Horn of Africa, bordering Ethiopia, Kenya, Djibouti, and the Gulf of Aden

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Somalia

• Horn of Africa, bordering Ethiopia, Kenya,
  Djibouti, and the Gulf of Aden
• 6.66 million population
• 75 of population are farmers or raise camels,
  cattle, sheep or goats.
• Hot, dry climate with brief rainy seasons
• Capital Mogadishu
• Religion Muslim

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Somalia Life before the War
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Somalia The Civil War

• Independence gained in 1960 from Great Britain
  and Italy
• In 1969, General Mohammed Siad Barre led a coup
• 1 million persons left for neighboring countries
• Over 300,000 others have lost their lives since
  1991.
• By the fall of 1992, 25 of all Somali children
  under the age of five had died because of famine.
  

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   Mogadishu was a beautiful, quiet town before
the war. Somalis were respectful and kind. Now,
everything is different. Life seems to have lost
its value we have become aggressive and do not
care about anything.
During the day, it was racket all the time. The
constant boom-boom-boom of guns in and out. You
didnt go out for vegetables or rice. You didnt
want to get shot. But at night, you didnt sleep
either. It was quiet at night, but scary because
someone might just come up and slit your throat.
Theyd kill you and all your children and take
everything. We had to take different night
watches to sleep and protect ourselves, but if it
was your turn to sleep, worry kept you awake.
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Health in Somalia

• Child mortality
• The rates of child morbidity and mortality in
  Somalia remain among the highest in the world
• Childhood diseases
• Infectious diseases, notably respiratory
  infections and diarrhoeal diseases are the
  leading killers of infants and young children.
• Neonatal tetanus and other birth-related problems
• Measles, malaria

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Health in Somalia

• Child immunization
• The level of immunization is still low. Only
  about 10 percent of children under one have all
  eight recommended vaccinations. 
• Nutrition
• Malnutrition is a chronic problem in Somalia,
  with 25 per cent of children underweight
  (moderate and severe).

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Health in Somalia

• Access to water
• Only 23 per cent of the population has access to
  safe drinking water.
• Hygiene and Environmental Sanitation
• Only 48 per cent of the population has access to
  sanitary means of excreta disposal, and
  traditional pit latrines account for 47 per cent
  of sanitation methods.

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We walked to the Somali-Kenyan border from
Mogadishu and when we arrived in Mandera, Kenya,
we just wanted food. People stared at us and
started to try to sell us things. We just wanted
food. Then we had to take a four-day trip to
Nairobi on a lori truck. Half of the lori was
goats and the other half was people and children.
I remember them saying that certain areas were
dangerous and we had to be quiet and get low and
sit as close as possible. There I was, with my
nine children, separated from my husband leaving
a good life behind for what?
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Oregon
Capital Salem City of Portland population
600,000 National Language English
Demographics The racial makeup of the city is
77.91 White, 6.64 African American, 6.33
Asian, 1.06 Native American, 0.38 Pacific
Islander, 3.55 from other races, and 4.15 from
two or more races. 6.81 of the population are
Hispanic or Latino of any race Climate The
city has mild wet winters, and warm, dry summers.
155 days with measurable precipitation.
Religion Christianity is the stated religious
preference of about 75 to 79 of Oregonians.
About 17 call themselves "nonreligious", 1.2
agnostic, and less than 1 each for Buddhists,
Jews, Unitarian-Universalists
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Oregon

• Oregon is a New Gateway for Immigration
• Oregon saw a 108 increase from 1990 - 2000 in
  the foreign-born population
• Immigrants are underrepresented in Census and
  Bureau of Citizenship and Immigration Services
  (formerly INS) Data
• The Census groups communities together
• Many immigrants do not fill out the forms because
  they are non-English speakers
• Secondary migration to the Portland area is
  common, so these numbers shift rapidly

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Portland and Somali Refugees
Resettlement Characteristics employment
opportunities at entry level, low cost of living
and its traditionally welcoming atmosphere.
Somali Refugee First Arrival Dates
1975 Number of Somali Refugees (ORR) 475,
expecting 300 Somali Bantu (2005) Number of
refugees/immigrants, Somali 3,400 most
likely the most valid because these are the
people that are truly a part of this culture and
word of mouth is how the real numbers are
gained Number of African Refugees (ORR)
11,000
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Adjusting to a New Culture
Though the Bantus, have lived a life of
persecution in a primitive setting, they are
highly adaptive people who will quickly learn to
cope with modern life. What makes me sad is those
who say they are incapable because they dont
know how to flush. Its easy to show someone how
to do those things. They may not be entirely
sophisticated in modern ways, but they are not
coming from a cave. They are known as the
hardest workers in Somali society, and the women
work even harder than men. The most difficult
adjustment will be the loss of the Bantus
communal village structure. In Somalia, it is
almost literally true that the whole village
raises the child.
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Adjusting to a New Culture

• Somali families living in apartment complexes can
  be large, and at times, interrelated. Living
  conditions are crowded. These conditions contrast
  starkly with the conditions in Somalia before the
  war, as each extended family often owned a house,
  the mothers were able to stay home and take care
  of the family, and materially they had everything
  they needed. The standard of living here in the
  United States thus differs for these refugees
  from their prior lives. In addition, the American
  concern with materialism contrasts with their
  lives in Somalia.
• In Somalia, you wore sandals, and if your
  sandals broke, you fixed them. In the United
  States, you have to wear sneakers, and other
  students make fun of you if you dont have the
  right kind of sneakers.

