A WORKSHOP that I enjoy leading, pre-COVID-19, is one I developed for our Filipino immigrant community. It is based on Stanford University’s Chronic Disease Self Management Program, a program that is now widely adopted by several organizations including AARP. The focus of this program is to assist those with chronic illnesses like diabetes, asthma and cardiovascular disease to manage their symptoms more effectively.
I will not be writing about this workshop here. Information about it is widely available over the internet. But I would like to start a conversation with our Asian Journal readers on a topic that I cover at these workshops. Why do we often have difficulty acting in our own best interests, when it comes to our health?
At the beginning of the workshop, I ask, “How many of us suffer from some form of chronic illness, like diabetes, hypertension, asthma, arthritis, etc.?” The show of hands is almost everyone including myself. I then follow this up with “what are some problems you have in managing your illness effectively?” Over the many iterations of this workshop, participants have invariably identified cultural factors, such as food and the many norms associated with it as posing challenges. For example, when you visit a home, food is automatically offered, a merienda if its in between meal times, and it’s impolite to refuse.
When you come to a party, the host expects you to eat heartily —nevermind that the food may not be compliant with your dietary restrictions. When a friend arrives from out of town, we get together over food. If you arrive after a meal, you are asked, “Kumain ka na ba?” Food is the medium that greases our social interactions.
For many of us, especially diabetics like me, we must observe dietary restrictions. Since many of our social interactions involve food, keeping to these restrictions is difficult.
Then there are the comfort foods that are non-compliant with dietary rails for diabetics.
Diabetes is, in layman’s terms, having excessive sugar/glucose in our blood. The solution sounds simple enough, reduce consumption of sugars and carbohydrates which are metabolized into glucose. But our culture creates challenges that keep us from effectively managing our symptoms. We have a sweet tooth: leche flan, kakanin, and the many traditional cakes we make from sweet rice include sugar. Our staple diet involves rice, large helpings of it. Reducing our intake of foods that metabolize into glucose requires changing our traditional diet and avoiding the many comfort foods we are used to. Even with admonitions from family, lapses are common. I remember having lunch with a famous writer. He was having one of those huge hamburgers. He dug into it with apparent gusto, saying, “My wife would give me so much grief, if she found out what I am having now.”
Without the pandemic, it is challenging to manage our health issues because these involve behavioral and lifestyle changes to habits that are routine. Most of us like the way we live our lives. Even in normal times, it is challenging to make behavioral changes for our health issues. The COVID-19 pandemic has made these behavioral changes even more difficult as the recommendations from professionals run against the grain of our social instincts. Avoid the 3 C’s: crowded places, closed spaces, and close contact. Practice the 3 W’s: wear a mask, watch distance, and wash hands. Yes, these are doctor’s orders, but we are social animals and build relations and community through social behavior.
Add a layer of cultural habits, and the challenge increases. Asians and Latinos are noted for large extended families. It is not unusual for us to have multi-generational households. The parents seed the immigrant family (spouse and children). They then sponsor their parents, and may have U.S.-born children. But shortly afterwards, their siblings (aunts and uncles to their children) follow suit. And the extended family continues to grow with families of aunts, uncles, and cousins. Large extended families are not unusual in immigrant communities. Every adult member counts to adequately provide for family and children. Culturally, since immigration forces immigrants to abandon their established social networks in the Philippines, family members become even more central to their social life. Family celebrations and gatherings acquire more meaning. Absence at a celebration can be interpreted negatively. Among Filipinos, these celebrations often center around food, copious amounts of it. With an extended family, celebrations are endless.
Let’s follow this trail.
How compliant can we be with 3-C and 3-W admonitions at these gatherings?
It’s hard to wear a mask when an event centers around food and conversation. It’s just as difficult to socially distance as folks crisscross each other’s paths around the food table.
Conversations are difficult to hold at an appropriately distanced setting—especially if two other conversations are happening within earshot of each other. We resolve this by getting closer. In multi-generational settings, kids are playing games, running around with their cousins, deftly avoiding running into grownups as one would be running around in a forest of trees. Even if we put on masks after eating, we are usually carrying around coffee or some beverage. They come off again whenever we take a sip—and most likely, we just keep them off.
Definitely a nightmare scenario for a professional like Dr. Fauci. All it takes is one infectious person in the group to have a super spreader—and we have heard of these stories. The scenario I have sketched is not uncommon among immigrants, Asian or Latino, as we are known for large extended families. It is no surprise then that scholars find minority communities especially immigrant communities bearing a disproportionately larger burden of COVID-19 infections.
Given our cultural predispositions, can we manage our infection risks more effectively? I have no specific solutions. Only suggestions on how we might navigate through our cultural thicket amidst COVID-19.
Admit that our culture poses challenges to staying healthy and COVID-safe.
Our culture has been our guide for navigating through daily life, reducing many choices and decisions to the level of a routine. Under COVID-19, health professionals are asking us to behave in ways that go against our instincts and culture. Socially distance, when we are social animals; wear a mask, when the smile on our faces is our most basic form of greeting. Avoid crowds, when coming together is our way of building relations and community. Gatherings with our extended families always involve food, which precludes wearing a mask at all times and the value we assign to family gatherings add a layer of behavioral tendencies that increase our risks. We need to act with greater intentionality and awareness rather than habitually to avoid culturally layered risk-taking.
Our attitudes toward health also play a role. For many, health is an individual thing. We decide what to eat, whether to be compliant with doctor’s orders and prescriptions, whether to stay active and exercise regularly; these are all individual choices. But staying covid-safe requires a community effort; a shared sense of responsibility for everyone’s health, not just yours. Staying healthy (and safe) during this pandemic is a collective endeavor. We avoid infection only if we collectively control its community spread. Thus we need to think in terms of our collective health rather than our individual health. E.g., wearing a mask by yourself does not help much in a gathering if others do not behave likewise.
Keeping everyone safe in a family gathering is a challenge that must be faced collectively by those present.
Gather the tribe, and have a brief conversation about how best to keep everyone safe at this gathering. By the way, this is often done, pre-COVID, to orient guests about restrooms, where things are, and give a shout-out to cooks and food. To these we might add suggestions about taking distanced turns at the food table; holding conversations outdoors where distancing is easier, making hand sanitizers readily available, etc. The key is raising collective awareness about safety during the event. Actually, raising collective awareness makes it easier to follow guidelines since everyone looks out for everyone else.
If there are some tough calls, ensure that everyone has had a chance to voice their opinion. Consultations should not just be confined to the “elders.” Many times it’s the young adults who have fresh eyes and can suggest a better solution.
Stay safe, enjoy the holidays, and if you can think of other ways where our cultural habits make it difficult to stay healthy, write a letter to the editor, or post a comment on the online edition. We will appreciate it.
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The opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of the Asian Journal, its management, editorial board and staff.
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Enrique de la Cruz is Professor Emeritus of Asian American Studies at Cal State University, Northridge.