Friday, July 10, 2020

In Her Words: On the Frontlines

A refugee from Iraq steps in to help fight Covid-19.
Sol Cotti

By Jenna Krajeski

“I said: ‘We are from Baghdad. We know how to handle difficult situations.’”

— Lubab al-Quraishi, a pathology assistant in New Jersey

This piece is a collaboration between The New York Times and The Fuller Project.

A few days a week, Lubab al-Quraishi, 47, wakes up before sunrise and drives to the diagnostics lab where she works as a pathology assistant, in northern New Jersey. There, she picks up the gloves, gowns, face masks and face shields she needs to do her job in relative safety. Then she’s back on the road, crossing the Hudson River into New York City, sometimes alone, staving off exhaustion, and sometimes dozing in the passenger seat while a colleague drives.

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Months ago, when the coronavirus was just starting to spread through the U.S., the director of the lab asked employees to help test for the virus in nursing homes. Many of al-Quraishi’s colleagues were nervous about the work. One of the first major outbreaks in the U.S. had taken place in a Seattle-area nursing home, and now it seemed elderly Americans across the country were vectors of a little understood but frightening disease. The director explained that testing for the disease could expose his staff members’ families. “He didn’t think anyone would do it,” she said. “I said, ‘I am ready.’”

Now al-Quraishi spends half her week visiting nursing homes across Staten Island, Queens and Brooklyn. Some of the homes are fine, like a cross between a hospital and a decent hotel. Others leave her in despair for the residents and workers.

One home she visits is dark and filthy. It smells of urine. Residents, gathered together in the basement for testing, seem to al-Quraishi stuck in a lonely and uniquely American tragedy, one exposed and exacerbated by the pandemic. In her native Iraq, al-Quraishi didn’t know anyone who sent their mother or father to a nursing home. It was never a question that her mother, who is 78, would live with al-Quraishi. “I prepare her food, I take her to the restroom, clean her, put her back to bed, give her the medication,” she said. “She’s a little disoriented. But I would never put her in a nursing home. That’s another thing I learned in Baghdad.”

The nasal swabs are painful, and if residents test positive they have to be retested again that week.

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“I feel guilty when I swab them,” she said. “They’re at the end of their lives. They are in a different world.” The tests take less than a minute to administer, but the mornings are long as al-Quraishi talks the residents through their discomfort and confusion, trying to connect with them.

Al-Quraishi, who graduated ninth in a class of 300 from the College of Medicine at Baghdad University and went on to specialize in surgical pathology, is one of a large number of immigrants and refugees being asked to lend their expertise to America’s coronavirus response. Their sacrifices come during an administration that has passed legislation severely limiting refugee resettlement, that has used the health crisis to further deny asylum to migrants at the U.S. border with Mexico, and that has made it more difficult for foreign doctors to work in the U.S.

In Iraq, al-Quraishi was expected, like most of her colleagues, to take a turn in the E.R. The conditions were appalling, brought on by years of war and years of sanctions preceding it, she said. “Kids were dying of the simple flu, a simple GI infection, because we had no medicine,” she said. “I worked in a hospital where we had no IV fluid, and when we did, no line to run the fluid through.”

For reasons she still doesn’t know, al-Quraishi and her husband, who also trained as a doctor, were targeted by the insurgency in Iraq. “We kept moving from one area to another,” she said. “Trying to keep my children safe. We were one family of thousands who experienced the same thing.”

Eleven years after the U.S. invasion, after a lengthy and often bewildering application process, al-Quraishi and her young family were resettled as refugees in Texas, where she tried without success to resume her life as a doctor.

“I made an appointment with the head of the pathology department at a huge local hospital,” she told me. “I said, ‘I am a pathologist from Iraq and I am interested in volunteering.’ I just wanted them to know me.”

Recertifying in the U.S., though, is notoriously costly and time-consuming; in 2020 there were, by one estimate, about 263,000 immigrants and refugees living in America who, despite being trained internationally in health and medicine, are unable to work. Instead, al-Quraishi took jobs at CVS and Popeyes and tried to stay current in her field, eventually moving her family to New Jersey for the job as a pathology assistant, for which she was initially paid so little she struggled to make rent. Working, once again, in the medical field, was both a relief and a heartbreak. “Doctors don’t take you seriously,” she said. “That’s the most painful part.”

