Report from the front lines: A nursing assistant from Liberia describes working during COVID-19 pandemic

Isabella Wreh-Fofana came to the U.S. in 2002. Now, she’s working to keep Minnesotans healthy, despite a lack of protective equipment.

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A Liberian nurse, Isabella Wreh-Fofana
Isabella Wreh-Fofana, pictured here, said she sometimes doesn’t find out until after she’s met with a patient that they’ve come to the hospital to be treated for symptoms consistent with COVID-19.
Courtesy of Isabella Wreh-Fofana

This story comes to you from Sahan Journal, a nonprofit newsroom dedicated to providing authentic news reporting about Minnesota's new immigrants and refugees. MPR News is a partner with Sahan Journal and will be sharing stories between SahanJournal.com and MPRNews.org.

By Joey Peters | Sahan Journal

For Isabella Wreh-Fofana, working as a nursing assistant in the midst of the global COVID-19 pandemic for the past few weeks has been nerve-wracking.

Wreh-Fofana, who is one of the estimated 3,000 to 4,000 Liberian immigrants working in Minnesota’s health care industry, works at United Hospital in St. Paul. Like healthcare providers across the country, she tends to patients–often taking their vitals and feeding and bathing them–without an adequate supply of personal protective equipment (PPE).

The lack of PPE, including N-95 medical masks, for healthcare workers is a growing problem. On Monday afternoon, Governor Tim Walz issued an executive order requiring businesses and nonprofits in the state to inventory their supply of PPE for potential use in hospitals and clinics.

Sometimes Wreh-Fofana, who is in her 50s, doesn’t find out until after she’s met with a patient that they’ve come to the hospital to be treated for symptoms consistent with COVID-19. “By then, you’ve already dealt with the person, unprotected,” she said. “So then, what happens to you after you’ve dealt with that person? It’s kind of scary.”

The situation is causing fear among nurses and nursing assistants like Wreh-Fofana throughout the industry, she said. Some workers have to make tough choices between their jobs and the safety of their families. Wreh-Fofana speculates that some of her colleagues at the hospital have chosen to stay home to avoid the risk.

That’s not the choice Wreh-Fofana is willing to make. She plans to carry on and work through the pandemic. She’s even picking up a few extra shifts here and there. “We are working because we made a commitment to serve people, to take care of them,” she said. “We are doing our best.”

Wreh-Fofana came to the U.S. in 2002 on a health visa for medical treatment for her son, who required three open heart surgeries at a young age. She stayed under a program designed to allow people from certain countries facing upheaval and instability to remain in the U.S. on a temporary basis. An order from President Trump nearly ended the program. But, last December, he signed a defense omnibus bill that included the Liberian Immigration Fairness Act, which opened a pathway to citizenship.

She has since applied for permanent residency under the new law, though she still needs to submit to the required fingerprinting and is expecting delays.

According to a 2017 report from the Minnesota Department of Employment and Economic Development, foreign-born workers tend to take up occupations that are facing critical workforce shortages, such as nursing and personal and home health care. In 2015, according to the report, 15.4 percent of nurses, psychiatric workers, and home health aids in the state were immigrants. Twenty-two percent of physicians and surgeons were foreign-born.

Hannah Lichtsinn, a primary care doctor at HealthPartners and co-founder of the Minnesota Immigrant Health Care Alliance, an advocacy group, said front-line health workers like Wreh-Fofana and those staffing emergency rooms are likely experiencing the most exposure to the virus right now. “I’m worried about our health care systems being overrun by people who are sick, and we don’t have the supplies and staff to care for them,” Lichtsinn said. “I’m worried about the economic impact on our communities—all the people in [industries like] food service and transportation who don’t have paid leave, who don’t have much savings, and who don’t have the capacity to work from home.”

Lichtsinn predicted the pandemic could take an especially hard toll on immigrant communities. People without ample power and resources are at a high risk of suffering through the crisis, she said.

She is also worried that many immigrants will decline to get tested and treated for COVID-19 because of a lack of insurance and fear of accessing healthcare. For example, a new public charge rule, which the Trump administration enacted just last month, expands federal rules that deny immigrants green cards and certain visas if they are deemed too reliant on public aid programs like Medicaid and the Supplemental Nutrition Assistance Program, formerly known as food stamps. Last week, U.S. Citizenship and Immigration Services announced that public charge will not apply to immigrants seeking health care treatment for coronavirus or COVID-19.

Despite that announcement, Lichtsinn said she was still worried that fear would prevent immigrants from seeking proper health care.

So far, Wreh-Fofana is not aware of coming into contact with anyone who has tested positive for COVID-19. But, she knows that testing is backlogged and that many people with the virus don’t exhibit symptoms. She said she and her colleagues do their best to wear gowns, gloves, and masks while treating patients. They wash and sanitize their hands after each appointment.

She has had no access to N-95 medical masks, she says, which are most effective in protecting medical workers from the novel coronavirus and which are in short supply across the country. “Maybe other floors that have it, they are using it,” she said. “But I have not used it yet.”

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