Sapna Pandya, director of programmes, South Asian Health Initiative (Sahi), New York University, has first-hand knowledge of the difficulties immigrants face. When she helped her grandmother study for the US citizenship test, questions in Gujarati elicited blank stares. She switched to English, which her grandmother didn’t speak. But pat came the answers. “She memorized the entire exam!” Pandya says.
Roughly one in 10 persons of Indian origin settled in the US is over 65; many emigrated at an advanced age. Of family category immigrants to Australia, again roughly one in 10 is a parent going to join a child. As young professionals migrate abroad in large numbers, parents often follow. The transitions, though, are often not smooth.
Home alone, abroad
Just getting around can be a challenge for the elderly—they miss their neighbourhood communities and often lack the confidence or driving skills. Monica Nandan, a professor of social work at the University of Missouri, Kansas City, says, “Taking an aged person from her or his home into a new environment is like uprooting an oak tree.”
Jayalakshmi, 72, is based in New Delhi but spends half the year in New York with her son and his family. She relies on her children to get to the local temple. “They anticipate my needs, so I’m thankful,” she says.
However, Sookia Ramsahoi, 76, who lives in Queens, New York, says, “My children work during the day, so the ambulance is called if I need medical attention.”
Pandya recently organized a focus group to study hypertension among senior Indian immigrants. Almost every participant pinned the blame on loneliness, she says. Other experts agree. Chan Jamoona, executive director of the United Hindu Cultural Council Senior Center, New York, cites “depression, isolation and cultural alienation from grandchildren” as factors that exacerbate health problems.
Lonely vigil: Constrained by an unfamiliar language and the violence of New York’s immigrant neighbourhoods, Tara Singh sits in the window of his son’s home in Queens. A retired sergeant major of the Indian Army, Singh spends his days escorting his grandchildren to a nearby private school run by the Roman Catholic Church — a school the family of Punjabi Sikh immigrants finds superior to local public schools — and watching satellite television news from India. (Steve Raymer)
Nandan notes that in ethnic enclaves, “seniors find emotional and spiritual support in gurdwaras, temples, masjids, churches”. Programmes in areas with large South Asian populations coordinate activities for seniors. The India Home, New York, transports elderly Indians to other centres each day to socialize. At the Hindu Senior Center that Ramsahoi attends, there are yoga classes as well as prayer and bhajan sessions, medical referrals and experts called in for health lectures. “Before coming here, I was sitting at home, bored and depressed,” she says.
Mary Ganguli, director of psychiatric services, Benedum Geriatrics Center, University of Pittsburgh Medical Center, says: “If the immigrant is very old, physically ill or frail, has depression or memory problems, is unable to speak and learn English, unable to get around independently, he/she is going to have a harder time adapting. If their children and grandchildren are out of the house all day, they will feel lonely. If there is nobody to talk to or visit with, they will feel even more isolated.”
Beyond the emotional is another problem area for elderly Indian immigrants—diet. “They eat deep-fried food, eat late at night and go to sleep, so they gain weight,” says Pandya. A 2002 US study of first-generation immigrant Gujaratis in the 45-plus age group found a high fat intake, plus significant nutritional variation between men and women.
Exercise is a good part of the answer, say experts. Santi Manubhai Sheth, 81, from Pennsylvania, radiates enthusiasm for physical activity: “I swim at the local sports centre and stay active. It helps me stay independent.”
Also, the elderly don’t always seek routine medical care. A publication by the Australian government noted that among recently arrived women migrants (1991-96), only 51% spoke English well in the group that includes India. It also noted a gender bias: “Older women report consistently poorer English than older men.” And a lot of research points to lower medical care utilization among elderly Indian women.
There’s worse. Rajeshwar Prasad, long-time advocate for seniors and executive director of the National Indo-American Association for Senior Citizens, New York, mentions instances of abuse—financial abuse, complete social isolation, cultural suppression, even physical abuse. Prasad says the problem is rarely discussed.
Loss of independence
The flip side of the loneliness coin is loss of independence. “I’m depressed,” says 81-year-old Mahadai Singh, a long-time resident of Queens till her daughter got her to move in with her in Virginia. “I was happy living by myself, but my daughter was worried I couldn’t take care of myself.” She is deeply troubled by the prospect of increased dependence on her daughter’s family, but (like many seniors) is struggling to balance her children’s concerns and her own inclinations.
Relying on the adult child as the sole source of support for an aged immigrant may be impractical and unhealthy. Ganguli notes that tolerance and independence play a large part in helping an individual adapt to a new environment.
Some immigrants sponsor a parent’s emigration to garner assistance in rearing their child. For many grandparents, this is a welcome transition; for others, it curtails a much-anticipated “retirement”. Yet others are compelled to migrate in order to realize a filial obligation felt by their adult child.
Health cover essential
Immigrants face a bewildering array of possibilities in terms of health insurance. In 1996, the US curtailed automatic roll out of Medicaid to recently arrived immigrants. Those arriving later may find partial coverage in certain US states or have to do without. Jayalakshmi, recently issued a green card, is currently uninsured.
Health care costs are high. In 2007, the American Association of Clinical Endocrinologists estimated the average yearly health care cost for a person with Type 2 diabetes was $10,000; in 2003, a Duke University Medical Center study found that the elderly who suffered heart failure might spend three times more on health care than others their age. Both conditions are common among Indians.
The Australian government, meanwhile, anticipates cuts in health care spending. A recent paper on “Migration Myths and Realities” said the country’s elderly population is likely to increase 50% in 40 years, putting pressure on the state-subsidized health care system.
In India, a new Bill passed in the Lok Sabha in December seeks to legally enforce a family system of care. If it becomes law, those inheriting land from a senior citizen, regardless of which country they are in, will be responsible for that person’s care. More importantly, the Bill underscores the centrality of filial aid as the primary source of care for seniors.
Usman Gani Vohra, 66
Hanifa Ben Vohra, 63
The Vohras have a full life in India. Usman chairs a bustling school in Nadiad, Gujarat. However, since 1998, Hanifa and he have divided their time between the US, where their son Feroze and his family live, and their home in India. At first, the visits were infrequent, mainly to get to know their grandchildren.
Now they have applied for citizenship and the rules take them overseas every six months and require them to stay there for six months as well. Pending lawsuits in Gujarat—a legacy of the 2002 riots—call them back to the courts in Ahmedabad the remaining six months. The Vohras now travel to the US for a sense of security as well.
The senior Vohras’ part-time residence in India has advantages, however—their medical costs in India are a fraction of what they would pay in the US.
Auckland, New Zealand
Portia Joshi, 33, senior administrator with the Real Estate Agents’ Licensing Board, Auckland and a volunteer ESOL (English for Speakers of Other Languages) teacher to immigrants, is one of those who considered uprooting the oak—but didn’t.
Joshi is concerned about her mother, Beatrice Banee Ghosh, 57, a schoolteacher, living alone in Kolkata. Says Joshi: “She lives alone in an apartment. If she fell ill or had a fall, I worry no one will know for days on end! And in India, she has to do everything on her own; here, I could help her out.” However, she is mindful that Ghosh has always enjoyed her independence, adding: “Many people feel they have to look after their parents and end up encroaching on their privacy, practically bullying them. I’ve told my mother she could live in a separate apartment, even take up a job if she wanted.”
However, Ghosh visited the Joshis when her granddaughter Nitzana was born and is convinced the local accent is impenetrable. At her age, she doesn’t fancy “starting over” either. The key reason for Ghosh to hold on to her roots, though: Her brother also lives alone in Kolkata and she wants to stay near him.
Aruna Viswanatha contributed to this story.
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