Thursday, September 12, 2019

Flashback 1994: Cultural Differences Hamper Health Care

Station Hospital, by Robert Smullyan Sloan (Metropolitan Museum)
    
     "Medical stories are always interesting," I told my wife, justifying the hours I've been spending downtown this week, researching an upcoming column at a Chicago hospital. Between that, and a big piece due for Mosaic early next week, I'm going to have to phone in the blog for a few days. Since I'm in a medical mode, a few medical stories from the hazy past, including this, which I found out about through contacts in the Russian emigre community.

     They complain of serdtsa boleet -- literally "heartache" -- or pitchen boleet, a pain in the liver. They wave mysterious bottles with Cyrillic labels and demand valerian, an herbal tranquilizer rarely used here since the 1800s.
     They are immigrants, mostly Jewish, from the troubled, fractured land that once was the Soviet Union. Their steady influx into Chicago—3,000 last year, 14,000 in the last seven—has created a massive health care challenge for local social service agencies and affiliated hospitals.
     "They're sick folks," said Joan M. Schulhoff, director of Jewish Federation programs at Mt. Sinai Hospital, summing up the general health of the immigrants.
     "We are seeing many more problems than had before, because of the deterioration of the economy of the former Soviet Union. We are seeing more untreated cancer, untreated heart disease, untreated diabetes."
     Mt. Sinai and Michael Reese Hospital treat without charge any Soviet immigrant with a serious medical condition for the first four months they are in the country. Sometimes it's longer.
     "Any urgent or emergency care," said Carol S. Goldbaum, director of Michael Reese's department of social work. "We're not piercing ears, we're not doing breast reconstruction. We do cardiac bypass, radiation therapy, anything that has to do with cancer. Cataracts or glaucoma if they're looking at permanent damage unless something is done."
     The program is set up under the auspices of the Jewish Federation of Metropolitan Chicago, under contract with the state to provide health care for all refugees.
     Mt. Sinai provides $1.5 million a year in unreimbursed services, and Michael Reese as much as $1 million. The federation spends $2.5 million a year on immigrant health care, including the money it gets from the state.
     "We've been refugees for thousands of years—we know how to do this stuff," said Joel Carp, associate executive director of the federation.
     Many of the new immigrants are elderly relatives of people who came to this country years ago.
     Naum Zhits and his wife, Tslya, both 68, spent only one night under the roof of a relative in Highland Park before Tslya, who has a history of heart trouble, needed to be rushed to the hospital. Less than a week after leaving Minsk, she is in Michael Reese awaiting a triple bypass.
     For those with less urgent needs, the first step is a screening at the Touhy Health Center, run by Mt. Sinai. Doctors have two goals—ascertain individual health care needs and spot public health dangers—syphilis, AIDS, even leprosy.
     It is no vain exercise: One-third of all the immigrants are carrying tuberculosis.
     Ed Gilmore, a physician assistant, helps examine the 30 patients a day coming into Touhy.
     A major challenge is dealing with the myriad differences in medical culture. The Russians, for example, often are averse to taking aspirin. But many are addicted to tranquilizers. "It is an over-tranquilized population," Schulhoff said.
     Then there are the aftereffects of Soviet medicine with which U.S. doctors must deal.
     "Oftentimes their doctors lacked the facilities to perform necessary tests, so they made diagnoses 'from the ceiling,' " said Gilmore, using the Soviet slang term for a doctor sitting back in his chair, gazing skyward, and making up a significant-sounding diagnosis.
     An important part of this care is teaching new patients fundamentals of nutrition and preventive care, and how to use the U.S. medical system.
     Caregivers have been sent to Berlitz courses so that they have at least a rough understanding of Russian.
     It helped Gilmore one recent day, as he examined 8-year-old Ilya Samovskiy.
     Gilmore set the boy at ease with a magic trick, and proceeded to examine him, speaking a mixture of English and poorly pronounced Russian. "My bad accent amuses the old folks," he says. "They like it a lot."
     The boy's condition, he tells Ilya's mother, Galina, is "ne seriosna," -- he just has a slight fever -- and Gilmore perscribes "Tylenol, two tabletski."
              —Originally published in the Sun-Times April 4, 1994

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