Episode 213: Antiracism in Medicine Series – Episode 13 – Centering Asian Americans: Racism, Violence, and Health

https://clinicalproblemsolving.com/wp-content/uploads/2021/12/ARM-EP13-RTP.mp3CPSolvers: Anti-Racism in Medicine Series Episode 13: Centering Asian Americans: Racism, Violence, and Health Show Notes by Naomi F. Fields December 21, 2021 Summary: This episode is about racism faced by Asian-Americans, why it often goes unrecognized, and how we can work to rectify these wrongs. This discussion is hosted by Jazzmin Williams, Rohan Khazanchi, MPH, and Jennifer Tsai MD, MEd, as they interview Thu Quach, PhD, an epidemiologist and galvanizing leader who has led the Asian Health Services (Oakland, CA) in addressing racial disparities in COVID-19, and Tung Nguyen, MD, a Professor of Medicine at the University of California, San Francisco, and a nationally-renowned health disparities researcher. Our inspiring guests help us to contextualize struggles faced by Asian-Americans even as they outline and energize within us a path forward – together. Content Warning: This episode contains themes of violence, trauma-induced mental health concerns, and brief mentions of suicide. If you or someone you know is struggling with suicidal thoughts, please call the National Suicide Prevention Hotline at 800-273-8255, that’s 800-273-TALK. Episode Learning Objectives: After listening to this episode learners will be able to…Define the myth of the “Model Minority” and explain how it impacts the racism experienced by Asian-Americans.Describe how divisiveness amongst minoritized groups was and remains politically orchestrated, and how minority groups can work together in solidarity against White oppression.Appreciate how intergenerational trauma may surface amongst Asian-Americans, and how these intergenerational relationships may also offer fertile ground for generating understanding. Highlight how structural racism against Asian-Americans surfaces in clinical settings, and describe means of counteracting such structures.Understand how engaged community-based work, centered on trust and accountability, has supported the health of communities served by Oakland, CA’s Asian Health Service.Reckon with the health disparities that exist amongst Asian-Americans, how such disparities are related (in part) to insufficient data-gathering, inequitable clinical settings, and violence, and how they were further exacerbated by the COVID-19 pandemic.   CreditsWritten and produced by: Jazzmin Williams, Rohan Khazanchi, MPH, Jennifer Tsai MD, MEd, Alec Calac, Victor Lopez-Carmen, MPH, Utibe R. Essien, MD, MPH, Sudarshan Krishnamurthy, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Ayana Watkins, and Michelle Ogunwole, MDHosts: Jazzmin Williams, Rohan Khazanchi, MPH, and Jennifer Tsai MD, MEd Infographic: Creative Edge DesignAudio edits: David HuShow notes: Naomi F. FieldsGuests: Thu Quach, PhD, and Tung Nguyen, MD  Time Stamps 00:00 Introduction 04:00 How Dr. Thu Quach’s and Dr. Tung Nguyen’s journeys shape their work 11:40 Policy work as a way of mitigating burnout 12:55 Balancing individual and communal focus (include?) 14:12 Origin of Asian Health Services 16:35 Impact of the COVID-19 pandemic on Asian communities in Oakland  17:40-17:50 Content Warning: Mention of suicide 22:25 Forms of Anti-Asian racism  25:17 The danger of gaslighting Asian-Americans and of comparing oppressions 27:51 Explanation of the model minority myth and a deeper dive into comparative oppressions 30:03 Engaging with community members via validation, and operationalizing means of working against anti-Asian racism 33:58 Dr. Jennifer Tsai reflecting on her father’s experience  37:10 Dr. Nguyen on pathways to intergenerational connection and combatting erasure 39:45 Dr. Quach on intergenerational trauma and reconciliation  43:56 Rohan Khazanchi reflecting on Asian-American disparities in Nebraska and community strength 46:30 Data collection and disaggregation: strengths, challenges, and insufficiencies  56:14 Structural anti-Asian racism in clinical settings 59:22 Clinical tools and takeaways Episode Takeaways:Recognize that structural barriers can embed anti-Asian racism into clinical settings. Insufficient language services (i.e., provision in only English +/- Spanish), limitations of medical technology (i.e., difficulty of sending patient messages through the electronic medical record in languages other than English), limited healthcare literacy, and English-only signage on healthcare campuses are just a few of the structurally racist barriers faced by many Asian folks seeking healthcare. Dr. Nguyen encourages us to recognize how such