Last year, Narendra Butala, a long time member of India Home, was facing a health crisis. He had been feeling breathless for a while. His blood pressure would drop suddenly and he would sweat profusely.
Still, he was afraid to go to the cardiologist because his brother had got a pacemaker in 2004 and had passed away shortly after. Even as he worried about the condition of his heart, he heard from one of his relatives. Pacemaker technology had changed, she said, and urged him to get a check-up. Finally, in July, a few months after his 78th birthday, Butala, took the plunge and went to Mount Sinai Hospital in New York City, and got a pacemaker inserted. “I was home after two hours,” he said. “They monitor my heart from the hospital, remotely.”
South Asian seniors like Mr. Narendra Butala (left) will benefit from a new bill introduced by Rep. Pramila Jayapal that targets heart health in the community
Mr. Butala, who emigrated from India 20 years ago, lives an active lifestyle, and is a life-long vegetarian who doesn’t smoke. At first glance, he would not appear to be a typical candidate for heart disease. However, there is one indicator that increases his risk exponentially – his South Asian descent. Several recent studies have found that all over the world, individuals of South Asian descent account for 60 percent of heart disease patients. A study conducted by the University of California San Francisco found that in the United States, South Asians have the highest death rate from heart disease compared to other ethnic groups. Other research published in the Annals of Internal Medicine, discovered an even more troubling trend. Among people of normal BMI (Body Mass Index), South Asians were twice as likely as whites to have risk factors for heart disease.
BMI, a height-to-weight ratio, is used to determine whether someone is overweight or obese. Body Mass Index and weight are often the first numbers doctors consider. Many doctors may not screen for heart disease and Type 2 diabetes if they are within normal range, but what the study indicated was that when it came to South Asians, even patients of normal weight were showing risk factors for heart disease.
Fortunately, someone in the federal government has been paying attention to these concerning numbers. Representative Pramila Jayapal (D-Washington) introduced in the House in late July a bill aimed at the issue of high levels of heart disease in the South Asian American community. Called the “South Asian Heart Health Awareness and Research Act,” the bill garnered bipartisan support and was co-sponsored by 18 other members of Congress, including Rep. Joe Wilson (R-South Carolina).
In an email to NBC News, Jayapal said that she introduced the bill because she thinks the US, needs, “to take action by expanding funding for research and spreading awareness targeting [these] communities. We’ll save lives and reach a better understanding of heart health that will benefit all Americans.”
Rep. Pramila Jayapal (D-Washington) sponsored the “South Asian Heart Health Awareness and Research Act,” in the House of Representatives.
NBC News reported that the bill would “establish grants at the Centers for Disease Control and the National Institutes of Health to provide information about heart health to South Asian-American communities and fund medical research on cardiovascular disease in South Asians in the U.S. The bill would also fund grants through the U.S. Department of Agriculture for the promotion of better South Asian heart health nutrition.”
India Home, which runs the largest South Asian senior center in the North-East, has made its own modest contribution to improve heart health among the older South Asian adults it serves. Regular yoga, meditation and Ayurveda is taught at its centers along with holistic and healthful ways to exercise and maintain their physical and mental wellness. Moreover, in partnership with NYU Langone’s Center for the Study of Asian American Health (CSAAH), India Home has introduced its members to a number of educational projects like Keep On Track / REACH FAR.
Eighty seniors from India Home took part in Reach Far, a project in collaboration with NYU Langone, which taught community volunteers to monitor blood pressure for better heart health.
This project trained 26 volunteers at India Home to monitor blood pressure as part of a Community Health Assessment. Over 80 Bengali seniors from India Home’s Desi Senior Center participated in the project. Another project helped to disseminate nutrition information with culturally and linguistically adapted brochures in Bengali and Hindi and taught seniors how to measure their food portions and try new nutrition strategies.
As for Mr. Butala, he’s back at India Home’s Sunnyside center, being the first to volunteer to push the lunch cart, as usual. “I’m feeling fine,” he said the other day. “The doctor said I can do all activities.”
