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Giving Birth in Hong Kong

Communication challenges and successes in a cross cultural birth experience...

Photo of Anna Lee
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I conceived and gave birth to my son in Hong Kong in 2012. I know you are focusing on birth experiences in the United States, but I found my experience, living thousands of miles away from either of our families or support networks and going through a foreign and unfamiliar health system, opened my eyes up to a new perspective. I realized from this experience just how much of healthcare is about communication. Of course, it is critical to have affordable availability of experienced doctors, functional equipment, accurate tests and appropriate medications, but the communication among patient, nurse and doctor — about the patient’s concerns, feelings and symptoms, and about the doctor’s understanding, synthesis, diagnoses and prognoses — is crucial to the overall quality of experience as well.

I used the Hong Kong public healthcare system (my employer did not provide me with health insurance) so the choice of hospital to give birth at was determined by the neighborhood I lived in. Not only was I nervous about navigating the pregnancy journey as a new mom — which I was starting fairly “late” at the age of 38 — but I was also nervous about navigating a government healthcare system in a foreign country / culture / language. At this point, I had lived in Hong Kong for only 2 years and knew a tiny bit of Cantonese, but I could not read in Chinese and I certainly did not understand any Chinese medical terms. In addition, as an American, I was completely unfamiliar with the process of using public healthcare — I admit I had some preconceptions that the services might be substandard or require long wait times, I feared that seeing a different doctor or nurse at each visit would mean that I would not get individualized care, and moreover I had no idea where to even start. I wondered if I would be able to effectively advocate for my own health using only English. Although Hong Kong government services are technically available in English as well as Chinese, I worried about potential communication problems since English was not the first language for the majority of nurses and doctors.

I remember thinking “Maybe this is how new immigrant moms feel when they become pregnant in the United States,” but I realized that these challenges I was facing were ones not of access to healthcare (which I was privileged to enjoy freely) but of communication.

So much of my journey at the beginning of and throughout my pregnancy involved the search for information. Many expats in Hong Kong work in banking and finance and have the money or insurance to buy into private health care at international clinics, but my financial situation was different. When searching online for information about Hong Kong healthcare in English, it was particularly difficult distinguishing between targeted marketing information designed to make me spend money on unnecessary items vs truly need-to-know safety/health information. “What do I do first?” “What do I do next?” “Do I REALLY need to buy this product?” “Is this safe / dangerous / necessary for the baby?” “Am I on the right ‘path’?” “Am I correctly using all the available resources?"

Guidance and Information

The government hospital prenatal journey begins by making an appointment at one of Hong Kong’s Family Health Service Maternal and Child Health Centres. When I finally learned that important fact (after consulting other expat friends and Google), that is just what I did. At 11 weeks, I called and made my first appointment at one of the MCHC locations near my workplace. 

At the first visit, I inevitably waited needlessly in the wrong line and got scolded by the administrator at the front. It turned out the first step at any government clinic is registration and getting a number. Okay, that done, I eventually did get to see the nurses and doctor, who confirmed my pregnancy and thus entered me into the “system". I could begin to see why other expats complained about feeling like "cattle" in the “impersonal atmosphere” of public hospitals. Being pretty clueless, I felt some relief when at the end of my first visit I received a thick pink binder and an appointment card. Finally, information from an official source! 

The binder was filled with illustrated pamphlets (English) regarding what to expect and do (or not do) at each stage of pregnancy; signup information for both “optional” (prenatal exercises) and “required” (what to expect during labor) classes; a timeline of appointments, scans and tests; and a sample hospital plan with checklist of items and contact numbers. The appointment card had on it a scan code, my HK identity card number, the date of my next scheduled appointment as well as a timeline, and empty spaces for all the subsequent appointments and test results. 

Admittedly, the binder looked like it was last designed 20 years ago, but in a way I found this oddly reassuring. I guess some things — like the process of giving birth — just don’t change much. And the binder clearly was NOT trying to get me to buy any products from anyone. The sheer number of little pamphlets was a little overwhelming, but later on my husband and I came to joke about it. Whenever we had a question we weren’t sure about the answer to we would turn to each other and say “Well, there MUST be a pamphlet about this in the pink binder,” and sure enough, there usually was. With my appointment card, I was able to go to my employer and tell them how many and which afternoons I would have to take off to go to my regularly scheduled prenatal visits. I don’t want to underestimate the importance of that pink binder to my personal prenatal experience there in Hong Kong… More than anything, it served as kind of an official, non-marketing, "instruction manual" for an oftentimes intimidating and overwhelming life event. My mother, sisters and girlfriends were not nearby, but I had that pink binder!

