Somalian patients

Specialties Ob/Gyn

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I am wondering if any of you have experience with Somalian culture and childbirth. I work LD/postpartum/nursery and our small town has had a huge influx of Somalian workers. This transition has been very rocky in our unit, even though we are very accustom to working with other cultures (nearly half of our deliveries are hispanic). I am trying to do some research, but am not finding much. Any input appreciated!

Specializes in L&D.
I'm going to have to jump in here and ask you to please call it what it really is. Female genital mutilation. Males undergo circumcision. I don't know why some people want to make a nice word out of such a horrible thing that kills and maims young girls.

Many of the women who have had this done do not consider themselves to be mutilated and consider the term mutilation to be offensive. We are supposed to be culturally sensitive and nonjudgmental to our patients, but many of these women report that they found medical and nursing staff to be insensitive and alienating in their reactions and comments.

There is a very good article on Female Genital Cutting (a less emotionally loaded word than either circumcision or mutilation) in the August/September issure of Nursing for Women's Health (formerly AWHONN Lifeline).

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I'd have to agree with Nora; if you are going to call it what it is, how can you call male circumcision anything but genital mutilation? Removing a normal part of that anatomy for mostly aesthetic reasons?

If you want to argue that it is healthier; well, I submit that if all of us gals would have our labias removed at birth, we would not see all the old ladies with UTIs. They just can't keep themselves clean down there in their older years. And the other positive effects of male circumcision would hold, too. Fewer cases of HPV (since it would have less moist areas to live in) and therefore fewer instances of external genital cancers. Woo hoo, shall we sign our daughters up?

Honestly, I don't really want to argue the risks/benefits of the removal of the foreskin. I just wanted to point out that if you are going to call one type of genital surgery (performed without consent fomr the infant and indeed against the wishes of the infant--I've assisted with them, and every infant fights it) circumcision, you can't then demand that, just because it is performed on a female, it be called mutilation. It's either one or the other.

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Our experience has been different than yours so far! They have kept their hijabs on but have taking off the rest of their stuff. All of them so far, (we have had quite a few) have had the female circumcision. Varying degress of such. One was very easy to get a foley in, and one was exceedingly difficult.

The issues seem to be regarding infant bonding and also the mother's self cares after delivery. None of the patients we have had are interested in holding their babies. At all. In fact, they act almost angry when you ask them to hold the baby.

Then, the nurses feel like the patients are very demanding and rude to them in the postpartum area. I feel like that probably relates to the language barrier, but it is leaving a very bad taste the nurses' mouths. The patients also do not want to get out of bed and very dependent on the nurses for every little thing. I have seen this with other cultures (female family members really pampering the mothers and the mothers doing very little) so I understand where this is probably coming from, but it is just opposite from our Western experience of encourage mothers to do things independently.

I have worked with Somali pts in the chronic outpt hemodialysis setting and they are the same way- angry, rude, demanding, push staff away from them. This happens with pts who are strong and pretty healthy not at all acute, so I don't think it's related to the pain/stress of birth.

I've wittnessed Somalis hit staff and spit at them.

I just think that their culture is very different- very unique..

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It does seem reasonable for me to expect my culture to be respected in my home country. I have always respected the culture and customs in the countries where I have visited and worked. In Saudi, I did not drive or walk around in shorts even tho it was culturally comfortable. It is discouraging to have immigrants here who do not want to adapt.And no,I would not expect to be fluent in Spanish in a few months BUT I would get a book and make an effort to communicate in the customary language of the country rather than stand around with a blank look on my face and expect the service provider to make all the effort to communicate.And I would, and have, immediately learned enough to get me by in an emergency.I am curreently caring for a brain-dead teenager with immigrant parents. Mama never learned English...it is not cultural for them...and couldn't call 911 when the young person had an event and now this young human is for all intents and purposes dead.Because the mother wouldn't take the responsibility of reaching out of her own culture to adapt enough in her host country to protect herself and her child.It is not heartless to expect that people adapt to the country they voluntarily came to.It is ultimately beneficial to the immigrant group,and a reasonable expectation.

