by Talib Qizilbash
At Avenue Eyecare in Vancouver there are stickers on the main door of the clinic advertising that the optometric practice is run by Cantonese- and Mandarin-speaking doctors. Once inside, patients will not only find business cards and brochures about the office in Chinese, but front-desk personnel who can also answer questions in Chinese.
Dr. Sherman Tung, OD FAAO and co-owner of the practice, says he and his partner, Dr. Jessica Chang,
made a conscious effort to hire Mandarin-speaking staff when they opened last year.
Providing Chinese-language services is not simply about helping those who don’t speak English.
“Fostering Healthy Sight in Canada: Focus on Culturally Diverse Groups,” a 2010 study published by Transitions Optical, states, “While 85 per cent of Chinese Canadians can converse in either English or French, the same percentage speaks another language at home.”
No one should be surprised that people are most at ease conversing in their mother tongue. Giving them
this opportunity during an eye exam often means that they will be more open, thus sharing more about any concerns.
“It’s about allowing people to communicate and get information in the language that they are comfortable in,” says Dr. Tung.
Like many people in Canada, Dr. Tung is fully aware of the demographic shifts happening across the country. He noticed the growing Chinese community in the Kerrisdale neighbourhood and saw an opportunity. Of course, the opportunity is about more than business growth: it is also about improved patient care.
According to Statistics Canada, by 2031 visible minorities will comprise 32 per cent of the population across Canada. In some of our largest cities, the cultural mix will be more intense. By 2031, minorities will be 59 per cent of the population in Vancouver and 63 per cent in Toronto. And for almost one third of the population, neither English nor French will be their mother tongue. By providing better, more tailored service to the ethnic Chinese community in his area, Dr. Tung is
not riding a short-term demographic trend. Across the country the number of Chinese Canadians is expected to exceed 2.4 million, double 2006 levels. With 82 per cent living in either British Columbia or Ontario, it would seem that Dr. Tung has found himself a good location. And with Chinese populations younger than the average, Dr. Tung has the opportunity to build lasting patient relationships that will grow with his business.
As the population changes, eye care professionals are becoming increasingly aware of the health issues
that are prevalent within certain ethnic communities. And that includes the Chinese community. Dr. Tien Y. Wong says, “Asians have different risk factors and profiles of eye diseases.”
Dr. Wong, who is both a MD and PhD, is the director at the Singapore Eye Research Institute and lists
myopia, closed-angle glaucoma and a subtype of early age-related macular degeneration called polypoidal choroidal vasculopathy as common among Asians. Armed with this information, eye care professionals can provide superior care not only in terms of screening for disease but also in terms of patient education. At her practice, Foresight Eyecare in Calgary, Dr. Dianna Leong is doing just that. She has taken a special interest in diabetes.
“Diabetes is a big drain on healthcare dollars,” says Dr. Leong. She has made it her goal to provide education on how the disease affects the eyes. Her plan makes good sense since her clinic is in an area with a growing Chinese community and there is a high prevalence of the disease among Asians. Dr. Leong has even recruited the help of a diabetes educator. The trained pharmacist comes in to the clinic by appointment.
It is part of a larger effort to adjust the services she provides where health education is key to overall care. Through her seminars, conducted in both English and Chinese, attendees have learned that
if there is a problem controlling diabetes, then it can be detected within the eyes.
“The retinal photo is a good visual teaching tool for patients, and hopefully this can help with compliance in controlling the condition and promoting healthy lifestyles,” says Leong.
Unfortunately, despite great feedback, attendance for Dr Leong’s diabetes clinics has been a bit lower
than hoped. But her belief in the value of her project is undiminished.
“We can fill a very big hole,” says Leong. “In primary eye care, we can be strong educators.”
But everything hinges on clear communication.
Dr. Ken Mandadakis understands that doctors and patients have to overcome language barriers everyday.
As the son of Greek immigrants, he remembers how his parents struggled with poor English. When his mother had a doctor’s appointment, she would drag the young Mandadakis along as translator.
Today he’s the doctor. The North York-based optometrist says about one-fifth of his patient base are of Chinese heritage and 25 per cent of those patients don’t speak English.
While Dr. Mandadakis agrees that having Mandarin and Cantonese speaking staff would help, he manages
the diverse multilingual aspects of his practice differently.
