A few blog posts ago I mentioned how Dr. So told a group of APAMSA Hepatitis B conference participants that before one does any screening/outreach, you make sure there are institutions in the community that let the patients go on to the next step. In other words, if you educate them about the susceptibility and severity of hepatitis B, make sure there are places for people to get screens and vaccinations. Many people don't have primary care physicians or don't have health insurance, don't want to get registered in the health system, whatever. If you do a screening event, make sure that people have somewhere to get to get care.

Today that message was reiterated at a dinner discussion hosted by Team HBV at Harvard, featuring Dr. Daryl Lau, an associate professor of medicine at HMS and Director of Translational Liver Research at Beth Israel Deaconess Medical Center. She told us a story about the community outreach work she did in Houston some years back at an Asian health fair. She and a team of GI doctors and graduate students and research associates set up a station at the fair and administered hepatitis B screens to about 500 people.

While people waited for their turn with the phlebotomists, they filled out 15-ish-item educational surveys. To boost response rate, they wouldn't get their blood tube until they handed in a survey, and there were volunteers walking around offering to clarify questions and to essentially make sure they were doing the surveys. In the waiting area, people could also view a educational video about hepatitis B. They found some pretty analyzable things about the cohort there, such as frequency of misperceptions concerning transmission.

They were testing out a new quick HBsAg screening kit that would give results in just a few minutes, but they also checked with serological testing in Dr. Lau's lab. As expected with any Asian American population, there's a significant number who turn out to be chronically infected and they didn't know it. In this case, thirty-something people had chronic hepatitis B, who were then contacted and advised to see their PCP.

Tough thing is, many people didn't have PCPs or health insurace. So one would feel bad for doing these screens and scaring chronic carriers who did not have the means to seek care. So, while these people were not her patients (and I think might've not been able to register as her patient if they lacked insurance?), Dr. Lau met with them and gave them advice. I've from another physician that sometimes the most important job of being a doctor is just giving advice, being sympathetic to the patient's needs and listening carefully to their concerns.

Sometimes these patients would bring their families; finding out you have a disease is a big deal. In our outreach, we are cognizant of the major role that families play in Asian cultures. We mention that getting screened and vaccinated helps protect their family. We hope that our brochures can be left on the kitchen table and spark a discussion in the family. Some people in the ESL classes we visit seemed especially concerned about vertical transmission and how to prevent it; I surmise that they asked those questions because they are/know carriers who plan to have children.

Moral of the day is: if you're doing screenings in a community setting, partner with PCPs. Research how much people have access to health care in your area.

Luckily, in our outreach population, people can turn to Free Care and MassHealth. Data from the Boston Public Health Commission show that >96% of Asians in Boston have health care coverage (I suppose illegal immigrants are excluded), but only 71%, the lowest of all ethnic groups, have a primary care provider. I think people don't know they have all these resources at their disposal, or they see them as unnecessary (I feel healthy!).