Carey Ramirez, ANP-C, ACHPN

Kaifan Zhao, AGACNP-BC, came to the United States as a high school exchange student from China. When he was 17 years old, he found himself unexpectedly in the hospital. He had a sore throat but no knowledge of the health care system. Kaifan’s understanding was that in China you could get antibiotics anywhere. He did not know what primary care or urgent care medicine was, and he had no resources to turn to. This early experience for Kaifan made him realize that many immigrants have no clue how to navigate the U.S. health care system.

After the hospital visit for his sore throat, Kaifan received multiple bills that were almost impossible for his family to pay. He received separate bills for the emergency room, emergency room doctor and the hospital. This was eye-opening for Kaifan. After experiencing life through the lens of an immigrant, Kaifan decided to dedicate himself to providing holistic and inclusive care for patients. 

Kaifan has worked at City of Hope for seven years as a clinical supportive care nurse practitioner. Throughout his time in supportive medicine, Kaifan has seen the significant need to serve the immigrant population, especially in supportive and palliative medicine. Kaifan recruited another Mandarin/Cantonese nurse practitioner to serve as the exclusive palliative pain management provider for this population.

Sitting down with Kaifan Zhao, AGACNP-BC.

Kaifan recalled that although he had many Chinese-speaking colleagues, no one was taking a stand to advocate and serve this population. Having had such a tumultuous experience navigating the health care system as a teenager, Kaifan felt called to make a difference for Mandarin- and Cantonese-speaking patients. He was uniquely positioned with the skills and knowledge to make a difference.

According to Kaifan, most Asian patients are stoic and will endure pain silently during their cancer treatments, but they do not know how to utilize proper resources. Despite use of translators, many patients still do not have a full understanding of their diagnoses or treatment plans. Kaifan explains that there is no exclusive word-for-word translation for “supportive medicine” in the Chinese language. The word “palliative” can connote conniving toward or promoting death. He feels that translators are not equipped with the medical understanding to provide context around the translation. In essence they can translate word for word; but according to Kaifan, the message has to be trans-created. If patients do not comprehend the message, what is the point?

“Don’t aspire to make a living. Let’s aspire to make a difference in the Mandarin/Cantonese-speaking community.” —Kaifan Zhao, AGACNP-BC, palliative care nurse practitioner at City of Hope

Kaifan got right to work in 2017 when he joined City of Hope. At that time, the supportive medicine program consisted of five doctors and three nurse practitioners. The program has grown to more than 20 clinicians. Kaifan recognizes that greater cognizance of supportive medicine, quality of life and pain management are necessary not just for patients, but also for clinicians. Educating and promoting supportive medicine to other providers is a win-win for providers and patients. 

Kaifan conducted a spot check survey at local Chinese grocery stores. He wanted to know what the average understanding of supportive and palliative care was in the Mandarin and Cantonese populations. The survey confirmed his suspicion that most of the individuals had little to no understanding of what supportive medicine was and associated it only with end-of-life care. Kaifan did all of this on his own time because he felt motivated to help this population that was so near and dear to his heart.

Subsequently, Kaifan created a nurse-led supportive/palliative care clinic at City of Hope for the marginalized Mandarin- and Cantonese-speaking community. The clinic has two primary objectives: Develop and provide community education and resources for Mandarin and Cantonese speakers about integrating supportive and palliative care into their cancer care, and launch and pilot test a supportive care clinic for Mandarin and Cantonese speakers that could be scaled up and disseminated to other areas. Kaifan recognized the urgent need to support this vulnerable population. He recalled a Mandarin-speaking patient from Taiwan who was very adherent to his care and never had issues with following instructions. One day the patient did not show up for an appointment, which made Kaifan curious, so he looked through his chart. He saw that the patient had missed all of his recent appointments. Kaifan called one of the patient’s relatives and found out that the patient had passed away the week prior. The patient was socioeconomically disadvantaged and lived alone. It was determined that he had a fall in his home and was discovered a week later.

Many immigrants live alone. Kaifan initiated referrals to a vetted home-based palliative program as a way to monitor patients he considers high risk. This provides wellness checks for these patients and Kaifan can monitor their safety. He knows that a lot can happen between appointments and wants to be sure his patients are safe.

Kaifan has a profound understanding of immigrant life in the United States. When he was a nursing student, Kaifan’s grandfather had advanced Parkinson’s disease and was in the intensive care unit at a small community hospital. The medical team was deciding whether to do a tracheostomy for him. Kaifan’s family had no guidance on how to make this decision, resulting in his grandfather being in pain from the tracheostomy. There was no palliative care involvement at that time. Kaifan’s family regretted the decision. In the midst of all this, Kaifan had to serve as the counselor, social worker, navigator, translator and everything in between. Kaifan cannot help but think that if they had a supportive medicine program like the clinic he has created, it would have made an enormous difference for his family.

Articles

Kaifan Zhao, a palliative care nurse practitioner at City of Hope, has dedicated his career to improving healthcare access for Mandarin- and Cantonese-speaking immigrants. His personal experiences navigating the U.S. healthcare system as an immigrant inspired him to address the unique challenges faced by this population, particularly in supportive and palliative care. Zhao established a nurse-led clinic to educate and provide resources for these communities, emphasizing the importance of culturally sensitive care. His efforts aim to enhance understanding and utilization of supportive medicine, ultimately improving patient outcomes and quality of life.

“Don’t aspire to make a living. Let’s aspire to make a difference in the Mandarin/Cantonese-speaking community.” 

Carey Ramirez, ANP-C, ACHPN

Aspiring to Make a Difference for Immigrants

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