Hearts of Mercy
Four Oakland physicians continue the Covenant’s legacy of medical outreach to immigrant communities
Photography by Benjamin Chan, Story by Russell Yee
Non-English-speaking immigrants from overseas arrive in America and find themselves in need of health care. Who understands their language, foods, family structures, and cultural perspectives? Who will take the initiative to seek them out, explain unfamiliar drugs and treatments to them, learn their stories, and help them find ways to afford their care?
For Swedish immigrants to the Midwest in the late nineteenth century and for Southeast and East Asian immigrants to the West Coast in the late twentieth and early twenty-first centuries, Covenanters have responded. Swedish Covenant Hospital in Chicago was founded in 1886 as the Home of Mercy to care for immigrants and their particular needs. And today in Oakland, California, four Covenant physicians and their colleagues likewise serve immigrant communities where even the most urgent or basic health-care needs might otherwise go unmet.
“As a follower of Jesus who believes that God loves all people equally, I believe it’s wrong for people to suffer pain and poor health because of poverty, race, education, immigration status, and language,” says Esther Li-Bland, a family practice physician. She and physicians Joan Jeung (pediatrics), Evelyn Loo (internal medicine), and Lisa Yee (family practice) all serve at Asian Health Services (AHS), a comprehensive community health center based in the heart of Oakland’s Chinatown since 1974.
AHS has more than thirty full- and part-time physicians, some 24,000 enrolled patients, and staff capabilities in English and eleven Asian languages (Cantonese, Vietnamese, Mandarin, Karen, Korean, Khmer [Cambodian], Mien, Mongolian, Tagalog, Lao, and Burmese). On Sundays, Evelyn worships at Great Exchange Covenant Church in Silicon Valley, pastored by her husband, Scott Loo. Esther, Lisa, and Joan all worship at Oakland’s New Hope Covenant Church, pastored by Dan Schmitz.
“Doing My Part”
Esther’s own family emigrated from Taiwan to the Toronto area when she was five years old. She remembers how a high-school class on world issues opened her eyes to inequalities and injustices in the world. “I felt very strongly that I needed to do my part to change that, and in fact that all Christians should do their part to change it.” A childhood interest in medicine and later an inspirational missionary doctor she heard at an Urbana missions conference led her to medical school.
While in medical training, she went on a short-term mission trip to Calcutta, India. Serving in some of Mother Teresa’s hospices and orphanages, she was overwhelmed by the huge numbers of homeless families and hungry children. She struggled to reconcile God’s infinite power and love given the vastness of such suffering and need. She decided that the mystery of God’s ways included using individuals like her to bring healing and love bit by bit, individual by individual.
Coming from Canada, Esther found herself also perplexed by the mysteries of American health insurance. “Despite being an educated English-speaker, I had a lot of trouble navigating the complicated world of HMOs, copays, and insurance when I first moved to the U.S. Just imagine how difficult it would be for someone who doesn’t know English and has little or no insurance!”
It especially troubles her that some of her patients with diabetes, cancer, or mental-health conditions were afraid or confused about paying for care and delayed seeking help until their conditions had progressed dangerously. Even at a clinic as well-staffed as AHS, Esther bemoans that “there are the endless hurdles we face trying to get our patients access to medications, tests, specialist consults, and medical equipment”—all this as “extra” effort on top of the already overwhelming work of actual medical care. Nevertheless, as exhausted as she is at the end of each clinic day, she says, “I feel a sense of satisfaction and peace, because I feel I’m doing what I’m supposed to be doing, and fulfilling the reason I went into medicine.”
“Don’t Forget Us!”
Joan was visiting a refugee camp in Thailand and talking with a Karen grandfather. He explained how the Karen (ka-REN, rhymes with “ten”) were a majority-Christian people group who had suffered longstanding and often violent persecution by the officially Buddhist government of Burma/Myanmar. (The first American Protestant missionary, Adoniram Judson, introduced Christianity to the Karen starting in 1827, which makes the Karen church a half-century older than the ECC.)
“Don’t forget us!” the grandfather implored Joan and her husband, Russell, who is a professor of Asian American studies at San Francisco State University.
Back home, while helping Russell do an Oakland-based community needs assessment for recent immigrants from Burma, Joan noticed that most of the Karen had the same zip code as the AHS satellite clinic where she practices. Seeing the need, she helped secure grants to start some of the very first health outreach efforts to this new immigrant community.
With the hiring of three Karen staff workers, the clinic quickly enrolled more than 100 Karen patients. (Until then, what medical care these Karen had received here was often via Burmese translation, which was neither linguistically nor politically appropriate.) One of their most successful initiatives has been well-child check-ups done in groups, so that the moms can later compare notes and help each other with follow-up. Something as simple as teaching parents to trust and prefer tap water to (unfluoridated) bottled water becomes an important group accomplishment.
Joan’s sensitivity to the needs of marginalized people first took shape when she was sixteen and feeling displaced herself after her family had moved cross-country from North Carolina to Los Angeles. In praying for Jesus to reveal himself to her, she was drawn to Jesus’s words in Matthew 25, “Whatever you did for the least of these you did for me.” Soon she was leading her Koreatown church youth group in volunteer efforts at a local rescue mission.
