Tag-team approach to health care reaches older adu...

Tag-team approach to health care reaches older adults in Bangladeshi community during COVID-19 pandemic

From translation to wellness calls, pop-up vaccine clinics to cash assistance, providing treatment included services far beyond the doctor's office.

Illustration by Naina Hussain.

This story was originally published in Tostada Magazine.

Typically, Farzana Noor, a nurse practitioner at the Children’s Clinic of Michigan in Hamtramck is accustomed to bandaging up cuts and scrapes, treating colds, and soothing fussing children getting their first shots.

That all changed last year when the pandemic raged through the Bangladeshi community in Hamtramck. When nearby health care providers abruptly ceased operations amid the crisis, Noor began seeing an influx of older Bangladeshi women patients who often serve as the primary caregivers spanning generations in their households enter her office.

Noor, who is Bangladeshi American, found herself in familiar territory as many of the older patients were accompanied by their children to help translate care plans from English to Sylheti.

“When I have (an older) patient, there are certain things that even though they kind of understand what I’m telling them, if the child understands it, they can help reiterate it when they get home,” she says.

“It’s almost like a form of accountability.”

Language is a longstanding obstacle in diaspora communities, making everything from understanding utility bills to letters from teachers to public assistance correspondence difficult to navigate.

In traditional Bangladeshi families, the lines between caretaker and those in their care are blurred as children often translate communications to parents, grandparents, aunts, and uncles. Likewise, caretakers may be well into their 50s and are charged with looking after small children and aging parents alike.

Rebeka Islam, executive director of Asian and Pacific Islander American Vote-Michigan a nonpartisan civic engagement organization, says the group developed and distributed a sharable Google drive featuring wide-reaching information to address the dilemma of language access during the pandemic.

Proper hand-washing, how to social distance, travel safety precautions, and how to properly cover one’s mouth, were just a few tips that English-speakers may take for granted published in the Google drive in dozens of languages.

“As we know… a number of our Asian American and Pacific Islander communities fall under the radar and don’t have access to the same resources that other communities do,” she says.

“Oftentimes, this means that individuals whose first language is not English won’t be able to get critical information because that information is not translated into the languages they speak,” Islam added.

That’s certainly the case for the Bangladeshi community in Michigan, Islam says. Most recently, APIA Vote-Michigan undertook a similar effort by collaborating with others to translate voting materials for the 2020 election.

Metro Detroit is home to the third-largest Bangladeshi-American community in the United States. According to data analysis published in 2017 by the Pew Research Center, Detroit’s Bangladeshi population was 10,000. APIA-Michigan’s Islam says the population size is not well documented but estimates the number in Michigan at anywhere between 30,000-100,000. The community only trails in size behind New York City and Washington, D.C. As the coronavirus ravaged throughout Metro Detroit in 2020, the region’s Bangladeshi community was hit especially hard.

Many Bangladeshi households are made up of several generations of family members making social distancing difficult. These households are more likely than the general population to live in poverty (19 percent of U.S. Bangladeshis versus 13 percent of all Americans, according to the Pew Research Center). What’s more, not all Bangladeshis speak the same dialect of Bangla. In Metro Detroit a majority of Bangladeshi-Americans who speak Bangla use the Sylheti dialect.

Noor says Shuddho Bangla — the national dialect of Bangla in Bangladesh — is the most often used in translated materials, spelling a problem for Bengalis in Metro Detroit.

With some of these obstacles in mind, it’s clear to Noor and other health care providers that a more holistic approach is needed.

In New York, social services organizations that serve the South Asian population are finding other ways to reach the community and provide an added essential layer of care during the pandemic.

Shyda Rashid, an anti-violence program manager of Sakhi for South Asian Women in New York, an advocacy organization that connects people to resources, says many of the people the organization contacted needed language assistance when they were hospitalized after contracting COVID-19.

“(About) 80 percent of our clients have language barriers, you know they prefer to speak in their native language,” she says.

Rashid says the city of New York’s Language Access Plan helps to fill some of the gaps. Bangla is among 10 languages available for free interpreter services through the program.

“We always encourage our clients to say to every service provider that I need an interpreter because interpreter or translation service is a right of New York City.”

Still, the language line has its limitations. Callers can spend a long time on hold until they connect with a service provider, interpreters do not always show up on time, or incorrectly interpret the information or by inserting their own opinions or voice, and some do not speak the same dialect. Rashid also said that gender can also play a role in the quality of the care that callers receive.

What the organization has found impactful is going beyond translating by offering other services that help to build trust within the community.

Throughout much of the pandemic in 2020, the Sakhi group conducted about 1,500 wellness calls and needs assessments in the South Asian community, increased the organization’s caseload from 400 in 2019 to 450 in 2020, and provided cash assistance ranging from $300 to $1,500 to 50 to 60 clients. She says Sakhi also helped pay for groceries and medication for those who are undocumented from the Sakhi Solidarity Fund.

Sakhi’s website includes an extensive list of resources available during the pandemic including mental health, food pantry locations, mutual aid, bill assistance, and infographics on how to develop a safety plan. The group’s pro bono legal partners also provide legal support on family law and immigration, including workshops and clinics. Sakhi a weekly newsletter for 739 clients. Much of the information published by the group is available in nine languages, including Bengali, Hindi, and Urdu.

