Taking the Slavic pulse
Six of the Kaskevica children stood elbow to elbow around the family’s kitchen counter on a recent Tuesday evening.
Four were on one side of the Formica island, two were on the other, and 6-week-old Aenamul-Alen slept in a bedroom down the hall. They took turns washing their hands, singing the words to “Happy Birthday” twice to ensure all the germs went down the drain. They good-naturedly fought over who got to brown the hamburger. And, in a sweet chorus of “Aw, c’mon,” they coaxed 6-year-old Marks to pull his face from the crook of his elbow when shyness overtook him.
Who knew preparing dinner could be so delightful?
The healthy, happy Kaskevica family, who emigrated from Latvia 16 months ago, is a minority within a minority. They are among the 20,000 to 25,000 Slavic immigrants living in Spokane County, and, within that community, they are outnumbered by people who don’t have health insurance, don’t see a regular doctor and don’t eat healthy foods.
“It’s good for your blood,” 12-year-old Rufina Kaskevica said, explaining why the family eats pomegranates for dessert every night.
The Spokane Regional Health District released a report last month comparing the state of health in Spokane County’s Slavic community with the general population. It has surveyed other groups in the past, including Native Americans, and plans to focus on roughly one sector per year, including upcoming efforts to survey the Hispanic and elderly populations.
According to the new survey, Russian- and Ukrainian-speaking immigrants are less likely to have asthma than their English-speaking counterparts, but they’re at greater risk for diabetes and much more likely to report poor mental health. Almost half of respondents to a survey don’t have health insurance, and two in five don’t see a doctor when they should. And while fewer Slavic adults smoke or drink than the rest of the population, their children engage in risky behavior on pace with English-speaking youths.
The Slavic community “is underserved,” said Tatyana Bistrevsky, a paraprofessional educator and coordinator of Cultivating Community Strengths Together, an outreach program for immigrants, through Washington State University’s Spokane County Extension. “Their needs haven’t been met yet.”
Two results from the survey stood out to Bistrevsky, who was part of a team of Slavic immigrants who reviewed the survey results for the health district.
First, she was surprised that Slavic people have more problems with diet and weight-related conditions than the general population. Nine percent of Slavic adults and 12.3 percent of Slavic youths had diabetes compared with 7.9 percent of the general population and 3.3 percent of English-speaking youths. Almost 38 percent of Slavic adults are obese, while 23.5 percent of the general population is, and nearly two-thirds of Slavic adults eat fewer than five fruits and vegetables a day.
Teens drink, adults don’t
The survey’s data on drinking among youths also struck Bistrevsky, whose face sank as she recalled a fiery crash last August in Mead that killed three Slavic teenagers and injured another.
“This is a problem for the Russian youth,” she said.
Slavic teens’ drinking habits are almost identical to their English-speaking counterparts. Seventy percent surveyed hadn’t consumed alcohol in the last 30 days, 15.8 percent drank one to four times in the last 30 days and 13.5 percent drank five or more times in the last 30 days—figures that are no more than three-tenths of a percentage point away from English-speaking youths.
What’s striking is that they’re not learning how to drink from their parents. Almost 85 percent of Slavic adults considered themselves non-drinkers compared with 40.3 percent in the overall community.
The low drinking rate among adults is attributed to the fact that many Slavic immigrants are devout Christians who came to America for religious freedom, Bistrevsky said. The Slavic youths, she believes, are trying to fit into their perception of American teen culture, something she saw occur often when she worked for the Spokane School District as a tutor in the 1990s.
“They wanted to do everything they could to be like other kids … to be accepted,” Bistrevsky said.
Her goal is to open a youth center for Slavic teenagers, whose main social outlet now is the ice arena at Riverfront Park, she said. Many of their parents won’t let them participate in extracurricular activities at school, such as clubs and sports, because they distrust government, Bistrevsky said.
She had two siblings taken away by the Russian government when they were young, although she encouraged her children to be involved at school once they came to America.
Alex Kaprian, a social worker with the Department of Social and Health Services and pastor at Pilgrim Slavic Baptist Church, said the fear of government is real, especially among older immigrants who vividly recall the communist regime.
In addition to the ice arena, he said, many youths participate in church activities. But the cost of school sports uniforms and band instruments can be daunting to immigrant families, especially since many have six or more children who are supported on one low salary.
Kaprian said Slavic children are quite isolated from the general population and often feel “pushed away” by American-born youths.
” ‘Hey, go back to Russia,’ ” Kaprian’s nine children have often heard, even though three of them were born in the United States.
District studies disparity
Alicia Thompson, an epidemiologist with the health district who headed the survey, said Health Officer Dr. Kim Thorburn has made it a priority to examine health disparities in the community.
Although Spokane’s Slavic population has grown rapidly in the last decade, Thompson called it a “hidden population.” That’s because immigrants from the former Soviet Union are Caucasian, so when they answer questions about race on medical forms they’re lumped together with other whites.
The health district used three different surveys in its analysis. The Slavic Community Health Survey was conducted between spring and fall of 2004. Slavic immigrants were asked to fill out surveys at public health events, in Slavic churches and at other community venues.
