Dr. Yeng Yang spent five years in a refugee camp before her family moved to St. Paul, Minnesota, when she was 10. Her experiences as a child, including the pain she saw her father go through before he died, drove her to pursue a career in health care focused on equity. Dr. Yang shares changes taking place and the opportunities to improve experiences, especially for patients from non-English-speaking cultures.
Dr. Yeng Yang spent five years in a refugee camp before her family moved to St. Paul, Minnesota, when she was 10. Her experiences as a child, including the pain she saw her father go through before he died, drove her to pursue a career in health care focused on equity. Dr. Yang shares changes taking place and the opportunities to improve experiences, especially for patients from non-English-speaking cultures.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Yeng Yang, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome back to Off the Charts: Examining the Health Equity Emergency. We are pleased to be talking to Dr. Yeng Yang, who is the regional medical director of primary care in the NEST region, northeast south territory. Woo! I got that right.
Kari Haley:
It's a mouthful.
Steven Jackson:
All right. We're done. Thank y'all for listening. And also my partner in crime, she's a co-chair and medical advisor of the Equity, Inclusion and Anti-Racism Cabinet here at HealthPartners. Happy to be talking to you, working with you, and knowing more about your story today. How we doing?
Yeng Yang:
Great. Happy to be here. Really excited to be here with you and Kari.
Kari Haley:
Well, we're glad that you made the time to come on over and hang out with us for a little bit.
Yeng Yang:
Yeah, thank you.
Kari Haley:
I think just kind of to get things started, what's your story? How did you get here? Where did things start? Let's learn a little bit more about Dr. Yang.
Yeng Yang:
Oh, my gosh, this is a 20-minute podcast, right?
Kari Haley:
Yes.
Yeng Yang:
Yeah, I mean, I think maybe just a little start about my background in that. So I'm Hmong American. I'm first generation. My family immigrated to this country in 1980; I was 10 years old. We left Laos, which is where I was born, when I was 5 years old at the height of basically after the Americans withdrew from the Vietnam War. My father had just died a month before, and then we left the country, spent five years in the refugee camp as a child. That was interesting, formative years over there. And then once we got here, we kind of moved all around St. Paul.
So I lived in the Cathedral Hill community there for a while before it was Cathedral Hill and then east side, and then eventually we settled over at the north side, so by Como Park, and that's kind of where I went to school and then went to college in the St. Paul community here at Hamline University and then off to medical school. And then took a four-year stint outside of Minnesota to Milwaukee, not too far, and then came right back to the Twin Cities after I was done when my family said, "You got to go get a real job and not do a fellowship."
So I came back here and I've been kind of all over the Twin Cities, mainly in the west metro area and the Brooklyn Park area, and then Maple Grove and did a bunch of different things in between, but mainly I landed here at HealthPartners a little bit over three years ago. And I've been doing health equity work, I guess even before there was a name called health equity, because that's just been the nature of my work and what I saw as a need in my own community as well as the community at large. That's kind of my quick story.
Kari Haley:
That's a good, nice, what was that? Two-minute summary?
Steven Jackson:
Yeah, that's pretty quick. And I didn't know you went to Hamline. I went to Hamline.
Yeng Yang:
Did you?
Steven Jackson:
I went for grad school.
Yeng Yang:
Oh.
Steven Jackson:
So we're both Pipers, I guess.
Yeng Yang:
We're Pipers, yes.
Steven Jackson:
So, interestingly enough, you said you spent five years in a refugee camp. I mean, how was that and how did that shape you and your view of life, the world, even health equity?
