On World Suicide Prevention Day: Because Emotional Self-Expression Is Not Part Of Bhutanese Culture

Kamana Khadka, MPH

  

“Golden Gate Bridge board Oks $76 million for suicide barriers,” read the headline in SFGate.

Despite the controversies regarding $76 million investment in creating 20 feet steel-cable suicide net, I would like to congratulate Mr. Roger Grimes who started the campaign for suicide barrier at the Golden Gate Bridge.  It was reported that he regularly walked on the bridge with a sign reading, "Please care: support a suicide barrier" in addition to attending several meetings.  While I do hope that placing the barrier will prove to reduce suicide rate and bring peace to family members of 1600 individuals who jumped to death from the bridge; I cannot help but begin to imagine the ethnicities (often minorities) of individuals who will be involved in labor intensive and risky (perhaps hanging off the bridge in the thin air while placing the suicide barrier) jobs during actual implementation of the project.  I would also like to point the fact that according to Centers for Disease Control and Prevention (CDC), in 2010, the most common methods of suicide were firearms (50.6%), suffocation (including hangings)  (24.8%), and poisoning (17.3%). Sarcasm apart, I certainly do hope that this million dollars project will be successful in raising increased awareness about suicide in general including minority communities such as the Bhutanese in U.S.

Suicide is among the top 10 causes of death in America.  According to CDC the reported suicide in 2011 (most recent year for which data are available) was 39,518. The numbers drastically changed for U.S. post Bhutanese refugee resettlement.  The global suicide rate is 16 per 100,000.  For general population, U.S. rate is 12.4 whereas its 20.3 for Bhutanese. 

"If you treat them, what are you treating them towards? If you treat them to sit in a chair all day and do nothing, what’s the treatment?"

–      Ken Thompson, Squirrel Hill Health Center

I not only work closely with the Bhutanese community in Arizona, but having been born in Nepal, I share a common language and culture with them.  And because we speak Nepali (common language), often times I pitch in as a Qualified Nepali Interpreter (one who received training to become an interpreter).  My personal opinion is that, yes, it is a mental health situation, but working through trauma, depression, and post-traumatic syndrome disorder with the Bhutanese is not the only concern here.  It is very important that we find something to engage them here in the U.S. as they start their new lives.  It is wrong that 45 minutes counseling session, often with an untrained Nepali interpreter (who omits and adds to what is being said in the room leading to inaccurate interpretation) is the only solution for a Bhutanese man who once the breadwinner and role model for his family (in Bhutan and Nepal), cannot find a job in U.S. to provide for his family and is dependent on his English speaking child for simple conversations with the outside world.  We leave him hollow, helpless, and depressed outside the session, outside the hospital, and outside the home visit.

 “Most suicide decedents were generally unemployed men who were not providers of their family; the most common post-migration difficulties faced by the victims were language barriers, worries about family back home, and difficulty maintaining cultural and religious traditions,”

– Centers for Disease Control and Prevention

Are We There Yet? Civil Rights Act, 50 Years Later In Arizona.

Kamana Khadka, MPH

At about 4:30 pm on weekdays, my Mum would yell from just outside the dinning area of our Kathmandu home, “Kamana. Monika. Come eat first.  Did you two change your school uniforms yet?”

Immediately, after returning from school, my sister and I, sat next to each other, on Galaicha (Carpet, handmade in Nepal), leaving sofa behind us, and stared at our 32 inches, Sony, color television set.  We impatiently flipped through several of our favorite American shows on Star World, HBO, Cinemax, MTV, Nickelodeon, Cartoon Network, National Geography, BBC, Channel V, Disney World, and so on.

We painted a picture of the United States of America, as the land of most progressive minded and intelligent people.  We thought, new innovations, exciting discoveries, and strong systems of law that protect the rights and ensure happiness of All its citizen, were part of everyday life in the United States.

“Chori (daughter), do you want to wear thick glasses like your Hajur Buwa (Grandfather)?” my Dad would say, as he literally picked both of us, one at a time, and placed us further away on the Galaicha. 

“I can’t wait to graduate from high school Dad.  I want to go to the United States,” said I.

In 2005, I was in Phoenix, Arizona. 

“Heavily accented teachers removed from Arizona classrooms,” read the headline in The Washington Post, 2010.

“Arizona bill 2281 targets ban on ethnic studies,” read the headline in The Arizona Republic, 2010.

When SB1070, the anti-immigration law was passed in Arizona, President Obama commented that it threatened “to undermine basic notions of fairness that we cherish as Americans, as well as the trust between police and our communities that is so crucial to keeping us safe.”

Almost a decade has passed since I first arrived in the United States. 

50 years has passed since President Lyndon B. Johnson signed The Civil Rights Act of 1964; the law that outlawed discrimination based on race, color, religion, sex or national origin. 

But, are we there yet?

Sure.  There have been prominent movements for equality.  After all, equality is what we, the Americans, are all about. 

