From the way he tells it, Jimmy Thao has a simple job.
“I watch people take their medicine,” he says.
Each day Thao climbs into a Multnomah County car. He carries ziploc bags filled with pills - Isoniazid, Rifampin, Ethambutol, Pyrazinamide -- in combinations of 10 or more, and a white disposable mask.
He’ll stop five or six times at homes across the county. At each address, he climbs out of his car and rings the bell, fastens the mask to his face and greets a patient who also wears a mask, then follows the client inside.
Thao is one of two community health workers at the Multnomah County Health Department’s Tuberculosis Clinic, one of the most proactive and effective programs in the country.
For 18 years Thao has met patients being treated for tuberculosis at their homes, in their offices, on the side of a road, under a tree. He sits with people at their kitchen tables, on their living room couches, in the front seat of their cars. And he doles out medication that he then watches them swallow.
Some visits last just five minutes. Others, much longer.
“A very sick person can’t swallow all the pills at once,” he says. “Some clients ask questions. They ask why do I have to take this medication? Why are you coming to my house? Why are you watching me?”
Once, early in his career in another county, he was chased by a dog.
“But no one has slammed the door in my face,” he says with a smile.
Thao speaks softly, doesn’t garnish his story with unrequested detail, doesn’t share the anecdotes that make him remarkable.
Like the story of a family who refused to allow health officials to get close.
“We had a family a few years ago, they were very difficult to work with,” said Dr. Amy Sullivan, manager of Communicable Disease Services. “They came from a country where TB was heavily stigmatized.”
In some countries, a person with TB is taken from his home and put in a special hospital. Some never see their loved ones again.
This family came from a place where people don’t trust government, or doctors. But when a screening identified multiple cases of TB in the home, Multnomah County health officials tried to convince the distrustful family to accept treatment.
“They weren’t returning our phone calls, weren’t letting people in the house,” Sullivan said.
“They pulled the curtains if someone knocked on the door. They weren’t going to doctor appointments.”
Thao didn’t speak the family’s language. He wasn’t a tall, TV-doctor with wide shoulders. He wasn’t white. Wasn’t born in the United States. He spoke with an accent.
Perhaps that’s why they trusted him.
“They basically told the program that, ‘we’ll take treatments, but the only person we’ll let in is Jimmy,’” Sullivan recalls.
Laos was considered neutral during the Vietnam war. As tension spilled over from north Vietnam and communist support grew within Lao borders, the CIA recruited a force of ethnic Hmong, already at odds with its government.
Thao was one of the Hmong recruits, after one of his brothers had already been killed and another joined their ranks.
He was 16 when he arrived at Long Tieng in September of 1971.
The CIA base had built up around a landing strip the length of a valley in the center of Laos. Hmong came from across the region and Long Tieng became a city of sorts, the largest community of Hmong in the world.
Thao lived with a military police captain on the hill above the air strip. They were relatives, both from the same village. He was there when his second brother was killed. And he was there in December when Vietnamese forces surrounded the base and began firing rockets into the camp.
He watched the gas tanks and planes explode on the air strip below. Miraculously the base held for another three years. Thao worked as a guard at the jail; the occasional rocket would drop nearby. He later became the captain's body guard, and his cook.
While at Long Tieng, he never met the girl who years later would become his wife.
Thria was 11 when she arrived at the camp to care for her brother’s children. During the day she worked in a garden to grow food for the family.
Instead, Thao and Thria met years later at a refugee camp inside the Thai border. U.S. forces withdrew from the region in 1975, forcing Thoa and other Hmong fighters to flee the Communist government that would soon come after them. Both Thao and Thria had reached safety at the Thai camp. They married that year.
The United States had promised visas to any Hmong who fought against a Communist take-over. In 1978, authorities found Thao and resettled him and his young wife to Wisconsin. The couple eventually moved to California where Thao entered a job training course, which assigned him to the Stanislaus County Health Department.
He began working with TB patients doing “Direct Observation Therapy.”
Or, as Thao says, “watching people take pills.”
Patients begin to feel better after a few weeks on the medication, and may stop taking it. But that has led to drug-resistant strains of a disease that, without drugs, is virtually always fatal.
“We really don’t want to reintroduce to the world a disease that’s untreatable,” Dr. Sullivan says.
Best practice is to make sure patients remember to take those pills.
“It’s done as a matter of policy,” she says. “You watch them take their meds.”
After six years in California, Thao and his family moved in 2002 to Portland, where he hired on with Multnomah County.
The family saved money over the following years and bought 20 acres south of Hillsboro, where they grow dahlias and gladiolas, tulips and lilies, which they sell on Saturdays at the popular farmers market at Portland State University.
His wife Thria does the hard work on the land during the heat of day, which makes her hands rough. Jimmy helps after work, pulling on rubber gloves to keep his hands soft and his short nails clean.
Their land, their five children who have scattered, and their eight grandchildren claim his nights and weekends.
Pills and patients and the many miles of road in between consume his days. When he meets a suspicious new patient, the work slows with soothing humility.
“Usually people don’t trust doctors, maybe they heard rumors about doctors killing people,” Thao says. “So they don’t talk to you until they trust you.”
It’s his body language, which is unassuming. His shoulders soften. It’s his eyes, which don’t claim superiority by staring, which soften too, and look away.
Some workers are impatient. They have places to go, appointments to meet, and hurry their clients to swallow their pills at once.
Jimmy seems to have nowhere else he needs to be. He waits patiently for the swallowing and settling stomach, for the questions. A patient tells him her dream and wonders, what does it mean? Or she might read his a passage from the Bible.
And he listens and waits.
Only after all of that, do his words matter.
“I try to explain that my job is to serve you, but I can’t serve you properly unless you allow me to,” Thao says. “When I talk, I try to show myself as humble. When you’re humble they observe your eyes, your expression. They can tell if you’re honest.”
Some of his patients today are from Vietnam, triggering memories of loss, and sometimes, of blame.
He can’t explain why, but it’s easy to put those aside.
“They need you,” he said. “So you serve them.”
