Nepali in USA (a pseudo thought bubble)

My work right now also involves me in meeting Nepali in USA, and then talking/learning about ideas on how to improve the holistic health approach in Nepal. This involves me talking about good examples of health projects in Nepal, and also about my own (Nidan). I talk about environment project, deforestation, occupational health and the main course of Maternal and Child Health. There are different genre of Nepali speaking population and great deal of information gets shared, both to and fro. But this post is not about what I talk, but to whom(?).

What (they) said back home

“Certainly not rumors, but more of an exaggerated facts” were my initial thoughts when I heard about the two classes of Nepali in developed countries. The educated – working group and the non-educated labor group. For a quick disclosure – Nepali migration to this part of the world only increased from late 90s. So as a whole, there are very few numbers in this all.

I was warned by friends and families alike, by not to get into Nepali groups of “Beer-n-Gungis”

Let me explain – FIRST GROUP –  These are not hard facts, but portray a general feature exploration. These are the groups of people who work all week, mostly labor works. Most the work is either in retail shops, gas stations, and beauty parlor/saloon. I do not have any facts or number, but these are the jobs that you hear back home. Kind of makes me think that most are not used to heavy lifting and machine or construction work.  These work may be legal or illegal, but most fall into the grey zone of unknown. Pretty good work ethics, and silent/sober Asian feel which includes soft spoken voice, and not so heavy English (Hindi) Accent. There is a definite Nepali English Accent, which is slightly different then our Southern neighbors, which is also, in my opinion, a bit better (I guess nationality creeps in). Its not thick as Hindi Accent, but it has its own perks of ups and down.

Then they come home, and do nothing. Then comes the weekend, and they do nothing. Their sole purpose of existence is to make a decent living and enjoy this developed nation – literally. May be a little too hard on critics, but these are the population cohort, who, more or less have nothing to gain or loose. Every evening, and most weekends are usually time spend with Beer and Cards (“marriage” anyone). One very distinct feature is the heavy use of white sleeveless shirts (the gungis) and briefs for men. They are very fond of Chicken and even greater a fan of Bacon/Pork meat.

SECOND GROUP – These are the educated bunch. They definitely live a better life. They are the ones who usually graduated in USA, and have families and make their children study like those akin to Chinese and Indian parents. Depending upon the years of stay in here,

  1. 5+ years – unmarried – still studying, is in relationship or about to get married
  2. 7+ year – usually married – has a stable job or doing his/her PHD
  3. 10+ year – usually has 2 kids (i don’t know, but most Nepali in USA, that I know of have two children), a beautiful home, and stable income
  4. 15+ years – Their kid is very good in studies, Family still intact. (The divorce percentage is still very low)

Obviously there are few exception, but this is the general idea I have, from around 20 Nepali origin families I know in USA.But now, with some first hand exposure, here is what I think, I know now. There ought to be one more group – which definitely comes before these two groups.

THIRD GROUP – the students – Yes ! finally the group where I belong to. There were around 9000 Nepali students in USA for the year 2011/12. These are mostly non-medicals students, and have come mostly for undergraduate education. We are the population that might, some day, be Nepal’s executive class of thinkers and policy makers. We represent Nepal’s future. Disclosure –  I do not know what my thought process a year from now will be, but for now, I am certain going back to Nepal, and working my way up to the executive level.

However, this student group has seen a gradual decrease in application for the last two years, as US Embassy back home tightened its Visa process in recent years, which ultimately led to this student group opting more for other developing nations like Australia and West Europe (including England).  For the record, there were around (I guess) 40+ Visa applicant when I applied for US Visa this year on that favorable day in early June, this year.

The Eyeball

One small note – Nepal is almost a fail state – and the whole economy of the country runs through remittance through Nepali migrant labor workers from Middle East and South East Asia. Those so called educated Nepali (including me, maybe) who are in developed world have very (extremely) little share in Nepal’s economy. Nepali in developed world usually do not send in remittance, and/or have very direct/indirect role in Nepal’s economy and development. This is sad. 😦

Not to sound eager and patriotic, but I hope I am able to do something about it. For the readers, I am definitely not in love with Nepal, I just think I need to do some good work for my birth place and family/friends.

