Health Care Beliefs in the Somalia Culture, Research Paper Example

Somalia has experienced significant turmoil in recent years as a result of sociological and political conditions.  In this country, residents often believe that healthcare is inaccessible or does not provide them with the desired benefits.  Many Somali refugees have fled to Kenya, the Netherlands, or even as far as the United States, these healthcare system appear to be foreign, difficult to understand, and often hostile (Heger, Boyle & Ali, 2010).  In the following discussion, the background of Somalia, Somali attitudes regarding healthcare, the potential for change, and recommended interventions will be addressed in greater detail.

In the late 1980s, Somalia experienced a difficult civil war, which illustrated the fundamental challenges associated with ethnicity and economic status, particularly when cultural recognition is critical (Webersik, 2004).  In Somalia, health care workers regularly encounter cases of murder, rape, and female genital mutilation, as this is a customary practice.  In addition, modern Somalia is rife with hepatitis, tuberculosis, malaria, and a many gynecological difficulties. According to Wallin and Ahlström (2010), beliefs regarding health are influenced by people, family units, prevalent culture, and social class.  For example, women cannot seek medical attention without the permission of their husbands. Some causes of illness based upon Somali cultural beliefs include Allah, spirits, casting an evil eye, curses by others, and even parental influences.  Suffering is believed to bring about forgiveness of the sins by God, and is also viewed as a means to salvation.  Whatever the cause of the disease, in some cases, it is believed that it may only be treated by the will of God, whether this is through traditional means or through Western medical practice (Finnström & Söderhamm, 2006).  It is very important that if this cultural belief exists in a given client, that the healthcare provider recognize this belief and act on it when giving treatment. Therefore, nurses providing care and treatment to the Somalian population must recognize any barriers that exist to determine how to address treatment options most effectively, while also exploring these cultural limitations.

Medical and mental patients in Somalia commonly exhibit symptoms of chronic disorders in response to stress, turmoil and lack of consistent medical structures throughout the country, which lead to limited access to healthcare in many cases.  Examples include post-traumatic stress disorder, depression, anxiety, malnutrition, chronic disease and high blood pressure, and approximately one-half of the Somali refugees and asylum-seekers suffer from a combination of two or more of these conditions (Gerritsen et al., 2006).  In addition to the civil war and history of strife, issues of land ownership, usage and drought have contributed to periodic food shortages, which only add to other medical concerns.  Given that illness may be attributed to the will of Allah or even the diagnosis of a commonplace disorder, such as diabetes, is a cause for dismay and disbelief or avoidance (Wallin & Ahlström, 2010).  Somali minorities, such as the Bantu culture, have not been afforded the same economic opportunities, and frequently struggled with health challenges related to the food supply, such as starvation, malnutrition, susceptibility to diphtheria, etc. (Webersik, 2004).

In the United States, it is often assumed that healthcare is an automatic provision of residency, and that the reasons for health issues hold scientific roots, but the Somali refugees living in the country are not accustomed to this perspective. Sweden, which harbors a large portion of Somali refugees, exhibits similar health care to the UK and the US, and continues to counsel Somali refugees with the belief that adverse health is not a karmic punishment, as the superstitious inhabitants commonly believe (Wallin and Ahlström, 2010).  Barriers to managing the relationship with a Somali client include the following: a lack of awareness of the culture, language issues, confidentiality of the translators, and the attitudes of health care providers.  For the health care worker, it is extremely important that these cultural beliefs are well understood, and used effectively to influence how the client’s care and wellbeing is managed at all stages.  The ability to be aware of and act upon the knowledge of these beliefs make a substantial difference in the probability of success of the treatment plan.

While the physical health of Somali inhabitants is the primary concern, the necessity for counseling and health education are also important to the country’s recovery.  Sadly, much of the damage of the Somali Civil War era is permanent, and has been largely destructive for the culture and the overall economy.  However, there is much ground to cover in order to ease the mental pain of survivors and to promote a positive restructuring of access to healthcare and related clinical capabilities.  The range of typical stress-inducing events in Somalia is quite different from those faced in most countries.  In a study of more than 300 refugees and asylum-seekers, stressors included forced separation, unnatural death(s), rocket attacks, and long-term hiding (Geritsen et al., 2006). Each of these stressors has created many different challenges for healthcare providers seeking to provide effective methods to locals to improve their healthcare status and wellbeing.

In general, Somali men do not commonly express an acquaintance with contraceptives, and Somali women are not educated about sex, childbirth, or breastfeeding.  In addition, the intermittent scarcity of food has created a poor dietary way of life for marginalized groups in Somalia. Furthermore, Somali refugees in the UK and Australia have faced obesity and diabetes because they do not differentiate between the health benefits of particular foods; they just eat whatever they can (McEwen, Straus, & Croker, 2009).   Therefore, this culture and its population is far behind that of many other cultures in its efforts to promote positive knowledge regarding healthy choices and customs which will improve healthy outcomes.

