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Youth Depression

Youth Depression

Editor’s Note: As in other immigrant communities, open discussion of mental health issues is taboo for many Indian American families, despite the fact that incidences of depression and similar disorders are on the rise. For one young woman, that stigma led to years of hidden suffering and missed opportunities at treatment, all in the name of maintaining her family’s “model minority” image. Leela (not her real name) spoke to NAM Health Editor Viji Sundaram about her experience. 

85

It started in middle school, when I was around 11 years old. I started feeling weak, had memory lapses and had no motivation to do anything. I felt sad most of the time. I thought the sadness was a normal part of pre-teen angst. I often starved myself for attention from my parents and friends. Most days, I cried myself to sleep.

Often, I didn’t finish my homework or turn it in. How could I? My thought processes were so chaotic. My grades slipped, and I felt guilty about it. I knew I was letting down my parents. My dad had done well in Silicon Valley. How I wish they understood what was going on inside of me. Whenever they asked me why I looked so exhausted, I just told them I was fine. And they didn’t press me further.

I tried to pull myself together, to work through my issues. I hid my pain, plunging myself into Indian classical music and South Indian classical dancing. Many people told me I was a good singer, but I didn’t recognize it as a skill I possessed and I had no confidence to sing before a gathering.

At school, my teachers didn’t understand me, either, but that may have been because I couldn’t articulate what I was going through. But even so my counselor sensed something was not well with me. My classmates began kind of bullying me, telling me I was dumb. It made me feel awful because I had always been a high achiever. My self-esteem hit rock bottom. My social life all but disappeared.

When I was in middle school, the principal told my parents to have me checked. They took me to an occupational therapist/educational strategist, who diagnosed me with Attention Deficit Disorder. While she treated my depression as a mere footnote, I was relieved to know that whatever it was that had been troubling me had a name.

But it was a tough pill for my parents to swallow. We South Asians are a model minority community and children are not supposed to have mental health issues. Sympathetic as my mom was toward me, she told me I wasn’t to tell my relatives or people in the community about my problem.

I was trapped inside a ball of depression and heartache. I felt so alone. Nevertheless, I was determined not to let that come in the way of my academics. At my parents’ insistence, I enrolled in some advanced placement courses like math, even though I wasn’t good at it.

Then my grades began to slip again. In my second year of high school, I grew anorexic. I dropped from 110 pounds to 84 pounds. For months, I kept slipping between binging and starving. I frequently flirted with the thought of committing suicide.

When I got accepted to the UC system, my parents were thrilled. With continued medication and therapy, I did well in school, although I didn’t have many friends. This was the first time I was living away from home and away from the networks I had built growing up.

One day, while in my freshman year, someone whom I knew sexually assaulted me. I was traumatized and I went into deep depression. I shut down completely and barricaded myself in my room. I stopped going to class. When my parents found out, they were angry.

I continued having panic attacks into the next year because the guy who raped me was still around. I kept retracting into myself and binging. I put on almost 50 pounds. My attendance was so poor that at the end of my sophomore year, I got kicked out of school and went back home.

I confided in my mom and told her about the rape. She was sympathetic. I enrolled in a nearby community college and isolated myself from my community because I didn’t want to be judged. I developed social anxiety.

More recently, I have been opening up to my mom and my dad, especially to my mom. They are doing their best to help me cope with what I am going through. But my mom still can’t read me because I still hide things from her.

Until recently, I didn’t know depression was treatable. I wish my teachers had recognized what was happening to me, and had not treated it as a passing phase.

I also wish Indian American parents realize how prevalent mental depression is and recognize it in their children so we won’t have to suffer in silence. I know other kids in my community who have mental health issues. Recognition is the first step in the healing process.

Accepting as my parents have been of late of what I’m going through, they have still not told anyone outside the family. That’s why as I share my story, I have to hide under the pseudonym, Leela.

This story was produced as part of New America Media’s #FeelBetter project, a storytelling campaign about depression in young people of diverse backgrounds. To explore the story collection, visit the #FeelBetter page and follow the campaign on Facebook.

Viji Sundaram is New America Media’s Health Editor/Writer. (Originally Published November 15, 2014)

The Art of Tying a Pug and other Sikh Stories

The Art of Tying a Pug and other Sikh Stories

2019 is the 550th birth year of Guru Nanak, the founder of the Sikh religion, that is indeed, the youngest religion in the world! Some of the most iconic symbols of Sikhism are Sikh men with their colorful turbans, gurudwaras which welcome everyone regardless of their religion, and langar, the simple community meal that all visitors to a gurudwara can share. 

As it turns out, some lovely children’s books capture various aspects of Sikhism’s rich culture and offer both adults and children a sneak peek at some best loved symbols of Sikhism. 

Have you ever wondered how Sikh men tie those beautiful turbans? Or the fact that colloquially, the turban is referred to as a pug, or that fifty is not a number when tying a pug? 

Natasha Sharma, one of India’s best known children’s authors, weaves a brilliant story in The Art of Tying a Pug, where a young Sikh boy learns to wear the pug but the family’s pet pug gets progressively anxious because he thinks the family is referring to him when they discuss ‘tying a pug’.  Sharma, a sardarni who grew up in Amritsar in Punjab, hoped the book would be a small step in fostering understanding, open-mindedness and respect about the Sikh culture. 

“The Art of Tying a Pug” is a book that is extremely dear to my heart for many reasons.

Helping my father with his morning pooni before he could fasten his turban was a regular feature. I’d help him match his fifty to the turban and scout around for the salai that he invariably misplaced. In case you’re wondering what all this means… pooni, fifty, salai … “right there was my inspiration for the book!” Sharma says.