Some More Facts

How many Nepali speaking citizens in USA?

A 2010 Census report on Asian Origin Americans reveals that there are around 59,490 Nepali speaking individual in USA with legal citizenship.[9] Significant communities of Nepalese Americans exist in large metropolitan areas such as New York City, Boston, Chicago, Denver, Gainesville, Florida, Portland, Oregon, and Saint Paul, Minnesota.[5]

Nepal and USA

What about legal residence?

A quick web search reveals the number to be around 110,616 through Wikipedia.  But this does not say legal residence or citizens. Lets break it down first to Diversity Visa Program. Applicants registered for the DV-2013 program were selected at random from 7,941,400 qualified entries (12,577,463 with derivatives) received during the 30-day application period. Nope, I did not enter this year, but those who did, 4,370 Nepali getting this opportunity, which included my one distant cousin,  and one very awesome friend from high school years. This number was 3,258 in 2012.

Students? anyone

In the 2011/12 academic year, 9,621 students from Nepal were studying in the United States (down 6.6% from the previous year). Nepal is the eleventh leading place of origin for students coming to the United States. 53.3% are undergraduates, and 29.3% are graduate students.[2,3]

Bhutanese (Nepali) Refugee – in USA

In 1988, the government of Bhutan conducted its first real census exercise. The basis for census citizenship classifications was the 1958 “cut off” year, the year that the local Nepali population had first received Bhutanese citizenship. Those who could not provide proof of residency prior to 1958 were adjudged to be illegal immigrants. Majority fled to India, and significant number arrived to Nepal, as well. During the last 20 years or so, number of refugees in Nepal (more than 69,000 of an original total of 108,000 refugees) have found a durable solution in third countries, thanks to the support of support of resettlement States and Government of Nepal. These resettlement program were started in 2007, and among the eight working under the UNHCR, USA has accepted the largest number of refugees. [4]

I mention the Bhutanese refugee here, as they’d lived in Nepal for almost 20 years, and most have similar Nepali culture/traditions. Legally they have a convoluted presence, however, culturally they are every bit Nepali, and speak Nepali as well.

[quick questions] –  So how many Nepali (from Nepal) got a refugee status (in USA)?

In 2011, there were some 56k admitted to USA as refugee. About approximately three percent were of Nepali origin (seeking refugee/asylum). This is give or take 500 as numbers. Well there are three variation of these refugee status – Affirmative Asylees, Defensive Asylees, and Follow-to-Join Asylees – the scope of which is beyond me, at the moment. For more information, refer to the report by Daniel C. Martin and James E. Yankay from May 2012. [4]

References – 

  1. Nepal DHS 2011 [pdf link]
  2. Open Doors® 2012 – Report on International Educational Exchange [pdf link]

  3. Open Doors Data – Fact Sheets by Country – 2012 – Nepal [pdf link]
  4. Daniel C. Martin and James E. Yankay. Refugees and Asylees: 2011 [May 2012]
  5. Nepalese American – Wikipedia [web link]

  6. Demographics of Nepal – Wikipedia [web link]
  7. Nepal Census – 2011 – [pdf link]
  8. 2013 UNHCR regional operations profile – South Asia Working environment [web link]

  9. The Asian Population : 2010 Census Briefs[web link]

  10. Nepalese Americans – Countries and Their Culture [web link]

NEXT POST – Next Wednesday 🙂

of Castes and Cows

I got curious on farming and cattle herding. Tried some internet search, asked around and here I am sharing of what I know. My question – Is there a relation between cattle herding and caste system in Nepal? From what I know, there is a definite relation, but I want to know at what extend.

NP! ID: 328008 Title: Nepali cow // File Size: 799 × 526 – 397.95 KB
Created: Wed, 05/09/2007 – 7:16pm // Modified: Wed, 05/09/2007 – 6:19pm
File Type: image (jpeg) // License: Public Domain

Writing something about “Cow” always reminds me of my primary school English teachers, and how we had to write about essays related to cows, mother, green Earth, and Forest in Nepal. My love for education at the moment, justifiably, was improper and poor. My parents were once informed that I would always ne a below average student, and that my English was so poor that I’d need a tuition for it, at a monthly price of Nrs.3500. This was grade three (1993) when my monthly tuition fee was Nrs.1200. Yeah, and the English Teacher was non Nepali, with fluent British-Indian Accent. I do not remember anything else about her, but my guess is that she was from Sikkim, or Darjeeling in India, unmarried and living in Kathmandu at the moment.

