Transcript
Carol Stiles: Good evening and welcome to One in Five. I’m Carol Stiles. On tonight’s programme we’re meeting a man who was honoured in this year’s New Year’s Honours list. Auckland psychiatrist Dr Sai Woh Wong was appointed an Officer of the New Zealand Order of Merit for services to mental health and the Chinese community. Dr Wong came to New Zealand 40 years ago. Very early on he recognised there was a need to provide support and services to Chinese people in Auckland. He’s been serving the community ever since.
Carol Stiles: Congratulations on your New Year’s Honour.
Dr Sai Woh Wong: Oh, I think I’m not worthy for that. My aim is just to work and this is not my aim. It’s just picked up on the way. I think it’s important, though, because I think it’s important for people to understand that perhaps service for the psychologically infirm is not a bad thing. It’s an honourable profession. I remember when I started to do psychiatry oh my parents dissuaded me.
Carol Stiles: Did they?
Dr Sai Woh Wong: Of course. They said of all specialties why get into that? So that tells you how stigmatised and how discriminatory that is.
Carol Stiles: What was your answer to that?
Dr Sai Woh Wong: Because I could get away from them I can do it.
Carol Stiles: (Laughs) So you trained where?
Dr Sai Woh Wong: I was trained here. I graduated from the university of Hong Kong, and then I wanted to do psychiatry. Obviously a lot of objections. ‘Why don’t you do pediatrics?’ and so on. It so happened that there is a vacancy here for training so I just came over here for training. So that was in the ‘70s - ’75. I actually spent more of my life in New Zealand than in my home country. I was born in Canton, China, Guangzhou. But obviously I was a refugee. The whole family actually escaped and went to Hong Kong and Macau. I was raised there. And my aim in life is more to do with providing a service – to serve and not to be served. So that’s my aim in my life and I also do it quietly. There’s a Chinese saying about cultivating the field quietly. That’s what I’m doing.
Carol Stiles: He may have been doing it quietly, but he’s also been doing it comprehensively. For ten years Dr Wong was clinical director at South Auckland Mental Health, and with his colleagues developed a cultural liaison consultation service. He was involved with setting up the Chinese Lifeline telephone counselling service, and worked to establish day centres for elderly Chinese. You might find him speaking at public meetings, to church leaders, publishing articles on Chinese mental health issues all with a view to upskilling people with cross-cultural knowledge. He’s been a strong advocate for integrated multicultural mental health services.
Dr Sai Woh Wong: I think a psychiatrist is no different from a surgeon. He needs a team. You need an occupational therapist to help you. You need the community to provide resources to help you get your patient out and going and to employ them. And you need a psychologist. You need lots of other professions. So when I first came over here I was everything. I had to take patients to OTs and to sheltered workshops to introduce them to it. Very few other professionals around. So all these years I’ve been trying to rally a team around myself which is culturally relevant and acceptable by the Chinese. And by doing that I’m actually a community psychiatrist, you work with a community. I always tell patients that discrimination is both ways. You discriminate against westerners, as well, and therefore you invite discrimination, as well. That can be a danger. That’s why we have been working, not as a separate Chinese service; we operate as a consultation liaison to the mainstream services.
Carol Stiles: You lecture at Auckland University to the medical students about cross-cultural practices. What are the most important messages that you try and get across to the new generation.
Dr Sai Woh Wong: The first thing I speak in the lecture is that you and I are the same. There’s no difference. We respect that we are all human beings, we all suffer. And these are the commonalities that you and I share. We all have depression, for example, but we express it differently, that’s all. And we expect different help, of course. But the help is not that different. All you need is to modify it so that they can have it, they can accept it.
Carol Stiles: What’s culturally specific about a Chinese person’s requirements from a mental health practitioner?
Dr Sai Woh Wong: I always tell them that our cultures are not as different as you people might think. Having said that, what are the differences? Asians are collective societies. They prioritise on the whole family so you try to comply with others’ wishes. This is the main difference. Europeans in a individualistic society, they look at individuals. So they are different. Chinese, for example, one of the main things. If you are dealing with adolescents and you bring in the parents and you talk about their rights and so on and so forth they will feel shameful. Shamed by you, because you bring the family in and talk to them about what they should do or should not do. Because in the family they are the eldest. They have authority over their children. Obviously there is a downside to it, too. But what we need to do is respect that and then, out of that, gradually gain their respect for us and then gradually we help them to change their views. That is how we do it. So the difference is the collective society and the individualistic society. For Chinese the worst is shame. You don’t induce shame. Because shame is to say that you are culpable, you are responsible for it…you are damned because you do it.