 

Artika Aurora Bakshi’s My Little Sikh Handbook  focuses on Ardas, the special prayer that Sikhs recite before and/or after any special occasion. 

The interactive book, with plenty of fun exercises, explains what the Ardas is comprised of and why it is important to Sikhs. It also explains why the sacred Guru Granth Sahib became the eternal guru for the Sikhs after the 10th Sikh Guru Gobind Singh passed on. 

For Bakshi, Ardas was a shared moment of bonding with her family when she was growing up – it was also a time to make requests to God for a book or a good exam result. And even if you know nothing of Sikhs or their culture, Bakshi’s book has a delicious treat — the recipe for the karah parshad that all gurudwaras serve and that everyone loves, because, as Bakshi says in the book “Karah parshad is always tasty because it’s blessed by Waheguru. We also put in a lot of love when we make it.”

“I remember laughing sometimes, when we were seated in our prayer room and the verses from the Guru Granth Sahib Ji were being recited, and our mother was trying to hush us up. Life turns a full circle and I find myself doing the same with my boys… if on some occasions, there was laughter while praying, then it was a blessing,” Bakshi said. 

THE ART OF TYING A PUG. By Natasha Sharma (Author) Priya Kuriyan (Illustrator). Karadi Tales, 2019.₹ 225.00. 50 Pages. Hardcover

MY LITTLE SIKH HANDBOOK. By Artika Aurora Bakshi. 2018. £14.53. Paperback

 

Preeti Singh is a New York-based business journalist. She is an avid book reader and runs a book review blog thegoodbookcorner.com

 

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    Youth Depression

    Youth Depression

    Editor’s Note: As in other immigrant communities, open discussion of mental health issues is taboo for many Indian American families, despite the fact that incidences of depression and similar disorders are on the rise. For one young woman, that stigma led to years of hidden suffering and missed opportunities at treatment, all in the name of maintaining her family’s “model minority” image. Leela (not her real name) spoke to NAM Health Editor Viji Sundaram about her experience. 

    85

    It started in middle school, when I was around 11 years old. I started feeling weak, had memory lapses and had no motivation to do anything. I felt sad most of the time. I thought the sadness was a normal part of pre-teen angst. I often starved myself for attention from my parents and friends. Most days, I cried myself to sleep.

    Often, I didn’t finish my homework or turn it in. How could I? My thought processes were so chaotic. My grades slipped, and I felt guilty about it. I knew I was letting down my parents. My dad had done well in Silicon Valley. How I wish they understood what was going on inside of me. Whenever they asked me why I looked so exhausted, I just told them I was fine. And they didn’t press me further.

    I tried to pull myself together, to work through my issues. I hid my pain, plunging myself into Indian classical music and South Indian classical dancing. Many people told me I was a good singer, but I didn’t recognize it as a skill I possessed and I had no confidence to sing before a gathering.

    At school, my teachers didn’t understand me, either, but that may have been because I couldn’t articulate what I was going through. But even so my counselor sensed something was not well with me. My classmates began kind of bullying me, telling me I was dumb. It made me feel awful because I had always been a high achiever. My self-esteem hit rock bottom. My social life all but disappeared.

    When I was in middle school, the principal told my parents to have me checked. They took me to an occupational therapist/educational strategist, who diagnosed me with Attention Deficit Disorder. While she treated my depression as a mere footnote, I was relieved to know that whatever it was that had been troubling me had a name.

    But it was a tough pill for my parents to swallow. We South Asians are a model minority community and children are not supposed to have mental health issues. Sympathetic as my mom was toward me, she told me I wasn’t to tell my relatives or people in the community about my problem.

    I was trapped inside a ball of depression and heartache. I felt so alone. Nevertheless, I was determined not to let that come in the way of my academics. At my parents’ insistence, I enrolled in some advanced placement courses like math, even though I wasn’t good at it.

    Then my grades began to slip again. In my second year of high school, I grew anorexic. I dropped from 110 pounds to 84 pounds. For months, I kept slipping between binging and starving. I frequently flirted with the thought of committing suicide.

    When I got accepted to the UC system, my parents were thrilled. With continued medication and therapy, I did well in school, although I didn’t have many friends. This was the first time I was living away from home and away from the networks I had built growing up.

    One day, while in my freshman year, someone whom I knew sexually assaulted me. I was traumatized and I went into deep depression. I shut down completely and barricaded myself in my room. I stopped going to class. When my parents found out, they were angry.

    I continued having panic attacks into the next year because the guy who raped me was still around. I kept retracting into myself and binging. I put on almost 50 pounds. My attendance was so poor that at the end of my sophomore year, I got kicked out of school and went back home.

    I confided in my mom and told her about the rape. She was sympathetic. I enrolled in a nearby community college and isolated myself from my community because I didn’t want to be judged. I developed social anxiety.

    More recently, I have been opening up to my mom and my dad, especially to my mom. They are doing their best to help me cope with what I am going through. But my mom still can’t read me because I still hide things from her.

    Until recently, I didn’t know depression was treatable. I wish my teachers had recognized what was happening to me, and had not treated it as a passing phase.

    I also wish Indian American parents realize how prevalent mental depression is and recognize it in their children so we won’t have to suffer in silence. I know other kids in my community who have mental health issues. Recognition is the first step in the healing process.

    Accepting as my parents have been of late of what I’m going through, they have still not told anyone outside the family. That’s why as I share my story, I have to hide under the pseudonym, Leela.

