Immigrants are America’s Past, Present, and Future

Written by Jane Eng, CEO

I grew up in an immigrant family.  My parents operated a hand laundry in Poughkeepsie, New York.  Sadly, my father passed away when I was in high school.  My mother was left with the responsibility to raise four children.  Despite the challenging circumstances, she made sure that all of her children went to college and beyond.  Today, my siblings and I are contributing members of our communities.

Jane Eng’s brother in front of Eng’s Hand Laundry.

My family’s immigration history is not unique.  People from around the world have come to this country seeking freedoms and opportunities woven into the American dream.  The first generation works hard, and many make great sacrifices to secure a better future for their children.  In doing so, immigrants contribute to the rich diversity of cultures, backgrounds, skills and experiences that makes this nation great.

In New York City, immigrants have helped revitalize neighborhoods such as Coney Island, Jackson Heights, Flushing and Sunset Park, and account for about $250 billion of economic activity annually.  About 20% of Fortune 500 companies in the United States are founded by immigrants.  Many of these firms have a strong presence in this city.

Immigrants are also playing an important role in helping New York meet its healthcare workforce gaps.  One in three physicians in New York graduated from a foreign medical school, a sign that they were born outside the United States.

Immigrants are bringing vibrancy to the cultural life of this city through food, songs, dance, music, and other performing arts.  Their economic and cultural contributions have made New York a truly international city.

Jane Eng with her mother and brother inside Eng’s Hand Laundry.

Today, I am proud to give back to immigrant communities by working at the Charles B. Wang Community Health Center.  The Health Center provides high quality primary health care to all patients regardless of language, culture, age, disability, gender, sexual orientation, immigration history, or ability to pay.  More than 85% of our patients prefer to be served in a language other than English.  I truly believe that the Health Center’s success is due to our staff’s unwavering commitment to excellence and our ability to deliver linguistically accessible and culturally effective services.

2016 Grand Opening of CBWCHC 45th Ave site in Flushing, Queens. CEO Jane Eng is 8th from left.

The Charles B. Wang Community Health Center has served a vital role in meeting the health care needs of Asian Americans and other immigrant communities for more than 45 years.  My hope is that we will continue to be a vital force in building healthy immigrant communities for many more decades to come.

Jane Eng is the chief executive officer of the Charles B. Wang Community Health Center. A graduate of Harvard Law School, Jane has been involved with the Health Center since 1975. She is a board member of the Association of Asian Pacific Community Health Organizations (AAPCHO) and Community Health Care Association of New York State (CHCANYS).

Repeal of the Affordable Care Act and Impact on Our Patients

Written by Maria Bryan

The Charles B. Wang Community Health Center knows firsthand that this country has come a long way in in expanding health insurance coverage for millions of uninsured Americans. About 20 million Americans have gained health insurance as a result of the Affordable Care Act (Obamacare) since it became law in 2010. Congress is now vowing to repeal the Affordable Care Act, which puts this advancement in danger if an appropriate replacement is not in place.

Lanying Lee was one of the first people we assisted to enroll for health insurance through the New York State of Health exchange in 2013. The exchange was set up by New York State to meet the requirements of Obamacare and help consumers shop for health insurance and apply for government subsidies.

Lanying is a petite Chinese woman who lives in Flushing, Queens with her small family. She had been a manicurist in New York City for ten years. Her husband owns a small shop that sharpens tools used in nail salons and does odd part-time work for added income. While their modest income made them ineligible for government funded health insurance, they did not earn enough to pay the high cost of private health insurance. “I read about Obamacare,” says Lee. “We were hearing a lot about it. I thought, ‘I need this.’”

According to the Department of Health and Mental Hygiene, two in ten Asian American residents of New York City were uninsured prior to the implementation of the New York State of Health initiative under the Affordable Care Act. For Lanying Lee, Obamacare could not have arrived soon enough. “We did not have health insurance for three years. We are getting older, and we want to take care of our health. We have specialist doctors to go to and general check-ups that we should have regularly. We were not going to the doctors because we could not pay. Having insurance has made such a difference for us. We are going to the doctors on schedule, and we are staying healthy. Obamacare is what we needed. It has been a bumpy ride to enroll, but it was worth it. We are very happy.”

