When Silence Becomes Deadly: Hepatitis B in Vietnamese-American Communities

Every Saturday afternoon, I made a weekly pilgrimage to my friend Phuong's house. Phuong, draped in an apron smeared with ochre and cerulean, transformed discarded aluminum cans into abstract masterpieces, while I, cloaked in a fraying white lab coat, would heal her from the delicate wounds of her craft (printer paper cuts). In that living room, no sculpture was too high, and every ailment had a cure. Then, I’d turn my rounds toward my practice’s most loyal patient—her grandmother.

Even as a child, I sensed the heaviness that lingered behind our games. Despite our parents’ attempts to conceal the truth, I still noticed Phuong's grandma's swollen legs and difficulty moving around the house. I did not yet know what liver cancer was, nor did I understand the cruelty of a body betraying itself, but these signs of her grandma's deteriorating health were ones I attempted to remedy. I administered gummy bears like tiny, colorful promises and pressed my small, earnest hands into her tired limbs, trying to massage away a pain I couldn’t yet name.

I would later learn my weekly appointments were the only "medical care" her grandma received. To Phuong's family, the U.S. healthcare system was not a place of healing, but a labyrinth of cold glass and foreign tongues that they were too terrified to enter. They lived in the silence between survival and superstition, not knowing English to communicate with physicians, how to apply to Medicare, and believing it to be bad luck to drive Phuong’s grandma to seek help should she die en route to the hospital.

In Phuong’s house, their fears revealed a deep, unspoken divide between the Western attitudes of the country they had sought refuge in and the Eastern traditions they had carried across warring oceans. This experience is not an isolated story; it reflects a larger systemic issue within the Vietnamese community in the United States. Hepatitis B is a viral infection, often transmitted from mother to child during birth or early childhood, that attacks the liver but can remain unnoticed for decades, slowly damaging liver cells before erupting into liver cancer or cirrhosis. According to a study published in 2021, Vietnamese Americans were three times more likely to die from liver cancer compared with non-Hispanic White individuals. Research shows that Vietnamese Americans have a chronic hepatitis B prevalence, ranging from approximately 7 to 14 percent, compared to <1 percent in the broader U.S. population. And, in one screening study, Vietnamese Americans had the highest exposure rate to hepatitis B at 53 percent. These statistics are not just numbers. Rather, they represent parents, elders, and entire communities slipping through the cracks of a healthcare system that rarely speaks to them, let alone for them.

While implementing an ethnic group-specific hepatitis B program could appear too costly or redundant, especially since universal vaccination for infants and general hepatitis B screening guidelines already exist, universal policies assume equal access and comprehension. Hepatitis B is both preventable and treatable; thus, what stands in the way is not a lack of will, but a lack of systems that meet people where they are. Clinics rarely have Vietnamese interpreters available; educational materials are often written at reading levels or in formats that alienate non-English speakers; and public health messaging rarely reaches Vietnamese communities through trusted channels like ethnic radio or Buddhist temples. When care feels linguistically, spiritually, or socially foreign, it becomes inaccessible.

Hepatitis B should not be a death sentence defined by language or birthplace. We can change this. In cities with large Vietnamese populations, such as San Jose, Houston, and Orange County, we can bridge the gap by funding Vietnamese-language health navigation programs focused on hepatitis B prevention and treatment. These navigators, trained in both medical interpretation and cultural context, can help families understand screening options, apply for insurance, and schedule follow-ups. Healthcare providers should also be trained in cultural humility, recognizing how values like filial piety, fate, and communal decision-making shape medical choices. Likewise, public health departments should partner with Vietnamese community organizations to host mobile vaccination and screening clinics in familiar spaces such as temples, markets, and cultural centers. The cost of failing to address the barriers of mistrust, stigma, and language is far greater than any fiscal caution—late-stage liver cancer treatments can exceed hundreds of thousands of dollars per patient, compared to a $30 screening test or a $60 vaccine series.

As a child, I thought healthcare was as simple as gummy bears. Today, I know better: true healing is found in the deliberate dismantling of the invisible walls that kept Phuong’s family in the shadows. My Saturday playdates introduced me to the critical importance of building cultural trust and more navigable healthcare systems for marginalized communities to public health practice. It will take policy, language access, and compassion to bridge the silence that divides communities from the care they need. Only then can we ensure earlier interventions and better health outcomes for those like Phuong's family, and create a stronger, more equitable foundation for all.