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NEW YORK, NY /
The New York Times / Times People / August 31, 2009
Indian men gathering at a shopping center plaza in Fremont, California, to discuss the news from home and the issues of the day.
Jim Wilson/The New York Times
FREMONT, California — They gather five days a week at a mall called the Hub, sitting on concrete planters and sipping thermoses of chai. These elderly immigrants from India are members of an all-male group called The 100 Years Living Club. They talk about crime in nearby Oakland, the cheapest flights to Delhi and how to deal with recalcitrant daughters-in-law.
Together, they fend off the well of loneliness and isolation that so often accompany the move to this country late in life from distant places, some culturally light years away.
“If I don’t come here, I have sealed lips, nobody to talk to,” said Devendra Singh, a 79-year-old widower. Meeting beside the parking lot, the men were oblivious to their fellow mall rats, backpack-carrying teenagers swigging energy drinks.
In this country of twittering youth, Mr. Singh and his friends form a gathering force: the elderly, who now make up America’s fastest-growing immigrant group. Since 1990, the number of foreign-born people over 65 has grown from 2.7 million to 4.3 million — or about 11 percent of the country’s recently arrived immigrants. Their ranks are expected to swell to 16 million by 2050. In California, one in nearly three seniors is now foreign born, according to a 2007 census survey.
Many are aging parents of naturalized American citizens, reuniting with their families. Yet experts say that America’s ethnic elderly are among the most isolated people in America. Seventy percent of recent older immigrants speak little or no English. Most do not drive. Some studies suggest depression and psychological problems are widespread, the result of language barriers, a lack of social connections and values that sometimes conflict with the dominant American culture, including those of their assimilated children.
The lives of transplanted elders are largely untracked, unknown outside their ethnic or religious communities. “They never win spelling bees,” said Judith Treas, a sociology professor and demographer at the University of California, Irvine. “They do not join criminal gangs. And nobody worries about Americans losing jobs to Korean grandmothers.”
The speed of the demographic transformation is leading many cities to reach out to the growing numbers of elderly parents in their midst. Fremont began a mobile mental health unit for homebound seniors and recruited volunteer “ambassadors” to help older immigrants navigate social service bureaucracies. In Chicago, a network of nonprofit groups has started The Depression Project, a network of community groups helping aging immigrants and others cope.
But their problems can go unnoticed because they often do not seek help. “There is a feeling that problems are very personal, and within the family,” said Gwen Yeo, the co-director of the Geriatric Education Center at the Stanford University School of Medicine.
Many who have followed their grown children here have fulfilling lives, but life in this country does not always go according to plan for seniors navigating the new, at times jagged, emotional terrain, which often means living under a child’s roof.
Mr. Singh, the widower, grew up in a boisterous Indian household with 14 family members. In Fremont, he moved in with his son’s family and devoted himself to his grandchildren, picking them up from school and ferrying them to soccer practice. Then his son and daughter-in-law decided “they wanted their privacy,” said Mr. Singh, an undertone of sadness in his voice. He reluctantly concluded he should move out.
So when he leaves the Hub, dead leaves swirling around its fake cobblestones, Mr. Singh drives to the rented room in a house he found on Craigslist. His could be a dorm room, except for the arthritis heat wraps packed neatly in plastic bins.
“In India there is a favorable bias toward the elders,” Mr. Singh said, sitting amid Hindu religious posters and a photograph of his late wife. “Here people think about what is convenient and inconvenient for them.”
Move to the Ethnoburbs
Sociologists call Mr. Singh and his cohort the “.5 generation,” distinct from the “1.5 generation” — younger transplants who became bicultural through school and work. Immigrant elders leave a familiar home, some without electricity or running water, for a multigenerational home in communities like Fremont that demographers call ethnoburbs.
A generation ago, Fremont was 76 percent Caucasian. Today, nearly one-half of its residents are Asian, 14 percent are Latino and it is home to one of the country’s largest groups of Afghan refugees (it was a setting for the best-selling book “The Kite Runner”). Along the way, a former beauty college has become a mosque; a movie house became a Bollywood multiplex; a bank, an Afghan market, and a stucco-lined street renamed Gurdwara, after the Gurdwara Sahib Sikh Temple.
