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Okay, today is July 1st, 2020. My name is Ann Shi and I'm with the Houston Asian American Archive. Here with us today is Johnny Lee-On, who is a Doctor of Physical Therapy at the Hermann

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Memorial Hospital. Thank you very much for joining us, Dr. Lee-On. No problem. So to start since it's the first time of your interviewing with us. Can you tell us a little bit about

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yourself? Okay. Ah, well, as far as you know, I came as a foreign student here in the United States. Actually, I came from Holland.

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That's where I did my undergraduate work. Then I worked for a little while in England as a physical therapist assistant, and then I came here and also got my degree here.

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And then finally in the end, actually, I got my degree at Southwest Texas State University and work for a while. And then I got my doctorate at the University of the Incarnate Word in San Antonio. Great. Thank you for sharing that.

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So this is the COVID-19 Special Collection and we just want to ask you some specific questions on how your life has been impacted during COVID-19. And as a doctor, you probably have a lot more to share, and we really

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appreciate that. Can you share with us how it impacted your life and your job? Correct. So this is what happened. Before this. I was mostly in the outpatient clinic, you know,

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orthopedic outpatients, anything from sports injuries to spinal and all that. And then, as this pandemic started happening, you could see a shift. So what I'm doing right now, to just explain briefly is, I'm

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contracting with the CMS what is called the "Center of Medicare and Medicaid Services". In general, a little bit older patients but not always. And what we do is we're kind of like the "forgotten heroes." So

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you can hear with this whole pandemic, you can hear a lot of the stuff in the hospitals and all that stuff, but what happens to the patients that 1that quarantine and after quarantine do not go into facilities or 2patients who are sick or are disabled in a

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way but but do not want to be admitted or their physicians at one time, especially at the height of this pandemic did not want to admit people into the hospitals unless they were COVID patients.

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So what we do is as as there are not enough medical doctors available if you will, we we go with either nurse practitioners or doctors or physical therapy, we go to the patient's homes, and we evaluate their medical needs and complete a whole medical assessment there in the

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house. This is, of course, well regulated through the CMS to Medicare, for short, if you will. And so there is quite a bit of official paperwork to be done with that.

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And then you look at the whole picture of the patient within their home environment, what can be done for them within the home environment, what prevents them from having to go into a facility where the chance of contamination is higher. Yeah, that's great to hear you're helping out.

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And also you spoke about helping patients who are positive with COVID. Can you share some experiences about that? Correct. So what happens is this.

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Let's say for instance, I just had a patient being discharged from MD Anderson, very, very weakened, very hectic, very, you know, so deconditioned, if you will. So patient like this, although they are positive, they still need to be seen.

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Especially, you know what we've seen with–with people who have COVID or just post-COVID, let's say people come out for the ventilators are being discharged home, they have been very deconditioned, their lung function capacity

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is less. So, you know, these patients need to do something besides, you know, just trying to get back to their previous level of functioning.

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And so what you do is you do everything you address, everything from the—from the lung capacity by cardiopulmonary rehabilitation, to–to strengthening functional getting the patients back to their previous level.

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Yeah. So a lot of people don't know that. You know, they think, "Oh, the patient goes home; Oh they–they beat COVID, or they're off the ventilator," but they're usually in very deconditioned state. And that takes a couple of them quite a while to get back.

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So you need to look at it this way, if somebody comes home, if you see them going out on TV or in a wheelchair, that's because they most likely cannot walk. They don't have the strength nor the energy, nor the endurance to walk.

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So you have to start all over again. So that's where you were the home physical therapy, the home rehabilitation starts. But and, and what you do is you have to strengthen the specific muscles that are needed to go

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back to function. Because if a person has been laying down in bed, there's a lot of muscle wasting or atrophy that has happened. Yeah. Yeah, that's great to hear.

