Racism on the frontline: Britain’s Asian healthcare workers

It was just after eating Christmas dinner with her son last year, that Bristol-based care home nurse Carine* started experiencing the worst headache of her life.

Carine, 65, who is from the Philippines but has lived in the UK for more than 30 years, cast her mind back to the moment three days prior, when she had learned that a resident she had just been helping wash himself had tested positive for COVID-19. “But you told me he was negative just half an hour ago,” she recalls saying to the duty manager who broke the news to her.

Sure enough, Carine – who has worked at the care home since 2019 – went on to test positive herself. Falling ill with a severe case of COVID – an ambulance was called to her home when she started hallucinating from the pain – she was forced to take two months off work.

After one month, however, her employer stopped paying her full wages. For the following four weeks, she received just £96.35 ($132.70) per week – well below what she needed to be able to afford to take the time off. “I even tried applying for Universal Credit [a social benefit available in the UK], but I couldn’t as I am not a British citizen,” she says.

Months after becoming infected, however, she says, “I found out from my colleague that [those who caught COVID] all got paid in full and I should have gotten paid too.” Carine believes she is the only person at the care home not to have been notified of this entitlement.

“Whether or not all of this is because I’m the only Filipino staff in the home, I don’t know…,” Carine says, her voice trailing off. There is a long pause before she points out that her concerns have not been without precedent. She says there have been many instances she has been mistreated by her duty manager: being falsely accused of other employees’ mistakes, of clocking out early, of taking too many breaks – her list of grievances is long.

As resident after resident passed away at the care home, all from COVID, in just two short months last year, Carine was shellshocked from seeing death on such a scale; she’s plagued by feelings of survivor’s guilt up to this day. “I was really, really ill,” she recalls. “I was very lucky to survive, but I feel so guilty. People said, ‘Carine, it’s not your fault’, and I know that, but I can’t help it.”

Carine’s battle with her employer for the wages she is owed continues, but is hampered by her delayed recovery from the virus. A few months after being infected, Carine speaks to Al Jazeera from her bed, where she explains that her symptoms continue to be debilitating. She suspects she is suffering from Long COVID, a condition that is not yet fully understood by medical professionals but has been reported widely around the world since the onset of the pandemic. “I still can’t feel the left side of my body,” she says, in between deep breaths. “I thought it was maybe because I worked so much and did so much overtime. But then it never went away.”

Still, she continues working because, she says, she does not have enough savings to be able to afford to quit and she can’t get by on statutory sick pay.

It’s been a thankless job for her. Of the remaining residents at the care home – so many have died from COVID that they had to close down one of three residential units due to a lack of residents – regularly use racial slurs in her presence, accusing her of bringing the virus to the home. “I don’t want to repeat [the slurs] to you,” she says, sadly.

Carine’s story makes for grim reading, but hers is far from an exceptional experience in British healthcare. Increasing numbers of Asian healthcare workers like her have reported alarming instances of racism, fear, and mental health issues in the long shadow of the pandemic.

‘All I hope is that it doesn’t turn violent’

Callista*, 55, is Vietnamese and now a naturalised citizen of the UK. She has been working here since the 1990s. To her, the pandemic has felt a lot like “déjà vu”, she says. Over her career in the UK, she has switched between the NHS, private hospitals and care homes. Now, she observes that “the pandemic has definitely made [the racism] worse, but it’s always been around”.

She recalls how, in the mid-2000s, there were patients in the hospital she was working at who were afraid of interacting with her. “Some patients assumed I potentially had SARS (severe acute respiratory syndrome) and would ask for a ‘British’ nurse,” she says, despite there having only been four documented cases in the country over the course of the SARS global epidemic, which originated in China in 2003.

The current coronavirus pandemic has proven to be a similar experience. “At the start I had patients requesting a change of nurses when they saw me. Some of my colleagues were scared of standing too close to me,” she says. The fear abated as the first wave brought many patients to the hospital and “they realised that many had already gotten [the virus],” she says.

Now the racist behaviour she encounters in the hospital appears to her to be rooted in anger. She says: “I’ve had patients accuse me of bringing the virus here.”

Experiences like this are no longer shocking to her. “It hurts, but I’ve got used to it over the years,” says Callista. “All I hope is that it doesn’t turn violent.”