A group of Indian immigrants gathers at a mall in Fremont, California.
Photo: Jim Wilson for New York Times
Reliant on their children, late-life immigrants are a vulnerable population. “They come anticipating a great deal of family togetherness,” Professor Treas said. “But American society isn’t organized in a way that responds to their cultural expectations.”
Hardev Singh, 76, and his wife, Pal Keur, 67, part of Fremont’s large Sikh community, live above the office of the Fremont Frontier Motel, its lone nod to a Western motif a dilapidated wagon wheel sign.
MULTIMEDIA
They rented the fluorescent-lighted apartment after living for three years with their daughter, Kamaljit Purewal, her husband, his mother and two grandchildren.
Graphic
AMERICA'S OLDER IMMIGRANT POPULATION
As the children grew, Mr. Singh and Mrs. Keur were relegated to the garage, transformed into a room. As Mr. Singh said, “in winter it was too much cold.”(Ms. Purewal said that she “tried to give them a better life,” but felt unappreciated because her parents favored her older brother in India. “If you’re a happy family, a small house is a big house,” she said. )
Fraught family dynamics when elderly parents move in with children often leave older members without a voice in decision-making, whether about buying a house or using the shower.
Pravinchandra Patel, the 84-year-old founder of the 100 Years Living Club, intervened when he heard that the son in one family was taking his parents’ monthly Supplemental Security Income check, for $658, then doling out $20 for spending money.
“I ask the son, ‘How much money do you figure you owe your parents for your education?’ ” he said.
Crying, Not Smiling
Once a lush landscape of fruit trees and cauliflower fields, Fremont, 40 miles south of San Francisco, is now the Bay Area’s fourth-largest city, with voters from 152 countries. Physical distances can be compounded by psychic ones: 13 percent of the city’s immigrant seniors live in households isolated by language. Theirs is a late-life journey without a map.
For the men in the 100 Years Living Club, the road leads to the Hub, where they have been meeting for 14 years, since the Target store was a Montgomery Ward. Mr. Patel, who was an herbal doctor in India, started the group after he noticed his friends were in “house prisons,” as he put it, without even the confidence to use a bus. The men keep their spirits alive by sharing homemade chaat snacks. They are the lucky ones.
Zia Mustafa moved to Fremont from Afghanistan with her son. Jim Wilson/The New York Times
Two miles away, Zia Mustafa, an Afghan widow, sits at her kitchen table with its plastic tablecloth, looking at a scrapbook with bright color postcards of Turkmen girls in elaborate dress posed against an azure sky.
Mrs. Mustafa arrived here on a desolate emotional road. Her husband and eldest son were killed by a rocket in Kabul; her son Waheed, now 24 and living with her in Fremont, lost his leg in the attack. Other children remain in Afghanistan and Pakistan.
“My family is divided in three,” she said through a translator, weeping.
Waheed Mustafa, after surgery in Oakland, leads the life of a young man in his 20s — going to school, working out, talking on his cellphone, hanging out with friends.
Mrs. Mustafa, who was home-schooled in the Koran, spends her days watching television soap operas, attempting to decipher stories through actors’ facial expressions. She sleeps with the lights on, worrying that even within these safe white walls this son, too, will not come back.
“They come from a country where it takes so much to survive, yet they feel they haven’t done enough,” said Dr. Sudha Manjunath, a psychiatrist who consults with the city’s mental health unit. “To tell them now, ‘It’s time to take care of yourself’ — well, they’ve never heard of such things.”
A recent health survey by Dr. Carl Stempel, a sociology professor at California State University, East Bay, found that most Afghan women here suffer from post-traumatic stress.
“I thought they would be so happy in this country — all the houses, the food, the cars,” said Najia Hamid, who founded the Afghan Elderly Association of the Bay Area, an outreach group for widows, with seed money from Fremont. “But I was met with crying.”
Young couples who need to work to support families have imported grandparents in part to baby-sit. There is a misguided assumption that baby-sitting is sustenance enough for the aging, said Moina Shaiq, founder of the Muslim Support Network, which brings seniors together. “We are all social beings. How much can you talk to your grandchildren?” Mrs. Shaiq said.