    This story was produced as part of New America Media’s #FeelBetter project, a storytelling campaign about depression in young people of diverse backgrounds. To explore the story collection, visit the #FeelBetter page and follow the campaign on Facebook.

    Viji Sundaram is New America Media’s Health Editor/Writer. (Originally Published November 15, 2014)

    Bombay Rose and Kashmir Guns

    Bombay Rose and Kashmir Guns

    I am not ashamed to admit that I sometimes cry in darkened theaters. It happened during the Jallianwala Bagh massacre scene in Gandhi, Naatak’s powerful play that tugged so expertly at my heartstrings. And my lachrymal glands were at it during Vrindavan, another superb Naatak play also by Sujit Saraf. Vrindavan was about the plight of widows cast off by society, that included a powerful performance by Ranjita Chakrabarty. When I complained to Sujit Saraf that his plays kept ruining my eye makeup, he grinned happily and said, “Aur ro lo, aur ro lo,” (Go ahead and cry some more).

    Salim and Kamala in Bombay Rose.

    I took this advice and confess to weeping discreetly in the theater while watching Bombay Rose last week at the 2019 Third i festival in the storied Castro theater in SF, a movie palace from a bygone era. The film was like the delicious pain of a loose milk tooth. The refrain of the song about Reva, flowing like a river to the ocean, was sorrowful, like a replay of Stevie Wonder’s My Cherie Amour in Silver Linings Playbook. Like nostalgia for a glorious era of Bollywood that has slipped into history. Like doomed love of the small and powerless for whom pain has already occurred and will occur again. Like regret for a lost paradise where Shammi Kapoor serenaded Sharmila Tagore in Kashmir ki Kali (1964) but now has more guns than roses.

    Tareef karoon kya uski, jisne tujhe banaya. (What praise can I offer your creator?) (Kashmir ki Kali, 1964)

    Kashmir ki kali (the flowerbud of Kashmir) Source: Wikipedia

    Bombay Rose had a melancholy undercurrent that I thought of for days afterwards. The main characters in the film labor in the “informal economy” of Bombay’s mean streets. There is a Hindu girl and a Muslim boy, a dastardly villain, romance, deception and heartbreak. So, is the Bombay Rose a homage to Bollywood? When the film begins, Salim, who has sought refuge in Bombay as violence engulfs his home in Kashmir, is one of the audience members in a movie theater. He is enthralled by the swagger of a six-packed, swashbuckling larger-than-life Raja Khan, a sendup of Bollywood’s grandiosity. Salim’s own existence as a traffic light flower-seller is more meager, but his view includes the lovely garland-maker Kamala across the street, and love blooms.

    Is the rose flower Hindu or Muslim? Gulab Singh or Gulab Khan? The film raises this question in a voiceover.

    There are flights of imagination to Mughal miniature paintings where our beleaguered couple can escape the indignities and cruelties of their crushed-under-the-heel-of-poverty existence. (The paintings were reminiscent of Nina Paley’s 2008 Sita Sings the Blues). This animated film might not get the highest points for technical excellence, but Anjali Rao has put together a memorable film that holds its bleak characters lovingly, like something fragile. A newly-hatched chick placed in one’s hands might elicit a similar response.

    Or a bruised Kashmir ki kali.

    Bombay Rose. 2019. Director: Gitanjali Rao. Writers: Asad Hussain, Gitanjali Rao. Actors: Anurag Kashyap, Shishir Sharma, Makrand Deshpande.

    Geetika Pathania Jain is the Culture and Media Editor at India Currents. She sometimes finds catharsis for geopolitical sorrows in the dark, cocoon-like insides of theaters.

    From Our Sponsors




    Making Sita Come Alive

    Making Sita Come Alive

    Warrior. Smart. Luminous. Strong. Best mother. Great lover. Strategist. Honest. Almost perfect. Fierce. Enacte’s Vinita Sud posed a 1-minute challenge to Drs. Chitra Banerjee Divakaruni and Anita Ratnam to speak phrases and words that brought Sita alive for them. The quest to find Sita united the speakers and the audience through an evening that explored the all-too human goddess who continues to have an enduring impact on the soul of India. This is just the kind of event that explores artistic and intellectual horizons that Enacte aims to bring to Bay area audiences. Dr. Chitra Divakaruni Banerjee talked about the process of writing her new book – The Forest of Enchantments and Dr. Anita Ratnam is all set to present A Million Sitas on Saturday, November 9th. Her production is being co-sponsored by Enacte, Indiaspora and Laya Dhwani Academy of Performing Arts.  https://www.eventbrite.com/e/a-million-sitas-tickets-69455486229 

    Through the evening, we learnt about how both of the artists have journeyed to find Sita for themselves. Looking back at her early days of training in Bharatanatyam under Guru Adyar K. Lakshmanan, Dr. Anita Ratnam in her opening remarks said, “A popular compositionJanaki Ramana in Bharatanatyam refers to that Lord Rama who married Sita and then the whole composition goes on to only describe the greatness of Rama. Other compositions like Seethamma Mayamma and the innumerable compositions of Saint Thyagaraja celebrating his ishta daivam Rama form a big part of the cannon of Carnatic music. Given this oversized impression of Lord Rama and the primacy with which he has been celebrated, it takes more for an artist to find Sita and to tell her story.” And, that’s exactly what Anita has done – she has delved into various versions of the Ramayana including contemporary voices to find her own “voice” to bring alive Sita’s story. Her production A Million Sitas brings that unique  “voice” to the stage. And, through her production, Sita’s story has resonated with women all over, she said. In Durban, South Africa women who watched the production insisted that Sita’s story was an African story, she shared, expressing awe at this resonance. 