A cow (status) in our society

A 2010 blog (here) has made an excellent points on cow-status. Yes its revered, its worshipped, and we cannot kill it, even if its already dying, but not dead yet. When a cow (or few of them) get Mad-Cow-Disease (or any other non infectious or infectious diseases) we cannot kill. At best, we try to quarantine it. Also, there is no culling of this animal. If a cow  herder/s that are smart, however, opt for some shady ways, by which a diseased cow, vanishes the next morning.

According to a Lodi News-Sentinel news story written in the 1960s, in then contemporary Nepal an individual could serve three months in jail for killing a pedestrian, but one year for injuring a cow, and life imprisonment for killing a cow. Seriously, its here. According to Vedic scriptures they are to be treated with the same respect ‘as one’s mother’ because of the milk they provide. They appear in numerous stories from the Puran (English word is Puranas) and Ved (English word is Vedas). The deity Krishna was brought up in a family of cow herders, and given the name Govinda (protector of the cows). In a related cattle worshipping matter, my favorite Hindu diety Shiva is traditionally said to ride on the back of a bull named Nandi. So much is the importance for this one animal species. This got me thinking, was its care taken by elite people in arm, or a normal person.

As one of the jewels in Hinduism, who takes care of it (Cow) ? by elite guards or normal pheasant?

what does cow do?

In South Asian context, its primary use is for milk and milk based dairy product. These days, a dead cow (not killed, I’m just saying a cow can die of natural causes) can also fetch for leather goods. Internationally, meat of a adult cow (also known as beef) is a big hit. Apparently its very high in demand. Global beef production is virtually unchanged at 57.5 million tons (pdf file) in 2012-13, with India as a lead beef exporter (18.53%) as of April of 2012. A very convoluted conclusion, Ironic as one probably should get imprisoned for doing this in countries like India and Nepal. I took this information from a report here. Lastly, there is also cow dung and urine used in some yucky  religious and good economical way.

wait what? India as a lead beef exporter (18.53%) in the world .

Cow dung, or “gobar” is used in very many ways, including as a cooking gas. Well other animal shit (including those from humans) are also used as biogas. Two papers published in 2009, from Renewable and Sustainable Energy Reviews – Elsevier explain more on the benefit of biogas in Nepal, (Abstract available here and here). I could not afford to read these papers, SciVerse demanded $37.95, but abstract reading sounds promising.  Will not write about the yucky  part, where people touch and revere this fecal matter. Its an animal shit that is being worshiped at. What could be more irksome?

of caste and cows

Back to my primary reason for this post. After a good amount of time spend on Internet and asking around here is what I found about the Methodologically  Implanted Slavery (MIS) and cows.

Turns out, me being a Brahmin (one of the four Varnas in one group of Nepali cohort) am free to be a herder. I can be a cattle farmer. In other news, not so long ago (say 50-60 years), a Brahmin could not be a regular land farmer, that I was not allowed to plow land (neither with buffalo/ox/oxen nor a machine). In a similar respect, Newars in Kathmandu Valley also could not plough a land with bigger plough (called “Halo” or “Hali” in Nepali) and were limited to “Kodalo” (smaller in size). In Kathmandu, this was Newari religion; it was said that Lord Pashupatinath would get angry.

[To make my stance clear, I do not believe Newari Culture originally to be in the same Varnas (meaning particular sect of cultural) where Brahmins, Kshatriya, Vaishya, and Sudra were divided.  Newari culture have their own higher and lower caste within them. This is true for Madhesi and the various Mongoloid culture in Nepal also. Each of these culture includes high ranking priests and low ranking untouchables, but somehow only Brahmins (13% of total population) get the blame game of being supreme, smart-a$s. Will write about this very soon.]

past/present?

