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Health , US

The Pathologist: She Confronts the Virus From Inside Nursing Homes

by Jenna Krajeski July 13, 2020

This article was originally published in The New York Times.

What you need to know
  • Trained as a doctor in Iraq, Lubab al-Quraishi now works on the front lines of America’s Covid-19 crisis, testing older adults for the coronavirus.

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

Lubab al-Quraishi, a pathology assistant in New Jersey

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.

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.

“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.”

Uniquely prepared

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.”

Months into the pandemic, more than 40% of deaths in the U.S. can be linked to nursing homes.

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.”

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