Monday, November 16, 2015

[Pakistani Culture Workshop] Health and the Pakistani Community

Multiculturalism in Action 2015-16
Pakistani Culture Workshop: Making a Change for the Better

Session 4: Health and the Pakistani Community

Speakers: Dr. Nazia Shahid and Ms. Asma Batool

The Multiculturalism in Action Project organized a public seminar entitled Health and the Pakistani Community on 7 November, 2015 at The Chinese University of Hong Kong.
Prof. Siumi Maria Tam, Director of the Project, gave an introduction to issues related to healthcare among the Pakistanis in Hong Kong. Cultural and social factors, such as language barrier and lack of information, affected the quality and frequency of healthcare seeking. Many Pakistani patients found it difficult to communicate with Cantonese-speaking clinic staff, including the doctors and nurses. Some did not know there were free interpretation services provided in government hospitals and clinics. On the other hand, the lifestyle and occupations of Pakistanis in Hong Kong triggered specific health problems. Obesity, for example, was common among Pakistanis because their diet contained high fat and sugar content.
Prof. Tam giving an introduction
The Hospital Authority and some non-government organizations have started special service programs to meet these needs. For example, ethnic minority languages were used in response cue cards, disease information sheets, and patient consent forms in public hospitals and clinics. The United Christian Nethersole Community Health Service and HKSKH Lady MacLehose Centre have been providing outreach and public education for the general public. Prof. Tam encouraged the audience to think whether these services were accessible to those in need, and to what extent these services were effective and helpful.
Our guest speaker, Dr. Nazia Shahid delivered an informative presentation on the general medical issues among the Pakistanis. She highlighted the fact that 37.6% of Pakistanis were born in Hong Kong, which was a relatively high ratio when compared with other ethnic minority groups in Hong Kong. First, Dr. Nazia explained some basic concepts on how Islam understood “health” and “disease”. Islam perceived health and illness as balance and imbalance of a body respectively. The Quran has provided guidelines to Muslims to stay healthy, such as one should maintain good personal hygiene, avoid drinking alcohol, and eating halal food. She also explained the concept of “life” in Islam, and the belief in afterlife - death was a transition for the soul to depart the body and enter another realm. Islam helped to comfort Muslim patients and their families who perceived illness as a test or punishment from God, and provided a spiritual healing power through prayers and meditation to ask forgiveness from God.
Dr. Nazia giving a presentation
Dr. Nazia explained that it was mainly non-communicable diseases such as obesity, heart attack, and high blood pressure that affected Pakistanis in Hong Kong. Females were more vulnerable to these diseases because they were not encouraged to go outside so they rarely had physical activities. Limited information on healthcare, and an oily diet, led to heart attacks, high blood pressure, and obesity. Compared to their counterparts in Pakistan, those in Hong Kong had better health in general, as they had adjusted to a steamed cuisine and more attention on their body shape. Pregnancy was another factor affecting the health of women. As each pregnancy made it harder to get back to pre-pregnant physical conditions, when Pakistani women needed to bear more children according to the cultural concept that children were a symbol of fortune, Pakistani women were more at risk due to childbearing. Dr. Nazia believed it was essential to educate fellow Pakistanis on dietary hazards and raise awareness on leading an active and healthy life, especially among the women.  
According to Dr. Nazia, Pakistani men suffered more from occupation-related accidents, such as in construction sites, as little attention had been paid to safety in the workplace. Moreover, Pakistani children in Hong Kong were often obese because they consumed lots of junk food and frequented fast food shops.
Dr. Nazia continued her presentation by discussing the socio-economic factors affecting the Pakistanis’ healthcare seeking behavior. Language was a big problem, as not all Pakistanis in Hong Kong could speak and understand Cantonese and English. Even if they know these languages, it may not be good enough to communicate in medical terms. Dr. Nazia mentioned that the interpretation services for ethnic minorities were not always satisfactory as some interpreters were not well trained. This topic was further discussed during the panel session, which will be mentioned below.
Gender was another factor especially affecting the healthcare seeking behavior of Pakistani women in Hong Kong. Muslim women preferred to have female doctors or nurses in order to follow modesty requirements in regard to opposite sex. However, in Hong Kong, doctors and nurses were often males. Muslim women would feel very uncomfortable if a male doctor conducted prenatal checkup on them. Dr. Nazia advised the government should pay more efforts in training female doctors and to create a user-friendly environment to help all patients with their needs. On the other hand, it was a tradition for Muslim baby boys to be circumcised at the earliest. However, most doctors in Hong Kong had little awareness of this and were not trained about circumcision. It usually took a long time to wait for circumcision in public hospitals, while the fee in private hospitals was high. Compared to the United States, where circumcision was routinely done to meet the religious need of the Jewish faith, Dr. Nazia suggested that the Hong Kong government could pay more attention to the special needs of ethnic minorities.
Following a short break, a panel discussion was carried out. Dr. Nazia was joined by Ms. Asma Batool, a Community Health Officer in South Asian Health Support Program United Christian Nethersole Community Health Service, who gave us some ideas on the limitations of clinics in Hong Kong, for example, the lack of prayer rooms, and lack of nursing facilities. Ms. Batool believed that there should be more cultural sensitivity training for frontline doctors and nurses.  
Panel discussion
The focus of discussion then turned to interpretation services for ethnic minorities, and everyone actively expressed their opinions. Some in the audience questioned the effectiveness of interpretation services as these were seen to be passive action as patients needed to get approval from the hospitals in advance. Clinic staff often asked out-patients to bring family members or friends who know Cantonese to translate for them. Moreover, interpretation in the emergency room was not available. Some patients even did not know how to apply for the service.
Pakistani guests expressing their opinions during the panel discussion
Representatives from Hong Kong TransLingual Services (HKTS), Mr. Ryan Choi and Ms. Candy Hui, opined that the culture in public hospitals, which emphasized time and cost efficiency, has restricted the effectiveness of interpretation services. Some of the reasons why hospitals discouraged the use of interpreters were cost minimization, and limited consultation time. Mr. Choi said that as service provider, they were trying hard to monitor and improve the quality of staff. The latest statistics showed that there were 800-900 interpretation cases per month last year, and the number was increasing as more patients knew about the services. HKTS also organized talks and sharing sessions in public hospitals to promote their services and to heighten the cultural awareness of hospital staff. Lastly, Mr. Choi reminded service users to be punctual to make sure the services were properly used.
After the fruitful discussion, Prof. Tam concluded that although there were structural and other factors affecting the healthcare seeking experiences of ethnic minorities in Hong Kong, many efforts had been done to improve the situation. Both healthcare service users and providers needed to know their rights and responsibilities to make the healthcare system in Hong Kong a more user-friendly and effective one.

(First Row, from left) Dr. Nazia, Ms. Batool and Prof. Tam, together with guests and participants of the Workshop


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