Joan Jeung AB '93 MPH '16 MD MS

Introduction

My name is Joan Jeung. Way back in the day, as an undergrad, I was Joan Kim, Harvard College Class of 1993. I was at Currier House majoring in Sociology, and I was pre-med at the same time. I'm currently on the Pediatric Clinical Faculty at the University of California San Francisco (UCSF) School of Medicine. But for many years before that, I was working as a community pediatrician at Asian Health Services, which is a federally qualified health center in Oakland, California largely working with Asian American immigrant and refugee communities.

Who would you say has been your most influential mentor in your life or in your medical career and why?

I want to mention an early one from my undergraduate days. His name was K.W. Lee, and he was not in medicine; he was considered, at the time, the godfather of Asian American journalism and a civil rights activist. I went to work for him as he was starting The Korean Times, Los Angeles English edition, and spent a summer doing some journalism for him. This was a time of escalating racial tension between the African American and the Korean American community in L.A., happening in the run-up to the L.A. Riots. It was a really interesting time to have your ear to the ground in the community and understand what was starting to happen in the realm of race relations. 

When I was an undergrad, I had this big heart for social justice and really wanted to understand what caused urban poverty, what perpetuated it, what would we do about it.

When explaining the evolving landscape of race relations, one of the things K.W. told me when I was going off to Harvard was, “Don’t forget your community. Don’t forget where you came from. Don’t forget the low income immigrant community that’s here, that they're part of this Asian American community too, and how they’re not part of that whole model minority experience that people think about when they think of the Asian American community.”

K.W. was a real mentor in this way. 

Another thing that really stuck out for me was how he pointed out that, especially in a time of escalating racial tension, the Korean American community and the Asian American community in general owes a lot to the African American community. Before the Civil Rights Movement, there were great restrictions on immigration from non-European parts of the world. The doors essentially opened for immigrants from Asia due to the Civil Rights Movement, so we can thank many of those leaders for our presence here in this country. It’s such a different landscape for race compared to what it had been in the 1950s and 60s, thanks largely to leadership in the African American community and the Civil Rights Movement. That was an eye-opening comment to me, and it has played such an important role in my development and understanding of social justice. He came of age reporting during the Civil Rights era in the South. He also talked about how white Europeans had exerted control to divide up racial minority groups in the U.S. and globally to pit non-white groups against each other who are unable to question that power structure. This was a long running practice in European colonies, and one reason why colonization left so much racial conflict.

After the L.A. Riots were over, he pointed out where the U.S. National Guard had stopped: it went to the edge of predominantly white suburbs and left non-whites to duke it out. He said, “Don’t get pulled in by this and don’t fall into that trap of thinking that African Americans are your enemy. Understand where this is coming from and don’t get caught down in the wrong battles.”

And finally, he said, “We are here to spread light, not heat. Remember that.” Those things very much stayed with me as I continued my journey after working with him. I did not go into journalism, clearly— I wound up in medicine— but I very much appreciate the impact he had on me and what he taught me. It has certainly influenced the work I do.

Why were you drawn to minority health policy and pediatric care, and how do you view the intersections between those two?

I was drawn to minority health partially because this is my life experience growing up as an immigrant. I spent much of my childhood in the South, in North Carolina and Tennessee, where we were very much a racial minority. I became sensitized to what it means to live life on the margins with a different point of view.

Pretty early on, starting in high school, I was very drawn to working in social justice. I didn’t know what field I was going to wind up in professionally; I had thought about many, many different things, including public policy and journalism. But ultimately— this was another mentor [of mine]— I did meet a family practice doctor who used her work as a platform for direct community service working with homeless families, doing a lot of policy work and research and advocacy. I realized, when I saw her life, that this is what I wanted. I wanted to create programs that serve the community, let them be a model for others, and use this as a platform for advocacy, for communities, for social justice. All of that is to say this drive for social justice was part of me from very early on. The experiences of delving into race and perpetuated injustices in this country really drew me to minority health, to work in and directly serve my immigrant community. Also, I was committed to building bridges with other minority communities and trying to build solidarity as a way of promoting better chances and life opportunities for us all.

Now, why pediatrics: Before I went into medical school, I took a little time off as I wasn’t quite sure I wanted to go to medical school. I worked for a consulting company in Washington D.C. that dealt with many federal contracts. While I was there, I had the opportunity to help start an after-school program for kids in D.C. In the program, there was a Korean merchant family who was reaching out to their largely African American neighbors to start this program. It was so rare and so different and, again, this was in the aftermath of the L.A. Riots.

There weren’t too many people attempting to build bridges like this, so when I saw this I jumped right on. I was like, “I want to help!” I helped to start this program and the organization is still there 25 years later, called Little Lights. It is still doing this work of racial reconciliation and promoting educational equity. Because I was there from the very beginning, I really got to know kids in the neighborhood deeply and it was almost like I became a part of the family for some of them. It absolutely changed me. I mean, I can’t even begin to tell you how getting to know the children and their experiences got under my skin and changed the way I view the world. That’s a big reason why I wound up in pediatrics.

