HEALTH-U.S.:
City Takes Aim at Hepatitis Among Asian Americans
Ngoc Nguyen
SAN FRANCISCO, Apr 27 (IPS) - This west-coast city has earned a reputation
as a health trendsetter. Last year, San Francisco unveiled a plan to offer
universal health care to all its residents (to take effect Jul. 1). Now it
has become the first U.S. city to launch a plan to test and vaccinate all
Asian and Pacific Islander American residents for hepatitis B.
In the heart of San Francisco's Chinatown, the mayor, other elected
officials, medical professionals and representatives from community-based
organisations kicked off the city's new "Hep B Free" campaign Wednesday
before sitting down to a sumptuous Chinese banquet.
The goal of the campaign is to raise awareness and increase collaboration
amongst clinics, hospitals and community groups in offering free or
low-cost testing, vaccinations and screenings to the public.
Hepatitis B virus (HBV) is a serious infection of the liver, and can lead
to premature death from liver cancer or liver failure. At a press
conference before the banquet, Mayor Gavin Newsom said HBV is a global
problem, but one that hits close to home for San Francisco. The city has
the highest liver cancer rate in the United States, largely due to its
sizable Asian-Pacific Islander population, who are particularly
susceptible to the disease.
Newsom said the city has a special responsibility to raise awareness and
encourage testing, because "a consequence of having it and not knowing
it... is that you can pass it on to other people. Therein lies the
challenge."
HBV can be passed to a newborn baby from an infected mother, through
unprotected sex or through contaminated blood through sharing
toothbrushes, razors or hypodermic needles. The virus can live in the body
for a long time without causing any symptoms, and, if left untreated, can
lead to liver cancer or failure.
Asian and Pacific Islander Americans (APIs), who comprise about one-third
of San Francisco's population, are being encouraged in particular to get
tested for HBV.
In the United States, about 60 percent of the 1.2 million people living
with chronic hepatitis B infection are APIs. And the disparity doesn't
stop there: Asian men are four times more likely to die from liver cancer
than are white men.
If the test is positive, there are medications to reduce the harm done by
the virus and regular screenings are recommended to detect and treat
cancers early. If the test is negative, there is a vaccine against HBV
that is so effective the World Health Organisation has called it the
"first anti-cancer vaccine."
Dr. Mitch Katz, head of the San Francisco Public Health Department, said
the city is tackling the hepatitis problem because it is treatable and
manageable.
"We don't see any polio, why? Because polio had a vaccine that prevented
it, so over time, if you put great effort into making sure that every
person who could be affected is vaccinated, you eradicate a disease.
Sometimes. Hepatitis B can be eradicated," said Katz.
Dr. Samuel So founded the Asian Liver Centre at Stanford University more
than a decade ago, when he first recognised that HBV was a big Asian
American problem that no one was addressing.
"You would think that doctors routinely test patients," he said. "We found
in over 3,000 screenings in the (San Francisco) Bay Area, two out of three
people who were found to have chronic hepatitis B weren't even aware they
were infected. So a large percentage of Asian Americans walking around the
streets of San Francisco, who are chronically infected, are not aware
until the day they get sick with advanced liver cancer. We have to put a
stop to this."
Commander Bok Pon, 65, is an active member of the American Legion Cathay
Post #
384, a group of Chinese American post-World War I veterans.
He first learned that he had hepatitis B two months ago when blood test
read abnormal. Several tests later, Pon learned he had liver cancer and
that he had an estimated six months to live.
Pon is using the time to get educated about HBV and to share his story, in
the hope of convincing others about the importance of getting tested, and
then vaccinated or treated.
"A lot of people I know, some veterans, have hepatitis B and they talk to
me privately about my experience," he said. "They want to know about
medications and how to manage it." He said he uses humour to help people
get past fears and to demystify the medical technology and treatments.
"I tell them that an ultrasound doesn't hurt and that getting a CAT scan
is like going through the time tunnel at Disneyland," Pon said.
He is currently undergoing chemotherapy and, depending on how he responds,
may become a candidate to receive a liver transplant. His advice is to
develop a positive attitude, exercise to maintain health and get good
health insurance. "In the last two month, my medical procedures have
totalled 90,000 dollars, and a liver transplant can run half a million
dollars."
In the coming months, a number of community organisations, clinics and
hospitals will be offering HBV testing and vaccination services at sites
across the city. Testing is offered free or at a cost of 10 dollars. A
vaccination - a series of three shots over the course of six months -
runs about 60 dollars. At an Asian heritage street fair in the city last
year, organisers said they were able to vaccinate about 500 people in five
hours.
One site where locals will be able to get tested and vaccinated is Chinese
Hospital, a 59-bed acute care non-profit facility that was founded in
response to racism against Asian Americans in the 1920s. Dr. Stuart Fong
operates the hepatitis B vaccination clinic the first Wednesday of every
month. The clinic screened about 800 people last year. He said having
diverse staff has helped provide culturally competent care - an important
aspect in addressing HBV in the API community.
Incidence rates - the number of new cases in a given time period - are
highest among Asians of Cambodian and Laotian origin, followed by Korean,
Vietnamese and Chinese, according to Fong. Cultural barriers are a
particular challenge when it comes to outreach efforts aimed at new API
immigrants.
"I don't believe hepatitis B can be completely eradicated from the city
due to global travel and immigration, not just from Asian countries, but
from countries in Latin America and the Caribbean," where HBV is also a
health problem, he said.
Community clinics help to remove some of the obstacles to receiving care,
said Fong, explaining that one of the barriers to getting vaccinated is
the lack of or inadequate health insurance. "They can get (the vaccine)
cheaper and faster at a community hospital or clinic," he said.
And hepatitis B also exists in the broader population. "We need to expand
HBV prevention and treatment services to more than the API community.
Other groups will be targeted down
the pike, but everything has to be done incrementally," said Fong. San
Francisco first promoted hepatitis B awareness in the homosexual
community.
San Francisco's Hep B Free Campaign could be a model for the state and the
rest of the nation. State lawmaker Fiona Ma, a Democrat from San
Francisco, has authored legislation that would set up pilot programmes to
test, vaccinate and treat HBV in the broader Los Angeles and San Francisco
areas. The bill has already passed its first hurdle and is working its way
through the state legislature.
"In a year or so, perhaps anybody who walks through the door should be
screened," said Dr. Fong.
(END/2007)
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