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Background

 

 

 

Somalia, officially called the Federal of Somalia, is a country located in the Horn of Africa. The present-day Republic of Somalia was formed when British and Italian Somaliland were united as an independent state in 1960 [1]. Ethnically, a majority of the population is Somali. The official languages of Somalia are Somali and Arabic. Most people in the country are Muslims, and the majority of them are Sunni Muslims.

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Many regions across the country experience varying levels of poverty. Political instability in the early 1990s resulted in a protracted humanitarian crisis and territorial civil war [1]. The mass internal displacement of people due to political conflicts has contributed to diverse understandings of their culture. Famine and drought also led to the displacement of Somalis worldwide. Providers must be respectful of the emotional vulnerability of the Somalians due to the nature of their previous experiences in their country of origin.

Disclaimer: This group was included as part of Africa as it presents the major group that has been resettled by IISTL since 2016.

Health Beliefs

  • In general, Somalis believe that keeping the mind and body active is beneficial. They utilize modalities like fire-burning, herbal medicines, casting, and prayer to treat hepatitis, chicken pox, measles, mumps as well as fractures [1]. Somalis also believe in the concept of ‘Evil Eye’. For example, in fear that the Evil Eye will harm their child, Somali mothers cringe when doctors tell them that their infants are large and fat [1]. Saying the child is "healthy" or "beautiful" is more appropriate.

  • Male and female circumcision is a mandatory custom. For females, infibulation is the common type of circumcision [1]. Though this practice is proven to have medical and psycho-social complications, most Somali women view the practice as normal and desirable. Practitioners should be receptive to discussions regarding this cultural health belief. 

  • Female Genital Mutilation (FGM): partial or complete removal of the external female genitalia or other harm to the female genital organs for cultural, religious, or non-therapeutic reasons. While treating a patient with genital-related diseases or conditions, FGM or a history of FGM should be considered [2].

Relaxation
Group Hug

Social Traits

  • Patriarchal

  • Traditional gender roles

  • Age hierarchy

Implications for Health Practitioners/Health Questions

Greeting: The common way to greet is by saying ‘salam alaikum’ which involves shaking hands [1]. Due to the Islamic religion, men and women do not touch each other and therefore men shake hands with men and women with women. 

 

Traditional Somalis may follow cultural modesty where direct eye contact and physical proximity are avoided between people from the opposite sex. Patients may also prefer a healthcare provider and/or interpreter of the same sex. This can extend to childbirth - Can compromise with the patient by having a female physician in the room

 

Individuals may also feel uncomfortable disclosing health information to strangers, potentially making initial diagnosis difficult. It can be beneficial to have a close relative accompany the patient during patient interaction 

 

Mental Health: Providers should consider the experiences and circumstances of immigrants from Somalia to better assist patients. Factors like the long-standing civil war, difficulties in assimilation, and social isolation can negatively impact the mental well-being of many Somalis. Mental health is considered a stigmatized and contemporary topic for Somalis, and there is minimal translation regarding this topic in their language Af-Somali [3]. 

 

Some Somalis may also view mental complications as spiritual causes or evil possession. Interpretation services can be beneficial in helping patients better understand their degree of illness, as well as the appropriate care needed for the patient. 

 

Diet: Somalians prefer ‘halal and haram’ meat, food with high salt, carbohydrates, proteins, and fats [2]. They follow the practice of fasting during the month of Ramadan. Breastfeeding of children for two years is recommended in the religion. Frying is the most common method of cooking. Tea with high amounts of sugar 4-5 times a day is common among Somalis.

Pharmacist

Questions/Education

  • Healthcare challenge:

    • Language can be a barrier while providing healthcare due to Limited English Proficiency.

    • A study regarding the health priorities in Somalis revealed that diabetes, hypertension, and weight-related issues are the top priorities [5]. Previous literature on Somali health disproportionately suggests communicable diseases as a top health priority. 

    • Lack of women-only exercise facilities can be a challenge when recommending physical activity to women [5,6].

  • Social History:

    • Questions related to dietary habits can reveal answers to health conditions and proper discussion with the patient can help in modifying health behaviors.

    • Information about the use of hookah/shisha, and frequency of use is important when recording social history [6].

  • Women: 

    • Women play a significant role in advancing their family’s health. 

    • For new mothers in the United States, lack of support from extended family can be a challenge and can affect ideal breastfeeding practices [5].

    • There is an increased need for exercise facilities exclusively for women due to the cultural traditions of the Muslim religion.

    • Due to the Muslim culture, married women are expected to cover their bodies including their hair with a traditional headdress called a hijab. 

      • The hijab should be addressed respectfully.

      • Women should be asked if they prefer a male or a female health provider as well as the supporting staff.

Health Challenges

  • High salt, carbohydrates, proteins, and fat foods are common in Somali culture and can be a challenge when it comes to managing diseases related to dietary behaviors [4].

  • Some of the common causes of death in Somalia are nutritional deficiencies and enteric, neurological, and musculoskeletal disorders [7]. Child and maternal malnutrition is also the leading factor for communicable, maternal, neonatal, and nutritional diseases. 

  • Women may find it challenging to discuss issues of sensitive topics with healthcare providers.

  • Low adherence to preventive medicine is a barrier to care within this community and is attributed to social barriers (language and culture) as well as low literacy rates among minorities [10].

