PARENTING: BRIDGING THE LANGUAGE DIVIDE

By SHAGORIKA EASWAR, with files from DR RIPUDAMAN MINHAS

Some immigrants, trying to navigate parenting in a new land, are able to reach for help and advice from people they trust in their network, others flounder.

When little Pinky began complaining that her tummy hurt, Meenu Arora gave her water in which fennel seeds had been soaked and rubbed some oil gently on her stomach to help ease the pain.

It didn’t help much and soon she was doubling up with cramps, had an upset tummy and said she felt like throwing up. She was also, Arora says delicately after a pause, “passing gas”.

Thinking she’d picked up a stomach infection, she took her to their family physician, who said Pinky was lactose intolerant.

It was not something Arora was familiar with and when the doctor explained, she found it hard to believe that her daughter could be reacting like this to milk and milk products.

“I’d been raised on a steady diet of doodh-dahi-ghee (milk, yoghurt and clarified butter) and followed the same with our children,” she says.

Whenever Pinky was thirsty, she was given milk. Gallons of it.

“Think of me as Saina Nehwal’s mom on steroids!” Arora says with a laugh, referencing the biopic of the badminton star in which her mother plies her with milk and ghee-soaked parathas “for strength”.

With the doctor’s help, she was able to make the necessary changes to her daughter’s diet and is happy to report that her symptoms not only eased, but that as she grew older, she was able to tolerate milk more.

The Bajwas* were at their wits’ end. Their son Arjun* was acting up and no form of disciplining they tried seemed to work.

“It only made things worse, in fact,” admits Dolly Bajwa. “He was refusing to make his bed, keep his room tidy, help with little chores around the house as he used to – you know, empty the dishwasher, cut the grass, stuff like that?”

Arjun was also talking back a lot. His parents took away privileges, didn’t give permission for him to attend a rock concert he was really looking forward to. They talked, they scolded, but all to no avail. It was almost like he’d turned into a stranger, she says.

A friend suggested they seek counselling, but the idea made them uncomfortable, they didn’t want to air their problems in front of a stranger. But with things getting out of hand, they caved and sought an appointment with the school counsellor.

“We thought at least she knows us and so it will be easier to talk to her. I still regret doing that.”

The counsellor, says Bajwa, dismissed their concerns as “normal teenage behaviour”.

“She was friendly enough, but appeared clueless about our expectations as parents. She lectured us instead of talking to Arjun about his responsibilities at home or giving us tools to deal with the situation. It only made things worse as now he had ‘official’ sanction for his behaviour.”

The family went through a long and difficult period before achieving some sort of calm.

“I have to say, that came more from our compromising on our expectations than from any real change in him, but by then, we were just so tired of the unpleasantness at home,” she says ruefully.

Parenting issues can range from the seemingly frivolous to the all-important. There are no manuals, really, no blueprint or one-size-fits-all solution as we all muddle our way through following our best instincts and well-meaning advice from family and friends. But sometimes parents just need to be able to source sensible, practical, medically-sound advice that is also culturally sensitive. Both Meenu Arora and Dolly Bajwa, for instance, might have benefited hugely from Punjabi Kids’ Health had it been around a few years ago.

Led by St Michael’s Hospital pediatrician Dr Ripudaman Singh Minhas, Punjabi Kids’ Health is an invaluable resource for Canadian parents of South-Asian descent, providing health information from a pediatrician who understands their language and culture – in a medium doctors don’t normally tread: TikTok.

Dr Minhas completed the Developmental Pediatrics sub-specialty training program at the University of Toronto and the Holland Bloorview Kids Rehabilitation Hospital. He was a Global Health Scholar at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and completed his Master of Public Health and a certificate in Global Health there. He completed his medical degree at the University of Toronto, with General Paediatrics residency at the Hospital for Sick Children in Toronto.

He is now a Developmental Paediatrician with the Women’s and Children’s Health Program at St Michael’s Hospital and an assistant professor in the Department of Pediatrics, University of Toronto. His research interests are in the development, behaviour, disability, and rehabilitation of children in urban settings and in newcomer immigrant and refugee families. He is working to develop interventions to support the developmental potential of children in the unique context of their social determinants of health and inequity. His team uses community-based participatory research principles to guide the co-creation and implementation of family-based interventions and the evolution of health systems.

His current focus is in supporting parenting in communities experiencing marginalization. This includes the Maple Circle program which aims to support the parenting journey of families of refugee background, and Punjabi Kids’ Health, a social media-based health literacy program to support families in the global Punjabi diaspora.

Dr Minhas saw the need for this online parenting support resource, because, he says, “When we think about the concept of ‘communities’, it can also be important for healthcare providers to reflect on the communities in which we sit, not only as professionals, but also as humans with lived experience ourselves. Sometimes we may feel the need to mask that in the name of professionalism, but, who we are (with our perspectives, experiences, culture, and attitudes) adds richness and context to the care we provide.

