By Michelle Andrews

A visit to the emergency department or a physician’s office can be confusing and even frightening when you’re trying to digest complicated medical information, perhaps while you’re feeling pain or discomfort.

For the 25 million people in the United States with limited English proficiency, the potential for medical mishaps is multiplied.A trained medical interpreter can make all the difference. Too often, however, interpreter services at hospitals and other medical settings are inadequate.

Family members, including children, often step in, or the task falls to medical staff members who speak the required language with varying degrees of fluency.

According to a study published in March, such ad hoc interpreters make nearly twice as many potentially clinically significant interpreting errors as do trained interpreters.

The study, published online in the Annals of Emergency Medicine, examined 57 interactions at two large pediatric emergency departments in Massachusetts. These encounters involved patients who spoke Spanish at home and had limited proficiency in English.

Researchers analyzed audiotapes of the visits, looking for five types of errors, including word omissions, additions and substitutions as well as editorial comments and instances of false fluency (making up a term, such as calling an ear an “ear-o” instead of an “oreja”)

They recorded 1,884 errors, of which 18 percent had potential clinical consequences.

For professionally trained interpreters with at least 100 hours of training, the proportion of errors with potential clinical significance was 2 percent. For professional interpreters with less training, the figure was 12 percent.

Ad hoc interpreter errors were potentially clinically significant in nearly twice as many instances — 22 percent. The figure was actually slightly lower — 20 percent — for people with no interpreter at all.

A Civil Rights Issue

It makes sense that trained interpreters, especially those with more experience, would make fewer errors, says Glenn Flores, a professor and director of the division of general pediatrics at UT Southwestern Medical Center and Children’s Medical Center of Dallas, who was the study’s lead author.

Experienced interpreters “know the medical terminology, ethics, and have experience in key situations where you need a knowledge base to draw on,” he says.

More From This Series: Insuring Your Health

Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color or national origin. Courts have interpreted that to mean that all health-care providers that accept federal funds — because they serve Medicare and Medicaid recipients, for example — must take steps to ensure that their services are accessible to people who don’t speak English well, according to the National Health Law Program, a nonprofit that advocates for low-income and underserved people. (Doctors whose only federal payments are through Medicare Part B are exempt from this requirement, however.)

The Census Bureau estimates that nearly 9 percent of the population age 5 or older has limited English proficiency, which the bureau defines as people who describe themselves as speaking English less than “very well.”

Hospitals and other medical providers are in a tough spot, say experts. The law prohibits them from asking patients to pay for translation services, and they may not receive adequate or in some cases any other reimbursement.

“It’s a civil rights law, not a funding law,” says Mara Youdelman, managing attorney in the Washington office of the National Health Law Program.

A dozen states and the District reimburse hospitals, doctors and other providers for giving language services to enrollees in Medicaid, the joint federal-state program for low income people, and in CHIP, a federal-state health program for children, according to Youdelman.

A 2008 survey by America’s Health Insurance Plans, an industry trade group, found that 98 percent of health insurers provide access to interpreter services, but providers and policy experts question that figure. According to a survey by the Health Research and Educational Trust, in partnership with the American Hospital Association, 3 percent of hospitals received direct reimbursement for interpreter services, most of that from the Medicaid program.

“Most hospitals that make this a priority make it a budget item,” says Youdelman.

Lost In Translation

Hospitals and other providers realize that providing competent interpreter services can help ensure that they don’t miss or misdiagnose a condition that results in serious injury or death, say experts. Trained interpreters can also help providers save money by avoiding unnecessary tests and procedures.

Youdelman cites the example of a Russian-speaking patient in Upstate New York who arrived at an emergency department saying a word that sounded like “angina.” The emergency staff ran thousands of dollars’ worth of tests, thinking he might be having a heart attack. The real reason for his visit: a bad sore throat.

Like many hospitals, Children’s Medical Center of Dallas provides interpreter services around the clock via varying modes of communication — face-to-face, telephone and video — delivered by a mix of trained staff interpreters and outside contractors.

When Nadia Compean, 23, was six months pregnant, her doctor in Odessa, Texas, told her that her baby had spina bifida, a condition in which the spinal cord doesn’t close properly, leading to permanent nerve and other damage.