Yeng Yang:
I definitely think that it had a great impact on a child's brain, because I saw lots of things that a child shouldn't see. And we got to Thailand, we were at this camp called Ban Nam Yao, and it's one of two large camps that was set up for the refugees from the Southeast Asian community there. So refugees from Laos, refugees from Vietnam, and from even Burma, but mostly most of the folks who ended up in that Ban Nam Yao and then Ban Vinai is the other one were from Laos and as a result of the Vietnam War. And I saw lots of things as a kid, saw death really close up, really quick, saw rape, saw assaults. Because it's an enclosed perimeter with barbed wires and there's curfews. And so it's very much like you imagine the Holocaust concentration camps, very similar to that in terms of living conditions. And you could only go out of the camp main gate during certain hours and there were guards.
And so the United Nation basically provided some services, but most of the services were provided by the Thai government on behalf of the United Nation. And so really the Thais had full control of that camp, and they were not so nice to some of our people. So I saw lots of suffering. Health care access was minimal, and you only really go to the hospital or the doctor when you are super sick and there's no preventative visits, there's no immunizations. The only time you get immunizations is when you're actually getting ready to be resettled to a third nation. So living condition was really poor, poor sanitation, illnesses were everywhere, infectious disease everywhere, and hard labor too. So I saw a lot of things. Nowadays, when I look at my days and I'm like, "Oh, I had a really tough day," I think back to those days, and I'm like, "It's not so bad. Relatively, it's not so bad."
Kari Haley:
Do you feel all that, your experience has shaped like you going into medicine or how you want to practice medicine? How has that formed your now career and what you do?
Yeng Yang:
Yeah, I think it definitely did. So my father was ill for about a year. And so I spent a lot of time with my father during that last year. We think he died of maybe liver cancer. We weren't exactly sure, but he had bone mets everywhere, and he was in a lot of pain and there was no pain medication. So as a child, I was spending a lot of time massaging his legs, and I saw how much he suffered during that year when he was dying. And that really left a big impression on me in terms of going into medicine and then during my years at the camp, and then of course coming here and seeing how my community was adjusting to life in America and how health care access here was spotty at best.
That really did influence my A, decision to go into medicine because I really didn't want people to suffer the way my father did and the way that I saw other people in my community did. And it really told me about just the enormous amount of work, and the responsibility I felt as a kid or as a teenager to take this work on. And I think not just in the camp, in the way that the guards were treating the people there, but also once we got here, the way that the health care industry here treated the Hmong community and the Southeastern community that I saw as a teenager here, that really drove me to say, "OK, I have to be on the inside. I have to be on the inside in order to change the system."
Steven Jackson:
Obviously, working directly with you on our cabinet and partnering on projects aimed at addressing these disparities and poor access to health care and those kinds of things, what are some of the opportunities that we have today? And you can go in any direction, but what's top of mind when you think about the opportunities we have today to make health equity not just a topic, but something that we execute on?
Yeng Yang:
Yeah, I mean, I could probably be here for five hours and we can talk about that. I mean, I have lots of ideas, and of course I've been doing this for 20 years, and so we can certainly do a lot of different things, but I think the biggest thing is we need to make some systemic changes. And so for me, I think one of the first things that we do is really to tackle the unconscious bias that we all have as clinicians and as health care workers. And we all have that, myself included. I mean, I was educated in the same system as you and everyone else. And so I inherited the same policies and the same education that gets perpetuated from generation to generation. And so I think one of the first things I really feel strongly about is to tackle that unconscious bias in clinicians as well as in other health care workers that we have.
And as you know, we as physicians, we want to do the right thing. We wake up every morning wanting to do the right thing and doing our best, and yet our own conditioning, our own cultural conditioning sometimes gets in the way of us doing the right thing. And so I think that's one of the biggest things that I think we should tackle and could tackle first because as you know, we only impact 20% of the total health of a person in health care. And so we could certainly think about all the other things that we're doing, like community partnership and all the other social drivers of health, but in terms of how we personally can really impact that equation, that's really where I think it should start in addition to all the other policy changes and institutional changes that we need to do.
Steven Jackson:
Now, you were kind of on the frontline, particularly after 2020 when the pandemic started, and you did a lot of great work with the COVID-19 vaccine and vaccine equity. Tell us a little bit about your work and some of the wins.
