Culturally Effective Medicine: an interview with Dr. Phuc PhaE

To better understand the actual nuts and bolts of providing culturally effective medicine, I had the opportunity to spend some time talking to Dr. Phuc Pham, a Phoenix-based internist. Dr. Pham is well known in the local Vietnamese American community and serves a large percentage of Vietnamese patients. I was curious to ask him about the differences in serving this population as compared to Anglo patients. Here were some of his insights:

• Vietnamese patients defer to physician authority more so than Anglo patients.

• Vietnamese patients are generally less knowledgeable about health and medicine, though this is changing as they are able to access Vietnamese language TV and radio.

• Vietnamese patients can be fearful of Western medicines, and some prefer to try herbal remedies first. They may faithfully take two or three medicines but seem resistant to taking more than that.

• Not surprisingly, Vietnamese patients that have been seen by non-Vietnamese physicians find communication difficult and prefer a Vietnamese-speaking physician.

• Vietnamese patients occasionally seek care in their native country, but sometimes have diagnostic tests run again in the US because of concerns about quality of care.

• Traditional practices such as “coining” (placing hot coins on the skin to alleviate fever) are still used in Vietnamese households.

• Vietnamese patients are more likely to discontinue taking medications after completing the first bottle because they mistakenly believe that completing the bottle is a “cure” rather than an ongoing form of therapy.

Dr. Pham believes that medical schools should offer courses in “cultural medicine” to better prepare medical students to serve diverse populations. Mandatory rotations among culturally diverse populations (e.g., refugee communities) would also assist.

I want to thank Dr. Pham for sharing his time and insights. He has become a valued APCA volunteer and supporter.

-Doug Hirano, MPH, APCA Executive Director

The Next Generation: The Arizona Collaborative Consortium

The Asian Pacific Arizona Initiative (APAZI) is an initiative coordinated by the ASU Asian Pacific American Studies program to educate Arizonans about the diversity, issues and specific needs of Asian Americans and Pacific Islanders (AAPIs) in Arizona. As a community member, I was privileged to serve on the APAZI Advisory Committee during its planning and execution of a report documenting the economic and social/cultural impact of the AAPI community and corresponding policy implications. This report, “The State of Asian Americans and Pacific Islanders in Arizona”, was published in October 2008 and has been widely disseminated within the AAPI community, to policymakers, and many others. A sequel to this report is planned for 2012.

Other racial/ethnic groups have produced similar reports, i.e., “The State of Latino Arizona” and “The State of Black Arizona”. Leaders from each of these communities (including the Native American community) have now begun meeting under the name “Arizona Collaborative Consortium” to discuss a framework for combining the efforts of the various racial/ethnic communities in continuing to gather and utilize data and research to improve quality of life in their respective communities.

We met this past Saturday to continue the dialogue and discussion. Dr. Karen Leong (pictured above), Asian Pacific American Studies professor, laid out a draft model for collaborative research and action. For my part, I suggested that the data gathering and research efforts be connected to efforts to mobilize communities to create positive action for social change. Too often, very creditable and actionable reports collect dust on the shelves of policymakers who are either ideologically opposed to social change or who lack the motivation or incentive to move an initiative forward. Grass roots mobilization must be at the core of policy change, and I’ll be curious to see if the Consortium can be the nexus for collaborative and effective action in this regard.

- Doug Hirano, MPH, APCA Executive Director

New Grant to Reach the Chamorro Community

I’m happy to report that APCA was just awarded a Legacy Project grant from the Center of Excellence in the Elimination of Disparities (CEED) to conduct a breast and cervical cancer education project within the local Chamorro population in Maricopa County. APCA was one of only a handful of awardees in a national grant competition.

Within this project, APCA will be developing and disseminating culturally appropriate educational materials and training and deploying a group of Chamorro lay health advisors to educate and assist Chamorro women in accessing preventive services such as mammograms and pap smears. Funding will support a part-time community outreach specialist.

For more information, contact Ms. Elexia Torres, Programs Director, at elexia@apcaaz.org or at (602) 284-8565.

