As COVID-19 spread in Minnesota, Lwepaw Kacher feared that some Karen citizens discounted the virus.
They had seen plenty of sickness in refugee camps on the border of Myanmar and Thailand, after all, and some had survived malaria. This was yet another affliction.
Kacher made a video about COVID-19 in Karen, distributed fliers in the language and offered to give out face coverings. "Where is your mask, auntie?" she'd ask when she ran into acquaintances at the grocery store, as cases surged among the Karen.
As one of the earlier Karen people to move to the United States, in 1996, Kacher has long been accustomed to serving as a bridge for the refugees who followed her on their journey to escape persecution as ethnic minorities in Myanmar.
Now she's employed by M Health Fairview as a "cultural broker" to serve as a navigator for her people — a service she never had as she adapted to American life on her own.
M Health Fairview has other cultural brokers who support the Black, Hmong, Latino and American Indian populations on St. Paul's East Side. Like Kacher, such navigators are hired as trusted members of their communities who understand the cultural complexities that affect public health.
"I learned about the culture here," Kacher said. "I've been through a lot myself. ... So I was able to share my story with the people who were new to the community and teach them, 'This is how we do this.' "
Kacher works with Karen refugees to fill out applications for health insurance and energy assistance and reads them their mail from clinics, courts and government agencies. She connects them with substance abuse and mental health counseling, accompanies them to visits with probation officers and helps them find transportation, legal aid and other services.
Such work has taken on greater urgency this year, as COVID-19 cases spike among Karen residents. Though the state doesn't track detailed ethnic data on the virus, the Minnesota Department of Health reports that it needed Karen interpreters in 522 cases.
This is likely an underestimate because it does not count Karen people with COVID-19 who speak English. But it suggests a higher rate of infection than the overall state population, with at least 3% of Karen residents infected compared with about 1% of all Minnesotans. Higher rates among some groups of immigrants and refugees occur in part because they have essential jobs that do not allow for remote work, such as positions in meatpacking plants, and live in close quarters with larger families where it is hard to keep a distance from ill relatives.
When Karen patients with COVID-19 are discharged, Kacher calls them to see how she can help with food, medication, insurance and other resources to help prevent them from infecting others.
One of her recent charges was the St. Paul family of Eh Moo, which had struggled since he was laid off as a school bus driver during the pandemic. He had two toddlers to support, and his wife, Yoe Naw, had to leave her job as a personal care assistant because she was pregnant with their third child.
In June, Naw was diagnosed with COVID-19 and pneumonia. Kacher called after she was released from the hospital and helped the family apply for the Supplemental Nutrition Assistance Program and emergency assistance from Ramsey County, though they were rejected for the latter. She also helped with groceries, diapers and baby wipes. Moo soon found a new job as a FedEx delivery driver and the family got off food stamps, while his wife fully recovered and is set to deliver the baby soon.
"It's a hard time for me the last few months" said Moo, who spoke for the family because his wife does not know English.
He felt relieved for the help, especially from someone who spoke Karen. People who have been here for much longer "know things more than we do," said Moo, who came to the U.S. in 2013. "They have more experience, they have more knowledge, so it's really helpful."
Myanmar (formerly known as Burma) is home to the world's longest-running civil war, and the Karen people have fled ethnic cleansing by the Myanmar military for decades. More than 17,000 Karen refugees have migrated to Minnesota since the early 2000s.
Kacher's family was forced out of their village to the Thai border when she was a child. Amid their hardship, she used to read about America in Christian magazines. "It's kind of like a fairy tale knowing that somewhere out there is better than where I am right now," Kacher recalled, "and I always wanted more."
She went to Bangkok to further her education and won a scholarship to study in the U.S. in 1996. A year after she arrived, soldiers destroyed her old village and the rest of Kacher's family moved to a refugee camp. Back in California, she earned her bachelor's degree in liberal arts at San Francisco State University.
Kacher visited St. Paul for the first time in 2003 for a national reunion of Karen people to share their stories of being new in the country and offer one another support. The Karen began arriving in greater numbers to Minnesota, with yearly arrivals peaking at 1,026 in 2011.
"I thought, one day I have to go back and help my people," Kacher said.
She moved to Minnesota in 2017 with her husband and two daughters, now ages 12 and 19. She works out of the office of the Karen Organization of Minnesota and also regularly visits clinics with patients to advocate for them.
Kacher maintained that Karen refugees think their transition will work out if they just have a job, but learning English remains the biggest barrier to making a life here. Many don't have time to learn if they work long hours. Some drink to cope with the hardship of looking for work, not speaking the language, and men losing their social and financial status in America.
As the pandemic persists, Kacher has reached out to churches and apartment complexes in the Karen community to get the word out about free COVID-19 testing events this month in Ramsey County. And she's been sharing fliers with people while they pick up free produce from her.
The pandemic has coincided with other difficulties for Kacher's community, from mounting layoffs to the unrest after the killing of George Floyd.
She helps clients fill out unemployment forms and lets them know that it's OK if they can't go to work because they've contracted COVID-19. Knowing they're eager to get off the jobless rolls, she tells them it doesn't mean they're lazy.
She's also found herself and other Karen Minnesotans trying to make sense of the nation's reckoning on racial injustice against African Americans. Many are still learning about America's history of oppressing Black people long after slavery ended. They ask, " 'Why are people so angry? Because the Civil War finished many years ago,' " Kacher said.
During a tour of a local police department last year, she saw one Karen youth ask why officers kill people without punishment. But some refugees don't want to participate in political movements out of fear, given the violent oppression they faced from the Myanmar government. And the riots stir traumatic memories.
"The recent protest and the burning, it's just like when the Burmese military burns our village," said Kacher. "It's the same thing, the flames and the fire, and it's a lot of reflection back to where we grew up."
Her mother, who joined her here in 2005, pales and panics when she sees buildings burn, saying "Oh my gosh, when is it going to stop?" But the younger generation has reacted differently. After learning about the country's history of racism, Kacher's 12-year-old American-born daughter said she's not supporting this country anymore. That scared Kacher.
"No, no, this is your country," Kacher said she replied. "No matter what, we have to still support it and love it. We cannot go anywhere."
Maya Rao • 612-673-4210