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Undiagnosed and Untreated: A Culture at Odds with Western Approach to Mental Illness

by Michael Wang

“I just felt like when I was relating my problems to the counselor, it felt like I was talking to a stranger,” said Edward.

Edward, a Chinese-American student, has been diagnosed with depression. Studies conducted throughout the past decade indicate that Edward (who requested that his last name not be published) is one of a very small number of Chinese-Americans who has sought professional, medical help for his mental illness.

Statistics compiled by the American Psychological Association show that Asian American college students have a higher rate of suicidal thoughts than their non-Asian counterparts, with the rate 12.44 per 100,000 for Asian Americans 20-24 years of age.

The New York University School of Medicine’s Institute of Community Health and Research and Mental Health Services Research have both found that in Chinese immigrant communities, the majority of Chinese Americans with mental illnesses go undiagnosed and untreated due to cultural norms and beliefs that clash with Western medical paradigms.

“I know she was a professional and all, but it was basically [the counselor’s] job to help me,” said Edward. “She was getting paid for it.”

Views differ significantly between East and West on how to treat and manage mental illnesses.  The Western model of psychotherapy of exploring negative thoughts would be counterproductive in the eyes of the Chinese. The Chinese believe it is detrimental for an individual to dwell on negative thoughts and feelings.

Huang Ai Ying, a registered nurse in China, lives in New York City and works in Chinese immigrant homes, taking care of the elderly or disabled.

“People view those with mental illnesses in a very negative way,” said Huang. “Families will try to keep it very quiet because they fear the shame that will come.”

Chinese immigrants and Chinese Americans forgo mental health care due to a variety of factors. One is a concept in Chinese culture that can be translated as “face.” Similar to pride or honor in Western culture, this concept can permeate Chinese life and influences an individual’s actions or inactions. “Face” is tied closely with the family name.

“Families who have a member with a mental illness usually hide from the community,” said Li Yan, a recent immigrant from Guangdong. “They tend to avoid talking about the mentally ill and sometimes they may not go out at all because they believe they can’t be seen.”

Chinese culture is family- and community-oriented. Family includes not just immediate family but all those with ties to the family name. Individuality is a much weaker concept, especially for the older generation. Failure or illness does not afflict just the individual but the family as a whole. This, in turn, affects the family’s standing within the larger community.

The differences in culture are particularly evident for Chinese immigrants and their children, with the children suffering an even greater sense of cultural confusion.

“There is a stigma that you try to avoid,” said Edward. “We try to avoid professional help because we were brought up into thinking that we can control our actions.”

A study published in Culture, Medicine, and Psychiatry described a family confining a schizophrenic son until his symptoms became unmanageable. They sought professional help only when the son became violent, and the family distanced itself from the son soon afterwards.

The problem is not a new one. A study published in 2001 in the journal Mental Health Services Research found that social stigma was the primary reason for not seeking medical help and that they tend to seek help within their own families to avoid having their name viewed negatively by others.

Depression and suicide are the two biggest mental health issues that affect the Chinese immigrant population. Statistics compiled by the Centers for Disease Control and Prevention show the national suicide rate for senior Asian / Pacific Islander women is 6.01 per 100,000. In New York City, that rate is 11.6 per 100,000, an official of the New York City Department of Health and Mental Hygiene told the City Council in 2006.

In 2005, there were 28 reported suicides among the Chinese immigrant population in New York City, according to the New York Coalition for Asian American Mental Health. The Office of Minority Health, an arm of the U.S. Department of Health and Human Services, suspects the actual number to be much higher.

Studies have shown that Chinese Americans tend to view mental illness as problems that can be solved through willpower and avoidance of suicidal thoughts. For example, in depression cases, the solution is to simply, don’t think the bad thoughts.

Some psychiatric patients like Edward may take professional advice with caution. “They probably never have experienced what it feels like to have a deviant state of mind,” Edward said.

Huang, who oversaw psychiatric patients as a nurse in China, said the belief system of the Chinese is detrimental to the success rate of any medicine or treatment for mental illness.

“By the time the patient is admitted, their circumstances have already advanced to the point where treatment becomes extremely difficult,” said Huang. “It’s just a headache for all those involved.”