Since the NY State of Health exchange was implemented, the percentage of uninsured New Yorkers was reduced by half. Having health insurance means that patients are able to maintain regular check-ups and preventative care, where they otherwise might forgo care or resort to going to an emergency room.  Many plans under the Obamacare provide free preventative care and well-woman visits, and reduced costs on prescription drugs.

On January 4^th, 2017, NY Governor Cuomo stated his concern for the repeal of the Affordable Care Act without a replacement in place. The repeal of the Affordable Care Act may result in over 2.7 million New Yorkers losing their health coverage.  “Since its implementation, the Affordable Care Act has become a powerful tool to lower the cost of health insurance for local governments and New Yorkers, and it is essential that the federal government does not jeopardize the health and livelihoods of millions of working families,” Governor Cuomo said.

We believe that patients like Lanying Lee may suffer great harm if they lose their health insurance. We implore our members of congress to not repeal the Affordable Care Act without a replacement in place.

*Name of client has been changed

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

Let’s Talk About Colon Cancer

 

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 (37^th Ave) or (929) 362-3006 (45^th 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.

Smoking Cessation Medications

Written by Michelle Chen

At the Health Center, we see many patients who believe willpower is the key to quitting smoking. However, it often takes more than motivation to quit successfully. When you smoke, your body becomes addicted to nicotine, a substance found in cigarettes and other tobacco products. Nicotine can make you feel good, but leaves you wanting more. You may feel irritable, anxious, or depressed when you do not smoke for a period of time. These withdrawal symptoms make quitting hard.

Fortunately, there are safe and effective medications to help you manage withdrawal symptoms. Nicotine replacement therapy (NRT) is one of them. It gives you a small dose of nicotine without 7,000 of the toxic chemicals that the typical cigarette has. NRT is available as patches, gum, lozenges, an inhaler, and nasal spray. There are also pills (Zyban® and Chantix®) that you can take to fight discomfort and help you quit.

Nicotine Replacement Therapy (NRT)

Method	Availability	Description
Nicotine Patches	Over-the-Counter	The nicotine patch is placed on the skin and gives users a small and steady amount of nicotine.
Nicotine Gum	Over-the-Counter	Nicotine gum is chewed to release nicotine. The user chews the gum until it produces a tingling feeling, and then places it between their gums and cheek.
Nicotine Lozenges	Over-the-Counter	Nicotine lozenges look like hard candy and are placed in the mouth. The nicotine lozenge releases nicotine as it slowly dissolves in the mouth.
Nicotine Inhaler	Prescription	A nicotine inhaler is a cartridge attached to a mouthpiece. Inhaling through the mouthpiece gives the user a specific amount of nicotine.
Nicotine Nasal Spray	Prescription	Nicotine nasal spray is a pump bottle containing nicotine, which is put into the nose and sprayed.

Other Medications

Method	Availability	Description
Bupropion (Zyban®)	Prescription	Bupropion helps reduce nicotine withdrawal and the urge to smoke. Bupropion can be used safely in combination with NRT.
Varenicline (Chantix®)	Prescription	Varenicline helps to reduce nicotine withdrawal and the urge to smoke. It also blocks the effects of nicotine from cigarettes.

Speak to your doctor to learn if smoking cessation medication is right for you. Some smokers may need to use smoking cessation medication for 3 to 6 months before their withdrawal symptoms end. Most insurance companies will cover the cost of prescription drugs.

We know quitting can be hard, but your health improves the moment you stop. Just one day without smoking can lower your blood pressure and your risk for heart attack. Your loved ones will be thankful for it, too. Are you ready to take the next steps, but don’t know where to begin? Check out our posts for reasons to quit and more ways to handle cravings, and learn about secondhand smoke.

At the Health Center, we can help patients quit or cut back on smoking.

• Charles B. Wang Community Health Center
  Internal Medicine (Manhattan)
  (212) 379-6998

You can also get free patches and help from:

• Asian Americans for Equality
  (212) 979-8988 (Chinese)

• Asian Smokers’ Quitline
  1-800-838-8917 (Chinese)
  1-800-556-5564 (Korean)
  1-800-778-8440 (Vietnamese)

• NY State Smokers’ Quitline
  1-866-697-8487 (English)

This article is made possible with funding from the RCHN Community Health Foundation. Medication information is from CDC.