Her fear of violence is not unfounded. The campaign and advocacy group, End the Virus of Racism, has reported a 300 percent (four-fold) increase in hate crimes against East and Southeast Asians in the UK since the pandemic began. On social media, videos of Asian people on the streets being spat at or assaulted are becoming increasingly commonplace.

Fears of racism and potential assaults have infiltrated all aspects of healthcare workers’ lives. They report worrying about previously insignificant aspects of their working days.

Anne*, 29, is Chinese-British and works as a radiologist at an NHS trust in London. Where she would previously take public transport, for the last six months, her father has insisted on driving her to and from work.

“My family – they are quite worried about me at work,” says Anne, who was born and raised in London. “They discourage me from walking anywhere outside of the hospital after seeing videos of East Asian people getting assaulted on the streets.”

Like Callista, she was a victim of SARS-related discrimination years ago at school. “I remember being made fun of for it. Many of my classmates would call me names like ‘bat eater’ and a lot of their parents said they couldn’t go near me,” she recalls.

The easing of lockdown should ordinarily come as exciting news for many. But Anne and her family are anxious as, to them, more people being back out on the streets means more potential attackers. “There is definitely some level of unease about going out alone now,” she says.

‘You’re from China, you’re carrying the virus – why are you here?’

With anti-Asian hate crimes on the rise in the UK, some Asian healthcare workers are trying to encourage others within the profession to speak out against racism.

Cola Chen is the Education Programmes Lead for University College London Hospitals NHS Foundation Trust, and has been working as an administrator for an NHS hospital in London since moving to the UK from China more than a decade ago.

I first meet Chen, 35, who lives in West Sussex in southern England with her husband, on a Zoom conference call in late March for the #StopAsianHate movement in the UK. Participants are discussing ways to mobilise East and Southeast Asians in response to the growing number of racist incidents against the community. Many participants take turns sharing their experiences of racism over the past year.

During the call, a psychotherapist announces that he will be volunteering his time to anyone who feels like they need to talk – a testament to how pervasive anti-Asian sentiment has become.

Chen attends these conferences eager to bring the energy and urgency from such discussions to her workplace where, since 2018, she has co-chaired the Black, Asian, and Minority Ethnic (BAME) network in her trust, one of the first to be set up in the NHS.

During the pandemic, Chen has been leading efforts to get more healthcare staff to participate actively in anti-racism and encouraging staff to voice concerns, pushing for more involvement from East and Southeast Asian colleagues. Successfully lobbying her trust’s head of workforce to put out an internal statement expressing solidarity with the Asian community in the wake of the mass shootings in Atlanta – in which six East Asian women were killed by a white gunman – has been one of her key achievements.

As co-chair of the network, Chen says staff members have frequently shared their experiences with her. During the pandemic, in the absence of mental health resources dedicated to diaspora employees – and being the first point of contact for these staff – she took on an informal counselling role. “I had non-Chinese Asian staff come up to me and say at the beginning of the pandemic that patients tell them, ‘You’re from China, you’re carrying the virus. Why are you here?’ I did what I could to relay these to management. It was very saddening.”

But racism in healthcare is not just prevalent during interaction with patients. Research published in December by the NHS Confederation, the membership body of all staff across the service, found that although the NHS has an anti-bullying policy, there persists a culture of intimidation where bullying and harassment “were a fact of life” for a majority of BAME staff interviewed. Nearly nine in 10 (88 percent) of the 115 survey respondents – who are all BAME senior executives in the NHS – said that BAME staff do not speak out because they fear for their jobs.

Chen says her own experience of racism came in the form of persistent microaggressions from an employer. “My line manager would think that I just arrived in the UK and didn’t know how to speak English,” she recalls, despite knowing that her background was as an English interpreter. “She would spell out simple words she assumed I didn’t know and micromanage me, thinking I had no idea how to do things, even though I was her secretary,” she says. “That was a really stressful time for me.”

Although participation in such independent networks is encouraged by the NHS as a means to foster dialogue, Chen notes that in her experience, “[East and Southeast Asian] people think that when you join something [like a network], it means you’re not happy and want to see change.”

She says that “non-visibility” is seen as a positive by the community. “We don’t tend to speak out, as it’s seen as creating problems.”