Economy Hurts Filipino Nurses

By Roxanne Torres

Jennifer Cabero keeps a file up to date at the nurse's station at Bellevue Hospital.  Photo by Roxanne Torres

Jennifer Cabero keeps a file up to date at the nurse’s station at Bellevue Hospital.
Photo by Roxanne Torres

Two guards stood outside the main entrance of Bellevue Hospital in Manhattan, the oldest public hospital in the United States. As two Filipino nurses in their blue medical scrubs walked by, they nodded to the two men in a show of familiarity.

These nurses have been working in one of the city’s busiest hospitals for 23 years. Once, they were immigrants, part of the great influx of nurses coming from the Philippines, drawn by America’s nursing shortage. These two nurses earned work visas within three months of applying and promptly found employment.

Two decades later, the nursing shortage is still prominent. But while some Filipino nursing graduates wait roughly two years to earn nursing positions, others wait far longer, as their hopes and patience diminish, because a weak economy and budget cuts have curtailed hiring.

Jennifer Cabero, a 46-year-old registered nurse at Bellevue, was an immigrant Filipino nurse hired by an agency during the 1990s. “The agency that I applied for took care of all the visa processing and all other papers I needed in order to come to this country and everything was free,” she said, as she turned the combination to her locker in the nurses’ changing room. “Even airplane tickets were paid for by the recruiter.”

During the early 1990s, 61 percent of trained nurses in the Philippines found jobs in, and migrated to, other countries, according to the Philippine Nurses Association. Close to 2,000 Filipino nurses found jobs in the United States at that time, according to the Philippines Overseas Employment Administration.

The numbers continued to increase until 1996, when the number of nurses obtaining jobs in the United States dropped to 270. These nurses not only passed the nursing exam administered by the Commission of Graduates of Foreign Nursing School but had experience in hospitals in the Philippines, which is part of their collegiate training.

The global demand for highly skilled nurses began to grow in the 1970s, according to the International Migration of Health Workers. Filipino nurses saw an opportunity to work overseas in such countries as Saudi Arabia and the United States. During that time, American working visas were a trade-off for lower wages and what were seen as dangerous working conditions, especially after the discovery — and growing numbers — of HIV/AIDS cases. To address these conditions, Filipino nurses formed nursing organizations, such as Philippine Nurses Association of America, to unite and protect themselves.

As of 2012, about 2.7 million registered nurses were employed in the United States, and roughly 7.3 percent of those were Asians, including Filipinos, according to the Bureau of Labor Statistics.

In recent years, the tide has turned. After the financial crisis of 2008, many hospitals scaled back or closed, including St. Vincent’s Hospital in Greenwich Village, North General Hospital in Harlem, and St. John’s Queens Hospital.

Anna Pineda, an honors graduate of LaGuardia Community College, feels the constant disappointment of rejections. At age 46, Pineda managed to complete numerous college term papers, study for exams and work at two part-time jobs to pay her bills, all before attaining her citizenship. “It was hard for me because being out of school for 15 years and not being able to speak the language like you know, the kids in my class,” Pineda said. However, despite her status as a nursing graduate and American citizen, she is still unable to find a nursing position. “Most of my classmates who were younger got a job, but the ones like me, who are old, don’t,” Pineda said. “Though I know hospitals now can’t hire as many nurses,” because of budget cuts.

Gema Santos and Jennifer Cabero outside of a patient's room at Bellevue Hospital. Photo by Roxanne Torres

Gema Santos and Jennifer Cabero outside of a patient’s room at Bellevue Hospital.
Photo by Roxanne Torres

“Back then, there were 11 RNs working during the day shift,” said Aleth Abadilla, a 50-year-old staff nurse at Bellevue, referring to the years before the recession. “Now, we are happy to have six or seven.” Abadilla is not only sympathetic toward her fellow Filipino nurses who are unable to obtain working visas, but she is also feeling the immense pressure of having her responsibilities increase from the time she arrived in the 1990s. Both Cabero and Abadilla are no longer serving the usual one patient at a time; they now dash between at least three patients at a time.

While Pineda continues to pursue her goal of finding a nursing position, others simply give up. This is the case for Joseph Lopez, a 23-year-old graduate of LaGuardia. “I said that if I keep pursuing nursing without getting the requirements, I would just be wasting time,” said Lopez. Like many other Filipino nurses, Lopez  migrated to United States to study nursing and find a job in the field. But he arrived in 2005, a decade after the boom.  Now Lopez is pursuing a different medical career path as a physical therapist’s assistant.

