Editor’s Note: This story is part four of a new four-part series from WDET’s Nargis Rahman called, “Shustho: Mind, Body, and Spirit,” exploring health care and health care access for Bangladeshi women.

Ayesha Tanjum moved to the U.S. about two years ago with her husband, an international student. Shortly after, she learned she was pregnant.  

“It was really tough for me in Michigan, because I didn’t have any friends or relatives around, and I was struggling to make friends,” she said. 

Tanjum said she was having mood swings due to hormonal changes and a complicated pregnancy.

“I had loneliness, frustrations, fear, anxiety, and I was alone. So I had a hyper, hypertension that time. And in the last time, my doctor figured it out that my baby’s baby’s growth is restricted,” she explained. 

Tanjum says she ultimately got the care and support she needed. She also read books to learn more about maternal health and nutrition, and began reaching out to old friends and connecting with new ones. That helped to improve her mental health. 

Speaking about mental health remains a taboo subject for many Bangladeshi women. 

Shuhrat Choudhury is a Bangladeshi American mental health counselor. She says stigma is the biggest reason many women don’t seek care — especially in older generations.

“I would be contacted by their sons, their daughters, their daughter-in-laws, that we need help for our mom or, like the older generation, but they are not OK. Like, they just, it’s that stigma around mental health, they go, ‘I’m not crazy,’” she said.  

Choudhury says younger Bangladeshi Americans struggle with navigating between American individuality and the Bangladeshi culture’s collective family expectations, in which personal boundaries do not exist in the same way in Bangladeshi culture.  

“When I transition to working someone with from our community, I have to find that balance. I just can’t advise them to move out, because you know that’s just not how it works in our culture,” she said. “I might use that terminology, but as long I’m explaining in our culture, it might not be feasible exactly the definition, but maybe a different version of it.” 

Choudhury said affordability is another barrier which can keep people from getting mental health care services. 

“Not a lot of our community members have access to better insurance plans, or they’re not financially stable. That when mixed with that stigma that we’re already trying to overcome, one obstacle on top of it, if it’s not financially feasible, then that just creates more delay in getting that help,” she added. 

There’s also a shortage of Bangla or Bengali speaking mental health professionals.  

“The need is much more than I could have ever anticipated, so I hope that more people join this field, from our community, and there is a need, and we desperately need to fill that.”

– Shuhrat Choudhury, Bangladeshi American mental health counselor

“I have been reached out by people from out of state, like someone in Michigan worked with me and their mom, brother, sister, someone’s like in Texas, but they just can’t find someone Bengali there,” she said.

Choudhury says she didn’t know there was such a need until she entered the field. She says she made that choice, in part, to give back to the community. 

“The need is much more than I could have ever anticipated,” she said. “So I hope that more people join this field, from our community, and there is a need, and we desperately need to fill that.”

Like Choudhury, Fariha Ghazi entered the mental health field to provide culturally competent care. Ghazi is a psychiatric physician assistant in Grand Rapids, who lives in the metro Detroit area and has telehealth options. 

She said she frequently sees Bangladeshi women struggling with anxiety, which manifests as physical symptoms first. 

“When they go see their general primary care provider, they’re often treated for things like stomach pain or acid reflux or, given sleep medication to help with sleep, a kind of root cause of a lot of those physical symptoms, it tends to be what I see being anxiety and trying to get them treatment for it,” she said. 

Ghazi says many women hesitate to discuss their mental health. She takes a creative approach to uncovering their struggles. 

“If someone has children, you know, I’d maybe ask her what are things that she thinks about in terms of her children, so if she’s always kind of like jumping to worst case scenarios, like thinking something bad’s going to happen to her child, or she kind of expresses that in our session, I’ll kind of note that as being, part of her symptoms.”  

Many women are also hesitant to take medication due to cultural taboos surrounding mental health treatment.

Ghazi said there is cultural taboo around taking medications to treat mental health, and part of her role is to explain treatment options and encourage self-advocacy, which she said plays a role in coverage. 

“If someone’s not fully aware of the terminology or what’s out there as resources, they’re not likely to get the health care that they need. They’re also much more willing to just kind of not question medical providers either. They’ll, be more complacent in their care,” she said. 

Choudhury and Ghazi say mental health is a vital part of caring for Bangladeshi women. They see a growing need for more Bangladeshi mental health professionals to serve their community.  

For now, they are using their language skills, cultural awareness, and lived experiences to provide better care. 