The local hospital wasn’t equipped to handle the birth and subsequent surgery that her daughter would require, so Nadia and the child’s father traveled to Dallas, about 350 miles away.

Neither speaks much English, but at Children’s Medical Center of Dallas, interpreters helped them understand what to expect, Nadia said (through an interpreter).

Nadia says she learned that her daughter, Eva, would be born with a lump on her back and would require immediate surgery. She also learned about problems that Eva may experience walking and using the toilet, she says.

Eva was born on March 6. Because of her medical needs and the lack of adequate interpreter services in Odessa, the couple is considering relocating to Dallas, where the father hopes he can find construction work.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

KHN wants to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

• Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.

• Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.

• Vaccines offer protection from hepatitis A and hepatitis B.

• No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.

• Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

What are the symptoms of viral hepatitis?

Symptoms include

• jaundice, which causes a yellowing of the skin and eyes

• fatigue

• abdominal pain

• loss of appetite

• nausea

• vomiting

• diarrhea

• low grade fever

• headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

• international travelers, particularly those traveling to developing countries

• people who live with or have sex with an infected person

• people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely

• day care children and employees, during outbreaks

• men who have sex with men

• users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

• people who live with or have sexual contact with an infected person

• men who have sex with men

• people who have multiple sex partners

• injection drug users

• immigrants and children of immigrants from areas with high rates of hepatitis B

• infants born to infected mothers

• health care workers

• hemodialysis patients

• people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed

• international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

• People most likely to be exposed to the hepatitis C virus are

• injection drug users

• people who have sex with an infected person

• people who have multiple sex partners

• health care workers

• infants born to infected women

• hemodialysis patients

• people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced

• people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

• people who live with or have sex with a person infected with hepatitis D

• people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

• international travelers, particularly those traveling to developing countries

• people living in areas where hepatitis E outbreaks are common

• people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179

Email: info@liverfoundation.org

Internet: www.liverfoundation.org

Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/hepatitis

Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702

Email: hfi@comcast.net

Internet: www.hepatitisfoundation.org

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

Dhan Biswakarma and his wife, Bee Biswakarma, who live in Kent, are among several deaf Bhutanese refugees who have been learning American Sign Language at Highline Community College. Photo Allison Barrett

By Allison Barrett

Nancy Allen, an American Sign Language (ASL) teacher at Highline Community College, goes through a stack of name cards, holding up each one and looking quizzically at the students.

“Whose is this?” she signs.

A short man in his 50s smiles hesitantly and raises his hand slowly as he sees the card with his name.

“What is your name?” Allen signs.

The man points to his chest, crosses his fingers in the sign for “name” and then slowly shapes his stout, weathered fingers to form: “D-H-A-N. My name is Dhan.”

Sitting next to him, his wife laughs out loud as her turn comes. She stumbles over the signing sequence, but she follows Allen’s lead and carefully signs her name.

“My name is B-E-E. Bee.”

For Bee and Dhan Biswakarma, Bhutanese refugees restarting their lives in Kent, the struggles of resettlement are intensified by the fact that the deaf couple has few means of communicating with the speaking world.

The Biswakarmas are among a number of deaf or hard-of-hearing Bhutanese refugees who have been resettled in King County in the past several years. Last spring’s class at Highline represented the Biswakarmas’ first exposure to a developed language.

“They have gone their whole lives with no formal language, getting by without a lot of communication,” said David Van Hofwegen, the couple’s caseworker from the World Relief Organization.

They have a repertoire of gestures to communicate with family members. But when it comes to sharing their thoughts with the hearing world, they are limited to signing the basics: eat, sleep, sick, house, wife, child.

And family.

In class, Bee has difficulty remembering how to sign her name, but she immediately grasped the expression for family. At home, she makes the sign after pointing to each relative seated on the mismatched jumble of couches and wooden chairs.

Sher Pandey (in baseball cap), his wife, Basu Pandey (to his left), and Man Budhathoki (at right) practice signing at Highline's American Sign Language class last spring. Photo Allison Barrett

Bee, 47, and Dhan, 55, met in a refugee camp along Nepal’s eastern border after each fled Bhutan by foot in 1991.