The Slavic survey was compared with the Behavioral Risk Factor Surveillance System, a random telephone survey of the general population conducted every year in Spokane County.
To compare youths, the health district looked at the 2004 Healthy Youth Survey, which is conducted each year by the Office of the Superintendent of Public Instruction and other state agencies. The data from 8th-, 10th- and 12th-grade students who speak English at home was compared with those who speak Russian or Ukrainian.
Completing the Slavic survey were 167 people; 1,255 members of the general population took part in the Behavioral Risk Factor survey and 180 of the 7,560 respondents to the youth survey spoke either Russian or Ukrainian.
The district’s analysis also found that:
“ About 53 percent of Slavic respondents have one person they think of as their personal doctor, compared with almost 80 percent of the general population;
“ 48 percent of Slavic respondents have health coverage compared with 85 percent of the general population;
“ Almost four times (41.3 percent) as many Slavic respondents said they skipped seeing a doctor when they needed to in the past year compared with the general population (11.9 percent);
“ 29 percent of Slavic women reported having had a Pap smear at some point in their lives, compared with 93.1 percent of the general population, and about 19 percent of Slavic men have had a test for prostate cancer, compared with more than 47 percent;
“ And 28.7 percent of Slavic respondents had been tested for HIV, compared with 39.4 percent of the entire community.
Bistrevsky said some immigrants are sharing medications with family or neighbors because they either can’t afford care or don’t know enough English to navigate the medical system.
Kaprian added that many Slavic immigrants are traveling back to their home country to have their teeth fixed or medical problems addressed. The trip plus the cost of their care in the former Soviet Union is cheaper than having to pay for it out of pocket in Spokane, he said.
“There’s a myth going on that immigrants are abusing the health system in America, but it’s not true,” Kaprian said.
They’re not even using it, he said.
Poor mental health
The survey also shed light on the state of mental health in the Slavic community.
Almost 20 percent of Slavic respondents reported being “sad,” “crying a lot” or “feeling down or hopeless” on 15 or more of the previous 30 days, compared with 10.6 percent of the general population. While almost two-thirds of the entire community had zero days like that, only 40 percent of Slavic adults could say the same.
Bistrevsky said the culture shock of moving to a new country contributes to this. Also, immigrants who can’t get good-paying jobs because their English skills are poor might feel down, especially if they are the male head of a household.
The elderly might be depressed because they miss living in the same apartment complex or neighborhood as their children and grandchildren, as was more common in the former Soviet Union. In Spokane, many older immigrants live in nursing homes, Bistrevsky said.
“They miss their children,” she said.
Also, “Russian-speaking people went through lots of hardships” under the communist regime, Bistrevsky said. “It was hard to leave everything else behind.”
What’s being done
The paths of the Slavic community and Spokane’s general population are crossing frequently these days—a trend that likely will grow as the immigrant population does.
Bistrevsky listed numerous efforts under way to make immigrants feel more connected to the community. And Kaprian said he often hears of Slavic immigrants working side-by-side with American-born workers – that is, when Slavic men and women aren’t edging others out of jobs because they’re willing to work hard for less pay, he said.
Thompson, of the health district, said the state of Slavic immigrants’ health should be of interest to the entire community.
“If my neighbor down the street can’t get dental care and they live in pain, that’s going to affect me in some way, whether their children are told to go outside and play and they’re not supervised,” she said. “We’re all connected whether we acknowledge it or not.”
As the community becomes more tightly woven, Kaprian said, “education is the key to preventing discrimination.”
The health district plans to use the results of the survey to develop materials for health-care providers and Slavic people next year that target specific health issues brought to light by the report. A grant will pay for that project, Thompson said.
“If we had stable funding for public health, I’m sure that we would do a whole lot more with those results,” she said.
WSU Extension is taking various steps to better connect the Slavic community with the general population and teach healthy habits. It publishes a monthly newsletter with nutrition, education and other tips that has become so popular some immigrants are storing past issues in binders.
The organization recently hosted an information session for Russian-speaking seniors interested in signing up for Medicare’s new prescription drug benefit and is teaching sewing and other classes to keep immigrants connected with their community.
Bistrevsky also visits homes to teach families how to prepare healthy meals.
That’s what brought her to the Kaskevica home in north Spokane late last month. She taught the children to make smoothies of yogurt, milk and fruit and gave recipes to their mother, Anzelika, who stays home with the children while her husband, a truck driver, is on the road.
Ten-year-old Santa Kaskevica said she and her siblings often go to a nearby park for exercise, but staying active was easier in Latvia where they often played soccer with their cousins.
While the Kaskevicas are staying healthy – thanks to state health insurance and desire – Bistrevsky works with a family of eight that isn’t as fortunate. On a recent visit to that home, Bistrevsky found an empty refrigerator and an exhausted mother who’s pregnant with her seventh child.
“They’re so poor. She has no car. She gets stuck at home” while her husband works 12 hours a day, Bistrevsky said.
That day, Bistrevsky went to the grocery store and returned to stock the family’s cupboards.
“And then I came back to work and cried,” she said.