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  1. 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

  2. Somalia: Life before the War

  3. 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.

  4. 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 didn’t go out for vegetables or rice. You didn’t want to get shot. But at night, you didn’t sleep either. It was quiet at night, but scary because someone might just come up and slit your throat. They’d 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.

  5. 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

  6. 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).

  7. 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.

  8. 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?

  9. 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

  10. 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

  11. 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

  12. 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 don’t know how to flush. It’s 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.”

  13. 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 don’t have the right kind of sneakers.”

  14. 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 don’t always say what we want them to say, but we can’t 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”

  15. Building Relationships • “In Somali culture, it is important to show concern about how a community member’s 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 ”

  16. 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 don’t 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.”

  17. Concept of Time “Somali culture doesn’t 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.

  18. 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 can’t 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.

  19. 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. • (

  20. Guidelines during Ramadan for Health Professionals “It's Not Just a Food Fast” • When one is fasting, blood can’t be drawn • Individual can’t take medications during the day • Yearly check up for women for should be avoided • One shouldn’t fast if there are pregnant or breast feeding • Dental check ups should be avoided unless it’s an emergency (These guidelines are only for healthy individuals, however one should decide their state.)

  21. Focusing on Strengths • Extended family • Community • Value of education and learning • Religion • Women’s role in the home