Doctor's Notes


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Repeal of the Affordable Care Act and Impact on Community Health Centers

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The Charles B. Wang Community Health Center Executive Team would like to respond to concerns about the impact to community health centers and our patients if the Affordable Care Act (Obamacare) is repealed by the new Administration.

Federally qualified health center advocates believe that Congress and the newly elected president will end some key provisions of Obamacare.  However, how much is changed or undone is not clear.  Any plans to repeal and replace Obamacare will take time; it can take up to two years for Congress to agree to major changes and for the president to get a new program in place.

It is hard to predict exactly how the changes will impact primary health care and our communities. However, we do know that the community health center movement in this country is strong and growing.  Throughout the past five decades, federally qualified health centers have thrived and expanded under both Democratic and Republican administrations.  We remain optimistic that the progress that we have made in ensuring accessible, high quality health care for the people who need it most will endure.  Our staff understands our mission and is the reason why we are able to provide great care to all, regardless of ability to pay.

The repeal of Obamacare will mean that many individuals and families could lose their health insurance coverage.  Now, more than ever, federally qualified health centers must continue to expand our service capacity so that we can take care of more patients. With the support of our board of directors, the Charles B. Wang Community Health Center has been working hard to develop a new site in Flushing.  This expansion project will put us in a stronger position to meet the community’s current and future health care needs.

Today, as on every day, the Charles B. Wang Community Health Center affirms our mission by doing our best to meet our patients’ and community’s needs.  We have an outstanding staff, a committed board, and many collaborative partners.  In the coming months and years, we will work together to make sure that we continue to help the lives of our patients and improve the community’s health. We will work together with other New York City, New York State and national groups to support an inclusive health care system that protects all of our residents regardless of their language, culture, economics, or immigration status.

Executive Team – Jane Eng, Dr. Perry Pong, Betty Cheng, Regina Lee, Lynn Sherman, and Kenneth Shieh


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Why We Support Asian Americans Living With Diabetes

shutterstock_112727437Asian Americans are at high risk to develop Type 2 diabetes. As with many health disparities faced by Asian Americans, the Charles B. Wang Community Health Center provides specialized care for our diabetes patients. We talked to Registered Dietitian and Certified Diabetes Educator Daniel Wong, RDN, CDN, CDE, about our diabetes care program—and what having a patient-centered medical home means for our community.

DN: What is your role in supporting our patients managing diabetes?

DW: I am referred both patients who are pre-diabetic and those who have diabetes. Some of our patients manage their diabetes well; some do not manage diabetes well at all. I support them on insulin injection and blood sugar checking skills, creating exercise plans, and managing their diet through meal planning, portion control, and reading food labels. I also educate them on foot care, eye care, and dental care, which is all affected by diabetes.

DN: What are barriers that diabetic Asian Americans face to manage diabetes?

DW: There are socioeconomic reasons that make it difficult. Many of our patients are Chinese American immigrants, who work long hours and have difficulty making time to go to the doctor. Some are under-insured or have no insurance. Some do not visit a doctor for decades, and at that point they may not know they have diabetes or that their diabetes is uncontrolled.

I also find that there are cultural barriers. Chinese Americans don’t like to take medicine—they think it is unnatural and often think medications damage their bodies.  When our patients are diagnosed with pre-diabetes, they turn to herbal medicine and traditional Chinese remedies. After a few years of this, their pre-diabetes turns into diabetes.

Like in many cultures, diet can be difficult to change for Asian Americans. Cutting down on starches such as rice, noodles, and bread is hard when it is a staple part of their diet. Also, Asian Americans have a lower BMI cut-off to be considered at risk for diabetes. If a doctor is not familiar with this, their Asian American patients at risk for diabetes can easily be overlooked.

DN: Can you tell us about a patient who you had success in breaking through these barriers?

