Thank you to all who submitted an essay to the 2011 Premed Essay Contest! We received over 50 entries from 22 different colleges and universities in which scholarship recipients, semifinalists, and honorable mentions were selected!
Congratulations to the following individuals!
The “Model Minority”: A Chronic Heartache
Meet Pedro Andrada*. He is a fifty two year old man living in a one-room shack in El Cajon, California with his wife, Marina*, and their four kids. Ever since they migrated from the Philippines to the United States, Pedro and Marina have been working tirelessly to make ends meet. Pedro is a bus conductor for a company located an hour away from his home. He recently started sleeping on the bus during the weekdays to avoid the cost of travel to and from work everyday, seeing his family only on the weekends. Marina started making and selling popsicles to help. Pedro, Marina, and their four children work hard in hopes of an easier life some day. The difficulty? Pedro was recently diagnosed with coronary artery disease and is in dire need of a $60,000 heart procedure that he does not have insurance to cover.
I encountered Pedro’s story as an intern this summer. I was writing press releases for the medical fundraising company, GiveForward. Pedro’s story is only one of many. A disproportionately high number of patients diagnosed with chronic conditions in the U.S. fall under the group “Asian Pacific American” (APA).
The chief issue in improving the health of APAs is overcoming the myth that they are the “model minority”: hardworking and quick to rise in ranks, and therefore acceptable to ignore. The statistics show that the Hmong, Laotian, Vietnamese, Cambodian, Samoan, and Tongan have a higher poverty rate than the general U.S. population—far from not needing aid (U.S. census, 1992). The stereotype that most APAs are “well-off” is an illusion created by per capita income calculations, which don’t take into account the average number of workers per family. The result is insufficient knowledge regarding the illnesses that affect them physically and especially mentally.
This misconception results in insufficient support for APA immigrants, making them especially susceptible to the isolation caused by immigration. They arrive in this country without a network of friends or family to consult for help with medical concerns. They find U.S. health services culturally and financially inaccessible, and are unfamiliar with health conditions prevalent in the U.S. (such as cancer and heart disease). The immigrant’s typically affordable and accessible diet leads to unhealthy intake of saturated fats, salt, and cholesterol (Kagan, Harris, Winkelstein, et al., 1974). They tend to be in denial of health concerns, viewing these as “minor” issues compared to the economic burdens and expectations placed on them. Family pride causes unwillingness to seek medical help, and attachment to indigenous home health remedies delays timely diagnosis.
The way to improve the health of APAs is to nationally identify their poor health status, and to create community support programs tailored to their needs. A good model to follow is “Live Empowered”: one of the African-American support programs started by the American Diabetes Association (there are also Latino and Native American programs, but none for APAs). The programs must target high-risk populations (for example, native Hawaiians’ high rate of obesity and diabetes compared to other groups), and work with local policy makers to provide incentives to participate (for example, free transportation, childcare help, or discounted food items). The programs must first address imminent issues such as unemployment, language, and immigration status before introducing health concerns. Finally, the programs must establish trust: working with religious leaders, community members, and culturally and linguistically pertinent materials.
So far, the APA community has been one of the most ignored due to bias. Once the bias is overcome, we can do much to ease the burden on families like Pedro’s.
*Real names undisclosed
Kagan, A., et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: demographic, physical, dietary and biochemical statistics. J Chronic Dis. 1974 Sep; 27 (7-8): 345-64.
As a little girl, I would accompany my mother on her Saturday morning trips to Taiwanese supermarkets. While she stocked up on rice and bok choy, I would dart up and down the aisles, wondering how many rice crackers and tofu puddings I could get away with piling into her shopping cart.
As a college student, I still spend my Saturday mornings at Asian grocery stores, but now I serve in a much different role as a community health educator for the Moores UCSD Cancer Center’s Outreach Team. Most shoppers, like my mother, are middle-aged, first generation Asian-American women. I speak to them in their native tongue because if I spoke to them in English, they would barely glance at me and continue on their trajectory towards the parking lot. But, when I speak to the women in Mandarin, they stop and listen as I tell them about the importance of yearly mammograms and clinical breast exams. Many women, upon practicing lump detection on our model breasts, become eager to learn more. Others are incredulous (“Are they sure that screening is necessary? I’m sure I’d notice if I had a tumor.”) or misinformed (“Those guidelines are obviously only for white people. Asians don’t get breast cancer!”). Whatever their attitude, they become more open to having a sensitive, potentially life-saving conversation with me. As a university student who shares their language and understands their culture, I am trusted as one of their own.
In America, marginalized communities are often isolated from mainstream sources of information, a trend I have noticed within my own immigrant family. My relatives only read Taiwanese newspapers and glean American news through word-of-mouth, a dubious source of information. My grandfather discouraged me from seeing a doctor when an angry, persistent rash crawled its way down my thigh, suggesting instead that I meditate to restore the circulation force (“qi”) within my body. (Later, I was diagnosed with cellulitis and put on antibiotics for a month.) As a bicultural community health educator, I want to reach out to these marginalized groups and bridge the gap between them and native born residents with the best that American medicine has to offer.