Michelle Chen is a Health Educator at the Charles B. Wang Community Health Center. She has a B.A. in Women’s, Gender & Sexuality Studies from Barnard College. She is interested in the intersection of public health and Asian American activism.

Social Work Month – Celebrating Social Workers

Social Workers in healthcare are unique from just about any other social work field. Their job is to help our patients and their families navigate the physical, emotional and financial struggles of living with acute or chronic medical conditions. To celebrate Social Work Month, we talked to clinical social worker Yuyuan Zheng, LMSW, who has supported patients at Charles B. Wang Community Health Center at our Flushing site for the past 3 years.

DN: What made you choose medical work in the healthcare field?

YZ: When I decided to go into social work, I did not know that I would end up in clinical social work. What drew me to Charles B. Wang Community Health Center was the opportunity to work with vulnerable Asian American populations. However, when I started, I found that clinical social work is about so many aspects of a person’s wellbeing. We do case management, care coordination, crisis interventions, counseling cases and support groups. I am also much more knowledgeable about medical terms, conditions and diagnosis since working with a range of healthcare professionals.

DN: What is medical social work?

YZ: A social worker that works in a healthcare setting collaborates with a medical team to best serve their clients. We work alongside family members, doctors, nurses, occupational therapists, physical therapists and more to ensure our patients are receiving the spectrum of care that meets their specific needs. Most of the medical social workers at the Health Center have a masters degree in social work and are NY State licensed social work practitioners.  Much of my job is coordinating the whole team to support the medical, emotional and social needs of our patients and their families.

DN: What is the population of clients and patients that you serve, and what are their needs?

YZ: The majority of our patients are low income, uninsured patients that face language and cultural barriers to accessing medical care. Some of our patients are undocumented. Many of the patients have specific needs—like cancer support, chronic disease management, home care, or other issues like needing support for emotional and financial hardships. Some patients are referred to me because they are domestic violence victims, because they become disabled due to chronic medical conditions, or because they are kids with special needs requiring extra support and resources.

DN: What are challenges in working in medical social work?

YZ: I am always learning how to be a better communicator! Communication can be challenging. Every person on the medical team has their own perspective on the needs of a patient. When I say medical team, I also mean the patient and their family.  I have to work hard to reconcile the perspectives of each member of the team. For example, a patient may not communicate with the doctor about his home care needs.  I have to be a patient advocate, but also communicate to a patient what the team believes is best for them. At the end of the day we all want the same thing—what is best for the patient.

DN: Can you tell me about a rewarding experience as a social worker at the Health Center?

YZ: There are too many. My job is very rewarding. I recently received a phone call from a patient who has been struggling with years of depression but had never sought out help. She wanted to cancel her initial appointment with me. She sounded a little bit hesitate over the phone, and I simply identified her feelings and said to her, “I hear you are a little bit nervous. I just want to make sure, are you OK?” She ended up meeting with me, and expressed that it was my caring approach that gave her the courage to seek help. She is now receiving the correct treatment and care she needs, and is feeling more hopeful. This patient made me feel that my job is really important and meaningful. It reminded me to always take that extra step with our patients, because you never know what you say or do that may change a person’s life!

Thank you for being an incredible support to our patients, Yuyuan. Happy Social Work Month!

National Nutrition Month – Celebrating Dietitians

How much rice should I eat in a day? What does one serving size look like? How much should I eat when I’m pregnant? These are the kinds of questions a Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) are experts in. RDs are the professionals who provide education and guidance on food and nutrition. They are the individuals who help patients or food establishments design meal plans and find solutions to eating healthy.

To celebrate National Nutrition Month we sat down with our dietitian, Daniel Wong, RDN, CDN, to talk about his work in the community:

 DN: You’ve worked at the Charles B. Wang Community Health Center for 7 years. What are challenges you often see in our immigrant community?