Carol Stiles: Some people, if they have a mental health problem, they may behave in a way that their family doesn’t like.
Dr Sai Woh Wong: Yes, yes, yes.
Carol Stiles: Is that seen to shame the family?
Dr Sai Woh Wong: Yes, yes. Well, I think there are several things. One thing is the culture itself. Even in Chinese traditional medicine we talk very seldomly about mental ill health. And there’s no special chapter for that. It blends into the physical chapter. It’s a common belief if you have got someone who is mentally unbalanced it’s your fault or you’ve done something wrong. This is the collective side of things that liabilities spread along.
Carol Stiles: The parents and the grandparents…
Dr Sai Woh Wong: Yes, yes. I think it’s probably to do with… in the past, syhpillis and all that sort of thing got inherited, so they generalise it to everything. Secondly, mental illness would be blamed on the parents. ‘Why did you raise children like that?’
Carol Stiles: So how do you deal with that issue of the parents feeling shamed by their child?
Dr Sai Woh Wong: I think it’s by psycho-education. The most important thing is not to rubbish their feelings. Empathy is the most important thing – universal empathy.
Carol Stiles: Dr Wong says some patients say they don’t want to see a western physician because they don’t understand Chinese culture.
Dr Wong: I think the bottom line is not that they don’t understand our culture. It’s that they do not respect how we feel. Understanding culture doesn’t mean to say that you condone that cultural practice. So first is to side with them, understand their feelings. Just like when you’re talking to a psychotic patient who’s been hearing voices. What you can say is that I don’t hear, but I understand if you hear the voices. And, if it’s so threatening, I understand while you feel so fearful. Let’s see what we can do about it. Same thing across cultures. There’s no difference.
Carol Stiles: Migration to New Zealand brings hurdles that can result in poor mental health. Dr Wong says leaving your home country is a loss.
Dr Sai Woh Wong: The loss is of support networks. You’re basically cut off from all your social networks back in your country of origin. So the first part of the hurdle is really to cope with the losses. Esteem is an important one. For example, in Hong Kong, in China, you’re well-respected. The more grey hair you have the more respect you have. You’re a wise man. But here is different. You’ve grown old and you get dependent and you’re no use. So you have to put things behind you. It’s not easy. Then the second thing is the challenge of here. The challenges are several things – one is the language. For physical things you can tell your doctor ‘I’ve got a headache. I’ve got this pain here or there,’ but once you try and express why you feel sad, it’s not easy. And sadness in Chinese terms is quite different from the western terms. In Chinese terms the word ‘depression’ carries with it some sort of value, negative value and shame, whereas change it into English and ‘depression’ is just ‘depression’. So the language is a difficult one. The other one is social isolation. There are a lot more older people that migrate now to join a reunion. And these people, they are all retired. And so they’ve lost their status. They come over here. Language is an issue. Transport is an issue because in China, in Hong Kong, transport is easy. For example, here, I have a day programme for elderly Chinese. I’ve got one in central, I’ve got in South Auckland and I’ve got one on the Shore. Recently we had to change from the city because the venue was crumbling and we had to actually move. Once we moved, the elderly have got to change buses three times before they can come down to Three Kings. Winston Peters did a good job, his only good job, I think, that he did for elderly, and that’s the Gold Card. And they can actually take a bus if they have a Gold card.
Carol Stiles: Another challenge is the concept of health and treatment. Dr Wong says Chinese people often view western medicine as too strong. Chinese herbal medicine is seen as ‘tuning’.