Since July 2015, India Home has been partnered with Memorial Sloan Kettering Cancer Center (MSK)’s Geriatric Resource Interprofessional Program (GRIP) to provide evidence-based and culturally responsive education to South Asian older adults in Queens, NY. This education aims to increase community awareness of geriatric syndromes – problems that usually have more than one cause and involve many parts of the body – and promote methods that aid healthy aging.
“What can I do next? : Teaching Practical skills for better Aging
Starting with needs assessments conducted at India Home sites, the GRIP team and staff from India Home developed a core lesson plan that India Home members were interested in learning about.
Manpreet of MSKCC explains medication management at India Home
These topics include: falls prevention, how to modify one’s home for safety, memory loss,and medication management. Clinical experts like occupational and physical therapists, geriatric pharmacists, physicians and nurse practitioners developed the lessons. All presentations and educational materials were designed with the adult learner in mind, providing practical skills and always trying to answer, “what can I do next?”. Educational sessions are continuously scheduled at all India Home sites and are repeated on rotation, so that our seniors understand and remember the content.
India Home and MSKCC’s GRIP team collaborates with other South Asian community organizations, like the South Asian Council for Social Services (SACSS) to review content for understanding and the ability to take action with specific cultural considerations in mind. We are always thinking about what works in the South Asian context.
With cultural relevance in mind, MSK translates written materials into South Asian languages and uses live interpreters at presentations. We also evaluate our results by asking small groups of seniors about their understanding and effectiveness of the educational programs.
Over 700 seniors educated
Since November 2015, the partnership has educated approximately 700 seniors at four different India Home sites. MSK, India Home and SACSS staff circulate pre-and post-education surveys to measure how much our seniors have learned and retained, and how they have changed their behavior. The surveys use open ended questions and one-month follow up questions. Take home messages and resource sheets are also provided to our seniors to refer in the future.
Overall, the partnership is aimed at improving the quality of life and health of older adults by educating them.
These efforts attempt to make changes in their behavior – for instance walking carefully or improving safety in the home by installing shower rails – that will positively impact their aging and improve their quality of life.
Content contributed by Natalie Gangain of MSKCC (edited for context and clarity by India Home)
We are collaborating with a sister organization, Sapna NYC, on the Tiffin Project. The project is named after the “Tiffin,” a stainless-steel three-tiered utensil that is used to transport lunch in South Asia. In the city of Mumbai for instance, home cooked meals are delivered to workers in offices and factories by an army of delivery men or “Tiffin Walas” on bicycles, rickshaws and motorbikes.
The Tiffin Project, helmed by Michelin-starred, Chef Surbhi Sahni, brings the familiar tastes of a home-cooked meal to our elders. On Thursdays, the congregate meal we serve at our Queens Community House program in Kew Gardens is a healthy, culturally appropriate 6-item vegetarian lunch from Sapna NYC.
The Tiffin Project also helps in the “economic empowerment of low income South Asian women,” who lack “job seeking skills, work experience and English language proficiency, ” according to Sapna NYC.
India Home collaborates with Sapna NYC to help underserved women bring culturally appropriate meals to our elders
As Sapna NYC says on its website: “Tiffin” trainees will receive a special ESL class, financial literacy training, resume writing, and life skills training. Each trainee will open a savings account and begin saving. Each trainee will have an opportunity to work in the industrial Hot Bread Kitchen for up to 12 hours per week, at a salary of $12/hour. It is expected that the life skills, ESOL, and commercial cooking experience will provide a bridge to entering the formal job market.”
DFTA Commissioner Donna Corrado at the Aging In Place Conference
Almost all of the adults we serve at India Home’s four centers in Queens are “aging in place,” or living independently in their homes. They get to choose their communities. They get to participate and contribute in their neighborhoods and maintain and widen their friendships and social connections. “Aging in Place” thus gives our members a sense of purpose and of their place in their immediate community and larger society. New York city has been active in developing age-friendly agendas, but suburban communities need to ramp up their efforts in creating livable and viable spaces for the aging.
