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Celebrating Asian/Pacific American Heritage Month: Why Diversity Matters in Health Care

Updated on May 13, 2024 | Diversity and Inclusion, Featured, Your Health

Alex Ky-Miyasaka, MD, Professor of Surgery at The Mount Sinai Hospital, seeing patients at the Chinatown clinic in Manhattan.

Asian American, Native Hawaiian, and Pacific Islander Heritage Month, also known as Asian/Pacific American Heritage Month, is observed in May in the United States. It celebrates the culture and historical contributions of Asian Americans and Pacific Islanders (AAPI) to the country, as the month marks the arrival of the first Japanese immigrants in 1843 and commemorates the completion of the transcontinental railroad in 1869, whose tracks were largely laid by Chinese immigrants.

AAPI people in this country are extremely diverse and represent a wide range of races and ethnicities, socioeconomic and educational backgrounds, and ability to access health care. In New York City, this group encompasses more than 1 million people from more than 30 different ethnicities, speaking more than 50 different languages. Providing effective health care to such a varied group can be challenging, but it is important for health care institutions and providers to keep diversity at top of mind as they connect with patients.

“It is our responsibility to ensure we’re evaluating how we can best provide care to all of our patients,” says Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Center for Asian Equity and Professional Development at Mount Sinai. “There’s a growing body of evidence that people receive different care based on gender, disability, and language spoken.” When it comes to conversations about the differences in care that patients receive, AAPI communities are often left out—for example, some may not know that 24 percent of AAPI individuals in New York City live in poverty, and as a result might be unable to access appropriate care, says Dr. Rhee, citing a report on poverty in New York City.

“Specifically for Asian Americans and Pacific Islanders, from our patient satisfaction surveys, we know that our patients are telling us that we have room to improve, and how we can deliver care for them better,” says Dr. Rhee. “I say this in the overarching context of approaching all our patients with an open mind, so that we can understand anyone’s background better, and do our best to meet people where they are.”

In this Q&A, Dr. Rhee explains the importance of culturally sensitive and compassionate care, and how Mount Sinai is working to improve that competence.

Why is it important to consider cultural needs of a patient when providing care? Might there be consequences for failing to do so?

Communication between our clinical teams and patients is so critical, not only for the medical side of the care, but also compassion and empathy. Cultural and language barriers could present a challenge for some of our AAPI patients. There could be certain sorts of traditions that may seem different to our clinical providers or teams, which could appear obstructive.

For example, in some Asian cultures, there’s a belief that drinking warm fluids can help people who are feeling ill, and they or their family members might want to bring in warm soups and drinks for the patient. But if the patient is in a situation where they should not eat or drink anything, such as before a procedure, these well-intentioned family members may not understand that, and conflicts and challenges in communication can lead to confusion and dissatisfaction. It would be better if our clinical teams, patients, and family members could better align expectations and help understand each other better.

What does it take for a health system or organization to provide culturally sensitive and inclusive care?

Normalizing things or traditions that seem different, and highlighting the diversity of the people whom we take care of, is an important way to do that. Having really engaging educational sessions or tabling events at an institution are effective ways to help providers understand how these different traditions are meaningful in these different cultures—and understanding these differences can have an impact on whether a patient gets better or not. And I think that better understanding also leads to more empathy and improved connections between provider and patient.

What work might be needed to improve AAPI communities’ care experience?

An important piece boils down to building trust. Patients and their families want to know they are being listened to. Our clinical teams have to be open-minded to cultural differences and communicate to patients and their families that they’re there to help and receive feedback. Once that trust is established, when we need to explain how certain rituals or traditions might run counter to care, that advice might be better received by the patients and family members.

What has Mount Sinai been doing toward providing culturally sensitive care for AAPI communities?

In recent months and years, Mount Sinai Health System has dedicated resources and launched initiatives toward improving competence and cultural sensitivity for its AAPI patients. Here’s a snapshot of what we have done:

Asian Health Services
Initially launched at Mount Sinai Beth Israel to serve the population in Chinatown and lower Manhattan, the team providing personalized care for AAPI communities has been expanded systemwide, across all eight hospitals. Asian Health Services includes multilingual Asian providers in different medical specialties, medical interpreters, and culturally competent staff to help patients navigate health care. The website has been updated to include information about specialists, their locations, and languages spoken.