    Dr. Chitra Banerjee Divakaruni spoke about how she had been blessed years ago by elders with the words – “May you be like Sita.”  “This invoking of Sita’s name made me bristle as a young girl,” she said, “because I associated Sita with someone who was meek and humble. The research that I have done over ten years looking into the various versions of the Ramayana – Valmiki to Tulsidas, Kamban, the Bengali Krittibasi to folktales from around India all point to someone far different – she is the one who displayed enormous strength, making critical decisions in her life while standing by her principles.” Her book, The Forest of Enchantments is told in the voice of that strong Sita. The book has seen strong demand all over, thanks to readers’ ongoing quest to find her story through the written word. I have written a review of the book here.

    Dr. Anita Ratnam pointed out a crucial point of difference between the written word which is frozen in time to the multi-layered ever changing nature of a live performance. She confessed that her production A Million Sitas has been staged about 40 times now, and each time there is some ephemeral quality that has shifted within her and onstage that makes the process of creation and performance something that is vulnerable and accessible. “Mythological fiction is the genre that is the fastest-selling genre in India because all of us want to recover or learn about these characters. Modern women relate to her – she was a single mother at a time when there was no term for women who lived a life like hers. And, in her life, she faced moments similar to that experienced by women today where the glass shattered and try as you might, when one attempts to put it all back together, it can never go back to what it was before. These emotions make her accessible to all.” 

    Watch this production onstage this Saturday. Details are here. 

    Nirupama Vaidhyanathan is a writer with India Currents magazine.

    Arrey, Do You Want To Be a Failure? 

    Arrey, Do You Want To Be a Failure? 

    Night One: All test centers open at 7:45 a.m. and doors close at 8 a.m., unless otherwise noted on your admission ticket. You cannot be admitted once testing has started.

        The metal doors of the auditorium opened like the jaws of a beast, its four-walled stomach digesting the students trickling within. He was strangely dizzy. It was as though the metal levers on his wristwatch (chosen, of course, for this occasion alone) had suddenly slowed, as though the usual glow of the fluorescent light panels had abruptly turned into a stinging glare. 8:00. Damn it, he thought. I really need a Red Bull.  He had been checking that very wristwatch for the fourth time, not searching for the minute hand but rather for a confirmation that yes, he could still read. It was at 8:00 that the beast turned silent. Doors clicked shut, cell phones turned to airplane mode, whispers died. All life begins, at some point or another, in the stomach. He knew that. But it was the womb of the local high school’s auditorium, when the SAT scantron fluttered in his hands, that changed life completely.

    Night Two: In the Reading Test, students will encounter questions like those asked in a lively, thoughtful, evidence-based discussion.

        Five sentences. Five sentences into the passage, and he still had absolutely no clue what anything meant. Read the sentence again, a voice inside him muttered. And so he did exactly that, inaudibly mouthing the metaphor in hopes that his tongue would decipher the passage better than he did. Nothing. Then underline it. Five weeks of SAT bootcamp practice over a generally depressing summer break had taught him the importance of underlining. Even if the mind was blank, there was the small consolation that at least the paper was not. He continued reading, registering absolutely nothing. It was an unfortunate winter afternoon that his mother had seen the advertisement for the bootcamp Scotch-taped to the window of an Indian grocery store. The “T” in “SAT” was blurred with a bright yellow turmeric stain, but the phone number at the bottom read perfectly. Then it was settled, all of his protests drowned by the single reminder that his distant cousin Raju got a 1600 last year. “Arrey, do you want to be a failure?” his mother demanded.

    Night Three: The SAT Writing and Language Test asks you to be an editor and improve passages that were written especially for the test—and that include deliberate errors.

        Failure. “The preceding sentence should not be included because it fails to address the main topic of the passage.” This answer is almost always right, he thought, his pencil tapping against the Scantron. And even if it wasn’t, there were three more passages to complete in the next twenty minutes. He began his usual, dark blotch of a bubble on the Scantron sheet until a shiver ran down his spine. What was the line number? Were there any lines on this thing? Numbers etched in black ink began clawing at his eyes, his vision swirling in inexplicable panic. 32, 33, 34, 35… the order of the passage-based questions yielded no answer to his lost mistake. The unfilled Scantron bubbles turned into small foaming mouths, each gaping ravenously. He screamed. And yet no bewildered student looked up from their own exam, no perplexed proctor rushed to his aid. He was alone, all alone with the ticking of the ever-dutiful stopwatch twelve seats away.

    Night Four: The SAT Math Test covers a range of math practices, with an emphasis on problem solving, modeling, using tools strategically, and using algebraic structure.

    4x+3y = 12, 8x+6y = 24… From kindergarten to sixth grade, math had been fairly innocuous, and then its untimely marriage to the alphabet changed everything. “x” and “y” ruthlessly plagued his pencil until the sheet was covered in more eraser marks than answers. He charlied out, (the unique practice of marking the choice c in a multiple choice format) unwilling to lock horns with advanced algebra again. “Brenda is walking to the convenience store…,” he read. It’s another stupid word problem, I’m never going to finish. “She stops by the bazaar to buy three kilos of aloo and five packets of masala chai.” Wait. What? When did the SAT get so globalized? “Assuming that Brenda did not make other stops during her journey, how long is it going to take for her to realize that she’s missing the final season of Sasural Simar Ka?” Mom? How did she follow me to the SAT? When in doubt, skip a question.