Yeng Yang:
Thank you for asking about that because you know and everyone else knows that the population that had the highest burden and the highest death rate and hospitalization rate are people of color and frontline workers. And many of those come from the Hmong community, the Southeast Asian community, the African American community, Hispanic communities, and so forth. And so we saw that very loud and clear because we had a dashboard, we were looking at that. And then when there was a vaccine available, and we started to see that the first implementation, first wave of implementation, we put that out as, you can go online and schedule your appointments by invitation.
What happened there was that the people who were affluent, the people who had access to computers, who had access to broadband internet and who were English speaking and who were savvy with computers and online scheduling, they got all those appointments first. They were scooped up as soon as they became available. And we saw the inequities already popped up, just like the testing and just like the impact of the disease. And so there was a small group of us who started speaking up about, "Hey, you know what? We need to do better than the testing that we did." Because we did a great job with testing, but all we did was show that there was disparity, right?
Steven Jackson:
Right. We proved the problem that were there.
Yeng Yang:
Right. So OK, it's great. We showed the problem, now what are we going to do about it? Because we know what the problem is. So we got a task force together, and I know that the cabinet talked a lot about that was instrumental in getting behind that effort. And we got together and basically worked with clinicians who were from the different community, so the African American community, the Hispanic community, the Southeast Asian community, and we partnered with them and did really a multiple-prong approach where one is that we really tried to do some videos of testimonies from us, clinicians within and in the community to really show our own community to say, "Hey, it's safe, the vaccine is safe," because there was some vaccine hesitancy out there.
So we did that. We also partnered with Minnesota Department of Health and also local community groups like churches and small community groups to really go out there and ask and say, OK, what's really effective? Do we go to you? Do you come to us? How do we actually do this? What we did was we started texting people because by doing what we did before in terms of just inviting people to do online appointments, those folks were not getting... A, they may have limited English proficiency, B, they may not have access to broadband, C, they may not have access to a computer or a smartphone.
So we texted them. We know that most people at least had a phone that could receive a text. So we texted them in their languages. So we did it in Hmong, Somali, I think Spanish and Vietnamese. We did those four languages. And then we also made phone calls using interpreters and some of our own clinicians and our own staff who spoke the different languages. We called and then we reserved some slots for them. So we basically pre-reserved some slots before we open it to the general public, and then we provided some transportation and provided interpreters. So we basically targeted each of those populations that we knew they had disparity. I think within two months or so of just doing that effort, we closed that gap between our white patients and our commercial patients, and then our Medicaid patients as well as our patients of color. So that was really exciting and really good work.
Steven Jackson:
Yeah, that's amazing.
Kari Haley:
I mean, that's stuff, tangible things that you can look at the numbers and track, and I think that's awesome and huge.
Steven Jackson:
Yeah. Oh, yeah.
Kari Haley:
Thinking about your past with being a first-generation Hmong, when we're thinking about taking care of immigrant population or underrepresented populations, non-English-initial-speaking populations, what kind of things in health care can we do better at? Because I work in the emergency department and we have iPad interpreters, we sometimes have in person, very rarely. So we have some limitations, but with the tools that we have, what can we do to make it a better experience for people?
Yeng Yang:
Yeah, I think that's a great question, Kari, because we know that language concordance really improves care. Because we used to think that, OK, you have to have an Asian doctor to be able to see Asian patients, or you have to have a Black doctor to be able to see Black patients. Well, there's not enough of us around. I mean, I was the second Hmong woman physician in this whole country, perhaps the world.
Steven Jackson:
Wow.
Yeng Yang:
I mean, think about that. So there's not enough of me to go around. So language concordance is really the most important thing. And so you don't have to be Hmong speaking or you don't have to be Hmong ethnicity, but having access to good interpreters, professional interpreters. So do not use family members. And whether you use the iPad via tele interpreters or in-person, I think that's the number one thing.
