Saturday, July 20, 2013

My Mum. The Internet. Skype. Moral For Service Delivery.

Kamana Khadka

            It was the midnight of April 14, 2013, in Phoenix when both my fascination and curiosity started to how versatile my Mum can get with the Internet. My Mum inherited my old MacBook when she moved to the United States from Nepal to live with me some four years back.  My Mum is definitely not tech savvy but she is a fast learner. 

            I was finishing up Sheryl Sandberg’s book “Lean In” when I heard my Mum chanting in her prayer room. 

            It was midnight.  Not her normal chanting hours. 
            My Mum’s prayer room is literally a step away from my bedroom.  I slide open my bedroom door that connects to the balcony and my Mum’s prayer room is on the left.  In addition to being a fast learner, she also is quite an innovator.  She converted the extra storage room in our balcony to a fairly comfortable prayer room.  My Mum does her prayers twice every day – early morning and early evening.  I hear her singing beautiful Hindu hymns, I smell the incense, and I see her offering water and flower petals to the morning sun everyday.  That night in particular was special because April 15th would be a New Year 2070 in Nepal.  Our midnight in the United States was already New Year’s Day in Nepal. 

            I curiously stepped out in the balcony to find out what my Mum was up to at midnight and noticed she was streaming a live video from Ahmadabad, India where her Guru (teacher) Sri Asharam also known as Bapuji was chanting mantras (Hindu prayers or repeated chanting done for concentration in Sanskrit language) especially for the New Year 2070.  My Mum was sitting in her prayer room with her legs crossed, eyes closed, and her fingers were carefully moving the mala (108 set of beads used while repeating mantras by Hindus), one bead at a time, as she was repeating the mantras after her Guru.  Pretty neat stuff.

            Since that night I have been pretty fascinated with my Mum’s journey into the world of the Internet. 

            Another fascinating chapter of my Mum’s Internet journey is the use of Skype. 

            She uses my Skype account of course! 

            Although there are over 31 million Skype users around the world, for those who don’t know what Skype is, it is a pretty cool app where you can make video call and voice call to another registered Skype user.  You can open an account for free.  The video call and voice call is also free. 

            Majority of our relatives from my Mum’s generation live in Nepal.  Majority of our relatives from my generation are spread all around the world – Spain, Germany, Australia, England, different states in the United States and many other countries in the world.  These days I almost never use my Skype account. 
            Mum hacked it.  I connect with my cousins and friends through other social media and phone apps. 

            I don’t think my Mum realizes how loud she is when she is Skyping with her sisters back in Nepal.  Well her sisters, on the other end, are competitively loud too.   I can clearly hear all their communication taking place in the living room from my bedroom.  Even with the door shut. 

            Last week, my Mum managed to shop for custom made gold jewelry from Nepal using Skype.  My cousins in Kathmandu, Nepal; there were actually four of them (One of my Mum’s elder sisters, her husband, and her eldest son who was visiting from Germany, along with one of my Mum’s younger sisters); who hopped around some famous jewelry shops in an over-crowded place in Kathmandu, showing my Mum different jewelries on display. 

            I think at some point my Mum was also bargaining with the shopkeepers in Nepal. 

            It was almost 1:30 in the morning here in Phoenix that is about 2:15 in the afternoon in Nepal.  They managed to buy the one that my Mum liked, at the price she liked.  They sent the jewelry with one of my Pilot cousins who recently came to the United States to do a short crash course.

            Also, through Skype my Mum has mobilized two groups of relatives – one in Nepal and one in the United States who are determined to find a perfect match for me to get married to.  They are determined to get me married in the next lagan (auspicious month to get married in Hindu religion).  Not only are they determined but also impressively efficient.  Don’t get me wrong; the group was not as efficient as they are now.  There has been multiple times when my Mum’s group has brought several proposals to me with detailed information about the man’s family what his parents do, where they live, and all the possible information under the sun but whenever I asked the basic questions that are relevant such as:

            What is the guy’s full name?

            What does he do for living?

            What degree does he have?

            The answers I got were really interesting.  I mean really interesting. 
            “His last name is Thapa.  Umm, I think the first name starts with an A.”

            “Degree?  He studied in England.  Very good looking man.”
            Exchanging e-mail addresses for instance was like moving Mount Everest from Nepal to the United States.  I kid you not. 

            My Mum’s group has also brought some super incompatible matches in the past.  I rejected most in less than a day, a couple of days, a week or maximum two weeks. But to my Mum’s credit, her mobilized group has made some pretty impressive progress and proposed forth some good finds in recent months.  They have recruited a few professional matchmakers to join the group.  I thought recruiting professional matchmakers was a pretty intelligent move.  I have had some lengthy and really interesting conversations with some candidates in recent months.  There have been few men I have talked to, that are surprisingly a good fit.  At first I was not quite sure about the whole “arranged marriage” thing.  So, intentionally, I posed some really tough clauses to what type of man I was looking for, so that they would give up.  But the group has done some commendable work I must say.