After college she was working in Washington D.C. when the L.A. riots happened. A nearby Christian Korean American thrift-store owner responded to the racial strife by starting a free/affordable community martial arts studio and tutoring program at the Potomac Gardens housing project. Joan volunteered with that afterschool program for two years. Seeing the manifold needs of inner-city children kindled her eventual choice of pediatrics. Presently she is taking a year off from clinical practice to pursue a fellowship in public-health policy at Harvard Medical School.
Meanwhile, she and Russell have long hosted their church’s weekly homework tutoring program in their home, with upwards of twenty to thirty children—many of them from the same Karen families who receive care at AHS. Joan and Russell are also foster parents to two refugees from Burma, biological sisters Bonny and Bethsy.
Of these four physicians, Lisa, my wife of twenty-seven years, is the only one who grew up in Oakland. Her parents had long been active in Chinatown family associations, so her work at AHS has been a way to care for the community she has known and been part of all her life. Although born and raised here, she speaks both Cantonese and the Toisan village dialect commonly used by older Chinese immigrants, as well as some Mandarin, so she can see most of her patients without an interpreter.
Of the four, Lisa has been at AHS the longest by far, now in her twenty-fourth year. When she first came on staff, there were only six providers. She was on staff in 1996 when AHS moved its main clinic and offices into the site of the former Lantern Restaurant, a longtime Chinatown landmark. As it happens, our wedding banquet was at Lantern in 1988. So it is that Lisa sees patients within the same walls where we celebrated our marriage shortly before she finished medical school.
Seeing Lisa working hard over the years, bringing work home, following up on patients with late night calls, coordinating specialists, and even making occasional home visits; and seeing the caliber of her colleagues and their dedication and skill, there’s no question in my mind that AHS patients receive truly excellent health care. The vision of AHS is: “To serve and advocate for the medically underserved, including the immigrant and refugee Asian community, and to assure equal access to health-care services regardless of income, insurance status, language, or culture.” As far as I can tell, that’s not just an aspiration—it’s a true statement of what AHS actually does every day.
One of the most challenging situations for any primary care provider is helping a family make end-of-life care decisions. Multiple layers of personal and cultural values, family dynamics, gender roles, religious beliefs, and layperson assumptions collide with medical options, insurance realities, and the actual uncertainties of every medical situation. In such moments, Lisa endeavors to bring the full depth of her medical expertise, cultural and language skills, and Christian compassion. She says that when she is able to help families come together and agree on a well-informed care decision in such a difficult moment, it is truly the result of prayer and God’s grace.
Lisa is also grateful for the advocacy work of AHS. From Chinatown pedestrian safety (successfully petitioning the city for reconfigured crosswalks) to voter registration, from health research (investigating toxic exposures to nail salon workers) to youth outreach (opening an on-campus high-school clinic, running programs for young women at risk for sex trafficking), AHS has been a leader in caring about wider community health matters. For Lisa, this has been a welcome way to further integrate her faith with social justice issues.
A Series of Steps
Born in the Philippines and raised on the East Coast, Evelyn sought out God’s call for her life while she was in college at the University of California, Berkeley. Texts including Isaiah 55 and 58 and experiences as an undergraduate pointed her toward medical missions. Her reaction was one of overwhelming fear—it felt too big, with too many sacrifices and too much risk. Was this really what God wanted for her?
It was, but it came about step by step: a change of college majors, going to medical school, doing a medical school rotation in Liberia (at one of the hospitals leading the response to the recent Ebola crisis), marrying Scott and embracing his call to full-time ministry, moving together to Bangladesh to serve in a rural health and development project, and then serving for four years in Manila, Philippines, where she was able to establish a tuberculosis health program serving a marginalized urban community.
Evelyn is particularly aware of the differing barriers to care in different communities. “In rural Bangladesh, there was an extreme shortage of resources and expertise. In the Philippines, there was a shortage of resources mixed with cultural obstacles to people accessing what was actually available. At AHS, the resources are mostly available, though often significantly harder to access than for someone who has private insurance. In all these settings, lack of knowledge, language barriers, and some cultural norms can prevent people from getting appropriate care.” Thus, some of the same obstacles can be found in both the poorest and in the richest places on earth.
Caring for the Whole Person
While AHS itself is not a faith-based organization, it well affirms and expresses Christlike care for our neighbors. Esther reminds us: “Jesus’s ministry focused strongly on physical healing and also reaching out to those on the fringes of society. I believe he came to make all people whole—physically, emotionally, and spiritually. Christians are called to have compassion on those who are broken, and carry on Christ’s work of healing. We can reach out to an individual in our life who needs Christ’s love, and we can also support and advocate for greater equality in health care, so that the poor can also enjoy good health.”
The Affordable Care Act has increased the percentage of insured patients at AHS, which has been a definite plus. As transpacific immigration continues at high levels, the need for multilingual, community-specific, multiculturally competent health care, health education, and health advocacy will continue into the foreseeable future. In recent years, AHS has fully transitioned to electronic health records, opened a third large clinic site, developed an integrated behavioral health program, and continues to expand its patient enrollment.
In the year 2103, AHS will be as old as Swedish Covenant Hospital is today. May both institutions continue to thrive as they serve their communities.
We thank God for Esther Li-Bland, Joan Jeung, Lisa Yee, and Evelyn Loo. In their lives and work we truly see Jesus’s care for the least of these.