Dr. Mandadakis uses printed informational material, family members and the Internet to bridge the communication gap. For example, he has made available a Chinese language pamphlet on dry eye (produced by Alcon) and relied on the family members of patients to act as translators. But sometimes even they
have trouble finding the right word.
When that happens, he leans on the internet and a service called Babblefish to translate specific health terms. He’ll type in the English word and then point at the translated result for the patient. It is a simple technique that can quickly enhance understanding of the issues. “If it takes 30 seconds more, so be it,” says Dr. Mandadakis.
Even professional associations are addressing the challenges of language. The Alberta Association of
Optometrists (AAO) helps patients find an optometrist who speaks their language.
Among the more than 25 languages listed in the AAO’s online optometrist-by-language listing, there are several optometrists who offer services in Cantonese, Mandarin or Taiwanese.
Meanwhile, the British Columbia Association of Optometrists (BCAO) has two pamphlets for the Chinese
population: one is title “Your Child’s Eye Health” while the second is called “Vision and your Family’s Health.” The BCAO says that it is also “working on new pamphlets specifically in relation to what patients should know when purchasing eye wear.” Unfortunately, when Optical Prism spoke to the
BCAO there were no immediate plans to have the pamphlets translated into different languages.
Not all professional associations, however, are addressing the language issue head on.
“The CAO has not provided resources to its members in languages other than the two official languages,” says Leslie Laskarin, Director of Communications of the Canadian Association of optometrists.
At the present time, Laskarin says it is up to individual members to draw on the policies and eye health information made available by their professional associations to develop foreign-language brochures or ads.
Still, Laskarin acknowledges the opportunity here.
“Although it would be quite expensive to do nationally, I anticipate this will be part of a future
communication strategy for the CAO,” he said.
Much can be learned from the Canadian National Institute of the Blind (CNIB). A 2009 study by the national charitable organization revealed just how large a barrier language was for many Canadians
seeking vision-related services and support.
“It came up again and again,” says Dr. Alexander Shaw, co-author of the study. The report specifically
examined barriers to accessing CNIB services in Punjabi and Chinese speaking communities.
“What a shame that the service is not suitable for Chinese, as they all speak in English,” said one focus group participant for the study. “They do not provide interpreters. You need to know English in order to use their services.”
Beyond language and health care, there are also obstacles to overcome at the intersection of culture and health care. Back in Vancouver, Dr. Tung says that many in the Asian community, including
Chinese and Korean immigrants, do not come from a culture that preaches about regular eye exams.
There is eye testing to determine corrective lens prescriptions but there is little understanding of
checking ocular health. Thus, says Dr. Tung, many new Canadians are familiar with being fitted for
glasses, but are not used to paying for an eye check-up.
“Over here they ask, ‘Why do I need my eyes checked?’”
An effective community outreach program can get the right messages out into the community. Local newspapers may be good for promoting a business, but they are not so great for building awareness of health issues. Church groups and seniors groups are a better way to connect meaningfully with people. This is something Dr. Shaw at the CNIB learned. He calls it “tapping into areas where there is a
high-level of trust.”
Dr. Tung and his partner, Dr. Chang, have given talks at their local senior community centre and
attended local fairs where they handed out information packages in Chinese. Recently, they participated in the “Bellies to Babies” trade show where they interacted with many expectant parents in English, Cantonese and in Mandarin.
“We educated them on the importance of eye exams for children, starting at six months of age,” says
But there is more to do. Currently, about 50 per cent of the clientele at Avenue Eyecare are ethnic
Chinese. Dr. Tung expects that number to grow. To keep pace, he wants to create more educational material.
“We currently do not have any Chinese brochures about dispensing,” he says. “We are working with our
local lab to put something together.”
Over in Calgary, Dr. Leong is trying to do more as well. She has a basic command of Cantonese, but with the Mandarin-speaking community growing quickly in the area, she needed to adapt. So her new
practice has both Cantonese and Mandarin speaking staff. And these days she is learning Mandarin too.
For eye care practitioners, there is a clear need to identify opportunities and adapt to demographic trends. But in doing so, communication shouldn’t be taken for granted. In fact, professionals like Dr. Tung and Dr. Leong illustrate that communication is a focal point in terms of providing better service. Eye exams only require the most basic communication but explaining results, educating patients and performing a comprehensive follow-up need much more. •
by Talib Qizilbash