But not all Filipino nurses in America are stuck with the choice of waiting or changing paths. “Instead of coming to the U.S., Filipino RNs explore the possibility of looking for employment in other countries like, the Arab and European countries,” said a nurse who asked that her name not be used. A 56-year-old RN, she was once an assistant director of nursing at a New York hospital. Like many others, she is very much aware of the cutbacks and their impact on the hiring process. “There was an influx of Filipino RNs coming to the U.S., then a few years later, due to the retirement of RNs, the shortage became a problem nationwide,” she said.

For Anna Pineda and those who refuse to see their journeys end, the future is not entirely doomed. “Perhaps in the next 10 years, America will be in great need of nurses again like before, because many will retire, including myself,” Jennifer Cabero said, as she tied  her shoelaces and pocketed her ID.



Organic in the Heights

By Antonio Viveros
[Read more...]

Never Giving Up

Article and photos by Lindsay Calleran

Trainer 2

A spinning class in progress.

YORKTOWN HEIGHTS, N.Y. — It’s early Friday morning in a packed spin class when the instructor, 21-year-old Ryan Dowd leaps onto a bike, sporting a giant henna tattoo of a diamond on his bicep. With a flick of his finger, Whitney Houston is screaming, “I’m Every Woman,” and they’re off.

“Are you ready? It’s only a bike!” he yells to men and women of all ages. “Fight it!”

Here, it’s only a bike. For Dowd, the real fight came 11 years ago when he was diagnosed with chronic renal failure, the final stage of kidney disease. Only a successful transplant could save his life.

His parents had taken him for a blood test after they noticed a tic in his eye. The next morning a doctor called with the shocking results. Dowd was only 10 years old. “I thought it was a huge misunderstanding,” he says. Doctors spent the next year and a half preparing his body for a transplant. After nearly a dozen surgical procedures, and 50 to 60 pills a day, Dowd learned his own mother was a perfect match.

On Aug. 6, 2003, Ryan, 12, underwent a kidney transplant. Ten to 25 percent of patients reject the new organ within the first 60 days, but a year later Dowd was able to celebrate his first anniversary with a slice of a kidney-shaped cake.

These days, it’s hard to imagine any of that as the music in the studio at Club Fit in Yorktown Heights, in Westchester County, transitions into Ricky Martin’s “Here We Go.” Dowd sings along. Long-time member Debbie Santavicca says she loves his style. “He gives you the most energy,” she says. “Others are very systematic. His classes are fun, good vibes. He’s different.”

“Different” is a word Dowd is used to. After the transplant, he returned to middle school feeling he had little in common with classmates. Those who had sent get-well cards now felt like strangers. “I didn’t speak to anyone,” he says. “I kept very much to myself. I had no friends.” Seeking comfort, Dowd relied on what he calls, “food escapism,” leading to rapid weight gain.

“The steroids change your body,” he says, “but they don’t make you gain a hundred pounds like I did.” A “healthy” snack for Ryan was a bag of romaine lettuce, a bottle of dressing, a box of croutons and a block of mozzarella cheese.

Suddenly Dowd at 15 years old weighed 225. He didn’t even notice until he saw a photograph of himself with his taller, slender brother. Wearing matching shirts, Ryan assumed they looked like twins – but the photo revealed a harsh truth. “I was gargantuan,” he says, “I didn’t know I looked like that. I just started bawling.”

Ryan Dowd

Ryan Dowd, a 21-year-old fitness trainer, has reinvented himself after a serious childhood illness.

Ryan desperately wanted to lose weight. He’d look at physically fit peers for inspiration. “That’d be good. I want that,’” he recalls saying — and he was determined to get there, but only by using shortcuts. “I’d run five or six miles a day and only eat something in the morning to sustain me.”

At 18, Dowd confidently left for college 50 pounds lighter but soon learned that looks weren’t enough. Having spent his pubescent years either in a hospital bed or in front of a mirror, Dowd had never developed a strong sense of self and quickly fell into a daily routine of trying to fit in. “It was ‘Groundhog Day,’” he says. “I wanted something to make sense,” but it never did.