barriers represent assumptions about people’s capabilities, how they can worsen people’s healthcare, and how they communicate exclusion to our Asian patients. See the world through others’ eyes, and act.Dr. Nguyen calls us to ask ourselves: “If [my] mother and father were like this person, how would they negotiate the system that I’m in? What can I do to either ameliorate those problems, or to fix those problems behind the scenes, so they don’t have to deal with them on a day to day basis?” This can help us reach the goal of taking care of patients in the ways that they want to be taken care of, by operationalizing the vision Dr. Quach shared for “letting lived experiences guide us.” Create spaces to have conversations about the broader contexts affecting patients. Dr. Quach reminds us that environmental factors and the political landscape affect patients’ wellbeing everyday. Creating spaces where these experiences can be shared by patients as well as by practitioners can highlight the structural nature of seemingly individualized problems. By appreciating the impact of factors affecting entire communities, we can be better positioned to act upon them. Remember that more deeply understanding your patients can provide meaning!Seeking to more deeply understand your patients is not an additional burden: ultimately, it is an additional benefit. Dr. Nguyen describes that in his experience, striving for understanding deepens the patient-provider relationship over time and offers fulfillment to him as well as to his patients.    PearlsCase study: Oakland, CA’s Asian Health Services’ origin, ethos, and lessonsDr. Quach describes the community- and advocacy-based origins of Asian Health Services, a Federally Qualified Health Center in Oakland, CA. She also describes their role in detecting and relaying the double-bind of challenges (COVID-19 and racism) being faced by community members throughout the pandemic, and how her team generated solutions that signaled their ongoing responsibility to the communities they served.Asian-Americans face both apparent and enshrouded forms of racism, both of which have directly related health effects.Dr. Nguyen goes on to expand on these forms. One form includes the eye-catching racist acts that explicitly manifest anti-Asian sentiments, such as violence toward elders, verbal abuse, and gun violence. In addition to the physical wrongs done to the victims, these acts function as community stressors that harm the mental, emotional, and physical wellbeing of so many others. Another more insidious form of racism is erasure. This often manifests in a glaring lack of recognition of many of the problems faced by many Asian Americans. In the healthcare space, it can also result in a lack of data collection to demonstrate and understand issues faced by these groups. As a result, there are often failures to address their unique needs. The “Model Minority” myth engenders both the racist erasure of Asian-Americans and division amongst minority groups. Created in the 1960s by conservatives seeking to divide minority groups during the Civil Rights Movement, the model minority myth projects the relative success of some Asian-Americans onto all Asian-Americans; and subsequently casts  them as an “ideal” group unaffected by the problems and negative stereotypes that plague other minority groups. In so doing, the model minority myth obscures how White supremacy actually affects Asian-Americans, and perpetuates a zero-sum game which pits minority groups against each other rather than alongside each other in solidarity. Data on the problems faced by Asian Americans is lacking. This perpetuates further erasure of Asian-American health disparities, and there are multiple needed interventions to redress this injustice disparity. Erasure often conceals the need for the collection of information that would spotlight challenges/inequities faced by Asian-Americans. For instance, Dr. Nguyen describes how the National Academy of Medicine and the Centers for Disease Control, amongst other major health organizations, issued valid and needed statements about the impact of COVID-19 on other minority groups, but did not mention the problems faced by Asian- Americans – nor the fact that the data was insufficient. The resulting message implied to the public was that no problems existed. Additionally, data collection practices often do not capture all experiences due to usage of inaccessible language, or neglecting to spotlight voices from the most marginalized community members. Data disaggregation, which seeks to spotlight specific ethnic groups within the Asian diaspora, can be a helpful