Click here to learn more about Asian Health Services

Guidance on translation services
Mount Sinai has been working with its Language and Communication Access Services to provide more culturally competent translation and interpretation services for AAPI patients, including guidance on cultural differences and cues. The service is provided free of charge and can be arranged through clinical teams to be made available during care.
Cultural cue handouts for providers
Cultural cue handouts that were originally available for providers under Asian Health Services are in the process of being rolled out systemwide. These resources include information about differences between traditional remedies and Western health care and various cultural norms that might affect decision-making.
Educational events
For Asian/Pacific American Heritage Month, there is a series of events to celebrate and raise awareness of AAPI culture, held across all eight hospital campuses. These seek to deploy education in a meaningful way, by highlighting similarities and differences across cultures. The Center for Asian Equity and Professional Development also hosts webinars and events throughout the year.
Curriculum for cultural sensitivity training
In its early stages, the Center for Asian Equity and Professional Development is developing a program to train providers who wish to be more informed about caring for AAPI patients. The goal is to eventually improve health equity among AAPI communities.
Partnerships with community organizations
Mount Sinai is working with community partners, such as the Chinatown YMCA, to provide health information and education. These include preventive care, tips on healthy living, and resources to access care at Mount Sinai.

“I hope that what we can build is heightened awareness about the specific needs of our AAPI patients,” says Dr. Rhee. “I would hope these efforts will create a way of thinking for all of our care providers to identify any kind of disparity that a patient may be experiencing, so that we can address challenges in this space for all of our patients.”

Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Dean’s Center for Asian Equity and Professional Development at Mount Sinai

Who are the Asian Americans/Pacific Islanders in New York City?

Asian American/Pacific Islander (AAPI) is a broad term, but it is not a monolithic description of their experiences and situations. In New York City, the largest and one of the most diverse cities in the country, understanding the diverse socioeconomic and health access conditions of AAPI people is crucial to population health. Pulling from two city agency reports, here’s a snapshot of Americans and immigrants of Asian and Pacific Islander descent in New York City.

>1 million

AAPI people in NYC; 14 percent of the city’s 8.5 million population.

>30 different ethnicities

A group speaking more than 50 different languages.

13 percent

of immigrants of Asian/Pacific Islander descent are undocumented, compared to 16 percent of NYC immigrants overall.

46 percent

of AAPI households report having limited English proficiency, compared to NYC’s overall average of 23 percent. For Asian/Pacific Islander immigrants specifically, that number is 59 percent.

40 percent

of AAPI individuals in NYC on average have income below 200 percent of the federal poverty level, compared to the city’s average of 39 percent. However, subgroup variances are large, with lows including Filipino (20 percent) and Japanese (23 percent) individuals, and highs including Bangladeshi (58 percent) and Pakistani (53 percent) individuals.

AAPI people in NYC by the numbers

Bird Flu: What You Need to Know Now

Updated on May 3, 2024 | Featured, Your Health

You may have seen recent news reports about the bird flu virus and the possibility that this virus could affect humans and our food supply, notably with milk from cows. Government health officials say there is no reason for concern, and experts at Mount Sinai agree.

“People should be aware, monitor the situation, and follow the guidelines of health authorities,” says Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.

The issue arose when a bird flu virus was detected in dairy cows in eight states. The concern is that this virus could pass to consumers who drink milk from infected cows.

The Food and Drug Administration (FDA) says tests have shown the commercial milk supply is safe. The FDA says the pasteurization process heats milk up to a high enough temperature to kill harmful germs, and milk from sick cows is diverted and not sold. Even if virus is detected in raw milk, pasteurization eliminates pathogens to a level that does not pose a risk to consumer health, according to Dr. Camins and the FDA. Recent testing by the FDA has shown that pasteurization is effective at inactivating the bird flu virus, and this testing did not detect any live, infectious virus.

Although bird flu viruses do not normally infect humans, sporadic human infections have occurred, according to the U.S. Centers for Disease Control and Prevention (CDC).

Click here for the latest updates from the CDC and click here for the latest from the FDA

On Monday, April 1, the CDC announced that one person in Texas had tested positive for a strain of the bird flu virus referred to as H5N1. The person was exposed to dairy cattle that were presumed to be infected.

The patient reported eye redness and is recovering. The patient was told to isolate and was treated with an antiviral drug for flu, according to the CDC. This is the second person reported to have tested positive for bird flu in the United States. A previous human case occurred in 2022 in Colorado.

The CDC says the risk these viruses pose to the public remains low. It recommends that people should avoid being near sick or dead animals. Also, people should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized (raw) milk or cheeses, according to the CDC. Dr. Camins says people should normally avoid eating avoid raw milk and raw cheeses because of the potential for contracting other infections and not just bird flu.

According to the New York State Department of Health, bird flu is caused by a group of viruses that occur naturally in wild birds. Animal health officials are watching closely for bird flu in poultry and wild birds in the United States. Early detection of the virus in poultry and wild birds is important to prevent the spread of bird flu, especially into commercial poultry flocks, the Department says.

