Mental Health
Note to Physicians
About half of all refugees present with mental health problems ranging from psychiatric disorders to severe trauma and emotional distress (World Health Organization, 1999, in Adams & Aseefi, 2002). Most Somali refugees have been separated from, or have lost family members. Close to 30 percent of all Somali refugees have been victims of torture and abuse. And approximately 3 out of 4 Somalis have been traumatized (Children’s Hospital and Clinics of Minnesota, 2003). Somali women are especially affected; sexual violence is a common occurrence within war-affected regions (Adams & Aseefi, 2002).
Clinical research suggests; Somali refugees that present with physical dysfunction may actually be suffering from depression, somatization, or posttraumatic stress disorder. Risks of mental illness are highest during the first few years of resettlement (Adams & Aseefi, 2002).
But, physicians should be aware – patients may not want to discuss mental illness, or traumatic past experiences, fearing stigmatization or re-experiencing painful attacks. Physicians would be better off waiting until a rapport has been built with the patient, before probing about traumatic histories (Adams & Aseefi, 2002).
Tuberculosis
There is some research indicating that some people of Somali heritage perceive Tuberculosis (TB) contraction as a punishment or test from God. Curative remedies may entail reading from the Koran or engaging with a spiritual healer. The entire family usually engages in prayer; the diagnosis of TB – carrying high social stigma — affects all members of the home (Citrin, 2006).
Of course many have a biomedical understanding of the transmission of TB. Or they may believe that there are a combination of causes, incorporating spiritual and biomedical concepts. But, regardless of awareness, some claim that the societal shame and stigma of being TB positive in Somali culture can prevent many from seeking health care services. Some fear that disclosing their TB status to health authorities will affect their living situations; many Somali immigrants share homes with extended family members (Citrin, 2006).
A number of community informants have cited TB “the worst disease in the world.” The level of stigma surrounding this diagnosis is comparable to that of HIV and STD’s within the Western world. Physician sensitivity is important (Citrin, 2006).
Barriers to care
Language barriers stand in the way of smooth communication between physicians and Somali patients. Family member translators may not be able to give unbiased services, or might censor patient requests or questions.
Professional interpreters can help to overcome language difficulties (but keep in mind, most Somali’s are comfortable interacting only with those of the same sex, and in some cases, from the same clan) (Adams & Assefi, 2002).
References:
Adams, K. & Assefi, N. (2002). Primary care refugee medicine: General principles in the postimmigration care of Somali women. Primary Care Update for OB/GYNS, 9, (6), 210-217.
Children’s Hospitals and Clinics of Minnesota. (2003). Clinics and departments: Somali culture and medical traditions. Available: http://xpedio02.childrenshc.org/stellent/groups/public/@xcp/@web/ @clinicsanddepts/documents/policyreferenceprocedure/web025020.asp
Citrin, D. (2006). Somali tuberculosis cultural profile. University of Washington. (12 pages). Available: http://ethnomed.org/clin_topics/tb/cultural/soma_tb_profile.htm Lewis, T.; Ahmed, B. & Hussein, K. Voices of the Somali Community. Available: http://Ethnomed.org/ethnomed/voices/Somali.html
World Health Organization (1999). WHO/UNHCR Mental Health of Refugees. Geneva, Switzerland: WHO.
