In the lobby of a medical clinic in South Philadelphia, the phrase “Welcome” is written on the wall in 30 languages.
The word appears in Chinese, Hindi and Thai and other languages that are not as widely spoken in the United States.
Philadelphia has nearly 80,000 residents who were 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 fluent in the unique needs of this community. Elsewhere, even making a doctor’s appointment or getting care in an emergency room can be overwhelming.
The center includes staffers 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,'” she said.
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The center, operated in collaboration between SEAMAAC, an Asian-American advocacy group, and Jefferson Health, combines medical care with services to help people with English skills, home insecurity and ignorance of the internet and technology.
A particular focus will be on hepatitis B, a virus of particular concern among Asian and African immigrants.
Under Asian immigrants are people who “can’t fill out forms, don’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, many 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 have trouble understanding cultural differences. Hepatitis B, a liver disease that can cause cirrhosis and highly fatal liver cancer, shows how a lack of cultural awareness and ignorance in the medical community can lead to serious health consequences in migrant communities.
There are about 2.2 million cases of the virus in the United States, and more than half are reported among Asian Americans. This is because the virus is endemic in some Asian countries, experts say. Although immunization for infants is recommended in the United States, it is less common in other countries, making screening and immunization critical for foreign-born Asian Americans.
Fewer than 10% of the city’s Asian, Pacific Islander and African residents have been tested or vaccinated for the disease, according to Hep B United Philadelphia, a local coalition formed to raise awareness of the virus.
Philadelphia’s best estimate is that 22,000 are living with hepatitis B in the city, said Danica Kuncio, director of the Philadelphia Department of Public Health’s viral hepatitis program. Between 35% and 45% of the city’s newly reported cases involve residents of Asian or Pacific islands.
“This is a silent killer,” said Grace Xueqin 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 examines how socio-historical trauma, cultural stereotypes, anti-Asian prejudice, and distrust of health care systems impede testing for hepatitis B among Southeast Asian American populations, particularly people from China, Korea, and Vietnam.
“When we look at the differences, we really have to look at structural factors, racism and implicit bias,” she said.
The virus is unknown 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 with Hep 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 like high cholesterol, diabetes and tuberculosis can be too expensive for some.
The virus can be transmitted through sex or drug use, although a more common route of transmission among immigrants is mother-to-child transmission at birth.
Carrying the virus can lead to discrimination and deportation in other countries, Freeland said, making people shy away from testing. The perceived stigma of infection means some prefer not to be diagnosed or seek a vaccine or treatment.
“Getting people to diagnose this has to be done in a sensitive way,” said Jessica Deffler, a Jefferson physician who works at the Wyss Center. “A lot of people are very shocked or nervous when they receive this diagnosis.”
The Wyss Center opened in March 2021 in the Bok Building near South Philadelphia’s large Asian community to specifically serve the diverse cultures and nationalities represented there.
Ming Tio, 75, an immigrant from Indonesia, doesn’t speak enough English to dispute $800 medical bills. He found out through a friend that Wyss could help. Tio, a retired worker, described the medical treatment Debt related to a car accident in 2021 as ‘stressful’.
“He knows it’s a bill, but he doesn’t know what to do,” Evelyn Kurniadi, a Wyss social worker, said as she flipped through the bills.
During a phone call where Kurniadi was helping Tio and a Jefferson associate communicate, she slowly made progress to understand the bills.
Kurniadi often has five people looking over her a day, she said, to ensure they are heard by health care and public aid agencies.
In addition to the languages spoken by the center’s staff, the clinic uses iPads with an app, CyraCom, 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 perfectly fine,” the Vietnamese immigrant, who arrived in the United States in 2006, said through the interpreter. “I’ve also had pain and weakness in my right leg for the past seven months.”
Trinh’s hearing problems, as well as misunderstandings between him and the interpreter, made the conversation faltering and at times frustrating. Still, Deffler, the Jefferson doctor in Wyss, was able to talk to him about his condition, advise on his medication schedule, and prescribe Tylenol and blood pressure medication.
She found that cultural competence can be taught.
“It’s about listening and being open,” she said.