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What are the risk factors that may be linked to suicidal ideation and/or attempted suicide among Bhutanese refugees to the United States from 2008 to the present?
Since last week, our Nepali speaking interpreters have been busy in helping Center for Disease Control and Prevention (CDC) find an answer to the above question. Since 2008 approximately 35,000 Bhutanese refugees have been resettled in the United State. 16 suicide cases in 10 states have been reported to the Office of Refugee Resettlement (ORR). As our interpreters were undergoing two days training session with the CDC staff, another suicide had been reported to ORR. Considering the pattern in which suicide cases are increasing among the newly resettled Bhutanese refugee population, CDC is conducting “Epi-aid” study in collaboration with Office of Refugee Resettlement and Refugee Health Technical Assistance Center at the Massachusetts Department of Public Health.
A random sample of Bhutanese refugees from four states – Georgia, Arizona, New York, and Texas were selected from which a total of 579 Bhutanese refugees, age 18 and older will be interviewed using a set of pre-designed questionnaire which is about 90 minutes long. After two days of intense training on research ethics, informed consent, questionnaire, addressing difficult situations, distressed respondent guidelines, and role play sessions, our Nepali speaking interpreters are ready to assist in face-to-face interviews with Bhutanese refugees. The study findings will help better understand the underlying causes and associated risk factors for suicide in the Bhutanese community, provide evidence-based guidance on prevention of suicide and reducing emotional distress among Bhutanese refugees, and raise awareness of suicide risk factors and mental health resources to Bhutanese refugees in the United States.
There is definitely the need for linguistically competent and culturally appropriate mental health programs in Arizona to address the issues of Bhutanese refugees and also other individuals who have Limited English Proficiency. With the use of our professionally trained interpreters, Bridging Cultures is in a unique position to help bridge the gap between mental health patients and medical professionals/facilities. Our interpreters, some of who are former refugees, found Bhutanese Suicide Prevention study with CDC very meaningful. We are very positive about the outcomes of this study and enthusiastic about the changes it will follow. Please check back with us for more progress on this topic.
Kamana Khadka, Program Manager, Bridging Cultures
For the past year, I’ve been following the career of Jeremy Lin for two reasons: he was originally signed by the Golden State Warriors (my hometown basketball team) and because he is an Asian American. As has become well known in the past two weeks, there have been very few Asian American professional basketball players. Consequently, I’ve watched with increasing interest (and yes, glee) his sudden ascent to NBA stardom with the New York Knicks.
But I am becoming more interested in his impact on increasing the visibility of Asian Americans as a whole in this country. He has now graced the covers of Sports Illustrated and Time Magazine. Other magazine covers may soon follow. But the point is that he has singlehandedly reminded mainstream America that there are Asian Americans in this country.
For while we Asian Americans have become fond of complaining about being stereotyped as the “model minority”, the reality is that we have actually been the invisible minority – reduced to intermittent blips in the national consciousness, as comic relief (the “Harold and Kumar” movies), cautionary tales of alienation (Cho and the Virginia Tech mass murders), or cultural stereotypes (overbearing “Tiger moms”).
Well, Jeremy Lin’s story seems to have found a special resonance with mainstream America. He is “the little engine that could” and “the ant that moved the rubber tree plant” (though he is 6’ 3”). He is the embodiment of the favorite American fable that anyone can make it if they try hard enough. He is one of us.
However, we’re learning that fame and attention can come at a cost. Witness the ESPN headline regarding “Chink in the Armor” after a recent Knicks loss in which Lin committed numerous turnovers. Other racial slurs have made it into the media, and more will no doubt follow. He is a “feel good” story for some, but for others he is resurrecting repressed feelings of race hatred and intolerance.
Most importantly, though, Jeremy Lin is bringing long overdue attention to the forgotten minority. Perhaps the CNN producers of the “Latino in America” and “Black in America” series will now consider an “Asian American in America” series. While his story has become a global phenomenon, the Asian American experience is in fact full of equally fascinating and culturally distinctive stories. Let’s hope “Linsanity” is the impetus for Asian Americans to finally find a worthy place in the American consciousness.