While the mass shootings in Atlanta brought the East and Southeast Asian community in her workplace closer together, Chen acknowledges that she has a lot of work ahead of her. “I think more needs to be done to get people to speak up,” she says.

Her next goal is to persuade more East and Southeast Asian colleagues to speak at BAME network activities, to show that representation at a senior level is possible.

‘Their line managers were not supportive’

For mental health professionals who have been treating frontline staff, the mental health fallout from the pandemic among East and Southeast Asian healthcare workers is abundantly clear.

Andrea Martinez is Programme Head for mental health and welfare services at Kanlungan Filipino Consortium, a London-based charity that focuses on supporting the Filipino diaspora in the UK. As a PhD student, she moved to the UK in 2018 to conduct research on the mental health of Filipino migrants.

Martinez notes that the charity’s mental health services have been “swamped” with requests for individual sessions from Filipino healthcare workers, who make up a large proportion of the Filipino population in the UK. In 2015, the Office for National Statistics (ONS) estimated the Filipino population in the UK to be 150,000; of this number, 40,000 – or 27 percent – work in the NHS.

At Kanlungan, Martinez says, service users “were able to discuss their problems at work with me because they felt they are more ‘at home’ when they speak to a fellow Filipino. There is no language barrier and they felt that we could understand them deeply since we do not have cultural differences”.

The Filipino community has been disproportionately affected by the pandemic. In May 2020, it was reported that 13 percent of frontline healthcare workers who died had been Filipino, despite making up just 2 percent of NHS staff. Campaigners said that more Filipino healthcare workers died of COVID in the UK than in the Philippines, having had the highest fatality rate out of all non-British nationalities represented in the NHS, with 40 recorded deaths as of October 2020 – though the true number is believed by nursing leaders and campaigners to be much higher.

In response, the NHS had set up a dedicated Tagalog-speaking trauma helpline for Filipino staff.

But the various mental health services provided by the NHS, it was observed, were insufficiently equipped to handle their concerns. “I have even had clients who request counselling service even when they are already having talking therapies with the NHS,” says Martinez.

Additionally, though workplace mental health initiatives have been made available to staff, many of them felt unable to express their concerns through work-related mental health initiatives for fear of repercussions – “especially those still in their probationary period”, says Martinez. “They fear it may impact upon the renewal of their contracts or their ability to receive good recommendations if they want to transfer to other trusts or move abroad.”

Many of those Martinez sees in her sessions arrived in the UK at the start of the pandemic and were immediately dispatched to work on the frontline. Often young and recently qualified, many were ill-prepared for the devastation that they saw.

At the same time, support and integration for them during this time was seen to be insufficient. “Their line managers were not supportive, thinking that as long as they still can stand on their two feet (literally), then they are able to work.”

For some, it was not the pandemic itself, but the stresses of working in a new environment and culture, alongside unsympathetic colleagues, which brought them grief. “I had clients whose employers and line managers were the cause of their stress. Two of them did not return to work and chose to resign. I had another client whose line manager was quite supportive but it was her colleagues who stigmatised her mental health condition,” says Martinez. “I think we need to educate them [fellow healthcare professionals] on the nature of mental health problems even if they are already in the healthcare profession.”

The rise in the number of people turning to the service for support has been alarming for the charity. “It is uncommon for Filipinos to seek mental health services and, when they do, that means that it is severe and is already causing them so much distress,” she says.

For Chinese-British care home worker Fiona*, 23, who had only recently started in her role as a healthcare assistant at a care home in London when the second wave of the pandemic began in October, the racism she faced was unlike anything she’d experienced before.

Fiona – who was born and raised in London and had previously worked in hospitality – knew she could expect devastation and hard graft working in healthcare during a pandemic and steeled herself for a tough experience.

But she was surprised to find that, in addition to the pain and suffering she witnessed, she would also have to endure so much racist abuse. “I was shocked that I would be treated so poorly,” she says.

Two residents with dementia, she recalls, addressed her using racial slurs. Because of their illness, she finds it challenging to speak out about the abuse. “Many racist incidents I’ve had to face involve older residents. I do sometimes think, ‘is it their fault?’, because they’re not of sound mind.

“But at the end of the day, I don’t feel like I should have to put up with this kind of abuse.”

