Elderly Refugees: The Experiences of Cambodian populations under the Khmer Rouge

War, natural disaster and fear of persecution often result in the tragic displacement of people far away from their homes. These people, refugees, live in uncertainty and under significant psychological and physical stress. Among these refugees are the elderly who are a particularly vulnerable group. Aging is not limited to disease and disability, but also the sudden change and a loss of belonging. The experiences of Cambodian elderly refugee populations is a clear example.

The Khmer Rouge took over Cambodia in the 1970s, prompting several years of genocide and a mass exodus of Cambodians into Thailand, US and other countries. By 1979, there were 160,000 Cambodians in refugee camps in Thailand.

A 10 year study sought to capture the experiences of Cambodian Americans in Northern California. Most Cambodian Americans lived in run down neighborhoods with a high prevalence of criminal activity. Elderly immigrants were at high risk of occupying poor housing conditions. Despite this fact, some refugees chose to move back into inner city neighborhoods as they aged to be a part of the community they once were as recent immigrants. In the case of this refugee population, many elderly people did not want to return to Cambodia given the turmoil which influenced their flight. Of those who did, they were constantly reminded of the differences in living conditions between the two countries.

Many Cambodian refugees in the US had poor education. With low income and little to non-existent English skills, elderly refugees constantly needed support from other immigrant populations, their children, and resources from the government. One woman says, “At my age, I’ve nothing to do, but pray for my children. I know that now I am their pillar, but later when they all grow up and leave, I will be alone with only myself to rely on.”

The past experiences with the hardships of the Khmer Rouge are constantly woven into their current narratives. For instance, many elderly complain of diseases such as high blood pressure or sleeplessness, and attribute such ailments to the harsh lives under the the Khmer regime. Post-traumatic stress disorder and depression are also common among Cambodian refugees. According to one study, family-related anger is prevalent among refugee families because of the cultural gap between refugees and the general population, as well as between refugees and their children who are much better adjusted to American lifestyle.

There are many organizations working towards improving the lives of elderly immigrants. The International Rescue Committee (IRC), one of the world’s leading organizations for refugees, has an Elderly Refugee Program. This program provides English as a Second Language classes, and assists in part-time employment and obtaining citizenship.

Yet the question remains – What can be done about the sense of loss of loved ones, one’s home, country and citizenship?

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

How Robot Technology is Caring for the Elderly

Communication
Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

Why China Needs More Skilled Health Workers for the Aging Population

China’s workforce is aging. Of special relevance here, and a pressing issue for the country, is the aging of its healthcare workforce. These include China’s barefoot doctors who are rapidly aging. Barefoot doctors are farmers who receive basic and minimal medical training and work as health care providers in the rural areas of China.

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Xu et al.
highlights three main implications of aging barefoot doctors. The first implication is a high risk of healthcare workforce shortage in the immediate future, leaving many rural residents without basic healthcare. This will create a huge burden on China’s healthcare system, hindering any plans for health reform. The second implication is that aging barefoot doctors currently have lower education levels, are less susceptible to change and technology and lack the formal training of younger counterparts, which might deter rural residents to seek care from them. The third implication is that the very same characteristics of aging barefoot doctors can lead to poor treatment and provision of facilities, especially for non-communicable diseases. While data on urban health care providers and other types of health personnel such as nurses is scarce, the general trend toward a graying population in China tends to suggest that these types of workforce are also aging.

China has one of the highest proportion of aging population at over 9%. At the current rate, this proportion is expected to increase to 25% by 2050. The aging population is a result of population control strategies in the 1970s and 80s as the government promoted the “later, longer, fewer” lifestyle. Moreover, the government instated the controversial one-child policy which restricted families to having only one child. There are several consequences and impacts of an aging population that require a focus on chronic, non-communicable diseases. Close to two-thirds (60%) of the disease burden in China is non-communicable diseases such as cardiovascular diseases and diabetes, among those of 45 years and older.

The healthcare industry is not alone in facing an aging workforce. The increasing age of the workforce decreases productivity, while raising the average wage level. On a global level, this will make a dent in China’s manufacturing might and other labor-intensive industries, threatening the country’s economic growth rate. At the current rate, India and Indonesia are poised to overtake China in terms of economic growth by 2020. The trends are also seen in the Chinese migrant workforce, a population of about 245 million migrant workers at the end of 2013. The average age increased from 33.1 years in 2011 to 33.7 years in 2013.

However, the situation is not all bleak. An aging population provides great potential for a booming healthcare industry that needs to account for chronic diseases as well as elderly living options due to rapid urbanization and changing family dynamics. There is documented need and much scope for growth in China’s healthcare industry, particularly catering toward the elderly. However, the needs for the younger generations who may be facing lack of adequate healthcare should not be ignored.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Boosting Public Transport Supply to Meet Needs of India’s Aging Population

India’s elderly population is expected to rise by 360% between 2000 and 2050 and contributes to 20% of the total population. Due to population growth, infrastructure in India has to keep up with the demographic change by providing accessible and affordable public transportation, which is vitally important. India boasts of a well-connected transportation system with trains, buses, metro systems, auto rickshaws and taxis in urban as well as, to a lesser extent, rural areas. Despite the plethora of transportation options, many of these services are beyond the reach of the elderly population.

Mumbai
The large number of people utilizing public transportation is a major hindrance for the elderly. For example, in Chennai, a south Indian city, the elderly complain of how government buses are always crowded. While there are seats reserved for the elderly in these buses, it is hard to avail of these services. In Mumbai, another metropolis, trains are the preferred means of transport because they are fast, cheap and reliable. However, they are extremely crowded which makes it really difficult for senior citizens to get in the train. Like the buses in Chennai, these trains too have reserved seating for the elderly.

Another major issue is affordability. As Ravi Samuel of Vision Age India states, “If elderly people cannot afford private transport, it is very difficult for them to commute or attend social, religious and family functions.” Those who can afford it use the relatively expensive modes of transportation which include rickshaws and taxis. They can be hailed from anywhere, depending on the city.

There are national guidelines for age-friendly transportation in place. These include 2 reserved seats for the elderly in the front of the bus, fare concessions and subsidized bus passes, 30% concessions on trains, separate counters for senior citizens, ramps at stations for greater accessibility, disability-friendly train coaches and fare concessions by several major public and private airlines. It is heartening to see that many cities and/or states go above and beyond these guidelines.

For instance, Mumbai is currently petitioning for elderly-only compartments in all trains at the Bombay High Court. New Delhi, the country’s capital, has introduced low-floor buses. Since their introduction, the number of senior citizen bus passes has increased from approximately 255,000 in 2007-08 to 1,100,000 in 2013-14. These buses also display ticker messages on aboard buses, reminding passengers to not occupy or block the seats meant for the elderly.

Initiatives like these are great first steps towards accommodating the elderly population. Yet, it is important to remember that transportation is but one aspect of infrastructure that needs to be worked on. A cross-sectional approach, incorporating sectors such as housing, education, roads, law-enforcement and town planning, is necessary to provide an easier and holistic lifestyle for the elderly population in India.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.