But, I ask again, are we there yet?

The rights of LGBT community, women, undocumented immigrants, refugees, and limited English speakers/speakers of non-English languages still remain unaddressed for the most part.

What about in the State of Arizona? 

Are we there yet?

“We must come together as a proactive cross-cultural movement to eliminate racism within our lifetime. It is time to inspire people to believe – and act on the belief – that this can be achieved. As we lift up healing with efforts to transform, inequitable systems and structures will surely crumble as our collective power is applied.”

 - Mr. Lloyd Y. Asato, Executive Director at Asian Pacific Community In Action

 “Personally and as an immigrant, Civil Rights Act of 1964 and similar laws are one of the reasons why we left our original countries. Being a member of a minority always puts you at risk of discrimination in one way or another. It is usually the legal system that should protect citizens of any act of discrimination. This is why people from all around the world aspire to live in the United States of America.”

-       Ms. R. Radhi. Originally from Iraq.  Living in Phoenix since June 10^th, 2010.

“Although the Act was passed 50 years ago and despite the fact that many of the injustices it was designed to combat still exist today, many benefit daily from its passage and implementation.  Personally, I benefit from having a professional role that allows me to implement elements of the Civil Rights Act each and every day by ensuring our organization maintains equitable hiring practices, goes beyond ADA standards of accessibility, provides inclusive, quality service to individuals from all backgrounds, and much more.  Unfortunately, the elimination of important equity-focused programs like Affirmative Action seem to revers our national and state progress as they have had significant negative impacts in areas such as admissions to higher education institutions by people of color.”  

- Mr. Essen Otu, MPA, Diversity & Community Affairs Director at Mountain Park Health Center

“My experience has been in the military from around that time until 24 years later. In the military I did not see or experience anything that appeared to be discriminatory; on the contrary, any behavior of that type was not condoned or permitted and there were severe consequences if that were to occur. I spent a major part of those years outside of the United States.  As it is, I have little personal experience but in my current position I see that Title VI of the Civil Rights Act of 1964 has allowed for better access to health care services by prohibiting any discrimination based on race, color or national origin; this principally enhances the opportunity to communicate in a clinical setting in a form and language that the patient understands. Having experienced health care services in a foreign country and seen the difficulty of English speaking patients in attempting to communicate with the health care provider and having to rely on signals and signs compared to here in the US where the patient can rely of a qualified medical Interpreter… the Civil Rights Act of 1964 has made it possible for the patient not to be concerned if they would be someone available that could understand them and focus more on their health issue. I have seen the progress of language and cultural services in a health care setting… from the use of anyone that may be bilingual to the use of qualified bilingual staff. The professionalization of the medical interpreter has been the direct outcome of the civil rights act and has led to the improvement in communication and in the outcomes of the medical interaction. Positive comments made from satisfied patients and family members praising the medical interpreter for their thoroughness and their ability to help them deal with a difficult issue and understand the what is said is a testament of the importance of assisting in the communication process.”

- Mr. Luis Gendreau, BGS, MBA, Community Relations Director at Maricopa Integrated Health Systems 

“A few seniors asked me these questions during a recent visit to a senior center.  Please note that they are on AHCCCS. 

What do I do if the doctor told me to bring my own "translator"? 

A receptionist told me that the doctor would not see me unless I bring someone to "translate" for me.  What should I do? 

I was glad that the community center assigned an interpreter for me but the liver specialist referred by my family doctor told my daughter that they don't provide interpreter service.  What can I do now? 

The phone interpreter seemed so rushed.  I don't think that the doctor really knew what was wrong with me.  What can I do? 

These questions showcase the common language barrier that many individuals with limited English Proficiency have to deal with while accessing health and social services.  They encounter the language barrier while seeking services at clinics where federal  fund was provided.  And yes we are talking about 50 Years after the inauguration of Title VI, Civil Rights Act of 1964.  More workshops on Title VI are needed to educate the public about the right to receive equal service so that they are empowered to ask for language service.  More complaints should be filed by members from people speaking language of lesser diffusion.  More interpreters need to be trained.  Service providers should be educated on Title VI and CLAS standards so that they know to be compliant with the law by using certified/trained/qualified interpreters.  

The reality is that LEP patients are discriminated against everyday because of their "race, color, and national origin."   We have a lot of work to do.  Perhaps someday Arizona will also have state registry for healthcare interpreters and state certification.  Not in the too distant future, I hope.” 

- Ms. Emma Ditsworth, Co-founder/Interpreter Trainer at Hamro America

During my recent travels to Bhutanese Refugee Camps and a couple of countries in Asia, I was reminded that, just like my sister and I, many of the refugees, immigrants, tourists, and international students, still paint a similar picture of the United States of America; land of endless opportunities for all.  Opportunities, regardless of caste, class, education, color, language, sex, religion, and national origin. 