Get more answers to frequently asked questions from the Centers for Disease Control and Prevention

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Seasonal Allergies in Kids and How to Manage Them

Updated on Apr 11, 2024 | Featured, Your Health

Most everyone enjoys the warmer days of spring and the budding flowers and trees all around. But this also means that the pollen count is high and allergy season is back too. For parents, it’s always nice to send the kids outside to play. But when kids experience allergies, it can be frustrating. The sneezing, runny nose, itchy watery eyes, and nasal congestion can seem endless.

Scott Sicherer, MD

Managing spring allergies doesn’t need to be so difficult, and if you understand what triggers your child’s allergies, you can help them feel better. The key is to try to limit your child’s exposure to pollen from trees, flowers, grasses, weeds, and mold.

Here are the top ten ways to help give you child—and you—relief from seasonal allergies from a a leading pediatric allergist, Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute and Chief of the Division of Allergy and Immunology in the Department of Pediatrics.

Plan ahead and follow the weather and pollen counts. When the counts are elevated or when it is windy, plan for indoor activities and go outdoors when the counts go down and wind lessens. If traveling, look at the pollen count in that area and plan accordingly.
Keep the windows closed at home and in the car and use the air conditioner instead. Make sure to clean the filters often to keep the pollen away.
After being outdoors, change clothes and rinse off, and shower to wash away the pollen that may be on your child’s body.
Pets can bring pollen inside the home, so wipe them down with a damp cloth and bathe them regularly.
Wash your child’s hands after playing outdoors so pollen particles don’t go on the face or in the eyes. If your child plays outdoors, have them avoid wet moist areas where mold can grow and tall areas of grass. Keep your child indoors when the grass is mowed.
Use nasal rinses to eliminate the irritants.
Drink lots of fluids and stay well hydrated.
Wear a hat and sunglasses to avoid pollen going in the eyes when outdoors.
You can try to lessen your child’s symptoms by giving them over-the-counter medications like antihistamines, decongestants, nasal steroids, and eye drops.
Notify your child’s school about their allergies and symptoms and be sure an allergy treatment plan is in place.

If you have questions or if you are concerned that your child may have allergies, contact your child’s pediatrician and/or a pediatric allergy specialist.

Learn more abut Pediatric Allergy and Immunology at Mount Sinai

Learn more about Pediatrics at Mount Sinai

What Do I Need to Know About the Rise in Measles?

Updated on Apr 15, 2024 | Your Health

You may have seen recent news reports about a rise in measles cases. While there have been a small number of cases, the risk of a widespread outbreak is low due to high vaccination rates in the United States. However, measles can be a concern for people who are unvaccinated, especially children traveling abroad to countries where immunization is low.

According to the Centers for Disease Control and Prevention (CDC), measles cases in the United States originate from unvaccinated international travelers. If you plan to travel internationally, you should ensure you and your loved ones are protected against measles before departure, no matter where you are going.

Kristin Oliver, MD, MHS

In this Q&A, Kristin Oliver, MD, MHS, Associate Professor, Pediatrics, Environmental Medicine and Public Health, and Global Health, Icahn School of Medicine at Mount Sinai, discusses the recent uptick in measles and explains new federal guidelines allowing children to get vaccinated as early as six months if traveling abroad.

Why are measles cases higher than usual?

There are several reasons. First, unvaccinated people who are traveling to and from countries with low immunization are likely catching measles and bringing it to the United States. Second, rates of measles vaccination have declined since the COVD-19 pandemic. Some parents were unable to get their children properly vaccinated during the pandemic or lack access to vaccines; others are hesitant about getting kids vaccinated. Some people may be unaware that their child needs to get a second dose of the vaccine to be fully protected.

What are the symptoms?

The first stages of measles look like many childhood illness: A cough, runny nose, high fever, and red eyes. After a few days, patients develop a red rash on their face that spreads to the rest of the body—the telltale sign of measles.

Who is most at risk?

Most people in the United States received the standard two-dose measles vaccines as children and are immune. If an unvaccinated person comes in contact with an infected person, their chances of catching measles are extremely high. According to the CDC, children less than five years old and adults older than 20 (especially those who are immunocompromised or pregnant) are more likely to experience complications. These include diarrhea, ear infections, pneumonia, and swelling in the brain. About one in five unvaccinated people in the U.S. who get measles is hospitalized.

When can I get my child vaccinated?

In general, the measles vaccine is a two-dose series. Children get the first dose between 12 and 15 months, and the second dose between four and six years old. However, the CDC recently changed its guidelines for parents with children who plan to travel internationally.

