Hi All,
This Thanksgiving I decided to participate in a service learning through Stanford. The trip I ended up going on is focused on what we call "The Silent Killer": Hepatitis B. How familiar are you with Hepatitis B? I must say, before this trip I knew almost nothing about it. I've learned a lot over the last few days and have gotten to participate in some very novel experiences.
Here's some background about Hepatitis B: The disease has a low overall prevalence in the US, it is actually the biggest viral epidemic in the entire world. The main hot-spots of endemic prevalence are in Asia, the Pacific Islands, and Africa. In fact, 1 in 12 Asian/Pacific Islanders is infected with HBV. And sadly, over 2/3 of them don't know it because the disease is asymptomatic until it's too late. The virus finds its home in your liver, over time damaging it and causing mutagenesis. Hepatitis B is considered an onco-virus; it is the leading cause of liver cancer. This why we call it "the silent killer," because most often a person does not know they are chronically infected until they have symptoms of late-stage liver cancer or liver failure. Transmission of Hep B happens through blood, to blood contact, sexual contact, or--most commonly--from mother to child during birth. Luckily, all children born in the United States after 1992 (and many before 1992) have been vaccinated against the virus. However, in the U.S. we still have a high prevalence in the Asian/Pacific Islander community. This problem is especially pertinent where I live. Asians make up 37% of the residents of San Fransisco, and because of Hep B, San Fran has the highest rate of liver cancer in the entire United States. Hepatitis B is a staggering example of a health disparity apparent between ethnicities in the US. What's most frustrating about this epidemic is that we have a vaccine to prevent the disease, and drugs to control it and prevent liver cancer and liver failure. These tools to fight the epidemic were developed 30 years ago...so why haven't we tackled Hep B?
So, to learn more about this health disparity, our trip tried to look at the issue from a few different angles. On day one, we visited/volunteered at a Hepatitis B free screening event in East Palo Alto put on by the organization Hep-B-Free San Mateo. Since Hep B is present in asian pacific islanders, the screening targeted population of Samoans & Tongans. It was very interesting to see how the screening worked, and learn about the benefits of screening at-risk populations. Especially since most people don't know they are infected, allowing mothers to easily pass the virus on to the next generation. On day two, we shadowed heptologists (liver doctors) and transplantation specialists at Sutter Pacific Medical Center and San Francisco's Chinese Hospital. It was crazy to learn about how expensive a liver transplant is, especially in comparison with how inexpensive a screening and vaccination would have been. I should add here at liver cancer is an extremely deadly form of cancer, and that if you have it, or liver failure, to survive you have to get a liver transplant. In the end, our lack of prevention of the spread of this disease is costing our health care system a lot of money. Day 3 was focused around the legislative process, and being an advocate for HepB. Our group broke up into pairs and made visits to legislative offices of state senators and one national senator. We sat down with the senator's staff in charge of health and made our case for the support of Hepatitis B awareness and the need for funding. The staff we talked to were very receptive and interested to learn about Hepatitis B. It was perspective changing to feel like I was actually being involved in the legislative process, that I could make a difference by bringing this health disparity to the attention of major state players. Later that day, we were also able to visit in person with State Assembly-woman and Hepatitis B champion--Fiona Ma. I was excited to be able to talk to her about Hep B, and issues beyond, and about how difficult the legislative process can be. Today is the last day of our trip, and we will be cooking dinner for a group of Hepatitis patients who will be telling us their stories of Hep B, to give us a more personal look into the disease.
This trip has really challenged my definition of "service," and made me reconsider how I view approaching health disparities and other public health issues. I think most of all everyone in our group has had to grapple with the reality that getting funding for a project is so, so difficult, especially if it is not on the forefront of the public attention. I'm glad that I was able to educate myself about Hepatitis B in this unique setting, and I encourage everyone to educate themselves and support the effort to eradicate this blatant health disparity from the United States.
