Language barriers, bias, and cultural differences hinder access to health care for Asian Philadelphians

In the lobby of a South Philadelphia medical clinic, the phrase “welcome” is written on the wall in 30 languages.

The word appears in Chinese, Hindi, and Thai, and other languages not as widely spoken in the United States.

Philadelphia has almost 80,000 residents 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 fluent in this community’s unique needs. Elsewhere, even making a doctor’s appointment or getting care at an emergency room can be overwhelming.

The center includes staffers like Gao Vang, an intern this past summer 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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Operated as a collaboration between SEAMAAC, an Asian American advocacy group, and Jefferson Health, the center combines medical care with services to help people with English proficiency, housing insecurity, and unfamiliarity with the internet and technology.

An area of special focus is hepatitis B, a virus that is a particular concern among Asian and African immigrants.

Among 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, a lot of them lack the confidence to go to places where they don’t know if those places are safe,” she said.

Even hospitals with interpretation services can struggle to grasp cultural differences. Hepatitis B, a liver disease that can cause cirrhosis and highly deadly liver cancer, highlights the ways a lack of cultural awareness and ignorance in the medical community can lead to serious health consequences among immigrant communities.

There are about 2.2 million cases of the virus in the United States, and more than half are reported in Asian Americans. This is because the virus is endemic in some Asian countries, experts say. Though vaccination is recommended for infants in the United States, it is less common in other countries, making screening and vaccination critical for foreign-born Asian Americans.

According to Hep B United Philadelphia, a local coalition formed to boost awareness of the virus, fewer than 10% of the city’s Asian, Pacific Islander, and African residents have been tested or vaccinated for the disease.

Philadelphia’s best estimate is that 22,000 in the city live with hepatitis B, said Danica Kuncio, the Philadelphia Department of Public Health’s viral hepatitis program manager. Between 35% to 45% of the city’s newly reported cases are among Asian or Pacific Islander residents.

“This is a silent killer,” said Grace Xueqin Ma, associate dean for health disparities at Temple University’s Lewis Katz School of Medicine.

The virus killed about 1,700 Americans in 2020.

Ma is studying how social historical trauma, cultural stereotypes, anti-Asian bias, and mistrust of health-care systems are hindering testing for hepatitis B among Southeast Asian American populations, particularly people from China, Korea, and Vietnam.

“When we look at the disparities, we really need to look at structural factors, racism, and implicit bias,” she said.

The virus is not well-known to most primary care physicians, said Catherine Freeland, associate director of public health research at the Hepatitis B Foundation.

“Providers frequently misinterpret test results,” she said. “If you talk to someone in medical school, they don’t spend a lot of time on hep B.”

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A 2020 survey also found 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 health-care provider. Tests for this virus, as well as other conditions like high cholesterol, diabetes, and tuberculosis, can be too expensive for some.

The virus can be transmitted through sex or drug use, though a more common mode of transmission among immigrant populations is from mother to child at birth.

Carrying the virus can lead to discrimination and deportation in other countries, Freeland said, making people wary of testing. The perceived stigma of an infection means some would rather not be diagnosed, or won’t seek a vaccine or treatment.

“Giving people that diagnosis has to be done in a sensitive way,” said Jessica Deffler, a Jefferson doctor working at the Wyss center. “A lot of people are very shocked or nervous about it when they get that diagnosis.”

The Wyss center opened in the Bok Building in March 2021 near South Philadelphia’s large Asian community specifically to serve the diverse cultures and nationalities represented there.

Ming Tio, 75, an immigrant from Indonesia, doesn’t speak enough English to dispute $800 in medical bills. He learned through a friend Wyss could help. A retired laborer, Tio described the medical debt related to a 2021 car accident as “stressful.”

“He knows it’s a bill, but he doesn’t know what to do,” said Evelyn Kurniadi, a Wyss outreach worker, as she leafed through the bills.

Slowly, during a phone call in which Kurniadi helped Tio and a Jefferson worker communicate, she made headway understanding the bills.

Kurniadi often has five people a day looking to her, she said, to ensure they’re heard by health-care and public support 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 a critical 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 totally OK,” the Vietnamese immigrant, who arrived in the United States in 2006, said through the interpreter. “In the past seven months, I start having pain and weakness in the right leg as well.”

Trinh’s hearing difficulties, as well as misunderstandings between him and the interpreter, made conversation halting and at times frustrating. Yet Deffler, the Jefferson doctor at Wyss, was able to communicate with him about his condition, advise him on how to schedule his medications, and prescribe Tylenol and blood pressure medication.

She noted that cultural competency can be taught.

“It’s about listening and being open,” she said.