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Thank you. And I was just wondering, how do you protect yourself during this time as you're working so closely with the COVID patients? Okay. That's why I sent you that one picture of the PPE. Of course, I didn't have my gown on, that

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was just in my lap going on. But we have full PPE protection. If a patient is still positive, or even suspect of–of being positive, because you know, right

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now the tests are not hundred percent full proof. So what you need to do is, what they're doing is that that's three times and if–if three times two to positive or two negatives and one positive, no matter how you want to look at it,

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two to one ratio, there's two tests that show you the positive, the negative that gets the that labels the patient, but you have a lot of—I've we've seen a lot of patients who were suspect of COVID

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tests that were negative, but they're still that there's still a high risk patient so you still have to gear up for that. So it is full PPE protection and a little bit what we can also do is virtual

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health, virtual health through, you know, through online stuff, although that is a little bit limited, but we can do that too. We have done that. I see. Thank you very much.

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And just wondering how has the COVID-19 pandemic as many of the rest of us staying home, how has the—kind of, stay-home order impacted you personally? Not that much, right?

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Because we're in the healthcare profession. So, you know, especially now so what–what–what was happening in the outpatient clinic, we were getting, we were slowing down because that is more elective, people can choose to come or not.

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The sports injury you know, will–will–will heal by itself over time. So the acuity of an outpatient clinic is less. So personally what I

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did is as I saw that coming to a halt, basically, I switched mode towards one that has been busy, which is, which is the home healthcare for patients who do not want to be admitted into hospitals, or who come

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out of the hospitals after be, you know, after having won the battle with COVID. So personally, it's slow down maybe a little bit in the beginning, but once I made the switch, yeah, it's–it's busy and right now, it

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is definitely ramping up. A lot of more people see the value of home based therapies and treatments. Because think about it this way, when you're in the home, and one healthcare profession comes to visit you.

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You only deal with one person, you're going to be in a facility on the floor. There might be 50–100 beds on the floor. You know, there's always a little bit you had the staff walking around, there's more chance of contamination.

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So home health is has been a lot of the time a more safe ultimate alternative than, than being in a facility. Yeah. Thank you for sharing. And we're just so also wondering if

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you have been taking precautions to protect your family given you're also in contact with the COVID patients? For sure. So one thing of this is, this–this whole thing is you cannot be scared of

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it. You need to be informed you need to be educated on it. And we find a few new things out but pretty much we know how the other contamination happens right now.

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There's not too much new stuff out there is some new stuff out in signs and symptoms that– that sometimes come back or some new stuff sneezing now a little bit diarrhea, although that was from the beginning.

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So what– what I've done from the beginning is everything stays outside. So the decontamination, if you will, and and I'm not the only one of people who definitely work in–in–in healthcare facilities, you

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know, they– they have to do this even more. So when you come home, you decontaminate everything from the shoes. You know, I've used– I've used the techniques that are you being used in surgical centers,

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you clean the soles of your shoes, you leave them outside, you disrupt those, you leave them outside in the sun is best, really that is your free ultraviolet treatment.

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And then once you come in as soon as you come in the first, the first sink, our bathroom that is assigned the decontamination room so you clean up there and everything stays outside,

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backs everything yeah. And that's how you you keep things separate before you even get into the house. You're already clean. Some people use their garages which is good thing, you come into the garage they

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have a, they have a shower booth there, and– and that's where they leave it. It's great to hear you're taking so much precautions. And I'm just wondering as a healthcare worker who are probably experiencing a lot more pressure than before, have you experienced

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any anxiety or depression during this period? No, no depression, right? Because we all have a little psychological background.

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You've studied it enough. So um, anxiety, probably not. Basically one thing I can say is everything takes twice as long. So whether because of the whole gearing of when you when you arrive at somebody's home

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before you do you prep up, it takes twice as long. A visit that used to be an hour, at the most is now two hours easily, easily. So everything is slower, everything, everything takes more time. And actually, it's the same thing

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for the civilians. Because basically, if you go to the store, and if you're in your car and you clean your hands and you put on, you know, your gloves and your mask, you're not just jumping in and out of the

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car to go into the store, right? So, of course, we know a little bit more, we know sterile techniques. So that's why we take it one step further. Because there's also a certain amount of liability involved with

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that, you know, like, for instance, we have to send in our vital signs every morning before we even see any–any–any patient Yeah. So no anxiety and depression here.

