Disparities Facing Asian-Americans in the Healthcare System: Frances Kai-Hwa Wang



okay thank you very much for having me here it's a great pleasure for me to be here with you I wanted to start with a story about the importance of Asian Pacific American doctors and the difference you can make with one voice one alternate perspective oops wrong nigger okay hey wait wait wait what did i do I was working ah there we go here we go so this is my oldest daughter mango when she was a few months old when mangoes about nine months old we moved back to Ann Arbor from Katmandu and were assigned a new pediatrician a resident who was concerned that her weight was only 25th percentile now the baby was obviously healthy and growing but to be sure the pediatrician had us come in for monthly weight checks we were nervous new parents so of course we did what we were told even though we knew that she was healthy and thriving I mean look at that right so the young pediatrician had us force feeding her things like tablespoons of cream cheese to try to fatten her up after a few months of worry we happened to pass by her supervisor in the hallway and her supervisor happened to be multiracial Japanese American woman who said oh no those weight charts are for white babies of course a hapa baby is going to weigh less but of course that's not what the chart says at top right it says you know it's a weight chart it doesn't say it's for white babies so it was so obvious as soon as she said it but before that all my Asian American friends and I had been comparing our babies Oh mine's first percentile what's yours Oh mine's third percentile so mine was huge a 25-percent Tyler we didn't know the right questions to ask and it but it only took one Asian American doctor to see similarly it only took one doctor in Flint plus an investigative reporter and a research university to know the right question to ask about the water in Flint ironically dr. mona hanna-attisha got the idea to test the children of Flint for blood lab lead levels at a dinner party with a friend who happened to work at the EPA conversation connection issues of race and class are so obvious once you see it fifty-seven percent of the people in Flint are african-american forty-two percent live in poverty yet until you see it you have you have to know the right questions to ask the undocumented immigrants in Flint did not even know about the lead in the water likely because of language barriers and they are afraid to get the free donations of water because distribution sites are asking for ID before they give out the water and today was in the news that there's an outbreak of TB and Alabama another very poor african-american neighborhood meanwhile the guys in Oregon are going on three weeks and still asking for snacks as young asian pacific american medical students you stand at the confluence of history and family and cultures with so much privilege and so much potential anything is possible but it takes courage and intention you are so important to our communities and to our future and unlike some of us you actually have skills mad skills and so you've been talking about disparities facing asian-americans in the healthcare system all day today so now how about taking on those disparities facing asian-americans in the healthcare system in order to figure out what kind of badass Asian Pacific American doctor you might want to be it is important to know who you are learn from the communities from where you come and from the communities that are around you and dare to be a leader and advocate for all our communities first what do I mean by know who you are I have to confess that unlike you perhaps I I never had any interest in becoming a doctor nor was i pressured by my family to be a doctor like many are my childhood friend shall ma was the doctor she always knew and grew up to become a pediatrician that's her on the left and on the right is Malto he was always the test subject for our new mud pies and medical treatments and me I was always the dog so forgive me if if some of my examples are too pedantic for you but I'm coming at it from a different angle but different angles are good so aside from that I think my background is a lot like yours I was born and raised in California the oldest child of immigrants my parents were born in china grew up in taiwan and came to the states for graduate school pretty typical immigration pattern we spoke chinese food at home and ate Chinese food I called all my parents friends ie in mobile auntie and uncle I learned English by watching Sesame Street and I learned American culture by watching television sitcoms like happy days I wasn't allowed to date in high school and then later I was asked what was wrong with me that I wasn't married yet at 22 the struggle you know the struggle right and every Saturday morning I used to attend Chinese school with all the other ABC american-born Chinese kids it seems so weird to my regular school classmates that I remember one blonde girl stamping her foot in existing but it's against your constitutional rights to have to go to school on a Saturday but the Jewish kids who had to attend Hebrew school on Wednesday afternoons they understood they could make the connection and when I was in high school news we published an article about high asian-americans where the model minority naturally good at math and science not good leaders I was so naive that I thought that if it was published it must be true my father looked at me and said China has a four thousand year history who do