Treating Hepatitis B Runs Up Against Hmong Culture

In Fresno, Calif., 17 percent of the Hmong/Laotian community has Hepatitis B. The disease is a liver killer, fairly easy to transmit, and most of the people infected don't know they have it. The problem is, even if Hmong did know they had it, most of them wouldn't treat it. That's because their collective belief system dictates they handle this, and other diseases, as a spiritual problem. From Capitol Public Radio in Sacramento, John Sepulvado reports on how public health officials are trying to combat this problem.

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B: Hepatitis B. Infection rates in that community are dramatically higher than the national average. There is a vaccination for Hepatitis B and the virus is treatable.

But as Capital Public Radio's John Sepulvado reports, many of Fresno's Hmong won't seek medical help.

JOHN SEPULVADO: Fresno can be a pretty rough town. Just ask Yeng Mua. She's short and soft spoken, but even in her sketchy neighborhood, she always felt safe when she went out with her son Yia.

YENG MUA: He has a lot of talents. He was a pro. He's a four-time kickboxing in the whole world.

(SOUNDBITE OF CHEERING)

SEPULVADO: Yia "The Bull" Mua was a Muay Thai champion kickboxer. He was small and skinny - just five foot seven, and over 150 pounds. That's the sound of him kickboxing.

(SOUNDBITE OF KICKBOXING MATCH)

Unidentified Man: Oh, a stiff punch to the breadbasket of Escobar.

SEPULVADO: Yet, despite his tough exterior, his mom says Yia was the polite, quiet and strong type. So, when Yeng found her 34-year-old son doubled over the toilet, making very painful noises, she knew something was wrong.

MUA: I see him vomiting blood a lot.

SEPULVADO: He was vomiting blood?

MUA: Yes, a lot. And we took him to Clovis Community Hospital in June.

SEPULVADO: After two weeks of tests, Yia Mua was diagnosed with liver cancer caused by untreated Hepatitis B. He died six months later. Mua was born in Laos. The HB virus is common there, as it is in most of Asia. Many immigrants from the region contract the virus from their mother during birth.

MOHAMED SHEIK: The majority of the patients with Hepatitis B do not have any symptoms. So, that's the major issue.

SEPULVADO: Mohamed Sheik is a doctor with the University of California at San Francisco-Fresno. He says Mua's death and others could've been prevented with antiviral drugs and regular monitoring of the liver.

Sheik recently conducted a study of Hep B rates in the Fresno Hmong community. They're high. The national infection average sits at just about one percent. It's markedly higher for Asian Americans at 10 percent, with most of those carriers being foreign-born. But according to Sheikh's research, recently published in the journal of Community Health, that number jumps again to 17 amongst the largely immigrant Hmong community.

SHEIK: Hmong people might be having more infections as compared with the rest of the Asian population because they are more secluded and isolated community.

SEPULVADO: The Hmong migration to Fresno because in the 1970s, after the Vietnam War. Most are from the hills of Laos, and they brought with them folk medicines and a distrust of Western medicine. Many don't like to give blood, even just a blood test - an essential part of Hep B testing. They feel it will weaken them physically and spiritually.

Sophia DeWitt oversees health initiatives at the Fresno Interdenominational Refugee Ministries, a social service organization.

SOPHIA DEWITT: If 17 percent of the community in Fresno County is likely to be Hep B positive and most of those who are infected aren't aware of their status, clearly there's more that needs to be done.

SEPULVADO: DeWitt says canvassing and educational outreach efforts have been somewhat successful. Now, her and other health workers are trying to marry the Hmong's cultural beliefs with traditional Western medical care. Basically, they're saying, you can see a doctor, get immunized and keep your folk medicines - but that's a tough sell.

(SOUNDBITE OF PEOPLE SPEAKING FOREIGN LANGUAGE)

SEPULVADO: Down the street from DeWitt's Fresno office at the golden bowl Asian market, there is a family shopping for herbs. Kathleen Ying is 17 and she says her mother's been using chutes, herbs and vegetables to make medicines for most of her life.

KATHLEEN YING: It's like tea. It's fresh. It's, like, fresh.

SEPULVADO: Ying says there's a generational gap. She says her friends would go see a doctor - in fact, she wants to be a nurse after college - but her parents are scared to seek Western medical care. Instead, Ying says, they stick to their homemade medicines.

YING: Yeah, well, they like it because it reminds them of home. They're more comfortable with it because that's the only type of medicine they had. We're more Americanized now.

SEPULVADO: Ying says she's already made an appointment to get a Hepatitis B screening. She heard of the disease after kickboxing champion Yia Mua's death in January. That was the first time many younger Hmong realized Hepatitis B can be a devastating opponent that even one of their best fighters couldn't defeat.

For NPR News, I'm John Sepulvado in Sacramento.

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