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BOSTON--More than half of Asians living in Chinatown are uninsured, and the utilization of health care services by Asian elderly people is one-third less than average, panelists told 120 gathered at the Medical School this weekend for what organizers called the first conference to be held on Asian American health issues.
A former gang member and a national expert on AIDS were just two of the panelists who spoke Saturday at "Breaking the Silence," co-sponsored by the Asian Health Association and Ayurveda, the South Asian medical student organization, of the Medical School.
The day-long conference consisted of three panel discussions on issues affecting the Asian American community: AIDS and substance abuse, health care delivery, and violence.
Medical problems specific to the Asian population brought up during the conference included a high incidence of stomach cancer, tuberculosis and hepatitis. But most of the Asian health problems, said the panelists, stemmed from the stereotype of Asians as a "model minority" and the strong cultural pressure for Asians not to reveal their problems.
For example, said panelist Suki T. Ports, who heads various minority AIDS councils, Asians won't go to psychological support groups because it's shameful to do so in the Chinese community. And since being gay is frowned upon in the Asian community, no Asian homosexual support groups exist.
The strong aversion of Asians toward talking about sex also contributes to the spread of AIDS, said Ports, who threw out wrapped condoms into the audience at the beginning of the conference.
Dr. Jean Chin, a panelist and executive director of an Asian community health center in Boston, called for more Asian primary care physicians who could be "culturally competent" in servicing the needs of an Asian patient.
"We have found that being Asian is important [for primary care physicians]," said Chin. "There are certain elements in the context of the visit that makes for more competent care."
Hiep Chu, a panelist and former Vietnamese refugee, said in Vietnam, health care is virtually non-existent, so Vietnamese-Americans do not use health care services until it's too late.
"They won't visit hospitals and doctors even if they're very sick," he said.
Stereotypes and a closed culture both help spread the mistaken belief that Asians don't have health problems, and therefore don't need health care funding or special assistance, the panelists said. "We've had to threaten state departments with lawsuits to get funding," said Ports.
Other panelists said domestic violence, anti-Asian violence, and substance abuse were also not recognized in the Asian community because of the "model minority" myth.
For example, a Japanese exchange student killed in California was left dead with his wallet and belongings, yet the police still insisted it was an attempted robbery rather than a hate crime, said Helen Zia, former executive editor of Ms. magazine and currently director of an Asian women's shelter.
Atul Gawande, a third-year Medical School student and former advisor to the Clinton task force on health care, urged Asian-Americans to concentrate on universality and cost-containment rather than specific issues.
"Overall, improvements in longevity and health status for Asians have lagged compared to the average Americans," Gawande said.
Gawande said Clinton's plan would do the most to improve these problems with Asian-American health care. For example, capping business expenses on health care at 3.5 percent of gross revenues would help the many Asian Americans employed by small businesses.
Conference organizers said they weren't sure why Asian Americans have been so silent on health care issues, but suggested a variety of theories.
"Because the Asian population is so diverse, so spread out across the country, it's difficult to bring them together as a movement," said Andrew T. Chan, co-chair of the Asian Health Association.
Student reactions to the conference were mixed.
"I think the issue of primary care is very important, and we have to be able to admit that we're part of the problem," said Katrina R. Liu, a fourth-year student at the Boston University School of Medicine. "We never hear anything about the Asian community."
But other students were disappointed. "Since this is the first time we're having this, it's difficult to accomplish anything," said David S. Lee, a second year student at the Boston University School of Medicine. "They're reiterating a lot of the issues we already know, so it's not effective in getting grassroots support."
Conference organizers said that discussion of Asian American health issues was important because so many Asians work in the medical community. For example, said Patricia K. Lee, a second year medical student and conference organizer, about 20 percent of students at Harvard Medical School are Asian.
"There are a lot of Asians and Asian Americans in the health field and medical schools, but a real lack of discussion of their health concerns," Lee said. "We felt it was important to begin discussion of these issues.
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