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Commentary: African Immigrant People
How My Role as a Patient Navigator Helps African Immigrant People Living With Chronic Hepatitis B

Released: May 19, 2023

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Key Takeaways
  • Patient navigators can be useful for linking African immigrant people to HBV screening and care.
  • Culturally and linguistically appropriate education is key for improving HBV awareness and overcoming misconceptions and social stigma.

It is important to provide culturally appropriate education to African immigrant people to educate them on hepatitis B virus (HBV) vaccination and treatment. Trust is a key part of education—the person receiving the education must trust the person or organization providing it. I want my patients to understand how HBV is transmitted and how important HBV vaccination is for preventing chronic hepatitis B (CHB) and protecting not only themselves, but also their family members.

HBV Awareness and Knowledge
As a patient navigator who came to the United States in 1995, I know that some people think HBV acquisition is a death sentence, so I like to educate my patients with CHB on how important it is to follow instructions from their healthcare professional (HCP) to live a long and healthy life. People with CHB who are asymptomatic may not understand why they need to take medication, and it is important for me to educate them on how treating CHB can extend their lives.

HBV-Related Stigma
Although not necessarily as common in Western culture, social stigma can be associated with HBV, as can the feeling that HBV may be God’s will, which may have been brought on by some spiritual misdeeds of the person or their family. This highlights how religion within the African immigrant community may influence understanding of HBV and how that interplay may affect or influence social interactions, misconceptions, and stigma with how one acquires this disease. That same stigma can influence who gets tested for HBV and who does not.

Storytelling can be a powerful tool for overcoming HBV-related stigma. The Hepatitis B Foundation has done an amazing job of inviting and engaging people with lived experiences with HBV to tell their stories. By sharing these stories, the hope is that we not only increase HBV awareness, but also reduce stigma by having people share their experiences.

Language Barriers
One of the biggest barriers for me as a patient navigator is when I have difficulty communicating with a patient because we do not speak the same language. I speak 7 languages, but that does not come close to being able to communicate with every person who has immigrated to the United States from Africa. Sometimes my patient and I speak the same language, but our dialects are so different that it impedes our communication with and understanding of each other.

I have many examples of overcoming language barriers, including my work with a patient from Angola. This patient spoke Portuguese and was concerned that no one spoke his language. He was upset that he had been recently told he was diagnosed with HBV and had no one to speak to about it. I was able to ask him if he spoke another language and found out that he spoke a little French—which I speak as well—and once we resolved this barrier, we were able to communicate in verbal and written French.

It is important for HCPs to understand how linguistically diverse African immigrant people are and to not make assumptions about what language(s) a person speaks. HCPs should advocate for having translation services that meet the needs of our patients. Understanding that not all African languages have written forms of communication is important so that HCPs can leverage caregiver, family, and community support to communicate information to patients.

Navigating Health Insurance
Health insurance navigation will be unique to each patient, but 2 commonly asked questions that I get from my patients with CHB are, “Does health insurance affect my immigration status?” and “If I am undocumented, how do I obtain insurance?”

Although many US states have undergone Medicaid expansion, not every person is eligible based on their legal status. Something that still needs a lot of attention by HCPs and policymakers is how to have better pathways for undocumented patients residing in the United States to obtain health insurance. We can do our best to help patients access social services, other supportive charitable services, and financial services within individual health systems.

For my African immigrant patients who are undocumented, I assist them by taking them to one of the local public hospitals to enroll in an insurance plan. I also help them prepare their proof of address, employment, and income so the hospital can determine their fee scale for hospital visits and medications. I also try to escort them to their to appointments, not just to help with translation and to ensure they bring the required documents, but also to motivate them to stay in care.

For my African immigrant patients who are legal residents of the United States, the assistance I offer is different. I often help these patients by applying for or renewing their Medicaid or Medicare insurance.

To me, HCPs advocating for more services and support within health systems is a key component to better engage people living with CHB in care and provide healthcare coverage for their treatment and disease surveillance.

Your Thoughts?
How do you help your African immigrant patients living with CHB navigate the US health insurance system? Join the conversation by leaving a comment below.