Confronting Anti-Asian Hate and Violence

“Do the best you can until you know better. Then when you know better, do better.” – Maya Angelou

Michelle Leung, MS3 and Joseph Woo, MD

Dr. Woo and I are having a “bad

day”. Not so much that we’d perpetrate a senseless, xenophobic, and misogynistic act of violence… but we’re still quite peeved. After all, the world has changed. Just a little over a year ago, there was no such thing as “Kung-Flu” and we weren’t attending rallies to “Stop AAPI Hate”. We were focused firmly on our hospitals, clinics or studies, largely unaware of the undercurrent of anti-Asian sentiment that’s now sweeping the nation. While racism against Asian American Pacific Islander populations has always existed, this year’s surge was provoked by rhetoric and fear of the pandemic in the setting of tremendous social turmoil, according to SF State Professor of Asian American studies Russell Jeung. Dr. Jeung said, “The seeming increase is a function of both awareness as well as incidence.”

Perhaps we were actually a part of the problem, placidly content to play the part of the “model minority”: silent, well behaved, hard working. Did you know that ¼ of all Asian American have experienced a hate incident? More curiously, greater than 2/3 have been asked “where are you really from?” (Survey Monkey/AAPI data poll). Different cultures experience different forms of racism and it seems that Asians have the misfortune of being perpetual foreigners. Perhaps this is a wake-up call for all of us as so many of our colleagues have asked us, what can doctors do to change the narrative?

Physicians play a critical role in identifying victims of hate crimes and connecting them to resources. These include organizations such as Stop AAPI Hate, which keeps track of data and serves as a place where incidents can be reported, especially when victims fear calling the police. Cynthia Choi, co-director of Chinese for Affirmative Action (CAA) — said that prior to the pandemic, incidents of assault reported through the site were relatively minor. Now, the kinds of events reported in the media are “traumatizing.” In San Francisco alone, there have been sexual assaults, beatings, hospitalizations and deaths. Her organization has logged record numbers of harassment and discriminatory acts. Moreover, from March 19 through Dec 2020, Stop AAPI Hate documented 3,795 incidents, largely discriminatory treatment, verbal harassment, physical assault, or civil rights violations. Silence is complicity. We must continue to raise awareness and speak out against divisive rhetoric. Terms like “China virus” should not become part of our current vernacular. Further, let’s embrace and learn from our shared American history. The murder of Vincent Chin in Detroit, Japanese internment, and the Chinese Exclusion Act are just a few examples of times that rhetoric has led to the assignment of blame and encouraged misdirected anger. Recently, the many acts of violence and verbal abuse against all peoples of color reinforce this point. While we’re at it, let’s move away from stereotypes and improve cultural education. When we humanize and appreciate our common experiences, it becomes increasingly difficult to generalize and incite hatred.

And solidarity is our strength. Professor Jeung calls on physicians to stand together with their colleagues of color. He supports healing rallies like those already held in San Francisco and Oakland, to recognize communities of color who are traumatized by crimes, and that together need to be healed. There is good anecdotal evidence that racial solidarity is effective — but not vigilante patrols that can easily fall victim to racial profiling. Rather, according to Jeung, he prefers multiracial community ambassadors who “walk around and just greet and welcome people”. Not only do these ambassadors lower crime peacefully, they reduce the animosity between groups which targets the foundations of tensions between communities. Members have included formerly incarcerated Asian Americans who are paid to walk around and give directions, help unhoused, organize street cleanups, and work towards a common goal of safety. This concept saves so much more money than paying for police to patrol the same streets. Let’s support their sponsoring groups like Asian Health Services in Oakland and the Community Youth Center in San Francisco.

In addition to showing solidarity across communities, improving mental health is a key way for healthcare providers to acknowledge and combat racism. Pre-existing cultural stigma against mental health, now exacerbated by COVID and racism, results in worsening mental health outcomes — more anxiety, depression, and somatic symptoms.

“There's not a ton of infrastructure on the medical side and healthcare side,” said Choi. “And the mental health resources available are so short term, when in fact we know that when someone has gone through a traumatic incident, it takes years to recover and heal.”

Interpersonal attacks and violence are a public health issue, Choi continues. The impacts of racism, (what she calls “weathering”) and being mentally exhausted from the strain of fearing for safety or being subjected to racism, significantly affects the health of communities.

Disturbingly, in a population where mental health support has to be offered in a sensitive, indirect manner, and in the right language, we have few bilingual mental health providers. There are even fewer who specialize in supporting patients or families through a traumatic incident. At best, immediate responders might hand survivors a pamphlet they can’t read. Combined with the cultural stigma and distrust of police and the government, many events go unreported. Beyond individual care, what is needed on a national level is a mental health needs assessment. In fact, Stop AAPI Hate respondents are already showing higher rates of anxiety and depression than the general population. From his findings, Prof. Jeung suggests that targeted outreach is required. These measures could include a hotline, legal support, along with mental health resources. Currently, due to lack of structural support in the form of funding, organizations doing such work are mostly run by volunteers. We hope this is a flashpoint. A time to come together. A chance to raise the tide for all ships. After all, racism can be unlearned. Maya Angelou, again, gets the last words, “Hate, it has caused a lot of problems in this world, but it has not solved one yet”. Have a nice day.

Michelle Leung is a third year medical student at the University of California, San Francisco.

Joseph Woo MD, an emergency physician, is on the Board of SFMMS, Director of Community Relations at the Chinese Community Healthcare Association, and President of the All American Medical Group.