By Nadia Ho
Imagine it’s 1940 and you’re a pregnant woman from Hong Kong, on tour in San Francisco with your performing artist husband. Your water breaks. You speak English well enough to get groceries and give directions to a driver, but when you’re in labor, you might need to fall back on a more familiar language. On November 27, you give birth in a hospital two blocks away from the Mandarin Theater, where your husband performs every night.
This was the story of Grace Ho, a woman from Shanghai married to a Cantonese man; the newborn baby was none other than Bruce Lee. In the mid to late 20th century, the kung fu superstar was by far the most recognizable Asian face in the motion picture industry, one of only a few pop icons that transcended cultural backgrounds and ideologies.
Some people might claim that Bruce Lee is a San Francisco native, but he lived in the Bay for only three months at the beginning of his childhood. The family returned to Hong Kong at the end of the touring contract of Lee’s father. Their primary language was Cantonese, the dialect of Yue Chinese spoken in Guangdong province in southern China, the same as many of the staff members at the Chinese Hospital, both then and now.
In 1964, the U.S. Civil Rights Law was updated to include terms prohibiting any medical facility that receives “federal financial assistance” from discriminating against a person who has limited English proficiency (LEP). In practice, hospitals in the U.S. offer language assistance to two types of patients: those who travel from other countries seeking better treatments and local people whose primary language is not English. The law has always required the medical facility to hire an interpreter when the patient needs it. However, the law did not compel the insurance companies to pay for the interpreting services. Medical interpretation/ translation, of course, is crucial when major decisions are made in hospitals, and the quality of the services, to a degree, is determined by the cost. When the insurer is not likely to pay for the interpreting services, many patients might ask friends, relatives, or even children to do the job.
Medical interpreting is still a developing profession. According ot the U.S. Bureau of Labor, there is an expected growth in demand of 46% for hospital interpreters between 2012 to 2022 due to an anticipated increase in patients with limited English proficiency. The same data also suggests that the demand will be higher in the bicoastal metro areas, where the projected annual job openings for medical interpreters is 240 per year in New York State and 510 in California. The industry outlook for the Midwestern states varies, but the market is growing undeniably. In Colorado, for example, there will be 130 projected annual openings based on a 69% growth until 2022. The slowest job markets for hospital interpreters are in New England, Delaware, Montana and North Dakota, where the openings are as low as ten per year.
Most freelance interpreters, medical or otherwise, may choose to live in a metropolitan area for more on-site job requests. On the other hand, they may have the opportunity to work remotely with a client in a place where there is not much demand for full-time interpreters. Thanks to recent advances in communication technology, even American Sign Language can be interpreted over a video call.
Who can become a medical interpreter? There is more than one way for a person to become proficient in a foreign language, such as, taking classes at the night school, chatting with grandparents, or spending time abroad after quitting your job. You don’t necessarily need a degree in interpreting or translation. In fact, based on the actual job postings, most medical centers prefer to hire interpreters with a four-year college degree. Having a degree in the natural sciences or social work can be even more favorable for prospective employees. Certification is not required, but desirable. The National Board of Certification for Medical Interpreters was restricted to Spanish interpretation for decades, but since 2013, the list has extended to include five of the most commonly spoken foreign languages in the U.S.: Russian, Mandarin, Cantonese, Korean, and Vietnamese.
I had many assumptions before visiting the Chinese Hospital, presuming that what sets apart this institution is their strength in and resourcefulness in Mandarin Chinese. It turns out that I had misinterpreted myself.
It was easier than I expected to request a visit to the Chinese Hospital. In my own experience, hospitals don’t want to deal with media contacts they don’t already know, and in all seriousness, they couldn’t care less about a foreign correspondent like me. But when I called the Chinese Hospital, I got an immediate response from a real person. Despite my being an anonymous voice asking for someone to fill me in on the hospital’s Language Assistance Program, I was convinced by the fluency of the staff’s professional American service tone blended with the crisp efficiency of their Cantonese accent. Jenni Lau from the marketing department accepted my request and soon enough we scheduled a time for me to visit the hospital. All this happened within two transfers in one phone call.
