Closing Thoughts

First and foremost, I would like to extend my deepest thanks to the Brandeis Hiatt Career Center for this opportunity.

A model showing liver cirrhosis (scarring) as a result of hepatitis B infection.

Prior to this internship, I knew nothing about hepatitis B. After reading scientific papers my first day, I realized the complexity of hepatitis B and the importance of educating the public about it. (In fact, I even went home and urged my family members to check their immunity status.) I then read Charles B. Wang Community Health Center’s hepatitis B educational comic book and was trained to administer comic book evaluation surveys. For the next three weeks, research was underway: I asked patients in the waiting rooms of the Health Center to read the comic book and complete an evaluation. Each surveying day was different. Sometimes, I would encounter lots of willing participants; other days, there was less success. I especially loved it when patients had questions about the comic because interesting conversations would often ensue.

Analyzing data.

During the second half of my internship, I input data from 100 surveys into Microsoft Excel, analyzed subpopulations (by gender, education level, and language preference), and created tables/graphs summarizing overall trends. Finally, I wrote an abstract for the 2018 American Public Health Association conference describing the results of our health education material evaluation. Since the evaluation is now complete, 10,000 copies of the comic book (English, Chinese – other translations coming soon) will be printed and shipped to 30 national public health organizations by the end of the month – just in time for World Hepatitis Day. Aside from conducting research, I participated in Project ECHO clinic video conferences, comic book dissemination meetings, press conference planning meetings, and research grand rounds. Some of my other projects included mapping out comic book distribution sites and making a program for the hepatitis B press conference hosted by the Health Center (see pictures below).

July 20, 2017: The Hep B Team poses for a photo. At the press conference, we released the comic book, shared recent clinical findings on hep B core status in Asian household contacts, and hosted a Q&A panel.

Overall, I felt that my tasks were meaningful, not just busywork. I genuinely enjoyed surveying and analyzing data, especially since I had personal interactions with each of the participants. Although my responsibilities fell under the research department, my supervisors were supportive in helping me get clinical experience, too. They are among the many good natured people I have met at Charles B. Wang Community Health Center, and I have learned so much from their mentorship. Ultimately, this internship helped me develop a strong interest in immigrant population health, and instilled in me the importance of language fluency and health advocacy.

I highly recommend interning at a non profit organization. Some facilities are understaffed, but you will really get to see the impact you’re making. You will also learn more from the population you serve than you ever could from a textbook. By no means is social justice work easy. It requires unrelenting devotion, grit, and love for people. However, being on the forefront of change is extremely rewarding.

If you are considering a career in health care, my advice to you is to be openminded. Shadow various occupations, pay attention to job satisfaction levels, and observe what day-to-day life is like before pursuing a specific field. If any of this resonates with you, I wish you the best of luck on your career path! Everyone’s journey is different, but thank you for joining me on mine.

-Michelle Yan ’19

Looking Back, Looking Ahead

Awareness. Looking back, one of the biggest lessons this internship has taught me about the world of work is the importance of awareness. I’ve learned that with awareness – both awareness of self and awareness of others – comes transparent communication, cohesive teamwork, and an overall better work experience. With increased awareness, one also sets realistic expectations and meets problems with grace rather than frustration.

With today’s technology, it is easy to be aware of current events around the world. Thanks to accessibility of international news at the touch of a fingertip, we know how to handle certain situations by watching what did or did not work for others. For example, a physician or liver specialist who is aware of hepatitis B treatment guidelines may update a patient’s medication based on EASL recommendations. Besides awareness of the world, being aware of coworkers goes a long way, too. For instance, you may make your coworkers feel well supported if you inquire periodically about their project progress or do quality checks on their work. Additionally, being aware of people’s strengths and weaknesses can be handy for delegating responsibilities and ensuring efficient completion of long-term goals.

At my internship organization, self-awareness is essential in order to avoid burn out. I learned this lesson personally through my daily commute of 3-4 hours. Although health care is all about serving others, you cannot forsake taking care of yourself. For physicians at the Health Center who are pressed to give 15-30 minute examinations, they may experience a toll on their stress levels, mental well being, and physical health. Similarly, research associates and health educators also need to realize their own limits. Although deadlines for government documents, grants, and research proposals may not budge, they need breaks as well. Awareness of one’s shortcomings may lead to personal growth as one learns from mistakes, tries new approaches, and/or asks for help.

Speaking of self awareness… the following are some things that I have learned during this internship:

1. A NJ-NYC commute is tiring; ideally, it is best to live closer to your work site.

2. I work best when I make a tangible list of goals to accomplish everyday.

3. Speak up during meetings, respect others’ time, and take initiative to help out. Build a relationship with everyone you encounter. Be positive and work diligently without complaint.