The need becomes more pressing when we consider that by 2030 New York State is expected to experience a 40% growth in its 60+ population, increasing from 3.7 million in 2015 to 5.3 million. While almost all of New York State will experience rapid growth of people in the 75-85 and 85+ cohort, New York City, Nassau, and Suffolk counties are home to the largest older adult populations of immigrants and people of color, like the South Asian seniors we serve at India Home.
Dr. Vasundhara Kalasapudi and Jacqueline B. Mondros, Dean and VP, Stony Brook University
It is with all these important considerations in mind that DFTA Commissioner Donna Corrado and others from NYS Office of Aging, AARP NY, and several other government and medical organizations along with experts in various fields serving older adults joined together to hold a Working Summit at the Hilton Garden Hotel on the campus of Stony Brook University.
Dr. Vasundhara Kalasapudi represented India Home and provided input on the problems unique to South Asian elders at the conference. India Home’s early programs started in very suburban locations such as Queens Village, Baldwin, and Elmont. Through these experiences have given Dr. Kalasapudi a unique insight into best practices for culturally appropriate senior services in the suburban setting.
India Home wins the 2016 Local Community Leadership Award from NYU and AARP. Seen here with Daphne Kwok, the VP of Multi-cultural Affairs
India Home was awarded the 2016 Local Community Action Leadership Award by NYU CSAAH and AARP at the 8th Annual Aging Together, Bridging Generations conference for Asian Americans and Native Hawaiian and Pacific Islanders. This award recognized individuals and organizations that have made significant contributions to improving the health of Asian American and Native Hawaiian Pacific Islander (AA and NHPI) older adults. We were honored for our leadership and commitment in advocating for and providing vital health and social service needs to the Indian and larger South Asian immigrant older adult community. NYU CSAAH felt that the organization’s visionary leadership had been critical in helping to achieve their mission to reduce health disparities in the Asian American community through outreach, education and research. NYU CSAAH is the only center of its kind in the country that is solely dedicated to research and evaluation on Asian American health and health disparities.
India Home was also invited to be on a panel titled “Improving Health at the Community Level: Community-Based Innovative Approaches and Promising Practices.” We discussed our use culturally sensitive health practices like Ayurveda and Yoga classes to attract, retain, and attain buy-in for continuing health education from our South Asian members. We also discussed the myriad ways in which we use community-specific dance, food, talks and trips that are culturally appropriate to combat social isolation and keep our seniors happy and attend to their physical and mental wellbeing.
Among the special guests at the conference were keynote speaker Jeanette C. Takamura, MSW, PhD, Dean of Social Work at Columbia University School of Social Work (and Former Assistant Secretary of Aging at US Department of Health & Human Services), as well as MSNBC anchor Richard Lui and AARP’s community ambassador, the famous retired general Tony Taguba.
Dr. Kalasapudi, India Home’s ED, was in a panel with Councilman Barry Grodenchik and Deputy Mayor Richard Beury at the ThriveNYC Forum in Little Neck.
It is a well known fact that among South Asians and other Asian American groups mental health issues are regarded as taboo. “Emotional problems” like depression, bi-polar disorder, debilitating anxiety and so on are seen as embarrassing and go underreported, undiagnosed and untreated. Yet, 40% of Asian American elders report symptoms of depression that range from mild to severe. Suicide is the 10th leading cause of death among Asian Americans. For Asian women 65+, the suicide rate is double the rate of suicide among white, non-Hispanics.
On September 20, 2016, Dr. Vasundhara Kalasapudi, India Home’s Executive Director discussed these issues as part of a forum organized on the ThriveNYC program by Deputy Mayor Richard Buery, Mental Health Commissioner Gary Belkin and Councilman Barry Grodenchik (D-Oakland Gardens). The forum was hosted by Samuel Field Y at Little Neck. A geriatric psychiatrist herself, Dr. Kalasapudi brought her expertise to talk about how community organizations like India Home can help support the nearly one in five New Yorkers with mental health issues. Dr. Kalasapudi offered insights from her experience serving the needs of the South Asian community and shared prevalent South Asian expectations about and attitudes toward mental health :
Mental illness in South Asian communities is a growing problem and requires urgent attention to prevent calamities like the one reported in the New York Times about a postpartum depressed Bangladeshi mother last year. A significant portion of the South Asian community, particularly those living below poverty line, are vulnerable and tend to have higher burden of mental health problems due to cultural and language barriers. I hope Thrive NYC will focus on developing a special campaign addressing South Asian mental health needs by organizing community events and by funding South Asian community groups and health care providers to provide culturally and linguistically appropriate mental health services.