Can you speak more on how your work was influenced by these past experiences with social justice and race relations?

New Hope Covenant Block Party

First of all, going to Asian Health Services, remembering and serving the Asian immigrant community and starting out my professional life there, was influenced by the work I did in Koreatown that summer [working under K.W.]. This lent itself to some of my external work, as well. I am pretty active in the American Academy of Pediatrics in leadership at the national level, and I was a founding Executive Committee member for a new Section on Minority Health Equity and Inclusion. Before that, the American Academy of Pediatrics, or the AAP, didn’t have a group like this that was specifically dedicated to minority health. It was largely African American women who were starting it, but they wanted to diversify more. When I told them my story of having family members and attending church in L.A. at the time of the Riots, of being on the ground in the run-up to that and knowing that my understanding of race had to change and evolve when trying to work for social justice in this country, it helped convince the original founding core that I should be part of the starting leadership team. It has been one of my proudest accomplishments in medicine, knowing I helped start this group that, within its first year, went to nearly a thousand members across the country. I helped organize Continuing Medical Education events specifically teaching and advancing anti-racism in medicine to understand the impact of racism on child health and how social determinants of health— including race— really shape health from the earliest days in a child’s life.

The other thing that I’ve come to recognize since becoming a pediatrician is the impact of Adverse Childhood Experiences (ACEs) on downstream development and health. Early experiences in childhood play a large role in shaping brain development and architecture as well as regulating stress physiology throughout your entire life.

That shapes long-term risk for cardiovascular diseases, cancer, obesity, and diabetes, which are the leading causes of death in this country. A lot of this gets programmed prenatally and during the first three years of life. We talk about these critical first 1000 days, and really stressful, traumatic experiences— whether it’s maltreatment, exposure to domestic violence, parental substance abuse, incarceration, or mental illness— can affect early brain development, which in turn drives many health outcomes and long term educational and vocational outcomes.

This reflects many of the experiences I encountered at Little Lights in D.C. When I watched what family violence and community violence did to the lives of children, what they faced, the incredible odds they were up against and what happened to them in the long-term, I saw the reasons behind a lot of these health outcomes. I saw the explanations for what happened to many of my patients at Asian Health Services, the epidemic of developmental delay and mental illness, and the ways early experiences affected asthma rates and other health problems. 

We have an opportunity in pediatrics early on to affect the whole life trajectory. If we can do something about the social determinants of health early in life and build up buffers in children’s lives, help their families mitigate that stress so kids grow up resilient and healthier, we can really affect life trajectory for many, many years to come.

I really see the promise of this and that’s part of the reason why I made the jump into academic medicine. All this is to say that there is a real opportunity in pediatrics to get to some of the molecular roots of health disparities, educational disparities, and economic disparities, and there’s a real opportunity to make a huge difference.

You mentioned that you work with Asian refugee communities. What has been the greatest takeaway from working with refugee patients? Can you elaborate on the kind of work you did?

While I was working at Asian Health Services here in Oakland, I lived pretty much in the same community that my clinic was in. I moved here into East Oakland as a medical student and started tutoring and working with Southeast Asian refugee youth. They were largely Cambodian or from Laos, and I got to know the Southeast Asian refugee community in the area. One of the nonprofit workers who worked there told me early on that whenever there’s a disturbance in the world, we feel it here in Oakland because refugees come and settle here from all over the world. And that was true.

For example, we had this wave of refugees coming from Burma after George Bush opened up resettlement to refugees from there. We realized, however, that many of them didn’t speak Burmese, which was the language that was being offered to them for interpretation; they spoke smaller dialects. They had literally nobody who spoke their language anywhere in the healthcare system.

With them moving into our neighborhood, my husband and I created a series of health fairs to perform a needs assessment. We wanted to figure out, “What are the overall needs of this community? Where are they being met? Where are they not being met?” That’s when we realized this big language gap in healthcare and the lack of healthcare that many of them had.

We took the data that we gathered from our needs assessment and used it to advocate with the county health system; this was also when I had just started work at Asian Health Services. I walked in there and said, “Look at this data. Look at the zip codes where most of them are living, which is right here around this new clinic that you’re building.”

Asian Health Services existed for a long time in Chinatown, but they started building a new satellite just outside of Chinatown in the neighborhood where there are a lot of Cambodians, Vietnamese, and now Burmese people living. We emphasized how Asian Health Services is meant to serve Asian immigrants and refugees in their language. So we used that data again, wrote some grants, and hired our first Karen speaking community health worker, because this is the language that most of them spoke. We also did a lot of outreach to Mongolians because this was another small, but emerging community. After a lot of outreach, we got people connected to primary care providers with a community health worker serving as an interpreter, health educator, and outreach worker. We were able to open up our doors to smaller emerging immigrant and refugee communities that were just not being served before.

How have these experiences working with Asian immigrant communities shaped your approach as a provider?

Through this work I did at Asian Health Services, I feel I developed a closer connection to the local community. We really got to know community members who worked alongside us at the health fairs and gathered the data for our needs assessments. Some we hired to become staff and translate for us, and it was such a close connection that I developed.

