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My 82-year-old mother suffered a stroke last Monday. She passed out at a grocery store and was taken by ambulance to a local hospital (in San Jose). After the first few hours, her outlook was surprisingly good – verbally responsive and without any signs of paralysis. However, later in the day she began having trouble breathing, and her speech became slurred. Her CT scan indicated a large clot in the lower brain. Her chance of survival was now deemed to be 50%.
I had just spoken to her the day before, and all seemed fine. It was Father’s Day, and she was cheery and looking forward to dinner at my brother’s house. For an elderly woman, she was in relatively good health. She worked hard out in the yard, tending to her vegetables, shaping the shrubs, and keeping the weeds at bay.
Stroke is the 3rd leading cause of death in the United States – behind heart disease and cancer. Its warning signs tend to be slurred speech, trouble seeing in one or both eyes, confusion and/or severe headache – none of which my mother displayed before fainting at the grocery store. In fact, my dad, who was with her at the time, had to work hard to convince the EMTs to send an ambulance right away – perhaps because her symptom history did not match those of a typical stroke victim.
I also know that time is of the essence in treating a stroke victim. There is a short window by which intervention can effectively avert permanent brain damage or death. My dad’s ability to get an ambulance to the scene probably saved her life.
Asian Americans are not necessarily at increased risk for stroke; however, stroke is an equal opportunity debilitating condition. Risk factors include but are not limited to tobacco use, hypertension, overweight and obesity, and heart disease. More information is available through the Centers for Disease Control and Prevention.
I’m glad to say that my mom is making a remarkable recovery. Her speech is clear, she has a good appetite, and she’s strong enough to get out of the hospital bed on her own (against the nurses’ orders). Twenty years ago, her outcome may have been much different, but for all the complaints about high tech, low touch, overly expensive medicine, it can produce seeming miracles. The doctors used a catheter, guided by CT, to administer medication in the affected area of the brain and to clear the clot.
My mom is not out of the woods yet and has a few weeks of rehabilitation ahead of her, but she seems on the road to recovery. We’re thankful to the folks at Good Samaritan Hospital in San Jose for their rapid response and compassionate care.
- Doug Hirano, MPH, APCA Executive Director
With approximately 200 Asian American and Pacific Islander colleagues, I had the pleasure of visiting the White House today in acknowledgment of Asian American and Pacific Islander Heritage. Here’s what my “thank you” note to the President will read:
"Thank you, Mr. President, for the opportunity to visit your stately home. Your hospitality in the form of your kind words and the hors d’oeuvres and beverages was most generous – particularly since you already had a lot on your plate, including an imminent national TV appearance about the war in Afghanistan.
While I didn’t get a chance to speak to you directly, I did have the chance to speak to one of your key health officials, Dr. Howard Koh – your Assistant Secretary for Health and Human Services (pictured). He was kind enough to say that he would look into my suggestion that the federal government support a hepatitis B testing day for Asian Americans. Considering that there is already an HIV/AIDS awareness day for Asian Americans, it would seem reasonable that attention be paid to the preponderance of chronic hepatitis B infection among this group as well.
I will be following up with Dr. Koh about this matter. I believe hepatitis B among Asian Americans needs to stay on the radar screen until something more is done. There are far more Asian Americans unknowingly infected with chronic hepatitis B than all Americans unknowingly infected with HIV/AIDS. We on the front lines in various communities throughout the nation fight the good fight to increase hepatitis B awareness among the general public, among Asian Americans and Pacific Islanders, and the medical community, but sometimes one is not a prophet in his or her own land. Hearing more from our federal officials about this preventable epidemic of liver disease due to hepatitis B is critical and essential. Action can prevent more death and disability due to hepatitis B.
Again, thank you for your cordiality, and I hope that you and your family stay well. Please feel free to come visit us in Arizona, and we would be happy to share some of our Asian American and Pacific Islander hospitality in return."
