2. Health Care and Immigrant Populations in the US Seattle Washington Alan J Chun, MD Medical Director International Community Health Services

3. My background Family Practice residency Interest in International Health 4 th year medical student FP elective in Northern Thailand 3 rd year resident FP elective in Pohnpei, Federated States of Micronesia 11 years practice at Community Health Center in Hawaii Native Hawaiian/Pacific Islander population 8 years practice at International Community Health Services

4. International Community Health Services Serves the Asian and Pacific Island immigrant non-English speaking population in Seattle/King County Two clinical sites with medical and dental services 8 FP physicians, 5 FP physician assistants, 3 FP nurse practitioners, 5 dentists, 2 dental hygienists, 1 acupuncturist 50 % of providers are bilingual

7. health care needs Basic Health Education: Preventive health screening, chronic disease management Infectious Diseases: TB, Hepatitis B and C, H. pylori assc. GI disorders Medical Conditions: Diabetes mellitus, stroke, thyroid diseases, thalassemia, nasopharyngeal cancer Mental health: Post-traumatic stress disorder, depression, somatization Dental health: Caries, gingivitis, periodontitis

8. cultural and language differences Interpretation/Translation Coordination of care with outside health and social service providers Lack of knowledge about government and health care system Traditional healing practices: herbal and OTC patent treatments, coin rubbing, cupping, spiritual healers

9. community health center practice Population and public health approach with medical practice Community oriented primary care Outreach, population disease management, health education, disease prevention Disadvantaged populations

10. how different from international health ? More resources More technology, but still limited access due to lack of insurance or interpretation More institutionalized social services, but more social isolation and fragmentation of family structure

11. what daily practice is like ? Always deal with differences in language, culture, health knowledge, health practice Use an interpreter for almost every visit Practice my Cantonese

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