Uncle Tom's Chawl

For many aspiring students and professionals, the only hurdle between ordinary life and nirvana is generally a US visa. Add to that the belief that Indians in America are a 'model minority'—rich, successful and satisfied. But a new report on the health of Indian Americans shatters the soft and fuzzy myths, shining a bright light on the little-known, darker side of their being.

It seems all is not well in in America's little India. Apart from the difficulties of making cross-cultural leaps of adjustment, Indians show higher rates of cancer, cardiovascular diseases, risk of developing diabetes and domestic violence. To begin with, 21 per cent of Indian Americans lack health insurance compared to the national average of 18 per cent, according to the 'Brown Paper on the Health of South Asians in the US'. No health insurance means no regular visits to the doctor with most ailments going untreated. New immigrants choose to save and scrimp in this vital area. "Small businesses no longer provide health insurance for their employees and they can't afford to buy it themselves," says Abhijit Ghosh, co-chair of the South Asian Public Health Association (SAPHA), a group of public health volunteers who wrote the report.

It is the first ever compilation of health data on Indian and other Asian minorities based on existing studies and research. A group of Indian professionals in the health sector decided in the mid-1990s to get together to look at the real "well-being" of the community and fill serious gaps in information. It took them two years to sift through data, extract relevant details on Asian minorities and prepare the "Brown Paper"— the colour reference being a political statement of sorts since African Americans have brought out 'Black Papers' on issues for their community. The idea is to argue for more research, better funding and sharper attention to the problems of the South Asians. The 2000 US Census puts the number of South Asians at 1.89 million, a 106 per cent increase over the previous ten years.

"The picture of achievement results in a model minority characterisation which causes two problems that undermine public health efforts. First, South Asian Americans are perceived as being 'wealthy and healthy', with no health and social problems," says Neelam Gupta, one of the authors of the report. "Second, the low-income segment of the community is overlooked." She says that many immigrants who came in the 1990s have a markedly lower profile, lower income, fewer professional positions, higher unemployment rates, higher rates of business failures and higher rates of poor families. Many of them came as part of the 'family reunification programme' which allowed recent immigrants to bring over close relatives. Although hard numbers aren't available, Neelam Gupta says there is enough evidence to warrant attention to the needs of these immigrants. Another interesting statistic that plays into the whole issue—25 per cent of Indian Americans in 1990 were found to be 'limited-English-proficient' or lep in bureaucratese. The leps have a tougher time deciphering the mountain of paperwork and untangling the maze of rules required to access the government-funded Medicaid programme.

The breakdown of household income for Indian Americans can be a sobering exercise. Cast away the notion that every person who crosses the ocean lands himself a cushy job. True, the median income for Indians was $49,696—the highest in the country for any ethnic group and of the nearly 50,000 Indian households, almost 30,000 had a family income of more than $1,00,000 a year. But it is the other half which colours the rosy picture. About 25,000 families live on less than $25,000 a year, a little more than $2,000 a month. NY taxi drivers and owners of the infamous 7-11 convenience stores from India are members of this not-so-hip club.

A survey of families in 1993 ranked Indians 12th on the poverty ladder and a regional study in 1995 found that California had the highest percentage (14 per cent) of Indian American children living in poverty. The latest national figure from 2000 for children without healthcare is an astonishing 9 million and of these 5 per cent are Asian Americans and Pacific Islanders—a Census classification. The US Census Bureau does not report this figure by sub-groups but suffice it to say that Asian American children are two to three times more likely to be without a normal source of healthcare than white children.

Mental health of Asian children and youth is another concern. Immigrant children are at risk for emotional and behavioural problems, burdened as they are by the stresses and strains of surviving in 'dual' cultures—Indian at home, American at school. Studies show that depression is common, specially among girls. A national survey found that 30 per cent of Asian girls in grades 5 through 12 report depressive symptoms. More alarmingly, a 1997 study found suicide to be the leading cause of death among Indian Americans in the age group of 15 to 24.

Second-generation Indian children often grow up in a schizophrenic environment, struggling between patriarchal values of home and the more egalitarian atmosphere outside. If sex education in school teaches them about HIV/AIDS, at home the parents say it is not 'our' disease. The authors of the report warn that with an estimated 4 million cases of HIV in India, traditional notions of sexuality must be challenged in the community. Although little hard research is available, a few localised surveys in Canada and the US show Indians are in denial about AIDS. "There's no reason to believe that sexual practices of Indian Americans are different from that of other Americans even if they don't like to hear that," comments Nancy Groetzinger, who wrote the chapter on the dangers of HIV/AIDS.

Diseases like cancer also take a toll on the South Asian women. A study of screening practices of 6,048 Asian women found that 29 per cent over the age of 50 had not had a mammogram in the past two years and 27 per cent over the age of 18 had not done a pap smear in the past three years. A 1999 study of 1,688 Indian American doctors found that the rate of heart problems was 7.2 per cent compared to 2.5 per cent in another study of whites.

But it is the condition of South Asian women that raises the most serious questions. Not only are they at the thin end of the stick for medicare, they suffer domestic violence at much higher rates than the national average. The paper cites a 1999 Boston study of 160 South Asian women, 40 per cent of whom experienced violence at home. Most don't seek help because of the great cultural emphasis on saving the family izzat. Many are totally dependent financially on their husbands and can't seek jobs because of visa restrictions.

Margaret Abraham, who works with the New York-based Sakhi, a counselling centre for South Asian women, concludes that "isolation was one of the most painful and disempowering aspects of marital abuse in a foreign country" after a study of 25 women in the late 1990s. To put their plight in the national perspective, it is estimated that 2 to 4 million American women are assaulted by a domestic partner every year and 12 million women or 25 per cent of the female population will be abused in their lifetime.

The paper shows that Little India is a microcosm of Big India with all its cultural frailties, assumptions and taboos. These experts have shown that the community must overcome denial and complacency as a first step before it can tackle the looming problem.