Read more from this series:

• Free health clinic aims to close insurance gap for Bangladeshi women in southeast Michigan  
• Bangladeshi women rely on culturally competent care for better health outcomes
• How language access affects health care for Bangladeshi women in Michigan

Editor’s Note: This story is part three of a new four-part series from WDET’s Nargis Rahman called, “Shustho: Mind, Body, and Spirit,” exploring health care and health care access for Bangladeshi women.

The Health Unit on Davison Avenue in Detroit (HUDA Clinic) is the largest free health care clinic in Wayne County. It serves uninsured and underinsured patients helping about 5,000 patients annually.

Nurse Practitioner Joann Harrison says about 30% of HUDA’s patients are Bangladeshi women. She says many struggle with mental health and chronic conditions due to lack of access to regular care. 

“There are problems with hypertension and diabetes. I just see a wide variety of issues, a lot of it has to do with not knowing how to manage or not having the resources to manage issues,” she said. 

Within that care, Harrison says Bangladeshi women are more receptive to female health care providers. 

“I think they’re more open to talk with us. Unfortunately, that’s not always the case that we have female providers available or female translators available, but I do feel that when there is someone present, there is more openness, more freedom to speak with us,” she explained. 

The clinic also provides interpreters and translated educational materials. 

Harrison, who is Black, said she is learning more about Bangladeshi culture, including about food and family values, to better serve her patients. “I’m learning all the time about how to help them, especially the women, to better care for themselves and what issues affect them.”  

Dr. Nashita Molla is a Bangladeshi American physician who volunteers at the HUDA Clinic. Part of her care is educating Bangladeshi women about preventive care. 

“In Bangladesh there isn’t a whole lot of cancer screening, so patients don’t have a PCP that they go to continuously and get colonoscopies every 10 years, or pap smears every three to five years,” she said.

Molla said having more Bangladeshi doctors and health care providers who are women could improve care for Bangladeshi women patients. 

“If I’m not there, or, you know, another female Bengali provider is not there, or then they’re not going to be as open with those other providers. They might not do those tests because they don’t understand why they need those things,” she shared. 

Molla said there’s a need for more free clinics and educational materials in Bengali, such as informational videos on diabetes and hypertension, which are rampant among Bangladeshis.  

“I think it helps if there’s another Bengali female saying, like, ‘hey we gotta cut down the portions of how much they’re eating, and cut down on the fried foods, and it’ll mean a lot more coming from them than it would like any other culture,” she said.

Like some patients served at HUDA Clinic, some Bangladeshi women end up in the Emergency Room for primary care because they don’t have adequate insurance.  

Dr. Farjana Alam is an emergency medicine physician who works at several hospitals in metro Detroit.  

She says socioeconomic barriers contribute to these challenges. 

“Poverty is higher in our people. I’ve seen lack of education is higher. And so I think that also plays into effect with all the health literacy gaps which then leads to like issues with chronic illnesses and not having an overall, as great of a health outcomes as, like other people,” she said.  

Alam grew up helping her immigrant parents navigate the health care system.  As a result, she said she understands firsthand how having limited resources affects one’s health.  

Social determinants of health, factors such as limited English proficiency, inadequate insurance and needing help with transportation can make a big difference in health outcomes, she said. 

“You can’t compare someone like a white female from a family who has all the resources in the world, who has all the money in the world, her health outcomes, to this Bangladeshi female who barely finished school, who has all these financial constraints over her; like you can’t compare those health outcomes,” she said.  

Alam said despite these barriers, Bangladeshi women in metro Detroit are empowering themselves by learning English, learning how to drive, and educating their children to assist them to have better health outcomes.  

Read more from this series:

• Bangladeshi women rely on culturally competent care for better health outcomes
• How language access affects health care for Bangladeshi women in Michigan

Editor’s Note: This story is part two of a new four-part series from WDET’s Nargis Rahman called, “Shustho: Mind, Body, and Spirit,” exploring health care and health care access for Bangladeshi women.

When the pandemic shut down many doctor’s offices, Family Nurse Practitioner Farzana Noor noticed a growing need among Bangladeshi women seeking care at her clinic in Hamtramck. Noor is the medical director at the Children’s Clinic of Michigan.

“It’s hard for them to go elsewhere to a provider who maybe is not Bangladeshi and hope that they have the same level of understanding of what their needs are and everything that they’re dealing with at home,” Noor said.