They were driven out of their home country by policies implemented in the mid-1980s to forcefully integrate the ethnic Nepali inhabitants of southern Bhutan into the monarchy’s vision of a unified national identity.

Southern Bhutanese were required to go to impossible ends to prove citizenship, ordered to stop teaching Nepali in schools and to abandon traditional dress and customs.

They protested and the military cracked down.

Homes were raided at night and dissidents were jailed, said Bal Biswa, a relative who helps to take care of Bee and Dhan.

Dhan and his extended family, including his relatives and caretakers Bal and Pabita Biswa, joined 23 other families to walk out of Bhutan, sleeping in the forest by day and traveling at night.

According to the United Nations High Commission on Refugees, since 1990 almost 100,000 southern Bhutanese have fled the tiny Himalayan kingdom that is often hailed as the “happiest country in the world” and celebrated for its measurement of Gross National Happiness.

Sitting in the Kent apartment that he and Bee share with Bal and Pabitra, Dhan points at Pabitra and then brings his hand above the ground in a gesture that looks like he’s placing it on the head of an invisible child. He pantomimes that he is carrying something.

Pabitra explains that Dahn helped her carry her kids out of Bhutan. She and her husband, Bal, lost two of those young children to a fever that broke out in the squalor of the early encampments.

Bhutan. Map by Shahid Parvez under Creative Commons license.

Little preparation

Bee and Dhan arrived in Seattle early this year, part of the more than 1,800 Bhutanese who have been resettled in Washington state since 2008. They came with their son, 12-year-old Golpal, who is able to hear and lives with other relatives.

The couple had little preparation for life here.

Bee and Dhan were both born deaf, leaving limited options for employment or education. Bhutan had no established sign language until 2003, when the monarchy opened its first school for deaf children.

“You are considered backwater in society,” said Mitra Dhital, a Bhutanese refugee who works as a medical social worker for the Asian Counseling and Referral Services.

In many ways, they are even less independent in America.

Bee and Dhan don’t like to walk the five blocks to a grocery store alone, for fear of getting lost. Sometimes they stroll around the perimeter of the building, but never leave the grounds.

At first they were fearful of going to their ASL class. They were daunted by many things, including the bus ride there, until the World Relief organization provided a volunteer-driven van ride.

Among the eight Bhutanese class members, there is a range of hearing impairment, from Bee, who lives in complete silence, to a man in his mid-30s who has no hearing in one ear and is slowly going deaf in the other.

The number of those who are deaf or hard-of-hearing represent only a small percentage of the Bhutanese refugees here. But caseworkers say it is an unusually large number compared to other refugee groups. No one is certain why.

It is unclear whether that is the result of policies that give the deaf resettlement priority because of their lack of opportunities in the camps, or if the number reflects a high occurrence of deafness within Bhutan.

The World Health Organization estimates that of the 278 million people in the world living with moderate to profound hearing loss, 80 percent live in developing countries. And about half of all cases are preventable, caused in part by illnesses like measles, mumps and rubella that have readily available vaccinations in the developed world.

Ear infections, exacerbated by poor sanitation and hygiene, often went untreated in the refugee camps for Bhutanese, said Dhital.

Allen is adamant that even without a formal language, Bee and Dhan understand each other just fine. “All deaf people have a language,” said Allen.

The challenge for Bee, Dhan and the others in the class is finding a way to interact with the hearing world.

Allen, director of interpretive services at Highline, was approached about starting an ASL class for deaf Bhutanese about a year ago. She had never taught a class tailored to refugees.

Around the same time, Allen ran into a Bhutanese couple in the college’s parking lot, a hearing woman with her deaf husband. The wife, enrolled in English classes at Highline, was in search of a class for her husband.

“The light bulbs started going off,” said Allen. “There are other deaf refugees here. There is a need that is not being met.”

She says her deaf co-teacher, Ricardo Velilla, is the key to the class.

Extremely animated, he can model abstract concepts with ease. He acts out a jaunty stroll down the road, a runaway vehicle and narrowly averted catastrophe. He then runs the palm of one hand up the back of the other in a smooth motion. This is the sign for “almost.”

