SAPNA

The apartment’s small kitchen steams with the flavorful scent of cumin, ginger, turmeric, cardamom, clove, cinnamon and garlic. Slender pieces of chicken simmer in a yellow curry. On a platter, a handful of bright green, fiery-hot chili peppers sit atop fresh-sliced tomatoes and onions. A bowl of steamed rice waits to the side. Rubyna (Ruby) Begum and Rahima Akhter work their culinary magic, dressed in traditional salwar kameez dresses, both just as colorful as the brilliant meal being prepared. It’s almost noon and the two women are in the office of Sapna NYC, a non profit established in 2008 to serve South Asian women in the Bronx’s Westchester Square and Parkchester neighborhoods. Today, Ruby and Rahima will demonstrate a typical cooking partnership that is a core program of Sapna’s approach to addressing the social and health needs for many of the Bronx’s South Asian women.

Kajori Chaudhuri is the Director of Programs and Operations for Sapna NYC. She organizes what Sapna calls the Situated Learning Theory (SLT) approach, a process built out of the belief that personal change happens when an individual joins a learning community or a community of practice. Communities of practice refer to the development of intentional social settings to create a social network of people sharing language and experience. Many South Asian women live in Westchester Square and Parkchester but that doesn’t necessarily mean they know one another. Having a friend or group of friends who speak your language and who grapple with shared challenges can be an empowering thing.

“One of the antidotes to depression is creating social networks,” Chaudhuri says. “There are women in these groups who are in different phases of immigration. Some have just arrived, others have been here six or seven years. Education around health and food is a powerful way to treat and prevent mental health issues. But a big part of the equation here is about rebuilding community, supporting each other through the challenges.”

Sapna has created a community of practice called APPLE (Activating People to Pursue disease Prevention and Lifestyle change through Empowerment). In APPLE, each woman is assigned a bandhu or partner, often someone she did not know previously. The friendship is somewhat forced at first with required phone calls to get to know one another. The groups meet weekly for the first two months, each meeting facilitated by a community health worker. After two months, the meetings taper to twice monthly, though bandhus are encouraged to contact one another at least twice per week to check in, offer encouragement or just swap funny stories.

Programmatically, there are three phases to APPLE. In the Learning Phase, participants learn about healthy behaviors and why they matter. In the Practice Phase participants are taught day-to-day tools for healthy living, such as measuring the oil they use for cooking or employing a pedometer to motivate more daily exercise. There are weigh-ins at each meeting, so the women have attainable goals and friendly competition. Finally, the Outreach Phase calls on the participants to take their knowledge back into the community. Some do this through cooking demos, through becoming a bandhu, or through making a video to teach healthy practices, such as how to respectfully decline an extra helping of food when visiting a friend’s house. The women who completed the six-month APPLE course lost an average of 5.8% of the Body Mass Index.

“Women, in general, are nurturers,” says Chaudhuri. “They often put their health after that of their children and husbands, but if the woman’s health fails, the whole family is impacted. Providing healthy meals and being knowledgeable about healthy behaviors gives women a sense of control and a powerful way to contribute to the family.”

When Ruby and Rahima began learning the downsides of a diet heavy in oils and fatty meats, they worried that their families would not like the more lean meals prepared with measured-out amounts of oil. But they realized that they were good enough cooks to create appetizing, aromatic, visually appealing meals that were equal if not better in taste. The oil was just an unhealthy crutch. Plus, as Chaudhuri reminds them, “You’re in charge – you can use less oil, just don’t tell the family – it’s for their health so it’s ok!”

This year marks a new direction for Sapna. The APPLE program proved to be a success, but many of the women were also commenting on how their husbands and kids were losing weight and experiencing the benefits of healthy eating and exercise. Sapna created a pilot program called CHALO (Children’s Health Action to Lower Obesity). CHALO is a year-long program involving mothers and children between ages 8-12. Similar to APPLE, they meet weekly for the first month, then bi-weekly for the remaining ten months. The SLT theory remains the backbone with healthy behavior education,practice and outreach. Participants and their immediate family members are monitored throughout the year to record data for the ongoing research at Albert Einstein.Back in the Sapna apartment office, Ruby and Rahima finish preparing the lunch. It’s a typical South Asian curry. We eat family style at a long table. The dish is spicy and delicious. Rahima and Ruby are proud to share with us. Both women have moved beyond the initial “community of practice” phases in the Sapna programming. Ruby is a community health worker and ran one of the first cohorts of APPLE. She also completed a pilot CHALO session and will now lead a second round of women and children in that program.