    The timer went off, quiet and yet obnoxious. Distraught, he waited for the beeping to slowly die, for a proctor to half-scream at him to put his pencil down, but there was nothing. He looked up, and realized the timer was gone and in its place was a laughing Raju, snickering at his failure of a cousin. He blinked. The noise had turned into nine Bollywood songs playing at the same time. Head in his hands, he lucidly tried to fathom the unfathomable until all sound was replaced by the guttural yawn of the beast, a booming echo: “Arrey, do you want to be a failure?

    It’s About the Real World. To answer some questions you’ll need to use several steps—because in the real world a single calculation is rarely enough to get the job done.

        He awoke to the feeling of morning daylight spilling into his eyes like seeds of grain. The pillow, wet with nervous sweat, remained the sole evidence of his silent torment. Dreams. The sheer clarity of the images etched into his mind nearly stopped him from registering the comfort of his own bedroom walls. 8:00. His eyes settled on the “1600 Guaranteed” prep textbook beneath a vibrating alarm clock. Somewhere, between those pages, was a comfort that had been lost, a gnawing insecurity that evaded his better judgement. The stench of standardized testing had worked its way into the bottom of his subconscious, where it could not be fought nor ignored. He drowsily flipped through the prep book, its hollow promises an echo of his dreams and a reminder of a (perhaps) much more terrifying reality.

    Kanchan Naik is a rising junior (right in the middle of SAT prep) at The Quarry Lane School in Dublin, California. When she’s not having her own nightmares about standardized testing, she is most likely untangling her earphones or looking for something that happens to be — much like herself — lost.

     

    Verma Attacks Critics Of Medicaid Work Requirement, Pushes For Tighter Eligibility

    Verma Attacks Critics Of Medicaid Work Requirement, Pushes For Tighter Eligibility

    Seema Verma, the Trump administration’s top Medicaid official, Tuesday sharply attacked critics of her plan to force some Medicaid enrollees to work, a policy that led to thousands of people losing coverage in Arkansas.

    “We cannot allow those who prefer the status quo to weaponize the legal system against state innovation,” the administrator of the Centers for Medicare & Medicaid Services said in a fiery speech to the nation’s 56 state and territorial Medicaid directors in Washington, D.C.

    federal judge shut down the short-lived work requirement initiative in Arkansas and stopped it from launching in Kentucky last spring. Several states including Indiana, Arizona and New Hampshire that had won federal approval have put their implementation plans on hold pending an appellate court ruling.

    Advocates for the poor argue work requirement policies are illegal and unfairly add hurdles to people who qualify for coverage in the federal-state health program.

    But those opponents are seeking “to manipulate Medicaid into the prototype of a single-minded, single-payer nirvana – a utopia of open-ended government run health care,” Verma said. “Part of my mission is to fight such under-handed tactics and preserve the right of states to shape your programs in ways that are consistent with the needs of your residents, your cultures and your values. Anything less stifles innovation.”

    That would be “a disservice to the millions of people on Medicaid today and those who will need it in the years and decades to come,” she added.

    The federal government has approved work requirement plans in 10 states and requests are pending from 10 others. Most of those initiatives are directed at the low-income adults who gained coverage through the Medicaid expansion initiated by the Affordable Care Act.

    Verma first announced plans to open the door to work requirements in a speech to Medicaid directors in 2017.

    Medicaid – like Medicare – is an open-ended entitlement program, which means federal funding increases as costs and enrollment rise.

    In addition to doubling down on the controversial work requirements, Verma renewed her interest in letting states get Medicaid funding through a block grant system. Block grants would give states more flexibility to limit enrollment and enforce eligibility rules, she added.

    Critics have said such a change would cut Medicaid funding, limit coverage, hurt beneficiaries and lead to lawsuits.

    But Verma said CMS would soon publish guidance to states to allow them to get block grant funding for “certain optional adult populations.”

    “Many states have expressed a willingness to be held accountable for improving outcomes in exchange for greater flexibility and budget certainty,” Verma said. “Block grants and per capita cap proposals are two such alternative financing approaches.”

    Also Tuesday, CMS issued a proposed rule that would overhaul so-called supplemental payments that many states receive to help their hospitals, nursing homes and doctors get extra funding beyond those received when caring for Medicaid enrollees.

    The federal government spent about $48.5 billion on such supplemental payments in 2016 for states.

    The payments – as a share of total Medicaid fee-for-service expenditures for health providers – ranged from 1% in North Dakota to 65% in Tennessee, according to a Congressional Research Service report.

    CMS and congressional investigators have said the payments allow states to game the system to help bring in additional revenue for these providers without showing how they spend the money.

    “I recognize that these schemes often have their roots in self-interested providers, egged on by opportunistic consultants seeking to leverage regulatory loopholes or hide behind a lack of transparency,” Verma said. “I know that most state leaders want to make sure every dollar is supporting value and improving care for Medicaid beneficiaries, and those of you that are doing the right thing have nothing to worry about. We have your back.”

    The supplemental Medicaid payment system has come under criticism for many years because of the lack of transparency at the state level. However, efforts to curtail the spending has faced pushback from both states and providers fearful of losing dollars.

    Matt Salo, executive director of the National Association of Medicaid Directors, said state officials are open to efforts to bring more transparency but they will be cautious about anything that severely reduces their funding.

    “The challenge is how do you do this in a thoughtful, real world way?” Salo said. “We have to do it in a way that is achievable, but that does not jeopardize patient care in the process.”

    Verma acknowledged that the uninsured rate among children has grown in the past two years despite the strong economy. She said the solution is to lower health costs to make it easier for their parents to afford private coverage.

