By Mahlon Meyer
NORTHWEST ASIAN WEEKLY
The only place Phoenix Guo felt safe removing her mask and having a bite of food was in her room. The family respected this. So she, her son, and her daughter-in-law all ate in separate rooms.
At 75, Guo had seen much of the world, both in China and the U.S., but her experiences with the U.S. healthcare system had left her terrified lest she be stricken with COVID-19 and die, untended, in a U.S. hospital.
As a result, she stayed in her son’s house for three years—the duration of the pandemic—and only recently has started to meet people outside, where she still wears a mask.
While her decision to stay indoors was perhaps extreme, her reaction to the U.S. healthcare system is not uncommon for an immigrant to this country.
In fact, according to scholars who study immigrants in the U.S. and their interactions with the healthcare system, mistrust and feelings of repulsion are quite common.
In Guo’s case, there were multiple factors. Her experiences with American doctors seemed so different from her experiences in China. At the same time, she was exposed to news of Chinese immigrants supposedly being left to die, untreated, in American hospitals. Finally, she followed the advice of Chinese authorities in the Chinese media. All of these created in her a fever of fear. She vowed she would do whatever it took not to get COVID-19 while living in the U.S.
“Even such a young one died in a matter of days,” she said, referring to a 30-year-old Chinese activist who had come without a green card to Los Angeles and had at first raved about the cleanliness of the hospital. Later, however, she heard he wasn’t given any medicine, and was reported to have died.
Guo came to see him as a warning bell.
A health condition
When she was a child in Qingdao, she would become short of breath after running. She later went on, during the Cultural Revolution, to join a propaganda troupe in which she sang and danced, with other girls, exhorting the peasants and others in her area to follow the virtues of Mao Zedong, “the red sun.”
At that time, her chest would hurt, but she kept on.
It was not until decades later, after China had undergone reforms that catapulted its economy to nearly first-world conditions that she, now the president of a tourism company, began to seek out medical treatment in some of China’s top hospitals.
In Beijing, doctors performed an ultrasound and found she had a heart condition. For a more detailed diagnosis, she traveled to one of the top medical universities in the country, affiliated with Fudan University.
The first time she went, the new hospital was still under construction. But on subsequent visits, it was completed.
Cardiologists there performed further tests and found she had an abnormality in one of her heart valves.
But, they found, it could be treated with two different kinds of medication that must be taken simultaneously.
So all was well with her now.
Traveling to the U.S. and trouble
Her blessings increased when her son, who was living in the U.S., had a son with his wife, who was from southern China.
(In order to retain anonymity, the city where they currently live is being withheld.)
In 2018, Guo traveled to the city where her son lives and works in order to help take care of his new-born infant.
That is when the trouble started.
Without ever having visited the U.S., she had visions of American doctors as not only highly trained and educated, but as virtual saints who would sacrifice large swathes of time and show love and caring with all of their patients.
On her first visit to the hospital—she was almost out of the medications used to treat her heart—she arrived over a half hour early.
“I wanted to be really careful,” she said.
After an hour of waiting, however, the nurse finally let her into a room and took her blood pressure. She then waited another 15 minutes before the doctor arrived.
He was a tall white cardiologist in his 50s, she remembered. His attitude was not only dismissive—it was insulting.
“We don’t have that medicine here,” he said through an interpreter, referring to the second medication her Chinese doctor had given her. “Maybe you can find another doctor who will look for it for you.”
In subsequent visits, other cardiologists, all of whom were white and in their 50s, as if they had been stamped out of a pattern, seemed to speak down to her in the same way, she said.
Moreover, she could not understand why they only seemed to order one test after another.
Finally, a cardiologist wanted to test her son to see if her issue was hereditary, a test she could not understand the purpose of. Nor was it ever explained to her.
Each time, the doctor would see her for a few minutes, hardly, if at all, look into her face, and talk to her slowly and loudly, “as if I were an idiot,” she said.
Immigrant experiences in the U.S. health system
Her experiences have been replicated across the U.S. by other doctors treating other immigrants, according to Kimberly Aparicio, a physician and assistant professor in the Department of Family and Community Medicine at the University of Texas Southwestern Medical Center, in a journal article entitled, “Asking for Care, Not Favors: Experience of Immigrants in the US Medical System,” published in the AMA Journal of Ethics.
“I have seen the difference in attitude that workers have toward the immigrant patient,” wrote Aparicio, then a medical student.
