The “doctor” stereotype is well-known in desi culture. Yet, it coexists with a cultural distrust of medical institutions. Greater awareness and openness about mental health have brought positive change to the South Asian community — more people are seeking mental health care and discussing mental health than ever before. However, there is less conversation on how to access life-saving healthcare.
“I don’t think a lot of people realize that, as an immigrant moving here, and having a very heavy, thick Guyanese, Trinidadian, or Jamaican, accent is a language barrier.”
Arieana Pirbaksh, a public health student at NYU and a frequent volunteer at NYU Winthrop hospital, pointed out. Pirbaksh has navigated healthcare complications herself and on her immigrant parents’ behalf, facing everything from culturally incompetent therapists to having to translate her parent’s conversations for insurance companies.
[Read Related: The Hard Truths of Being Mentally ill and Indo-Caribbean]
Her experience underscores how many South Asians and Indo Caribbeans do not have strong affinities with American healthcare systems.
Studies show that South Asian groups (including members of the South Asian diaspora) have significantly higher rates of diabetes and hypertension than other ethnic groups in the United States. In New York City, around 20% of South Asians surveyed reported experiencing diabetes, compared with 11% of New Yorkers. Fewer South Asians in NYC receive preventative healthcare like colonoscopies than the rest.
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It can be easy to say “just do it,” and think that obtaining healthcare is easy, but there are many factors that stand in the way.
Public health experts like Dr. Harlem Gunness, former Director of the St. John’s University Public Health program, call these factors “social determinant factors of health.” These can include age, gender, country of origin, education, immigration status, income and access to healthcare. Gunness emphasized that even, “your social capital network, meaning who you know in positions of authority and positions that can really link you to the appropriate care that you need,” is critical.
South Asian populations face particular circumstances due to cultural and socialized behaviors. In scientific studies, Asian groups are often grouped together despite their cultural, religious, ethnic, and linguistic differences. This can make finding specialized, nuanced care even more difficult.
As Indo Caribbeans in the South Asian diaspora, how do we remedy this? How can we bridge the gap between grandparents who never saw a doctor and doctors who don’t understand our grandparents?
Dr. Gunness advised finding a doctor you can trust and visiting them once a year — the provider’s cultural competency is key to quality care that works for you. Diagnostic services provide a solid health baseline.
“… your doctor will run your blood test, your blood exam, your analysis, etc, take your blood pressure… check your lungs, check for heart disease.”
In NYC, uninsured individuals can access primary healthcare services through the public hospital system NYC Health + Hospitals which, despite its name, offers screenings, well visits, vaccinations, and other preventative services.
Dr. Farzanna Haffizula, a medical provider in Florida, who runs the Caribbean Diaspora Healthy Nutrition Outreach Project, also recommended looking into community health centers and government-funded healthcare facilities designed to provide healthcare to medically underserved communities. They focus on “connecting community members with resources and advocating on their behalf,” and can be a great starting point.
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If a patient needs a service that a medical provider cannot fulfill, Dr. Gunness shared, there are community leaders who understand a patient’s background and can refer them to local resources.
He stressed that patients do not have to cope alone — there are so many organizations and nonprofits that bridge the gap between providers and communities. These services are particularly helpful for seniors who may have language barriers and difficulty navigating technology and healthcare bureaucracy.
Shaaranya Pillai, Deputy Director of India Home, added:
“We provide that type of assistance where we have case managers who can help clients one-on-one with accessing government benefits.”
Our communities often don’t know about benefits or underuse them when they are eligible for them, she said. Case management exists to remedy that, mediating between patients and agencies so they can access care.
Providers also see positive outcomes when patients have a support system — whether family members, a community nonprofit, or a temple. As trusted community centers, temples can also play a significant role in helping vulnerable groups by building community trust, sharing resources, and raising awareness about community needs.
“There’s like a lack of trust at times, so when we’re going into new communities it’s really important to partner with local trusted leaders and trusted houses of worship.”
Pillai continued that working in a community’s best interest requires tapping into existing resources.
“You can’t just go in and just offer these things and expect people to come, it has to come from someone that is trusted.”
But obtaining quality, equitable care requires equal efforts from community leaders and the governments that are supposed to serve them.
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Many areas of the United States are designated “Medically Underserved Areas;” geographical areas where health services are insufficient for residents. “Medically Underserved Populations” are groups that may have linguistic, cultural, economic, or social barriers to care. Both measures indicate a greater need for health resources in those communities. Other places may be designated “Health Professional Shortage Areas,” a neighborhood, population, or facility that lacks mental, dental, or primary care to meet community needs.
The Health Resources and Services Administration (HRSA) determines these statuses and funds health centers, community-based healthcare hubs, that can respond to them. Some health centers meet the HRSA requirements but are not funded by HRSA grants.
Health centers are key to providing culturally competent healthcare because they are community-based and patient-centered. However, private healthcare providers — an option that many choose — are not always culturally competent.
Dr. Gunness added that when faced with a reluctant patient, a provider should empathize with them and understand how their background influences their hesitance.
“It takes quality, training, experience and expertise to be able to deliver that, and that’s where the legislation and advocacy come in. We need to educate healthcare professionals.”
A 2018 study published in the Journal of the Association of American Medical Colleges cites three main strategies that improve access to healthcare in vulnerable communities: systematic screenings and patient result reviews, navigation services, and alignment with community resources. Combined with increased diversity in the healthcare industry, barriers to care can come down.
Virtual care is heralded as convenient and accessible, regardless of location or time zone. However, the shift towards virtual care has also made accessing health resources impossible for some. In order to enter a Zoom call with a health provider, a patient needs access to the internet, a device with video capabilities, high-quality bandwidth and technological skills. For the elderly, low-income and rural populations, this can be challenging.
Because of this, Dr. Gunness encouraged “a variety of healthcare options” that are tailored to community needs.
So what should be next for South Asians trying to get their health on track? We often hear about the habits that bring our community down and rarely hear about those that uplift us.
Dr. Gunness highlighted cricket and cultural dance as traditions that uplift health outcomes. Spiritual activities like yoga and meditation have also been proven to improve physical and mental wellbeing. The tight-knit nature of desi communities also provides opportunities for bonding and social fulfillment.
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