Health and mortality impacts on Burmese Community by COVID-19 pandemic – SweSwe Aye
kaiYiYi Kline, 56, is one of the best known Burmese personalities in the U.S. since she migrated to the U.S. from Burma in 2000. In addition to her job as a registered nurse in the I.C.U. at Kindred Hospital Riverside in Los Angeles, she was active on social media, with almost 64,000 followers on Facebook. She regularly posted about Burmese politics and health tips such as the importance of keeping the kitchen and bathrooms in your home clean. During the pandemic, she focused on educating the Burmese community about COVID-19, explaining how infectious the virus is. “I want to share accurate information to Burmese people, in the U.S., and in Burma,” she said. For many in the Burmese community who don’t speak English, her daily videos in Burmese provided vital information, where she repeatedly emphasized the importance of wearing masks, washing hands, and social distancing. YiYi, with her shiny black hair and wide smile, also has been a familiar sight at Burmese events in Southern California for years.
YiYi got Covid and went through a harrowing year. She knows that Burmese people are typically shy and often don’t talk about their challenges openly. But she agreed to share her difficult health journey during the pandemic so the more than half a million Burmese living in the U.S. can learn from her story. “I want our community to feel confident talking to health professionals and advocating for themselves,” she said.
In several cities and counties, Asians have disproportionately died from Covid. A Kaiser Family Foundation September 2020 report found Asians were more likely to be hospitalized and die from Covid, compared to white patients. While there are no statistics specifically for the Burmese community, in some states, such as Iowa, estimates are that as many as 70% of the Burmese population has been infected.
One reason is that Asian Americans are disproportionately more likely to work in frontline jobs such as healthcare, food retail, and manufacturing. Dr. Than Naing Oo, M.D, works closely with the Burmese refugee population in Michigan and says there are several challenges. He said most of them work in factories and slaughterhouses and travel up to 60 miles to get to their jobs by carpooling. Their workplaces were not set up to socially distance. Several months into the pandemic, when many people started getting infected, factory owners started putting plastic sheets in between workers. Many of these workers were not given sick leave even when they showed symptoms of COVID-19.
Even at home Oo says, social distancing is a challenge because many Burmese live in multigenerational households. “Sometimes in two bedrooms, there are 11 people
living so overcrowding is common.” He says many don’t speak English and are not comfortable with computers or the healthcare system. “Most of them don’t have health insurance so they avoid going to see the doctor,” Oo said. He gave health presentations in Burmese, which were then translated into the Chin language.
YiYi’s health story begins in December 2020, when her family moved from California to Chillicothe, Missouri, a small town of 9,000 people. They wanted to be closer to her husband’s relatives. One of the last things YiYi did before she left California, got her first shot of the COVID-19 vaccine. She was excited about joining her husband and son and moving into their new house. But soon after she reached Missouri, she started feeling sick. On January 4, 2021, she went to the local emergency room at Hedrick Medical Center, part of Saint Luke’s Health System. She tested positive for COVID-19 but didn’t have a fever, so the doctor told her to go home and isolate.
The next day, she felt worse. YiYi was concerned because she has diabetes and hypertension, both underlying conditions that put a person at higher risk of COVID-19 infections and complications. So the next morning, she returned to the ER. She was diagnosed with bilateral pneumonia, serious lung infection, and pleural effusion, commonly known as fluid around the lungs. She was prescribed antibiotics and steroids and sent back home.
On January 9, 2021, less than a week after YiYi first started feeling ill, she couldn’t walk. She went back to the same ER. And YiYi says, despite some of her tests showing abnormal results, she was given an IV and told to go home. One of the doctors dismissed her concerns telling her, “It’s anxiety.” An experienced nurse, she pleaded to be admitted, but the medical staff there again told her to go home.
On January 12, 2021, she couldn’t stand up and again, went to the emergency room. It was her fourth time there in just eight days. But again, she was told, “You are suffering severe anxiety” and told to return home. This time though she was adamant about getting admitted and refused to leave. “I knew how bad my situation was so it was impossible to go back home.” She pleaded to be given a bed, using the traditional Burmese gesture of her hands pressed together with fingers pointing upward. She waited in the E.R. for eight hours. “I knew if I didn’t get admitted I would die,” she said. Finally, she was transferred to Saint Luke’s Hospital of Kansas City, Missouri.