After two semesters, Dowd bought a one-way ticket home. “I went to school rosy-cheeked,” he says. “I left chain-smoking, rail thin. Everyone said, ‘you look great now.’” But the result of Dowd’s over-exercising and under-eating while at school impressed everyone but himself. He was fixed on finding an identity based on positives — something that at 19 years old, he had still never known.

He began with a job as a receptionist at Club Fit. There, he was surrounded by instructors, trainers – and spin class. “I had taken it once when I was 225 pounds,” he says of indoor cycling. “I sat on the bike, approximately 16 seconds later I got off, got a tuna salad from the café and went home. I hated it.” But his first class as an adult was thrilling. Dowd left with the first clear vision he’d ever had: He wanted to be an instructor.

Dowd committed to taking two spinning classes a day, in addition to training by himself. Donna Berta, general manager of Club Fit and former spin instructor, said, “I remember him practicing. You’d look and he’d have his iPod in. He was serious about it.” Dowd soon received certification from an independent cycling center and applied for the position.

His timing was good. A long-time favorite spinning instructor resigned to pursue his own business, leaving behind a following desperately looking for someone to take his place. Very few believed that person was Ryan Dowd.

A 10-year club member, Paul Lonce, says he scoffed when he first heard that Dowd was being considered. “He had big shoes to fill, you know?” Lonce says. “I was saying, ‘him?’” But the gym was willing to give Dowd a shot — or at least an evaluation class.

The soundtrack? “Love Lockdown,” by Kanye West. The thumping hip-hop music may have been loud, but it was Dowd who commanded the attention that day. “It was amazing,” Berta said. “We felt he was strong enough to take over the class, even with the lack of experience. He can do it.”

Eighteen months later, Dowd’s class is filled with men and women, 17 to 70s, with a line outside the door, everyone looking up at Ryan, waiting for direction, encouragement and a chance to leave that class feeling like they worked hard for themselves.

Lonce voluntarily eats his own words. The man who once asked, “That kid?” now tries to catch his breath after class. “All you know when you get in there on that bike,” he says, “is that you’re gonna get the snot kicked out of you!”

Dowd is no longer the bed-ridden child, the insecure teen or the college freshman with a broken spirit, but he will always be a transplant recipient, awaiting the day when he’ll need another organ donation. “There’s no reason why I should be able to do this,” Dowd says.” “I can control my actions, but I’ll never be able to control how long my kidney keeps functioning.”

According to the National Kidney Federation, the average life span for a donated kidney from a living relative is 10 to 15 years. Dowd celebrated his ninth anniversary last Aug. 6, teaching three classes that day.

At first, his goal “was just to prove to myself that I could accomplish this dream, despite what I had been through, that I could break that cycle.” He stops, giggles for a moment.

“It’s true, I’ve broken three bikes in there.”

The Dog-Bicycle Conflict in Central Park

By Owen Diaz

In Central Park, dog owners and bicyclists have been getting in each other’s way, and the problem seems to be getting worse.

Under park rules, dogs are allowed to play off leash in 23 specified areas in the morning before 9 a.m. and after 9 p.m. So many dog owners go to the park early — but so do cyclists, many of whom prefer the early hours because there is less traffic in the park, and they want to exercise before they go to work.

Dogs off leash will occasionally dart into the 6.1-mile Park Drive that cyclists travel on, sometimes causing accidents.

Linda Wintner, who leads morning rides in the park for the New York Cycle Club, says she has been in one accident, witnessed another and seen many near-misses. Wintner says she was lucky because her accident occurred during her final lap, as she was traveling slower to cool down. Cyclists are not always without fault. The roadway, or “loop” as it is known, has traffic lights and crosswalks that many cyclists ignore. Amanda Lee, who walks her dog Arthur for an hour in the park every morning, says, “I try to wait for a break in the bikers to cross, but sometimes I’m standing there for minutes and one never comes. Then I just have to pick the best moment I can find, and go, often getting yelled at by a biker for doing so.”

What makes this conflict odd is how many members of both groups seem to agree on a solution for it. Since dogs are not going to the park to play on the paved loop, and cyclists are not allowed on the pathways through the rest of the park, the space where the two interact is a tiny percentage of the park. If the rules required dogs to be on leash when crossing the roadway—right now it is only suggested they be leashed—and bikers heeded the stoplights when people need to cross, fewer accidents would be likely to occur.