Dr Sai Woh Wong: We tone you up, tone you down. If you are too hot or whatever, we tone that down. If you’re not hot enough we tone that up. Whereas western medicines are seen as very strong and give rise to side-effects. So they only expect you to give western medicine when they have a dire physical illness. And also long-term western medicine is no good because it’s not tuning and it’s got toxic effects. So a lot of my patients sometimes they would stop their medication. And my headache is always… whenever I hear of a patient going back to China I have a headache because they go back there, they will stop the medication…a lot would stop the medication. And sometimes people would say ‘Why don’t you take this?’ And other people say ‘You shouldn’t be taking the medication too long’ and they stop it. And then they relapse and they come back here in relapse.
Carol Stiles: There’s a bit of reluctance to take western medicine?
Dr Sai Woh Wong: I won’t say everyone, but they choose when to take it. And they want an injection. But if you talk about long-term injections – no good. One injection, just like antibiotics, well, very good, takes care of my sickness. But for mental ill health it’s not that, it’s a long-term injection and these are all toxic. But let’s accept that, yes, they’ve got side effects, but then you have to weigh two things. ..whether it’s better to be ill all the time and not treatable at the end of the day with a lot of residual symptoms. Because if you don’t treat it the chances are that it becomes chronic.
Carol Stiles: Dr Wong says another concern is the mixing of Chinese herbal medicine with western pharmaceuticals. He says there’s little research about the interaction of the two.
Dr Sai Woh Wong: You talk about the incidence of multi medical system usage. That’s very common. Because our collective view is the more help we can have, the better. So we have to tell the patient about that. We can’t be too certain. The first thing would be if they’re not seriously ill then maybe they try the Chinese herbs first. If it doesn’t work come to us and stop the herbs. So the concept of treating an illness is another thing and then there’s coming to see a doctor. A western doctor is ok, a family doctor is OK for physical. But you see a psychiatrist – that’s not good. Therefore I always play it low-key. Nobody knows I’m a psychiatrist.
Carol Stiles: Well, I noticed when I pulled into your car park there is no sign outside to say who works here.
Dr Sai Woh Wong: Exactly, exactly.
Carol Stiles: So why have you chosen to do that?
Dr Sai Woh Wong: Two things – one is that it’s just like an ordinary house so when people walk in nobody knows that they are coming in to see anybody. The other one I don’t want to make it too clinical. If you are in an ordinary home it’s easier for you to divulge and express yourself. They all think of it as my home.
(Both laugh)
Carol Stiles: They think you live here?
Dr Sai Woh Wong: Yeah.
So I think that’s one of the hurdles.
Carol Stiles: He says older Chinese people are more reluctant to seek help than the younger generations.
Dr Sai Woh Wong: We know that older people actually have more stresses, in that they are not so healthy. So using the western system it’s a problem expressing themselves. They are isolated. They don’t have much transport. And worse is the shame if you are to go to a rest home. So rest homes are still not that well accepted because going to a rest home in China and other places… it’s getting better now, but rest homes are not always the most comfortable environment. Sometimes there are four or five beds a room depending on whether you can afford it or not.
The other thing, more importantly, is that why do you have to go to the rest home? Have all of your younger children died? If no then why are your children not sort of taking care of you? So that’s a shame.
Carol Stiles: And does shame lead to depression?
Dr Sai Woh Wong: Yes, yes. It’s related. Shame is worse than feeling guilty because shame is that you involve a lot of other people, as well. You bring a lot of people down with you. That’s shame. In the olden days… I mean, here’s a story but it’s interesting … in the olden days, 400 or 500 years ago, if one criminal was caught for killing people your whole clan got punished for it. On the other hand there’s honour. If you excel, you do something good, all your family shares your honour and glory.
Carol: I often think of some of the younger people who come out to New Zealand to attend university. Many of them will be only children and they’ll have a lot of pressure on their shoulders to do very well here, I would imagine. Do you see that translate into anxiety?