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The Role of Interpreters

• Practitioners tend to limit their relationships
  with the women and trust interpreters
• Interpreters create many barriers for the women
  in describing specific conversation details and
  providing private or confidential information.
• Hesitation with Interpreters
• Family members help with Interpretation
• Worry about sharing of personal information
  pride and saving face
• When the men go in, they speak for us. They, you
  know, say the things they want to say. They dont
  always say what we want them to say, but we cant
  say anything.
• He comes in, says hello, and you talk about
  symptoms, and with the interpreter there you
  frustrate yourself through the quickest fifteen
  minutes of your life. Then the doctor leaves and
  you look at the interpreter wondering if anything
  happened that will make you better

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Building Relationships

• In Somali culture, it is important to show
  concern about how a community members decisions
  affect others, said one community activist,
  and be willing to sacrifice personal activities
  for a member of the community.
• Emphasizing group harmony and commitment over
  individualist goals.
• Relationships between men and women
• If you want to be listened to, you need to put
  in time listening

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Concept of Time
Somalis do not seek treatment unless they are
chronically ill. You take care of things as
they come up. You do not need to visit the
doctor unless you are sick Somali women tend to
be frustrated with the amount of waiting time
involved in visiting clinics and scheduling
appointments. Their frustration mounted when
appointments could not be made on the same day
they were sick and were often two or three weeks
away. Many of the women agreed that they have a
frustration with the health care system here
because you have to call to make an appointment
when you are sick, but they dont have any
appointments, stating How can I get help from
a doctor if I am sick when I wake up, and then no
one will see me? They tell me I have to wait two
to three weeks. Yes, if you are sick, then
the doctor should see you. But, here they tell
you to wait.
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Concept of Time
Somali culture doesnt think about tomorrow.
They operate in today. You take care of things as
they come up. You do not need to visit the doctor
unless you are sick. This is one of the reasons
Somalis are prevented from seeking preventive
treatment. Community members experience large
amounts of frustration because they expect
solutions today and will forgo prevention and
treatment tomorrow if they wake up feeling
healthy. This also impacts the health education
and training, as most individuals will not change
their behavior if they, literally, can not
understand the future impact of that change.
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Religion
The Somali culture is approximately 90 percent
Muslims, and any illness that (Somali people)
suffer, they believe it is coming from the higher
power of Allah. Some people go to
religious clerics seeking cures here as a way to
stay connected to the higher power that can heal
them. We cant control our
illnesses. Several Somali community activists
and health workers stated that this belief
hinders their ability to create change and solve
health problems. They agreed that religion plays
a vital role and accept the role of God/Allah in
illness.
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Ramadhan Kareem

• Ramadan is the ninth month of the Muslim
  calendar. The Month of Ramadan is also when it is
  believed the Holy Quran "was sent down from
  heaven, a guidance unto men, a declaration of
  direction, and a means of Salvation" It is
  during this month that Muslims fast. It is called
  the Fast of Ramadan and lasts the entire month.
  Ramadan is a time when Muslims concentrate on
  their faith and spend less time on the concerns
  of their everyday lives. It is a time of worship
  and contemplation.

• During the Fast of Ramadan strict restraints
  are placed on the daily lives of
• Muslims. They are not allowed to eat or drink
  during the daylight hours.
• Smoking and sexual relations are also
  forbidden during fasting. At the end of
• the day the fast is broken with prayer and a
  meal called the iftar. In the evening
• following the iftar it is customary for
  Muslims to go out visiting family and friends.
• The fast is resumed the next morning.
• (http//www.holidays.net/ramadan/story.htm)

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Guidelines during Ramadan for Health
Professionals

• It's Not Just a Food Fast
• When one is fasting, blood cant be drawn
• Individual cant take medications during the day
• Yearly check up for women for should be avoided
• One shouldnt fast if there are pregnant or
  breast feeding
• Dental check ups should be avoided unless its
  an emergency
• (These guidelines are only for healthy
  individuals, however one should decide their
  state.)

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Focusing on Strengths

• Extended family
• Community
• Value of education and learning
• Religion
• Womens role in the home