Shustho: Bangladeshi women rely on culturally competent care for better health outcomes

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.