What was intriguing was who looked after the cattle grazing few decades ago. According to my parents, my father (from South Terai belt in Nepal) tells me that any caste/culture could be a cow herder. There were also no limits in who could milk the cow. Only after the milk was boiled/warmed, were the untouchables not allowed. Yes, it is inhumane. While my mother (from Hills in Western Nepal) tells that milking the cow by lower caste was not allowed in the village she grew up.  But now, with education and human rights campaign, any or all the caste in Nepal, are able to be a cattle farmer, with no limitations. Obviously, there are always some places, which may defy this progress, and still remain obsolete and uneducated.

Why was there discrepancy ?  I have few theories, which might not be true.

  1. I think, that the whole purpose of making “cow” a revered animal was that no one would be able to harm it, be it friend or enemy – it was very useful economical indicator of a well to do rich family.
  2. High priest of most South Asian Culture were not allowed to eat meat. My guess is, early on, someone definitely must have figured out that beef was good meat. In order to stop this, the smart(ass) people, made a god out of this animal; stopped its killing for meat, and used it as a sole purpose of Milk and Dairy products.
  3. But animal it was. It needed someone who could take care. Hence, the very likely, densely populated lower caste were utilized to graze and feed the cows. Now, no-one could kill a cow at all. Killing for beef meat was out of question.
  4. Huge, Fertile and Flat land in Terai (South Nepal) meant bigger cattle herds, which required many farmers. Hence the rules that might have been, were relaxed, till a point where the smart(ass) population could only discriminate after the milk was boiled/warmed/or inside their kitchen. Less land in Hilly region, meant less cattle, and the milking  was kept among those that were “touchable”.

so do I like beef?

No, not till now. I haven’t had beef till date. Its about respecting one’s culture, so I guess I won’t go this path. Although, I know there are a lot of things that my culture needs to improve on. For the record I believe in Asthik, Atheist Hindu. Don’t believe in god, but believe in Hinduism and the religion. Yes, we have this in Hinduism. read more here.

tertiary what? seriously where is public health?

English: Boudhanath stupa, Kathmandu, Nepal. Ε...
English: Boudhanath stupa, Kathmandu, Nepal. Ελληνικά: Η στούπα Mποντνάθ στο Κατμαντού, Νεπάλ. (Photo credit: Wikipedia)

There I was, all ready for the free food and great conversation. The CME (continued medical education) was about GERD (gastro-esophageal reflux disease), in Hotel Annapurna. Best minds of Nepal in the field of gastro-enterology (medicine about stomach and stuffs) would be there together with free-loaders like me (read – interns, medical officers and first year residents).

This was last Friday and I still have headache on what he ignored. “He” is a subjective grudge against this single speaker who as I found out later is also a third-degree-relative (father’s-mother’s-uncle’s-son-in-law or something) to me. My grudge is also directed toward the 50 or so bright minds that were invited there, to talk about GERD and their utmost loyalty to tertiary health care. A more of a vertical health approach twisted in the name of professionalism and wrong ethics.

so what did happen?

I went to attend this conference. The talk was wonderful and quite informative. The speaker had a Texas-Nepali accent mixed with periodic outburst of native tongue that just didn’t feel right. The 45 minutes of presentation had all sort of data and research citing from American, European and Indian Research Journals, which was then compared to Nepali citizens from Kathmandu and the periphery (in and around Kathmandu). He spoke of few clinical diagnostics procedures which are still not in Nepal, and then few Nepali medical culture/ethics regarding Gastric-Carcinoma (stomach cancer) with regards to Tripple-Therapy (medicines given to kill H. pylori bacteria). In the end there was a wonderful suggestion of making future CME in Nepal a little more responsive with written QnA sessions. With 30 minutes or so of good QnA sessions we went for the great Annapurna Dinner and liquor. Total number of participants were 50, out of which I had my wife (Dr Aditi) there with me, I knew one who taught me (Dr SL taught Medicine), his wife (don’t know her name) who’d come to our wedding. For obvious reasons, food was delicious, they even had the wonderful chat-dahi (curd thats like little too salty) and regular dahi (regular curd), with gulab-jamoon (lalmohan is what i call’em). During the dinner, we got a chance to talk with the speaker/presenter and raised some public health related inquiries. Five minutes into the talking, we being MBBS (the lowest ranked doctors in Nepal) were crushed and pushed aside with widely acclaimed speaker and his beliefs. Seventy Two hours later, as I recall the event and our little conversation, here is what he’d told us, and what we understood from the event as a whole.

why am I sad?