DW: We had a patient in his 30’s who came in with pre-diabetes. We didn’t see him again for three years. When he finally came back, his pre-diabetes developed into uncontrolled diabetes. His blood sugar was alarmingly high. His absence was due to being incredibly busy, and feeling like he didn’t have symptoms worth visiting a doctor. This is very typical for my diabetes patients. He came to see me to learn how to take his insulin, to check blood sugar at home, and how to manage his diet better. After learning about the severity of his diabetes, he cut out starch completely and experienced low blood sugar symptoms. This isn’t necessarily good either. He lost a lot of weight in a very short period of time. We worked together on medication management, meal plans, a balanced diet, and integrating exercise into his lifestyle. Within a month his diabetes was controlled and managed.

 DN: Charles B. Wang Community Health Center is a patient-centered medical home. What does that mean for our diabetes patients?

DW: Charles B. Wang Community Health Center truly does have comprehensive services, especially for those with chronic conditions that need extra care. Most people living with diabetes have a doctor who treats their condition.  In addition to our clinical team, we have case managers and a dietitians, like me, who educate and support our patients to managing their diabetes.  We have certified diabetes educators who host diabetes support groups, workshops and provide individual counseling. We have social workers that will work with our patients to get health insurance, if that is an issue.  Some of our diabetes patients have depression as a result of their diagnosis. We have therapists to support those patients.  All members of our team provide language and culturally appropriate care.

As a Federally Qualified Health Center (FQHC), we are held to a very high standard of care. Having improved health indicators is both important to us and expected of us. As a result, we provide top quality services to community members who really need them—like those living with diabetes.


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Coping with Breast Cancer

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Written by Josephine Tong

About 1 in 8 women (12%) will develop breast cancer. Breast cancer impacts not only the individual, but also the individual’s personal relationships. A breast cancer diagnosis can be scary, but learning how to cope with this illness can help you better manage your physical and emotional health.

Facing the diagnosis of breast cancer is never easy. Initially, you may feel that you have lost control of your life and are overwhelmed with some of the medical decisions that have to be made.  However, learning about breast cancer and discussing treatment options with your doctor can help you feel more informed and in control.

Coping with breast cancer may be a challenging journey, even for the strongest people. You may feel a mix of emotions such as confusion, anger, fear, sadness, loneliness, or hopelessness. This is in addition to some of your worries like the side effect of treatments, the medical bills, or your children’s future. All of these worries may keep you awake every night, but you do not need to face these challenges alone. You may ask your family and friends to be there by your side to support you through these times. You might consider seeking extra care and support from your doctor or other professionals like social workers or psychotherapists. If you are still concerned by the negative emotions and feel overwhelmed by your current condition, joining a cancer support group may also help.

Cancer support groups are led by professionals or trained cancer survivors.  It allows you and other patients with similar diagnoses to meet on a regular basis. The conversations in the group are about some of the experiences and feelings that you and other members might be going through. As you attend more sessions and gain more comfort in the group, you will begin to notice reduced feelings of anxiety, stress, depression, pain, and fatigue. The support group will also let you learn from each other on how to cope with the challenges of cancer, which may help you feel happier with your self-image and be more in control of your life. Research has also shown that breast cancer patients will have better survival rates as they increase ways of social support, including cancer support groups.

At the Charles B. Wang Community Health Center, our breast cancer support group is called Rainbow Club, and has shown to be a valuable resource to many of our patients. One Rainbow Club member shared, “After joining the support group, I can relate to other members about how I feel so I no longer feel scared or alone.” We invite all breast cancer patients, all women diagnosed with breast cancer, and breast cancer survivors to join our support groups located in Flushing and Chinatown. You do not have to be a health center patient to attend the support group. Please call 212-941-2233 ext. 2533 for more details. By joining a breast cancer support group, we hope that it will lead to happier and healthier lives, along with building mutual support between other women going through similar circumstances.

Click here to learn about upcoming Rainbow Club meetings.

Josephine Tong, LMSW is a clinical social worker at Charles B Wang Community Health Center. One of her current roles is overseeing program development with the Komen breast cancer support team and the director of social work, Manna Chan.


