offered me emotional support."

Now Nishida comes to Providence Park Hospital for follow-up visits with her oncologist every six months. And she says her appreciation for American medicine continues to grow.

American optimism
"My older sister in Japan has been diagnosed with cancer, and the culture there is so much different. There, people say, 'we are so sorry for you.' Here, they say, 'you will get better.' Everyone is so encouraging, and they give you hope," she says.

Nurse Coordinator Saori Miya takes the blood pressure of Yu Hiei. Hiei is a client of an executive health program offered by St. John Providence — Providence Park Hospital. He has benefited from the hospital's culturally competent care.

That kind of help, and hope, is part of St. John Providence's long tradition of providing medical care to the communities it serves, says Ann Boerkoel, manager-occupational health at St. John Providence Health System. The Japanese program, she says, is an important part of the continuation of that mission.

St. John Providence, which is part of Ascension, wrote a business plan for this program in 2010, when it discovered the need to serve the growing Japanese community in Novi. It began with a single nurse navigator, Sterchele, who was fluent in both Japanese and English, and has since grown to include seven members, including registered nurses and office staff, who are all bilingual and have taken medical terminology training to help provide better care for these patients, Boerkoel says.

Green tea chats
Translation services — offered at private physician appointments as well as at the hospital — are only one part of the program, however. Equally important are programs for both staff and patients to help bridge the gap between Japanese and American cultures.

When St. John Providence launched the program, it did a presentation for all staff members at the hospital so that they would have a cultural perspective on how to provide better care for the Japanese population. The health system reached out to the Japanese community, offering green tea chats and tours of the hospital, to showcase various activities they could participate in, such as parenting, yoga and English composition classes.

Understanding cultural differences has been key to the success of the program, which is now growing by more than 5,000 new patients per year. To begin with, the Japanese medical and health insurance systems are quite different; Japan has national, not private, insurance, and the Japanese are used to walk-in clinics where they can see doctors without making appointments first. Japanese patients, in general, also have a strong desire to keep health issues private, so often they are not forthcoming with details about their problems when they see a physician.

"Our Japanese patients tend to be very quiet, reserved people; they don't ask questions if they don't understand what a doctor says. That can cause big problems later on," says Sterchele. "They also do not want to talk about pain, and are fearful of taking pain medication because of the possibility of addiction."

Assessing risk
The Japanese, Sterchele says, also are used to remaining in the hospital when they are ill until they are well enough to immediately go back to work. "When we release patients, they often try to return to their jobs too soon because they are so dedicated to their employers that they feel guilty recuperating at home," she says.

Both patients and physicians have learned to adjust and accommodate for certain American protocols, says Japanese program nurse Saori Miya. Because breast cancer rates are typically lower in Japan, for example, most Japanese women are not used to regular mammograms, nor do they have regular Pap tests. Through discussions, staff encourages Japanese patients to get the screenings regularly.

In addition, the hospital's executive health program now regularly offers upper and lower gastrointestinal screenings, because Japanese patients are more prone to stomach, liver and colon cancers. And though diabetes and cardiac disease are not as prevalent among the Japanese — who tend to maintain healthier weights than Americans — strokes are a bigger concern, due to high sodium diets, and lung cancer and chronic obstructive pulmonary disease are more common due to higher rates of cigarette smoking.

Miya says a number of misunderstandings also occur when it comes to obstetrics and pediatric care. "Many women believe in what they call 'the stable period' of pregnancy around weeks 19 or 20, when morning sickness is over and they think the risk of miscarriage has passed. They view it as their last chance to travel before their baby is born," she says. "We have to explain that we don't want them to take long-distance trips and certainly not go overseas, since there are always risks involved."

There is also confusion about vaccinations, since guidelines vary between Japan and the United States. "Oftentimes families rush to get their children vaccinated before they come to Detroit, only to be told that the shots were given too early and are invalid here," says Miya. "Protocol is different as well; Hep B vaccines are recommended here but not given there, while the BCG vaccine for tuberculosis is recommended in Japan but not in the U.S."

Boerkoel says experience has shown that nurse navigators help put both patients and physicians more at ease in overcoming such difficulties. Based on the success of the Japanese program, in fact, a program to serve a large population of Arabic patients at another Detroit-area hospital, St. John Macomb-Oakland Hospital, is now being planned as well.


Copyright © 2016 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2016 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.