Kimberly S. G. Chang, MD, MPH

1. Who are you?

I’m a family doctor at Asian Health Services [AHS], and have been working here since I finished residency in 2002. I was born and raised in Honolulu, Hawai’i. Right now I’m seeing patients part time and part time as a healthcare policy fellow at AHS - a position that we created so I could continue my policy work.

2. What are the issues you fight for?

I focus on human trafficking and the healthcare intersections of that...but the broader issue is health equity and fighting for marginalized, disenfranchised populations, for their healthcare, for their equitable ability to prosper and succeed in our society. Health is a symptom of larger social problems and dislocations, and how social problems present in people’s lives is at the core of health equity and public health.

3. How did you get here?

When I first started at AHS, one of my clinical responsibilities was at the Teen Clinic. We were seeing a lot of commercially sexually exploited minors - teenagers - in the Teen Clinic in 2003. And we didn’t really know what to do about these issues, what to do about these kids who were being sold for sexual services in Oakland. We didn’t have the terminology or the language. And societally, we didn’t really know what to do with it either. There was no definition for this - we used to call it “child prostitution.” Now we know that there is no such thing as "child prostitution" - anyone under the age of 18 years exchanging sexual acts for something of value is a victim of human trafficking.

Federal legislation to define human trafficking passed only 2 years before, in 2000, and policy can take a while to translate into practice. So we were seeing this on the frontline - seeing drug use, mental health problems - but... there was really nothing we could do except through the criminal justice system. We tried reporting to Child Protective Services, but because it wasn’t a caregiver perpetrating the abuse, there wasn’t anything they could do, and they referred us to the police. But the police would these kids want to report it, and they didn’t. So there was really no space where this was being addressed... What you see is a disconnect between federal and state legislation, about these definitions - of these kids as victims.

AHS started Banteay Srei as a youth development program for these youth- we were saying this is not just a medical issue. But we also needed providers to be aware, so we created a screening protocol to make sure we were catching these patients, so we could intervene, hopefully early, or even prevent exploitation and trauma.

There was a patient I saw in 2008 who ended up being really really sick and she was hospitalized for 2 months, but she really didn’t want to go to the hospital - she said she would rather die than go back to jail. That was really an “aha” moment for me, because I realized we could do all the services, all the screenings, but that was all just clinical... what were we really doing for these kids, what were they facing? How could we change the way the structures were built, change the way the systems operated, so that the youth were not afraid of systems that care and protection. I ended up getting introduced to the Director of the National Center on the Prosectution of Child Abuse from the National District Attorneys Association in Washington, D.C., and I presented all these case studies of patients I saw, saying “these kids are terrified of law enforcement, what’s going on, what can we do?”

Advocacy is a lot of media advocacy, communication, building awareness… in 2011, we got the New York Times interested in this and they did an article, looking at our programs, and how we’re seeing this as abuse, not sex work, and this is a problem for youth in our community.

So all of this really comes out of my clinical work, and based out of real people and their life experiences - patients we've cared for at AHS.

4. How does activism/advocacy fit with your role in medicine?

I mean think about it - who has eyes on what’s really going on in the community? A mentor told me this: it’s teachers because kids come to school and repeat what parents are saying in the home, pastors because they take these confessionals, and clinicians because people are sharing all of their vulnerabilities, issues, barriers affecting them and their health. If we really pay attention to our patients, not just the really narrow medical piece - but what’s really going on in their lives, the conditions creating illness and disease, you have a whole, fertile ground on which you can provide information to influence policy. That’s very powerful.