Here are some reasons that I think is a little off track from what should have been. Some may be genuine, some may be paths that I would/might also follow in future (knowingly/unknowingly) and some plain dumb reasons with no apparent thought process. For deliberate reason of being afraid I will not write the names of any other people.

1. The presenter is some one very reputed, has practiced medicine for nearly 35 years (his quote), has worked as a clinician and in management position of huge organizations in Nepal as well as in India. Is a professor of Medicine, must have given number of presentations, written number of papers (Journal papers that are scientific research). In his 45 minutes of presentation, there wasn’t a SINGLE NEPALI PAPER (research) QUOTED, let alone his personal findings. He talked of American standards, and then Indian data, and boasted a working of 35 years, and yet he had not accumulated any Nepali data. Post presentation, post QnA session, during the dinner, when we (Aditi and I) asked about his personal data and findings, he said

“Yes, I have my data, but they are with somebody else, in another hospital, and I don’t have it now”

Firstly shame on him, for being so ignorant about his own country, and speaking about foreign data. It would have been a passable excuse If there were no data of GERD related to Nepal. It would be better if he said that he did not know more on research, data mining, paper writing and stuffs. But the speaker, knew vert well of the research process, and yet after working for 35 years, he had nothing to present of his own, or others related to Nepali prevalence and outcome of GERD in Nepal.

2. Our second question to him was on why weren’t there proper research being conducted in Nepal? This is something we ask each and every one, and we do know some of the likely possibilities to this question. Its basically because we have a nascent research culture in Nepal, doctors are still learning, plus the lack of funding (Nepal is definitely poor to do bigger RCTs and all). However, we should be able to do surveys and cross-sectional studies and there are many small RCTs currently being conducted that I know of. To this small and pretty inconspicuous question he went and answered something like this.

“Nepal is poor, the best we can do is take others data and rely on this”

By “Others” he might have meant USA, EU, and or India. Against which we tried to argue whether smaller research were viable or not in Nepal. We questioned if smaller surveys and cross sectional studies should be pushed forward by this intellectual elite groups or not. To this he had to say –

“So you want me to carry a bag of endoscopy materials and go to villages conducting research and this age?”

A person at his caliber and experience may very well assign a group of person to calculate or collect data. We even offered to write up a paper on his behalf (this was the part where we were advertising ourselves) saying that we’d worked in KUMJ (www.kumj.org.np) and JAIM (www.aimjournal.org).

3. In a typical of the attitudes that we see in many Indian sub-continent (read Nepal, India, and the likes of SAARC countries) senior professors (not limiting to medicine only) there was a blatant ignorance of shortcoming one might have.Our last question is a little too private to be written here, but we were, in a way questioning of something that is right or wrong on an ethical level. The outcome of which might as well change the practice of many new doctors. Something I’d definitely would like to write, but now now, not associated here. Hint – Its associated with the Triple Drug Therapy and H. pylori treatment and its prevention for Gastric Carcinoma.

4. My last sadness (or grudge) was against all the elites present there, that day in the room. These were mostly tertiary care clinicians (as far as their looks and likes went). Again none of the post presentation QnA had public health related discussions. Almost all focussed on the high-profile cases of complex GERD. None talked about Nepali prevalence and outcomes of GERD. This was an Internal Medicine conference and well this should definitely means high profile cases and queries. But something inside me wanted to hear that public health aspect of GERD, and I was sad hearing so little.

There, I’ve all but summed about my Friday experience here except one. When we were leaving, at about nine, I met two of my friends from school. Intrigued and happy, I also found out that another program nearby was some sort of Fashion program by another of my friend from school. Damn the CME, I’d have (We’d have) love to go here instead of CME had we known beforehand. But then again, we did learn something new about GERD.