Dr Sai Woh Wong: Yes, yes. There is no research to prove that but in clinical experience there are three types of international students who come here to stay temporarily. There are three types. One are those whose parents don’t have time to take care of them. Out of sight and out of mind. I’m not saying that everyone is, but there are some who actually say … when there’s some problem with the international students, you call the family and the family says ‘You fix it. I can pay, you fix it.’ But I’m not the parents. How can I fix it without them? So this is one mentality. So these are people who come here probably with a problem already. And New Zealand is asked to parent them. I’m sure the education department is going to sanction me for that, but that is some of the cases we see. Then the other ones you see are the ones who don’t actually have the money to come. Being able to migrate, having a son overseas, is still considered a glory to the clan. So the parents actually borrow, sometimes at heavy interest, to send the student over here to study. So these are the people who have got this expectation of them. And then there are the third type who actually come here – similar to the second type – still a lot of pressure - they come to herald their parents’ migration. So they come here. ‘You’d better graduate. You’d better get a job here. You’d better get your residency here and then get us all here’. It’s also easy, too, because of the one child policy. Where are the other children? There’s no other children. So they must come with them. These are people with a lot more stresses, anxieties and so on.
Carol Stiles: Do you see people like that?
Dr Sai Woh Wong: Yes, we see international students like that, as well. Sometimes 16 year olds or 17 year olds come over here with no previous experience of leaving the parents. And that is very stressful. I respect them, though, because I wouldn’t have survived if I was them. But they survive. The unfortunate thing is there are several types of people. There are the ones who exploit them because they are so naïve, they exploit them. And sometimes it’s fellow countrymen that exploit them, borrow money from them and vanish. There are people who actually want to borrow some money to buy a car. Once they’ve bought a car the money is gone and the money that’s on loan is for their three years expenditure. They dare not tell their parents about it.
Carol Stiles: That they’ve brought a car instead?
Dr Sai Woh Wong: No they didn’t buy a car. They lent the money to another person to buy a car and that guy’s vanished. So how do you help them? You can’t tell the parents because they don’t want to tell the parents. They shame the parents and so on. And they have no money to survive here. Going back is a shame, very shameful. You fail your parents’ expectations, you fail everything, and you’re so naïve.
Carol Stiles: Because language is key to a culture Dr Wong has helped set up training programmes for interpreters and for the health professionals who use them.
Dr Sai Woh Wong: How do you interpret? What are the things that a psychiatrist or a clinician would want from an assessment, how you help them to actually engage the patient. I think these are the most important things – how you engage them – for the clinician. And we train clinicians about how to use interpreters competently, how to use them as your eye and your hand and your ears and so on, and how to use them to help transfer your rapport to the patient.
Carol Stiles: Dr Wong also teaches registrars about cross-cultural practice, and 13 years ago set up a cross-cultural interest group that now has 500 members from many health disciplines. The group meets monthly to hear speakers and discuss how to improve their cultural competency. He’s also set up a group for the Chinese parents of psychiatric patients.
Dr Sai Woh Wong: Firstly, we educate them about medication and reframe it in Chinese terms and give them analogies to help them understand why they need to take medication. But after that we have mutual parent support, they meet here and talk about their children, how they cope with it, how they cope with suicide attempts and threats and aggressiveness, hearing voices and so on. And they also have the benefit of actually talking to professionals. So that’s a support group that is ongoing. There is another one that is actually … we are getting more and more Asperger’s syndrome these days. And Asperger’s is very difficult for them to accept, because ‘My son is not dumb’. Asperger’s is equivalent to low IQ. That’s how they see it. So we have to reframe it and say well it’s the emotional quotient – EQ, not IQ. Their IQ is bright, unfortunately the EQ doesn’t catch up. We are starting a group like that. The need’s been there for a long time, it’s just that no-one is there or the funding is not there to actually provide it.
Carol Stiles: Dr Wong says unfortunately statistics don’t give a true picture of the mental health of Chinese people in New Zealand.
Dr Sai Woh Wong: I think that they are under-represented. The whole thing is because of the shame. We need a national epidemiological survey which we never have the funding to do. Without that you don’t know whether the under-representation is really because we are better or, whether because of shame, we rot out there in the community, you know, and are not coming to the service.
Carol Stiles: Dr Sai Woh Wong there. Psychiatrist and Officer of the New Zealand Order of Merit. He told me there’s a hotline GPs can call during a consultation to get an interpreter instantly on the line. The 2013 census showed 118, 230 Chinese people living in Auckland. 73% were born overseas. We’ll put some links to organisations working in the field of Asian mental health on our webpage. I’m Carol Stiles and that was One in Five for this week. Thanks for your company. One in Five will be back at the same time next week with more on the issues and experience of disability. Until then, ka kite anō.
