immigration

Personal Spotlights

Linking Immigration and Health

by Iyanrick John

As the child of immigrants from Pakistan and India, I am very aware of the challenges that immigrants face when they come to this country. When they first arrived in Maryland in the mid-60s, it was challenging for my parents to adapt to life in the U.S. At one point, my mother was working full-time and my dad was working three part-time jobs, all while they were both attending graduate school. Thankfully, my parents were eventually both able to get good jobs that included health insurance coverage before I entered the picture. I am grateful to have grown up without severe hardships, I knew many relatives and friends in our tight-knit community who experienced challenges finding jobs, obtaining decent housing, and accessing health care services.

I’ve felt incredibly privileged to be part of the Policy Team for the Asian & Pacific Islander American Health Forum, an organization that works to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NHPIs). Our work is two-fold; we serve as a connector with community-based health organizations across the country and also as a representative in Washington, D.C., that can amplify the voices of AAs and NHPIs at a national level. It is challenging, yet fulfilling, to be able to do this work on behalf of communities across the country like the close-knit Indian community I grew up in.

With the expansion of health care through the Affordable Care Act, we have focused much of our efforts on addressing the language and cultural barriers that AAs and NHPIs face when trying to enroll in health coverage. As a part of Action for Health Justice (AHJ), a coalition of over 70 community health centers and community based organizations, we helped provided outreach, education, and enrollment assistance services to almost 850,000 AAs and NHPIs in 22 states to help them enroll in health insurance coverage through Medicaid and the Health Insurance Marketplaces.

In looking forward to the third open enrollment, we have been able to identify both best practices and the biggest challenges with outreach. It comes as no surprise that one of main barriers to health coverage for many is immigration status. Many AAPI families have mixed status and fear that enrolling one person in health coverage will jeopardize the immigration status of another family member. While this is not possible, this situation draws up deep emotions that prevent many families from enrolling in health coverage.

It’s the same fears and feelings of shame and guilt that pose barriers for young AAs and NHPIs who try to apply for Deferred Action for Childhood Arrivals (DACA). While many eligible young people have applied for the program, application rates have been lower for Asian and Pacific Islander countries. For example, young people from Korea, Philippines, China, and India apply at significantly lower rates than other countries even though they have large populations of eligible people.

Using the lessons learned from AHJ’s health enrollment outreach, we published a report applying best practices to increase AAPI applications for DACA. The report looks at barriers that AAPIs face when applying for the program and discusses how strategies used to increase health enrollment are applicable toward language and cultural barriers. For example, community interviews made clear that having an undocumented family member creates feelings of shame and guilt, as if they were “lawbreakers” in the community. This makes applying DACA tricky for young family members because some young people did not know they had an undocumented parent or because the family will fear negative repercussions from the application. Using best practices from health enrollment, AHJ recommends that community organizations work together to engage AAPI communities and provide one-on-one assistance to assuage fears and concerns.

Organizations and coalitions like AHJ are doing invaluable work all over the country to connect communities to the help they need, whether it be health insurance or applying for DACA. As immigration status continues to be a barrier to health care, it is essential that we work with immigrants and their families to help them access care and other services.

Personal Spotlights

Cultural Identity and Language Barriers: My Story as an Immigrant

by Tu My To

My parents and I arrived in the United States on October 1994, all our possessions neatly packed in several boxes and suitcases. Armed with plenty of wool coats for the ‘cold’ American (i.e. Los Angeles) climate and a few English words (Yes, No, and Thank you), our family was ready to start anew in a country we knew so little about. As my mom often told me in the years afterwards, my parents made the move because of the opportunities the United States had to offer, educational opportunities that would have been nonexistent had our family decided to stay in Vietnam. Thus, it was in hopes of a better life and a brighter future that my parents packed up our lives and settled in Monterey Park, California.

My parents and me on the road, riding extremely safely on our family scooter.

My parents and me on the road, riding extremely safely on our family scooter.

The city we decided to call home is known for its large Chinese population and its plethora of delicious Asian restaurants, but to me it was where I had gone to school, where I’d shopped for groceries with my parents, where I hung out with friends, with neighborhoods I played in and streets I had driven through. It was a city where stores had Chinese or Vietnamese words written in the front in addition to English letters and where people would greet you in Chinese because, more often than not, you’d understand what they’re saying. It was within this community that I grew up, surrounded by people whose backgrounds were similar to mine and who spoke the same languages I did.

Most of the classmates I had gone to school with also had parents who immigrated to the US, and many of us grew up in households where English was rarely, if ever, spoken at home. Our community molded itself to the ethnic identities of its occupants. School notices were sent home in English, Chinese, Vietnamese, and Spanish. Many of my classes had one or two teacher’s aides who spoke a second language. Our elementary school monthly calendars were marked with important dates that included Christmas, Lunar New Year, and Cinco de Mayo. It was the norm, rather than the exception, that the playground during recess and lunch breaks was punctuated by conversations in languages other than English.

Heading home from school, fully decked in 90s attire.

Heading home from school, fully decked in 90s attire.