In 2006, when Leather et al. published their journal article “Working together to rebuild health care in post-conflict Somaliland,” many Somali refugees had returned to the homeland, and the nation began to look toward health provisions for the country’s reconstruction.  Health care in Somalia continues to be predominantly privatized, owned by individual companies which are self-funded and self-regulated.  Somali citizens today prefer a mix of government, private, and industrial ownership, believing that a diversity of groups in power will discourage future civil wars (Webersik, 2006).

British hospitals have sent national ambassadors of health care to Somalia.  The King’s College Hospital employees in Somalia managed the Edna Adan Hospital’s first Cesarean Section and aided in supervising, training staff, and implementing care protocols to further accommodate patient needs (Leather et al., 2006).  The United Kingdom has also provided several grants to the King’s College outreach group and to the Tropical Health and Education Trust, which were endorsed by the UK and were partially funded by private health care groups in Somalia (ibid.).  The first step in moving forward is to analyze current health care and demonstrate better practices to enable Somalians to access the many benefits of healthcare in a more organized and comprehensive manner.  This requires government cooperation, volunteer and professional recruitment, and international funding.

Webersik (2006) suggests that without a central government, Somalia is likely to return to its former lawlessness, likely within the current generation’s lifetime, and given the current drought and conflicts among warlords appears to be taking place rather rapidly.  In addition, the involvement of outside investors within the country presents a unique opportunity for international influence and regulation under circumstances which are acceptable to the Somali government (Leather et al., 2006).  These new influences should also create the expectation of a universal approach to health care, while lessening the ingrained distrust which Somali inhabitants hold toward government organizations and professionals subject to governmental control.  This national intervention is currently taking place, demonstrating improved practice methods and financial support for every citizen, regardless of social status.

On an individual basis, the relationship between the healthcare provider and the Somali client will be more likely to succeed if that provider is very aware of the social and cultural differences of the Somali client.  The provider must gain an understanding of the client’s health beliefs, as well as his or her approach to health care.  Treatments must be based on approaches which are culturally sensitive, as this is crucial in the ability to respond to the client’s needs, as well as the client’s willingness to accept the healthcare provider’s advice. Under these conditions, it is important and necessary to address some of the most important obstacles that the residents of Somalia continue to face, given their existing cultural barriers, and to determine how healthcare providers, including nurses, might be effective in achieving improved outcomes within this population group. These efforts are of critical importance because they support the different dimensions of growth that are instrumental in shaping outcomes, and in reflecting upon the ability of healthcare professionals to recognize cultural differences and barriers, yet expand access to healthcare services throughout this war-torn and ravaged country.

References

Bhui, K., Craig, T., Mohamud, S., Warfa, N., Stansfeld, S. A., Thornicroft, G., & … McCrone, P. (2006). Mental disorders among Somali refugees. Social Psychiatry & Psychiatric Epidemiology, 41(5), 400-408. doi:10.1007/s00127-006-0043-5

Finnström, B., & Söderhamn, O. (2006). Conceptions of pain among Somali women. Journal of Advanced Nursing, 54(4), 418-425. doi:10.1111/j.1365-2648.2006.03838.x.

Gerritsen, A., Bramsen, I., Devillé, W., Willigen, L., Hovens, J., & Ploeg, H. (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Social Psychiatry & Psychiatric Epidemiology, 41(1), 18-26. doi:10.1007/s00127-005-0003-5

Heger Boyle, E., & Ali, A. (2010). Culture, Structure, and the Refugee Experience in Somali Immigrant Family Transformation. International Migration, 48(1), 47-79. doi:10.1111/j.1468-2435.2009.00512.x

Laitin, D. D., & Weingast, B. (2006). An Equilibrium Alternative to the Study of Culture. Good Society Journal, 15(1), 15-20. Retrieved from EBSCOhost.

Leather, A., Ismail, E., Ali, R., Abdi, Y., Abby, M., Gulaid, S., & … Parry, E. (2006). Working together to rebuild health care in post-conflict Somaliland. Lancet, 368(9541), 1119-1125. doi:10.1016/S0140-6736(06)69047-8

McEwen, A. A., Straus, L. L., & Croker, H. H. (2009). Dietary beliefs and behaviour of a UK Somali population. Journal of Human Nutrition & Dietetics, 22(2), 116-121. doi:10.1111/j.1365-277X.2008.00939.x

Wallin, A., & Ahlström, G. (2010). From diagnosis to health: a cross-cultural interview study with immigrants from Somalia. Scandinavian Journal of Caring Sciences, 24(2), 357-365. doi:10.1111/j.1471-6712.2009.00729.x

Webersik, C. (2004).Differences that matter: the struggle of the marginalised in Somalia. Africa (Edinburgh University Press), 74(4), 519-533. Retrieved from EBSCOhost.

Webersik, C. (2006). Mogadishu: an economy without a state. Third World Quarterly, 27(8), 1463-1480. doi:10.1080/01436590601027297