The problem is “an ongoing lack of trust in the medical system on the part of the immigrant population, fueled in part by a lack of compassion, the very essence of the patient-physician relationship.”
The source of this neglect and condescension, concluded Aparicio, is the attitude that medical providers are “doing a favor” to immigrants by treating them.
Such an attitude creates “a barrier far greater than that posed by language difference. As a furious patient once told me after seeing her doctor, ‘I come here for help, not to be treated like a child for not knowing English.’”
Other scholars have offered similar critiques of the U.S. healthcare system and immigrants in this country.
In the meantime, Guo was reduced to getting her second medication from friends or visitors, who would mail it or carry it over.
But that was complicated as there were restrictions on mailing it out from northern cities. So she would have to have it arranged to be shipped from the South.
“Oftentimes, it could be added to a shipment of clothing,” she said.
Meanwhile, the pandemic started. She was faced with a situation in which she had an uncertain supply of medicine for her heart condition, a U.S. healthcare system that either disdained or was unable or unwilling to seek a counterpart for a medication she had been prescribed in China, and a heart that was beating faster than it should.
As she cared for her son’s newborn infant, she wore a mask constantly, lest the contagion might be spread from her son, who needed to work outside the house, to her and from her to the infant.
While all this was going on, like many other Chinese immigrants, Guo turned to the steady stream of Chinese news she found online.
Unlike American news, she said, Chinese news brought forth a stream of “experts,” who would make pronouncements about the pandemic.
Because of their impressive credentials, she trusted them.
Unlike American news, which she would read in translation, the Chinese media presented scholars and professors and leading researchers, she said.
Her impression of American news was that it was mostly journalists without any advanced training simply commenting on events.
Sometimes, however, she would learn frightening things.
For instance, she learned from a Chinese authority that harmful microorganisms can remain alive indefinitely in the freezer or refrigerator.
“Since then, I always wash my hands each time after I open the freezer or refrigerator,” she said.
A pandemic of insensitivity?
She also loathed the idea of ending up in an American hospital, like the case she had heard about at the start of the pandemic—the young Chinese immigrant who had died there after extolling how clean it was.
There was, in fact, another case she heard about—the same thing happening to a 50-year-old man who was otherwise in good health before contracting COVID-19.
But like the younger man, he was an immigrant, and had been left untreated or mostly so in an American hospital, she heard.
This confirmed her determination.
It also seemed to confirm, for her, that the way she had been treated when she went for help about an equally serious matter—her heart—was not an isolated incident.
“American doctors are really well-educated and have good training,” she said. “But they lack the art of practicing medicine.”
In a sentiment shared by other Chinese immigrants in this area, she added another consideration that she said added to American doctors’ relative deficiencies.
“In China, doctors have to see so many cases, they learn how to treat illnesses in the most practical and efficient manner,” she said.
She mentioned a certain type of surgical procedure that had been common in the U.S. for decades.
“Chinese doctors have only just started to do this in the last few years, but they’ve already caught up,” she said.
Guo also took pride in her hygienic habits.
“Can you believe some people don’t wash their hands before eating?” she asked rhetorically.
Her clean habits began, she said, when she was in kindergarten in Qingdao. Her parents were able to send her to one of the top kindergartens, a school with a history that was connected to both the Japanese, when they occupied the province, and to Germany, before that.
“From the very beginning, we were taught about personal hygiene, such as never sharing drinking utensils or bowls,” she said.
To entertain herself, in her long sojourn inside her son’s house, and inside her own room, she would sing Chinese songs or try a few dance steps to traditional Chinese melodies.
“But between cooking, and taking care of my grandson, and cleaning, I never seemed to have that much time,” she said.
Into the open—or not
Thus, the three years passed like a dream. Imagine slumbering in a cavern for three long years, not knowing what was going on outside, except through the ghastliest reports or through the flights of your own sequestered imagination, and then suddenly stepping out again into the bright sunshine.
What a thing that would be!
But for Guo, she was unimpressed.
When she finally went out, recently, with her son to a restaurant, she kept her mask on the whole time.
“I learned from the Japanese,” she said. “I only removed it quickly three times, for three quick sips of wine.”
Now imagine that the prison you’ve been sequestered inside remains with you, like an iron mask.
I asked Guo how much longer she is going to wear her mask.
“Isn’t this virus here to stay?” she asked rhetorically.
Finally, she responded: “Forever, of course.”
Mahlon can be reached at firstname.lastname@example.org.