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Celebrating Disability Pride

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Written by Lilian Lin

Throughout July, we took part in celebrations that honored the 26th Anniversary of the Americans with Disabilities Act. These events were especially meaningful to us because of our efforts to support families with children with special health care needs.  Spearheaded by the Health Center’s Pediatric Special Needs Team and generously funded by the family and friends of Mrs. Vicki Chang, the Special Needs Initiative is a comprehensive effort aimed to meet the multiple challenges faced by Chinese immigrant parents and caregivers of children with special needs. Through providing parent workshops, training programs, referrals to parent networks, and enhancing community collaboration, the Special Needs Initiative engages, empowers, and improves services for immigrant families with special needs children.

One of the major goals of this Initiative is to bring about systematic changes to address the complex barriers to care for children with special needs. To date, our Special Needs Team has built collaborative relationships with several community service agencies in Manhattan and Brooklyn that serve children with special needs and their families. Taking part in advocacy activities, such as the July Disability Pride Month events, has strengthened the voice of the disability community.

On July 10, 2016, the Pediatric Special Needs Team and two Health Center volunteers participated in the Festival of Fun and Fraternity which took place at Madison Square Park following the 2nd Annual New York City Disability Pride Parade.

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The New York City Disability Pride Parade was started in July 2015 by Mike LeDonne, jazz pianist and Hammond organist, to promote inclusion, awareness, and visibility of people with disabilities, and to celebrate the anniversary of the signing of the Americans with Disabilities Act (ADA), legislation that demands equal access and equal treatment of people with disabilities.

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Our team set up a booth to distribute free educational materials about issues related to children and teenagers with special needs, as well as provided fun activities, such as bubble guns and temporary tattoos, to attract visitors of all ages. Our booth had a great turnout from individuals, families, and staff from agencies serving individuals with disabilities and their families.

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On July 24, 2016, the Pediatric Special Needs Team and three Health Center volunteers participated in the Chinatown Weekend Walk Disability Pride ADA Birthday Party which took place in Chinatown on Mott Street (between Canal and Worth Streets). Many cultural organizations and local businesses joined together to celebrate the diverse disability community and the 26th anniversary of the ADA.

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We appreciated joining this opportunity to raise awareness of the rights of people with disabilities and celebrate diversity among the Chinatown community.

Lilian Lin is the program coordinator of the Special Needs Initiative at the Charles B. Wang Community Health Center. She has an MPH in Sociomedical Sciences from Columbia University Mailman School of Public Health. She is passionate about working with people and supporting families.

 

 

 


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Summer Fun in the Sun – UV Safety Tips

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Written by Erica Wan

Though summer is a great opportunity to unwind and spend some time with family on the beach, it is important to remember that more time outdoors means more sun exposure. Sunlight is a great source of vitamin D, but ultraviolet (UV) rays from the sun can also damage your skin, causing premature aging, wrinkles, and an increased risk of skin cancer. UV rays can even be a concern even on cloudy days, as up to 80% of UV rays can pass through clouds. Here are some tips for having a fun, relaxing summer without the sunburn.

Monitor UV levels. It’s a good idea to check how high UV levels are in your area for a better idea of how to prepare and what activities to plan for a given day. You can find the UV index for your local area in the weather forecast or on epa.gov.

Use sunscreen. Sunscreen is one of the best ways of reducing UV exposure. You should use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30.  Broad spectrum means it protects against the major types of UV rays that cause damage (UVA and UVB). Don’t forget to check the expiration date on your sunscreen, and consider using a water-resistant sunscreen if you will be in the water. Since sunscreen can wear off, it’s important to reapply throughout the day, especially if you swim or exercise.

Cover up. Wearing clothing such as long-sleeved shirts or long pants will help protect against UV exposure. Tightly woven fabrics offer better protection against UV exposure.