This is basically what I recently said in another thread and I was lambasted for it.:angryfire

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I'd have to agree with Nora; if you are going to call it what it is, how can you call male circumcision anything but genital mutilation? Removing a normal part of that anatomy for mostly aesthetic reasons?

If you want to argue that it is healthier; well, I submit that if all of us gals would have our labias removed at birth, we would not see all the old ladies with UTIs. They just can't keep themselves clean down there in their older years. And the other positive effects of male circumcision would hold, too. Fewer cases of HPV (since it would have less moist areas to live in) and therefore fewer instances of external genital cancers. Woo hoo, shall we sign our daughters up?

Honestly, I don't really want to argue the risks/benefits of the removal of the foreskin. I just wanted to point out that if you are going to call one type of genital surgery (performed without consent fomr the infant and indeed against the wishes of the infant--I've assisted with them, and every infant fights it) circumcision, you can't then demand that, just because it is performed on a female, it be called mutilation. It's either one or the other.

The more accurate name for "female circumcision" would be CASTRATION.

Their external genital organs are completely removed. This would be the same as removing a male's member.

This can't even be compared with circumcision.

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That's interesting because over the years, I have been insulted by many a White doctor. Is it their culture to disrespect women or ...? Any explanation for that?

Actually, yes, it is the culture of white men (generally/historically) to look down on others who are not white men!

Umm..... that's pretty much the norm all over the world and all throughout history- i.e. slavery in the US, women's sufferage, the genocide of Native Americans....etc.

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Specializes in Community, OB, Nursery.

There is a very good article on Female Genital Cutting (a less emotionally loaded word than either circumcision or mutilation) in the August/September issure of Nursing for Women's Health (formerly AWHONN Lifeline).

Thanks for mentioning that article, Nora. I was going to mention it but you beat me to it. Very informative and eye-opening.

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Specializes in Community, OB, Nursery.
The more accurate name for "female circumcision" would be CASTRATION.

Their external genital organs are completely removed. This would be the same as removing a male's member.

This can't even be compared with circumcision.

There are varying degrees of FGC, with the most extreme being removal of the privy parts, labia minora, and most of the labia majora. The labia are sewn shut with a small opening left for urine and menstrual blood.

The 'mildest' form (if it can indeed be called mild - I don't think so) involves either making a pinprick mark on or removing the sheath (prepuce) covering the privy parts. This sheath is analogous to the male foreskin, as the privy parts is analogous in embryonic development to the glans member.

So why don't we consider removing the clitoral prepuce in girls?

Castration is removal of the gonads - ovaries or testes.

I think all of it - male, female and any degree, is mutilation.

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Specializes in postpartum,well baby nursery, L and D.

ZHLAKE- thanks for bringing up this topic. (by the way, i worked at truman medical in kc...just curious where you work..because that is where i saw the most somalian pts).

Wow, lots of interesting opinions. I am a Muslim woman who also happens to be a labor and delivery/post partum nurse. I have taught some cultural sensitivity classes and somalian patients always seem to come up.

Before I say anything else I'd like to reply to a few people. I know everyone is completely entitled to their own opinion but some of the things that are said can be very hurtful.

DEEHAVERRN- Quoting you...

"As far as religion goes, I believe that my religion teaches me to love others, but not to agree with them necessarily.

I guess we can't treat as terroristic, a culture that believes in mutilating young girls, or in keeping them ignorant, or in stoning women because they weren't fully covered,."

My religion Islam also teaches me to love others. However, I am taken aback by your ignorance. First of all, you are generalizing an entire group of people based on a few people you have come into contact with. Your comments about women being stoned for not fully covering or girls being mutilated is very much a stereotype. First of all, what somalians or people from other african countries do, is part of their CULTURE. Our religion islam, prohibits genital mutilation and the other things you listed above so please do not bring religion into the picture until you educate yourself about what Islam does and does not teach. Islam is the largest religion in the world so there are people from every part of the world that are muslim but it is important to separate islam from that person's cultural beliefs...BIG difference...