    Patient advocates have blamed states’ efforts to tighten Medicaid eligibility as a leading factor in the drop in coverage.

    Nonetheless, Verma said she would push states to further limit eligibility to make sure only those eligible are getting benefits.

    “Lax eligibility practices jeopardize the sustainability of the program,” she said.

    CMS will “ensure that states conduct timely redeterminations and make use of appropriate data sources to verify ongoing income eligibility.”

    Salo said state Medicaid directors agree with the need for appropriate safeguards to make sure people are not getting assistance who are not eligible. But, he added, forcing enrollees to go through more steps to get and retain coverage will come at a cost of losing people who truly deserve to get help.

    “You want government to work for people and want to create a system that if you are eligible it should be easy to get on,” he said. “And if you set barriers and hurdles you will lose a lot of people who are eligible but could not deal with the paperwork.”

    This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

    Hop-on Hop-off

    Hop-on Hop-off

    I saw the man for the first time in Budapest on the Széchenyi Bridge. The chain bridge connected the western and eastern parts of what was once two cities, Buda and Pest. We exchanged a smile, as any two people might. Standing a few feet apart, we saw the Parliament House and Margaret Bridge on one end, the Freedom Statue and Royal Palace on the other, and the quiet, flowing Danube separating and connecting the two cities. We watched the same things, like lovers seeing the moon on a dark night thousands of miles apart, yet together.

    A few hours later I saw him again, entering the hop-on, hop-off tourist bus my husband recommended. “This is the best way to see the city by yourself,” my husband said. He would be busy at the conference for the next few days and felt guilty about my being alone. Oh, how he wanted to see the city with me, he said, but I was glad to be on my own, free and independent, my sensibility so different from his.

    A Creative Commons Image by Brian Harrington Spier

    From the upper deck with the open roof, my eyes followed the man who was heading toward the upper level. I turned and saw him walking toward the front, looking for a seat with perfect views, where I was seated. His eyes wandered to the one empty seat beside me. He gestured, asking if he could sit.

    “I was hoping you’d ask,” I said with unaccustomed boldness and then hoped he might not understand English after all.

    “And I was hoping you’d say okay.”

    His voice was deep and full. He reminded me of my favorite Hindi actor, a tall, handsome man I fantasized about, a man of few words, confident on the outside, with a childlike vulnerability inside.

    “First time here?” he asked.

    “Yes, you?”

    “Yeah.”

    “You’re alone?” I asked, hoping he wouldn’t ask me the same. I was tired of defending and justifying why I was alone—why I didn’t have a partner before I was married, why I was alone without my husband while I was married. The man didn’t ask, and I was relieved.

    “Yes, always alone,” he said, shrugging casually and putting on his headphones.

    How comforting he made it sound—alone, like an exotic indulgence.

    Alone, I thought as I sat up straight, tucking my chin, feeling intoxicated instead of burdensome.

    The man had an educated, traveled accent. His olive complexion and dark hair could have been from three-quarters of the world. His sense of style was European—a crisp blue shirt, narrow linen pants, and a printed scarf around his neck. He looked professorial with his black-rimmed glasses. He smelled like fresh rain, and I breathed him in.

    A bit later he tapped my shoulder and pointed at the open map in my hand. I took off my headphones.

    “How many days here, tell me again?” he asked as if I had already told him.

    “Three.”

    “A lot for us to do in three days, huh?” he said, peering over his glasses.

    I liked his confidence.

    “What would you like to see? The Gellért Bathhouse for sure, yes?” he continued.

    “Hmm, yes.”

    “I’m Raoul, by the way.”

    “Revati.”

    It was strange, even absurd, that this man invited me, a stranger, to be a part of his journey. He was either very dangerous and I, apparently, easy prey; or he shared the familiarity and warmth I felt. Either way, he talked, I nodded, I talked, he nodded. With fascination I watched his arms, his long fingers, his clean, clipped nails, and his mannerisms. I let myself be hypnotized by his vocal undulations, his accent sounding like musical notes. I was glad I wasn’t wearing my wedding ring. I noticed he didn’t wear one, either. Together we chalked out a plan to see Budapest.

    In the nearly two years I’d been married, my husband and I never planned a day together. He decided what we did, where we traveled, what and who we saw, even the menu when we hosted. He was a stickler for detail. I’d been a thirty-nine-year-old spinster (too dark, too educated, too short). If I were a woman of a younger generation, I might have worn my personality and my education as a mark of pride. Instead, when my husband graciously offered to marry me without a dowry and implied I should be grateful, I acquiesced.

    “Wait for me,” I said as we stepped off the bus at the bottom of Gellért Hill.

    “Not going anywhere without you,” Raoul replied, offering his arm.

    I took his hand and we walked up Gellért Hill to the Freedom Statue. For once I didn’t hear the voices I’d heard all my life—what will people say, what will they think, think of your reputation, please don’t bring us shame. For once I wasn’t a student, an employee, someone’s wife, someone’s daughter. For once I wasn’t the responsible, sensible one. Even as I was distracted by my thoughts, I realized this was the first time in twenty years I was excited by a man.

    The liberation monument looked eastward, her metal hands holding a palm leaf above her head. She was majestic, exuberant in liberty. The monument was installed by the Soviets, who freed Hungary from Nazi occupation. After the Soviet Union collapsed, the monument was preserved and reinvented. A new plaque read: “To the memory of all those who sacrificed their lives for the independence, freedom, and prosperity of Hungary.”