A Skateboard Entrepreneur Draws Inspiration From New York Food Trucks

By Sean Creamer

Tre TruckSkateboarding has enjoyed a boom in New York City during the last decade, as the Bloomberg administration has doubled the number of skate parks.

With new parks in Brooklyn, Queens and Manhattan new businesses have emerged to meet the rising demand, among them the so-called Tre Truck. On any given day, outside the parks, you’re likely to spot the plain silver-sided self-proclaimed “World’s Finest Mobile Skateboard Shop” parked at a nearby curb.

The Tre Truck is owned by Alex Ritondo, 21, a skateboarder and entrepreneur who drew his inspiration from the food trucks that can be found throughout the city. The Tre Truck travels from the Lower East Side skate park under the Manhattan Bridge to the newly constructed Far Rockaway skate park and to points in between.

The goal is to bring hard goods — the skateboard decks (the platform on which the boarder stands), trucks, the turning apparatus and wheels — directly to skaters at prices comparable to those in a moderately priced skate shops. At an average skate shop, decks usually go for about $60 and trucks for $40.

“Skateboarding has always been my passion,” says Ritondo, his brown shaggy hair tucked under a baseball cap. “I originally wanted to open a shop. Me and my friends always talked about it.”

With skate shops, as with many businesses, location is a key element. And “a good location for a skate shop is going to cost a lot of money,” adds Ritondo.

Rent on the Lower East Side, a popular skate location — the Lower East Side skate park, on Monroe Street, is a regular stop for Ritondo — ranges from $2,000 to $3,000 a month, according to Tungsten Properties, a commercial real estate company in Manhattan. (Most local skate shops pay $25,000 to $100,000 a year, or roughly $2,000 to $8,000 per month, according to ReferenceUSA.)

Then, too, in the last few years a few skate shops have closed, in part because of a weak economy, but also because gentrification has pushed the shops’ customer base—typically young 20-somethings—to other neighborhoods in the outer boroughs.

A graduate of Borough of Manhattan Community College with a degree in entrepreneurship, Ritondo skateboarded daily while at school and decided to reimagine the idea of the traditional skate shop to make his dream a reality.

A traditional skate shop acts as the headquarters for a community of skateboarders. The shop typically purchases merchandise wholesale from larger suppliers who supply similar shops all over the country.

The Internet has taken some business away from brick-and-mortar retailers. But for die-hard skateboarders, the local skate shop/hangout is still the preferred locale for buying equipment and accessories, including skateboard brand shirts, shoes and other items that define the lifestyle.

While Ritondo couldn’t afford to open a skate shop, he saw opportunity in the proliferation of new parks.

“I don’t think that Tre Truck would have been sustainable without the creation of all the skate parks,” says Steve Rodriguez, a skateboarding legend in New York City who also owns Five Boro Skateboards. “Tre Truck needs that concentrated audience to do enough business to make it worth it.”

Ritondo bought a used truck from a friend on Long Island with savings and help from his family. He also got help from some of the bigger players in the city’s skateboard industry.

For example, Michael Cohen, shop manager of the Shut Skateboards brand and flagship store in the Lower East Side, agreed to let Ritondo open an account to sell Shut Skateboards.

“It is a win-win situation, people will buy from the Tre Truck and then come to the store,” says Cohen who has known Ritondo for several years. “At the same time we get kids who come here and we will tell them to check out the Tre Truck at their local park.”

The Tre Truck, which has been operating since September, has brought in about $10,000 in revenue so far. Ritondo knows that he will need to increase sales substantially in order to stay in business. He is hoping one day to franchise the operation and have trucks operating throughout Long Island.

Then too, skateboarding is seasonal and there isn’t much business in the winter.

Despite these challenges, Ritondo wins praise from both competitors and customers. “We offer a lot more variety, but what they are doing is a cool idea,” says Lennon Ficalora, the owner of Wampum skate shop on the Lower East Side.

Skaters like Frank Nicado, a regular at the Chelsea Piers 62 skate park, are often on the lookout for Ritondo. “The Truck just always has what I need,” says Nicado. “When I lose a bolt or a bearing they are always willing to hook me up.”