When Covid-19 hit the U.S., exposing systemic flaws in medical care, al-Quraishi felt uniquely prepared by her experience in Iraq. Not only did she understand how to work in extreme situations, she found the Iraqi medical education to be more well-rounded than the American one. “Not necessarily better,” she said. “But the system is different.” The fact that doctors were required to work in E.R.s strained by crisis felt particularly relevant now. “Iraq went through a lot,” she said. “There was always a need.”

After Gov. Phil Murphy of New Jersey wrote an executive order granting temporary licenses to internationally trained medical professionals to help respond to Covid, al-Quraishi and her husband put on their own scrubs and masks and showed up at a hospital. “I said, ‘We are from Baghdad,” she said. “We know how to handle difficult situations. Just give us the chance.”

She reached out to the governor on Twitter. “I wanted to say ‘Thank you, Mr. Governor, we will help you as much as we can. But we have been here for years. What happens when this is all over?’”

“Maybe it wasn’t the right time to tell him this, but I felt a little bit upset,” she said.

The staff members at the nursing homes where al-Quraishi works are primarily women of color and also vulnerable.

Al-Quraishi thinks frequently about their compassion for the residents, and their devotion to the work. Staff members sit with residents, holding their hands through the eye-watering swab. They painstakingly explain to the residents why they have to undergo testing. They explain it again a few days later when al-Quraishi returns. And they explain it again a few days after that, when residents have forgotten al-Quraishi was there in the first place.

At first, nursing homes seemed foreign to al-Quraishi. But, soon she began to imagine an older version of herself in place of one of the residents.

More than 70 percent of Americans using long-term care like nursing homes are women, according to a recent CDC study. “My daughter said, ‘This is how Americans do it,’” al-Quraishi said. “But I was raised in Iraq. To end up in a nursing home is really sad.”

Al-Quraishi will work in nursing homes as long as she is needed. She tries to tune out, or even to understand, the continuing pressures on immigrants and refugees coming out of the White House, but it can be difficult. “If you ask me to go back home, I would collapse,” she said. In November she filed an application for citizenship, but while the country is overwhelmed by Covid, she has been left waiting for the next step.

“I think we need to start a campaign,” she said. “We need to talk about our rights as refugees and international doctors. We need to talk about a system that needs to be thoroughly changed.”

What else is happening

Here are four articles from The Times you may have missed.

Anya Persaud, of Beacon, N.Y., has been quarantined with her husband, a 3-year-old and a newborn.Calla Kessler for The New York Times
  • “I am going to physically explode.” With coronavirus concerns, stay-at-home orders, financial instability and mounting civil unrest, it is no surprise that mothers are experiencing intensified ‘mom rage.’ [Read the story]
  • “Cost is a significant barrier to contraceptive use and access. The most effective forms of contraceptives are the most expensive.The Supreme Court on Wednesday upheld a Trump administration regulation that lets employers with religious or moral objections limit women’s access to birth control coverage under the Affordable Care Act, which could result in as many as 126,000 women losing contraceptive coverage. [Read the story]
  • “This is not a tale of patronizing Orientalism, overcome.” Alisha Haridasani Gupta, In Her Words writer, reflects on her marriage to a plant pot. [Read the story]
  • “Challenge assumptions, break down barriers, smash through stereotypes.” A female National Guard soldier graduated from Army Special Forces training on Thursday and earned the title of Green Beret, the first woman to do so since the Pentagon opened all combat jobs to women in 2016. [Read the story]

Today’s In Her Words is written by Jenna Krajeski and edited by Francesca Donner. Our art director is Catherine Gilmore-Barnes, and our photo editor is Sandra Stevenson.

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On Politics Poll Watch: SCOTUS Diverges From the Public

Polls suggest that on issues of religious exemptions, most Americans disagree with the court.
Welcome to Poll Watch, our weekly look at polling data and survey research on the candidates, voters and issues that will shape the 2020 election.

The Roberts Court giveth, and it taketh away.

Whether you’re more liberal or conservative, that’s how things feel these days in the ever-evolving debate over how to balance laws against discrimination with so-called religious freedom.