you think was running in it had never occurred to me to question what I read what I had been taught that there might be another point of view later in college as I started living with roommates I began to see that my parents way of doing things was not the only way when I made orange juice I poured in the orange juice concentrate at a three cans of water and then mix it with a chopstick right how else do you make orange juice at first my roommates laughed at what they called my Chinese swizzle stick because they had grown up mixing orange juice with a spoon but you know the spoons are too short right and you always get orange juice all over your hand so it was soon we were all mixing the orange juice with chopsticks at the same time my roommates fretted about how to make rice on the stove how much rice do you put in how much water how long do you cook it is it okay to lift the lid they're really uptight about lifting the lid I don't understand why um and then so I'm like I don't know use a rice cooker like normal people and and this is just an aside but did you know that not everyone saves the blue rubber bands from the green onions they're actually people who throw them away and then they go to office max and by rubber bags but we are not wrong for doing things differently than the mainstream so even though I was a terrible Chinese school student for some reason I started taking Chinese again at Berkeley almost immediately when I went to college I to also took courses in Asian history and political science and philosophy those courses gave me a historical framework and timeline on which to hang my parents lectures and my grandparents stories before that all I had were a few funny little stories like the one about the time when my grandfather who was in nationalist Air Force got shot down and had to parachute out of his plane only to realize he was about to parachute into a lake and he couldn't swim or the reason that my grandmother had such small fee was because they had only been partially bound not completely just little funny stories until I acquired the historical context to give the meaning when I came to graduate school at mission university of michigan how many people are from somewhere else not michigan ok so you know so i was still pretty naive i thought of myself as overseas Chinese or wachau and I still didn't know anything about other agent cultures or about Asian American Asian American coming from California I did not have much experience with being a minority or with racism and I just couldn't process some of the odd experiences that I was having what saved me was stumbling upon you of m's first Asian Pacific American Studies course learning about the history and the literature of our shared experience helped me realize that I wasn't crazy that it wasn't my fault and that there was more going on than i could see again I learned the historical context in which my parents came to the United States I understood the contributions of asians that came 150 years before us and for the first time I read literature that reflected my own experience like Maxine Hong Kingston woman warrior where she talks about being quiet in a in school but running wild and hanging upside down from the fire escape at chinese school so think about your experience and the collective stories of your family take those experiences and extend them to others see the parallels and the connections often these are the same stories and the same challenges just accented by different languages and different foods think about your privilege and as much as we fight against the model minority stereotype no matter how poor our families might have been while we were growing up we are all privileged in different ways at minimum because we speak English and we are educated and that is huge once you recognize and acknowledge it this is why whenever I find a Janie's grandma or grandpa who doesn't speak what English and is lost or struggling to communicate with a store clerk I always stop to translate it only takes a few minutes of my time but I do it because my own grandparents live far away and I can't help them and because it reminds me what a gift I have and as an aside let's get that no as an aside if you happen to have a pretty model minority background and and you know and if you can't see how invisibly privilege runs through your life and friends and reading don't help you to see then run some experiments and put yourself in other people's situations to see what does it actually feel like to be in a place where no one understands your language to have to ask for food in a food bank in this day and age to not use water out of the tap for one full day to be treated in a low-income medical facility where the protocol is for the staff to follow you to the bathroom while you do your drug test and then go and flush the toilet for you so they can make sure that you used it and I won't even talk about the humiliating paper gowns my ridiculous paper shorts also consider that Western medicine and teacher and your teachers do not know everything when I was in graduate school anything that was not analytic philosophy that is anything that was not english from England was dismissed as Eastern and anything Asian was Eastern mysticism there's probably oriental mysticism in those days there were many times when I had a hunch the professor was wrong but I was just a student I didn't know how to frame the argument or answer the question and it certainly wasn't ready to take on all of Western philosophy all caps you know there