On a Friday morning, I decided to commute San Francisco style, uberPOOL, which is somehow even cheaper than taking public transportation. What a strange world. The car took me through rush hour traffic along tiny downtown streets, then made a turn to enter Chinatown. All of a sudden, the signs were in traditional Chinese. Everyone I saw in the street was busy with one thing: groceries. Mario, my driver, broke the silence. “Do you work in the Chinese Hospital?”
“No, I’m visiting from New York,” I replied. “I’m a journalist. Do you know anything about the hospital besides its name?”
“Not much. All I know is that they finished a renovation this year.”
“Bruce Lee was born in this hospital.”
His face lit up. “Oh wow, I didn’t know.”
Upon arrival, I thanked Mario for the ride and he thanked me back. “Thanks for the information.”
When I walked into one of the member service offices for the Chinese Community Health Plan (CCHP), it was obvious enough that I was not there as a patient. Behind the glass was the customer service office, where most employees seemed to be in their forties and all the clients are elderly. For this most densely populated twenty blocks of San Francisco proper, the hospital provides not only health care, emergency services, traditional Chinese medicine and western medical treatment, but also companionship, cultural acceptance and comfort. Many of those who have spent most of their lifetimes in labor-intensive jobs to raise their children in America have not stepped out of Chinatown for decades; they probably have no desire or need for such a thing. On any given day, you can see the elderly sitting side by side in the entrance lobby of the Chinese Hospital Annex. There are enough seats for everyone, and they are free to sit there and chat all day.
Jenni was one of the few younger employees in the office. She led me through the narrow hallway into a small office, where I was greeted by Irene, CCHP Member Services Manager. Irene was one of the brightest people I’ve met in a while. The CCHP meets Affordable Care Act requirements and is one of only five in San Francisco and San Mateo Counties to provide coverage through Covered California, meaning that all plans meet or exceed quality standards set by state and federal guidelines. Although it has the word “Chinese” in its name, it’s open to all residents in San Francisco and north San Mateo Counties, in fact. Currently the plan has 28,500 active members (as of June 2014), including 8,800 in Medicare Advantage programs and 19,700 in Individuals, Families, Covered California and Employer Group plans. The make-up of this multicultural constituency is 65% Chinese and 35% non-Chinese (including Caucasian, Hispanic, African-American and Asians other than Chinese).
But wait: I came to see the language assistance services, so where were the interpreters?
There were none, because none are needed. Most employees are bilingual in English and Cantonese, or English and Mandarin Chinese, it’s that simple.
“Is there some kind of orientation class or manual for new employees – for example, a bilingual glossary of medical terms?”
“No. All of it is on-the-job training.”
After the meeting, Jenni gave me a tour of the newly finished patient tower. The replacement for the original construction from 1925, where Bruce Lee was born, was a self-funded major development costing more than $100 million. Self-funded? How is that possible? The amount was the sum of funds from the sixty family associations of Chinatown, in addition to many donations, large or small, by businesses and individuals. Only a few days before the grand opening of the new facility, I swung by the corner room with a view of the Bay Bridge, peeked through the glass at the untouched operation room ready to save lives, envied the breakfast menu with Chinese congee as the default, and kept thinking about how Bruce Lee was born on November 27, 1940, right here in the Chinese Hospital. Across the U.S., Chinatowns are better known as a place for late night meals, stereotypically exotic souvenirs, older men walking their caged birds and sidewalk vendors parading unbelievably economical fresh produce options. Not all Chinese Americans were born in Chinatown, but Bruce Lee was.
On the following Tuesday, I visited San Francisco Historical Center on the sixth floor of the San Francisco Public Library. Upon signing in with a photo ID, I received research assistance from a full staff of four librarians. They kept bringing out folders bursting with oversized historical photo prints. After flipping through more than two hundred prints dated from 1930 to 1945 in white gloves, I think I got the picture.