- Doug Hirano, MPH, APCA Executive Director
A few weeks ago, I participated in a press conference on behalf of the Asian Pacific Community in Action, a Phoenix-based non-profit health services and advocacy organization. We were one of several Asian American agencies and individuals calling for the resignation of Sheriff Joe Arpaio. Since then, I have received several emails, letters and phone calls inquiring as to what Sheriff Joe has done to members of the Asian American community to deserve a call for his resignation.
My answer is not a simple one. In fact, it is as steeped in history as it is in recent events. Asian Americans have a long history of not being welcome in this country. Beginning with the 1882 Chinese Exclusion Act, significant barriers have been placed upon Asian immigration. In 1924, the National Origins Act essentially closed the doors to immigration from Asian nations. This door was not substantially re-opened until the Immigration Act of 1965.
Obviously, Sheriff Joe Arpaio had nothing to do with historical American policy regarding Asian immigration, and I am not directly aware of discriminatory treatment of Asian Americans at the hand of the Sheriff’s Office. However, I would argue that his racial profiling of the Hispanic community is a salient issue for the Asian American community. As Martin Luther King, Jr. said, “Injustice anywhere is a threat to justice everywhere.” With a majority of Asian Americans being foreign born, it is possible that we could be the future target of “crime suppression” sweeps.
Asian Americans have come a long way in the past 100 years of Arizona statehood. Indeed, we are now the fastest growing racial/ethnic group in Arizona, and the vast majority of us are extremely proud to be Arizona residents. However, until we all can live without fear of unlawful discrimination and racial profiling, I believe we are obligated to speak out. As Martin Luther King, Jr. also said, “Our lives begin to end the day we become silent about things that matter.” It is time for change: Sheriff Joe should go.
-Doug Hirano, MPH, APCA Executive Director
The Centers for Disease Control and Prevention (CDC) has just released data regarding the utilization of cancer screening tests (i.e., mammography, Pap smear and colonoscopy) by race/ethnicity. Here’s a direct quote from the report: “Screening rates for all three cancer screening tests were significantly lower among Asians than among whites and blacks.”
As an example, the rate of mammography within the past two years for Asian survey respondents was 64.1%. This compares to 72.8% among whites and 73.2% among blacks. Similarly, Asians received up-to-date colorectal cancer screening at a rate of 46.9%, as compared to 59.8% among whites and 55.0% among blacks. Data is also presented by Asian ethnic subgroups, including Chinese and Filipinos.
Early cancer detection greatly increases the chances of successful treatment. Clearly, Asian American health organizations and their partners must work to address this disparity in cancer screening rates. I would urge you to review this report. Click here for a link to the report.
-Doug Hirano, MPH, APCA Executive Director
We were recently asked to join other Asian American community members in a press conference demanding the resignation of Maricopa County Sheriff Joe Arpaio. One may wonder why an agency with a mission towards health improvement would want to go out on a limb against a county sheriff. I’m providing the text of my comments as an explanation:My name is Doug Hirano. I am the executive director of the Asian Pacific Community in Action. We’re a non-profit agency that works on behalf of the rapidly growing Asian American and Pacific Islander community to ensure that they have equal access to the health services and information that can help them achieve good health. Since 2002, we’ve helped thousands of Asian Americans and Pacific Islanders get immunized, get screened for life-threatening diseases, and find a regular source of medical care. All of our programs are tailored to serve first generation immigrants and refugees facing real challenges of poverty, language, education and unemployment. In our 10 years of service, our work has taught us the power of grassroots advocacy, and so we also work to promote policies and practices that are fair to the needs of all Asian American and Pacific Islander individuals -- regardless of country of origin or citizenship status.It has become clear that the policies and practices of the Sheriff’s Office are a problem for communities of color, including Asian Americans and Pacific Islanders, many of whom are recent immigrants and refugees. Many of our service recipients come to the United States seeking a just and fair society. Unfortunately, the discrimination, racial profiling and unconstitutional retaliatory