Breaking taboos

Mother of two and local resident, Alya lives right on the doorstep of her employer, the Bromley By Bow Centre. With over 30 years of experience in local community work, she is a social prescriber and energy adviser. In this interview, where Alya gives an insight into the health needs of local Bangladeshi women, we start by chatting about the perils of working in her own neighbourhood.

Some of my clients live on the same street as I do - that’s a challenge. Sometimes you have to move on quite swiftly! In times of difficulty people don’t want added stress though, they want a familiar face. It takes away some of the anxiety. It reassures them. 

Most of your clients come from a similar background to yours. How does your language ability help create meaningful conversations?

Most of my clients are of Bangladeshi origins. The younger people I see are mostly second generation, so they can speak English unlike their parents and grandparents who spoke little or no English. In the 1:1 sessions they can open up, talk about their concerns and challenges. I can have that holistic conversation. We’re from the same culture and religious background, which automatically creates a connection for the client, keeping sessions person-centred and culturally appropriate. My background enables me to understand what their needs are. Just basic things like how you address and greet somebody, the way you offer information, those things make a big difference and help build trust between the social prescriber and client. 

Are there any conversations that stood out for you?

One in particular, came to this country and was then divorced. She was then taken in by another family as a house servant - basically what we could call modern slavery. She didn’t speak English, so when she saw me, our language was the first connection. It allowed her to talk about her mental health, which was one of the biggest things; to acknowledge she was suffering from depression. It’s not an easy thing in our culture, it’s still very much a taboo. Our connection allowed her to open up and share all her issues. The lack of money, going hungry, really sensitive conversations, she hadn't shared any of it. She felt shameful, that as a mother she should be able to provide. It took a lot of courage for her to say these things. 

What could you offer her?

At first, the referral was for depression and social isolation. I had to establish what was important to her. What did she want to get from the sessions? She wanted to be mentally strong so she could be a better mother to her son. Then we had to see how she was going to get out of her situation. She was an overstayer and she had no legal status. We had to establish what services could support her. How would we get legal status for her? So it was referrals for legal advice on how to establish her legal status. After that it was ensuring her basic needs were met for food and clothing. Even though where she was staying wasn’t ideal, she was safe, had a place to stay and some food. So we looked at charities and local donations for clothes. We approached The Biscuit Fund for small one-off grants for people with no recourse to public funds, and applied for winter clothing and money to get essentials, like female hygiene products. Then it was signposting her to food banks, The Salvation Army, Bow Road Food Bank. She was using these to tide her over. Through all of that I was using the sessions to help build her mental resilience, her patience. What can she do for her wellbeing? Go for walks, join social groups, go to social activities, the carers parents group at the school - where she wouldn't have to tell the family where she was going when she dropped off children. Within 6 months she had indefinite leave to remain. Our next goal was longer term - can she remain where she is, does she need to move out? So we had to look at housing. She’s now in temporary accommodation, so we’re looking at how to make it habitable and sustainable for her. Applying for Universal Credit, child benefit, but continuing with wellbeing at the top of the agenda. Then ESOL, then employment. She wants to do care work as she feels she can do it, and easily get that work. 

What are the specific health needs for most women you see?

One of the key trends I and other colleagues have noticed is weight management. During the pandemic people have struggled to stay fit and active. They’re now seeing the impact of that with weight gain. And this weight gain has had an impact on their health, management long-term health conditions like diabetes, Asthma. Cholesterol is higher, BP is higher, arthritis is worse, and eating styles have changed. This impacted the whole family. So if the key person in the home is not as health conscious and aware, it filters down to everybody else. So the weight then becomes the key factor for some that’s pushing all the other conditions. 

Is the need for weight management services being met?

Absolutely not. Although a lot of people need it, there are very few services providing weight management advice and support. There’s the NHS online 12-week weight management programme and the Couch to 5K. But if there’s a language barrier or digital exclusion, those programmes aren’t very useful. It’s assumed everybody has access, and a lot of people don’t. And some that do aren’t necessarily computer literate. Online is a scary place for some. Services to refer to are limited, and when we do find something there’s usually a fee. With the cost of living crisis and increased fuel prices, to refer them to a programme that costs £25 a month, they can’t prioritise that. So where do you send them? Or if I try to refer them to an online zoom class, they’re worrying about the electricity cost. Will they need to top up an extra £1 to log in? 

So what’s needed to support Bangladeshi women to access the services that are available to them?

One of the things as a social prescriber and growing up in a Bangladeshi household is that health and fitness was never a priority. Growing up, and I speak from experience, health was never discussed; how do you stay healthy and fit. If I’m doing X now, I’ll be better off in my forties and fifties. How to stay healthy mentally and physically is never part of a household conversation. Implications of eating too much red meat, cooking in certain ways or not changing unhealthy eating habits; what could happen. Unless those conversations happen within the family dynamic, we won’t see changes further down the line. We need more education and awareness of food, our relationship with food, how it impacts our health. It has to happen in the home. So when we see people coming in for weight management, high BP, diabetes, cholesterol, you’ll find they’ve never had a health and wellbeing conversation in their home. 

Why do you think that is?

The problem escalates to the point they're going to the GP, having aches, pains, night sweats, they feel funny. They turn up to the GP, get tested and informed. Once they think, ‘I’m now sick,’ they see it as a sickness, rather than a result of previous lifestyle. They think ‘I’m now in my 40s, I’m getting older, that’s why I’m getting sick.’ The connection isn’t made. The GP tells them to think about managing weight. Then they come to us, because the GP told them and therefore it might fix their issues, not because they’re proactively seeking self-help. That’s when we see resistance and can’t get them engaged, as it’s not coming from them. Some people do understand and will do what’s needed to make the lifestyle change. Or when we refer them for physical activity, they’ll go for a couple of weeks then stop. It needs to come from them, that wanting to change. It could be a mixture of both culture and education. With our ancestors in Bangladesh they were active, they didn’t have to do extra physical activity. Lots  of them were farmers so led very active lives, while women worked hard in the homes and this kept them active. The health issues are when people come over here and they’re not physically active. Social determinants also come into play - overcrowding, lack of awareness and education, lower incomes.

How can that health conversation be brought into homes?

There’s a key role to be played by everyone from the mother in the home to the mosque imams, as they’re seen as one of the most senior figures in our communities. Mosque imams have talked about knife crime, bullying, discrimination, racism. It can start there, and slowly transition into the home. School is a really important place as well. Schools can do more with parents and children, mother and toddler sessions are key where they can incorporate a wellbeing conversation into learning. In our local school they do that. That can get mums to start thinking about health and home, what does this mean for me and my children. People would then be more receptive to that conversation when it comes up outside of their home. Mum and dad might then be asking their child about things like PE, and understanding why it’s important, rather than just asking about progress with maths, English and science. Schools, our community centres and even mosques are the key places.

Learn more about the Bromley By Bow Centre and the amazing work they do!