2011 APAMSA Hepatitis B Conference

Saturday, November 5, 2011: National APAMSA Hepatitis B Conference at the Westin San Francisco Market St

Here was the business side of my California trip. As the president of Stony Brook’s chapter of APAMSA, I had a duty to educate myself and network with other students and professionals from across the nation and hopefully bring back what I learned to the local Long Island community in hopes of raising awareness about Hepatitis B. I had a full day ahead, from 8:00 am to 5:00 pm, packed with speakers, presentations, activities, and of course, food. The lunch was especially gourmet and appetizing!

Breakfast was wonderful: scrambled eggs, pastries, fruits, bread, and of course, COFFEE! I went overboard with the coffee that morning – nearly 2 tall cups worth of caffeine washed through my system. Since college, I made a ritual of drowning myself in coffee before major exams, then I deal with the headaches and jitters in my crash phase. I also got into a bad habit of making coffee time mandatory for early mornings, because I conditioned myself to believe I need coffee to succeed. While drinking my coffee, the plastic lid was not tightly capped and I spilled some over my sleeves and conference folder. What a great and embarrassing start to the day… A little while later, I tested out my hands for essential tremors from the caffeine (I just finished learning about Parkinson’s and different types of tremors in Neurology). I held out my hand and stared intently like a zombie. The guy next to me said to me, “Testing out your surgeon’s hands already?” Another guy gave me a sheet of paper to place atop my hands to better see the shakes. Indeed, I was shaking pretty badly. No surgery for me!

As in any social event, there is the god-awfully awkward Icebreaker. I was at a table of New Yorkers, representing Stony Brook, Upstate, Columbia, Mt. Sinai, and Einstein. The game was to write an interesting fact about yourself. The cards get shuffled and one person at a time draws a card and guesses who… I thought a game of Two Truths and a Lie would’ve been more engaging and fun, but whatever. On my card, I wrote “I do Step dancing in school…” and I doodled an ear with an arrow pointing to the stapedius muscle. It’s a punny joke amongst medical students. Anyway, I explained myself, how the dance is the ghetto type you do on the streets of Brooklyn. One guy luckily knew what I was talking about, since he did hip-hop in high school. The dude next to me asked for a demo… except there was one problem: it’d be silent stepping. Step dance requires hard slaps and stomps. With carpeted floors, business pants and tight blouse, and a whole room of onlookers, I would have a pretty hard time pleasing the crowd and raising the roof.

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Now onto serious business… Noteworthy speakers of the day included California State Assemblywoman Fiona Ma, the legendary Dr. Samuel So of Stanford University School of Medicine, Dr. Anna Lok of University of Michigan, Hepatitis B/Liver Cancer patient Anthony Chiu, and Janet Zola of Hep B Free San Francisco. The presentations covered the epidemiology, pathophysiology, prevention and treatment of Hepatitis B, in addition to personal stories and medical relevance. I personally found the presentations valuable. I recently completed Microbiology and learned a waterfall of microbial diseases and drugs. The hepatitis B virus was heavily touched upon in terms of viral replication and cycle, transmission, symptoms, blood antigens and antibodies in different stages, and treatment. It was the science that mattered. Notably absent was any discussion on epidemiology, predominantly among Asian immigrants. It would be one thing to draw out a Dane particle, but a much bigger priority to know your patient population, screening and preventing infection. In Asian society, hepatitis B has been a social stigma, preventing people from getting jobs and labeling them as ‘dirty.’ People just don’t talk about it. Because of this cultural belief, Asians are hesitant to get checked and treated; going to the doctor, finding out they have HBV, and seeking treatment is like admitting you are dirty and diseased.

Hepatitis B is endemic in Asian countries, particularly China, where it is primarily transmitted from mother to baby. In contrast, the main mode of transmission in Western societies is through sex, needle sticks, and IV drug use.  There are common misconceptions of the disease within the Asian community. For one, HBV (and HCV) is spread through blood-blood contact. It is NOT transmissible through saliva or casual contact. Hence, you cannot get the infection from touching a coworker (except if you sleep with him or her), kissing someone, or dining with relatives and friends, the traditional Asian style. It is infectious through sexual contact, needles, and mother to baby.

Hepatitis B is a silent killer, deserving just as much attention as diabetes and heart disease.  Because many Asians get infected as newborns from their mothers or as children, they become chronic carriers for life.  There are no symptoms, until devastating cirrhosis and liver cancer strikes at a relatively young age (as early as 30s-40s!). The cycle perpetuates from generation to generation, but here is where current and future physicians can intervene through early detection and vaccinations. Something can be done to target and break this cycle. Hepatitis B can be treated with anti-viral medications for life, but not cured. More importantly, though it is deadly, hepatitis B is highly preventable. That is why it is essential to screen for carrier mothers and vaccinate babies and children. Screening programs are set up in Asian areas to catch the disease early, and hopefully follow up with treatment or vaccinations.