Number two thing I think is just being aware that there are differences. And I'm not even talking about cultural differences, I'm just saying everybody's different, everybody's a little unique. I mean, I don't represent the entire Hmong community obviously. We are not a monolith. My experience is my experience. And so I think that just being a little bit humble and just ask them like, "What's working for you and where are you at?" And meet them where they're at, because there are a lot of differences. Like there are a lot of Christians in the Hmong community, but there are a lot of non-Christians who still practice our traditional religion. And so if you assume that everybody is that, well, you might be wrong because you might be talking-
Steven Jackson:
You might miss something.
Yeng Yang:
Yeah. You might get somebody who has converted to Christianity and they may have a completely different perspective based on their health.
The other thing is just the understanding of how we understand health. I think in the Western medicine or allopathic way of practicing medicine, we often are like, "OK, let's do the diagnostics and then let's get the answer and then let's dissect what that is, and then let's excise it out, or let's just flood it with medicine." But that's really not how everybody understands health and disease. And the Hmong community, if you believe and you still practice their traditional religion, for example, there is a lot of spirituality that it gets attached to illnesses. And so there's health and then there's unhealth, and then there's disease and dying.
Sometimes I tell my patients who, for example, suffering from anxiety, I say, "OK, in Western medicine, we say it is anxiety, but in our culture, it may be that you may have to do a soul calling ceremony too. And so go ask your folks to do that for you." And then I also have other recommendations, like medication and maybe a little therapy, talk therapy too. And so do all the above. So I think it's really about just learning from them and then asking them, "What is it that you need and what is it that you want?" And that would help.
Steven Jackson:
Yeah. Interestingly enough, we talk a lot about trust, and we talk a lot about cultural humility. And again, you've kind of defined that. What's meaningful for you? What do you need at this time? As opposed to as the super doctor with the cape on, I'm going to come in and do my diagnostics and follow my scripting, and you'll get better magically. And I don't think medicine works that way, especially if we're trying to develop relationships built on trust, which is what we stand on here. How important is building trust when you're particularly dealing with populations of people that may not look like you or may not practice what you practice or believe what you believe? How important is that?
Yeng Yang:
Super-important. I think trust is sort of that fundamental ingredient that without that you can do all you do and nothing will change. You won't move the dial. So trust is so important. And I know this is something that you talk about a lot and I talk about a lot too, in that trust is the quintessential ingredient before you get anywhere else. So the tricky thing about being non-Hmong or non-person of color when you're trying to establish trust with these communities of colors is that you don't have that inherent in, like I'm Hmong, so if I see a Hmong patient, I sort of have that inherent in in that we share the same culture. Even if I don't exactly know exactly their whole story, I at least have that baseline understanding. They don't have to explain to me about their religion, they don't have to explain to me about all the nuances that impact them. When they say, "I'm on a Hmong diet," I know exactly what that is, and I can say, "Oh, OK."
Steven Jackson:
And if I heard that, I'm like, "So can you tell me a little bit more about what that means?"
Yeng Yang:
Exactly. I think for me, it's a little bit of a double-edged sword. I get the automatic trust, but then I also feel like they expect a lot more from me, right?
Steven Jackson:
I know what you mean.
Yeng Yang:
Yeah.
Kari Haley:
Sure. Yes.
Yeng Yang:
But let's say if you are a white male and you walk in into a room and you see somebody who doesn't look like you, doesn't speak your same language, at least as a first language. I think really the first thing to do in terms of establishing trust is really just be open and just learn, be open to learn and ask questions and be genuinely curious about someone and to say, "I'm interested in learning about you and what you're about."
Steven Jackson:
Yeah. Awesome.
Kari Haley:
I mean, you both are on the cabinet with HealthPartners, can you, both of you or either of you, tell us a little bit about some of the initiatives one, but two, really kind of the goals now that you've been established? You guys have been doing this for a little bit now, so what kind of things are we doing next? What's coming in the future?