- Doug Hirano, MPH, APCA Executive Director
I very recently received an invitation to a White House reception that will be recognizing Asian American and Pacific Islander heritage. It appears that President Obama and the First Lady will both be in attendance. Invitations were made to Asian American and Pacific Islander community leaders, and I’m proud to be considered in that grouping.
Will I be attending? Who could turn down an invitation that starts with “The President and Mrs. Obama request the pleasure of your company . . . ”?
In any case, if I have a chance to speak at any length with President Obama, I think I will remind him that five million Americans are currently infected with hepatitis B or hepatitis C, and that these individuals will need medical monitoring for the remainder of their lives because of their high risk for serious liver disease. I will let him know that many of these individuals are among the working poor or unemployed who do not have health insurance and cannot afford medical care. I will remind him that exemplary government programs like the Ryan White CARE Act support medical care and treatment for low-income individuals with HIV/AIDS, but no such program exists for individuals with hepatitis B or C. I will remind him that more than half of the 1.4 million individuals chronically infected with hepatitis B are Asian Americans and yet there is virtually no large-scale public health effort to encourage Asian Americans to get screened for hepatitis B or to educate physicians to offer screening to these individuals.
I think I will remind him that Title VI of the Civil Rights Act assures individuals of language access in health care facilities that receive federal dollars, yet thousands of individuals are denied these services on a daily basis in facilities throughout the nation. I will remind him that Asian Americans and Pacific Islanders are the fastest growing racial/ethnic groups in this country and that while health care facilities are doing better in offering culturally competent services to Hispanic Americans, Asian Americans and Pacific Islanders are a virtual afterthought when it comes to culturally competent care.
Lastly, I think I will thank him profusely (and offer a fist bump) for his leadership and vision on the Affordable Care Act and let him know that our agency is actively supporting its continuation. Having said that, I will let him know that the same political will exerted on the ACA will be more than sufficient to address the continuing health disparities related to hepatitis and language access. I will humbly offer my assistance, proffer my business card, and then wander off in search of hors d’oeuvres.
- Doug Hirano, MPH, APCA Executive Director
According to a recent New York Times article, the Arizona Medicaid program, known as AHCCCS, is considering charging a $50 fee to smokers and obese individuals. This would apply only to childless adults. The idea is that since both smoking and obesity lead to preventable disease and illness and increased health care costs then why not have such individuals pay more for their coverage?
On the surface, this seems reasonable. An extra $50 fee might be just the incentive individuals need to make lifestyle changes relating to tobacco use, healthy eating and active living. If they make the needed changes to quit smoking and/or lose weight, then everyone wins – they’re healthier in the long run, and AHCCCS incurs less medical costs. If they don’t manage to make the behavior changes, then at least the State of Arizona can apply the extra revenue from the fees to partially offset the additional health care costs these individuals incur.
However, the third alternative is perhaps the most worrisome. If they don’t have the extra $50 to spare and can’t make the changes needed, then they will be deterred from receiving health insurance coverage. These individuals are indeed at increased risk for illness and therefore have a disproportionately high need for routine medical care – the very care that can help them quit smoking or work to drop some pounds. Perhaps AHCCCS should consider offering smoking cessation assistance and weight management counseling to all those who would be impacted by this new policy prior to its implementation?
Also, one could argue that obesity is not purely an individual behavioral choice. Genetics do come into play, and studies indicate that the economic, social and physical environment in which people live can influence obesity-related behaviors such as diet and physical activity. To a lesser extent, tobacco use is a product of both individual choice and environmental circumstance. In my mind, though, obesity is perhaps too far outside an individual’s choice to make it a logical candidate for penalization through a fee.
Lastly, I found it interesting that this fee would only be applied to childless adults. Don’t obese and smoking parents also incur greater health care costs related to their obesity and tobacco use? In fact, wouldn’t decreasing tobacco use among parents decrease the likelihood of secondhand smoke exposure among children?
In any case, one has to give credit to AHCCCS for thinking creatively about both revenue stream and health-related behaviors. It will be curious to track the impact of this proposal if it gets implemented.
- Doug Hirano, MPH, APCA Executive Director
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