YiYi lost consciousness and doesn’t remember what happened next. “I thought I had died,” she says, thinking back to her ordeal eight months ago. She couldn’t breathe. On her fifth day in the ICU, she had to have a tracheostomy, where doctors make a hole in a person’s neck so a tube can be inserted into the windpipe
to help them breathe. She couldn’t eat anything so had to have a PEG (Percutaneous Endoscopic Gastrostomy) done, where a feeding tube is inserted directly into a person’s abdomen so they can get nutrition and fluids. The most difficult part for YiYi, who was used to creating videos and sharing stories on social media, was not being able to speak. “I couldn’t talk at all,” says YiYi. “The doctors showed me the card printed with the alphabet and I just pointed them out to communicate. Sometimes my fingers were so weak that I couldn’t finish spelling the full word.” Even pointing out the spelling of short words like ‘What’ would leave her exhausted. “I was just able to point out the first three alphabets, W-H-A and then have to stop,” YiYi recounted.
That wasn’t the end of her ordeal. Between January 12 and January 31, 2021, YiYi had a lumbar puncture, a medical procedure where a needle is inserted into a person’s spinal canal to collect fluid for diagnosis and was diagnosed with Guillain Barre Syndrome, a condition where a person’s immune system attacks their own nerves. It can be triggered by a viral or bacterial infection. She was then transferred to Kindred Hospital Northland in Kansas City to continue her ICU care. It took almost two months for her to be able to breathe on her own. Ironically, YiYi, a registered nurse herself, had to apply for Medicaid to help pay her medical bills which added up to almost $500,000.
We reached out for comment to Saint Luke’s Health System, but Laurel Gifford, the Senior Director of Media Relations, said she could not comment on the case.
“Our team is very small and we are working on multiple media stories right now across our health system as well as our care teams are extremely busy caring for patients,” she said.
YiYi may be out of the hospital but most of her time is spent getting rehabilitation therapy, physiotherapy and occupational therapy at the University of Kansas Health System Acute Inpatient Rehabilitation. This nurse, who up until a few months ago had been working 12-hour shifts, six days a week, cannot walk for more than 10 minutes. Her fingers are still numb and she cannot hold a fork or spoon. “I did not die because of coronavirus but my quality of life is now limited. How can I get back to work when I can’t walk more than 10 minutes, even with the help of a walking stick?” YiYi, who was used to helping others all her life, now needs help to do even basic, everyday tasks.
She is frustrated that the medical staff didn’t take her seriously during her multiple E.R. visits and dismissed her concerns, despite being a nurse herself. “E.R. nurses should do proper triage to avoid making assumptions about patients,” YiYi says. “I had complained that my legs and hands were weak on my 2nd, 3rd and 4th visit but
the nurses told me the same thing, ‘It’s just anxiety, severe anxiety.’ I wish I would get the proper treatment on time,” she says sadly, staring at her walking stick.
We asked Dr. Zeyar Thet, an infectious disease specialist in Flushing, New York to comment on YiYi’s case. He has not treated her but said two things stood out to him. One was her complaint of leg and hand weakness is a typical symptom of Guillain Barre Syndrome, so it should have been taken more seriously. “The second, is when a patient comes to the E.R. multiple times within a short period of time, we should be seriously concerned.” He says in January 2021, New York hospitals were giving the monoclonal antibody treatment to treat Covid patients older than 55 years with underlying health conditions. This is a very effective treatment that uses antibodies manufactured in a laboratory to help a person’s immune system respond to an infection. If YiYi lived in New York, it’s likely she would have got this treatment. “I don’t know whether the hospitals in other states and hospitals in smaller towns had the same protocol or not at that time,” Thet said.
YiYi believes her concerns were dismissed because she is Asian. Just two percent of the population in Missouri is Asian. “This is a state where white Americans are dominant. I think, being an Asian woman, I didn’t have the same quality of healthcare got by white Americans. I feel like I was discriminated against.” She feels the medical staff didn’t take her symptoms or suffering as seriously. YiYi knows the Burmese community is typically shy and not assertive. But she urges them to speak up when they are not well. “When you visit a doctor, tell them everything you are suffering from. Don’t feel bad asking for lab tests and proper treatment.” She wants the Burmese community to advocate for themselves instead of just agreeing with everything health professionals say.
YiYi tries to be positive and keep a sense of humor, despite what she’s been through the past year. “Thank God, I am still alive. I had one umbilicus in my tummy when I was born but COVID gave me another umbilicus at my neck,” she says as she laughs and points to her tracheostomy scar. She dreams of being able to walk and go back to doing what she loves – being a nurse and helping others.
· This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2021 California Fellowship.
· Swe Swe Aye received training, financial support and reporting and engagement mentoring for this project as a USC Annenberg Center for Health Journalism 2021 California Fellow.