“As a part of this journey for myself, as a clinician who identifies as a Punjabi Indo-Canadian Sikh, a settler, and as a parent, I have worked to create (along with a wonderful team) Punjabi Kids’ Health. This came from watching the unearthing of grave disparities in how racialized communities participate in our healthcare systems, as evidenced by the COVID-19 pandemic, including in my home community of Brampton, Ontario.

The social media health promotion campaign in English and Punjabi is aimed at a broad range of ages, from prenatal parental content to adolescence, and provides advice on topics such as starting solid foods, dental care and growth and development, etc., in videos that are 60 seconds or less.

In just a few months since launch, Punjabi Kids’ Health has grown to 2500 online community members and on TikTok, nearly 14 thousand. Followers in Canada, the United States and India look to the accounts for trusted advice through regular posts and live Q&A sessions.

The goals of the campaign are to:

• Provide culturally-sensitive evidence-based medical advice to both parents and grandparents (and practitioners who work with them).

• Fill the gap of inclusion and diversity in the “mommy blogger” space.

• Address the mistrust many South Asians feel towards Western European medical institutions – particularly at a time when racialized communities are disproportionately impacted by COVID-19.

“At a time when families are isolated and spending even more time parenting than before, families are turning to social media to recreate parenting communities and to share and gain knowledge,” notes Dr Minhas. “In a recent systematic scoping review, we found barely evidence-based social media interventions that focused on the unique needs of racialized or marginalized communities in their parenting or child health literacy needs. Or in other words, the virtual space of mommy-bloggers and evidence-based parenting resources continues to be exclusive of culturally diverse populations’ needs.”

Dr Minhas also works with school-based clinics in Toronto to provide healthcare to the city’s most vulnerable inner city children in an innovative partnership between St  Michael’s Hospital and the Toronto District School Board. Students who are struggling at school are provided developmental assessments. Many patients have diagnoses such as autism spectrum disorder, global developmental delay, speech and language impairments, attention deficit-hyperactivity disorder, anxiety, learning disability or intellectual disability.

Maple Circle and Punjabi Kids’ Health are focusing on supporting parenting in marginalized communities with the Pediatric Ambulatory Clinic.

 “We share information from people who look like and speak like the target audience, and we attempt to do it in an engaging, responsive way with a cultural group that manifests in a widespread, yet close-knit diaspora of 102 million, with a deep history of multigenerational trauma which includes colonization, the fight for independence, a painful partition, cycles of genocide, and a resultant mistrust of Eurocentric institutions.”

Most new parents receive advice from their own parents and extended family on best parenting practices – “After all, we raised you and you turned out fine!” Well-meant, it can sometimes clash with what medical professionals are saying.

“It’s so tricky to balance advice from sources like family, friends and media with evidence-based care-giving strategies,” agrees Dr Minhas. “With a changing landscape, parents nowadays encounter resources and risks that are very different from generations past. While some parenting strategies continue to be tried, tested and true (like eating together, singing, reading), there are new challenges around managing screen time and safety. Historically, humans have always sought to create parenting communities to share knowledge and support one another – it only made sense to create an online space for this shared journey.”

Each week, Punjabi Kids’ Health has a topic theme.

They’ve covered a range of topics including COVID, virtual school, nutrition, autism, and the mental health impacts of the Indian farmers’ protests (and the current COVID crisis in India) on children and families.

They’ve shared information on nutrition and dietary habits, including the importance of offering healthy snacks, the value of cultural foods, and approaches to kids who are deemed “picky eaters”.

They have discussed speech and language development, the importance of early identification of speech delays, therapies and the neuro-developmental benefits of bilingual homes.

And they recently added content on managing screen time and understanding the various types of screen time, its merits and risks, developmental impacts of prolonged screen exposure, and recommendations for screen time limits.

“We had an amazing multidisciplinary live expert panel for Mother’s Day about maternal mental health, and another for Father’s Day about the evolving role of male caregivers, cultural stereotypes on masculinity, and the impact of paternal addictions on children’s well-being,” says Dr Minhas.

“Mental stress relating to all of the changes in the pandemic has taken a toll on our adolescents. This may look like changes in mood, sleep, appetite and behaviour. It’s important to make a safe space at home and school to reflect and process as a family. This may be through talking about feelings and perspectives. But there is also value in being in a space together – not forcing conversations, but reminding your teen that you’re there and that they’re safe.”

Many online community members have responded to say they appreciate the bilingual content, which allows for easy sharing with grandparents who may find the Punjabi content more accessible. This multi-generational approach to information sharing allows for all caregivers to be able to access this health advice and be on the same page for care-giving practices at home.

But why is it important to have practitioners who “look like and speak like” the online community?