Small Things Matter
In 1965 changes to immigration policy allowed naturalized citizens to sponsor the immigration of parents without quota restrictions. By 1996, a growing perception that elderly immigrants were “gaming the system” — that their children were pledging to support them and then enrolling their parents in the Supplemental Security Income and food stamp programs — became an impetus for welfare reform. Congress imposed a five-year waiting period for Medicaid and Temporary Assistance for Needy Families and restricted S.S.I. and food stamp eligibility for adults.
Some states, including California and New York, have chosen to eliminate the waiting period for Medicaid for lawfully residing immigrants, paying with state money.
Michael Fix, senior vice president of the Migration Policy Institute, a nonprofit center in Washington, said that as immigrants form a larger part of the elderly population, “all the issues that bear on health care and social services will increasingly be transformed in part into immigrant issues.”
Devendra Singh grew up in an Indian household with 14 family members. He now lives alone.
Jim Wilson/The New York Times
In 2007, according to census data, about 16 percent of immigrant seniors lived below the poverty line, compared with 12 percent of native-born elderly, said Steven P. Wallace, the associate director of the Center for Health Policy Research at the University of California, Los Angeles. Another 24 percent of immigrant elderly are “the near-poor,” he said, “sitting on the edge of a cliff.”
Kashmir Singh Shahi, 43, a former engineer who was born in India, is a volunteer the Community Ambassador Program for Seniors, offering people like Hardev Singh an attuned ear.
Mr. Singh, a retired driving instructor for the Indian army, is 76 and determined to work full time. He takes two buses to work the night shift at a gas station an hour away. “I don’t want to become idle in the heart,” he said matter-of-factly.
Mr. Singh had not been to a doctor in years, and Mr. Shahi helped him and his wife apply for Medicare. Mr. Singh is also entitled to Social Security but will not accept the additional assistance.
Mr. Shahi’s experiences with his own parents have illuminated the way for his clients. He came to the Bay Area in 1991 to work at a fiber optics company, and he sponsored his parents six years later.
After his father died, Mr. Shahi changed careers so he could care for his mother, who has suffered from depression.
She shares a room with her 12-year-old grandson, Kirat, improbably surrounded by Iron Man and Incredible Hulk posters. In this affectionate setting, amid decorations for her granddaughter’s Sweet 16 party, the 84-year-old woman sat quietly, blue slippers on her feet, her eyes cast downward at her folded hands.
“In India, she would walk to the grocery store, go next door to have tea, talk about common things like the wheat and the corn,” said Mr. Shahi of the ingrained visiting culture so universally missed by many ethnic elders. “At home anyone can knock on the door anytime, to relieve the pressure. Here nothing is similar.”
So at the end of his day counseling others, Mr. Shahi sits with his mother before she goes to bed. He always asks if she needs any warm milk.
“The small things matter,” he said of his mother and other elders longing for home. “The feeling that they are welcomed.” [
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Copyright 2009 The New York Times Company
Dr. Daniel Fulham O'Neill has been performing knee surgeries for more than 20 years, many for members of the U.S. national ski and ski jumping teams. For him, knee surgeries are old hat, but he started to realize that his patients were often confused and unprepared for their surgeries and their aftermaths, so he started putting together handouts.
His handouts grew into a big packet, and many colleagues started asking for copies. Recently, he decided it was time to collect his notes into a book for patients facing knee surgeries. The book, Knee Surgery, describes how knees work and what knee surgeries are designed to do. It also recommends ways to prepare - physically and mentally - for surgery and suggests an exercise and stretching plan to help with recovery.
Less than a year after his knee injury, Tom Brady is playing in the NFL again. For many of the same reasons that recreational athletes shouldn’t expect to play as well as Brady, they also shouldn’t expect to recover from major surgery as quickly. AP file photo
O'Neill, who spoke with us about his book and his experiences, practices with the Alpine Clinic in Plymouth. He is an orthopedic surgeon with a master's degree in sports psychology.
How common are knee surgeries?
Incredibly common. Literally, a half million total knee replacements in a year. That's just in the U.S. One hundred thousand anterior cruciate ligament reconstructions, and literally millions of knee scopes, knee arthroscopies.