    A Creative Commons Image by Brian Harrington Spier

    “What would you do to reinvent yourself?” I asked Raoul.

    “Become your pet, of course. A little Chihuahua that fits in your handbag,” he said, making me laugh.

    “You want a photo with this view?” I asked, my hand still holding his.

    The city below looked like a picture postcard. The sky was blue, and beneath it lay the Danube. On either side of the river were buildings old and new, each with a distinct style and built during different times.

    “No, because all beauty can only be captured here,” he said, tapping his chest.

    “Then you’ll take one of me? I want the river and bridge in the background, okay?”

    I thought of my husband, of showing it to him if he asked.

    I posed twice for Raoul—once for a photo on my phone, once for his.

    “Want to see?” he asked, showing me his phone.

    I didn’t recognize myself. My complexion looked radiant, my height seemed befitting rather than mockable, my hair cascaded–my “crowning glory,” just as my mother always said. I looked chic instead of homely. I had a smile I hadn’t had in so long. I blushed. He put his phone away, took my hand and locked it around his elbow, and in step we walked back toward the bus stop.

    Raoul was an Italian-English translator. He was in his early fifties and single, though I found it hard to believe he didn’t have someone significant in his life. He was about six feet tall with a head full of peppered hair and a well-trimmed beard. Although briefly married when he was much younger, he said he had no children.

    “Did you not find anyone else to marry?” I asked.

    “Hard to live with a man who travels; it’s selfish, you know. And you?”

    “I am a scientist, trying to change the world,” I said, surprised at my confidence and pride.

    “Aha, no Chihuahua for you, then?”

    “Oh, yes, yes, a Chihuahua-prince, like a frog-prince, of course,” I said. I watched him tilt his head back and laugh. I yearned to drop all caution and let go of the reserve that ruled my marital life.

    I dreaded the thought of going back to the hotel room, of interacting with my husband. The room overlooked the busy street close to the old Jewish quarter and was central to sightseeing and public transport, yet it was dark, dingy, and claustrophobic. My husband didn’t notice. He came in late, did his work, and slept.

    “Let’s change our room,” I said after we checked in.

    He considered me fussy.

    “What for?”

    “I feel claustrophobic; the ceiling of the portico feels like it’s on my throat.”

    “Aww, stuck in an elevator. Heard that story. Get over it.”

    “Please,” I pleaded. “I find it hard . . . it’s like your OCD, you know,” I added, hoping he would understand.

    “Oh, please, Revati, don’t compare my need for being clean to your silliness,” he scolded.

    Once, early in our marriage, I suggested that my husband see a therapist for his OCD. Instead he called me lazy and clumsy.

    “I’ll pack, I’ll get another room on a higher floor, it’ll be nice,” I persisted.

    “Stop. Don’t waste my time,” he said, shooing me off without looking up from his computer.

    An engineer from MIT, my husband assumed we would be a good match. Both of us were educated and independent. He was charming and convincing. I had heard of his brilliance in academic circles. He came to Budapest to negotiate an important contract, hopefully make enough money to retire and leave enough for our children, he said, then bit his lip. I didn’t believe he could ever retire, and by mentioning children, he made me feel like a failure.

    At the hotel, after my first day sightseeing with Raoul, I was surprised to find my husband back early from his conference. I pulled out the Budapest map. I also wanted to show him the pictures Raoul took of me looking beautiful.

    “Looks like these folks here are interested in closing the deal,” he said, his eyes on his computer.

    “That’s good. Let’s keep our fingers crossed.”

    I too was busy looking at my screen. That’s how it was with us. We carried on conversations as if nothing happened between us or ever would. A new email was in my inbox. Patent approved, said the subject line. My patent! Raoul brought luck into my life, I thought.

    “I have good news too,” I said, but my husband didn’t respond.

    I retreated to my world, recalling my mother’s words: “If he wants to share, good. If he doesn’t, excellent!” So I sent out some emails sharing the news of my patent, then showered and went to sleep excited about meeting with Raoul the next day. My husband worked well into the night. When I woke up the next morning, the room looked sterile. My husband had tossed out loose bills, receipts, brochures, and other trash. This was his routine.

    A Creative Commons image by Avinash Bhat.

    Each morning I looked forward to meeting Raoul at the junction stop. I walked one level down from the street, went through the underground tunnel to the other side, climbed stairs, walked past coffee shops, and waited for him. We hopped on a bus and worked our way through the city, per our plan. No one paid any more attention to us than they would to any couple. Over the course of time, I rested my head on his shoulder, put my arm around his waist, wiped crumbs near his lip. His arm intertwined with mine, my hands interlaced with his. Like an entitled wife, I let him buy me lunch and care for me. I fussed and whined about my tired feet, and he indulgently got us foot massages. He sensed when I was cold and helped me put my jacket on. He watched me try on swimsuits, my first ever, so we could spend time in the bathhouse. I should have felt awkward or exposed, but I didn’t.

    “Looks too old for you,” he said when I tried one on.

    “Yes!” he said of another. “Perfect.” He pushed my wallet back into my purse, and I let him pay.

    Ritually, each day he took two pictures of me, one on his phone, one on mine.

    We got used to hopping on and off buses—green line, red line, purple line, yellow line—going to different parts of the city. We took breaks for coffee or lunch. We sat on park benches, people-watching, leaning into each other. Where had he been all my life?

