Resettlement, ethnic identity, and health care experiences of first-generation Pakistani immigrants

Immigration is a multi-faceted and dynamic phenomenon. Few descriptions are available about the experiences of immigrants from South Asia. Pakistanis are among the fastest growing immigrant populations in the US. The purposes of this cross-sectional, retrospective, qualitative, grounded theory study were to explore the immigration and resettlement experiences of first generation Pakistani immigrants living in the US; how they construct self and ethnic identity in the US; and their health care experiences in the US. Semi-structured interviews and participant observations were conducted in community settings with 13 women and 11 men, who self-identified as first generation immigrants from Pakistan, primarily Karachi, living in the San Francisco Bay Area. They were between 21 and 77 years, with a majority of them between 31 and 40 years.Open coding and data mapping via constant comparative analysis resulted in three basic social processes: transitioning to resettlement, constructing self and ethnic identity through representation, and navigating health care. Participants voluntarily chose to immigrate to the US. Most participants, especially women, struggle with the stress and depression of resettlement on a day-to-day basis. For women especially, the U.S. phenomenon of "living independently" is a positive experience once resettlement adjustment occurs. Participants felt invisible and gained visibility by engaging in public and private social settings as Muslim Pakistanis. Various personal and social forces affect participants' struggle for representation, but none was more evident than that of perceived discrimination, particularly following the September 11, 2001 events. The relatively healthy participants appreciate having access to advanced technology in the U.S. health care system; however, they had concerns about barriers to and difficulties in navigating the U.S. health care system.Conclusions of the study indicate the need for extensive intervention for immigrants to gain social presence and representation and to overcome the feeling of being invisible and marginalized in the host society; the resettlement process is continuous rather than static; the meanings of self and ethnic identity are shaped by individuals, families, sociocultural, environmental, gender, and other contextual lived realities and representational discourse; and the health of and health care for immigrants warrant attention.