Somalia Background and a Context for Medical Treatment
Somalia is unique in that it is composed of a single, homogenous ethnic group that shares a common language and religion (Lewis, 1996). The universal language is Somali and Arabic is the second common language (Lewis, 1996). Somalis from Northern Somalia are likely to be conversant in English whereas those from Southern Somalia are conversant in Italian (Lewis, 1996). Cultural practices are also very similar throughout the country. The life expectancy for males is 47 years of age and 49 for females (BBC, 2008). The population of Somalia, as of 2007, is 8.7 million (BBC, 2008).
Somalia’s citizens have faced great hardship since a civil war erupted in 1988 and ceased in 1991 (Lewis, 1996). The infrastructure of the country has crumbled and an effective government has yet to transpire. In fact, Somalia has been without a central government since 1991 (BBC, 2008). In the face of hunger, rape and death, Somalis began leaving their homeland in 1991, escaping to Ethiopia, Kenya, Djibouti, Yemen, and Burundi refugee camps (Lewis, 1996). Many families have moved to the United States, residing in New York, Los Angeles, Washington DC, San Diego and Seattle (Lewis, 1996). In recent news, the UN Security Council authorized a six month African Union peacekeeping mission for Somalia in February 2007 (BBC, 2008). In August of 2007, the Human Rights Watch accuses Ethiopian, Somali, and insurgent forces of war crimes and also accuses the UN Security Council of indifference toward the Somalia conflict (BBC, 2008).
More than 99% of the population is Sunni Moslem, which includes several religious holidays that health care professionals should be aware of (Lewis, 1996). Ramadan lasts for 30 days and consists of prayer, fasting, drinking only during the day, and eating only at night. Physicians should be aware of this because medications will only be taken at night and on an empty stomach during Ramadan. Medical providers should also consider limiting exercise requirements during the fasting period. During all times of the year Islamic tradition forbids drinking alcohol and eating pork (Lewis, 1996).
Somali traditional medical practice is guided by older men of the community that have acquired skills from their elders (Lewis, 1996). The practitioners use fire-burning, herbal remedies, casting, and prayer. During a fire-burning procedure, a stick from a special tree is heated and applied to the skin to treat ailments such as hepatitis, malnutrition, and pneumonia. Often the modalities will be combined to treat a disease, such as seizures which are treated with herbs and readings from the Koran. Traditional doctors have been identified as being especially successful at treating hepatitis, measles, mumps, chicken pox, hunch-back, facial droop, and broken bones. Somalis may also seek a traditional doctor to cure an illness caused by spirits. The Somalis believe that the spirits, which reside within each individual, can become angry and cause illness. These illnesses caused by angry spirits could be fever, headache, dizziness, and weakness. The doctors heal the person by hosting a ceremony that appeases the spirits that involves reading the Koran, eating special foods, and burning incense. If all goes well, the illness will subside within 2 days of the ceremony (Lewis, 1996). The Somali’s concept of angry spirits is similar to the Western model of germs and pathogens; doctors may be able to relate to their Somali patients by making this comparison.
While Somalis residing in the US complain of many of the same symptoms as United States born citizens, such as headaches, back pain, and joint pain, they do exhibit unique indications of disease (Lewis, 1996). For example, a doctor treating a Somali patient should not be surprised to hear them say that they have too much hot, cold, or wind. Common health issues that they seek Western medical treatment for include parasitic illness, diarrhea, fever, and vomiting. Shistosomiasis and terminal hermaturia are the most common parasitic-related illnesses. In a screening around 1996 at Harborview Medical Center, 72% of East African children had pathogenic fecal parasites. TB is also prevalent among Somalis who resided in refugee camps. Somali families associate Western medicine with oral medications, especially antibiotics. Somalis are often initially perplexed by using a medical system to keep people healthy, rather than treating a disease once it has surfaced. Therefore, it is rare for Somalis to use Western routine prenatal care and well child care (Lewis, 1996). Physicians should be aware of these common health problems and also consider the Somali perspective on the potential causes of disease and traditional healing methods. Also, if it is the 9th month on the lunar calendar, doctors should consider how Ramadan will affect their treatment. Including prayer, or other traditional healing methods, in the physician’s treatment plan may build trust between the patient and doctor and also speed up the healing process.
Diet in Somalia varies between the North and South. The Northern diet centers around milk, meat, and rice, which is characteristic of their nomadic lifestyle (Lewis, 1996). Southern Somalia citizens consume lots of green vegetables, corn, and beans based on their large agricultural and international trading component to their economy. Those who reside in big cities of Southern Somalia can also be expected to eat Western foods like pasta and canned goods. Somalis drink brown and black teas imported from China as well as a coffee drink that is made from the coffee bean shell rather than the bean itself (Lewis, 1996).
The Somali world view greatly affects how they interact with Western society and allopathic health care. Their world view is largely shaped by the Islamic belief system, which is not just a religion but a culture, a structure for government, and a way of life (Lewis, 1996). Therefore, the Somali world view must be considered when examining and treating a Somali patient. For example, men and women are separated in most spheres of life and are not allowed to touch each other unless married. This implies that a male Somali would require a male physician and a female Somali requires a female physician. Somali women also prefer to have female interpreters. The Somali world view is also influenced by status where a woman’s status is enhanced with each child that she bears (Lewis, 1996). Health care professionals should be especially aware of this when discussing family planning with their Somali patient.
BBC News. “Country profile: Somalia.” February 9, 2008. Accessed February 18, 2008. http://news.bbc.co.uk/1/hi/world/africa/country_profiles/1072592.stm
Lewis, Toby, MD. “Somalia.” August, 1996. Ethnomed University of Washington Harborview Medical Center. Accessed February 18, 2008. http://ethnomed.org/ethnomed/cultures/somali/somali_cp.html