    On our last day together, Raoul and I pretended it was just another day. I hadn’t felt the need to talk about my life, and so I hadn’t told him about my patent or my past. We were like children with no concept of beginning or end. We were like the Danube—flowing on. That morning we were unusually quiet. We chose the longest route to the outskirts across the river. We held hands, as if letting go might jolt us back to reality. He guided me to the ferry, putting his hand on the small of my back. We cruised along the river and got off at Margaret Island and sat on a bench with our lunch bags. We watched the locals run and stretch, mothers and children at play, and young lovers lost in their own world.

    I felt as old as the river and as young as a teen. I wondered if Raoul imagined a life with me, as I did with him. To have his baby, speak his language, sleep with him at night, grow old together, bicker about our pets and our kids. I stopped myself. Alone, I thought. Alone.

    “We’ll stay in touch, yes?” Raoul said, as if reading my thoughts.

    I held onto his arm as we walked back to the ferry. The evening sky was clear, and against it the Gothic Parliament House stood tall. The river reflected its lights’ glowing amber. Its Gothic steeples soared into the sky like dreams of all its people. Its Revival dome embraced old and new. With Raoul, my eyes opened to beauty. The din of life melted into silence, and we communicated without words.

    As we approached the terminal, I dreaded our farewell. Would we make promises to each other? Would we rehash our time together? Would we ask each other questions that might or might not have answers? Would we exchange our contact information and plan to meet? Would this be a tearful goodbye? Did any of this mean anything to him? We would kiss, wouldn’t we?

    I saw the hop-on, hop-off buses gathered, conductors removing their vests, marking the end of the day. A few of them sat at the roadside café, sipping coffee or beer. I was unable to let go of Raoul’s hand. We would always sit in one of the cafés—Raoul drinking beer, I sipping coffee—before we parted.

    But before either of us could speak, I saw my husband sitting at one of the cafés looking at every passenger who got off the bus. I quickly retracted my hand from Raoul’s before my husband saw us. Then he came forward.

    “Oh, there you are, Revati. I was hoping to find you here,” my husband said, hugging me uncharacteristically, his eyes scanning Raoul.

    “Come, it’s getting late,” my husband said as he took my hand and led me away.

    What happened then I don’t remember, just a few words like dinner, colleagues, contract, words I didn’t care to weave into anything meaningful. I turned around to look at Raoul, who still stood by the bus. When his eyes met mine, he pointed to the map in his hand and mouthed, “Your map has my contact info.”

    A Creative Commons Image by Nathan Hughes Hamilton

    That night at the company dinner my husband was in a good mood, probably because his male colleagues were impressed with me—beautiful, intelligent, funny, they said. My husband, talking with his boss, placed his hand on my back, claiming me. The evening came to an end inconsequentially, as all the company dinners did. Later in the night my husband stroked my arm… afterward falling comatose.

    The next morning he was in a good mood. The meetings had earned him praise. He went down for breakfast, and I stayed to pack and to think about the previous day. I sat on the edge of the bed and closed my eyes. Over and over I replayed the last scene with Raoul. He wanted to stay in touch. He had a plan. He always did, and it was all on the map.

    I toppled the contents of my purse onto the bed. I emptied my backpack. I opened my suitcase. I checked between the pages of my books. Where was the map? Then I remembered that I’d emptied all my papers on the bedside table before dinner last night. I looked there. Nothing. I looked under the bed. Nothing. I looked in the trash. Nothing. I left the room, looking for the housekeeping cart. “I lost something,” I said to the housekeeper, shaking her hand, and she looked at me with dread and pity. “Please find it. I lost something.” I ransacked her trash. She helped. Nothing.

    Back in my room the phone rang. It was my husband, asking me to come down.

    “The taxi will be here soon.”

    “My map,” I said, “my map, the hop-on, hop-off map, where is the map? It’s red. Did you take it, did you toss it?”

    “What map? I didn’t see any map,” he said. “I threw out some trash, that’s all. I didn’t see any map. Hurry up, Revati.”

    I sat on the bed. Little plumes of tears sputtered down my cheeks, the room closing in on me.

    In a few moments my husband came in, his expression shocked at seeing my clothes scattered on the bed.

    I sat unmoving. “Where is the Budapest map? I want the map.”

    “Enough of this nonsense!” he shouted, his spittle spraying. “Get up now, we have to leave soon.” He pulled at my arms to make me get up. I furiously punched his hands, and he swung his right hand across my wet cheek.

    I stood up almost compliant, possessed by the ghost I’d become. But then I paused. I was shocked at what I did next. I grabbed his arm and bit deeply, then pushed him. He stumbled onto the bed.

    “Don’t ever touch me again,” I said.

    He looked bewildered. He took his right hand with his left and started slapping himself on his cheeks. I had never seen him do this. Then he kept hitting his head with the base of his hand. I wanted him to stop. “The bed is a mess. Clean it up,” I said, then took my purse, wiped my eyes, and left.

    Photo credit: Vikram Valluri

    Manikya Veena was born and raised in Hyderabad, India. She earned a master’s in economics from Osmania University, and authored a short story compilation for children, The Banjara Boys. She serves on the advisory board for Narika, a nonprofit in the San Francisco Bay Area, whose mission is to help South Asian victims of domestic violence. She also volunteers at Community Overcoming Relationship Abuse (CORA) in San Mateo, answering hotline calls. She is a master class student at the Writers Studio in San Francisco and works as an assistant editor at Narrative.

    First published in the Narrative Magazine. This story is reproduced with the permission of the author.

    This story was curated by Culture and Media Editor Geetika Pathania Jain.

    Cover image credit: a Creative Commons Image by Brian Harrington Spier

    Additional images by Brian Harrington Spier, Nathan Hughes Hamilton, and Avinash Bhat.

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