step in better understanding the experiences unique to Asian-American communities we serve. It requires recognizing the diversity of experiences and gaining buy-in from community members. “You don’t fight fire with fire, you fight fire with water.” – Fred HamptonDr. Nguyen mentioned this quote, and expounded upon it to say, “You don’t fight racism, with more racism you fight racism with solidarity and partnership and coalition building.” Although the Model Minority myth has generated divisiveness amongst minority groups, true power can come from folks turning away from gaslighting and the wrly named “Oppression Olympics” to recognize that we all need to work together against the real enemy: Oppression writ large by White supremacy. Within Asian-American communities, intergenerational relationships can be a critical strength. Multiple members of this episode describe challenging experiences with bridging understanding of their elder family members that may mirror dynamics within Asian-American communities more broadly. On the one hand, these relationships convey the intergenerational traumas (of migration, of racism, and the like) that impact elders’ experiences, yet may differ from those of younger individuals. Simultaneously, these relationships present opportunities to connect interpersonally as “genuine human beings,” and to find solution-generating commonalities. Relatedly, our guests both describe experiences acting as “cultural brokers” to assist with healthcare needs of their elders that impacted their own journeys into medicine. These insights primed them to understand what challenges community members might be facing now.   ReferencesAsian Health Services. https://asianhealthservices.org Catch Me Up to Speed Podcast. “Episode #9: Asian-American history.” https://www.audible.com/pd/Episode-9-Asian-American-history-Podcast/B094JN9KMY?ref=a_pd_Catch-_c0_lAsin_0_1&pf;_rd_p=1da7ab30-c785-4a0e-a160-4a7e7077b353&pf;_rd_r=3QRHMQRNRTAS8S8BFX2Q Public Broadcasting Service. “Asian Americans: The history of identity, contributions, and challenges experienced by Asian Americans.” https://www.pbs.org/show/asian-americans/ Asian American Voices. “My language, my right.” https://www.asianamvoices.org/     Chu JN, Stewart SL, Gildengorin G, et al. Effect of a media intervention on hepatitis B screening among Vietnamese Americans. Ethn Health. 2019;1-14. doi:10.1080/13557858.2019.1672862Quach T, Von Behren J, Tsoh J, et al. Improving the knowledge and behavior of workplace chemical exposures in Vietnamese-American nail salon workers: a randomized controlled trial. Int Arch Occup Environ Health. 2018;91(8):1041-1050. doi:10.1007/s00420-018-1343-2Yan BW, Hwang AL, Ng F, Chu JN, Tsoh JY, Nguyen TT. Death Toll of COVID-19 on Asian Americans: Disparities Revealed. J Gen Intern Med. 2021 Nov;36(11):3545-3549. doi: 10.1007/s11606-021-07003-0.Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D,  Essien UR, Khazanchi, R. “Antiracism in Medicine – Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/antiracism-in-medicine/. January 19, 2021.Los Angeles Times (2021). “Hate crimes against Asians jumped 107% in California in ‘an epidemic of hate’.” https://www.latimes.com/california/story/2021-06-30/california-attorney-general-hate-crimes California Department of Justice (2021). Anti-Asian hate crime events during the COVID-19 pandemic. https://oag.ca.gov/system/files/media/anti-asian-hc-report.pdf  The Practice (2019). “The Model Minority Myth.” Harvard Law School.  https://thepractice.law.harvard.edu/article/the-model-minority-myth/Kawai, Yuko. (2005). Stereotyping Asian Americans: The Dialectic of the Model Minority and the Yellow Peril, Howard Journal of Communications, 16:2, 109-130, DOI: 10.1080/10646170590948974Smith, Andrea. “Chapter Six: Heteropatriarchy and the Three Pillars of White Supremacy: Rethinking Women of Color Organizing”. Color of Violence: The INCITE! Anthology, edited by INCITE! Women of Color Against Violence, New York, USA: Duke University Press, 2016, pp. 66-73. https://doi.org/10.1515/9780822373445-008Hampton, F. (1969). “Power anywhere where there’s people.” https://www.historyisaweapon.com/defcon1/fhamptonspeech.html   Disclosures  The hosts and guests report no relevant financial disclosures. Citation Quach T, Nguyen T, Williams J, Tsai J, Fields NF, Calac A, Lopez-Carmen V, Krishnamurthy S, Nolen L, Onuoha C, Watkins A, Williams J, Essien UR, Ogunwole M, Khazanchi R. “Antiracism in Medicine – Episode 13: Centering Asian Americans: Racism, Violence, and Health.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/antiracism-in-medicine/. December 21, 2021. Show Transcript