Health workers battle racism as well as virus
Asians, Pacific Islanders face pandemic xenophobia
The patient needed a test to see if the esophagus muscles that help swallow food worked properly. At the dawn of the pandemic, an esophageal manometry posed risks for both the patient and her nurse.
It was February 2020, and San Francisco General Hospital’s nursing staff was starting to talk about the coronavirus. There hadn’t been a local confirmed case yet, so nurse Juliet Palarca wasn’t wearing much protection beyond a standard surgical mask. Palarca was going to open the woman’s mouth to insert a camera; if she coughed, respiratory particles would spray everywhere. And if the patient had the coronavirus, Palarca might catch it, too.
Palarca, a San Francisco resident, said she’s used to patients asking her where she’s from. This patient was more direct.
“Wait, you’re not Chinese, are you?” the woman asked.
Palarca tried not to react. She simply responded: “No, I’m Filipino American.”
The patient went on to discuss her personal experiences on public transportation. “If any of y’all coughed around me, I’d just get up and get off the bus.”
Palarca was included in that
“y’all.”
“I still have to complete her procedure; she still has to trust me to touch her and get close enough to do this procedure safely,” Palarca told The Chronicle. “It was very disheartening, and I struggled to be professional. I didn’t want to pull the race card.”
Stoked by racist political rhetoric about the coronavirus, encounters like these became more common in the months to follow, according to anecdotal reports and antibigotry groups. Now, Asian American medical professionals and advocates say the discrimination continues a year later — even as health care workers try to save the lives of the people disparaging them.
In California, 25% of active registered nurses are either Asianborn or Asian American, according to research from the Healthforce Center at UCSF. As workers on the front lines, they’re more likely to be exposed to COVID19. They’re also more likely to die.
The changing health care workforce is a result of 60 years of the United States recruiting Asiatrained nurses — especially from the Philippines — to fill shortages in American public hospitals. Now, these nurses are experiencing anti-Asian bigotry while they work to save American lives, said Catherine Ceniza Choy, professor of ethnic studies at UC Berkeley.
“What would happen if the Filipino nurses stopped working? What would the consequences be?” Choy said. “We’d see how our health care system would not be as efficient and effective without their labor.”
For decades, immigrants have played a critical role in America’s health care system. Among the 14.7 million U.S. health care workers employed in 2018, an estimated 18% — or 2.6 million — were foreignborn, according to the Migration Policy Institute in Washington, D.C.
U.S. and foreignborn Filipino nurses play a particularly big role in the Bay Area, where they account for more than 20% of the region’s licensed nurses, according to the 2018 Survey of Registered Nurses. An additional 13% selfidentified as Asian or nonFilipino Pacific Islanders.
“Post1965, so many Filipinos coming to the United States were coming to fill those jobs,” said Valerie Francisco-Menchavez, a San Francisco State associate professor who studies Filipino caregivers and home aides in the U.S. “They were getting them through immigrant social networks in their communities.”
FranciscoMenchavez interviewed approximately 70 caregivers last year about their experiences, and said they often described racebased discrimination in the workplace. Throughout the pandemic, some of that discrimination has been tied to the coronavirus, she said.
“The virus has been sort of coded as a ‘China virus,’ and many of them are definitely mistaken as such,” she said.
Former President Donald Trump was the person most responsible for that, according to a report from Stop AAPI Hate, a project from Chinese for Affirmative Action and the Asian Pacific Policy & Planning Council. Many frontline health care workers have shared experiences of anti-Asian racism in the past year, the project’s creators say. In one case recorded by STOP AAPI Hate, a physician working in a COVID unit at a hospital in the Bronx last year said she was preparing to do a nasal swab on a patient when the woman raised her hand and yelled, “get your Chinese ass away from me!”
“Like every other site and workplace where Asian Americans have been shunned and harassed, health care sites are no different,” said Russell Jeung, a professor of Asian American Studies at San Francisco State and one of the creators of Stop AAPI Hate. “Part of the problem is that when they use the term ‘Chinese virus,’ it stigmatizes people as having the virus . ... The virus isn’t just a physical thing; it’s a racial entity.”
Dr. Kenny Mok said comments by the former president — including frequent uses of “Chinese virus” or “kung flu” — made his professional life more difficult.
Mok, a hospitalist who specializes in inpatient care at Kaiser Permanente San Francisco, said he was often the target of bullying and racism growing up in the Mission District in the 1970s and ’80s. But the discrimination subsided as more Asians migrated to the Bay Area, and Mok said he never encountered it in his professional career.
That changed in September, when a patient crudely imitated Chinese dialect as Mok entered the patient’s room during morning rounds, he said. The encounter shocked and frustrated Mok, who said Asian doctors are risking their health to care for COVID patients — while also exposing their own families — only to be discriminated against in return.
“We risk our lives taking care of really sick patients with contagious diseases, and we just want to focus on getting patients well,” Mok said. “When you have this added stressor in your work life, it just makes it really difficult. We still do our job, but it certainly doesn’t help our mental wellbeing.”
Mok said he confronted the patient before leaving the room and immediately told the onduty nurse manager, who spoke to the patient and urged Mok to fill out an incident report. Mok said the patient is no longer enrolled with Kaiser, meaning he can receive only emergency care at Kaiser hospitals.
Mok said he believes the vitriol surrounding the virus has emboldened people to express antiAsian sentiments that were brewing under the surface.
“There have always been microaggressions against Asians, even in liberal San Francisco,” Mok said. “I think maybe COVID just gave people permission to act them out.”