For a short time, Allen and Velilla had a deaf man from Somalia in their class.

“One day he came in very agitated, making all these wild motions,” said Allen. “Ricardo took one look at him and explained to me, ‘He used to have a driver’s license in his home country but he’s frustrated because he can’t get one here.’ ”

Allen knows lots of other deaf refugees and immigrants could benefit from access to ASL. But for now, the class is only offered once a week.

Until Bee and Dhan acquire enough ASL to communicate ideas to the hearing world, their prospects for employment are dismal.

Van Hofwegen is assisting them with the lengthy and very difficult process of qualifying for federal disability benefits.

The program doesn’t accept international evidence. You have to visit a primary physician for a referral and get screened by certified audiologists and other specialists, a procedure that requires Bee and Dhan, accompanied, to run to appointments all over the county.

Evening sets in, and the Kent apartment is filled with the scent of Nepali dumplings. Golpal and some neighbor boys are engaged in a cutthroat game of marbles on the floor. Bal and Pabitra’s sons are using the bulky computer in the corner, browsing Facebook and watching Bollywood videos on YouTube.

Dhan retreats to the bedroom and returns, carrying a sheet of paper. He takes a seat next to Bee on the couch.

They both lean over the manuscript that is covered in a scrawling alphabet, written in Dhan’s shaky hand, and start to shape their fingers into signs, beginning with the letters of their names.

Allison Barrett, a UW senior, wrote this piece for Health Intersections, the UW Communications Department’s class on global health reporting. She can be reached at allisondbarrett@gmail.com

The hepatitis B virus, or HBV, is a leading cause of liver cancer, so when Connie Chan’s grandfather was diagnosed with liver cancer, all the members of her family wondered if they too might be infected with the cancer-causing virus.

“It was scary,” said Chan, a student of public health at the University of Washington “He could have transmitted it to everyone in the family and no one might have known.”

In the end, it turned out her grandfather did not carry HBV. Nevertheless, the scare led Chan to want to learn more about the virus, so in January she joined UW’s Team HBV, a chapter of a national organization dedicated to raising awareness of the risks of hepatitis B infection and to promoting testing and vaccination, particularly among Asian and Pacific Islanders (APIs) and other immigrant communities.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that between 800,000 and 1.4 million Americans have chronic HBV infections—and that two-thirds don’t know they carry the virus.

HBV virions -- CDC

APIs are at particular risk: although they make up about 4.5 percent of the U.S. population, they account for 50 percent of the cases of chronic hepatitis B infection.

Asian Americans and Pacific Islanders not only have the highest rates of chronic infection, the CDC says, they also have a higher risk of developing liver cancer as a result of the infection than do other racial and ethnic groups.

In fact, liver cancer is the third leading cause of cancer death among Asian American, Native Hawaiian and other Pacific Islander groups, whereas liver cancer is 16th leading cause of cancer among non-Hispanic whites.

Vaccination can prevent infection and treatment is available for infection.

Earlier this month, Chan joined with fellow students, health professionals and community members at the 2011 Hepatitis B Forum, one of a series of community events this May to mark Viral Hepatitis Month.

Among the event’s participants were Virginia Mason Medical Center, International Community Health Services, and Harborview Medical Center .

The partnership with the international community, said Kim Nguyen, program manager for the Hepatitis B Coalition of Washington, which organized the forum, is important because it offers innovative approaches to tackling a virus that disproportionately affects many foreign-born populations.

“Many [of those infected] don’t know they have it because it’s a silent virus, it doesn’t show symptoms readily or quickly,” Nguyen said.

HBV is most commonly transmitted through contact with blood and infected bodily fluids. Intravenous drug use and sexual activity are common causes of its spread, but many infants are infected during childbirth if their mothers carry the virus.

In underdeveloped countries, many mothers lack basic prenatal care and so give birth without screening for such viruses as hepatitis B, Nguyen explained, and if HBV is contracted in infancy, individuals are significantly more likely to develop a chronic infection.

People who are at highest risk are those who are born overseas in regions where rates of HBV infection are high. This includes Southeast Asia and China but also sub-Saharan Africa, home to many of the region’s new immigrants, said Nguyen.