And, just like my sister and I, they too are bound to be disappointed upon their arrivals.  Because soon, very soon, they will access our health care, social and human services and see right through the discrimination we practice in our State, in our country; sometimes openly and often times very subtly.  Our service delivery and hard-to-change systems reflect the practiced discrimination on a daily basis.

Today, as we celebrate the 50 years of accomplished progress, after the signing of perhaps, one of the most important laws in our country, The Civil Rights Act, let us not forget that indeed, we are not there yet.  Much work lies ahead of us; in the State of Arizona and in our country.

Indeed, I Have Become A Foreigner In My Own Country!

Kamana Khadka, MPH

“People like you, living in America and biting on burgers, what do you know about the struggles of Nepalese living in Nepal?,” said a Nepalese surgeon, referring to me, within the first five minutes of our conversation.  We were complete strangers, meeting for the very first time. 

“Hey, take my photo with this foreigner! I want to upload it on my Facebook,” yelled a Nepalese gentleman in his mid-twenties, handing a digital camera to his friend, upon spotting me hiking up a mountain in Nepal.

“Excuse me Miss, please pay the foreigner’s entry pass here,” said a Nepalese police officer.

         Such were among the many comments that lead me to believe “Yes indeed, I have become a foreigner in my own country of birth.”

         So, how do I feel about this? 

         Having well traveled to several countries in Africa, Asia, and Europe, and having lived away from Nepal, my country of birth, for more than a decade, I feel that being called a foreigner is perfectly normal.  It is no more distinctive than being referred as short, tall, fat, skinny, fair, or dark.  However, I must admit, being treated, as a foreigner in your country of birth, is quite annoying.  It is annoying, for instance, when your relatives and friends ask you to hide while they negotiate Taxi fares or make purchases, as prices instantly go up the moment vendor’s spot you.  It is annoying when your own people either overestimate or underestimate your knowledge on certain topics.  It is annoying when people make all sorts of absurd assumptions about your lifestyles, decisions, and preferences.

         Well, I think that a lot of our perspective about being a foreigner is drawn from outdated philosophical assumptions that humans are social animals and they should belong to a particular society.  Herder, an eighteenth century Prussian Philosopher, argued that man can only flourish among his own people, with who he shares his language and culture.  I’d say, Not in the 21^st century Mr. Johann Gottfried Herder.  I think what makes a complete nonsense of this long-established philosophical consensus, are the long standing lines of thousands of Nepalese, at Tribhuvan International Airport, who desire to live in foreign countries.

         While I am not in complete support of nearly 2.2 million Nepalese leaving Nepal (Nepal Institute of Development Studies, 2014), in order to secure employment abroad; I keep an open mind in understanding that often times these are imposed choices due to poverty, persecution, or exile. Of course, it’s a troubling reality for Nepal that more than 1000 citizens leave on a daily basis. However, labeling people’s choice to study, work, or reside abroad, as an act of disloyalty to Nepal, is only going to create more problems. 

         I strongly believe that everyone has the right to live in societies that they think is best for them.  Having said that, I also believe that there needs to be a solution to minimize the increasing number of Nepalese migrating to Gulf countries, Malaysia, and South Korea.  The solution lies in not pointing fingers and throwing harsh comments at each other, but coming to the realization that “Nepalese residing outside of Nepal hold up half the sky of Nepal’s future.”

To the Nepalese surgeon, I love my Dal Bhaat and eat it once everyday in America. 

Show me some love Nepal.

;0)

Ever Wondered Why So Many Were Born On January 1st?

Kamana Khadka, MPH

“Birthdays are not important to me.  It does not mean anything.” 

- Ms. Emma Ditsworth

         The State Department and the United Nations must have found Emma’s family tradition in Taiwan of celebrating birthdays on Chinese New Years day very fascinating.  Just like Emma’s family, majority of our refugee friends in the United States celebrate their birthdays today, on January 1^st.  Refugees who do not know their date of birth are assigned 1/1.  This is not a formal policy, but it is commonly practiced around the world with refugees from South Sudan, Ethiopia, Somalia, Burma, and elsewhere. 

         I have asked many of my refugee friends, “How do you feel about sharing your birthday with so many?” and they often laugh and answer, “Coming to America is like being born again.  So it is my birthday.”

         Being born and brought up in Nepal, where birthdays are so important, not just for celebration purposes, but also religious, there is a tiny part in me that feels a little sad that so many have to share one birthday.  At the same time, I do understand the importance of having exact birth dates while living in the United States.  As soon as refugees sets foot on United States, 1/1 becomes their identity, as it is recorded in their driver’s license, social security cards, health insurance, and almost all documents.  Let us all hope that the authorized personnel overseas are always correct while assigning the birth years.  Otherwise, can you imagine all the problems a 16-year-old refugee, whose age was wrongly recorded as 19 years, would go through while seeking admission at schools in the United States?  He/she would be denied admission.

         As I send my wishes for a very Happy New Year, 2014, I would also like to wish all my dear friends who celebrate their birthdays today, a very Happy Birthday; you are a year older.