Seniors in the Fresno Hmong community attend a health fair promoting early steps for cancer prevention. Health professionals say Hmong seniors sometimes resist undergoing cancer screening tests due to cultural beliefs. (Farida Jhabvala Romero/KQED)
At a community center in southeast Fresno, dozens of Hmong seniors gather for a health fair. They tentatively approach tables with pamphlets in Hmong and English on breast cancer screenings, how to safely dispose medicine, and other health topics.
Later in the day, they'll hear presentations by doctors and nurses about understanding a doctor’s visit and the rights of patients, such as the right to seek a second opinion. The event, organized by the Hmong Cancer Coalition, aims to get seniors and other members of this community more familiar with the health care system, so they can benefit from screenings and diagnostic tests such as mammograms and biopsies to detect cancer early.
Older members of the Hmong community, in particular, often resist undergoing screening tests that could save their lives because of cultural beliefs, say health professionals and advocates. Studies show the Hmong community has a higher cancer mortality rate when compared to other Asian Americans, in part because the disease is diagnosed at a later stage, which greatly reduces chances of survival.
Part of the issue -- low utilization of cancer screenings -- is rooted in a distrust of invasive medical procedures, says Kay Vu Lee, chair of the Hmong Cancer Coalition and one of the event's organizers.
The issue hits home for Lee. Her own father, who is 71, refuses to undergo a biopsy that his doctor recommends to confirm a suspected case of prostate cancer.
"He doesn’t want to do a biopsy because he’s afraid that when they intervene and go into his body, they might accidentally scrape something or break something," says Lee.
Those beliefs are shared by a lot of the seniors in this community, says Lee. Many came to the U.S. as refugees from the remote mountains of Laos in the 1970s and 1980s. They prefer herbal remedies and the advice of a spiritual healer or shaman over seeing a doctor at a clinic or hospital.
"Even though most have been in America for an average of 30, 40 years, going to the doctor is still very new," says Lee. "They don’t believe in it like they do the shaman."
This preference for traditional healing practices poses big challenges for the early diagnosis and treatment of cancer, says Dr. Amardeep Aulakh, an oncologist in Fresno, home to the second largest Hmong community in the country with 32,000 people.
"It's a barrier towards the best care I can provide," says Aulakh. He is currently struggling to convince a Hmong patient with a growing lump in her breast to have a biopsy. "My hands become tied when (patients) say they don’t want to undergo a procedure to confirm it's cancer."
Aulakh says he attends events like this to talk about the potentially life-saving options that are available to detect and treat cancer.
"Cancer if caught early and treated appropriately is curable," he says.
It's a message Nao Vang Yang, 80, is now passing on to others in the Hmong community. Eight years ago, the retired truck driver woke up one morning not feeling well. He has nine children, and some of them are physicians who convinced him to get checked. He was diagnosed with an aggressive type of lymphoma.
"The doctor told me I didn’t have a lot of time to live if I didn’t pursue treatment," says Yang in Hmong, as the Cancer Coalition's Kay Vu Lee translates.
Yang went through months of chemotherapy. He saw the tip of his fingers turn black and his chest get covered in a red rash after each IV treatment. But the ordeal was worth it, he says. He's been cancer free ever since.
Now, Yang hopes sharing his story will motivate others in his community to avail themselves of screenings and treatments. He believes it's best to find cancer early, when patients still have the strength to fight the disease successfully.
Kay Vu Lee wants more Hmong cancer survivors like Yang to come forward with their experiences, so that skeptical members of their community learn about the potential benefits of western medicine in catching cancer early.
Lee now plans to bring shamans and doctors together to collaborate more, so their patients benefit from both healing practices.
"If we can get shamans and doctors on the same page to work with each patient, that would help," says Lee.