  • Many Somalian refugees have experienced experienced trauma associated with war, rape, mass violence, severe poverty, famine, migration, and living in refugee camps for a long period. [11]

    • This trauma predisposes this community to higher instances of psychiatric disorders such as PTSD and depression. [12]

A girl feeling sad
Crowd

Women's Health

  • Recording the history of female ritual genital surgery is very crucial.

    • Alteration in the anatomy following female circumcision, especially infibulation, is a cause of recurrent urinary tract infections [8]. 

      • Federal Law 18 Code 116: It is illegal to perform infibulation on women below the age of 18 [9].

  • Most women refrain from discussing and reporting symptoms due to their sensitive nature [6].

  • Most young nulliparous women and older women will not allow male physicians to do a genital examination.

  • Discussions about challenges to bonding and breastfeeding should be carried out with new mothers.

    • Be understanding of certain myths regarding breastfeeding, such as spoilage of breastmilk if in the breast for more than 3 hours or colostrum not being milk.

Conclusion

  • Traditional Somalis are people who follow their culture as passed on to them by their previous generations. These may have many myths related to health, health behaviors, and health practices. It is up to the healthcare providers to respectfully tackle the lack of knowledge while addressing the health issues of the Somalis.

  • The civil war crisis in Somalia has created an aftermath that has led to the migration of many Somalis. It is essential to show empathy and understanding as well as pay close attention to the mental health status of patients that the providers see.

  • Health issues related to women must be dealt with special care and respect to the culture of Somalis to increase trust in the healthcare provider and the overall healthcare system.

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Resources for Patients

  • Somali Refugee Women: Learn About Your Health!

  • Vitendo4africa

    • Non-profit organization whose activities are directed towards empowering communities through educational and outreach programs in Missouri and in Africa.

    • Address:  7220 N Lindbergh Blvd, Hazelwood, MO 63042

    • Phone: 314-252-0488

    • Link: https://vitendo4africa.org/

  • Oasis International

    • To love and care for those seeking refuge from a war-torn country with the heart of Jesus.

    • Address: 5035 Gravois Ave. St Louis, MO 63116

    • Phone: 314-353-3800 - Mon to Thurs from 10:00 am-2:00 pm

    • Link: https://www.oasis4refugees.org/refugees/

  • The Migrant and Immigrant Community Action Project (MICA Project)

    • A community organization committed to working with low-income immigrants to overcome barriers to justice 

    • Address: 2650 Cherokee St, St. Louis, MO 63118

    • Phone: 314-995-6995 - Mon to Fri from 8:30 am -4:30 pm

    • Link: http://www.mica-project.org/resources--recursos.html

  • Welcome Neighbor STL/START

    • To partner with refugee and immigrant families, connecting them with the people and opportunities that will empower them to build and live their best life in their new country.

    • Address: 4170 Delor St., St. Louis, MO 63116

    • Email: info@welcomeneighborstl.com 

    • Link: https://welcomeneighborstl.org/

This information was read and approved by ______, the representative of ____.

References

(1) Lewis, T., Mooney, J., Shepodd, G. (2009, March). Somali. Somali - Ethnomed. Retrieved March 9, 2024, from https://ethnomed.org/culture/somali/

(2) Centers for Disease Control and Prevention. (2021, March 18). Somali Refugee Health Profile. Somali Refugee Health Profile | CDC. https://www.cdc.gov/immigrantrefugeehealth/profiles/somali/index.html

(3) Schuchman, D. M., & McDonald, C. (2004). Somali Mental Health. Somali Mental Health - Ethnomed. Retrieved March 9, 2024, from https://ethnomed.org/resource/somali-mental-health/ 

(4) Haq, A. S. (2003, August 1). Report on Somali Diet. Report on Somali Diet - Ethnomed. Retrieved March 9, 2024, from https://ethnomed.org/resource/report-on-somali-diet/

(5) Mohamed, A. A., Lantz, K., Ahmed, Y. A., Osman, A., Nur, M. A., Nur, O., Njeru, J. W., Sia, I. G., & Wieland, M. L. (2022). An Assessment of Health Priorities Among a Community Sample of Somali Adults. Journal of immigrant and minority health, 24(2), 455–460. https://doi.org/10.1007/s10903-021-01166-y    

(6) Persson, G., Mahmud, A. J., Hansson, E. E., & Strandberg, E. L. (2014). Somali women's view of physical activity--a focus group study. BMC women's health, 14, 129. https://doi.org/10.1186/1472-6874-14-129 

(7) Morrison J, Malik SMMR. Population health trends and disease profile in Somalia 1990-2019, and projection to 2030: will the country achieve sustainable development goals 2 and 3? BMC Public Health. 2023 Jan 10;23(1):66. doi: 10.1186/s12889-022-14960-6. PMID: 36627611; PMCID: PMC9832660. 

(8) Toubia N. (1994). Female circumcision as a public health issue. The New England journal of medicine, 331(11), 712–716. https://doi.org/10.1056/NEJM199409153311106 

(9) House of Representatives, Congress. (2011, December 30). 18 U.S.C. 116 - Female genital mutilation. [Government]. U.S. Government Publishing Office. https://www.govinfo.gov/app/details/USCODE-2011-title18/USCODE-2011-title18-partI-chap7-sec116 

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