Is there a greater connect?

Or a belief that he/she knows where we are coming from, a better understanding of our issues?

And is medical advice and parenting info different for Punjabi families from medical advice and parenting for others?

Dr Minhas points to multiple studies that have shown that health outcomes improve when providers look like and speak like their patients, particularly if they are of racialized or marginalized backgrounds. Families have also cited in the PKH community and also in the literature, that it is easier to trust and operationalize health advice from someone who shares part of their lived experience, including an understanding of barriers and concerns.

“Medical advice – either in its content, or in its delivery – needs to be tailored to the strengths, needs and values of each family.

“The decisions that parents make daily, around things like screen time, nutrition, bedtime routines, and homework, are all tied to long term outcomes.

“Parenting behaviours are health behaviours. Prescriptive approaches don’t work to engage families in changing these health behaviours!

“Thinking about other health behaviours, like whether someone smokes or exercises enough or eats too much junk food – we would not expect those behaviours to change simply because a doctor advised them to do so once. Rather, it’s important to think about the unique constellation of each family’s and community’s resources, values and barriers, to meaningfully impact sustainable change.”

It could be argued that someone who is social media savvy enough to access health info on social media doesn’t need it in Punjabi (or any language other than English). 

“There are many parenting resources out there for English-speaking, resource-abundant families, though these all tend to apply Euro-centric approaches to raising children,” explains Dr Minhas. “We have seen with the disproportionate impact of COVID-19 on racialized communities, that language or access to technology is not the only barrier. Cultural communities have differing knowledge, attitudes, values and practices when it comes to their decisions and behaviours around health. We know that English-speaking South Asian families still tend to have different lived experiences, considerations and approaches than White Canadians. PKH attempts to make spaces for these conversations and considerations.”

Coming to “the mistrust many South Asians feel towards Western European medical institutions – particularly at a time when racialized communities are disproportionately impacted by COVID-19” that PKH hopes to address, Dr Minhas says this is not just anecdotal, data supports this thought that some people hesitate to see a non-desi family physician and that racialized communities in the Greater Toronto Area had a seven to nine times’ increased risk of being infected by the coronavirus than their White counterparts.

The team plans to pivot the project to study its impact through focus groups and to involve followers and youth in the evolution of the campaign.

Initial feedback has been key in helping them understand what they are doing right, wrong, or not enough of. But, generally, there seem to be themes of:

• Appreciating evidence-based, bilingual information.

• Being able to connect with other parents and practitioners despite the isolation of the pandemic.

• Having content that is perceived as relevant to multi-generational households and caregiving practices.

• And an appreciation of seeing professionals who share lived experience (which we know from many studies helps to improve health outcomes).

In reciprocity with the community, the PKH team is mentoring volunteers and students from the community in research methods and health promotion frameworks.

They are seeking to engage with artists, filmmakers and content developers from the Punjabi community to help provide context to how the intervention is carried and to support capacity building with the community.

Recognizing their team’s position, power and relative privilege within the Punjabi community, they are assembling a community advisory board to steer, sustain and host the project.

And Dr Minhas is happy to note from a provider standpoint that their guest experts and trainees have expressed excitement about being able to share their training and expertise through Punjabi Kids’ Health with a community with which they culturally identify, but felt professionally disconnected from due to the frameworks in which they train and practise.

 “We really want this initiative to be driven and sustained by the community itself,” he says. “We hope for PKH to be a place that enables equal partnership between the community and healthcare experts to create a living resources that is both evidence-based and relevant to the evolving needs of families. As our group thinks about lessons learned and potential replicability to other South Asian communities or ethno-cultural groups, we must keep in mind that the experiences of South Asian subpopulations are vast and diverse, and will require representation, intensive community engagement, translation, adaptation and iterative refinement of the model as we consider tailored support programs like Tamil Kids’ Health, Bengali Kids’ Health or Gujarati Kids’ Health and so on.

“The most rewarding aspects of the project have been the comments from PKH’s online community members.

“We have gotten many comments from people who share their insights on what we can improve or do next – this is truly appreciated and tells us that folks are taking in the content, and feeling safe enough to share their insights on how to steer the project. Some of the comments are also lovely testimonials from families who have tried some of our strategies or have shared them with others and found improvements in their family’s health, well-being and connection with one another.

“One mother wrote to share that she had implemented our approach to turning off screens during meal times with her toddler, and that this had now transformed into a wonderful time for them to eat, play and sing together. This is what it’s all about!”

COMMUNITY CONNECT

Questions about COVID vaccine? 

Watch www.instagram.com/tv/CLfemucjOP2/.

Tips for virtual school? On www.instagram.com/tv/CMBGqI8FApF/.

For content on Punjabi Kids Health, check out www.instagram.com/punjabikidshealth/.