The Global Problem of Hepatitis B: Sharing Experiences from China and New York City
On November 4, 2009, I participated in a panel discussion on “The Global Problem of Hepatitis B: Sharing Experiences from China and New York City” which was hosted by
NYU Medical Center and moderated by Dr. Henry Pollack, the Associate Professor of Pediatric Infectious Diseases at NYU School of Medicine and the Scientific Investigator of B Free CEED. The Panelists included the surgeons and physicians from Bellevue Hospital and Charles B. Wang Community Health Center. There were 51 Chinese distinguished Hepatologists and 5 Roche Pharmaceutical representatives from China participating in this panel discussion. The panel was discussing the epidemics of Hepatitis B and sharing their challenges and successes in managing the disease.
This event enabled health professionals from China and New York City to discuss and share their perspectives on the global problems of Hepatitis B. Since there are many Chinese immigrants in New York City, they share many things in common. Therefore, there was much can be learned from each other. By sharing, it can improve Hepatitis B prevention and care in the New York City and in China. Many partners of our B Free CEED network were also present and it was gratifying to meet them and learn more about them.
posted by Tze-Jen C.
Last Thursday, I attended a lecture titled “Providing Culturally & Linguistically Appropriate Care to Immigrant Populations”, which was part of the Asian American Health seminar series provided for CSAAH interns. Director of Programs from the South Asian Health Initiative (SAHI) Sapna Pandya, M.P.H. came to speak to us.
Sapna Pandya gave us a very thorough and informative presentation simply because she got us thinking in such effective ways. She started off very broadly by telling us about the need for attention to detail regarding patients. Something as basic as a person’s name can reveal a lot about a person, such as their possible ethnicity, religion, what foods they ate, etc…At the same time, these very assumptions that are made about a patient could be detrimental if coupled with insensitivity and cultural incompetency. Names may have as many as four parts in some cultures and last names may be the first part of a person’s name in other cultures. Because a patient’s name makes up a large part of a person’s identity, it’s also very important not to get a patient’s name confused with that of another. Switching up middle names with first names, misspelling a letter and mistaking last names with first names can be the difference between saving and killing a patient.
Sapna Pandya also discussed differences between stereotyping and generalizing before delving into the meaning and importance of cultural competence. I learned that there are macro cultures (such as ethnic and racial groups) and there are micro cultures (sexual orientation, socioeconomic class, age, etc…), both of which are crucial accessing a patient’s health care needs. Obtaining a good understanding of a patient’s faith and religion is also necessary in order to provide quality health care. Pandya lists dietary laws, clothing & modesty, after death rituals, fatalism and observance of holidays as just a few examples of how awareness and sensitivity of a person’s culture is critical. A person’s immigration status is also another influencing factor in receiving and accessing quality health care. According to Pandya, immigrants are at a higher risk for health problems because the work that they do are often dangerous, low-paying and offer little workplace protection. Racism, unwelcoming staff attitudes, language barriers and other inconveniences further the divide between accessible/inaccessible and quality/poor health care.
Pandya did a great job covering different communities, including the LGBT and transgender communities, both of which are marginalized and discriminated against frequently in medical settings due to inequality and insensitivity. I can only imagine how scary it must be if a sick patient’s partner is not allowed to be by his/her bedside due to a lack of visiting rights available to the LGBT community. Pandya effectively debunked numerous myths regarding various communities and access to health care. For example, although many think that undocumented immigrants are reaping in all of government’s health care benefits through Medicaid, the only government health benefits available to them are Child Health Plus, Emergency Medicaid and Prenatal Care Assistance Program. I was also surprised to learn that immigrants constituted only 14% of the U.S. population, a figure which was much lower than what I had expected (perhaps this is because I’ve lived in NYC all my life). Pandya further emphasized the differences among the API community when she told us of the proportion contrast between different ethnic groups with limited English ability (LEP). Twenty one percent of Filipinos are LEP, compared to 60% and 70% within the Bangladeshi and Chinese community respectively.
I’m really glad Pandya gave us such an engaging and informative presentation, for I think cultural competency is undoubtedly necessary in providing quality healthcare.
posted by Cynthia K.
