Jessica Deffler, a doctor at the Wyss Health Center, checks Tong Trinh's blood pressure during an examination. An interpretation app through a tablet next to them helps the Vietnamese immigrant and doctor communicate.

Asian healthcare in Philadelphia is scarce, leading to risks of hepatitis B and other diseases

In the lobby of a South Philadelphia medical clinic, “Hello” is written on the wall in 30 languages.

The word appears in Chinese, Hindi, Thai, and other languages ​​that are not widely spoken in the United States of America.

Philadelphia has approximately 80,000 residents who were born in South, Southeast or South Central Asia, but Hansjörg Wyss Health Center is one of the few places in the city with medical providers who are fluent in the unique needs of this community. Elsewhere, even making an appointment with a doctor or getting care in the emergency room can be overwhelming.

The center has staff like Gao Vang, an intern last summer who is fluent in Hmong, a language spoken in parts of Cambodia, Laos, Vietnam and southern China.

“When I came here and saw my own language on the board, I was like, ‘What! I’ve never seen that before.”

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Operating as a collaboration between SEAMAAC, an Asian American advocacy group, and Jefferson Health, the center combines medical care and services to help people with English proficiency, housing insecurity, and an unfamiliarity with the Internet and technology.

An area of ​​particular focus is hepatitis B, a virus of particular concern among Asian and African immigrants.

within Esther Hugh Tong Castillo, founder and program director of the Chinese Immigrant Families Welfare Initiative at the Philadelphia Foundation for China Development, said Asian immigrants are people who “can’t fill out forms and don’t speak English.”

“As immigrants, many of them lack the confidence to go to places where they don’t know if those places are safe,” she said.

Even hospitals that have interpretation services can struggle to understand cultural differences. Hepatitis B, a liver disease that can cause cirrhosis and highly fatal liver cancer, highlights the ways in which a lack of cultural awareness and ignorance in the medical community can lead to serious health consequences among immigrant communities.

there around 2.2 million cases of the virus in the United States, and more than half of it has been reported in Asian Americans. This is because the virus is endemic in some Asian countries, experts say. Although vaccination is recommended for infants in the United States, it is less common in other countries, making screening and vaccination critical for foreign-born Asian Americans.

According to Hep B United Philadelphia, a local coalition formed to raise awareness of the virus, less than 10% Of the city’s residents from Asia, the Pacific Islands and Africans have been tested or vaccinated against the disease.

The best estimate for Philadelphia is that 22,000 people in the city live with hepatitis B, says Danica Concio, director of the Viral Hepatitis Program at the Philadelphia Department of Public Health. Between 35% to 45% of the city’s newly reported cases are among the Asian population. or the Pacific Islands.

“This is a silent killer,” said Grace Shuken Ma, associate dean for health inequalities at Temple University’s Lewis Katz School of Medicine.

The virus killed about 1,700 Americans in 2020.

Ma studies how social historical trauma, cultural stereotypes, prejudice against Asians, and mistrust of health care systems hinder hepatitis B testing among residents of eastern South America, especially people from China, Korea, and Vietnam.

“When we look at disparities, we really need to consider structural factors, racism, and implicit bias,” she said.

Virus is unknown To most primary care physicians, said Kathryn Freeland, associate director of public health research at the Hepatitis B Foundation.

“Providers often misinterpret test results,” she said. “If I talked to someone in medical school, they wouldn’t spend a lot of time on hepatitis B.”

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Survey 2020 It also found that about 40% of Philadelphia residents at risk of contracting the virus were uninsured, and 70% of those with confirmed infections did not have a regular health care provider. Tests for this virus and others Conditions such as high cholesterol, diabetes, and tuberculosis can be expensive for some.

The virus can be transmitted through sex or drug use, although the most common mode of transmission in the immigrant population is from mother to child at birth.

Freeland said carrying the virus can lead to discrimination and deportation in other countries, which makes people wary of getting tested. The perceived stigma of infection means that some prefer not to get diagnosed or to seek a vaccine or treatment.

“Giving people this diagnosis has to be done in a sensitive way,” said Jessica Devler, MD, a Jeffersonian who works at the Wyss Center. “A lot of people get very shocked or worried about it when they get this diagnosis.”

The Wyss Center opened in the Bok Building in March 2021 near the large Asian community of South Philadelphia to serve the diverse cultures and nationalities represented there.

Ming Teo, 75, an immigrant from Indonesia, doesn’t speak enough English to object to $800 in medical bills. He learned through a friend that Wyss could help. Teo, a retired worker, described the medical condition Debt linked to a 2021 car accident is labeled “stressful”.

“He knows it’s a bill, but he doesn’t know what to do,” Wyss outreach worker Evelyn Cornyadi said, browsing through the bills.

Slowly, during a phone call in which Cornyadi helped Teo and Jefferson’s agent communicate, I made progress in understanding the bills.

Corniady often has five people a day who look to her, she said, to make sure they are heard by health care agencies and public support.

In addition to the languages ​​spoken by the center’s staff, the clinic uses iPads with the CyraCom app that connects doctors with interpreters who speak hundreds of languages.

The app was an important tool for Tong Trinh, 67, who came to the Wyss Center with knee and leg pain.

“Seven months ago, my left leg was weak, but my right leg was completely fine,” said the Vietnamese immigrant, who arrived in the United States in 2006, through the translator. “In the past seven months, I’ve started to have pain and weakness in my right leg as well.”

Trine’s hearing difficulties, as well as misunderstandings between him and the interpreter, interrupted and sometimes frustrated the conversation. However, Devler, Jefferson’s physician at Wyss, was able to communicate with him about his condition, advise him on how to schedule his medications, and prescribe Tylenol and blood pressure medications.

She noted that cultural competence can be taught.

“It’s about listening and being open,” she said.

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