In the lobby of a South Philadelphia medical clinic, the phrase “welcome” is written on the wall in 30 languages.
The word appears in Chinese, Hindi and Thai, as well as other less spoken languages in the USA.
Philadelphia has nearly 80,000 residents born in South, Southeast, or South-Central Asia, but the Hansjörg Wyss Wellness Center is one of the few places in the city with medical providers who are knowledgeable about unique needs of this community. Elsewhere, even making an appointment with the doctor or getting treatment in the emergency room can be overwhelming.
The center includes staff members 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 got here and saw my own language on the board, I was like, ‘What! I’ve never seen this before,” she said.
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Operated in collaboration between SEAMAAC, an advocacy group for Asian Americans, and Jefferson Health, the center combines medical care with services to help those with fluent English, housing insecurity and internet unfamiliarity. and technology.
One area of particular interest is hepatitis B, a virus of particular concern to Asian and African immigrants.
Among Asian immigrants are people who “can’t fill out forms, can’t speak English,” said Esther Hio-Tong Castillo, founder and program director of the Chinese Immigrant Families Wellness Initiative at the Philadelphia Chinatown Development Corporation.
“As immigrants, a lot of them lack the confidence to go places where they don’t know if those places are safe,” she said.
Even hospitals with interpreting services can struggle to understand cultural differences. Hepatitis B, a liver disease that can cause cirrhosis and life-threatening liver cancer, highlights how a lack of cultural awareness and ignorance by the medical community can have serious consequences for the health of immigrant communities.
There are approximately 2.2 million cases of the virus in the United States, and more than half are reported among Asian Americans. Indeed, 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 essential for Asian Americans born abroad.
According to Hep B United Philadelphia, a local coalition formed to raise awareness of the virus, less than 10% of the city’s Asian, Pacific Islander and African residents have been tested or vaccinated for the disease.
Philadelphia’s best estimate is that 22,000 people in the city are living with hepatitis B, said Danica Kuncio, manager of the Philadelphia Department of Public Health’s viral hepatitis program. Between 35% and 45% of new cases reported in the city are among Asian or Pacific Islander residents.
“It’s a silent killer,” said Grace Xueqin Ma, associate dean for health disparities 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, anti-Asian biases, and distrust of health care systems impede hepatitis B testing among Southeast Asian American populations, particularly people from China, Korea and Vietnam.
“When we look at disparities, we really have to look at structural factors, racism and implicit biases,” she said.
The virus is not well known to most primary care physicians, said Catherine Freeland, associate director of public health research at the Hepatitis B Foundation.
“Providers often misinterpret test results,” she said. “If you talk to someone in medical school, they don’t spend a lot of time on hepatitis B.”
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A 2020 survey also found that about 40% of Philadelphians at high risk of contracting the virus were uninsured and 70% of those with confirmed infections did not have a regular healthcare provider. Tests for this virus, as well as others conditions such as high cholesterol, diabetes and tuberculosis can be too costly for some.
The virus can be transmitted through sex or drug use, although a more common mode of transmission among immigrant populations is from mother to child at birth.
Carrying the virus can lead to discrimination and deportation in other countries, Freeland said, making people wary of testing. The perceived stigma of an infection means that some prefer not to be diagnosed or will not seek a vaccine or treatment.
“Giving people this diagnosis has to be done in a sensitive way,” said Jessica Deffler, a Jefferson physician working at the Wyss Center. “A lot of people are very shocked or nervous about it when they get this diagnosis.”
The Wyss Center opened in the Bok Building in March 2021 near the large South Asian community of Philadelphia specifically to serve the diverse cultures and nationalities represented there.
Ming Tio, 75, an immigrant from Indonesia, doesn’t speak enough English to contest $800 in medical bills. He learned from a friend that Wyss could help him. A retired worker, Tio described the medical situation debt related to a car accident in 2021 as “stressful”.
“He knows it’s an invoice, but he doesn’t know what to do,” said Evelyn Kurniadi, an outreach worker at Wyss, flipping through the invoices.
Slowly, during a phone call in which Kurniadi helped Tio and a Jefferson employee communicate, she made progress in understanding the bills.
Kurniadi often has five people a day turning to her, she said, to make sure they are heard by health care and public support agencies.
In addition to the languages spoken by center staff, the clinic uses iPads with an app, CyraCom, which connects doctors with interpreters who speak hundreds of languages.
The app was an essential 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 just fine,” the Vietnamese immigrant, who arrived in the United States in 2006, said through the interpreter. “Over the past seven months I have also started experiencing pain and weakness in my right leg.”
Trinh’s hearing difficulties, as well as misunderstandings between him and the interpreter, made the conversation interrupted and sometimes frustrating. Still, Deffler, Jefferson’s doctor at Wyss, was able to communicate with him about his condition, advise him on how to plan his medications, and prescribe Tylenol and blood pressure medication.
She noted that cultural competence can be taught.
“It’s about listening and being open,” she says.