Charito Sico, M.D., grew up in the Philippines, so a few years ago when she moved her pediatric practice from Fresno to Daly City, Calif., it was a homecoming once removed — the San Francisco suburb has the largest Filipino population living abroad. Since her arrival at Kaiser's South San Francisco Medical Center, she has made it her mission to improve health outcomes among Filipino-Americans with wellness programs designed specifically for them and cultural sensitivity training for hospital staff.
In 2009, Sico enlisted the help of Kaiser colleagues familiar with Filipino culture, bringing together a cross section of people with expertise in health education, language access, service, technology, palliative care and community health. They came up with the Filipino American Care Experience, with everything from end-of-life planning sessions co-taught by a doctor and a priest to Mula Sa Puso ("From the Heart"), a heart-healthy cooking class for Filipino restaurant owners and their chefs.
Jocelyne Vistan, a Filipino-American patient care experience leader, helped develop a curriculum for the palliative care class, Planning Your Journey. "In our culture, it's very difficult to talk about death and dying," Vistan says. "And it's very difficult for providers and nurses to have that conversation with a community that really isn't ready to have it."
Patients are encouraged to bring their families to Planning Your Journey, "so they can have some honest and transparent conversations with one another about end-of-life wishes," Vistan says. An intensive care physician and a palliative care nurse lead the class, along with a Catholic priest. Handouts are offered in both English and Tagalog, the official language of the Philippines.
The priest provides reassurance that the church approves of advanced directives. He also has the moral authority to dismiss concerns that just talking about death expedites its arrival.
The Rev. Mark Reburiano, who served as the class' pastoral leader until recently, says that Filipinos tend to see death as a spiritual issue and feel more comfortable talking about it with clergy. "[Priests] receive a lot of phone calls from families with questions about end-of-life issues," he says. "When I was in the FACE program, I thought, 'Wow, if only all hospitals would have this program,' where they invite a priest with a background in moral theology or ethics — it would save a lot of phone calls."
Doctors and nurses receive cultural sensitivity training through FACE. The 280 nurses have completed an hour-long class that addresses cultural idiosyncrasies like the fact that a nod doesn't necessarily mean understanding.
"When patients come into the clinic or the hospital, they look at the physicians and staff as persons of authority, and they dare not question authority," says Sico. "The physician or nurse might be giving them instructions about something, and they nod as a way of showing respect.
"So one of the training tips that we give out to our staff is to say, 'It's OK to ask me a question;' or to say, 'Can you tell me what instructions I gave you? Can you say it back to me?'"
The training also highlights differences within the community. "We have 120 dialects in the Philippines alone," Vistan says. "So when you have two Filipino people, that doesn't necessarily mean they speak the same language."
FACE pays special attention to chronic conditions widespread in the community like high blood pressure, heart disease and diabetes. A diabetes class addresses healthy eating, physical activity and insulin management. Chefs who attended the restaurant class learned flavorful recipes that are lower in salt, fat and sugar. "We actually went around and did a little taste test afterward, and you could see just how motivated they are to truly make changes," says Sico.
Now that FACE is established in South San Francisco, Sico intends to adapt and expand it for the area's large Latino population and share it with Kaiser medical centers in other cities.
In the meantime, she's tracking FACE's impact through blood test results of diabetic patients. So far, blood sugar and hemoglobin A1 levels are improving.
She's also seeing more advanced directive forms in patients' medical records: "Those are very heartwarming for me."