When hepatologist Dr. Samuel Sigal joined Montefiore Health System in November 2015, he said he was "overwhelmed" by the number of hepatitis B patients he was seeing from the Bronx's large West African community.
"There's a big knowledge gap and [there are] a lot of cultural issues," Sigal said. "There's a lot of stigma and a lot of people don't want to talk about it."
To address the problem, Sigal recently launched the Montefiore Starfish Program, a community outreach campaign that's named after one of his former patients' favorite parables. In the story, a passerby encounters a young man who is picking up beached starfish and throwing them back into the ocean. The passerby asks the young man how he can possibly make a difference when there are so many starfish and he answers: "It makes a difference for this one."
There are about 120,000 residents from West Africa living in the borough. An estimated 10% to 15% of that population may be infected with the blood-borne virus, based on the incidence in their home countries, a Montefiore spokeswoman said. Hepatitis B can be passed during childbirth, through sexual transmission and through intravenous drug use. The disease can cause cirrhosis, or scarring, of the liver and liver cancer.
Starfish aims to inform the community about the health risks of hepatitis B, the availability of screening and treatment for people who are already infected, and vaccinations for newborns and others who are disease free.
Sigal recently saw a West African patient with hepatitis B who was pregnant with her second child. It was too late to prevent infection in her first child. "She was sent to me during her second pregnancy so we could prevent her from transmitting it to the second baby," said Sigal. "So, relatively little input can make a huge difference for a person's life."
On Sunday, Montefiore held its first outreach session at Yankasa Masjid, a mosque on Townsend Avenue in the Bronx. Dr. Emmanuel Emeasoba, an intern from Nigeria, who is volunteering his time, spoke to an audience of about 80 men and women. Afterward, everyone expressed interest in getting screened for hepatitis B, said the Montefiore spokeswoman. Montefiore is offering to hold free outreach sessions at other mosques, local churches and community centers. The project is a collaboration of Montefiore's liver disease division and Health Education on Wheels.
As Starfish expands, Sigal said, Montefiore hopes to offer free screenings for every West African in the Bronx, as well as vaccinations to prevent future infections. People who are positive for the hepatitis B virus will be referred for evaluation and treatment.
Hepatitis B cases have risen slightly in recent years, according to the New York City Department of Health and Mental Hygiene. In 2015 the city recorded 7,719 newly diagnosed cases of chronic hepatitis B, a 3.5% increase since 2013, according to its latest annual report on hepatitis B and C, published in October 2016.
About 1.2% of all city residents, or about 100,000 people, have hepatitis B, according to the Health Department. Sunset Park, Brooklyn, and Flushing, Queens, both with large Asian populations, have the highest rates of infection. Many of the people with hepatitis B were probably infected during birth, said Dr. Ann Winters, medical director of the Health Department's Viral Hepatitis Program.
In 2015, 1,493 hepatitis B–infected women gave birth to a live child. The majority of those women (63%) were born in China.
Immigrants from Africa represented 13.6% of the perinatal cases. "There are strong barriers in terms of educating the community and raising awareness," said Nirah Johnson, capacity-building director of the city's hepatitis program.
That's because the African-born population has disproportionately lower education, lower literacy rates and less English proficiency than other immigrant groups. Often they lack health insurance.
The city's Viral Hepatitis Initiative helps pay for peer navigators at health systems to improve health outcomes. Montefiore is one of eight health systems receiving funds in fiscal 2018 for hepatitis B programs.
"Montefiore looks to engage West African community in hep-B prevention campaign" originally appeared in Crain's New York Business.