Did you know, the HBV vaccine, developed nearly 30 years ago, is the FIRST vaccine to prevent cancer? Not Gardasil and HPV/cervical cancer. Then why is hepatitis B still prevalent around the world, causing 60-80% of liver cancer cases worldwide and killing 600,000 people every year?

Raising Global Awareness: The Jade Ribbon Campaign

“Considered to be the essence of heaven and earth, Jade is believed in many Asian cultures to bring good luck and longevity while deflecting negativity. Folded like the Chinese character meaning “person” or “people,” the Jade Ribbon symbolizes the united voices of those fighting hepatitis B and liver cancer worldwide.”

Dr. So, the founder, explained the origins of the Jade Ribbon. All other ribbon colors were taken for different causes: pink for breast cancer, yellow for troops at war, red for HIV/AIDS, puzzle for autism, and even red/black for ‘atheist solidarity.’ There’s only so many colors, and numerous causes have overlapped on colors. So… what on earth to do with the Hepatitis B ribbon?! Someone creative decided to stretch out the common ribbon and make it look like the Chinese character for ‘people’ or ren. And no one non-Asian would ever think about using the color jade, so there you go, a ribbon cause was born. The fight against hepatitis B is a unified, collective effort, so everyone joins in as one family to raise awareness. I wear my precious Jade Ribbon pin on my book bag in honor of my support and promise to the hepatitis B cause.

SF Hep B Free Campaign: Who Deserves to Die?

These were controversial when they first came out last year. Chinese people are superstitious and find it unlucky to be associated with words related to death.

For the men out there...

Look what I found on a cable car in San Francisco: a Hepatitis B ad called HOPE

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B a Hero campaign

One question was posed to the audience: what will you do when you go back to your community? I found the conference powerfully moving and educational. As a result, I had ideas steamrolling through my mind and I hope to make a difference!

Hepatitis B Initiative at Stony Brook (possibly):  APAMSA at Stony Brook is active mainly with the Bone Marrow Drive and Asian Extravaganza. I’m disappointed there has not been any work with hepatitis B. Then again, I’m not too surprised either because Stony Brook is in the middle of nowhere in a predominantly white community. Stony Brook University itself is infested with Asians; I see them left and right on the main campus and at the HSC. The nearest community of Asians on Long Island is Plainview/Syosset in Nassau county. The primary epicenter of Asian immigrants is out in New York: Flushing, Chinatown in Manhattan, and perhaps areas of Brooklyn and Queens.

Many medical schools across the country have some sort of screening program for the local Asian community: Chinese, Koreans, Vietnamese, etc… Students try to educate the community, set up shop at Asian food markets or wherever, screen for hepatitis B, and have some kind of follow-up, which can be difficult. Even with student-run clinics, there can be low turnout; people are uninterested. There are roadblocks no matter how passionate and altruistic the cause.

So… screening in Long Island at Stony Brook is a bit of a stretch; I don’t have the target patient population. The student-run clinic called SB Home primarily serves the Hispanic population, not Asians. Instead, I’ll take baby steps. In an effort to raise awareness about hepatitis B in the local community, I’m making it my home mission to educate students and health professionals. I hope to bring back my newfound knowledge and make sure people are informed about hepatitis B beyond just the microbiology and risk in needlesticks. The knowledge I intend to pass along is relevant to broad specialties and many people: future physicians who plan to work in major cities, California or New York, primary care providers, or GI specialists/hepatologists. All it takes is for the primary care doctor to check off the box for HBsAg and anti-HBs tests. All it takes is for the properly educated and compassionate physician to debunk misconceptions and give the patient all the right information.  Personally, I fit in well with the above points, since I see myself as a city doctor in California who stays connected with the Asian American population. Whether I go into internal medicine, family medicine, oncology or hepatology, I will always remember my Chinese roots. I have found a cause I can say I feel personally invested in. And I want to make my first major initiative a success…

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Now the question is, how do I get started? I have a big blueprint unraveling. With no precedents from previous years at Stony Brook, where do I begin? Let me make an agenda here…

1) Talk to Dr. Granek of Preventative Medicine. Get some ideas from her and find out if any doctors at Stony Brook would be interested in raising awareness and giving lectures on behalf of APAMSA =)

2) Gauge interest among medical students. Email out to the first years, see if they’re remotely interested. So far 2, one of whom worked with the Charles B. Wang Center in Chinatown, and that’s enough for me. Still need to email out to the second years. I have the support of one of my friends who came with me to the conference, who also happens to be president of American Medical Association (AMA). He has physician networks for contacts and an E-board of Asians. He’s certainly in on my plans =) An APAMSA and AMA collaboration ready to go!

3) Talk to a fourth year next week. He was a very active member of APAMSA years back, and I’m sure he’d be interested in getting something started. He has connections with clinics in Flushing. Now there’s a start.

4) Write that Hepatitis B Grant Application by the end of December for money. Not likely it’ll be for screening just yet, but perhaps for an Educational Event for hosting talks.

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