actions taken by the Sheriff’s Office are reminiscent of the policies and actions for which they originally left their home countries. We are concerned that our community members are not seeking the government services they need and are entitled to because of the hostile and fear inducing atmosphere created by the Sheriff’s Office. Data indicate that Asian Americans and Pacific Islanders are over-represented among the very poor, but do not utilize government-funded services such as behavioral health care, cancer screening and nutrition services proportionate to their population size. For an agency charged with improving the health and well being of our communities, this is unacceptable.We believe that government services and policies are meant to level the playing field for all. We believe that law enforcement must protect everyone’s safety and rights equally. We believe in equal access to justice. Under Sheriff Joe Arpaio, none of these beliefs can be realized. Change is demanded. As Martin Luther King Jr. once said, “our lives begin to end the day we become silent about things that matter.” We therefore request that Sheriff Joe Arpaio resign from office immediately. Thank you. - Doug Hirano, MPH, APCA Executive Director
2012 is indeed a very exciting year for us. We received a grant from Healthy People 2020 to conduct nutrition education intervention/workshops in the Bhutanese community. Bhutanese are nationals of the Kingdom of Bhutan. Bhutan is a landlocked country in South Asia, located at the eastern end of the Himalayas. India borders the south, east, and west areas of Bhutan and China borders the north. Nepal and Bangladesh are also not too far from Bhutan.
The ancient traditions of Bhutan have been fiercely guarded as a result of having been almost completely cut off for centuries from the outside world. Bhutan, also known as “Land of the Thunder Dragon,” began to open up to the outsiders in the 1970s. Although ancient cultures and the breathtaking sceneries make Bhutan irresistible, tourism is restricted.
There might be restrictions in traveling to Bhutan, but there sure are no restrictions in learning from our Bhutanese friends who are among the newest members of our community in the United States. This project is a result our commitment in learning and growing together. Bhutanese community leaders identified the need for nutrition education among their people.
“Elders believe that they should drink water only when they sweat.”
“Regardless of whether or not they are in pain, some religiously take pain killers three times a day just like the medicines prescribed by their English-speaking doctors, whom they do not understand.”
“They suffer from diabetes, high blood pressure, cholesterol, stress, depression and yet eat fatty food cooked in corn oil which is cheap and comes by the gallon.”
“What do doctors really mean by exercising?”
We not only actively listened to the community but did our part in researching the facts. According to the Centers for Disease Control and Prevention, there is a severe case of Vitamin B12 deficiency among the Bhutanese, which results in numerous hematologic and neurologic disorders. A nutrition education/intervention is crucial.
We are in the process of developing a culturally appropriate and linguistically competent nutrition education curriculum specifically designed for the Bhutanese. In partnership with Bhutanese Community Association of Arizona, input from experienced Bhutanese medical assistants and staff members from Mountain Park Health Center, we are striving to build a curriculum that will reflect the input from the community leaders, members, and Bhutanese women who do almost all the cooking. The curriculum will be delivered by trained lay health workers fluent in English and Nepali. The curriculum will also be translated in Nepali, which is the language spoken by the Bhutanese resettled in the United States.
For further information, please contact Ms. Kamana Khadka at (602) 265-4598.
- Kamana Khadka, Program Manager, Bridging Cultures
While many of us have very recently made resolutions around our eating and exercise habits, the Centers for Disease Control and Prevention (CDC) is asking the public to adopt at least one additional New Year’s resolution: Be ready. To make this easy, they’ve initiated a “31 days of preparedness” blog offering a tip a day to improve readiness for any type of disaster or emergency.
The first three days’ of readiness tips have included some simple but sensible suggestions for preparing your “second home” – in other words, your automobile – for emergencies. Check back with the CDC blog for additional daily tips. I suspect you’ll be more knowledgeable and better prepared for the unexpected.
- Doug Hirano, MPH, APCA Executive Director
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