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Um, anxiety may be in the form that yeah, you have to go with the flow. So, so there's not, uh... It's not fun. It's just sometimes it's a pain.

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It's a hassle. But what can you do? Right? You gotta you got to continue. So, the following question may be a little bit tricky, I guess. Since the start of the pandemic,

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especially early on, there's the finger pointing, and calling names and xenophobic attacks on Asian American community, and also even on, like Asian American nurses and healthcare workers, they

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experience the kind of treatment from their patients as well. I'm just wondering if you personally experienced something like that? Or have you—do you have any thoughts you want to share regarding

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that? That's interesting, that's almost a little bit more political than it is real life. I have not experienced that. I have not seen a patient flinch when I show up and the kind of over your mask, see that you kind

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of have Asian eyes. Now I'll tell you why. I personally think this is a little bit overrated. And that's why I haven't seen it maybe but in general

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in the healthcare profession, there have been always a lot of Asians a lot. Whether it's the Philippine nurses, whether it's the Chinese researchers at MD Anderson, whether it's many Asian, whatever Asian

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backgrounds, there are Korean, you know, ABC, there's been always a lot of them in the healthcare field. So I feel that the public, the patient, the public, has–has become very

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familiar with an Asian healthcare provider. And next, as a matter of fact, Asian providers in general, in my humble opinion, we excel in giving care. For instance, let me just call for instance the Filipino

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nurses are–are–are–are very known for that compassion, you know towards patients patients have picked up on that over the years. So we have established a good reputation with the patient population because

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of that. I have not seen or heard from my colleagues any anti-Asian sentiment within our field. Now, if you look at the things that happened somewhere in West Texas where some some Cambodian family was–was–was–was attacked,

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that person I think that attack them was, if I—if I'm, if I read correctly was–was I think Hispanic that the name was sounded Hispanic, but I'm not sure. So anyway, it seemed like it was somebody who went over the edge deranged,

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definitely some kind of mental disturbance, if you will. I think those are rare. I haven't heard anything here in Houston though.

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And what I what I have heard of in Houston is people robbing the Asian consumers in Chinatown, that I've heard more off; and that's because I have a lot of friends who are in the restaurant business. They have

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shopped stores in Chinatown, so that I've heard of more. So those are crimes of opportunity. You know, people are getting desperate with this times. Everybody's hurting but some people feel that they need to

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go robbing and stealing and mugging people. So I've heard that on a personal level– on personal level. I've heard many stories that people are shopping at H-Mart or at Welcome Supermarket and then they're

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being robbed, people's drive-bys steal their, steal their bag from the car, the purse, or even while they're sitting in a car, they get mugged inside their car stolen the personal. That I've heard. Yeah. But not like

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not–not–not the anti-Asian sentiment. Yeah, that's good to hear you haven't, yeah, those are definitely the kind of negative side of the pandemic we're in from the human beings, I guess. But this thing, right?

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Have you experienced any of it yourself? Okay, this is the it's an interesting thing, because I know that they had a town hall meeting, I

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think Gene Wu and all that, they had some town hall meeting, virtual town hall meeting. And, and my friends, I told them, "Listen, maybe there's something in it for you." These are businessman decision restaurant owners.

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So I told them, "Why don't you listen in on this thing, because I'll be busy working around that time; but maybe there's something and maybe they are lending assistance." But it was mostly on anti-Asian sentiment.

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And, and frankly speaking from the field, these people, my–my–my–my friends or my acquaintances, they told me, "Well, when we heard what it was all about, that was not well, while we—that's what—that was not what we were expecting from a town hall meeting.

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We were expecting things like, the Asian businesses have been hurt hard, what can be done, to point them into the right direction to go and get some financial aid, economic assistance to prevent businesses

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from going down." That's what we have people were interested in. Remember Chinatown was hit hardest early on. When the– when the news came in from—what was it from people come out of Egypt or something like that,

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they've been on a trip, right? And then they had gone to one of the stores. And that contaminated the profess— produce market.