4. What I appreciate about the Health Center is that outside of doing research, I’ve gotten to shadow a few health care professions. After much soul searching, I’ve finally settled on pursuing a career as a doctor of optometry (O.D.) – a fulfilling balance of one-on-one patient interaction, problem solving, and clinical care. I’ve had an inkling of interest from my own experiences with vision treatment/eye health. In the picture below, I saw a glimpse of how I might be able to serve the Asian American population in this field through shadowing an optometric physician at Charles B. Wang Community Health Center.

I’ve also picked up a skill or two:

1. The ability to conduct research surveys and strike up conversation with strangers. Data analysis using Microsoft Excel’s “filter” function and abstract writing techniques.

2. Confidence in brainstorming and proposing ideas during meetings, writing emails, and planning public health press conferences.

3. Increased fluency in Mandarin.

Looking ahead, I am excited to further advance my Mandarin skills and apply all that I’ve learned to my future endeavors.

-Michelle Yan ’19

“We are your medical home, we care about you”

This is what I believe social justice is: acknowledging the world’s greatest needs, and helping people right where they are.

The two core social justice goals of my internship organization are to provide health care access to everyone regardless of income and eliminate health disparities among Asian Americans.

In terms of achieving the first goal, the Health Center funds most of its initiatives through government grants. I have witnessed my supervisor write these grant applications. It is a lot of work! However, what can be accomplished through them is incredible. Grants cover transportation costs for patients (via a two-way subway metro card) and provides the finances to establish mentorship programs such as “Smoking Cessation” and “Hep B Moms.” Even my project this summer is funded by a grant. My role has been to evaluate an educational comic book’s effectiveness and write up an abstract on the research findings. In a few weeks, we will be able to print, publish, and disseminate the innovative material to public health organizations all across the U.S.

Hepatitis B comic book: TBP (to be published!)

The nature of the organization as a nonprofit requires smart financial decisions where every dollar is allocated for patients rather than for private spending. I think this is a significant factor as to why the Health Center is effective in accomplishing its social justice mission. Outside of government-funded initiatives, primary care and urgent care visits are offered to everyone; no one is ever refused treatment due to financial reasons. Patients can either pay through family health insurance or through a sliding scale fee determined by yearly income or their W-2 tax release. Essentially, this expands the health center’s accessibility to out-of-state patients (often extended family members or migrant workers), as well as patients without Medicaid / Social Security / Medicare.

NYC public transportation system.

The Health Center has also made strides in its second mission to eliminate Asian American health disparities. It has implemented key services such as mental health therapy, social work consultations, and referrals to health care providers within the Charles B. Wang Community Health Center network. These efforts significantly reduce the amount of traveling and time that patients take out of work in order to meet their health needs. Additionally, for Asian dialects that are less common (e.g. Fuzhounese), there are in-person and language access line interpreters available to assist physicians in translating clinical diagnoses. Care managers also make follow up calls to ensure patients are continuing their treatment at home.

Attending a press conference with Commissioner Mary Bassett on mortality among Chinese New Yorkers.

On a broader scale, the Health Center has formed close connections with specialists at NYU Langone and pharmacists at Metropharm to guarantee that patients are directed to quality referral care and receive the most affordable prescription medicine. The Health Center’s education and research departments are also great at maintaining relationships with Chinese press reporters, elected city council officials, NYC Department of Health, and national public health organizations. As a result, there are ample opportunities for press conferences, free citywide tuberculosis and hepatitis B screenings, publicity/outreach, and enrollment of the Asian American population into programs that will be of lifelong benefit to them.

As I watch all of this progress unfold, I remember Charles B. Wang Community Health Center’s slogan, “We are your medical home, we care about you.” It is neat to watch the various departments fulfill the slogan and reach the goals they had set forth to accomplish.

-Michelle Yan ’19

Intersections of Culture & Health

Inside a clinic room.

Recently, I have been reflecting on my undergraduate experience and what it means to me. I am so thankful to have a college education, professors who invest in my personal growth, and peers with whom I can discuss ideas. My time at Brandeis has taught me the importance of interdisciplinary and experiential learning. For instance, in my science lab courses, I learned how to think critically and apply learned concepts to real life situations. My Anatomy & Physiology course brought together concepts learned in biology and chemistry, and this background has allowed me to better understand viral Hepatitis B (the health disparity that I am addressing as an intern at Charles B. Wang Community Health Center). Additionally, at Brandeis I have been able to explore the complex intersection between culture and medicine through my anthropology course, Introduction to the Comparative Study of Human Societies. After reading ethnographic texts, as well as the book “The Spirit Catches You and You Fall Down,” I realized the importance of cultural sensitivity and open-mindedness. I try my best to keep these cross-cultural communication principles in mind while administering surveys to patients at my internship.

Attending a Grand Rounds Conference to learn about the impact of CBW programs.