            Arranged marriage is like online dating.  Arranged marriage is like being a member of eHarmony.  Just my opinion of course.

            I must say that being open to the process of arranged marriage has stirred up a different cultural learning in me.  For some odd reason, partaking in this whole arranged marriage thing is giving me a deeper understanding to where my culture places marriage; the value of marriage, and the whole reason of why we get married. 

            Well, my arranged marriage is a whole different topic.  Perhaps future blogs.


            People accept change.  They adapt to change.  They make the change part of their everyday lives.  But this change has to be introduced to them in a way where it is not a threat to their existing lifestyles but an addition.  The change has to be introduced in a way that is relevant to them.  If we apply the same principle of introducing change to our patients and clients while we deliver health and social care; the future where our patients and clients, willing maintain the suggested change, part of their lives, is not too far. 

Bottom Line - Make It relevant.

Friday, July 12, 2013

Bittersweet Health Disparities Moment. Time Spent With The Bhutanese In Tucson, Arizona.

Kamana Khadka

     Tucson, Arizona is home to about 1,400 Bhutanese; one of the newest refugee communities in America.  Among many health issues faced by Bhutanese who come from fairly underserved and sub-standard living conditions in refugee camps in Nepal, poor nutrition related health concerns remain one of the most voiced by Bhutanese residing in Arizona. Bhutanese have not only shown keen interest but have actively participated in establishing a healthy lifestyle in a new country. 
     On June 29,2013, I was asked to facilitate Bhutanese Community Health Promoter Training with Bhutanese Mutual Assistant Association for Tucson (BMAAT) in partnership with the Pima County Health Department and Mel & Enid Zuckerman College of Public Health, University of Arizona.  My role as a facilitator was to emphasize on cultural sensitivity. Having worked extensively with the Bhutanese in Phoenix and also on Healthy People 2020 funded Nutrition Project in 2011, I was excited to share my experiences. 

     Learning about the Food Plus program was the bittersweet health disparities moment for me.  Food Plus, is a USDA food program that provides emergency food boxes in Tucson to low income mothers, children, and the elderly on a monthly basis.  According to what was shared in the presentation, the emergency food boxes that are circulated contain pasta, milk, flour, canned vegetables, beans, cheese, beef stew, and juice for the most part.  Let me tell you, majority of the food that are included in these emergency food boxes are not only new to the Bhutanese and might never be used by them, but delivering beef stew, for instance, to a Bhutanese household, is very offensive. 
Cow is sacred in Hindu religion. 
Majority of the Bhutanese are Hindus. 
I doubt that majority of the food items included in those emergency food boxes would be used by refugees and immigrant population.
     Don’t get me wrong.  I truly appreciate the thought behind the emergency food boxes and commend USDA Food Programs for being consistent with their services.  Yes, the food that goes into those emergency food boxes solely run from donations from the public.  I believe that one of the main reasons why USDA Food Program have been able to consistently provide Food Plus/Emergency food boxes to the Tucson residents for years is because the donors strongly believe that by donating food they are able to fill the much needed gap in their community.  The fact is, our communities have changed and so have the choices of food consumption.  
     If the USDA Food Program would inform and provide demographics data to their faithful donors, I believe that there will be more variety in the food donations.  Perhaps the donations can actually benefit the ones in need and it will not be an addition to the list of already provided services to minority communities that is a pretty clear indication of “checking the box service” provisions.  If nothing is done to change the current trends of collecting food donations, Food Plus will continue contributing towards health disparities in America’s attempt to eliminate health inequalities.
     My health disparities comment regarding food content in the emergency food boxes is no reflection of the Pima County Health Department staff or the excellent work blossoming in Tucson, Arizona.  I was very impressed with the group lead by Dr. Karen Heckert.  This group has stretched a small grant of $5,000 to the limits.  The quality of their Community Trainer Program is at the same level, if not more, with some of the heavily funded projects.  Dr. Heckert has more than 30 years of experience working globally with some of the renowned organizations such as WHO, USAID, John Hopkins University etc.  Currently Dr. Heckert is with the University of Arizona and is doing what she does best – bridging theory and practice as public health practitioner in academia.
I had an instant connection with Dr. Heckert as she greeted me with a warm “Namaste” on the phone and she also has traveled to my birthplace Kathmandu, Nepal.
     I would also like to take this moment to congratulate 11 BMAAT Community Health Promoters – Purna, Ram, Santa, Keshab, Bishnu, Indra, Purna, Chadra, Mousami, Sumitra, Jamuna, and Yamuna who successfully completed their training on Nutrition & Diabetes Education.  Staff of the Pima County Heath Department – Soraya, Gabe, Kasey, and Lilly were absolutely amazing and of course Dr. Karen Heckert and her 'super intern' Kristin without whom this project would not have been such a tremendous success.
     Please join me in congratulating the team. 
     I hope to join them soon for the outreach planning.     



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