Discuss Diagnosis and Natural History

Somalia: A Country and Its Culture

Until 1949, when the nation became a territory of the U.N., Somalia was controlled by England, Ethiopia, France, and Italy. In 1960, Somalia was granted independence as a democratic nation. After nine years, General Barre led a coupe and created a socialist military government which was, at first, highly supported. As years passed, dissention grew and clan-based militias were formed. Civil war erupted in 1988 and since Barre’s overthrow in 1991, the various militias have contended for control (Diversity, 2007). Prior to the civil war, Somalia had an estimated population of 7.7 million people. Forty-five percent of the population has been displaced internally or fled the country altogether and around 400,000 people have died of famine, disease or have been killed in the war (Noor & Putman, 1993). Thousands of refugees initially sought protection in Kenyan refugee camps directly across the border. However, clan fighters were located in very close proximity and often came into the camps to prey on the refugees, rendering these camps unsafe (Adams & Assefi, 2002). Currently, 561,000 Somalis are seeking refuge in other countries; this makes them the third largest group of refugees in the world (The UN, 2009). In 2008, 2,523 Somali people were admitted to the United States as refugees (U.S. Department, 2009).

Somalia is slightly smaller than the state of Texas and is bordered by the Indian Ocean, Gulf of Aden, Ethiopia, and Kenya (Alarcón et al., 2007). The population is mostly rural, consisting of farmers and herders who share a uniform culture, language, and religion (Diversity, 2007; Lewis, 1996). Somalis speak the language Somali, though many people also speak Arabic and Swahili. A small percentage of people speak English as well (Noor & Putman, 1993). Most members of the Somali population are Sunni Muslims. Their culture is intertwined with Islamic tradition affecting social customs, dress, diet, gender roles, and attitudes (Lewis, 1996; Diversity, 2007). In urban areas of Somalia and in the United States, many women dress according to western cultural norms. However, some women follow the Islamic tradition which requires them to be covered from neck to ankle in non-form fitting clothing. In addition, women may wear veils to cover their faces. Men also have dress requirements and are often covered from neck to knee (Diversity, 2007).


(Central, 2009)

Family Life

Family is the ultimate focus in the Somali community. Elders are respected and addressed as “aunt” and “uncle” even if there is no relation. Men are in charge of the household, at least in public, but Somali women play major roles in keeping the finances and supporting the children. In fact, most women are forced to find work outside of the home due to financial difficulties caused by the war. There is a great deal of community support in Somalia that makes it possible for mothers to be away from the home.

Childbearing usually begins immediately after marriage because the status of a Somali woman is enhanced based on the number of children she has. There is no concept of planning or child spacing in Somali culture other than abstaining from sex while the mother is breastfeeding. Most births occur at home with a midwife. After birth, the mother and baby stay inside for forty days while the female relatives and friends visit to help take care of them. They bring certain foods and teas for the mother. Both mother and child wear special jewelry to ward off the evil eye (see Medical Beliefs and Traditional Healing below). Incense is burned twice a day to protect the baby from ordinary smells of the world. After the 40 day period, a naming ceremony is held. The child’s first name is original, given specifically to him or her. The child’s second name is the name of his/her father and the third is of the paternal grandfather (Lewis, 1996).

Medical Beliefs and Traditional Healing

According to Somali tradition, illness can be caused by evil spirits, God, or one’s own or others’ behaviors (Children’s, 2003 & Schuchman, n.d.). God may use the illness as a form of punishment, or it may simply be God’s decision to give an illness to someone (Children’s, 2003). It is believed that humans can cause one another to be ill; this is called the “evil eye.” The concept of the “evil eye” entails purposeful or inadvertent praise of another person, causing harm or illness to occur. For example, Somali mothers are often upset if the doctor compliments their child by describing him/her as “big and fat.” They fear that the evil eye will harm their child (Alarcón et al., 2007). Illnesses such as measles, hepatitis, chicken pox, mumps, hunch-back, broken bones, and tuberculosis are treated by traditional healers. These healers, typically men, have learned their expertise from family members. To cure these diseases they use combinations of fire-burning, herbs, and prayer. Fire-burning involves heating one end of a stick from a special tree and applying it to various points on the skin to cure an illness. Hepatitis, tuberculosis, and diarrhea are cured by applying the stick once to each wrist and four times to the abdomen to stimulate the immune system. Malnutrition is treated by applying the stick to the head in order to reduce the person’s head size. Herbs and prayer are used to cure other ailments such as seizures, backaches, stomach-aches, rashes, and more (Lewis, 1996; Children’s, 2003). Somalis also use massage therapy with certain oils primarily as treatment for pain, headaches, and backaches (Diiriye, Guerin, Guerin, & Yates, 2004).

Spirit possession is believed to be another cause of some illnesses in the Somali culture. Every individual has spirits inside of them and angering those spirits can lead to fever, headaches, dizzy spells, or weakness (Children’s, 2003). Psychotic symptoms are attributed to spirit possession as well. In order to cure an illness caused by spirits, a ceremony led by a traditional healer or waddad is performed that includes eating special foods, incense burning, and readings from the Koran (Alarcón et al., 2007; Lewis, 1996). The chosen readings are selected carefully based on the condition and can be read for a few hours or a few days (Diiriye et al., 2004).

Please read “A Qualitative Investigation of Somali Immigrant Perceptions of Disability: Implications for Genetic Counseling” from the Journal of Genetic Counseling.

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