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That's when people stopped going to Chinatown. And I must say Asian people themselves. Yeah, there's definitely things that we need to distinguish between

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political and... Right. This is a this is a pandemic. It has hit—if you–if you ask any of, if you walk into Chinatown right now and you go into a store or a restaurant, and you ask

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anybody, "How can we help? What do you need?" It's not gonna be on their—the first reaction is not gonna be like, "Oh, we need protection against anti-Asian sentiment." What they'll tell you is, "Show me the direction because

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we Asians are usually not used to asking for economic assistance." This is the problem, I think I see with–with–with the people I know in industry.

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They have a hard time asking for that. So most of them have gone back on their reserves; but they, nonetheless they are hurting bad, you know, the businesses are hurting. So, but they are not getting the assistance,

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which is economic, small business loans, you know, that, that is usually, and I think this has to do with the Asian community in general being a little bit isolated. They're a little bit isolated, as far as they're self-sufficient, you know, that

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they're self-sufficient. So that has made them over the years a little bit more isolated. And, and I'm not sure if the, if their representatives that have been elected are actually, you know, trying

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to assist with that, you know, rather than go into this whole thing about or anti-Asian sentiment. Yeah, we definitely see a lot happened during this period, including the social movement we're in

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right now. And at Rice University, the William Marshal Rice's statue has actually recently been taken down. Okay, they took it down. Oh, wow.

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Well, I have my own. I have my own thoughts on that. You know? Where are you from? Are you from Taiwan?

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Mainland. What province? Guangzhou. So you speak Cantonese? Ah, I see. Okay. Okay.

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So my, that is the other part of it. But most of my, my martial arts background, my–my Sifus are in Hong Kong, and Guangdong origin. So that's what, where we're from.

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But I'm Hakka. I'm Kejia, yeah, Hakka. So anyways, but we went to South America a long time ago, but that's another story, right?

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That's another interview I guess so um. Yeah. It's tough man because I know a friend, a good friend of mine from college, his father graduated from Rice University, and so that his nieces you know the family's tied into to

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Rice University and I don't think they necessarily agree with it. Because it's part of history. You cannot change history.

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You can learn from history, but you cannot change history. It would be the same thing as if–as if, if the CCP— and I don't want to be, I don't want to be political— but if the CCP would have said, "Hey, that was

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never an emperor in China. The Imperial stuff never happened," you know, you cannot erase the history like that. So you can learn from it that for instance, in this– in this example CCP select the imperial court, they

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were selfish, they do most of the monies, you know, the population was poor, starving and all that stuff. So that, that was learned but you cannot say there was no imperial court, but that's just my personal

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opinion. I like history. So, I study history for what it is and any history in the world. And then you can learn from it but you cannot erase it. Yeah, definitely. I think in the Cultural Revolution, they did somehow like

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erase... Correct, which was wrong because what happened now are all the–all the–all the artifacts and historical artifacts and all the treasures, fortunately, Kuomintang took it to Taiwan; otherwise it would

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have been destroyed. See, so, this is how history works, you know, why destroy all your books? Oh, you know that, that was not good. Cultural Revolution was no good, I think you know, but, but

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yeah, same thing here you, they can learn, they can change for sure; but you cannot erase history. Because then if you think about it philosophically, if you erase the history, then you erase

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yourself as a nation, right? So if you if you say like, "Oh, um let's say, you know, the Emperor court never existed, well, then, then the revolution in 1911 never existed either,

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right, because there was no imperial court to overthrow..." Something like that. Yeah, it's definitely love to discuss more in oral full history interview. And to carry on

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with our discussion on COVID-19. Like, we're seeing so many things happening online these days, including Town Hall, you mentioned it's on Zoom. And you're also taking patients on virtual settings.

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Like how do you see this kind of virtual culture has becoming more predominant? And are you kind of optimistic or pessimistic on this? That's a difficult question.

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Ah, it's efficient maybe because what you see now if one person behind a computer can see multiple patients, one done the other one, right, even if they're not even in the state, you know, they can be anywhere.