Accessorize with sunglasses and a hat. A wide-brimmed hat can help protect the sensitive parts of your face, neck, and ears from too much sun exposure. UV rays can also damage your eyes, increasing your risk of developing cataracts. Opt for UV-absorbent sunglasses to protect your eyes; most sunglasses sold in the U.S. offer broad-range protection against UV rays.

Limit exposure, and stay hydrated!  Generally, UV rays are the strongest from 10am to 4pm. If you have to be out in the sun during this time, don’t forget to take breaks in the shade. It’s important to stay hydrated throughout the day, so you lessen the risk of heat exhaustion or heat stroke. Check out our tips for healthy summer drinks. Keep drinking, even when you’re not thirsty.

Now that you’re all summer ready, get out there and have some fun!

Written by Erica Wan. Erica is currently a health education intern at the Charles B. Wang Community Health Center. She is studying Biology, and Culture, Health & Science at Smith College, with an interest in immunology and medicine.


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Let’s Talk About Colon Cancer

 

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Written by Dr. Ady Oster

People do not talk about colon cancer very much.  Perhaps this is because it’s embarrassing to discuss, perhaps because they do not know much about it. That is a shame, because colon cancer is common and it is one of the most preventable cancers.

Colon cancer is the fourth most common cancer among Asian Americans, for both men and women (after breast, prostate, and lung) and (because it is more deadly than prostate cancer) colon cancer is the third most common cause of cancer deaths. While a few people with colon cancer have family members who also had colon cancer, most colon cancer occurs in people who do not have a family history of this cancer.

Cancers occur when a group cells grow out of control. Initially, they remain in one organ forming a lump. In time they can spread to other organs.  Most cancers are much more easily treated when they are still in one organ. Colon cancers start as a polyp. These are small, warty-looking bulges in the inside lining of the colon.  Over time, some of these polyps can become cancers (10% in ten years), invade the lining of the colon, and eventually spreading to other organs. Because polyps are small, they do not cause pain, diarrhea or constipation.  It is impossible to feel polyps.  The only way to know if you have a polyp is by having a doctor look at the inside of the colon.  If polyps are removed, they can no longer become cancer. Therefore, the best way to prevent colon cancer is to have a colonoscopy to look for and remove polyps.

Most polyps and cancers cause bleeding (not visible) into the stool. Usually it is too small to be visible, but it may be detectable with special stool tests. Another way to look for polyps or colon cancer is to have stool tested for microscopic blood. Older tests required eating a special diet for several days and collecting several stool samples. Newer tests do not require any special diet and only one stool sample. If any blood is found, a colonoscopy will be required to find the source of the blood and remove any polyps that are found.  If no blood is found, stool tests will need to be repeated every year in order to provide adequate reassurance that no polyps or cancers are in the colon.

During a colonoscopy, a doctor uses a long, flexible fiberoptic scope to examine the entire colon.  If any polyps are found, they are usually removed at that same time. Since polyps take several years to develop and will take even longer to become a cancer. People without any polyps can safely wait ten years between each colonoscopy. People who do have polyps will need to have colonoscopies more often, depending on how many and how big these polyps were. People are usually sedated for a colonoscopy, so most people do not remember having the procedure.  Unfortunately, in order for doctors to clearly see the lining of the colon, it must be cleaned of any stool. Therefore, people are asked to drink only clear liquid on the day or two prior to the test. On the evening before the test, they need to drink medicine that cleans the stool in the colon by causing diarrhea. This can be uncomfortable for a few hours.

The risk of cancer increases with age. Most people should begin testing for polyps or colon cancer at age 50.  People who have family members with colon cancer should talk to their healthcare provider about the right age to start.

Despite the embarrassment or discomfort, it is important to talk about colon cancer. Talk to your primary care doctor about whether colon cancer testing is appropriate for you.  Talk to your loved ones to make sure they have talked to their doctor about colon cancer. You can make an appointment to meet with a primary care provider here at Charles B. Wang Community Health Center by calling (212) 379-6998 for Manhattan, and (718) 362-3006 (37th Ave) or (929) 362-3006 (45th Ave) for Queens. For more information, visit the internal medicine webpage.