are thousands of years of medical research in these herbs but it's just written in another language but many of them do work other maybe not the big danger species ones but but many of them work right or people wouldn't keep using them I used to not believe but my aunt dragged me to see all these Chinese doctors one time because she of course was convinced I was dying and you know they took my pulse of a Chinese doctor to think that you sit there they take your pulse and they say okay this is what's wrong with you right and they know and they and then they prescribe all these herbs for you and they were right right and the medicine worked so the trick is to figure out which trim which traditional remedies are useful and then to appreciate the cosmic the the complex cosmology or worldview behind it that might be informing your patients second learn about the communities from where you come and the communities around you my friend Ryan Sudha owns a company called black lava that makes asian pacific american themed t-shirts and one of the most popular ones is the one that reads did you eat means i love you this is an idea that crosses so many cultures think about how many times you have gone to see your grandma or your auntie or your mom and they say did you eat and you answer yeah I already ate and then they feed you again anyway right there's no stopping though don't even try it's a cultural thing right and this crosses many cultures it's not just an Asian thing so we all have that connection so learn as much language as you can and what things actually mean beyond the words I have three older cousins who I like to joke are the perfect Chinese family three sons one lawyer one businessman and one doctor all hugely successful and incredibly rich largely because they can speak Chinese even though they can't read or write it my oldest cousin the lawyer was put in charge of the Pacific Rim division of this big law firm primarily because he can speak chinese and make pleasantries with people make them feel comfortable my second cousin the businessman does import-export between China and Australia and he married into the tiger balm family so I was like super rich ok and then so Mary well that helps to my third cousin the doctor now he also speaks Spanish because when their immigration pattern went by way of Argentina so he speaks Spanish and Chinese and he opened a geriatric health clinic in Los Angeles ok you already know the answer to this one right he caters to elderly Chinese and Latinos who don't speak English and he has a very long wait list of people and they only want to see him because he's the only one they can talk to also read the stories and literature oh and then there's there's also you know language comes into play all the time this is a poor Indian grandpa and Alabama who was who was partially paralyzed by police because he didn't didn't speak English and there's no federal hate crime crime charges because you should have known English long story also read the stories and literature and authors of our communities cultures and countries study asian and asian american history and geography find the commonalities and connections to what is going on in the world today and what is going on with your patients they may not know that there is a connection between say exposure to conventional weapons from a childhood during wartime and cancer today and another non asian doctor my not even know that there was a war at that particular country at that particular time or what country the person's from I mean half the people I need around here can't tell the difference between Taiwan and Thailand so while you are this one and so while you are learning about our and other cultures and communities challenge yourself to take a global or international perspective and develop critical thinking skills there's no one right way of doing things but it just so happens that American or me or Western culture is very loud all around us so unless you look at things from a different perspective you might not even notice always ask who is missing from this picture this is a much more difficult skill than just critiquing the results because what you're doing is prety 'king what is not there here's a picture from the completion of transcontinental railroad is in every US history textbook right here's where they drive the bronze spike the silver spike the gold spike all connected by telegraph wire new technology then all the way to Washington DC but we also know that Chinese laborers built half the Transcontinental Railroad but and Irish labors built the other half but they're not here in this picture you don't need Photoshop to make us forget as a society Hercules trying to reclaim that moment during Hurricane Katrina 30,000 Vietnamese Americans were displaced but other than the asian american magazine that i was writing for at the time there was very little news coverage and even less social service help the Red Cross just dumped all of them at the Hong Kong mall in Houston oh look there are some asians over there maybe they can help you and vietnamese american students flew in from all around the country to try to help translate also if you have any sort of committee that is you know supposed to be the diversity committee or the asian-american committee look around and make sure everyone's there if they're if everyone's Chinese you need to get some South Asians that in right if everyone is South Asian you need to get some you know make sure you got Muslims and Hindus you know just make sure everyone is