As a Bangladeshi-American she understands the struggles firsthand of the women who come to the clinic. That’s why she’s working to close the cultural gap in health care.

Many Bangladeshi women are stay-at-home mothers, often prioritizing their families over their health.

“But they’re missing out on their screenings, like pap smears, and they’re missing out on mammograms, and they’re missing out on this routine screening for diabetes and high cholesterol and high blood pressure,” she said.

Noor says language is another way she can connect with her patients. She speaks multiple Bangla dialects and says that can make a world of difference in treatment and care.

“When they’re able to tell me something in their native language, in their first language, versus if they were telling me something in English, it’s a night and day difference and then it’s like, we go from 10% to like, 110%,” she said.

Seeking primary care in the Emergency Room

Dr. Tabtila Chowdhury is a resident doctor at Henry Ford Health in Detroit. She frequently sees Bangladeshi women in the ER. Many arrive with untreated conditions because they don’t have a primary care physician.

“They’ll come in for the headache, but then they’ll be like, ‘Oh yeah, my blood pressure, your sugar’s been high. And then also, in Bangladesh, I used to take this, like, one medication for, like, you know, seizure-like activity,'” she explained, adding that many new Bangladeshi immigrants only have emergency health insurance and do not have a primary care doctor to manage their daily maintenance medication.

Chowdhury says she sees one or two people per shift with similar concerns. She says many times Bangladeshis have atypical symptoms of illnesses, which can put them at further risk.

For example, they might feel stomach pain and acid reflux for heart attack symptoms. Chowdhury sends them for an EKG if they have such symptoms.

Chowdhury says she feels a responsibility to go the extra mile to take care of her Bangladeshi patients.

“I make it a fact when I’m working, I always pick up all the Bengali patients, and I do a much better, more in depth, just like, dive into, their health care because half the time, people can’t even explain what’s going on with them,” she said.

Health literacy, comprehension and advocacy

Rumyah Rafique has had similar experiences at The Health Unit on Davison Avenue, where she’s a medical interpreter. She offers her services to Bangladeshi patients, finding that women are more receptive to female health care providers.

“I usually can tell if a patient is Bangladeshi, and I always let the provider know that if this is a patient that needs interpretation, that I am a qualified interpreter, that I’ve done this type of work, and that I’m more than willing to provide that service for this patient,” she said.

Rafique sees firsthand how cultural barriers can impact care for people with diabetes. According to the National Institutes of Health, South Asian patients are three times more likely to get diabetes.

Rafique says Bangladeshis have a rice-heavy diet, which leads to diabetes.

“Diabetes runs rampant in our communities, and I think that a lot of people don’t understand the concept of rice being a carbohydrate,” she said.

Rafique says having a family advocate in the room is also another important element to health care for Bangladeshi women.

“Our cultures are very communal and very family-oriented, and it’s a little bit different from the Western idea of individualism, and I think that that makes it difficult sometimes for Bangladeshi women who want to have their family as a part of their care,” she said.

Rafique says while women rely on male family members for transportation and interpretation, they need to advocate for themselves, especially when it comes to sensitive topics like reproductive health.

She says that’s not unique to Bangladeshi culture, however, it can be a challenge.

“That balance is really difficult for a patient to navigate, how do I make sure my needs and wants are being heard by my physician, how much I want, say my husband or my brother or my father to be a part of my care, versus, those things to remain private,” she explained.

Bangladeshi-American health care workers like Noor, Chowdhury and Rafique are stepping up to provide culturally competent care and bridge the gap, by understanding the sensitivities and the lifestyles of Bangladeshi women.

However, they also say there should be more health care education for non-Bangladeshi providers to create culturally sensitive services for this population.

Editor’s Note: This story is part one of a new four-part series from WDET’s Nargis Rahman called, “Shustho: Mind, Body, and Spirit,” exploring health care and health care access for Bangladeshi women.

Michigan is home to the third largest population of Bangladeshis in the U.S., with a significant number living in the metro Detroit area.

Bangladeshi immigrants struggle with a number of challenges when trying to access health care, including language, cultural competency and adequate insurance.

Community organizations like the Detroit Friendship House in Hamtramck are working to bridge the language gap many Bangladeshi women in southeast Michigan face when trying to access health care.

The nonprofit provides health education workshops to help them understand and navigate the health care system.

Khurshida Hossain is the executive director. She says women are the lifeline to their families. 