Yet, many things were still difficult for my non-English speaking parents. As I spoke to the key informants for our BRAVE study, I realized that a lot of my experiences are reflected in the stories that they tell me. In particular, as the first English-speaker in the family, we often act as the spokesperson for our parents. Open house at school often meant acting as the translator for my teachers and parents. Mail at home had to be reviewed and translated. Some things I took for granted were often obstacles to my parents. How can you select the option for Chinese or Vietnamese in automated telephone menus if you cannot understand the English instructions for doing so? How do you ask questions in an unfamiliar setting if you are unable to interact with those around you?

Back then, my parents had few outlets for news or resources in Vietnamese. Today, there are plenty of over-the-air TV channels, several radio stations, a good selection of newspapers, along with numerous websites catered to many languages. However, when I was growing up, many of this did not existed. In the mid 90s, the only TV program my parents had was a fuzzy thirty-minute news segment that occurred every weekday. Over the years, the amount of resources available has grown considerably. As our key informants have pointed out, the ethnic media is one outlet immigrants often look towards to be more informed about their health, their community, and the resources available to them. While more still needs to be done, it is nevertheless exciting to see efforts being made to include everyone in the conversation.

As the years pass, I find that a lot of the memories of my initial years in the United States are fading. I remember that things were difficult, and sometimes they still are, and that adjusting to a new country was much easier for a young girl than for her parents. I also remember the teachers I've had, whose patience and guidance were always at hand. As an immigrant, there are a lot of habits and traditions that I grew up with that are still part of my life today, and I look upon these traits with pride because they are part of who I am. However, I also find that I am creating my own story, one that merges the echoes of the past, the experiences of both me and my parents’, with the present and future. It is important that we all listen to one another and share our stories because it is our histories and our experiences that shape our communities and mold us into who we are today. 

Personal Spotlights

Reflecting on My Immigrant Heritage

by Jason Melo

Growing up in the San Francisco Bay Area, being a half-Asian/half-white kid isn’t the strangest thing in the world but it definitely makes you think a bit about your identity. My mother comes from a Filipino heritage and my father comes from an Azorean Portuguese one. What do these heritages have in common? Hailing from island regions, strong Catholic traditions, and an instinct to constantly feed their grandchildren. And the differences? Simply put; language, food, and appearance. When you mix these two you get a Filipino-Portuguese-American who speaks basic Portuguese, almost no Tagalog, has no fear of strange foods, and gets mistaken for Latino more than anything else. Many cultures intersect in my identity and I truly cherish the stories of my ancestors because I would know so much less about myself without them.

Having the opportunity to work on the BRAVE study with Asian and Pacific Islander immigrants has made me think especially of my maternal side, starting with my grandmother, Margarita Cereñado Salom, born February 26th, 1921. My grandmother came from a ruling, upper-class family in the Philippines who lost everything during the Japanese occupation. As a child, I remember being told that fleeing from her home was not something grandma wanted to talk about. From what relatives have told me, she saw her town burned, her brother killed, and had to bribe people with everything she had to reach safety. Eventually, my grandmother made it to the territory of Hawaii with very little to her name. In America, her life was very different. She was forced from a comfortable life in the Philippines in a time where being an ethnic migrant in America was as much of a disadvantage as ever. She lost her wealth and family when she immigrated yet one thing I remember about my grandmother was that she always had a refined, almost regal presence to her. My mom always says it’s because she was raised that way before the war. I’ve always been captivated by this idea that her demeanor was a remnant of her past life in the Philippines.

My maternal grandparents, circa 1940s

My maternal grandparents, circa 1940s

Anyway, going forward in time, my grandmother married Higino Salom, a merchant marine and my grandfather, after WWII. My grandfather’s life and mine never crossed but I’ve been told we share the same passion to travel the world. (And the same eyebrows!) My grandfather spent much of his time at sea with the merchant marines and my grandmother was left to work and raise the children. Not only did she have my mom and uncle to worry about; but she worked to bring her sisters’ children to the United States and taking care of them became part of her responsibility too. Margarita was also very involved in the local Filipino community; organizing events, working at church functions, and cooking for these events. Her community and her family were important to her and by the time I came around you could see she was a true matriarch to our family and in the Filipino community.

Me as a toddler, being fed by my maternal grandmother

Me as a toddler, being fed by my maternal grandmother

Additionally, working on the BRAVE study has often made me think of my mother’s experiences as a Filipino-American. After Hawaii, my grandparents moved to Sunnyvale, California in the South Bay where my mother, Josephine was born. The city of Sunnyvale may be a culturally diverse part of Silicon Valley today, but when my mom was growing up it was almost totally Caucasian. According to her, there were only ten Filipinos in her whole high school and they all called each other “cousin.” I’ve heard about racism towards Filipinos that my relatives experienced at the time but this wasn’t something that my mom ever let hold her back. One of my favorite stories from her high school years is managing to win the election to be head song girl on the cheer squad even though she was such a minority at the time. If you look at the picture of the team you’ll see my Filipino mom surrounded by a dozen blonde girls.