there always ask who is missing and also learn to question assumptions who was actually included in this study what other factors might have been overlooked and what other options are there for example the standard recommendations everyone should get a thousand milligrams of calcium a day or else you'll get osteoporosis you'll be one of those bent little ladies hobbling around right and often the doctor will hand you a sheet of paper with a list of recommendations of good calcium sources in quantity and top of the list right milk cheese yogurt and quantities I would absolutely kill me oh my god right and then they'll say it's okay if you don't drink milk you can get calcium from broccoli and tofu you just need to eat 12 cups of broccoli or three and a half cups of tofu every day who can possibly eat 12 cups of broccoli every day right oh and I added it up five cups of collard greens every day that's insane no yes four of us so then I learned because I'm a journalist so I poke around in these things that Japanese ladies and Northern Japanese fishing villages who don't eat dairy don't get osteoporosis it turns out that one of the reasons you need so much calcium is because red meat leeches the calcium out of your bones so you need to eat more calcium to compensate for that so what if you don't eat red meat what if you're vegetarian what if you eat some meat but not in the quantities that the stereotypical red meat and potatoes type of American would what if you're Asian American but you don't need a traditional Japanese diet you know some of us aren't Japanese right so what if we eat some Asian food in some American food who knows right who was in these studies who knows all we know is the punch line 1,000 milligrams of calcium every day 12 cups of broccoli pro tip from ma my beloved japanese-american hapa pediatrician there's a lot of calcium those little dried fish snack but I don't know why it's not on any of those charts that they give you at the doctor's office often when people talk about lactose intolerance it's embarrassing because you know right and it's talked about as if what is wrong with you that you can't digest milk when really if you look at it globally almost no one can digest milk only just a few isolated hurting communities northern in Europe Tibet Mongolia Kenya Tanzania certain Indian groups that had a genetic mutation thousands of years ago and thus retained the ability to digest digest milk actually when I first start learning about this I had a cute boy I mean a biologist friend who was helping me research this for me and he found out that really lactose intolerance is a function of us being mammals so then if you look at a globe really globally at mammals right we're all born with the ability to digest milk and then after we're weaned we just don't need it anymore because we aren't supposed to be drinking milk anymore so that's why you're not supposed to feed your cat milk right so when you look at it that way it shouldn't even be called lactose intolerance because it's normal not only normal for human beings it's normal for mammals it's those people who I never get to say that word it's those people you know who can digest milk who are the freaks I mean the exceptions right so you have to flip your thinking around and it's it's it's a it's just flip it around and along those lines whenever working with asian american populations disaggregate the data i've got a bunch of activist friends here you can talk to them about disaggregating the data the US Census definition of asian pacific americans includes over 44 different countries and cultures and largely comes out of the way we face the same kind of discrimination and Prejudice here in america but if you break it down by ethnic group you will find that we are an incredibly diverse community certainly not the model minority but in fact we usually have both the highest and lowest levels of whatever issue you're looking at highest and lowest levels of education unemployment health care coverage poverty health status cetera so this is the not covered by health insurance look at the climate looking so here this is the one I mean this is the number of Asian Pacific AAPI asian-american Pacific Islanders without health insurance before the Affordable Care Act Tongans are twenty-six percent Japanese are seven percent and the differences are a function of where do they work are they self employed all sorts of you know what is the the you know all sorts of stuff so it's a huge range poverty rates when you when you put everything together it sometimes it's hard to see again here's asian-american median household incomes we got asian indians at 95,000 Bangladeshi 46,000 huge range and often the way that you owe an undocumented is this some time no no no this is food insecurity huge numbers we don't think of it right so look at Asian Americans is nine percent but a native Hawaiian Pacific Islanders is twenty-four percent overall ten percent of aap is it's a huge number and people don't think of that because this model minority myth which incidentally just celebrate its 50th birthday if that's something celebrate is is a this month right we don't we don't even know it we don't eat no one even knows to ask the questions and we're talking about the undocumented one in eight asian immigrants is known documented undocumented you know all that on documents of this is our this is one of our issues too but people don't think about it so if you're interested there's all sorts of data AAPI datacom Karthik Ramakrishna is on TV all