I dont even know what you me by "terroristic" but once again that shows your ignorance. Terrorists can be found in all religions and all groups of people however in the western media it stands out more with Muslims being labeled terrorists because any time a so called Muslim does any type of terrorist act it is called "ISLAMIC fundamentalism" or "Muslim Terrorist" but you do not see that with acts that israelis commit against palestinians as "JEWISH terrorists" or the IRA in Ireland being "CHRISTIAN terrorists"...so I cant blame you completely for being drawn into the propaganda that the media is so good at spreading. my advice to you is educate yourself rather than throwing out statements that are untrue and very narrow minded.

ANNE74- I quote you...

"Sorry dude - you may come from a culture that disrespects women, but you're in my neighborhood now - and that don't fly here!

anne74"

I think that sharonH and Queenjean put it beautifully. You say he disrespects women and quite frankly I have worked with some doctors from the middle east that have been rude etc. But I have also worked with many white/black/asian doctors that have been the same exact way. That is his personality and not his culture or religion that teaches him to behave that way entirely. Disrespecting women can come in many shapes and forms. Women in the west do get disrespected in MANY ways as well....which is a whole new topic..please expand your horizons and read a little more about the world around you before you throw out those generalizations..

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I agree with what some people have said that you cannot completely cater to every culture/religion and there are times that they need to compromise and also adapt. I am in no way just defending somalian women because I am a muslim woman myself..i do agree that some somalian women can be aggressive and i honestly think that is just how their culture has shaped them...they are very vocal and they can be demanding however ive run into women from all backgrounds that can be that way....I work in cambridge, MA so trust me i know what demanding can be like!!

One of the things to keep in mind with Muslim patients on the OB floor is that the private parts and just a woman's body in general is considered very personal...meaning many muslim women do not even show their legs or reveal the shape of their bosom etc....and A LOT of muslim women do not have sexual relations before marriage so they are shy about that aspect of their body at times.....I was born and raised in America but I never ever wore a tampon and even now that I am married i dont..because thats how i was raised....So you will run into muslim women who hate lady partsl exams etc and the best you can do for them is be there for them...hold their hand...and tell them exactly why it is important to do the exam or whatever is being done....and you may be surprised that if you actually show them you understand that they arent comfortable but you will work with them rather than rolling your eyes or outright making comments to their face ( i have witnessed that many times) that they will actually be responsive.

One of the questions i get asked a lot is why are Muslim women afraid of their sexuality...the answer is that they are not. The thing to remember is that modesty is a big aspect of a muslim's life...whether male or female...you will run into muslim men that wont shake a woman's hand or touch a woman and that is not because he is scared of a woman but it is out of respect to that woman...that he doesnt touch them....up until even the 1960's women in america were also very modest in their dress etc...so this isnt only a concept that muslim women hold on to....there are many christian and jewish women ive met that are also modest in that sense....but the fact that modesty has become a thing of the olden days in this society it becomes weird for people to accept that when a woman is modest....that woman (especially muslim women) are called oppressed and so on...we must remember that freedom is measured differently by each person and to a muslim woman freedom may mean covering her hair and body from men's eyes versus wearing revealing clothes and letting men see that part of them..

There are so many different cultures out there that sometimes it can be difficult and challenging working with different groups of women but I love that part of it...and I think that aslong as you know the limits and your patient understands the limits and that their health and well being or their baby's well being is not being undermined because of a cultural or religious belief that you can work well with these women. I have worked with MANY muslim women and never have I had one that refused a male doctor when there was no females or refused a lady partsl exam....or any other group of women for that matter....the most important thing is educating yourself....and if you want resources to help you just let me know...

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Specializes in Critical Care.

:yelclap: Very well said AfghaniPrinzess :yelclap:

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Here's a story about a town that has been taken over by Somali refugees - over 1,000 in a sleepy college town of 20,000.

http://www.emporiagazette.com/news/2007/nov/03/emporia_readies_more_somali_refugees/

The comments are especially interesting.

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Specializes in Community, OB, Nursery.

I found the comments to be not interesting but mostly crude, arrogant, and shortsighted.

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