From bubonic plague to COVID-19, SF Chinese Hospital has seen it all

In its 125-year history, San Francisco’s Chinese Hospital has weathered three of the most infamous diseases in human history: COVID-19, influenza and bubonic plague.

“The bubonic plague hit San Francisco in the early 1900s,” said Dr. Jian Zhang, CEO of Chinese Hospital, referring to the 1900-04 epidemic that preceded the Spanish Flu pandemic of 1918-19. “So at that time, when bubonic plague hit San Francisco, the government built walls around San Francisco Chinatown.”

Residents of the Chinatown neighborhood had only Chinese Hospital — then known as the Tung Wah Dispensary — which was established in 1899 to serve members of the community who had been shut out of other health care services in The City.

“Inside Chinatown, only the Tung Wah Dispensary was here to take care of the community, care for the sick patients, and also did all the public health work to prevent an outbreak,” Zhang said.

More than a century later, Chinese Hospital endures. The facility celebrated its 125th anniversary earlier this month, a significant milestone for the last independent community hospital in San Francisco — and the only one in The City with a fully bilingual staff providing cultural and medical care.

But as it navigates the 21st century, the hospital faces many of the same challenges as its peers in The City.

Zhang said finances are a growing concern for Chinese Hospital, which largely relies upon donations from community members and former patients. It also works in partnership with UCSF and recently received $5 million in state funding for a new subacute-care unit.

“Compared to pre-pandemic, labor costs have increased more than 15%,” she said, while pharmaceutical costs have increased more than 41%, and the costs of other medical supplies have also increased more than 15%.

The hospital’s Medicare and Medi-Cal reimbursements haven’t risen alongside inflation and the growing costs, Zhang said. Because the hospital serves a large proportion of elderly and low-income patients, these costs add up.

“For every dollar hospitals spend to take care of Medicare patients, you only get back 75 cents,” Zhang said. “For Chinese Hospital, more than 80% of our patients are Medicare patients.”

Board of Supervisors President Aaron Peskin, whose district includes Chinese Hospital and is a patient there, said he shares these concerns.

“This is a function of our broken, weak federal health-care system,” he said. “For every poor person that they are giving medical treatment to, they’re losing 25 cents.”

The hospital has made up the difference with its local partnerships, Peskin said, with USCF and the Department of Public Health sending patients to Chinese Hospital for certain types of care.

Peskin said Chinese Hospital’s economic challenges are ones that other hospitals and systems would struggle to overcome. He said Chinese Hospital has been able to survive so far due to its strong community ties.

“It has defied economic realities,” he said. “It has defied the hospital industry that has continually consolidated and left people out. It is a remarkable community resource that we need to make sure not only continues to get by, but it’s the best thing that The City could invest in.”

Just as it did during the bubonic plague outbreak, Chinese Hospital provided a lifeline for residents during the COVID-19 pandemic. Many in the neighborhood live in cramped single-room-occupancy hotels that leave little room for social distancing.

“Because of the anti-Asian hate, a lot of the elderly were too afraid to come out for testing or for vaccines,” Zhang said. “So we actually went to them.”

Hospital staff set up testing and vaccination on the street outside of SROs, and they shared educational materials on how to social distance even with several people living in one room or sharing a kitchen and bathroom among multiple families in one building.

Zhang said that the hospital was able to deploy contact tracing and other safety mechanisms faster than the San Francisco Department of Public Health due to its close proximity to the community, helping prevent major outbreaks.

“Having your own health-care system in a community makes a huge difference,” she said.

Dr. Jennifer Chen, a family practitioner who started working at Chinese Hospital in the fall of 2019 after she finished her residency at a Pennsylvania hospital, said she knows about these community ties on a personal level.

“I was born at Chinese Hospital,” she said. “This was when they still had an [obstetrics] unit and pediatric unit. My little brother was also born there as well.”

Chen said her parents, who immigrated to San Francisco in the late 1970s, have been patients at Chinese Hospital for about as long. Zhang served as the primary care physician for Cheng’s paternal grandfather before she was promoted to CEO.

Chen said that after working in other hospitals in other states, she wanted to come back to Chinese Hospital for several reasons. She would be closer to home, for one, but also able to help members of her community, many of whom rely on the hospital’s bilingual staff to navigate the U.S. health-care system.

She arrived just in time. The pandemic hit months after she came home.

“I don’t think anyone expects that when they first come out and become an attending [physician], that they’re going to be thrown into a worldwide pandemic,” Chen said.

Chen said she was thrown into the thick of things in an environment where not much was known about the virus. In some ways, she said, her work during the pandemic was quieter for her than it was for others, as many patients put off procedures or issues to avoid going out. She said her schedule has returned to a more normal pace in the last couple of years.

Working at the hospital that her family has relied on for generations has brought Chen full-circle. She said she has come to value the unique environment Chinese Hospital provides for its patients.

“I’m not the only provider who was born at Chinese Hospital who actually came back to work in the system as well,” she said. “I think part of what brings us back is seeing the experiences that our own family has gone through, and we’re trying to make it easier for other individuals not to have that difficulty.”

One such common difficulty is for newly immigrated parents or grandparents having to rely on their children or grandchildren to translate for them during appointments, which Chen said she remembers doing herself.

“I’ve been through the system both as a patient and now as a provider,” she said. “When it comes to providing care, as well as making sure things are done in a culturally competent manner, I would say that they [Chinese Hospital] definitely excel.”

Chen said she hopes that all residents of San Francisco know that the hospital is open to everyone, not just those of Chinese heritage.

“When you hear the name Chinese Hospital, people expect that the only people who come here are Chinese — but it’s not true,” she said. “Everyone, regardless of age, gender, ethnicity, anything like that, is welcome.”