ThriveNYC is a health plan which will train 250,000 employees to bring about a change in the way mental illness is viewed. The initiative aims to transform mental issues into a problem that New Yorkers can easily seek help for – without shame – just as they would for a broken arm. Some aspects of the ThriveNYC program are already in the works. According to Deputy Mayor Buery, operators who can speak different languages have already been hired for a mental health hotline. This is welcome news, because even when Asian Americans and South Asians do seek help, they are often stymied by the lack of access to health care providers who are culturally competent or able to speak to them in their own language. Nevertheless, these hotlines need to be staffed better with operators who can speak a full array of South Asian languages and dialects.
Deputy Mayor Richard Buery with Dr. Kalasapudi at the ThriveNYC Mental Health Forum.
India Home’s Executive Director, Dr. Vasundhara Kalasapudi, along with Dr. Swapna Dontinneni, Dr. Pratik Jain and Ms.Vani Tirumal presented a study on Attitudes to American Health Care among Elderly South Asians at the 34th Annual AAPI Convention.
AAPI or the Association of Indian Physicians, is the largest non-profit ethnic medical organization in the United States. It stands for over 60,000 practicing doctors and 20,000 students and residents of Indian origin. Every year doctors and healthcare professionals come together for an annual convention in a major American city. They meet to talk about medical advances, health policy, participate in presentations and exhibits that highlight the newest advances in caring for patients, and medical technology. This year, India Home’s Executive Director, Dr. Vasundhara Kalasapudi, MD, attended the convention in New York city in her capacity as a practicing geriatric psychologist. Dr. Vasundhara Kalasapudi, Dr. Swapna Dontinneni, MD, Dr. Pratik Jain, MD and Vani Tirumala made a presentation about Attitudes to American Health Care among Elderly South Asians using their research conducted with participants from India Home’s Sunnyside Center and Services Now for Adult Persons Center. Most of the doctors leading the 2010 study were from Brown University.
Some of the key findings were that elderly South Asians relied on non-allopathic forms of medicine such as homeopathy, Ayurveda and herbal home remedies as a first line of defense. When they used allopathic medicine it was a second choice, and very few believed that it was important to have a primary care physician.
The Poster for the study
Barriers to healthcare
Interestingly, the study* also found the barriers to healthcare were the burden of paperwork, discrimination, communication (lack of English access) and affordability. With this study, the doctors made an important contribution to the growing body of knowledge about South Asian seniors and their attitudes toward American health care.
* Please enlarge image of poster for references
National studies have shown that South Asians in America face difficulties in getting good healthcare. Many South Asians report that language is an issue; they cannot communicate well in English and therefore find it harder to make their health needs understood. Often large percentages of the South Asian population are uninsured. All these factors prevent certain South Asians from seeing a doctor regularly and getting check-ups. Consequently, they are screened less for blood pressure and diabetes, diseases that are easily manageable if properly diagnosed and treated.
Now India Home’s Desi Senior Center is doing something about this problem. We recently had a program to teach volunteers from the community how to properly use and read blood pressure monitors. The DREAM Coalition and NYU in collaboration with India Home has started the first steps of the Keep on Track program. According to Leah of NYU’s Center for the Study of Asian American Health, “This CDC funded federal program is aimed at reducing heart disease in Asian American communities throughout New York City and New Jersey by allowing members of the community to have regular blood pressure screenings. Local volunteers were trained at Star Kebab by the DREAM Coalition and observed by the NYC DOH. ” Twenty-five community volunteers, recruited through India Home, were taught about the risks factors that contribute to heart disease. They were also taught about how to prevent heart disease, and the proper use and reading of blood pressure monitors. The first screening event was held on November 11th at India Home.