In one instance, Rashid says, a Bangladeshi mother of a newborn and 3-year-old who was hospitalized due to COVID-19, contacted Sakhi for assistance. They were able to find childcare for the kids by splitting the cost with Project NewYorks, a nonprofit in Queens  that provides free babysitting services as the family recovered from COVID-19.

Rashid says the pandemic brought up issues beyond the virus. Anxiety and depression spiked among clients — many of whom are survivors of intimate partner violence — who lacked a safe space once they were stuck home in one-bedroom apartments.

Laal NYC (laal means red in Bangla, symbolic of Bangladeshi women empowerment) is another community-based service organization in New York serving Bangladeshis in the Norwood neighborhood in the Bronx.

Ishrat Aishee, a strategic development coordinator of Laal, said that last year, Laal organizers had intended on making calls to remind community members to fill out the U.S. Census, but they quickly pivoted to include wellness and needs assessments during those calls.

What organizers found while making phone calls was that many people — about 40 to 50 percent of the population the group serves are undocumented — were cut off from pandemic relief, food, and other city services.

“We ended up partnering with Bengali Mental Health Initiative (another NYC-based nonprofit) and disseminated pamphlets that were culturally conscious of certain language and phrasing to really identify what symptoms are and (what they) can lead to.”

Aishee says people fluent in Sylheti or Shuddo were also hired to communicate directly with the community to find out what their needs were. 

Laal hired a substantial number of Sylheti-speakers to provide classes and other programming in the Norwood neighborhood.

“They don’t have the resources at home or people to seek help from, in that sense, and so this is where all of our conversations (with) our outreach team” come in to fill that gap, Aishee says.

While this holistic infrastructure for support in Metro Detroit’s Bangladeshi has a ways to go before matching the impact of organizations in New York, Noor and others have taken some steps to get there.

Noor partnered with Kroger Pharmacy in March and April to provide pop-up vaccine centers, serving more than 2,000 people. In May, Children’s Clinic of Michigan became a vaccination site.

“On average we vaccinate 150 to 200 people on Saturday and Sunday, and 75 to 100 people Monday through Thursday,” she says.

Locally, a group of researchers from Eastern Michigan University in Ypsilanti is working to identify the health care needs of the Bangladeshi community so they can take that next, more holistic approach.

EMU’s Center for Health Disparities Innovations and Studies developed a survey to learn the information needs of people in underserved Asian American communities in Michigan — including the Bangladeshi community. The center is one of nearly 40 organizations throughout the United States that have received funding from the U.S. Centers for Disease Control and Prevention’s Racial Ethnic Approaches to Community Health (REACH) program. The EMU group recently received additional funding to educate Hamtramck’s Bangladeshi population about flu and COVID-19 vaccines.

Sarah Lally, a nurse educator, and coordinator for the center who served as a project manager for the EMU initiative says the group of researchers worked with the CDC to identify social determinants — such as socioeconomic status and sparse access to health care providers — in specific ZIP codes to find out which populations need the most assistance. The information was used to determine where more education was needed. 

The team also leaned on trusted members of the community — physicians, elected officials, as well as with researchers at social service agencies like J&E Community Service and Detroit Friendship House — to gather and inform them on concerns they heard from residents. They held two listening sessions and trained people to help residents learn how to speak about COVID-19 myths and facts, Lally says.

“We can sit back and guess what people want to know, but why don’t we ask people what they want to know, you know, why don’t we find out what people’s concerns are,” Lally says. “We’re asking people to be the boots on the ground and messengers.”

The result, researchers were able to identify the information needs of the community, vetted that information, and printed materials in Bangla using professional translation services. REACH partnered with Hamtramck Public Schools to share information via the school messenger system Class Dojo. 

The team also provided six pop-up COVID-19 vaccine clinics in Metro Detroit, with Bengali and Bangla speaking language interpreters, an effort that vaccinated  500 people.

“We are well aware of the inequities that exist, and personally I’m very excited to get to a point where we can start getting some people vaccinated so that then, word of mouth can spread, you know because that’s one of the biggest things that people have told me is the best way that we get information to each other is by talking to one another,” Lally says.

Lally says the goal of this initiative is to drive sustainable policy change for communities by working with city, state, and federal representatives.

That information could prove to be vital to informing other health care providers in meeting Metro Detroit’s Bengali population where they’re at.

Noor says the Bangladeshi community is accustomed to taking care of health problems rather than seeking preventative measures, such as maintaining good health and lifestyle. She says this is directly correlated to low literacy levels.

“This community definitely needs a lot more community resources outside of just within the doctor’s office,” she says.

She says, because many Bangladeshis moved to Michigan in the late 1990s and 2000s, they are still the first generation. She says many children of immigrants are the first ones who went away for college and have access to resources to give back to the community. 

“It’s up to our generation to kind of step up and help (by) coming together to help provide some of these services and make health care more available,” Noor says.

Illustration by Naina Hussain. Find more of her work on Instagram by clicking here.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and the Silver Century Foundation.

This story was also produced through a collaboration with the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and universities dedicated to rigorous and compelling reporting about successful responses to social problems. The group is supported by the Solutions Journalism Network.