The Doctor is In – Victoria Phan Educates the Vietnamese Community by Meeting Them Where They’re At

Asian Americans for Community Involvement (AACI) provides health services for the Asian community in Santa Clara county.

In 2007, Victoria Phan’s father went home after a trip to his doctor with the saddest news possible: he was diagnosed with lung cancer and he had a few months to live. Prior to this, Mr. Phan—an immigrant from Vietnam—did not feel extremely sick or weak. He only complained about a persistent cough that had been bothering him.

With much grief Mr. Phan’s family started preparing themselves emotionally for his passing. They also arranged for his funeral and wake. They could not believe they were losing him. Curious about the diagnosis on his father-in-law, Dr. Tang decided to review Mr. Phan’s medical records and to meet with the attending physician. To their utmost shock, the family discovered that Mr. Phan actually had a treatable form of lung cancer and that he was going to be fine.

This story is one of many reasons Victoria Phan works to increase cancer awareness in the Asian American community. As coordinator for the Asian Americans for Community Involvement (AACI), Phan deploys 16 lay health workers to the Vietnamese immigrant community in Santa Clara County. Phan and her trained peer educators promote colorectal cancer (CRC) prevention by advocating early screening and proper nutrition.

Her team of Vietnamese health workers holds after-office gatherings in homes, coffee shops, and restaurants explaining how crucial early detection is when fighting cancer. Phan admits that there are stigmas related to cancer testing among Asian immigrants that are difficult to counter. “It’s almost a taboo,” Phan explains.

Aside from these, Phan points out that there are also dominant social factors that affect immigrant health in general. The language difference, for instance, prevents foreign-speaking patients from getting a better diagnosis from their doctors. Understanding and navigating the complex healthcare system is also a hindrance to the improved health of immigrants.

According to the 2010 technical report by the Santa Clara County Public Health Department, cancer is the leading cause of death among Asian Americans here with a mortality rate of 30.1 percent. This figure is alarming considering that 545,045 residents—one third of the entire county population—who identify themselves as Asian.

Phan, a Master of Public Health graduate from San Jose State University, says she focuses on cancer awareness because groups like the Vietnamese community, who have less access to information, have a difficult time understanding the disease. Phan adds that CRC in particular is a disease that not a lot of Vietnamese know about.

As an immigrant herself, Phan knows that Vietnamese prefer to keep their health conditions to themselves because sickness is traditionally seen as a punishment for bad behavior. Healthy individuals also refuse to undergo cancer screening because they don’t see the need for it.

According to Phan, 7 out of 10 Vietnamese ages 50 and older in the county do not have health insurance coverage. She says that this is one of the reasons Asian immigrants do not undergo cancer screening. Currently, no government assistance is available for those who wish to be tested for CRC. Although free clinics may provide help, Phan explains that they prefer to address more pressing medical cases and cancer screening is not one of them.

Various studies have shown that immigration affects health and health awareness, owing to differences in income, education, and culture. A study by Keiko Honda published in Clinical Genetics, for instance, showed that immigration was one of the strongest predictors of a lack of genetic testing (GT) awareness among US residents. Only 13.8% foreign-born subjects were aware of GT as a cancer diagnostic tool compared to 86.2% of the US-born subjects.

When asked to share stories about the linguistic difficulties immigrants face during clinical encounters, Phan is evidently wound up. Aside from the distress she went through with her father’s (mis)diagnosis, Phan has heard countless other accounts from her clients at the Santa Clara Family Health Plan

According to a study in CA: A Cancer Journal for Clinicians, low cancer screening rates among Asian Americans in California may be linked with the linguistic and cultural barriers they face. This is despite the passing and implementation of the Knox-Keene Healthcare Policy Act of 1975 in California which requires, among others, healthcare providers to offer interpreter services to limited English proficiency (LEP) patients.

After 20 years in the field, Phan understands that her work entails patience. “Public health has a very slow momentum to make change and making change in a diverse population is even harder.”

Phan says that the lay health worker program is also a research project and the next step is to advocate for funding from the county administration. Government assistance, however, will have to wait says Phan. Because of the recently implemented budget cuts on social services, Phan says free preventive tests will not come in two years or more.