In the late 1930s, when you flew Imperial Air, you had to spend $17,600 (adjusted to inflation) for one of the twenty seats in an Empire class airplane. For a group of performers from a Cantonese opera company invited to go on tour in the U.S., they were more likely to have taken an ocean liner steamship. (Trivia of the day: both flights and ocean liners took more than a week to arrive at the destination due to the limited capacities of fuel and food).
It was in March of 1940 when Hitler and Mussolini met face to face in the Alps. The worst times for the European peoples were about to begin. In May, the International Olympics Committee announced the cancellation of the Summer Olympics. Meanwhile, in San Francisco, California, things were just fine. The economy was just starting to recover from the Great Depression; the urban middle classes were willing to spend money on entertainment and exotic experiences. At 363 Sutter Street, one block outside Chinatown, a cabaret-style nightclub named Forbidden City was the first entertainment venue that paved the way for Asian Americans in showbiz. The nightclub offered shows, musicals and other entertainment skits featuring an all-Chinese cast, including “the Chinese Frank Sinatra,” “the Queen of Pilipino Jazz,” body contortionists, and the semi-nude burlesque “bubble dance” that arose amid critique by the Chinese-American community in spite of generating revenue from a mostly Caucasian clientele. For the first time, excitement over exoticized stereotypes was becoming a moneymaker; even Ronald Reagan visited once before he became the President of the United States.
Inside Chinatown, the atmosphere was also vibrant within a very different cultural context. Only a few yards into the Dragon Gate, the architectural demarcation of the entry into Chinatown, a Cantonese opera group was touring from Hong Kong and providing traditional Chinese performing arts to the old-timer residents, most of whom were native Cantonese speakers. The Mandarin Theater, the center of traditional performing arts and entertainment, was where famous Cantonese opera comedian Mr. Lee Hoi-chuen performed during his one-year contract in the U.S. Towards the end of his tour, his wife Grace Ho gave birth to their fourth son, Bruce Lee, in the Chinese Hospital of San Francisco. At that moment, they didn’t know that one year later, on December 8, 1941, the Japanese air force would attack Pearl Harbor in Hawaii and lead the U.S. into World War II. What’s more, soon after they moved back to Hong Kong, the British colony would surrender to Japan the day after Bruce Lee’s first Christmas.
The Japanese occupation of Hong Kong lasted three years and eight months. Throughout Bruce Lee’s childhood, he, like all other surviving residents, experienced the aftermath of WWII, including hyper-inflation, food scarcity, hygiene and security problems, and fear of another war. Yet it was only because of another war, the Chinese Civil War, that former Nationalist party officer Yip Man fled from Foshan in Guangdong province to Hong Kong, where he eventually opened a martial arts school there. The martial arts master met Bruce Lee for the first time in his studio and taught him Wing Chun. It was the beginning of an unprecedented trend of cultural shifts that would allow kung fu to enter the English lexicon and create the image of the Asian male as something besides obedient or nerdy: he could also be playful, sexy and muscular.
Bruce Lee was iconic, and so was the hospital for its time.
One of the hundreds of old photos in the library showed the Representatives of the Chinese Six Companies Association in Chinatown, which reminded me of the names I saw on the donor’s wall in the hospital the other day. In my imaginary documentary footage of the annual meeting of the Chinese Six Companies (a.k.a. “Chinese Consolidated Benevolent Association”), the bosses from the seven (not six) divisions would come together and start with some benevolent kung fu matches over the spinning tables. Then the men would flatten their ropes before sitting down for teatime. This would be when the director of the board would announce, “We shall build our own hospital.” It was 1899 when the Tung Wah Dispensary opened to provide services to the underserved Chinese community grappling with a language barrier. Beyond this, the association also helped build their own schools, markets, theaters, churches and temples and marching bands. (Check out the emblem of Central Chinese High School in America: it has 128 years of history and its emblem is a GIF of a blinking tiger).