Prevalence of HBV surface antigen a sign chronic infection -- CDC

In many of these regions, HBV infection carries a social stigma making frank discussion about the disease difficult, says Chan. “It’s related to sex and drugs and that’s not really talked about as openly as in America,” she said.

To encourage discussion, Chan and others are developing “ethnically sensitive” awareness campaigns.

In one campaign, Chan and her teammates at the University of Washington made life-sized posters of individuals holding signs about HBV and displayed them throughout campus to encourage students to get informed.

The Fred Hutchinson Cancer Research Center with the help of several community partners has created informational pamphlets in Chinese, Farsi, Korean, Punjabi, Khmer and Vietnamese.

Progress is being made, said Nguyen, several community health fairs are now offering hepatitis B testing in addition to the usual high blood pressure and diabetes screening.

But more and broader outreach is necessary, says Nguyen, as immigration patterns have changed and more and more people arrive in the region from East and sub-Saharan Africa, so has the face of hepatitis B.

Celina Kareiva is a contributing writer for Seattle LocalHealthGuide, Seattle Weekly and Real Change. She is a graduate student in the Journalism program at the University of Washington and has written and edited for the student paper, The Daily.

To learn more:

• Visit the website of UW Team HBV.
• Visit the website of the Hepatitis B Coalition of Washington.
• Read the section on hepatitis B in the HHS Plan for Asian American, Native Hawaiian and Pacific Islander Health.
• Visit the CDC’s Hepatitis Awareness Month webpage.
• Visit the educational material page of Ethomed, which includes brochures and videos in a variety of languages.

The half-day event, called B Informed Now! Patient & Community Workshop on Hepatitis B & Living with Liver Cancer, is free and breakfast and lunch–as well as and Cantonese, Mandarin, and Vietnamese interpretation–will be provided.

Hepatitis B is a viral infection of the liver that can, if it becomes chronic, cause cirrhosis and liver cancer.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that as many as two million people in the U.S. have chronic hepatitis B infections.

Hepatitis viruses - Photo: E.H. Cook/CDC

Of these, more than half are Asian Americans, Native Hawaiians, or other Pacific Islanders.

These groups not only have the highest rates of chronic infection, the CDC says, they also have a higher risk of developing liver cancer as a result of the infection than do other racial and ethnic groups.

In fact, liver cancer is the third leading cause of cancer death among Asian American, Native Hawaiian and other Pacific Islander groups, whereas liver cancer is 16th leading cause of cancer among non-Hispanic whites.

The risk of chronic hepatitis B infection is highest among foreign-born Asian Americans and other Pacific Islanders with approximately 10 percent being affected, the CDC says.

There is an vaccine to prevent infection, and, while there is no cure, there are drugs that can reduce the risk of liver damage due to the virus.

The workshop’s talks will be given by Dr. Chia Wang, an infectious disease specialist at Virginia Mason Medical Center and Dr. Stephen Chen, a cancer specialist at Polyclinic First Hill.

The workshop’s organizer, the Hepatitis B Community Engagement Project, is a collaborative initiative between the Hepatitis B Coalition of WA and International Community Health Services.

The event is sponsored by the Hepatitis B Foundation, a national nonprofit research and disease advocacy organization, and Seattle Public Schools.

TITLE:

• B Informed Now! Patient & Community Workshop on Hepatitis B & Living with Liver Cancer

WHEN:

• Saturday, Dec. 4th, 9 a.m. to 1 p.m.
• Registration begins at 8:30 p.m.
• Free but RSVP requested. To RSVP: call 206-788-3687 or email kimn@withinreachwa.org

WHERE:

• Asian Counseling & Referral Services (ACRS) Community Hall
• 3639 Martin Luther King Jr. Way S., Seattle, WA 98144

To learn more about hepatitis B

• Visit the National Library of Medicine’s Hepatitis B information page, which provides basic information as well as links to a wealth of online resources.
• Visit Public Health – Seattle & King County’s Hepatitis B information page, which has information about the virus in Burmese, Chinese, Korean, Russian, Spanish, Somali and Vietnamese.

• Another good resource can be found on the webpage of the National Hepatitis B Initiative for Asian Americans and Pacific Islanders.