Living here with Karen neighbors around the corner, it felt a little bit like being a small town doctor in the middle of a big city. I got to walk out and see patients in my neighborhood, see them at the local dollar tree or grocery stores. My son was attending the elementary school right around the corner from the clinic and I remember going to different school district events and seeing some of my patients there as well. Having this connection is rare in medicine these days, so it was a lot of fun just being part of that.

Some of the biggest takeaways that I took from the whole experience include how the quality of care that we [doctors] provide is really based on the quality of the relationships and connections we formed with our patients and communities. We can only move at the speed of trust. People only listen to us to the degree that they trust us. So, the importance of relationships and of trust really stuck out for me as being critical for clinical medicine and the advocacy that we did, involving community members and advocating for their needs. That was very powerful and that advocacy effort worked because we were able to develop connections with the community.

Also, I don’t know if you’ve heard of community health workers or know who they are, but they’re basically folks from the community who are not licensed medical professionals or nurses, but have some leadership ability and credibility within the community to serve as a bridge. They often serve health education roles because they’re trusted messengers. In our case, they speak the language, they come from the community, they come from the same culture, and they understand the mindset. For all the health ed and ongoing primary care programs that we offered, they served incredibly important bridging roles.

I think there is a big role for community health workers in our public health and medical systems. I’m a big fan now of involving community health workers and hiring them into our programs and clinics because they bring direct community involvement to our program planning and advocacy.

You've been doing that kind of advocacy work for a little while now. After working in that particular field for some years now, what kind of changes do you see that have taken place in terms of expanding those programs or where else do you see them going in the future?

Actually, that directive at Asian Health Services is permanent. We still have Karen and Mongolian speakers in the clinic working full time, and that’s still a big part of the communities being served at Asian Health Services; that was a long term institutionalized change. Even though I’m no longer there, that didn’t die with my leaving, so I’m very proud of how there’s a permanent expansion of services in that way. Going beyond that, I mentioned the work that I did in the AAP, the American Academy of Pediatrics; I termed out of [my leadership position] after it started, but that group is still growing. It has a pretty prominent role within the Academy now— I don’t know how many millions of people are part of the American Academy of Pediatrics, this is one of the bigger groups within organized medicine.

For them to take such a proactive stance in talking about racial justice… I am very, very proud of that. I’m proud to be part of the AAP, proud that the AAP is putting its voice in organized medicine for racial justice matters for child health. One of the medical education programs I developed for that was recorded and is being offered nationally as part of free anti-racism training for pediatricians.

Empowering Mothers Initiative Dr. Jeung founded (video here: https://www.youtube.com/watch?v=jfmo_fQhx0w)

I guess I didn’t plan on doing any of these things. I responded to needs that I saw around me and opportunities as the doors opened, and one thing led to another and led to another and then led to another. Along the way, these are a few things I can look back on and say, “Okay, something good happened here. This happened and it’s going forward and it's staying there.” We founded Little Lights and it’s still there, serving hundreds of children in D.C. Asian Health Services is still serving these small communities. The AAP has this very active, powerful section within it dedicated to mental health with relevant resources to push the message out to all our membership.

The work that I’m doing now has moved more into early childhood development and mental health. As I said, I see a real opportunity here to move the needle on health and educational equity because the same determinants are shaping both. It’s the same thing that’s happening in the brain, which impacts overall physiological development in early childhood. That work is more or less just beginning, but I think it’s still very much tied to this endeavor towards health equity.

What advice do you have for undergraduates who are interested in pursuing these fields in medicine and what kind of insights do you have to offer to them?

Number one, there’s no substitute for direct person-to-person community service to keep you grounded. I’m thinking of this quote from Robert Coles, a pediatric psychiatrist who used to teach an undergrad course [at the College] and also taught in Harvard Medical School and the Graduate School of Education. He was a social justice warrior and, in one talk he gave us, he said, “Only connect.”

This is our job in clinical medicine, this is what keeps us true and prevents us from going off into weird, strange diverging tangents that we can easily get lost in. I find that as we connect with communities we’re trying to serve and be part of, that connection and change goes both ways. The times that I truly felt, “Something good happened here, something transformative happened here,” I was transformed at the same time. I think it is an important part of this journey and this process, and the best things that happened to me were honestly things I couldn’t plan.

This transformation happened because I was in the community and actively volunteering, for example. I was in East Oakland, volunteering with youth, living here and recognizing who was here. Recognizing that they needed something and then running with that shaped 10 years of my life at Asian Health Services; that’s how long I was there, 10 years of my life shaped by this. It started out with volunteering experiences and my decision to go to pediatrics. This even applies to the work that I’m doing right now around trauma, toxic stress, and early brain development— understanding how to translate science to programs came out of my volunteer experience running that after school program in D.C. Watching what happened to the lives of children who I cared very deeply about helped me realize that this is my why. I see their faces, and I think of them still. Always prioritize relationships and person-to-person connection.

Joan Jeung AB MPH MD MS

AB Sociology | 1993   

MPH | 2016

Pediatrician, HS Clinical Professor 

Interviewed and Compiled by Christine Lee

Edited by Felicia Ho