Andrej Ćorković (2018) is a student at Grinnell College majoring in Chemistry with a concentration in European Studies. His main academic interests involve organic chemistry and the synthesis of new molecules, and he hopes to contribute to the medical field one day. When not in class, he is playing basketball, soccer, YuGiOh, or FIFA.
A land of freedom. A land of opportunities. A land of hope. The United States of America is known for all these qualities and more. People from all corners of the world move to America in search of safety, freedom, hope, and so on. Yet, many immigrants arrive with few strategies of how to reach their dreams once arriving in the new country. My family and I are examples of such immigrants. We moved to America 19 years ago with the intentions of building a better future. We have faced constant struggles throughout our stay in America including language barriers and general knowledge about how America operates among others. Like most immigrants, health care is something that we avoid. However, in the past four years, my family has been searching for the right form of health care to address my mother’s dementia. Like many of our counterparts, we do not know the resources available to help. In addition to general health care, finding treatment and help for mental health conditions, like dementia, among immigrants is grim because of immigrants’ lack of information and their language barriers. Following 1996, new legislation has been passed to help migrants find resources in more accessible and reliable methods.
My family and I immigrated to the United States in 1999. Although I have little recollection of the health of my family at the young age of four, I have been led to believe that we arrived happy and healthy. We were fortunate to have avoided going to doctors or hospitals often in the early years as the “1996 federal welfare reform law (Personal Responsibility and Work Opportunity Reconciliation Act, or PRWORA) restricted Medicaid eligibility of immigrants, so that those admitted to the United States after August 1996 cannot receive coverage, except for emergencies, in their first five years in the country.” Being new to the country, many legal immigrants are eligible for Medicaid, but the new law prevented many new immigrants from obtaining insurance coverage. Furthermore, both insured and uninsured immigrants have less access to medical care compared to native-born citizens [1]. As cited in the opening paragraph, this may be due to lack of information, language barriers, and so on.
There have been recent efforts to support immigrants with new legislation being proposed that would “give states the option to restore immigrants’ eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program) for children and pregnant women.” Other pundits suggest that jobs should develop methods to offer health insurance for immigrant families. However, studies show that immigrants were offered health insurance less often than native-borns [2]. This is simply unfair. Thus, some policy changes that should transpire are: (1) to expand health insurance coverage, (2) to address limited English proficiency, (3) to expand and strengthen the safety net infrastructure, and (4) to revise PRWORA [3]. During the Obama administration, many of these suggestions were addressed with Obamacare being the most significant. However, more still needs to be done to assist immigrants.
Immigrants are often recognized as a vulnerable population, “a group at increased risk for poor physical, psychological, and social health outcomes and inadequate health care.” Some of the factors that help to contribute to this vulnerability include their socioeconomic background, immigration status, residential location, PRWORA, English proficiency, and stigma and marginalization. Of these six factors, I suggest that English proficiency has the greatest impact. Coming to America, my family spoke only Croatian and German. We did not know many people in America that we could communicate with, and translators were a requirement in almost all situations. Going to the doctor was understandably difficult, especially since finding Croatian translators was even more difficult.
Many immigrants experience similar situations. Limited English proficiency typically results in families with no insurance, fewer physician visits, lower quality of care, and worse patient safety [4]. However, patients with interpreters are more likely to be curious about their care and use preventive services. Thus, improving access to interpreters may be a large aspect in improving health care among immigrants. Access to the preventive services would have great benefits because it “can lead to future lowered utilization and expenditures of non-preventive services, and… it seems efficient and beneficial to prioritize the provision of preventive care to immigrants in public funding of medical care” [5]. Not only would increasing the availability of interpreters result in more informed patients, but it would save the patients and government money in the future. As I have stressed, a lack of information of available health care resources for immigrants is a large part of their difficulty in finding appropriate health care.
When my family moved to America, we moved to Rockford, IL because my father knew friends there. Like most immigrants, my dad “[began] gathering information about [his] receiving society and locating possible social ties that can be quickly mobilized to help absorb the initial shock of migration” [6]. This absorption is vital for the first few years when an immigrant moves; however, after a few years, the immigrant is expected to determine information for themselves. Once I entered elementary school, I became my parents’ informant. I was learning English at school at a faster rate than my parents, so it was easier for me to learn about landlines, Internet service, and much more. However, even to this day, other aspects of American society are still foreign to us such as politics and health care. This brings me to the matter at hand: dementia in immigrants.
Mental health is a difficult subject to discuss, and dementia is one of those conditions that many people cannot define. Dementia is “a chronic or persistent disorder of the mental processes caused by a variety of brain diseases or injuries marked by memory disorders, personality changes, and impaired reasoning” [7]. Dementia is essentially a death sentence with no cures and limited treatments. Those with dementia first start to forget small things like words, but then they forget how to use everyday objects like spoons and forks, and they can get to the point where they do not know who their own children are. This is the case for my mother, who suffers from dementia.
Even though dementia is so devastating and painful to the patient and the families of the patient, it is also highly preventable. According to a study by Benjamin K.P. Woo and Jamie O.P. Chung, “Chinese-American immigrants may not seek help for their cognitive impairments out of fear of ‘losing face.’” Although their research focuses on Chinese-American immigrants, the shame concept can be applied to all immigrants. People move to America hoping for success and happiness, but a disease like dementia can make immigrants feel like lost potential and a waste of space. Many areas of the individuals’ lives are affected, ranging from employment to social relationships. One of the key aspects in helping dementia treatment is community support, so public participation is vital to overcoming dementia stigma, but a lack of understanding of dementia among immigrants leads to social exclusion and discrimination [8]. A greater understanding and knowledge of the disease can help destigmatize dementia and offer patients an essential support network. Being an immigrant, my mother’s social network is not very expansive, and thus, she receives little support from her family and friends. Therefore, a better educated public will result in a greater support network that can help patients suffering with dementia and the family that cares for them.