Yeng Yang:
Yeah. Thank you for that. I think besides celebrating you guys, because you guys have been so great in spreading the word and allowing for this podcast to be conversational starters for so many of our leaders and so many of our people who are out in the HealthPartners community. So that's great, and I want to thank you both for doing that.
Steven Jackson:
Sure, thank you.
Yeng Yang:
And secondly, I think that for right now, we just launched the clinician unconscious bias training curriculum that went out in January for the masses to consume. And so I think that's one thing. That's part one. Part two is coming a little bit later after we are all done with part one, so stay tuned for that. That's a little commercial. And then I think that there are a lot of really great work.
The one piece that I really love to highlight is that, I know Steve's been involved with this too, is the development of pipelines for us, because it's really about, you know, we're working really towards a culture of belonging and a culture of inclusion, but before we get there, we need diversity too. And we are not currently, in our leadership as well as our frontline and even middle management, we are not necessarily representative of the populations that we serve right now. So that's one goal. We are making progress, but we need to continue to make more progress. And so continue to recruit, continue to grow those diverse colleagues and diverse leaders and making sure that our colleagues of color get advanced into leadership so that we can be part of the decision making in order to dismantle those institutional changes that I talked about earlier.
So I think those are the biggest things. So to that point about the mentorship, and Steve can probably talk more about that, but we're doing some really neat things in terms of just tapping into pipelines earlier. So instead of waiting until they're in med school or they're in nursing school and say, "Hey, come work for us," we want to invest way earlier than that. And so we're investing in elementary, junior high school, high school kids and trying to show them to come to do observership, internships and really just see people like Steve and myself and you and others to say, "Hey, you know what? We look like you and we are doing this, and you can too," so that people can train them.
Steven Jackson:
Absolutely. Yeah, and you often hear, "You can't be what you don't see or what you can't see." And sometimes when you look at numbers, when you look at academic success numbers or academic failure numbers, the narrative is skewed or numbers are presented in improper context. If I haven't been exposed to fill in the blank and then I take a test with a group of people that has been exposed their entire life, then obviously they're going to do better than me. In some cases, there are generations of knowledge that are passed down from great-grandfathers on down. There's a tradition, there's a culture within the family of academic excellence and contacts and networks. And so once your time to go to school, well, you've seen the test 10 times over where someone else, they might be first generation, so they don't really have anybody in the family to say, "Hey, how is your first year of college?" Well, you're the first one, so you don't have anybody to ask.
And so one of the things that we want to do with the mentorship program is to increase exposure and to give people opportunities as early as possible so that they can again, develop those networks and develop that experience so when their number is called, they're ready and they can be competitive and successful.
Yeng Yang:
Yeah, that is so important because as a first-generation person, I am the first one to go to medical school in my family, and I was never exposed. I didn't really have a role model. I didn't know any doctors, I didn't know anything. I mean, it's a miracle that I actually made it where I'm at because it was probably just the sheer stubbornness and sheer will that got me here. Not that I had a roadmap. And it's my job then I feel like and my responsibility to turn around and provide that roadmap for the people behind me. I think that that's really what the mentorship is about.
Kari Haley:
I mean, it's going to be huge and it's hopefully building a better, bigger future for others within our community. So thank you both for doing.
Yeng Yang:
Yeah, absolutely. And our HR partners have started a partnership with the Wallin Scholar program where we will be sponsoring 20... Our organization is financially going to be sponsoring 20 scholars, Wallin Scholars, who will be able to then spend the summer with us seeing different things and going into their two-year college career in health care. So we're doing different things like that. So not everybody has to be doctors and nurses and stuff, but there are a lot of different jobs at HealthPartners and other organizations that we need to expose our communities too.
Steven Jackson:
Absolutely. As we kind of begin to wrap up, you've been heavily involved in our health equity work. Again, a big voice on the frontline, bringing people up that are coming behind you. And there are many, even today in 2023, who say that, "Well, why are we still talking about health equity and diversity, equity and inclusion?" And then there are others that are saying, "Well, why aren't we doing more?" As we move forward and continue to I guess, be a voice for those that don't have a voice, how do we go forward reconciling that polarizing view of where we are in this work?