Several expansions and renovations of the hospital coincided with historical events when tensions arose between Chinatown and its neighboring communities. The Dispensary relocated to 845 Jackson Street in 1925 and expanded to become a healthcare provider for those who were rejected by other hospitals because of their ethnicity. This facility was a staunch comeback after the 1906 Earthquake, when rumor had it that Chinatown was going to be relocated outside of the city center. Yet long before the earthquake indiscriminately damaged everyone’s lives, new immigrants from Asian countries had already been impacted by the Page Law of 1875 and the Chinese Exclusion Act of 1882 that classified certain Chinese immigrants as “undesirable.” Local Chinatown residents experienced discrimination in physical form, including racially motivated quarantines without medical and sanitary support during the 1900 to 1904 plague. This also explains why autonomous governance and self-sustainability were so important to the hospital’s decision-making. And it is unique because it’s an all-around bilingual hospital. If demand for a specific language is high enough, it is logical to think that having bilingual staff in the hospital is an effective way for cost reduction and efficiency. And within the 1.34 mi² area of Chinatown, there is a total population of 100,574. Are they all bilingual? No. Surprisingly or not, about half of the residents in Chinatown are monolingual Mandarin or Cantonese speakers (2007, NICOS Chinese Health Coalition) — even among those who have lived in the United States for years. The bilingual hospital stands strong in Chinatown partly because the patients remained monolingual.
I met with Jenni for a quick drink before I headed back to New York. If she hadn’t been spending time with me at the trendy bar Dirty Water, she would have been home with her two dogs. Before taking the marketing job at the Chinese Hospital in downtown San Francisco, she used to work in a casino about an hour away from the city. She has lived in Bay Area for fourteen years ever since she moved from Hong Kong for college. When I asked why she had chosen universities here over her hometown, she groused, “Too much competition in Hong Kong. In the U.S., there are way more options when it comes to getting a college degree!” She is right. In the 2011-12 academic year, there were 486,800 students enrolled in secondary schools in Hong Kong; only 305,000 of them continued to higher education in the city’s thirteen universities or colleges, although the number of degree-awarding institutions has increased to twenty in 2016. Parents were sending their children to the U.S. not only for more options in education, but also to develop a more diverse resume that might lead to better job opportunities. For some of these students, coming to the U.S. is a relief from the score-centered education system in East Asia and an escape from their family manifesto. For Bruce Lee’s parents, back in the day, they had to send their eighteen-year-old son back to San Francisco after Bruce caused enough trouble by getting into street fights, including beating up the son of a member of a fearsome Triad (Hong Kong mafia) family. He spent a few months with his sister in San Francisco before moving to Seattle. There, he started teaching martial arts in 1959. Two years later, he enrolled at the University of Washington where he studied for four years. Did he get his degree? I don’t know. But he didn’t need a degree to succeed in life. We know the rest of the story.
We are now in 2016. According to U.S. Census data, the Asian community in 1940 accounted for only 4% of the entire population of San Francisco. Today, this figure has grown to 33.3% (2010 data). One third of the city’s population is of Asian descent. You can have bánh mì or dumplings for lunch in the Financial District. Teenage students continue to move here from Hong Kong for more educational and professional opportunities. New babies continue to be born in Chinatown. The Chinese Hospital was never only Chinese; it has always been very American, too. In the end, its century-long history of resistance against racial segregation through capital accumulation and community organization is, in my opinion, a great example of the American dream.
Photo Credit: Ken Lund@flickr
Editor: Mike Fu
About the author
Nadia is a Taiwanese novelist/ journalist living in Brooklyn. A Columbia-SIPA and iHouse NYC alumna; currently Writer-in-Chief at Crossing. She also writes long-form journalism on Human Rights, Conflict Resolutions and International Affairs for media across China, Hong Kong and Taiwan. She is bilingual in English and Mandarin Chinese, speaks some Japanese and Taiwanese Hokkien Twitter: @dirty_shoes
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