Maichoua Lor Earns a UW-Madison
Ph.D. in Nursing
Community Responsibility
Maichoua Lor, a former participant in the Information Technology
Academy and PEOPLE Scholar,
is the first Hmong nurse to attain
her Ph.D. in nursing from an American university.
By Jonathan Gramling

Maichoua Lor has been blessed. Lor, the first Hmong nurse to earn a Ph.
D. in nursing from an American university, has found a calling that she is
passionate about that also deals with issues in the Hmong, immigrant
and refugee communities. Lor feels a certain responsibility to the
community. Her degree and talent are not entirely her own.

Lor came to Madison in 1994 when she was six-years-old as a refugee
from a Thai refugee camp where she was born. She was blessed, in a
way, to have Madison as the only home that she can really remember.

“My parents experienced the Vietnam War,” Lor said. “I still hear stories
about it to this day. Even for my grandmother, that has impacted her in
losing my grandfather during the war. Both of my grandmothers, from my
mom and dad’s side, lost their husbands. My dad comes from a large

family of 15 kids. So my grandma took care of 15 kids by herself. My dad
was the second youngest. So just hearing about how much trauma, the
issues they had to deal with after the war, has really impacted me a lot. I
grew up very close to my grandma.”
In listening to the stories, Lor also realized that the Hmong elders in particular, still suffered from the impact of the war, their uprooting as
refugees and living in a strange land where they didn’t know the language or the culture.

“The worst part too is that coming to a new country, coming with this trauma and then learning that you are being diagnosed with a new health
condition was devastating to people,” Lor said. “Not understanding what the health concept is like diabetes and hypertension was very
frustrating to a lot of elders. And there was a lot of mistrust as well because of the lack of medical terminology in our language as well. That
makes it difficult for the older adult generation.”

What was also difficult for the elders was that the roles were essentially reversed with their children. It was the children who learned English
and learned about American life. And so the Hmong elders had to depend upon their children to explain things to them, to navigate the system
for them and to translate for them. That gave the children latent power over their parents, whether they used it or not.

Lor decided early that she wanted to pursue a career in healthcare. She became a certified nursing assistant while she also prepared for
college in the UW-Madison Information Technology Academy. Lor saw the problems that the Hmong elders experienced.

“There were times when I felt family members were discriminated against in healthcare,” Lor said. “For example, a lot of our elders, when they
are hospitalized, they don’t speak English. And we know that there is a federal mandate that any federal funded health organizations are
supposed to provide interpreter services. And a lot of these Hmong elders, even my elders in my immediate and extended family, don’t get
interpreter service and I will be the one going there and saying, ‘Wait a minute. This is where the mistrust is coming in.’ It’s because when
care is provided to patients, they don’t understand what is being done to them. They are frightened. And of course, they aren’t going to adhere to
a medication because we aren’t telling them why it’s important to take it or even what it is. And so, I thought there are a lot of these issues that
I feel we can work on to provide better quality of care for all populations.”

Lor credits the ITA and the UW-Madison PEOPLE Program with giving her crucial support as she pursued her academic dreams.

“ITA has helped me tremendously,” Lor said. “It helped you prep for college and being in the setting to help you think about what it is like to be
in college. That was so helpful. And when I came to UW-Madison, I became a PEOPLE Scholar. That was also very helpful as well, finding
people who are similar to you, having a ‘home’ is very helpful, especially because this is a predominantly White university. Sometimes you can
have imposter syndrome where you are like, ‘I don’t feel like I belong here.’ And people question whether or not you are here because of
Affirmative Action or are you truly bright.”

While Lor’s father’s clan lived in the La Crosse area, he decided to stay in Madison because he had heard that UW-Madison was an excellent
university. And he had a dream that one of his children would graduate from it. Lor was the first to fulfill that dream.

While Lor and her parents knew little about higher education beyond getting an undergraduate degree, when Lor was presented with the
opportunity to enter the early-entry Ph.D. program in nursing at UW-Madison, she knew that was the direction she wanted to take. While she felt
a lot of satisfaction serving individual patients and having a positive impact on their health and their lives, Lor also realized that the Hmong
also needed to sit at the health decision-making tables to influence healthcare policy and research to ensure that the healthcare system was
meeting the needs of the Hmong and other immigrant and refugee populations.

“If I wanted to make things more equitable for a lot of populations like immigrants and refugees, I had to do a Ph.D.,” Lor emphasized. “Even if
populations are forgotten that not a lot of focus is on, all of their care is pretty much driven by studies that have been done on the mainstream
population. The care — even the treatment we give — we provide is not tailored to these populations. We know that in clinical trials, not a lot of
minorities participate in them so the medications that we are giving may not work for immigrants and refugees. So I thought that if I really
wanted to make a difference for my community, I had to go for a Ph.D.”

Even as an undergraduate, Lor began to gain status in the Hmong community as an authority on healthcare. Lor wasn’t yet an expert, but the
Hmong community trusted her as one of the few Hmong in the field.

“Because I am in the health field and I am getting my Ph.D., I do get a lot of calls because everyone is interrelated,” Lor said. “With any health
situations, whether they are immediate or extended family members, people would just call me to go visit them at the hospital. I think it has to
do with a comfort. Having me be there makes them feel more comfortable and they feel like they are being taken care of well. And I can
advocate for them if I saw that things weren’t right. I do get called in a lot. I guess because I grew up with my grandma, I’m just so close to the
elderly population here. I just have this special connection. Often, I feel they are the most vulnerable because they don’t really know much
about the Western culture. The language also makes a huge issue as well. So I feel like it’s my job to help them and give back.”

And as Lor went through her Ph.D. program specializing in research, she was able to look at issues in the Hmong community and begin to look
for solutions for those problems.

“I have had all of these different issues that I identified in the healthcare system, such as interpreter services,” Lor said. “And so, a few years
ago, I did a study — this situation is more relevant in bigger cities where there is a larger Hmong population — and travelled back and forth to
Minneapolis to talk to family members about their experience. Why are the elders moving from home settings because we come from a very
tight-knot collectivist culture. We take care of our elders. Why is there a shift? So I’ve been able to answer these questions to get a better
understanding of why things are changing and things that play a role in providing quality of care for this particular population. But what really
drove me and got me so motivated was the recognition that in order to get more resources for populations like this, we always, always need
evidence. And evidence comes from data. Without data about what are the health issues, health problems that this particular population is
having or encountering, we can’t get resources to help them. And so, I learned that very early on.”

When Lor decided on a subject area for her dissertation and began to apply to the National Institutes for Health for grant money to study chronic
diseases in the Hmong community, she faced an uphill struggle because there was no data to support the need for her to do research in that
area. And so her dissertation took a new direction.

Next issue: Collecting data