My grandmother’s passion for the Filipino community was not lost on my mother and in her adult years, she and my god-father lobbied to get veteran’s benefits for Filipinos who fought under the American flag during WWII. During the war, the Philippines was still part of the United States and Filipinos serving during the war were fighting for the United States; my grandfather included. Because the Philippines gained independence following WWII, these veterans did not receive benefits. My mom saw this as an injustice to Filipinos and became politically active to expand benefits to these veterans. She and my god-father succeeded in getting this legislation passed and it’s always been an inspirational story for me. I think it’s a great example of how working together and raising voices can bring change to one’s community. 

Recently, I was reminded at my grandmother’s funeral how important it was to her that we grandchildren never forget our heritage. As a multi-ethnic student in primarily Caucasian elementary and high schools I sometimes brushed off being Filipino as something that just made me stand out and not necessarily in a good way. In more recent years I’ve really come to reflect on how important my multiple heritages are to who I am. I am a proud descendent of immigrants. I am a proud Filipino-American. I want to help my community the same way my grandmother and my mother have before me and I think working on the BRAVE Study team has given me an amazing opportunity to do this, in my own way, as a public health student. This is just a piece of my family’s immigrant story and I know there are many more voices that need to be heard. The BRAVE Study wants to hear these voices so that we can ultimately bring about action that will address the needs of Asian and Pacific Islander immigrants. 

Personal Spotlights

Around the World in Four Generations: Speak Up, Share Your Story

by May Sudhinaraset

Growing up in Long Beach, California, I was raised in a very Caucasian neighborhood. As a descendant of Thai/Chinese ethnicities, I felt very different from the other kids. There was the constant experience of having kids in my class make fun of my rather long, Thai last name (Sudhinaraset or “Soon-to-be-a-horse-head”); having parents that worked all the time; and not having my grandparents around because they lived in Thailand (“Bring your Grandparent to School” day was particularly hard). I was a quiet, reserved child, never really speaking up in class.

The Sudhinaraset Family and Neighborhood Kids in Thailand 1960.

The Sudhinaraset Family and Neighborhood Kids in Thailand 1960.

When I was 13 years old, my seventh-grade history teacher had us do a class project on family histories. She wanted each of us to produce one cloth piece with depictions of where we came from, with the idea that each of these pieces of square cloths would be interwoven into a class quilt. I felt nervous about doing this project, hyper-aware that my past was different from others.

This project, however, gave me a chance, at a relatively young age, to ask my mother about our family and to see how this story progressed through my mother’s eyes –it gave me a chance to understand the story of our family through my mother’s narrative and how each generation linked to the other. I learned that my Indonesian great-grandmother was living in China at the time of her death. Living as a second wife and faced with political persecution during the Chinese Cultural Revolution, she had seven children before taking her own life. My grandmother migrated from China to Thailand at a young age, where my mother was born and raised and met my father while working with his family. My parents immigrated to Queens, New York when my mother was just 26 years old. Like many others, she moved to the US for better job opportunities, working for a number of years as a seamstress before settling in California and raising my three sisters and me. When I shared all of this with the other students, I was nervous –my story was unlike any one else’s in my class.

The Sudhinaraset Family, 1980s

The Sudhinaraset Family, 1980s

My story spanned four generations of strong, immigrant women, traversing four countries and two continents –following the ups and downs of migrant stories.

It was an important activity in my childhood. My teacher really appreciated the story; my classmates were interested and excited to hear more, including wanting to taste my family’s secret Hainanese chicken-and-rice recipe, which my mom brought to class to share with everyone. From that point on, I felt more understood and accepted. My classmates stopped making fun of my last name and started asking more questions about my unique heritage. I came to embrace my history and culture.

Looking back, I don’t think my 13-year old self realized how important it was to share my family story. I realize now how important it was, not only for myself, but for others in my class, including my teacher. Sharing stories-- whether through oral or written histories, photos, documentaries, or other means – can be a transformative process. Story-telling transcends past, present, and future, connects generations, helps us learn about our history to evolve and grow from past struggles, and helps us understand one another. 

The Sudhinaraset family, 1980s.

The Sudhinaraset family, 1980s.

There are others who might have similar stories; or completely different stories. From an Asian-American perspective, I find that the stories and voices of Asian and Pacific Islanders (API) have been left out of political discourse. More than ever, given discussions surrounding immigration reform, LGBTQ issues, health reform, women and gender equality discussions –the voices of APIs are needed. The ultimate goal of the BRAVE Study (Bridging community, Raising API Voices for Health Equity) is to share stories and raise collective action to better address the health needs of undocumented APIs who qualify for DACA. Undocumented youth are oftentimes hidden in the shadows and face significant health and educational challenges.

I invite you to share your story. Participate in this blog, sign up for this research study, and engage in your community.

May Sudhinaraset is currently Assistant Professor in Global Health Sciences and the Department of Epidemiology and Biostatistics at the University of California, San Francisco. She is the Principal Investigator of the BRAVE Study and focuses on issues of global migration, health equity, and social determinants of health.