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 🙂

experience at medical (specialist) conference

English: Kathmandu sunrise
English: Kathmandu sunrise (Photo credit: Wikipedia)

I was fortunate enough to be a part of ten volunteers at a conference this past week. This was a specialist conference in medicine, and most of the attendees were prominent Nepali clinicians. I had a good opportunity to see these faces for the first time, and this post is dedicated to these heroes from Nepali Medicine Fraternity. I write names of few who were really impressive, quote few that were good, and mention some that were plain dumb. The conference was held in Kathmandu, for two days.

the good
As I see it, Dr SL (nickname) had the best presentation (also read the disclaimer below). He talked about emergency medicine and critical care management, and it was the most fruitful 20 minutes of learning experience during that 48 hours. Everyone else was mostly mediocre and some simply dumb. The post presentation / oral session discussions were quite good (all expect one related to Vitamin D). Few good questions and some great answers. Few faces came out again and again, with good talks and reasoning. Great learning experience.

Food was “okay” – nothing out of the world, but rather a standard Nepali set (of good looking rice, vegetables, meat and some cakes). Tea break had good tea/coffee, but very bad cookies selection. Lunch was crowded, but dinner was calm. As usual, dinner was served along with alcohol and 40+ doctors joined us (out of no where) during this feast.

the bad
There were ten of us (volunteers) and we did not get any public appreciation. We were junior doctors, working tireless throughout these two days and there was very little or no acknowledgement for us. There were few (three – to be precise – part of organizing committee) personal note of thanks from good people out of the 250 that attended. This, compared to another conference I attended three years prior, is a nightmare when it came to management (cultural and copycat) aspect.

Every speaker somehow had to be presented with a certificate of appreciation after the sessions, and even those who chaired the session got it. Then there were felicitations to some prominent senior doctors (read more than ten senior doctors). Then there were pharmacy company giving out weird appreciation/gift wrapped up. The so called prominent doctors society had very less ingenuity and patient to sit and listen properly. At one time, there were six audience/participants (three were volunteers), the MC was calling out names, and four doctors lined up to receive their post presentation certificates. The hall was empty.

There was virtually no interaction among the me and these senior doctors. This was mostly my fault (read busy). However, this is also due to our culture of not standing along with the senior faculty members and teachers. Asian education (Indian sub-continent) to be precise, has this great barrier among the teachers and student, which was very evident at this conference. Most of the junior doctors had no urge to question the authority and reason with our senior faculties.

we have this absolute anarchic culture; taught in medical school, not to question our teachers and seniors

The result of which makes most of us a little less bold, and we lack confidence. I know, that among the 45 of us, in my medical school, only handful were bold enough to utter wrong stuffs with absolute confidence. I wasn’t one of them, and a little part of me regrets for not being this. We were not to speak unless we were knew absolute concrete knowledge. If we spoke, were ridiculed and smirked upon.

the ugly
The last two years after my graduation has been very much revealing in aspects related to drug companies. I don’t hate them, but I am not comfortable with some marketing gimmick they put up with. They sure know how to suck it up to the doctors fraternity. There were around 20+ stalls of various pharmacy products just outside the hall where the conference was happening. One stroll through this, and I was filling my complementary bag with free pharmacy gifts, brochures, drug trial literatures/papers, posters/pamphlets and sample medicines.

I am uncomfortable with this. But hey !!! couldn’t resist the free stuffs that they were giving out. All my friends were getting it, some even went the second time, and came back with two sets of everything.

On the medicine side, I god ampules clindamycin (anti-biotics). Oral Tablets of PPI (proton-pump inhibitors) the brand name of which i don’t remember (they were not omeprazole or pantoprazole though). I got a month supply tablets of combination drug – Losartan + Amplodipine. This combination drug has something I will write in my next post. There were paracetamol leafs, and some wet-wipes also. Out of the ordinary, I got a key chain, a pen (good one), numerous cheap pens, coffee mug, a calendar, a beer glass, and lots of chocolates.

I took papers/pamphlets from all the available stores representing some 40 drugs. Read them, and found out that only seven of the medicine had mentioned their side-effects and adverse effect on these advertisement. Another thing I am uncomfortable with. It ought to have been written there. Only three pharmacy provided the drug trials (trials done in USA – sadly Nepal is too poor to conduct RCTs).

There was one strange oral tablet for curing hemorrhoids. It had not pharmacological name, and the brand name suggested it to be an ayurvedic medicine. This oral drug also had a small trial conducted in India among 300 patients with 90% cure rate. I am unaware of Ayurvedic medicines, and my knowledge to this is very limited, so I can’t really comment on it. However, this whole thing looked extremity dubious.

other stuffs…
Both of us went (my wife and I). She was the MC, and I was (as she put it) – “volunteer-by-relation”. We did had our friends circle there, and it was definitely an educational (some) and fun filled event. I had my camera, and at times, I’d go out and take pictures here and there (perks of being a volunteer). Some presentations were plain boring, so we (me and friends) would go out and talk, walk, or eat. With few extra passes, we’d also called our friends for dinner and free alcohol. I must thank Dr PP (nickname) for inviting us to this conference (as volunteers). We did not need pay the usual Nrs.2500 participant fee.

my judgement criteria (my perspective for presentations/oral-sessions)
I looked for the following criteria, in all the presentations for my judgement; and even though I was not present in all of the presentations and discussions, I now have the rough idea of who could present. It would be wise to mention that I very much like reading journal paper, and am keenly interested in public health issues, so my judgement – may be biased.

1. Simple English, Short Presentation.
2. Evidence based Medicine (preferentially local – Nepali evidence)
3. Up dated and latest research findings (with landmark research included)
4. Public or Primary Health related component.

Based on this, there were only three presentations that had all four components, five that had at least three of the component. Remaining were not so appreciable. The international faculty members who presented (read – four – from India) were all good. One of them even questioned the standards of Ethical Review Board (ERB) in Nepal. Rude thing to say, but somehow, he was correct and spot on on pointing out mistakes. So like can’t judge that.

in the end..
The weekend was not that bad, but it could have been a lot better. My past experience attending international conferences, tells me we need to do a lot. But, somehow, I am content, to know that, this is evolving and in times, we will get there. Still, there was no need to gift wrap every presenter with a certificate as soon after he/she spoke. Thats just stupid.

disclaimer – Dr PP and Dr SL was a faculty member to the medical school I graduated from, and I (we) have been in more than few of his lectures to highly appreciate them both.

YouTube Share – Cycling for Freezing Gait in Parkinson’s Disease

A 58-year-old man with a 10-year history of idiopathic Parkinson’s disease presented with an incapacitating freezing of gait. However, the patient’s ability to ride a bicycle was remarkably preserved. (In Video 2, the patient is not wearing a safety helmet because in the Netherlands, wearing a safety helmet is neither required by law nor customary.)