“It’s the mothers that come to pick up food, and we need to understand that women, even though if they don’t have access to education or transportation, they’re the ones putting the meals together, they are the ones that have more autonomy over the nutrition and the well-being of their children, and that’s important to us,” she shared.

The organization holds workshops on topics like women’s health, nutrition, and chronic illnesses. But information alone isn’t enough to educate women about their health. Hossain says making health care more approachable is essential.

Workshops are paired with direct enrollment into health care services to help women navigate complex systems. 

“Having them enroll on the spot and explaining those medical terminologies, or having someone that can translate that on the spot makes it more accessible, rather than having just a workshop and saying, ‘Okay, now you have to go here, downtown somewhere, to enroll and speak to a certain person that’s very disconnected and very intimidating,’” she said.

In 2018, Detroit Friendship House partnered with Eastern Michigan University’s Racial Ethnic Approaches to Community Health program (REACH), to create more targeted workshops.

Hossain says a key goal was to help Bangladeshi women learn English so they could better advocate for themselves at the doctor’s office, instead of relying on a translator or their child to provide interpretation services. 

“Instead of taking the registration form and handing it to a translator or their child to fill out this sensitive information, they are empowered to answer those questions and fill out those forms themselves,” she said.

The organization also encourages women to sign up for free mammograms and pap smears to educate them about breast and cervical cancer.

Volunteers like Mst Begum, a student at Hamtramck High School, play an essential role. She serves as a translator.

“I was chosen because I’m also Bengali, and I had an easier time connecting with the patients,” she said.

She says part of her job is breaking down stigma.

“That is so necessary to have people who are Bangladeshi trying to get people who are Bangladeshi to sign up for these programs because they feel more comfortable and confident,” she explained.

The growing need for health care workshops for Bangladeshi women

A decade ago, providing culturally specific health education for Bangladeshi women was rare. Dr. Subha Hanif, a cancer rehabilitation fellow at the University of Michigan, started a similar effort in the metro Detroit area in 2012 through her organization Bangladeshi Americans for Social Empowerment.

“I felt this like, this disconnect between the resources being there and then the community, nothing really bridging them together,” she said.

She worked with Beaumont Family Medicine to create women-only health workshops. But gaining support for the program wasn’t easy.

Traditionally, men in the Bangladeshi community would gather information and relay it to their families. Hanif had to convince the elders that women needed their own space to acquire health education.

“I had to do a lot of sitting down with, you know, the uncles in our community and making them understand that if you send your wife here, she’s going to be more empowered to learn about her health,” she added. “She’s going to inadvertently help your family, your children and your health, and she’s going to be more empowered to take care of herself better as well.”

Hanif says many women said they benefitted from these spaces and learned how to ask more questions about their health care.

But language barriers go beyond just medical terminology.

Sylheti-speaking interpreters, health care workers, are in demand

Zak Ahmed is an interpreter for the U.S. Department of Justice and several Michigan hospitals. He says many Bangladeshis in the state speak Sylheti, a dialect used by 11 million people in the world. However, interpreters often speak Shuddo Basha at institutions, the standardized formal Bengali language.

“When I used to do the asylum cases and immigration court, we’ve seen so many people that they are denied or deported because of the language barrier. So we found out that they don’t understand these are, these are basically Sylheti speakers,” he said.

Ahmed says the U.S. Department of Justice added Sylheti as a separate unique language in 2018.

But he says there is still a need for more Sylheti-speaking interpreters, although many patients don’t realize they can request one.

“They do feel much better actually, when they speak their own dialect. They can feel better when they see someone that they can understand their needs,” he said.

The Michigan Department of Health and Human Services says interpreters are available  at no cost for anyone who needs one, including in Bengali.

Last year the state also passed the Meaningful Language Access to State Services law to prompt government agencies to translate important documents in different languages.

However, more bilingual speakers in health care are needed.

There isn’t a formal health care language certification for Bangla or Bengali in metro Detroit, like the one offered in Arabic for health care workers at Wayne State University.

Khurshida Hossain from the Detroit Friendship House says it’s important to amplify efforts to increase the number of Bangladeshi Americans entering health care.

“Then you have doctors and nurses and pas that not only can speak and understand the language, but that look like the community, and it makes that doctor’s appointment that much less intimidating, that much more accessible,” she said.

Language access is a delicate balance between learning health care terminology, advocating for themselves, and finding resources like interpreters for Bangladeshi women in southeast Michigan.