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So that is kind of effective. I don't know if you know, but you know, we can listen to the lungs right now through the computer. So we plug in and USB stethoscope,

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somebody the family or an assistant is at the home. And they're just putting wherever we want to listen to. And we can listen to the auscultation the auscultation of the lungs. So that's kind of interesting to it.

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I don't know, you know, but is it more or less accurate. So, but but virtual has changed in as far as making things more maybe efficient, certain things that can be done virtually we never did before. And now we

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can do it, right. There's no reason why you cannot do an assessment of medical history taking over the computer, you can do that. You can, I can do pretty much almost all of my assessment

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by virtual even if it means movement of the patient, I can just ask a patient move with move like this in front of the camera, and I can make take my measurements from that I can do certain timings of how fast they move

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and all that. But there's a few things that you probably cannot do virtually. So if that's the case, then I still opt to go in. If there is certain things in the exam that I still need to be even if it takes maybe

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15 minutes to complete, then I'll ask I'll still go in to do that. But yeah, the virtual stuff, the–the bad part of the virtual stuff is it's still two dimensional. And I've seen this a lot with old people or people you know when they talk to you in

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person, no problem. When you have to do a virtual with them because they got sick or they got pneumonia. They get confused by the they're not as savvy as the young people so they they can't hear too well.

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They're like "uh, uh," they stumble more in their in their interview. So it's not so efficient that way though. So you can see the old people they can deal too much with that.

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Yeah, we give we give patients an option. Do you want to be virtual health or do you want to have in-person? And most 99% opt for in-person.

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It's an interesting thing right? Because it's still human. It's like this Chinese medicine, you know, if I would take, I can take your pulse over the virtual.

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I can–I can look maybe at the tongue but the lighting is off. So that is–that is... so it's difficult certain things you have to see in person. You cannot— I think one thing you cannot gauge a hundred percent—the emotion.

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That's you talking about depression. Depression is very real. Now anxiety and depression very real. So when you see a

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person in two dimension, or you , so you can see the Haunted Mansion because there is a distortion or a delayed–delayed voice transferring, then–then– hen you don't get a good feel sometimes

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of it. Yeah, I'm sure most people will be missing that human interaction after we come out. And also just wondering, you've been seeing mostly, you said patients with Medicare,

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and have you come across patients who don't have medical insurance and are struggling. So CMS stands for the Centers for Medicare and Medicaid. So Medicaid is the—no, well, they do

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have insurance actually, but Medicaid is in general for the for the poor population, you know, people you know, don't have enough money and also they go on Medicaid. I see mostly Medicare, so the

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elderly. I've not seen too many, you know, very, very poor or Medicaid patients. So most of our mixes either private as a commercial insurance or private insurance or

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Medicare because they're past 65 years old. Yeah. But I have not seen too much of the indigent or the Medicaid population, although they fall

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under the same, the same branch. Yeah, I guess just so one last question before I let you go. So do you see this pandemic has revealed some more severe aspects of the social

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inequality? For example, we're seeing the people who are in poverty being more impacted, and the homeless who have no, yeah, like resource or access to healthcare, and yeah, things like that.

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Okay, so that–that–that was existent before the pandemic. So how it works is, let me give you a quick thing. So people who are poor, you know, have no insurance. Usually they have still have access

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to community health centers. But since those centers are there, they are well in funding but usually they see, you know, they might be under capacity as

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far as there's very there's fewer centers then let's say commercial clinics over the state. So in general, those– those clinics are pretty busy. People come and

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you know and get seen but you can make an appointment is basically waiting in line and all that. So that must exist already. Now, if you're talking about healthcare and poverty,

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it's always obvious that the ones that have that are not so poor always usually have better insurance, especially in the United States. There is no national healthcare like in Europe, everybody gets to be

00:32:04.320 - 00:32:23.730

seen equally, but what they don't tell you is in Europe, that may be also long waiting lists. So, so, here in the United States as–as–as the character of the country and the nation, people have opted for "Hey, if I work

00:32:23.730 - 00:32:38.580

harder, if I make more money than I can, you can, I can afford better insurance. And if I can afford better insurance, I should be able to be you know, to be seen more faster, you know, being

00:32:39.110 - 00:32:57.540

faster, accepted into a facility or getting an appointment." So it's–it's a, it's–it's a different system. You can compare it to Europe or Canada where it's National Health. Yeah

00:32:57.540 - 00:33:10.410

so in general it's like anything else right? You're—more education becomes less poverty, becomes better health. Look at Rice University.

