At first glance, it seems like the Vietnamese community in Santa Clara County has made it. San Jose’s Little Saigon – the heart of the second-largest Vietnamese diaspora outside of Vietnam – is packed with immigrant-owned businesses. The smell of pho streams out of fast-casual food stands; the sounds of Vietnamese can be heard at gas stations, crosswalks and grocery stores. Just four decades after the first Vietnamese refugees began arriving in the Bay Area, they’ve made the region their own, now accounting for nearly 14% of San Jose’s population.
But beneath their vibrant enclave, the community is dealing with something much darker. Staggering health, social and economic disparities have plagued Vietnamese Americans for decades, both in Santa Clara County and across the United States.
According to a 2017 community health assessment, across all Asian sub-groups in the county, Vietnamese Americans have the highest poverty rate. The group also has the second-lowest per capita income and the highest percentage of adults who could not take medication because of cost. For many serious illnesses – such as liver cancer, lung cancer, and tuberculosis – the rate of afflicted Vietnamese Americans far surpasses the county average. And between June and December of 2020, Vietnamese Americans had the highest proportion of COVID-19 cases among Asian Americans in the county, according to Santa Clara County’s Public Health Department.
These disparities are nothing new for the Vietnamese American community, and the reasons behind them are complex. For many, poverty and poor health could be a result of limited English, difficulties with Vietnamese translation and misinformation, decades of suppressed trauma, and cultural taboos around seeking care. But on Dec. 13, San Jose’s Vietnamese American Service Center opened its doors to combat these disparities from a new lens.
The center is a culmination of nearly 10 years of work, and a response to findings from a county-issued report in 2011 that identified deep health and social disparities among the community. At the time, its data sent shockwaves through the county – but for many Vietnamese Americans, it just reflected what they already knew.
“We’re only a 46-year-old community, and many came straight from a civil war,” said Betty Duong, manager of the new Vietnamese American Service Center. “When people came [to San Jose], they were trying to learn a new language, recover from trauma and pull their lives together, all while starting off in poverty. They’re still moving on from that.”
The 37,000-foot, $50 million center aims to serve the 140,000 Vietnamese Americans that call San Jose home. Its design was led by Vietnamese architect Thang Do, who created the building with his country’s culture baked inside. The exterior’s light green façade is reminiscent of bamboo-based Vietnamese villages; a light fixture on the first floor resembles the traditional conical hat used across Southeast Asia. After the soft launch earlier this week, the sleek, three-story building began providing behavioral, primary and dental health care, a senior nutrition program, social service support, on-site child supervision, community programming and more. The center will begin operating at full capacity in February 2022.
“We have these identified needs that are disproportionately impacting the Vietnamese American community,” said Duong. “And the county has the services, infrastructure and dedicated resources to meet those needs. But somehow, they’re not being connected. After we saw the data, that became the mission.”
Duong has been working on the Vietnamese American Service Center since 2013. In the years since, she’s repeatedly seen the guilt, shame and stigma many in the Vietnamese American community associate with being in need, along with the repercussions of such invisible barriers.
“After going through so much trauma, it can be really hard to be vulnerable, to open up, to talk to someone, or ask for help,” said Mimi Nguyen, a Vietnamese American immigration attorney and San Jose native. “We’re taught that just dealing with things makes you stronger. But that perception is getting old.”
Nguyen said she didn’t fully understand what her parents had gone through until she reached adulthood. They never talked about their experiences, she said, and never mentioned the war or trauma they had fled. Even so, the impact of refugee-related trauma is well-documented, along with its influence on lifelong health. Such consequences also get worse when paired with economic disparity, and the daily grind of trying to pick things up when everything has fallen apart.
On top of that, nearly 60% of Vietnamese Americans in Santa Clara County stated they did not speak English “very well,” in the 2017 study, the highest among any Asian sub-group. Because of this, many Vietnamese Americans are not just uncomfortable seeking services due to stigma, but because of language barriers, are unaware of those services in the first place.
“People have always been reluctant to seek out care, at first because there weren’t enough people who could understand Vietnamese, and then, because of all the trauma they’d gone through,” said Dr. Hein Do, professor of Asian American Studies at Stanford University. “For years, many don’t want to seek out help. By the time they do, it’s already too late.”
In the 2017 study, 31% of Vietnamese Americans in Santa Clara County reported feeling depressed, while 47% – the highest of all Asian sub-groups – reported only “fair” or “poor” general health. Still, 66% of Vietnamese Americans in the county feel they do not have the social and emotional support that they need.
According to Duong, gaps like these do not exist because of a lack of services. They exist because of a failure to link up with those who need the services most.
“Once I started learning more about our history, I was finally able to put words to what I’d seen my entire life,” said Nguyen. “Seeing family members who couldn’t speak English, watching their struggles with navigating the system, having to fill out forms for my parents at a really young age – I didn’t understand any of that. But as I got older, I realized that they were trying to navigate systems that weren’t made for them.”
Hoang Truong is the recreation program specialist at the Vietnamese American Cultural Center, a community gathering place in Little Saigon. For years, he has seen Vietnamese Americans struggle with navigating social services, health care systems and everything in between, often because of difficulties with translation – and often among the elderly.
“Even if things are translated into Vietnamese, sometimes, those translations don’t make sense to the older generation,” said Truong. “Using the wrong words can make a big difference.”
A few years ago, for example, Truong discarded the typical translation of mental illness, tâm thần, for a different phrase, tâm trí. The former holds a connotation of permanent insanity – something that, Truong explained, makes many Vietnamese elders shut down a conversation entirely. Instead, he uses a lighter, less serious translation – tâm trí – to describe mental illness as something you can recover from. It’s with the latter phrase that Truong been able to make progress among members of his community, helping refer individuals struggling with mental illness to the help they need.
Such practices are something that many in the Vietnamese American community rely on, but are only beginning to be institutionalized at the county level. Through the comprehensive package of services offered – in language – at the Vietnamese American Service Center, the county hopes to change that.
Nguyen and many other Vietnamese Americans believe the center can serve as a model for other refugee communities, especially when addressing mental health care.
“When people flee their homes, they carry trauma with them,” said Nguyen. “That’s not unique to the Vietnamese. We will see this with Syrian refugees, with Afghan refugees… We need to get a handle on how to support refugees preemptively, so the hurt doesn’t compound over time.”
Though the center first opened its doors to clients on Dec. 13, the grand opening celebration will occur in February 2022, positioned to fall on the Vietnamese Lunar New Year. Individuals must be enrolled in the Valley Health Plan to receive medical services, but the center will have staff onsite to help with enrollment and plan navigation.
“Just from looking at it, you can tell it’s culturally responsive – and I think that will bring a lot of people out,” said Philip Nguyen, the Executive Director of the Vietnamese American Roundtable. “But I also think it’s just the beginning. I don’t think a building can solve all our problems right away, but it’s definitely a step in the right direction.”