While I work with groups with whom I am familiar, I also want to learn about other environments and cultures. With this in mind, I volunteered for a medical mission trip to Tijuana last summer. In preparing for my trip, I learned that if the US side of the border were to become the 51st state, it would rank last in per capita income, access to health care, and number of uninsured children. I met a young man with an advanced corneal ulcer and an elderly woman blinded by extremely mature cataracts, situations that could have been prevented had they had better access to health care. With no knowledge of Spanish, I often found it challenging to connect with the patients. Once, when I struggled to obtain a reasonable blood pressure reading with an old sphygmomanometer, the patient became alarmed and dissolved into a frenzy. My attempts to reassure her with universal emotions fell short, and I had to recruit a Spanish-speaking friend to calm her down.
This summer, I am studying abroad to further develop my cultural and linguistic skills. Learning to understand different lifestyles and customs will enable me to deliver the best care possible as an aspiring medical student and physician. Like the women at the Taiwanese grocery store, I hope that other marginalized communities will someday put their trust in me, even if I don’t speak their language.
Undergraduate Institution & Major: Received degrees in Genetics and Economics from the University of California Davis
Graduate Institution & Field of Study: Masters degree in Physiology from Georgetown University
Current Position: Research assistant at UC Davis.
Title of Essay: “Shame and Mental Health in the Asian American Community”
While cleaning my sister’s room during a trip back to Los Angeles to celebrate her birthday, I found a small photo album. I flipped through pictures that rekindled memories of my sister that I had long forgotten. The first was of her cradling me in her arms during a visit to a park. She must have been only ten or eleven at the time, but her face lit with joy and pride while I slept in a bundle of clothes. In the second picture, she was giving me a piggy-back ride along the beachfront and our faces radiated with laughter. The final picture was of her holding onto the back of my seat while I was riding my bike for the first time. Her face tensed with a look of concern as I rode fully protected in bright plastic gear.
As the memories flooded back, my vision began to blur from tears. The sister in those photos no longer seems to exist after being ravaged by years of untreated schizophrenia. Now my sister routinely accuses strangers of attempting to do her harm, starves herself to the bone without care, and will wallow in her own filth if unassisted. Despite all this, I still believe that the loving and brilliant sister is still buried somewhere within her scarred mind.
What is even more heart breaking is that it need not have been this way. When my sister was first diagnosed with schizophrenia while a student at UCLA, it seemed like a bolt from the blue. My family and I were ignorant of the nature of her condition due to the stigma associated with mental illness in Asian culture. My parents adamantly denied her diagnosis with phrases such as “just lazy” and “weak minded”, as if schizophrenia was a choice rather than an actual disease. Their attempts to “will” my sister into health, however, only agitated her further and caused her to flee from our home. It has been nearly a decade since her diagnosis, and only now is she starting to accept her illness. I can’t help but feel that our collective stigma only reinforced her reluctance to seek help and prolonged her suffering.
Upon researching my sister’s condition, I was surprised to find that my impression was supported by scientific literature. Published analyses of the 2002-2003 National Latino and Asian American Study revealed that mentally ill members of the Asian American community significantly under-utilized mental health services in comparison to other population groups. These analyses further suggest that this is due to the stigma and shame associated with mental illness in Asian culture.
The cultural stigma associated with mental illness leads to a desire to tuck away the “problems” for fear of being judged, discriminated, and eventually ostracized. As such, it plays a significant role in the prognosis of mental illness in contrast to other conditions that are prevalent in the Asian American community. For illnesses such as cardiovascular disease, cancer, and diabetes the patients willingness to seek treatment is much less of a limiting factor than the effectiveness of the treatment.
While Asian Americans can rest passively and reap the benefits made by others for diseases unhindered by stigma, overcoming the culture of “saving-face” requires that we become actively involved in dispelling the myths surrounding mental illness. Only by reaching out and educating entire families, rather than focusing solely on individual patients, can we move past our unfounded prejudices. The need to deconstruct the stigma that is so rooted in our culture is what makes mental health the most important, and perhaps the most difficult issue facing Asian Americans.
Jinal Desai is a senior at the University of North Carolina at Chapel Hill
William Wang is a senior at the University of Michigan
Jennifer Xu is a junior at the University of Michigan
Lucy Xu is a junior at the University of California Berkeley
Michelle Chen is a senior at the University of California Los Angeles
Arshya Gurbani is a sophomore at the University of Southern California
Naveen Kakaraparthi is a sophomore at the University of Michigan
Susan Lee is a senior at the University of Southern California
Vicki Hsieh is a junior at the University of California Berkeley
Tim Xu is a senior at Vanderbilt University