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Monday, February 25, 2008

UCSF School of Medicine: "Students Help Community Fight Hepatitis B"

By Camille Mojica Rey

Ben Huang knew that hepatitis B was a poorly understood disease in the Asian-American community, but not until the UCSF medical student came face-to-face with an elderly Chinese couple during a clinic at Mt. Zion Hospital did he appreciate the impact those misconceptions were having on families disproportionately affected by the disease. "The husband was a chronic carrier whose wife would not allow him to play with his grandchildren," said Huang, a member of UCSF's San Francisco Hepatitis B collaborative, a student-run organization. The couple had come to the collaborative-sponsored clinic so that the wife could get free screening for the virus. While there, the husband pleaded with Huang to explain to his wife that the virus could not be spread to the family through casual contact. "She wouldn't even let him use the same utensils as the rest of the family," Huang said. "He felt isolated."

The collaborative has proven to be a successful way to expose students to community-based health care while addressing an important health disparity faced by San Francisco's Asian-Pacific Islander (API) community, said Albert Yu, a UCSF clinical professor of family and community medicine who was the group's first faculty sponsor. "We are creating an educational curriculum for introducing students from all health professions to community-based health," said Yu, who is also the medical director at the San Francisco Department of Public Health's Chinatown Public Health Center (CPHC).

The success of the collaborative, which was started by students in 2004, has been recognized nationally. Last year, it received a four-year Caring for Community grant from the Association of American Medical Colleges. In 2006, it received the Paul R. Wright Excellence in Medical Education Award from the American Medical Student Association. The collaborative is a partner in the SF Hep B Free citywide initiative to eradicate hepatitis B.

Students who take part in the collaborative work to create community partnerships that raise public awareness and educate, screen and vaccinate patients against hepatitis B. The collaborative offers free screenings and low-cost vaccination during regular clinics at Mt. Zion and CPHC, as well as at community centers around the city. Members of the collaborative currently screen about 70 patients and administer an average of 30 vaccines on average per month to those who need them. "It's amazing the difference these students have made," Yu said.

Students from UCSF's schools of dentistry, medicine, nursing and pharmacy who take part in the
collaborative are required to sign up for a two-part elective in which they learn the basics of community outreach and hepatitis B education, as well the skills they need to draw blood and administer vaccines.

In addition to the satisfaction of addressing the needs of the community, Huang said first-year students benefit from working with patients so early in their careers. "What we're learning is more than data. We get actual patient contact and we get to educate them about hepatitis B," Huang said.

According to Yu, San Francisco's diverse API community is the city's fastest growing segment of the population and has a real need for the services being offered by the students of the collaborative. He pointed out that hepatitis B occurs at significantly higher prevalence rates in API communities, with as many as one in ten individuals being infected. Without treatment, between 15 and 40 percent of those infected will die from complications, including liver cancer and cirrhosis. APIs make up 50 percent of hepatitis B-related deaths in the U.S.

Alng with Yu, two additional faculty members serve as faculty sponsors: Cindy Lai, assistant clinical professor of medicine, and Joshua Adler, an associate clinical professor of medicine and director of ambulatory practices. First-year students perform clinical procedures, while second-year students are largely responsible for coordinating, publicizing and setting up the clinics. UCSF students have even enlisted help from UC Berkeley undergraduates who serve as interpreters.

The collaborative also hosts a website and has put in place an infrastructure to deal with the inevitable turnover of medical students as they advance in their studies. "The biggest challenge of working with students is transition among leadership," Yu explained. But with second-year students acting as board members and responsibilities divided among committees, the collaborative is able to go beyond screenings and vaccinations. "Our students are now helping to manage the care of those who test positive for hepatitis B infection," Yu said.

Students volunteering with the San Francisco Hepatitis B Collaborative

For Huang, being a part of the collaborative has been a life-changing experience. "I didn't really realize the different kinds of opportunities to serve underserved communities. Now I know I want to be part of something like this in my future career," Huang said. He also said that it has been empowering to see the impact students can have on the health of the community. "I have seen how we as students can be effectiveand make a difference."
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