Under these guidelines, the recommendation is for kids to get early vaccines before they travel. Babies who are six to 11 months old are eligible for their first dose before travel. Children over 12 months old who have already received their first dose should get a second dose before travel. For example, if you plan to travel abroad with a two-year-old who received their first dose at age one, you should get them a second dose before you leave. Check with your pediatrician before you travel to learn about when your child should be vaccinated.

How can I get my child vaccinated?

Schedule an appointment with your child’s pediatrician. If you plan to travel abroad, let your pediatrician know so they can schedule the vaccines appropriately. If you are unsure about whether your child is up-to-date on vaccines, speak with their pediatrician. If you do not have a regular pediatrician, low- or no-cost immunizations are available through the New York City Department of Health and Mental Hygiene.

How can I protect my baby if they are too young to be vaccinated?

The best way to protect a baby too young to be vaccinated is to make sure you, your friends, and family are up to date on vaccines. If your baby is unvaccinated and you are traveling in a region where vaccination rates are high, the risk of exposure is low. If you are traveling to a country with low immunization rates, the risk is higher. Keep in mind that even in countries with high immunization, there may be communities within those countries where immunization is low. It’s important to research the location and communities you plan to visit to fully understand the risk.

I don’t know my vaccine history. How can I know if I’ve been vaccinated for measles?

You can get a blood test from your doctor to see if you’re immune. You may also be able to check the immunization records of the city where you grew up.

Learn more about Mount Sinai's Pediatric services.

I Am Thinking About Freezing My Eggs. How Does It Work?

Apr 9, 2024 | Featured, Women's Health, Your Health

Egg freezing is popular among women looking for options and balancing family planning with other important responsibilities. Thanks to significant scientific advancements in the laboratory, success rates are higher than ever.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Mount Sinai Health System, explains the process of egg freezing and its benefits. Dr. Copperman is also Managing Director and Chief Executive Officer of RMA of New York.

“Fertility preservation has the potential not only to safeguard fertility, but also to empower women to choose parenthood on their terms, at their own pace, aligning with personal and professional aspirations,” says Dr. Copperman. “It enables informed decisions about future family planning.”

Why should I freeze my eggs?

Egg freezing halts the biological clock, which is crucial for women whose age may mean they are facing possible declines in egg quality and quantity. Preserving eggs at a younger age enhances the chances of future conception and reduces risks of chromosomal abnormalities in offspring. It safeguards a woman’s fertility timeline while optimizing her prospects of having biological children later in life.

When should I freeze eggs?

Freezing eggs at a younger age is advisable, ensuring eggs are preserved at their peak quality and minimizing age-related reproductive challenges.

How does the process work?

Over a two-week period, the ovaries are stimulated to release multiple mature eggs for retrieval. Patients self-administer fertility medications, attend monitoring appointments, and then undergo a brief egg retrieval procedure under light sedation. Eggs are frozen and securely stored for future use.

How many eggs are frozen?

The number of eggs to freeze varies based on a woman’s age and family-building goals. Some may require multiple rounds of egg freezing to collect an adequate number of eggs.

What happens next?

When you are ready to conceive, your frozen eggs are thawed and fertilized with sperm, leading to embryo transfer into the uterus to achieve pregnancy.

Contact RMA of New York at 212-756-5777 or email info@rmany.com to schedule a consultation.

Learn more about Reproductive Endocrinology and Infertility Services at Mount Sinai

What Nasal Allergy Spray Is Best for My Symptoms?

Updated on Apr 4, 2024 | Your Health

A sneezy, stuffy, runny nose makes it hard to concentrate and get a good night’s sleep. Nasal sprays, which are sprayed directly into the nose, can provide relief for your nasal allergy symptoms by targeting the mechanisms leading to them.

To make an appointment with Anthony G. Del Signore, MD, PharmD, call 212-844-8450

Many prescription and over-the-counter nasal spray options are available that reduce or eliminate nasal allergy symptoms, but each contains different medications that target different symptoms. In this Q&A, Anthony G. Del Signore, MD, PharmD, Director, Rhinology and Endoscopic Skull Base Surgery, Mount Sinai Beth Israel, and Assistant Professor of Otolaryngology, Icahn School of Medicine at Mount Sinai, explains what nasal sprays are available and how to choose the best one for you.

What nasal sprays are available to treat my allergy symptoms?

The following is a guide to some of the most popular nasal spray options. It provides details on how these sprays work, what they treat, and their potential side effects. However, you should consult your physician or otolaryngologist before using them.