00:33:10.990 - 00:33:31.180

You see so Rice University, it's–it's definitely that the clientele or the student body is definitely well educated, it's also more middle and upper middle class. And so with that healthy lifestyle you know it's being

00:33:31.540 - 00:33:45.590

it's being comes in barn off your studies is understanding healthy lifestyle wellness. Those concepts are usually more of a luxury if you compare it to, to the poor population.

00:33:45.810 - 00:33:58.520

So concepts of wellness, prevention, taking vitamins to, you know, all that stuff that you will see that probably less than, well, you will definitely see less than a poor population.

00:33:58.980 - 00:34:15.710

So the how that way will always be staggered in favor of the ones that are more educated and have a higher level of income. Thank you, Dr. Lee-On, for answering all my questions.

00:34:16.670 - 00:34:26.160

Is there anything else you would like to share with us? No, it was a–was a interesting interview. Yeah. Yeah.

00:34:26.900 - 00:34:41.500

Definitely interesting for me to understand more of our healthcare workers in the frontline, we really appreciate your effort and keeping the, yeah, people in need in–in shape. Yeah, let me say something about that.

00:34:41.970 - 00:34:54.810

Um, this is an interesting thing. So, for us healthcare workers, we chose the profession, whatever it may be. It's our job. It's our work.

00:34:54.810 - 00:35:10.120

So we appreciate the appreciation, but it's still our job, our work, right? So sometimes, you know, you go in, it's like, "Okay, I need to be careful now because, you know, my older mother is at home, so I don't

00:35:10.120 - 00:35:20.240

want to get her in fact that there's risks." So it's all about taking calculated risk due to knowing the mitigating factors, you know, the safety factors.

00:35:22.590 - 00:35:38.700

One thing that's, that is become a little bit, and I appreciate it, but personally, I don't look at it that way. Maybe it's a little bit political, but people are like, "Oh, we need to pay the healthcare workers more

00:35:38.700 - 00:35:53.800

because it's taking more risks." People need to realize that healthcare workers are the only ones that have had too much work in this time. And during these times.

00:35:54.630 - 00:36:07.360

So if you're looking at in general staff in the hospital, you know, they are doing over time overworked, granted, but also being overtime paid. So this also, you know, time one and a half.

00:36:07.770 - 00:36:20.130

So, as first line providers, they're just doing their job for them. They chose the profession. So that's what they do. Do they need more financial aid?

00:36:20.200 - 00:36:35.280

I don't think so. To be honest, although I would, I would welcome it; but I don't think so. Because they have had work. There are other segments in society, you know, as far as professional, professions and then an industry,

00:36:35.630 - 00:36:49.490

in the industry, that–that actually have, have been hurt much more, much worse. Right? So people who don't have a job, you know. The–the hospitality, in the hospitality industry, people who've been laid off

00:36:49.490 - 00:37:01.070

just lay it overnight, no income. Those people have been hurt harder. The healthcare profession in general has had steady jobs and actually more of it

00:37:01.930 - 00:37:14.720

than than before, if you will. So yeah, when people say all we need to pay them a little bit more for risk, that becomes political, you see, but it is not looking at the real thing.

00:37:15.130 - 00:37:33.220

The real life is how those that are hit the hardest. And we are doing okay, we appreciate the free food and also those tokens of appreciation. We do that, but at the same time, we're not asking ourselves for more money that can

00:37:33.220 - 00:37:47.830

go to other people who needed more. Well, that's great to hear and really, yeah, we really appreciate you're very thoughtful kindness as well to help other people who are in need other than...

00:37:47.830 - 00:37:48.160

Yeah, thank you.