When it first hit in 2020, COVID-19 tore through Minnesota’s Hmong community, sickening and killing people as it reached into family get-togethers, cultural celebrations and other gatherings favorable to its spread.
By early 2021, researchers estimated Hmong people accounted for about 50 percent of deaths among Minnesotans of Asian descent though they made up only about 25 percent of that population.
“Because we’re such a tight-knit community, all our events were like a huge gathering — weddings, funerals, social events, birthdays. Everything large and small, we would gather as a huge community,” said Dr. David Thao. “It was prime for COVID to spread, super spread.”
While the disease devastated early on, conditions are significantly better. COVID in the Hmong community appears to be mostly in check for now. Despite an early hesitancy, people of Asian ancestry now boast Minnesota’s highest COVID vaccination rate.
What made the difference? Observers point to a growing class of young Hmong doctors, nurses and public health leaders who recognized COVID’s threat and worked to guide people toward science-based answers. Many in that emerging professional generation have grown from kids helping their parents navigate medical appointments to adults helping stymie a deadly disease.
‘We look like and we sound like them’
For many Hmong health professionals, COVID is the biggest challenge they’ve faced. Early on, it was brutal.
The disease claimed several high-profile leaders in the first few months. St. Paul School Board Chair Marny Xiong, just 31, died in June 2020. In October 2020, COVID killed Choua Yang, 53, founder of a Hmong cultural language charter school in Brooklyn Park. Shortly after came news of the death of Tou-Fu Yang, 76, who’d fought in the Secret War and helped refugees resettle in the United States.
Five months later, the illness killed 52-year-old attorney Kao Ly Ilean Her, executive director of the council on Asian Pacific Minnesotans and the first Hmong person to serve on the University of Minnesota Board of Regents.
With COVID hitting the community hard, Thao knew he needed to reach out to people in Hmong, in mediums where Hmong people got information. He began posting videos to YouTube and social media and went on local Hmong television to help educate people.
“Our goal was multifaceted,” said Thao, 50, who founded the Hmong Medical Association in 2018. “One was we wanted to provide an education, outreach for the community so that if they had any questions about medicine, we would be able to answer that.
“Our second goal was because there are so few of us, we want to encourage the younger generation and the youth to pursue medicine. There’s a community growing. The more physicians out there, the more we can kind of touch everyone in the community in a positive way.”
When vaccines became available, the association along with the Hmong Nurses Association began hosting vaccination clinics, as well as the Minnesota Department of Health. Hmong leaders posted online about getting vaccinated, the associations held vaccine clinics at community sites like the Hmong Village Shopping Center and Hmongtown Marketplace, which are both in St. Paul.
Those efforts paid off. More than 88 percent of Minnesotans of Asian ancestry are vaccinated now with at least one dose — 15 percentage points higher than any other racial group.
“It felt like everyone was trying to do their part, right? You know, social media influencers, faith leaders, other smaller nonprofits and groups, professional associations,” said Xp Lee, Asian Pacific Islander COVID community coordinator lead with the Minnesota Department of Health.
Thao, now a plastic surgeon with a clinic in Woodbury, said he remembers being a kid translating at medical appointments for his family. It’s a touchstone for many among the small but growing cadre of Hmong medical professionals.
“As a child of refugee parents, when we first came, I remember being the interpreter for my family at the age of 10, trying to figure out how to explain these medical terminology or procedures to my parents,” said May Hang, 48, a doctor of nursing practice and a family nurse practitioner at NorthPoint Medical Clinic in Minneapolis.
“So, for us, fast forward to going through this pandemic, and being able to have health care professionals who are bilingual, bicultural,” she said.
“We look like and we sound like them, we actually have the knowledge to explain the issues, the concepts, the science behind what’s happening. I think that has been very helpful for the elders to understand what needs to be done and how to protect themselves and how to keep them safe.”
Real progress, growing needs
Just a few decades ago, things were much different.
Lee Pao Xiong, director of the Center for Hmong Studies at Concordia University in St. Paul, recalled 1990, when there were more than 450 cases of measles, almost half of which were in the Hmong community. Three children died from the disease.
“Some of the kids died because Hmong were using their own medicine to cure measles that was pretty much curable in America… back then you didn’t have children teaching the parents because they didn’t know, either,” he said. “But now you have family members with children in college or they graduated already. They’re able to convince their parents or educate their parents about this.”
Xiong noted that Hmong medicine is grounded in a culture 5,000 to 7,000 years old and that Hmong people have been in the United States for only about 50 years, so older generations are more likely to be skeptical of medicine here.
He also said there’s a spiritual and cultural aspect to things that most non-Hmong doctors don’t understand — people who “practice the old faith” that says people have three souls and 32 spirits, who trace sickness to one of those souls leaving the body and believe only a shaman can restore them.
“For the medical professions, they basically shrug off the spiritual aspect of things,” Xiong said. “But perhaps, for moving forward, perhaps some of these, the Hmong practitioners will say, ‘Well, that’s wonderful, I’m glad that you’ve done that. But you know, this medication I’m prescribing for you will help strengthen your spirit … so that you can better protect your soul and your spirit.’”
Xiong said he chose a Hmong doctor because he felt more comfortable talking to her. “So, if you say this is the best way to help me, I’m going to believe you, right? Because you come from my background, you understand my history, my culture, and you also understand my language, versus someone who knows nothing about me.”
There’s still a need for more Hmong health care professionals. Thao says his organization estimates there are around 35 to 40 Hmong doctors in Minnesota.
According to a Minnesota Department of Health study in 2019, just 0.2 percent of all doctors in the state speak Hmong. That’s compared with 2.4 percent of households in the state where Hmong is the main home language.
“I’m very, very pleased with the fact that we have grown in that sense. But to reflect the percentage of the makeup of our community, compared to the large community, are we proportional? The answer would be no,” said Hang, who sits on the executive board of the national Hmong Nurses Association and in August will co-chair the first-ever Hmong nurses national conference, which will be held in Minnesota.
She said whenever she sees patients, it’s clear to her how much representation matters.
“Even after all these years of practicing and being in the medical field, I feel like whenever I walk into the room, and they look at me and I look like them and we can talk the same language, it puts them automatically at ease,” she said. “And it never gets old. It never gets old.”
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