140408 Why NY Food as Medicine SAPNA038 miniRahima has moved on to be a leader in one of Sapna’s economic empowerment programs. Sapna recognized early on that economic empowerment was a vital piece of a successful immigrant experience.

“Initially, the idea was trying to find local jobs,” says Chaudhuri, “but the question was, do we want to feed into the low wage situation in the Bronx? We looked into alternative employment opportunities for women who are skilled, but language and navigating the job market proved to be barriers. Since part of Sapna’s mission is to create democratic work places, we looked at women worker’s cooperatives.”

The first coop involved a frozen food business – homemade samosas frozen and sold in the community. The second coop was a child-care collective.

“The child-care cooperative has taken off faster than frozen food,” says Chaudhuri. “One of the lessons we learned is it’s much more feasible to see a positive return on a service cooperative versus a business that requires start-up monetary capital.”

“Once I got used to the subway system, I found that transportation is easy here,” she says. “Back in Bangladesh, as a woman I couldn’t be out at night alone. Here I can go to the store or visit friends and come back at night and no one cares. Back home, my husband would buy the groceries and pay all the bills. Now I’m in charge of that.”The child-care cooperative began by training eight members, including Red Cross CPR certification and English classes. Now half of those members have part-time jobs with Sapna’s child care co-op. One of these, Rahima, reflects on how much she’s changed from her early years in the Bronx .

It’s easy to overlook the importance of community and social support to well-being. But the immigrant experience highlights the fast-moving and harmful mental and physical repercussions that ripple out of a drastically changed living environment. No one wants to be left alone for eight hours a day to face the most challenging adjustment of their lives. Creating communities of practice are proving to be a crucial foundation for gaining a foothold in an immigrant’s new world.

In many South Asian cities or villages, households live as joint families, meaning a mother and father sharing a home with their grown children plus their spouses and children. Often, the women work in the home, sharing responsibilities with mothers, aunts, sisters, cousins. It’s a tight-knit community. If not in joint family settings, most South Asian women interact throughout the day with neighbors, many of whom are family members living under different roofs. When a woman immigrates, it is most often with only her husband and children. She leaves behind the rich tapestry of community that existed in and immediately surrounded her home. The immigrant’s sudden immersion into a disorienting environment and language coupled with the lack of community support can be a debilitating combination.

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For many South Asian women, cooking is one of their strengths and a touchstone to the comfort of home. But it can be a pitfall, as well. Back home the most accessible food items were fish, legumes and vegetables. Meat was rare, often pricey, and considered a luxury. Here, because America subsidizes the meat industry, it’s a much more accessible, affordable option, despite its ecological and health costs. For women like Ruby and Rahima, it can be easy to rely on their new country’s cheap, filling meat products, not to mention the myriad processed junk food options displayed in supermarkets and corner stores. A shift toward unhealthy eating habits like increased meat and processed foods can lead to chronic diet-related illness like diabetes and heart disease, which compound the mental health strains. The link between mental health and diet is a tight one and it can often feed on itself: isolation begets depression begets unhealthy eating begets obesity, possibly disease, which worsens the depression and entrenches the isolation.

South Asia (which includes countries such as Pakistan, Bangladesh and India) is one of America’s fastest growing immigrant populations. There are roughly three million South Asian Immigrants in the US and a million of them reside in the New York Metro area. Dr. Alison Karasz is a clinical psychologist and researcher at the Bronx’s Albert Einstein College of Medicine. In the late 2000s she received a National Institute of Health grant to conduct community-based participatory research of the mental health needs of local South Asian women. The goal was to gather mental health professionals and women from the community to discuss what depression means for the South Asian women and what a culturally acceptable treatment might be for that depression recovery.

The initial aim of research quickly morphed into actionable response within the community when the women volunteering to take part in the study (and those on the long wait list) asked what could be done to address the social and economic needs that contributed to the high rate of depression in South Asian women of the Bronx. To address these health and economic empowerment gaps facing South Asian women, Dr. Karasz responded by founding Westchester Square in 2008 (the name changed to Sapna NYC, meaning “dream” In Bengall and Hindi, in 2013)