Because I was over 35 and automatically categorized in an “at-risk” pool, I also received another set of pamphlets — and additional appointments — to put in my pink binder. Later on, when I was diagnosed with gestational diabetes, there were still more pamphlets, as well as more required classes, a urine kit with ketone sticks, and another appointment card, to put into my now-bulging pink binder.

After the first couple of MCHC (Maternal and Child Health Centre) visits, which were scheduled for every few weeks, I felt like I was a pro. Once you got the hang of it, it was the same every time, and had a reassuring regularity to it: register at the front desk, get a number, sit and wait for number to be called (bring a book), go get blood drawn and/or pee in cup, get new number, wait for new number to be called, consult with doctor, done. In special cases (for example, the optional class about exercises to do to prepare for labor), I would visit the bursars desk and pay a small fee. At each visit, I saw the same bevy of nurses (some were there to take blood or measure blood sugars, others asked questions and took notes), but different doctors. Although the change of doctors was off-putting at first, I soon realized that they logged copious notes. It was not uncommon to hear the doctor say, “At your last visit, you mentioned X, Y and Z to Dr. M and we recommended A and B — do you still have this issue? How are things now?” And then, tap tap tap, they would record it all in the computer. And another thing was that you got to know the other expectant moms in the waiting room. Inevitably many of them were on the same appointment schedule and I even saw two of them in the maternity ward because we gave birth within moments of one another!

Complications and Reassurance

I should conclude by noting that my particular pregnancy ended in some late term complications necessitating an emergency C-section birth. Up to the moment of checking into the labor ward, I knew just what to do because the government clinic had offered us so many classes (and even a walk-through) on the process. But ultimately emergency C-section birth was not really covered in the preparatory materials they gave us. I’m not sure anything could have prepared me for the total panic I felt in the moment, as I shakily signed waiver forms and the nurses sped me toward surgery. But I will always remember that among the several nurses in the surgery room, there was one whose sole dedicated job it was to sit next to me, hold my hand and talk to me calmly. That was something that astonished me, even in my fear and confusion, and I was so grateful for her. Communication can truly be delivered in so many different forms.

What is a provocation or insight that might inspire others during this challenge?

How can we A) communicate to moms THROUGHOUT the prenatal journey about what to expect, re: both her changing body and the specific steps she will need to take in the healthcare system? B) anticipate the communication needs of new moms who may be inexperienced, lack support networks, lack fluency in English or medical terminology, have different cultural expectations for healthcare communication.

How does this research relate to our use cases and personas?

This story relates to the "under-resourced mom” persona. Though I was privileged in exceptional ways: I had access to free healthcare in another country; we did have some small savings that allowed me to quit my job; I did not experience overt racism as an Asian American in Hong Kong — yet even without all of those burdens, I experienced the challenges of communication across language and cultural barriers and found myself especially reliant on (and grateful for) that "pink binder."

Tell us about yourself:

I am a UI/UX designer with previous experience in advertising and marketing. I specialize in using design to guide "users" through interactive digital processes.

Are you currently an employee of Sutter Health or UCB Pharmaceuticals?

  • No

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Photo of Balint Katona

Hi Anna Lee Many thanks for sharing. This bumpy cultural/communication hurdle in focused situation like yours was a daily topic while we'd lived in HK. I'm also thinking about chipping in to the 'inspiration' phase. I've gathered several viewpoints, still I believe this is the one most pressing.
Thanks again Anna. B

Photo of Anna Lee

Hi Balint! Thanks for commenting. Yes, living abroad truly transformed my perspective on so many things. Beyond the initial culture shock (my husband and I first lived in Korea for 6 years, before relocating to Hong Kong for 4, and China for another year or so) where all one notices are how different things are from one's homeland, there was this moment at which I finally began to look back at my own homeland (the US) and start to empathize with how weird/shocking/off-putting it must seem to everyone arriving THERE as an immigrant! I also learned that language is only the tip of the iceberg when it comes to communication. I found Edward Hall's framework of "low" and "high" context cultures particularly useful for understanding some of the differences.

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