DW: The majority of our community shop in Chinatown, so they are only exposed to the foods in Chinatown. For example, most Chinatown bakeries often use lard, an unhealthy solid fat, in their products. The whole community is then exposed to a less healthy type of bread. It is a challenge because it is difficult to change the way bakeries operate and make healthy bread more accessible.

The dietary choices we make as individuals are also based on what our family eats. Some families grew up thinking that spare ribs and ox tail are “lean” meat, or leaner because of the less visible fat compared to pork belly. When I tell them that spare ribs are high in fat, they do not believe it. Because this diet has been a part of their upbringing, the challenge is to help them understand what is good or bad for their health.

DN: How do you help individuals overcome those challenges or reach their health goals?

DW: When educating patients, I give them alternatives, and help them find motivation to try changes in their diet. For example, I suggest to seniors to try oatmeal for breakfast instead of congee. Some seniors are new to oatmeal, but because they know it is good for their health and find it more accessible in the U.S. compared to China, they are willing to adapt to it.

I find that the most common motivation for behavior change in our community is to avoid the need to take medication. Explaining how chronic conditions like high blood pressure and diabetes affect them also motivates them to change. Once they are ready to make changes, we set goals together.

DN: Can you share a memorable or rewarding moment during your RDN career?

DW: The most rewarding part of my job is when I educate a patient and they understand and practice what I taught them. They pass it to their kids and the whole family now has a better understanding of what it means to be healthy. Being able to help people is always a good feeling. Some patients appreciate the advice I give them and some do not. But when I see that their lab results and health are improving, it’s a good feeling.

Thank you Daniel for your commitment to help our patients be their healthiest selves! Happy Nutrition Month!

Honor Your Heart by Quitting Smoking

Written by Michelle Chen

Quitting smoking is tough, and for many, takes more than one try. It may be one of the hardest things to do, but it will be one of the best decisions of your life. In addition to saving thousands of dollars each year, you will protect your family from cancer-causing toxins and live a longer and healthier life. Your heart will benefit from the relief—your risk for heart attack and heart disease will go down when you quit. After one year, your risk for heart disease will be half that of a continuing smoker’s. Over time, it will be that of a non-smoker’s. For American Heart Month, we encourage you to kick the butt for better heart health.

7 Ways to Make Quitting Smoking Easier

1. Prepare yourself. Have support—from family, friends, a counselor or provider, or an online program—ready by your quit date.

2. Create new habits. If certain places and situations tempt you to smoke, come up with new routines. Instead of joining your coworkers for a smoke break, tell them you are quitting and take a walk instead.

3. Use medications. Talk with a counselor or provider about nicotine patches and other medications that can reduce cravings. Many are covered by insurance.

4. Stay away from that cigarette! There is no such thing as having ‘just one.’ The first puff can make you start back up.

5. Find a quit buddy. Ask a friend or coworker who smokes to quit with you. Support each other through the quitting process.

6. Reward yourself. Use the money you have saved from quitting for a movie night or a dinner with your family. Marking milestones can improve spirits for all.

7. Be kind to yourself. If you start smoking again, don’t be discouraged. You have not failed—you have learned about the triggers and situations that make you smoke. It takes a few tries for most people to quit for good.

We know quitting can be hard, but your health improves the moment you stop. Your loved ones will be thankful for it, too. Are you ready to take the next steps, but don’t know where to begin? Check out more tips and reasons to quit, and learn more about secondhand smoke.

At the Health Center, we can help patients quit or cut back on smoking:

• Charles B. Wang Community Health Center
  Internal Medicine (Manhattan)
  (212) 379-6998

You can also get free patches and help from:

• Asian Americans for Equality
  (212) 979-8988 (Chinese)

• Asian Smokers’ Quitline
  1-800-838-8917 (Chinese)
  1-800-556-5564 (Korean)
  1-800-778-8440 (Vietnamese)

• NY State Smokers’ Quitline
  1-866-697-8487 (English)

This article is made possible with funding from the RCHN Community Health Foundation and adapted from NYCDOHMH’s Health Bulletin.

Michelle Chen is a Health Educator at the Charles B. Wang Community Health Center. She has a B.A. in Women’s, Gender & Sexuality Studies from Barnard College. She is interested in the intersection of public health and Asian American activism.