5. How does your AAPI identity influence your advocacy, if at all?

I work at Asian Health Services so I see everything through the lens of AAPI identity and experiences. I grew up in Honolulu, a majority minority state, and I didn’t really get that this was different, I was different - I just thought I was normal. I went to college in New York, at Columbia, and that was a bit more eye opening. People have ideas about who you are and how you should be, and cultural stereotypes. And that kind of opened my eyes. I went back to the University of Hawai’i for medical school, so I went back home, back to a majority AAPI location, and it was comfortable - easier to be just myself without having to worry about how people think of me. You know, there’s a tax when you’re a minority - you have to filter information through this lens, and it takes a lot of energy, and that energy could be better used and spent solving problems than trying to figure out how people see you. It’s the same thing with UCSF, where I went to residency - there’s a lot more awareness, and the mission was to serve vulnerable patients, which resonated with me.

My goal at the end of finishing residency was caring for disenfranchised patients, minorities, patients, who are vulnerable, so I wanted to see a wide variety of patients. I worked in a variety of settings after residency, and AHS was one of them. I felt like I could do more, and focus more on the patients, at Asian Health Services. Part of that was the cultural tax. AHS is very comfortable for me; even though I don’t speak fluently in another language, I think there’s an affinity with patients, of all Asian background, that we have with each other. And I think that helped with the healthcare.

6. What are some challenges you've faced in your work?

I took a year off from 2014-2015 to do a Minority Health Policy Fellowship at Harvard, and this was kind of a mid career switch, and I had already worked for 10 years and directed the Frank Kiang Medical Center. Some of the personal challenges I’ve faced were coming to this awareness about systematic and structural and internalized barriers. I think for me, it was very easy to just focus on grades, school, and you’re supposed to succeed if you just follow the rules. But that’s not necessarily true - there’s a lot of Asian Americans in medicine, but if you look at the professors, deans, NIH research awards, grant awards and foundation leaders - it’s very small. Why is that?... it’s because you have to have these social connections, social capital, and it’s not just about following the rules and getting good grades. It’s about networking, lifting others up, having others lift you up, getting noticed - and sometimes, we don’t get noticed because there’s some stereotypes about Asians… A lot of times, culturally, we’re very community and family oriented - you have to make sure that everyone is doing well, not just yourself.

...The structures that we’re placed in, sometimes it’s not like that - it’s very competitive, it’s very “me or you,” and so those kinds of structures may not be conducive to promotions or things for Asians. And that's important because these sorts of structural barriers mean less resources for underserved Asians, less opportunities, less attention to the problems faced by refugees, immigrants of Asian descent. So that’s how my personal challenges translate societally. If I am going to be a good advocate for my patients, if I can use my privilege and power effectively, I better know what the barriers are, because if I don't at least recognize them, how would someone with much less privilege be able to overcome them?

7. What's your advice for health students getting into advocacy?

Help each other, support each other - it’s not a “me vs. you,” it’s about you helping your colleagues and there’s an understanding that at some point they might be able to help you. The currency right now is how many groups or networks you’re a part of - information is the currency. So as many different types of groups that you’re a part of and you can get information from or contribute to, that adds to your work. Give opportunities to each other.

Look at community organizing. Advocacy is not about being the boss - it’s about the issue. What can you do to move the issue forward? Sometimes that means being the leader, and sometimes that means taking a backseat. Always keep the goal of moving the issue forward as the main priority, not your own position, not your own success. If you do this, then you will be successful.

Be intersectional - advocacy looking at other minority issues, other underserved/vulnerable populations issues - not just strictly AAPI issues. What other communities have faced and learned can be applicable to us and vice versa. Make allies.

8. What are you working on most recently?

I’m still doing human trafficking policy work - I was appointed to the National Advisory Committee on the Sex Trafficking of Children and Youth in the United States, and that’s a way to make recommendations to Congress, state Governors, and Child Welfare departments

and offices across the nation on this issue. I was elected as the vice speaker of the House for the National Association of Community Health Centers; it’s so eye opening to learn about the issues facing communities across the country - like the opioid crisis facing our partners in Kentucky and Ohio, and rural workforce challenges, among others - and I’m so proud to be working in the community health center movement.

9. Where can we follow your work?

I’m on LinkedIn and Twitter (though I’m not super active).