-Doug Hirano, MPH, APCA Executive Director

A Conversation on Immigration Policy and Health

On October 2nd, an event entitled “A Community Conversation on Immigration & Health Care in Arizona,” will be held. This community forum is being sponsored by Health Through Action Arizona and the Asian and Pacific Islander American Health Forum and will examine the health impact of immigration policy. This event will be an opportunity for health care professionals, policy makers, community-based workers and community members to talk about the impact of immigration policy not just on enrollment into health care programs, but also on health issues such as domestic violence, communicable disease control, and service utilization. To our knowledge, this is one of a very few gatherings to discuss the relationship between immigration policy and health. A representative from the National Immigration Law Center will by speaking at the event, which will be held from 10 am to 2 pm at the Japanese American Citizen’s League, 5414 W. Glenn Drive, Glendale. Further information is available on the events page of our website.

Introducing the "Community Development Specialist"

We’ve recently announced a job opening for a “Community Development Specialist." This position was formerly known as a “Health Outreach Specialist." This is more than just a name change. The change in position title represents a shift in our approach to outreach. In the past, the Health Outreach Specialist would reach out to one or more Asian American or Pacific Islander communities largely to recruit community members for APCA events. In addition, the Health Outreach Specialist would assist individuals requiring medical referrals and/or enrollment in health care programs for low-income individuals and families.

Going forward, a key responsibility of the Community Development Specialist will be to develop sustainable relationships with key community stakeholders, enlisting support for a wide variety of APCA activities, including but not limited to advocacy, volunteerism, applied research, and fundraising. The Development Specialist will also be more active in assessing community needs – serving as a liaison between APCA and the communities we serve. We believe that success in meeting our mission is highly dependent upon communities that are actively participating in all aspects of our work.

To continue the highly important event recruitment and medical referral efforts, we will be utilizing our growing pool of trained Lay Health Advisors and volunteers. The new Community Development Specialist and other staff members will help coordinate these efforts.

For the moment, we are looking for our new Community Development Specialist to focus on work within the Korean American community. Individuals interested in performing the work described above should contact Ms. Elexia Torres, APCA Programs Director, at (602)284-8565 or at elexia@apcaaz.org.

- Doug Hirano, MPH, APCA Executive Director

An Epidemic Silence

The silence is deafening. Every day, 6,000 Asian Americans and Pacific Islanders residing in Maricopa County live another day with a disease they don’t even know they carry. It’s a disease that may have already taken the lives of family and friends. It’s a disease that is so widespread in their native countries that it’s present in big cities, the rural countryside, the mountains, the plains, inland, and on the coasts. In many areas, it’s been passed along for generations. Mostly, it’s a disease that no one is talking about. The silence is deadly.

Hepatitis B is a virus that attacks the liver and causes liver cancer and cirrhosis. For those with “chronic” infection, the virus is carried for life. In the United States, it is a disproportionately significant source of death and disability among Asian Americans and Pacific Islanders. More than 50% of the 1.25 million individuals with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders. Tragically, less than half are aware that they are infected, even though a simple blood test can detect the presence of the virus.

Here are some simple, but possibly life-saving facts about hepatitis B:

• Among foreign-born Asian Americans and Pacific Islanders, many are infected as infants during childbirth or as young children through household exposure;

• One can carry the virus for decades without any symptoms – and still develop serious liver disease later in life;

• There is a vaccine that can prevent those who have not yet been exposed to the virus from becoming infected;

• Only a blood test can definitively diagnose hepatitis B;

• There is no cure for hepatitis B, but there are several FDA-approved treatments that can slow down the replication of the virus in the liver.

Every Asian American or Pacific Islander should get tested for hepatitis B. The only exceptions would be those who have already been tested and American born children less than 18 years of age. Ask your doctor for a hepatitis B test and vaccination.

Protect your family. Protect your community. Spread the word about hepatitis B. Break the silence!

-Doug Hirano, MPH, APCA Executive Director