SAN FRANCISCO - Bbali, Bbali.
It means quickly. You will hear it shouted in many places by Korean Americans, particularly in restaurants, because Korean Americans are often busy and have no time to wait. They have businesses to run, children to raise, churches to go to. Prioritizing is important.
"So many Koreans in our research own their own businesses, meaning sometimes they have to work 16-18 hours a day. This makes it difficult for them to focus on their health," said Haera Han, a Korean community health researcher and associate professor at the Johns Hopkins University School of Nursing in Baltimore, Md.
Their entrepreneurship also often means that Korean Americans don't have employer-based medical insurance and can't afford to purchase it for themselves.
Of any ethnic minority group, Korean Americans are the least likely to have medical insurance, according to the U.S. Department of Health and Human Services. In a 1998 survey, the department found that four in 10 Korean Americans had no health coverage.
More recently, Han said, her research has shown that Korean Americans don’t get regular checkups and screenings, underutilizing the health resources available to them.
"In Korea, you can see the doctor even if you have a cold," she said. "Here, it's very different because if you want to see a doctor and you don't have insurance, then you have to pay out of pocket, which has severe implications for people using preventive health services.”
Han continued, “Then if you want to get a cancer screening you have to find a place to do it, then figure out where to get the results.”
She added, “There is also the attitude that if you don't have any symptoms, you are in good shape. They don't go to the doctor unless they have some serious symptoms, by which time it may be a little too late."
A Close Call
That wasn't the case for Seh Chang Lee of San Jose, Calif., although he had a close call.
"I thought I was very strong so I didn't go for checkups," Lee said. Even when he and his wife had insurance, he went on, “we didn't go. Why would I go? I was healthy."
It took multiple symptoms before Lee sought medical care, including early onset of allergies, a hard red lump inside his mouth and difficulty chewing.
"One day it was lunch time and most people finish eating in 10, 15 minutes. I had been eating 30 minutes and I still hadn't finished lunch," Lee said. "I added water to the rice to make it easier to eat, but still I couldn't finish it.” Eventually, he realized, his difficulty in eating was not normal, “so I went to the hospital."
Lee learned he had oral cancer.
By the time Lee was able to arrange and go through the series of tests and preparations he needed to make before treatment, the cancer had begun spreading. Eventually, Lee had all his teeth removed, and the side effects from the radiation left his stomach so sensitive to pressure that he couldn’t even wear a shirt over the area.
Despite the personal reluctance to respond to seek cancer screening, the Korean American community steps forward in force to help those suffering from the illness.
Lee, for example, gets weekly meal deliveries of food prepared by volunteers at San Jose’s Emmanuel Presbyterian Church get together to cook and package hundreds of meals for people who cannot cook for themselves anymore. More than half of the 100 volunteers are also cancer patients, according to Kathy Kim, a co-founder of this volunteer effort.
“The food is good,” Lee said in Korean. “I try to eat everything. They tell you not to eat this and to be careful of salt, but you cannot eat enough like that. I eat everything I can.”
In addition to the physical manifestations of his battle with cancer, there were also financial ones. Lee, who once owned several properties, no longer has a car.
He relies on the Medicaid program for low-income people (called MediCal in California) and Medicare to pay for his medicines. To qualify for MediCal, many middle-class seniors, who cannot afford expensive health care, much spend down their income and assets until are poor enough to receive those benefits.
“I became a broke person to make the MediCal card,” he said.
“My son speaks good English so he helped me get a MediCal card from Valley Medical Center in San Jose. I became a broke person for the card, and so they pay for almost everything,” he said.
Han said Lee's case was not isolated.
"One woman who I personally encountered was afraid of using all her financial resources,” Han said. She explained that even though the woman felt physical abnormalities, she fear that seeing a doctor might lead to using up money she'd been accumulating for her children’s education.
By the time the woman saw her doctor she had and advanced case of breast cancer. “She died within two months of the initial diagnosis,” Han said.
Least Likely to See Doctors
Moon S. Chen, Jr., a University of California, Davis, professor of hematology and oncology, said that Asian-Americans -- regardless of whether they have insurance -- see their doctor less frequently than all other ethnic groups.
Chen, who is the principal investigator for the Asian American Network for Cancer Awareness Research and Training, wrote in an e-mail interview, "Cancer is the leading cause of death for Korean Americans. In comparison to Caucasians, Korean Americans experience the highest proportion of stomach cancer among all U.S. racial or ethnic groups.”
Chen noted that along with some other Asian Americans, Korean Americans are more likely to be infected with hepatitis B virus (linked to liver cancer). “Hence, the kinds of cancers that Koreans experience differ from Caucasians in that they are also attributed to infectious [contagious] agents, like viruses.” These cancers, he said, are unlike breast cancer, for example, which are attributed to non-infectious causes.
More Challenging for Immigrants
Han said Korean immigrants particularly need assistance to navigate the fragmented American health care system. “You have to figure out where to get screened and where to get their results. This is challenging overall, but more so when you are an immigrant," she said.
Additionally, Han emphasized, stigmas within the Korean American community also impact how effectively its members use the health care system.
"People do not want to talk about cancer because people believe others perceive cancer as something that can be passed on, like from mother to daughter, for example," Han said.
A key factor in her research in the Maryland area is that the Korean community “is very small, and people know everyone directly or through a friend.” As a result, word can spread quickly about someone who has the disease or has been treated for it
Han added, “Then people say, 'Wow, that person has cancer,' and moms worry that the children of the cancer survivors will carry those cancer genes, which might carry into their offspring as well. This makes cancer patients uncomfortable about talking about whether they had cancer or not."
Han also said that Koreans find cancer difficult to discuss because they find the disease intimidating.
"I have had groups of cancer survivors where only a couple talk openly about their cancer, but even then only within the group -- not to their friends or at their church," she said. "Cancer is still very intimidating to these people. Many times, when you hear about cancer, it reminds people of death. The devastating nature of cancer is such a threat, even for survivors."
Chen said it doesn't have to be this way. With more awareness, Korean-Americans could be encouraged to quit smoking -- rates are higher among the men than among the general population -- and to get regular checkups.
"What can be done is action, not knowledge," he said. "Bottom line: Get a good doctor and aggressively seek the best care. And be regular about seeing a MD."
Bo Hee Kim wrote this article as a project of the California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication and Journalism.