the time he is amazing but oh here's college degrees okay let's let's look at this this model minority stereotype look at the range of young people without a two or four-year college degree Indians twenty percent but Cambodian is sixty-six percent huge difference you should also so so data data is great that they always go back to the data okay also challenge and deconstruct media and social stereotypes it's easy to see how absurd these stereotypes are with all the medical TV shows that have only one Asian in the whole Hospital right so here's 11 asian one asian one asian one asian Mindy one Asian Oh dr. ken is the exception there's like four Asian American doctors there's dr. ken there's his wife his sister Margaret Cho and his wife's ex-boyfriend Willian and and Danny party's coming on soon I don't know if I don't think he's a doctor though but you know he's cute so so you know so if they can't even in these are all big cities so if people in because they can't get this right you know to imagine the more the more i want to say the harder ones to see Oh Perry Shen I I was looking for pictures I know Persia he's like he's but all the pictures of him were shirtless must have something to a general hospital so I looked for a long time it couldn't find any that weren't sure but you know okay we'll leave that went on for a while but there are many other stereotypes that seem more benign that have real-world ramifications in terms of child custody sex-selective abortion bans and domestic violence so Amy to a tiger mother right you guys would have been that age when that came out right a lot of us have Tiger moms but when this came out I said you know this is going to cause so many problems for people down the road if anyone gets caught up in social services they're gonna say oh she's a tiger mom let's take her kids away from her I guess what happened it happened right nan Hey Joe look up the case i'll talk about it later if you want sex-selective abortion bans they say all Asians you know they like they like you know what boys not girls they kill other babies right it's not even true it's not even based on say once they did some studies they found the opposite is true I think it's immigrant Chinese and Indian Korean they actually have more girls than boys and yet with the self selective abortion laws and they're only prosecuting women of color as well so that that's something to look at look up the pervy Patel case there's great stuff on on the arrow Graham calm and and then domestic violence the issues here are there multi-layered right there issues of if so say for example a woman is being you know this is being abused how does she get away right does she is her immigration status dependent the dude it does she have any money can she get a job is she undocumented does she have kids does she have a way to take care of kids can she speak English when the police come does the guy come up and say in his perfect English oh it's just a misunderstanding officer and just kind of talk right over her there are so many nuances there that at all the different layers they have problems so um and then one of the huge advantages I want to end on a good note because that's my depressing part is is when you can look at stereotypes and read through the stereotypes and tell what is real and what is not real right field a huge advantage and you and you become a better doctor as well right I have a friend who's at the medical school here and her sister in San Francisco saw a psychologist and psychologist had diagnosed her as type A personality and so she's telling her sister who's at medical school here in my men and my friend says I bet it was a white male doctor and she oh yeah he was why do you say that he goes because you're an Asian American woman asian-american women by definition are Type A personalities that's just the baseline right and that's not a problem you know he couldn't read through the culture there anyway so as you as you make your way into the medical world dare to be a leader and advocate for all of our communities you will need allies and then you'll encounter trolls but we need you to create community and create change to help care for our asian-american communities and other communities of color pro tip make allies big and small I grew up with few asians and little awareness of being asian-american the day I drove off to college at UC Berkeley my father SAT me down for one last lecture and he said when you go to college remember to make Chinese friends oh god there he goes again trying to marry me off to a nice Chinese boy bah I'm only 17 for once that wasn't his point he explained the first day I joined a new company another Chinese engineer will always stop by my office to introduce himself and take me out to lunch Chinese people will take care of each other in a way that Americans never will now that's a bit extreme and he's you know immigrant generation but think about it and look for look for folks right maybe Asian Americans other Asians other people of color and form those connections another pro tip make sure the big bosses know who you are be useful to them when things are good prove your competence and your worth and then when things are bad and you need their support or maybe if they want to double check whether or not that yellow face Pearl Harbor party might be a little bit racist they will already know who you are and know that you are reliable and you know what you're talking about another pro tip since we're also a beautiful dress extra professionally if you need to