Saline Spray or Gel:

These sprays help to lubricate dry nasal passages, and are often recommended for patients with epistaxis, or nosebleeds. However, they may not relieve nasal congestion.

Examples: Simply Saline™, Xlear®, A&H, Ayr®

Saline Irrigations:
These treatments, which mix purified, distilled or boiled tap water with salt and baking soda, help flush mucus from the nasal passages, thins nasal secretions and thus pair well with nasal sprays for relieving congestion. These are often first line and the backbone of nasal regimens when treating allergies to viral and bacterial infections.

Tips: It is important to regularly clean your irrigation device and to use purified water. Depending on your symptoms, your physician or otolaryngologist may recommend using steroids or antibiotic ointments to achieve the best outcomes.

Examples: Neti Pot, NeilMed®, Ayr

Steroid Sprays

Nasal steroids are typically recommended as a firstline treatment of nasal allergy symptoms. These sprays help decrease inflammation in the nasal passages, which reduces symptoms such as congestion, runny nose, and sneezing.

Tips: To achieve the full benefit of these sprays, you should use them as recommended—once or twice each day for several weeks. The benefit is not immediate and must be used consistently to see adequate relief of symptoms. To minimize the risk of nasal bleeding be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Side effects: Although oral steroid use has associated risks, including cataracts, elevated blood sugar levels, mood changes, and disturbances of sleep, these risks are considerably lower when steroids are taken in nasal form. The more common risks include nosebleeds and nasal perforations when improperly used.

Over-the-counter examples: triamcinolone acetonide (Nasacort®), fluticasone propionate (Flonase®), mometasone (Nasonex®)

Prescription spray examples: beclomethasone (Beconase®), ciclesonide (Zetonna®)

Antihistamine Sprays

Much like oral antihistamines, these sprays block the effects of histamine, a chemical in cells responsible for many allergy symptoms, including a runny nose and sneezing.

Tips: To achieve the full benefits of these sprays, it is important to use them once or twice daily. For an additive benefit, be sure to use in conjunction with the nasal steroid spray.

Side effects: Some patients have reported drowsiness when taking these sprays. If you experience drowsiness, consider taking them before bed. Other patients have reported a bitter taste, dry mouth, and dizziness.

Examples: Azelastine (Astelin®, Astepro®), olopatadine (Patanase®)

Steroid and Antihistamine Sprays

This combination spray (azelastine and fluticasone) is only available by prescription. It can provide relief from nasal allergies in cases where using a steroid spray is not fully effective.

Tips: Use consistently to see maximum benefits. Often prescribed up to two times in each nostril once or twice daily. To minimize the risk of nasal bleeding, be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Example: The only branded combination spray currently available is Dymista®.

Anticholinergic Sprays

Available only by prescription, these sprays help to block a neurochemical that increases mucus secretions in the nose. They mainly provide relief from nasal drip .

Tips: This spray can be added to other nasal spray regimens to control nasal drip. The spray can be used up to four times a day. Best results seen when a known trigger is identified, i.e., cold weather, eating, consuming hot beverages, and typically can be pre-treated prior to the inciting factor.

Side effects: Some patients have reported dryness, nosebleeds, bitter taste, headaches, and irritation when using these sprays.

Example: The only spray currently available is ipratropium bromide (Atrovent®)

Cromolyn Sodium Sprays

These over-the-counter sprays work by blocking mast cell release, which induce inflammation and lead to nasal congestion, runny nose, and sneezing.

Tips: To achieve the best possible results, you should use them one to two times a day, starting at least several weeks before allergy season begins.

Side effects: Some patients have reported a burning sensation in their nose and a bitter taste in their mouth when using this spray.

Example: There is only one branded cromolyn nasal spray: NasalCrom®.

Decongestant Sprays
These over-the-counter treatments work by reducing swelling of blood vessels in the nose, which helps to relieve nasal swelling and congestion.

Tips: Although decongestants are effective for short-term relief, prolonged use—seven or more days—can result in rebound nasal congestion, also known as rhinitis medicamentosa, with inflammation of the nasal passages. They are also not recommended if you have glaucoma or high blood pressure as they can make these conditions worse.

Side effects: In addition to rebound nasal congestion, some patients have reported dryness, stinging, rapid heartbeat, and higher blood pressure when using these sprays, particularly during prolonged use.

Examples: Oxymetazoline hydrochloride (Afrin®, Sinex™, Dristan®), phenylephrine hydrochloride (Sudafed®)

Remember, nasal sprays can provide effective relief from the allergy symptoms you experience. If you have tried one and it did not work, there are other options you can try. The key is to see an otolaryngologist and discuss your symptoms. Based on that, they will be able to recommend one that does work for you.