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Two weeks ago, Chief Justice John G. Roberts Jr. joined the Supreme Court’s four liberal jurists in ruling that workplace discrimination against L.G.B.T.Q. people was unconstitutional, striking a blow against the argument that such protections violate the employers’ religious rights.

Afterward, President Trump basically threw up his hands, saying, “They’ve ruled and we live with their decision.” It was probably a reflection of his awareness of public opinion on this issue: In polls taken before the decision came down, wide majorities across gender, race and even political ideology expressed support for extending workplace protections to L.G.B.T.Q. Americans.

But on Wednesday, the court handed down two 7-to-2 decisions going the other way. In one, it allowed religious employers to fire people on grounds that are otherwise considered discriminatory. In the other, it permitted the Trump administration to let employers with religious or moral objections deny their workers access to birth control coverage.

On these issues, surveys suggest most Americans disagree with the court. In 2018, a Public Religion Research Institute study found that — in addition to expressing widespread support for nondiscrimination protections — a majority of Americans thought that employers should cover birth control as part of their workers’ health care plans, even when those employers were religious hospitals (59 percent said so), religiously affiliated colleges and universities (54 percent) and small businesses run by religious individuals (53 percent).

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Robert P. Jones, the founder of PRRI, said that with marriage equality and L.G.B.T.Q. nondiscrimination protections now embraced by a wide majority of Americans and enshrined by the court, religious conservatives are leaning heavily on the argument that faith can be used to justify actions that would otherwise be unconstitutional.

“When you’ve lost the war, the question is how can you win a few battles, and I think that’s where the religious exemptions argument really comes into play,” Dr. Jones said. “The question is, how big can the carve-out be for religious exemptions? And even though we have a majority of Americans opposing those, it’s a much more complex argument, and we see much more ambiguity.”

The Supreme Court’s recent decisions on exemptions will affect many lives: Religious organizations employ over 1.7 million people, and the court has now significantly loosened the terms for when those people can be fired. As many as 126,000 women could lose contraceptive coverage as a result of the other decision.

And when it comes to the court, Democrats in particular say they are paying attention. According to a USA Today/Suffolk University poll from April, Democratic voters are slightly more likely to name the Supreme Court as a key voting issue than Republicans and independents: Forty-four percent of Democratic voters called it a crucial voting issue, while 37 percent of Republican voters and just 29 percent of independents did.

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And the rightward tilt of the court is a prime concern for women’s health organizations like NARAL and Planned Parenthood. Both groups, for instance, refused to support Senator Susan Collins of Maine in her tough re-election campaign this year, even though she had historically received their backing and continues to support abortion rights. Both organizations cited her votes to confirm Brett M. Kavanaugh and Neil M. Gorsuch to the Supreme Court as primary reasons for endorsing Ms. Collins’s Democratic opponent, Sara Gideon.

But few Democrats would call themselves single-issue deciders. It is on the right, among evangelicals and other conservatives concerned about the right to claim religious exemptions, that these kinds of Supreme Court decisions appear most central to their vote.

More than anything, those rulings serve as a reminder of the court’s 1973 decision in Roe v. Wade. Overturning that precedent remains a Holy Grail for conservatives.

“For the evangelical portion of the electorate,” said Ann Selzer, a longtime pollster based in Des Moines, Iowa, “it can be the one thing that decides a vote.”

“We have done numerous focus groups with Republicans, and especially lately, it’s not uncommon for them to volunteer that in voting for President Trump it was ‘all about the babies,’” Ms. Selzer added, quoting terminology she had heard participants use. “‘You’ve got to save the babies,’” she said.

However, for Americans more broadly — and for a vast majority of women specifically — there is little interest in outlawing abortion.

Just 29 percent of respondents said that they thought overturning Roe v. Wade was a good idea, according to a nationwide CBS News poll last month. Sixty-three percent said the decision should be left in place, including majorities of both Protestants and Catholics, though most evangelicals disagreed.

Correction

Monday’s On Politics newsletter referred incorrectly to Mississippi’s state flag. It was the last in the country to include the Confederate battle emblem, not the last in the country to include the “stars and bars” of the Confederacy’s first official flag; Georgia’s flag still contains the stars and bars.

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