appear older to you know be taken seriously and ladies be careful those creepy old agent files but you already knew that and get to know people at all levels don't be so arrogant to think that you're so great because it is only an accident of luck that each of us is here today enjoying a Saturday afternoon of ideas at a medical school ask your families there are so many stories of mists about missed boats and missed bombs that changed everything besides it's really the secretaries and the nurses and the other staff that make things happen I have a college classmate who now runs the Brookings Institute in Washington DC and he gave a speech once about how things would be different if intellectuals ran the world his secretary laughed at him you can't even run the copy machine and how are you going to run the world so don't be that only Asian American in the room ignoring that other only Asian American in the room just because it would be weird to talk to her because she's Asian American right support each other because even when you are in your Senate confirmation hearings to become US Surgeon General you still might be anteed that's a verb anteed by some old white senator from Kansas you ever been to Dodge City Kansas oh I have not served but I would love to come well good I'm going to invite you because we have a lovely doctor from India she's in her mid-30s and she's highly respected by the community and another doctor from India that did my carpal tunnel when I did a stupid thing and so I think you'd be right at home we would welcome you with that to look forward to become Surgeon General yo so you'll need your friends and your allies and community when you take controversial stance and all the trolls come out california state senator dr. richard pan who's a pediatrician wrote the legislation to close the personal preference loophole for vaccinations which was signed into law by Governor Jerry Brown in July there are a lot of other people in favor of vaccinations but the anti-vaxxers came after him and their attacks were decidedly racist but in the end Ilan and the children California are protected yay so dared to be a leader for communities and to advocate across lines of ethnicity and race if you need a Michigan look up Grace Lee Boggs she's a Detroit hero you need to know about her but when the FBI your Chi organized the march on Detroit March which was two weeks before two months before the march on Washington and but the FBI was so confused by her why would a chinese-american woman be working with african-americans on civil rights they didn't get it so her FBI file actually says that she must be afro Chinese because they couldn't come up with any other explanation so right now is a crazy time of Islamophobia and xenophobia bullying and violence and discrimination are rampant against Muslim Americans and those who are mistaken for Muslim Americans against immigrants and refugees anyone who's brown but it could be any of us Fred Korematsu is one of the four people who challenged the constitutionality of the incarceration of Japanese Americans in internment camps during World War two after nine eleven the japanese-american community was the first to stand up for and they continue to stand up for Arab American and Muslim American communities his daughter Karen car mats is coming to the law school on Thursday if you want to come hear her speak we are all in this together what have I got next so don't be afraid to dream to live life to love to create something new poi as we are between so many different cultures we have rich resources that uniquely color everything that we do from our relationships to our studies or politics to our art I think the key is that we all need to learn how to think and how to dream do not let society or your parents or fear make you limit yourself figure out how things work learn to think outside the box dare to take chances get messy think hard be creative be courageous and know that you are be loved and valued by our communities to at the Ann Arbor Chinese school many times older students teach younger students cultural classes like Chinese yo-yo and if you're yo u of m I'm talking about the revolution guys I've known them since they were in middle school and so are really important role ma you are really important role models and caregiver and leaders for the younger brothers and sisters and caregivers for our older generations when my boy DD or little brother was four years old he came running up to me one day eyes bulging and said mommy something terrible has happened Jeff goga that's older brother Jeff Jeff Koga went to college he was he was so so remember that whenever you look out for him for little brother or little sister little they stand when you look out for him little brother becomes a little braver and stands a little taller thank you how cute they are all right well thank you so much yeah I'm here if you want to talk to me I'm fine oh and then a website you can come find me at NBC news.com there's a drop-down menu look for Asian America we're the only mainstream media outlet that looks at asian american issues my blog is Frances kaval Wong com if you know what we have we are fortunate to have the editor of the era Graham here if you if you like south asian literature and arts we also have the the amazing stars of the the hot new podcast good muslim but good muslim bad muslim sorry yeah they're over there so and and Lynn from Mesa from U of M so so come talk to us thank you so much you

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