Why? Is there something about knees that makes them particularly fragile?
Absolutely. They're just not a particularly good design. You have these meniscal cartilage - these little pieces of gristle in there that get torn. Your ACL - for the sports we're doing - is just not good.
How many knee surgeries have you performed?
I've performed thousands. Right now, the vast majority of the surgeries I do - 99
percent - are knee surgeries. I don't want to say it's epidemic in the country, but it's huge.
How different are surgical techniques compared to when you started practicing?
Techniques have just gotten better and better and better over the years, and we've just gotten smarter. That having been said, we're still dealing with human knees that have to deal with biology. So even though our technology has gotten better, the damage people are doing to their knees is still significant.
We're better at it, but it's not a revolution. You're still much better off not hurting your knee.
Why did you feel the need to write this book?
The problem is that you go into the doctor's office, and as soon as you've heard the word surgery, most people just shut down. I say nothing makes you feel old like getting bald and having a knee replacement. There's just so much going on, and there's a certain amount of stress involved, of course. So I think the way I assimilate information, and most people do, is when you're able to sit in the comfort of your own home.
What are some common mistakes or misimpressions that you wanted to correct?
One big thing is that there is no such thing as minor surgery if it's your body. And believe it or not, we all think that the other person is a wimp and we're tougher than they are, and we go in there and we think it's no big deal. . . . Any time somebody touches you with a knife, it's a big deal, because it's your body. Even with the knee arthroscopies, I want people to take it seriously and to work not just after surgery but before surgery, getting better.
We talk about Tom Brady and Tiger Woods. These guys took many months to get better, and yet when my patients come in a few weeks after their ACL surgery, they're disappointed that they're not playing basketball yet.
A lot of the book focuses on what you should do before a knee surgery. Can you tell us about some preparations that make a big difference?
The best you can do is just getting as strong as possible, getting as good a knee as possible. For the arthritic knees, for the 75-year-old who's had arthritis for 50 years, you can only do so much. But you really want to maximize it.
Your book also touches on how to prepare mentally for surgeries. Why did you think that was important?
You're being presented with an incredible stress to your body, and again with jobs, with family. And you feel vulnerable, and for a lot of people, especially my younger patients, this is the first time they've been through this. So when I get this 13-year-old kid in there, they're 13, they're incredibly young, and now they're faced with a major surgery, and they get nauseated by the medications, and they get pain, and they're on crutches, and they can't go to the movies with Billy tonight, and all this stuff they're not ready for. The mental preparation is huge.
How important is rehabilitation treatment to the final outcome?
A lot of the studies show that you can do it on your own. We're talking about knees here, which is not really complicated. You can do it on your own by following the book. You don't actually need a physical therapist. But, of course, we use physical therapists a lot, because people need that additional guidance. But if you have an ACL or an arthroscopy, and if you don't do anything that anybody tells you to do, it'll probably be reasonably good. On the other hand, if you have a total knee replacement and you don't do anything we tell you to do, it probably won't work out too well.
After that, a lot of it is a question of speed. If you're more dedicated to the program, things will go a little bit faster, for sure.
When should you think about surgery?
That's a really good question. My theory is that you can't live your life without any kind of discomfort, but you shouldn't be keeping yourself from doing fun things, like dancing at you grandson's wedding, or taking that trip to Texas, because it's too painful to get into the plane.
How should you pick a surgeon?
I never hesitate to ask my doctor, 'How many of these operations do you do? How often do you do this?' They should say, 'I do a lot.' How many ACLs do you do a year? They should say, 'I do dozens a year.' How many total knee replacements do you do a year? They should say dozens. These are incredibly common operations, so if your doctor says, 'I do three or four,' that's a red flag. These doctors should also be able to answer your questions. [rc]
Knee Surgery
The Essential Guide to Total Knee Recovery
Daniel Fulham O'Neill, M.D., Ed.D.
St. Martin's Griffin
ISBN: 978-0-312-36293-5
ISBN10: 0-312-36293-5
240 pages
82 b&w illustrations and photos
Copyright 1997-2009
Concord Monitor and New Hampshire Patriot