Having studied both science and culture in the classroom, I was not sure what to expect when I initially began my internship at Charles B. Wang Community Health Center. However, it has been extremely encouraging to witness culturally competent care being executed in the Health Center on a daily basis. The physician whom I shadow once a week is bilingual and understands the cultural backgrounds of patients (e.g. why they may be reluctant to try physical therapy or take prescribed medications). Language interpreters and nurses are readily available to provide support. Staff members have excellent communication skills to assist a significant number of patients with low income or low English proficiency. Everyone works like a well-oiled machine to serve a diverse community in need. I am also amazed by all of the research, health education, advocacy, and care management programs that have been implemented throughout the years to promote healthy living in target communities.

Outside of the classroom at Brandeis, I have learned about various non-Western cultures through tutoring English as a Second Language (ESL) to Brandeis dining hall employees. There are so many challenges with learning a new language, and with this in mind, I find the service that Charles B. Wang Community Health Center provides for immigrant populations to be incredibly inspiring and valuable.

Literature review on Hepatitis B prevalence in NYC boroughs and various ethnicity groups.

Lastly, during my time at Brandeis, I was able to participate in a university-wide rally supporting the development of a Brandeis Asian American Studies Program. As a member of the task force involved in planning the event, I developed confidence in my own voice. I have learned at this internship that confidence and clear communication goes a long way in any career. In the public health sector, effective research skills, science writing, and oral communication skills are needed in order to convince government officials to allocate resources for a public health issue. Good communication also allows stakeholders to make informed, effective policy decisions that can save lives, prevent diseases, and reduce health system costs. I am humbled by what I have learned thus far at my internship, and am excited to be a part of expanding research initiatives on Asian American health.

-Michelle Yan ‘19

New York City AAPI: More Than What Meets The Eye

Over the past month, I have commuted 80 hours, talked with approximately 200 strangers, and used 2 times more Mandarin than English. This summer, I am grateful to have the opportunity to work as a Hepatitis B Program Research Intern at the Charles B. Wang Community Health Center in New York City.

The Health Center is a nonprofit federally-qualified community health center licensed by the New York State Department of Health. Its mission is to eliminate disparities in health, improve health status, and expand access to the medically under-served (treating all patients regardless of immigration status or income) with a focus on Asian Americans.

The Health Center has a rich history that dates back to 1971, when volunteer doctors, nurses, social workers, and students organized a 10-day Chinatown Health Fair; the first clinic ever held in the streets of New York City’s Chinatown. Forty years later, the Health Center has multiple locations throughout the city, with adequate clinical space and services that meet growing community demands of the Asian American Pacific Islander (AAPI) community in New York City. The Health Center is a leader in providing comprehensive primary care services that are high quality, culturally relevant, and affordable. It also promotes the health of the community through innovative, award-winning health education and advocacy programs, and by recruiting bilingual and bi-cultural health care providers and staff.

With regards to health disparities, the Health Center won the 2015 Tisch Community Health Prize for its Hepatitis B Program. Hepatitis B is a life long liver disease caused by a viral infection that is more common among Asian Americans and Pacific Islanders (AAPI) than any other ethnic group, with 1 in 10 AAPIs having chronic hepatitis B. Although AAPIs make up less than 5% of the U.S. population, they account for more than 50% of Americans living with chronic hepatitis B. Unfortunately, the disease can progress without visible symptoms and lead to liver cirrhosis, cancer, or premature death. Furthermore, since there is no cure, physicians need to treat chronic hepatitis B patients on a case-by-case basis according to Clinical Guideline Regulations. This is why effective education about hepatitis B prevention, transmission, and screening is essential.

As a research intern, I am taking the lead on a survey evaluation of a health education comic book on hepatitis B called “The Test,” developed by a local Asian American artist in partnership with the Charles B. Wang Community Health Center Hepatitis B Team and Health Education Department in order to make hepatitis B education more engaging for all ages. Each day, I administer 15-minute surveys in English and Mandarin to patients in the waiting rooms and analyze survey data in preparation for a poster presentation at the American Public Health Association’s conference. My goal by summer’s end is to complete at least 100 surveys, revise and improve the health education material, and provide meaningful data about where New York City stands in terms of hepatitis B awareness.

So far, I have administered 86 surveys to patients of varied ethnicity (including Chinese, Korean, Japanese, Malaysian, Indian, Filipino, Latino, Spanish, White, and African American), ages, genders, and educational backgrounds at the Internal Medicine Unit of the Health Center. The work has been both challenging and enjoyable. Due to the nature of human subject research, I have had many insightful one-on-one interactions with patients.

In a short period of time, NYC Chinatown and Charles B. Wang Community Health Center have taught me so much about public health, social justice, and my Chinese-American roots. Gradually, I am learning the nuances of my culture and that there is more depth to each person or situation than what meets the eye. As the American healthcare system falls short in delivering culturally effective care and bridging health disparities gaps, I realize how important it is to continue advocating for the Asian American community.

Thank you for reading my blog. More posts/updates to come!

-Michelle Yan ’19