Kentucky Fried Chicken's "finger-lickin' good" slogan first showed up on Chinese billboards as "eat your fingers off." In Taiwan, Pepsi's "Come alive with Pepsi" campaign became "Pepsi will bring your ancestors back from the dead." And the first Chinese transliteration of Coca Cola — ke-kou-ke-la — meant "female horse stuffed with wax."
If even multi-national corporations commit such cultural gaffes, it's no wonder cross-cultural miscommunication occurs in the health-care setting.
But the stakes are much higher in medicine, as more than 150 professionals from 10 states were reminded at a two-day symposium on cancer in Cambodian Americans held in Seattle in October. The meeting was sponsored by the Asian American Network for Cancer Awareness, Research and Training (AANCART), a five-year, $8 million project funded by the National Cancer Institute.
Headquartered at UC Davis, AANCART is the largest project ever undertaken to reduce cancer in Asian Americans. Principal Investigator Moon S. Chen, Jr., a professor of epidemiology and preventative medicine at UC Davis School of Medicine and associate director for cancer prevention and control at UC Davis Cancer Center, coordinates the efforts of researchers at eight other AANCART sites nationwide. The centers are the Cancer Research Center of Hawaii in Honolulu; Dana-Farber Cancer Institute in Boston; Fred Hutchinson Cancer Research Center in Seattle; Herbert Irving Comprehensive Cancer Center in New York City; Jonsson Comprehensive Cancer Center at UCLA; MD Anderson Cancer Center in Dallas; Solove Cancer Research Institute in Columbus, Ohio; and the UCSF Comprehensive Cancer Center.
Cancer mortality is increasing faster in Asian Americans than any other ethnic group. in the United States. And Asian Americans are the only ethnic group in the nation for which cancer, rather than heart disease, is the leading cause of death.
Cambodian Americans suffer particularly high rates of liver cancer, cervical cancer and lung cancer. Their rate of hepatitis B infection, a chief cause of liver cancer, is up to 14 times higher than in Caucasian Americans. Cervical cancer is almost 12 times more common. Lung cancer is epidemic.
Cambodian Americans urgently need information about cancer prevention, but the message hasn't taken hold. One new study reported at the AANCART meeting found that only 38 percent of Seattle-area Cambodian Americans had been tested for hepatitis infection. Even among those who considered themselves at risk, just one in three had been vaccinated.
Yet reducing cancer in this population will require carefully crafted, culturally competent health messages, according to Shing-Ping Tu, an assistant professor of medicine
at the University of Washington. Tu, community director for AANCART in Seattle, opened the meeting with a list of culturally incompetent
advertising slogans, such as "eat your fingers off."
Cambodian Americans have endured more loss and trauma than most Americans can imagine, making effective communication more difficult.
"We are torture victims caring for torture victims, and we are overwhelmed," said Theanvy Kuoch, who survived Cambodia's killing fields to found Khmer Health Advocates in West Hartford, Conn.
A survey of Kuoch's clients found that 24 percent had witnessed a suicide, 26 percent experienced American bombing, 50 percent were injured while performing forced labor, 52 percent knew someone who had disappeared, and 69 percent witnessed torture. Only 18 percent had not thought of killing themselves in the previous month.
While such experiences constitute a formidable barrier to preventive health-care practices, silence also plays a role. In traditional Cambodian culture, a virtuous woman is quiet – even during childbirth. In the doctor's office, she keeps her eyes downcast, her her responses short and asks no questions.
"The doctors don't understand," one middle-aged Cambodian American woman volunteered from the audience. "Please, tell them we are not really dummy. We don't make eye contact, but we heard everything you say."
What does work? According to Marjorie Kagawa-Singer, UCLA associate professor of public health, native health outreach workers are the key to reaching a community all but paralyzed by depression, mistrust and fear.
Doctors, too, can make a difference by asking careful questions and remaining mindful of cultural differences, said Richard Mollica, associate professor of psychiatry at Harvard Medical School and director of the Harvard Program in Refugee Trauma at Massachusetts General Hospital.
The Seattle meeting was the latest in a series of "cancer control academies" organized under AANCART auspices. The academies seek to reduce cancer among Asian Americans, ethnic group by ethnic group. The first, held in Oakland in 2001, focused on lung and liver cancers in Chinese and Vietnamese Americans. An academy in Boston last June looked at diet-related cancer prevention in Korean Americans. The next academy, to be held in Los Angeles later this year, will address breast cancer among Filipinos and Asian Indians. UC Davis will host the 2004 academy, addressing cancer in the Hmong community.