When she tried to raise it with her line manager, she says the response was that she just had to accept it. “There’s been absolutely no support for staff for this sort of behaviour.”

She has needed to go to therapy as a result of this abuse, and is actively seeking other jobs. “It does wear you down,” she sighs.

‘What’s the point of clapping for me when you don’t think I deserve to get paid for risking my life?’

During the first lockdown, healthcare workers across the country were lauded every Thursday evening with applause as part of the “Clap For Our Carers” initiative. Fiona describes the admiration she felt when banging her pots and pans for these heroes before she entered the industry herself.

But what felt initially energising gradually turned into an empty gesture for workers like Fiona. She – and many East and Southeast Asian healthcare workers like her – found a big gulf between public admiration and how they have actually been treated by patients and employers. “I get the feeling that when people clap, maybe they already have a face in mind, and maybe it’s not someone who looks like me,” says Fiona.

The appreciation also failed to manifest itself in financial terms. During the second wave of the pandemic, NHS nurses were hit with a real-terms wage cut, with the GMB labour union finding that with the 1 percent pay rise this year, nurses will actually be earning £2,500 less than they did in 2010 after adjusting for inflation. “After years of real-terms pay cuts, the government’s latest offer is a hammer blow to staff morale,” said Trades Union Congress (TUC) Secretary General Frances O’Grady in a press statement at the time.

Tin*, a Thai nurse who has been living and working in the UK for 25 years and is now a naturalised citizen, says she feels the applause has been hypocritical. She asks, “What’s the point of clapping for me when you don’t think I deserve to get paid for risking my life?”

Some nurses see the pay “rise” – branded as “pathetic” by O’Grady – as the final sign they need to begin thinking about leaving the UK for good. For years – and spurred in no small part by the introduction of Hostile Environment immigration policies in 2012 by the then-Home Secretary Theresa May, designed to make it more difficult for migrants to live in the UK – anti-immigrant sentiment has been on the rise, and a source of anxiety and frustration for many.

As a result, some are looking to move abroad.

Now that her children are at university, 50-year-old Tin, who lives in London, is putting into motion her decade-long dream of moving back to Thailand, where her mother lives, and where she grew up. “After such an exhausting year, it would be nice for a change,” she says, “to work and live somewhere you won’t have to live in fear.”

In recent months, during the deadly second wave that was responsible for two-thirds of all coronavirus-related deaths in the UK – the total was 127,100 in mid-April – healthcare staff who Al Jazeera spoke to said that their families and friends in East and Southeast Asian countries – all of which have been markedly less impacted by the pandemic – were concerned about the high number of cases in the UK.

Chen’s mother has been urging her to return to the city of Chengdu in China, where the rest of her family is based, to live with her. “She still keeps trying to get me to go home because of the out-of-control pandemic here, and because she is scared about the racism,” says Chen.

But moving is not easy. With pandemic-imposed restrictions on travel and immigration, and a husband who is unlikely to find work in China (he is Polish), “I explain to her that I have lived half my life here – it’s not that easy to just leave.”

The thought of the UK being unsafe is a sentiment shared by British Asian healthcare workers. “I was born and raised in the UK, but I no longer feel safe here,” says Fiona.

But there are glimmers of hope. Healthcare workers who have taken the step of publicising their experiences with racism are increasingly getting attention on social media. Recently, Filipino nurse Aldarico Velasco Jr, who lives in Derby, northern England, spoke about being racially abused by a patient, in a tweet that was liked more than 400,000 times. A staff nurse at University Hospitals of Derby and Burton NHS Foundation Trust who has been working in the UK since 2019, he also reported a robust and supportive response by colleagues and managers, and received an award from his NHS trust for speaking out.

Carine herself feels a sense of relief at finally feeling able to tell her story.

She works in healthcare because she cares about people, she says, believing everyone should be able to access respectful and dignified care. Her request, in return, is simple: “I just want to be treated in the same way by the people I care for.”

The devastation of the past year has forced her to take stock of her life and what she wants for her future. All she hopes for now is to be able to continue working to earn enough money to buy a small piece of land in France – where she previously lived for 10 years – to retire.

“After all this,” she says, “I just want a simple, quiet life.”

*Names have been changed for anonymity