I’ve been itching to write about the frightening prevalence of hepatitis B in Asian American communities since last Wednesday, which was the first day of my internship at CSAAH (Center for Study of Asian American Health).
On that day, I was required to complete a few online modules about hepatitis B, some of which were supposed to provide me some basic scientific knowledge about the disease and some of which informed about the notable disparity between hepatitis B among Asian Americans and other groups. I spent a good chunk of that afternoon constantly picking up my jaw, which dropped numerous times due to the shock I encountered after realizing hepatitis B is actually one of the biggest silent killers among Asian Americans.
According to Dr. Samuel So, founder of the Asian Liver Center at Stanford University, as many as 1 in 10 Asian Americans are believed to have chronic hepatitis B*, which, if left untreated will ultimately lead to life-threatening complications such as liver cirrhosis, liver failure, or liver cancer. Compared to the 0.3% of the U.S. general population who are suffering from chronic hepatitis B, 10% of Asian Americans are carriers of the virus — more than 1.4 million people in the U.S. are infected and 60% of them are Asian American. The incidence of hepatitis B is particularly high among Asian American men, resulting in liver cancer being the second leading cause of cancer death in Asian men living in the United States. In NYC Chinatown alone, surveys which were done via street interception indicated that as much as 15-25% of Asian Americans have chronic hepatitis B. This means that if you ever sat in one of those 12 seat roundtables in a Chinese restaurant, there’s a good chance that 1-2 of the people you were eating with might have hepatitis B! AH!
Perhaps the scariest part is the fact that many doctors (of all races) are not aware of this disparity and thus, many Asian Americans are not encouraged to be screened for the virus. The reason why cases of chronic hepatitis B are especially high among Asian Americans is because many get the disease from birth from their mothers. If babies are not vaccinated within 12 hours of birth, their chances of suffering from chronic hepatitis B are as high as 90%. If they are vaccinated within these 12 hours, their chances of being protected from this disease for life are significantly high.
Dr. Sam So actively advocates for the screening of hepatitis B among Asian American communities and has gone great lengths in raising awareness about this silent killer. As he states, “‘One case which really came to my mind is a doctor, himself. A young internist, practicing in San Francisco who was not aware that, if you have chronic hepatitis B, you need to be screened regularly for liver cancer. Unfortunately for him, he found out too late when he was diagnosed with advanced liver cancer at (the) age of 31. So, he actually became a spokesperson for the Jade Ribbon Campaign before he died, because he knew that most of the doctors he worked with was not aware of the need for screening Asian American patients for hepatitis B.’”
…THIRTY ONE! AND THIS PATIENT WAS A DOCTOR HIMSELF! Another of Dr. So’s patient (also very young) found out that he was also suffering from crhonic hepatitis B and urged his own brother to get screened. However, by the time his brother found out that he too had chronic hepatitis B, it was already too late — he passed away not soon after finding out. Hepatitis B is obviously a VERY serious disease, though one can easily become immune through a series of 3 injections. However, because many don’t know they have the disease – it’s a “silent killer” because there no are no noticeable symptoms until the late stages…and by that time, chances of survival are slim. Because many are not screened and were “vaccinated” when they were already suffering from chronic Hepatitis B, the disease continues to be especially prevalent among Asian Americans.
After my first day, I zoomed home, flipped through all of my family members’ blood test results and obsessive-compulsively checked the “positives” and “negatives” of everybody’s HBsAg, HBsAb, and HBcAb. Thankfully, no one (to the best of my knowledge) in my immediate family has chronic hepatitis B, although one of my mom’s blood tests stated that she had ”borderline immunity”. I insisted that she get screened for hepatitis B and I strongly advise that everybody, particularly those that are of API descent get screened by a doctor and make sure their loved ones are vaccinated!
*http://www2a.cdc.gov/podcasts/player.asp?f=8908#transcript
For more info, please visit:
Samuel So, MD, FACS: “How Serious is Hepatitis B?”
http://www.hepb.org/expforum/speaker.aspx?speakerID=drSo_07&language=English
Samuel So, MD, FACS: “Eliminating the Voodoo from Hepatitis B”
http://www.hepb.org/expforum/speaker.aspx?speakerID=drSo&language=English
posted by Cynthia K.