Written by Dr. Ady Oster. Dr. Oster is the section chief of internal medicine at the Charles B. Wang Community Health Center. He received his medical degree from the Albert Einstein College of Medicine, and completed his residency training at Yale-New Haven Hospital and University of California at San Francisco. Dr. Oster is board-certified in internal medicine.


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Man Up – Talk to Your Doctor About Sexual Health

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Written by Dr. Gail Bauchman

Women are more likely to see a doctor for regular check-ups than men, and yet it is so important that men have regular checkups to discuss all aspects of their health. Sexual health is one area that is incredibly important for men to understand. As a doctor at the Charles B. Wang Community Health Center, here are a few aspects of sexual health that I discuss with male patients.

When you see your health care provider for a routine physical exam or to be screened for sexually transmitted infections (STIs), you will be asked some rather personal questions. These questions are important for your provider to better understand your health risks and provide the best possible treatment.  Some of the questions may involve your sexual practice. For instance, what are you doing to prevent pregnancy? What is your partner using to prevent pregnancy? How many partners have you had in the last year? Do you have sex with men, women or both? What do you do to protect yourself from sexually transmitted diseases and HIV?  Do you know how to use a condom appropriately?

Condom use offers protection against some sexually transmitted infections, including HIV infection. They also offer some protection against pregnancy, but condoms along with the withdrawal method are considered to be the least effective methods to prevent pregnancy.  About 18 women out of 100 will get pregnant within the first year with condom use.

That is why it is important to know what your partner is using to prevent pregnancy. Your health care provider can help answer your questions about contraceptive methods for both you and your partner and help you decide on the most suitable methods. Learn more about birth control and family planning by reading this factsheet.

Question: if the condom breaks and your partner is not using an additional contraceptive method, do you know what to do next to protect her from getting pregnant? The answer is having your partner use emergency contraception.  One of the easiest options is if you or your partner buys a pill that does not require a prescription, called Plan B. The pill should be taken within 5 days of having unprotected sex, but the sooner it is taken the better. Plan B is not 100% effective, but does help reduce the chances of pregnancy.

Your provider may also ask you questions about whether you ever had any STIs. STIs can be transmitted through vaginal, anal, and oral sex and many of them do not cause symptoms, at least in the beginning.  If you do have symptoms such as urinary frequency, discharge from the penis or ulcers on the penis, seek out medical care to get treated. A urine sample is all that is required to test for the most common STIs, such as chlamydia and gonorrhea. Without testing and treatment, you may unknowingly pass these infections on to your partner. Chlamydia and gonorrhea can cause a serious pelvic infection in women that may lead to infertility. Some STIs in pregnant women can also impair fetal development or be passed on to their babies during childbirth. Learn more about STI’s by reading this factsheet.

For the protection of yourself, your partner, and your child, we encourage all men to receive annual physical exams and be screened for STIs whenever they have a new partner.

Come visit us at the Charles B. Wang Community Health Center to get your annual check-up and discuss these as well as other important health issues. Our OBGYN department offers family planning services and counseling to both men and women to help you improve your sexual health and achieve your reproductive life plan, whether you are seeking to have children or preventing pregnancy. You can make an appointment at our OBGYN department by calling (212) 966-0228 for Manhattan or (718) 886-1287 for Queens. Find more information by visiting our OBGYN webpage. You can also make an appointment to meet with a primary care provider by calling (212) 379-6998 for Manhattan, and (718) 362-3006 (37th Ave) or (929) 362-3006 (45th Ave) for Queens. Visit the internal medicine webpage.

Written by Dr. Gail Bauchman. Dr. Bauchman is a physician at the Charles B. Wang Community Health Center. She attended Stony Brook Medical School, and specialized in family medicine. She is board certified from the American Board of Family Medicine.