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Features: September/October 2015

The Northwest Regional Conference on African Immigrant Health is happening March 19-20, 2016 at the UW's Alder Hall in Seattle. For more information, click here.  

Hepatitis B Research and Immigrant and Refugee Communities

By: Margaret Shuhart, MD, MS, Director, Hepatitis and Liver Clinic Harborview Medical Center

Vietnamese Hep Brochure imageHepatitis B research traditionally has been underfunded, as diseases such as HIV and hepatitis C have been given higher priority by funding agencies. More recently, the NIH has established the Hepatitis B Research Network (HBRN), a group of 28 clinical sites across the US and Canada designed to address important clinical questions pertaining to hepatitis B in both children (7 sites) and adults (21 sites). Seattle has both adult and pediatric sites. Broad questions being asked by the HBRN include why some develop severe liver disease and liver cancer while others have inactive disease, how to improve the response to current treatments, and whether indefinite treatment is really required in those who have e antigen-negative disease. Most Southeast Asian/Asian adult persons have e antigen-negative hepatitis B, and many of these have active disease that places them at risk for cirrhosis and liver cancer. Despite the well-known benefits and excellent safety records of hepatitis B oral treatments, those with active disease are often reluctant to be treated, particularly if it is expected that such treatment will be lifelong. Identifying those for whom shorter duration treatment may be successful is critical if we are to engage more in treatments that can prevent the development of significant liver disease and liver cancer.

African-born individuals also have a high prevalence of hepatitis B infection. Through the HBRN studies, which to date have enrolled nearly 175 people from East and West Africa, we are able to explore risk factors for disease in these less frequently studied populations and include them in ongoing treatment trials. African Americans enrolled in our study, whether African or US-born, recently were found to be at increased risk for diabetes. Diabetes is known to further increase the risk for liver disease and liver cancer in people with chronic liver disease.

Additional HBRN studies in progress include the effects of hepatitis B on quality of life (in both children and adults), maternal knowledge of children’s hepatitis B infection and vaccination status, the impacts of alcohol and tobacco use on liver disease, the impact of pregnancy on hepatitis B activity, the role of the immune system in hepatitis B disease, and several others.

For more information about research studies, see:

  • Hepatitis B Research Network (this site includes related links to CDC, clinical, American Liver Foundation, Immunization Action Coalition, among others)
  • Registered Clinical Trials (nationwide) 
  • Research contacts for local HBRN studies: Alycia Wolfstone RN, 206-744-7053, and Dr. Margaret Shuhart, 206-744-7054,

Caring for Survivors of Torture - Selected New Resources

Obtaining Survivor Histories - Video Clips and Clinical Pearls
Absence4These videos are the newest additions in a series of short clips giving examples of issues to be aware of when obtaining a patient history. The clips are from interviews with patients of Dr. Carey Jackson (used with permission) demonstrating aspects of torture histories commonly encountered among torture survivors. New clips: 

EthnoMed offers information for clinicians and others who care for survivors of torture, with training materials developed through the Northwest Health and Human Rights (NWHHR) coalition. Read more...

Recent Features

Walking Together: A Mental Health Therapist's Guide to Working with Refugees

This free publication (114 pg, PDF) is designed for mental health professionals, clinicians and social workers who have the privilege of working with refugees. The Guide tackles important topics such as barriers to care, overcoming obstacles, clinical considerations in assessment, treatment planning, working with interpreters, medication adherence, and trauma. Produced by International Counseling and Community Services (SeaTac), a program of Lutheran Community Services Northwest.

Download "Walking Together" PDF

Migrant Children Health

Immigration ReformSome of the hyped claims and concerns over health risks from unaccompanied migrant children stem from ignorance, if not racial prejudice. The answer to responding to disease challenges is not scaremongering, not pointing fingers at migrant children, but rather ensuring that appropriate treatment is in place for them, regardless of where geographic borders lie. The following resources provide background information on the problem, factual information to help educate, and ongoing initiatives to address the misinformation. Read more... 

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Welcome to EthnoMed

EthnoMed contains information about cultural beliefs, medical issues and related topics pertinent to the health care of immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world.

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Torture Resources

Resources for clinicians and advocates around issues of torture, often related to warfare and political repression.  Includes information about Northwest Health and Human Rights (NWHHR) coalition serving refugees, asylum seekers, and immigrants in Washington State.  Visit Caring for Survivors of Torture page for additional information.

Scams Targeting Refugees and Immigrants

The U.S. Citizenship and Immigration Services (USCIS) and Federal Trade Commission (FTC) provide information about common immigration services scams and other kinds of scams targeting refugees and immigrants. To find information about recent scams, tools and education about avoiding scams, and to learn what victims should do if targeted, read more...