Yeng Yang:
I knew you were going to throw me a really hard one at the end there.
Kari Haley:
Give it to Steve.
Yeng Yang:
OK. For me, I feel like the reason why we still need to do the work is that yes, we have come a long way since I was a 10-year-old kid, arrived here, and I'm like, "What is all this snow?" So we have come a long way in terms of just how we see the different communities that make up our larger community. And the health care industry in particular have come a long way in terms of how we have started to open our minds, how we have started to humble ourselves a little bit and think, "Hmm, maybe we don't know everything." But there is a long way to go yet. And our institution has inherited 400 years of institutional racism that has perpetuated that over and over and over again.
It's going to take us a little longer than just a few years to change all of that policies and protocols and institutional and frankly culture. The culture of medicine is inherently very fraught with racist history, and that has impact, and it continues to have impact. So that's why we need to do it. If all you got to do is look at the data. At HealthPartners, we've been collecting data for a really long time, and yes, we have made progress, but we have not closed a single gap. Not a single gap until the COVID vaccine. That is it. That is the only thing we have closed. So to people out there who are saying, "Why do we need to do this?" Because until we close the gap and we can, I'll just give you guys a quick thing.
Last year, I participated in the maintenance of certification, a quality improvement project for colorectal cancer screening for people of color versus white patients. For the first time, I closed the gap and my patients of color actually exceeded my white patients for a little while there. And so what that showed me and our organization is that it can be done if we can actually just put the system and the effort into it. So that's why we need to still continue to do it.
Number two, the folks who are like, "Why are we still talking about it? Aren't we beyond race and all of that, we're post Obama, for God's sake." There's those voices too. And to me, I'm like, "OK, well, thank you for acknowledging that you are tired of hearing about it." For me, it's an opportunity to open that person's mind a little bit. And even if it's not all the way, even if it's just a little primer to say, can I just pour a little grease on that and let me share a little story about how my life is and what life is like on the other side when you don't necessarily have white privilege.
Now I'm married to a white man who is born in northern Minnesota, so when I go up north, I double, triple the Asian population up there, and it has taken many, many years to even get my in-laws and other people around me who live white privilege. Now, my husband grew up very poor, like me too. So he's a self-made guy. He's actually one of our faculties over at Creekside Family Medicine Program. I hope he doesn't mind me sharing that. But he's a self-made guy, but he has white privilege. I don't walk around with that. He walks around with that. He and I walked into an interview room together as a couple, not as a couple, but as a pair. People automatically talked to him first. People automatically thought he was the leader of the pack. And so that's white privilege. So just to have the opportunity to even talk about that, to say, "Do you even see that?" I walk into a room and I could have 10 degrees behind my name, but people will never assume that I am the smart one.
Steven Jackson:
I know what you mean, much to unpack there and so little time.
Yeng Yang:
Yes.
Kari Haley:
Well, I mean, I think as we wrapping up here, I want to just want to first thank you again for being on the podcast here, and thank you for all of your work that you're doing with Steve in the cabinet, in your work, in your practice. I hope that we just continue to keep doing good things together and trying to make a difference one little baby step at a time.
Yeng Yang:
Yeah. Thank you guys for having me. It's been a pleasure talking to you. And I know we could go on for another five hours to talk about all the different things that we're doing at HealthPartners because we're doing a lot. But like Steve said, in some ways, we're doing a lot and in some ways, we need to do more. And so keep on, like the two of you. I thank you for doing a wonderful job and continue to spread the word and to amplify the signal and the voice that's so important.
Steven Jackson:
Yeah. Thanks so much. See you in the meeting room.
Yeng Yang:
Will do.
Steven Jackson:
Off the Charts is a production of Health Partners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production service is provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.