Furthermore, the culture of the individual afflicted with dementia can have a huge impact on the way they respond to treatment. This has been evident with my mother. We have gone to several suggested resources to seek help, but most of the resources conflict with our cultural standards. We want someone to come to our house to interact with my mom for a couple of hours, but most resources suggest stuffing her in a nursing home or institution. In Mary R. Janevice and Cathleen M. Connell’s article, they argue that a “unique set of caregiving conflicts may arise in immigrant cultures when family members are at different levels of acculturation and have correspondingly different values or beliefs related to caregiving” [9]. The difficulty of acculturation is not only related to finding caregiving and help, but the individual with dementia begins to “revert to the more traditional end of the acculturation continuum” [10]. My mom believes that she is living in Bosnia, and she does not speak English at 5% of the level that she used to be capable of. She is reverting to the traditional culture that she grew up with.
Finally, many studies suggest that multilingualism helps delay the onset of Alzheimer’s Disease and dementia [11, 12, 13]. Immigrants tend to be bilingual upon entering the US, and this may be one of the reasons that dementia rates in immigrants is lower than that of native-borns [14]. However, immigrants who learn English once they arrive in America may be more prone to forgetting it and having more difficulty communicating as has been the case with my mom. She has essentially reverted to monolingualism in Croatian. Thus, being bilingual or better does not necessarily support the dementia preventative care.
Upon entering America, many immigrants have a desire to improve their lives, help their families, and reach their dreams. Once they have arrived, however, there are many trials and tribulations they must overcome. One such provision is health care. Immigrants have difficulty acclimating to their new society and are thus often viewed as a vulnerable population. This vulnerability leads to more difficulty in accessing the health care necessary for them, resulting in less information about American health care, particularly in mental health. Individuals with mental health problems such as dementia have more difficulty finding treatment and care due to differences in language and cultures. However, educating the public and immigrants can lead to better understanding of diseases, the health care system, and the available resources to help get immigrants and native-borns the necessary treatments they deserve.
Notes
[1] Leighton Ku, Sheetal Matani. “Left Out: Immigrants’ Access to Health Care and Insurance,” Health Affairs 20, no. 1 (2001) 247, 253.
[2] Ibid. 254.
[3] Kathryn P. Derose, Jose J. Escarce, Nicole Lurie. “Immigrants and Health Care: Sources of Vulnerability,” Health Affairs 26, no. 5 (2007) 1264-1265.
[4] Ibid. 1258, 1259-1263.
[5] Xu, Ke Tom, Tyrone F. Borders. “Does Being an Immigrant Make a Difference in Seeking Physician Services?” Journal of Health Care for the Poor and Underserved 19, no. 2 (2008) 388.
[6] Kuo, Wen H., Yung-Mei Tsai. “Social Networking, Hardiness and Immigrant’s Mental Health,” Journal of Health and Social Behavior 27, no. 2 (1986) 135.
[7] “Dementia.” English Oxford Living Dictionary. https://en.oxforddictionaries.com/definition/dementia (accessed April 20, 2018).
[8] Woo, Benjamin K.P., Jamie O.P. Chung. “Public Stigma Associated with Dementia in a Chinese-American Immigrant Population,” Journal of the American Geriatrics Society 61, no. 10 (2013) 1832-1833.
[9] Janevic, Mary R., Cathleen M. Connell. “Racial, Ethnic, and Cultural Differences in the Dementia Caregiving Experience: Recent Findings,” The Gerontologist 41, no. 3 (2001) 345.
[10] Day, Kristen, Uriel Cohen. “The Role of Culture in Desigining Environments for People with Dementia: A Study of Russian Jewish Immigrants,” Environment and Behavior 32, no. 3 (2000) 363.
[11] Alladi, S., Thomas H. Bak, Vasanta Duggirala, et al. “Bilingualism delays age at onset of dementia, independent of education and immigration status,” Neurology 81, no. 22 (2013) 1938-1944.
[12] Chertkow, Howard, Victor Whitehead, Natalie Phillips, et al. “Multilingualism (But Not Always Bilingualism) Delays the Onset of Alzheimer Disease: Evidence From a Bilingual Community,” Alzheimer Disease & Associated Disorders 24, no. 2 (2010) 118-125.
[13] Craik, Fergus I.M., Ellen Bialystok, Morris Freedman. “Delaying the onset of Alzheimer disease,” Neurology 75, no. 19 (2010) 1726-1729.
[14] Xu, “Seeking Physician Services?” 384.
For Further Reading:
DesMeules, Marie, Jenny Gold, Arminee Kazanjian, et al. “New Approaches to Immigrant Health Assessment,” Canadian Journal of Public Health 95, no. 3 (2004) I-22-I-26.
Guillermina, J., Douglas S. Massey. “Immigrant Health: Selectivity and Acculturation, “IFS Working Papers 23, no. 4 (2004) 1-47.
Kirmayer, Laurence J., Lavanya Narasiah, Marie Munoz, et al. “Common mental health problems in immigrants and refugees: general approach in primary care,” Canadian Medical Association Journal 183, no. 12 (2011) E959-E967.
