Somalian patients

  1. 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!
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  2. 51 Comments

  3. by   Belinda-wales
    I worked as a midwife in the UK and had some experience working this group- the main things I can tell you is that the women offten wore a hijab ( head and face covering) and are very private about showing there bobies in labour and often will not let male staff deal with them- they are often accompained by famlies -husbands may be the only english speaker. They are often very vocal in labour and wail throught labour very loudly. They will remove the hijab whilst in labour but the rest of the long gons they often keep. We did have some who had under gone (gfc) gential female circumcision now you will have to discuss with your team how you are going deal with this. Good luck I will add more when I can remember it.
  4. by   Zhlake
    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.
  5. by   Zhlake
    Oh they are very modest even with us also. And it is nearly impossible to do a fundal check. They grab our hands and say no. And I don't mean the aggressive massaging to get blood to flow, I mean just a quick check to see where it is at.

    I had a c/s patient the other day and we told her that the CRNA would be a man. She asked if we had a female available and we said no. She was flexible with that and it wasn't even an issue. We recieved some information from the Muslim Center in KC that they will prefer female caregivers but in emergencies or if none is available they will accept a male.
  6. by   CEG
    Quote from Zhlake
    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.
    This is what I thought of too. If you look at it from their point of view it is quite shameful to make a woman immediately care for herself, baby, family, and return to work in 6 weeks.

    OT but it would be interesting to see the rates of PPD in countries where this kind of support is available.
  7. by   Zhlake
    Quote from CEG
    This is what I thought of too. If you look at it from their point of view it is quite shameful to make a woman immediately care for herself, baby, family, and return to work in 6 weeks.

    OT but it would be interesting to see the rates of PPD in countries where this kind of support is available.
    I wondered the exact same thing about PPD.

    It is just very aggrivating for many of the nurses. We are so used to the women getting more and more independent before they leave. And then this culture pampers and dotes over the women so much more. Any time one of them goes to get out of bed, 3 of their friends will rush over to them to help them out. It causes a lot of eye rolling among the nurses, but I really think we need to change our perspective on that.

    In fact, one of the nurses was joking that the "entourage" had arrived the other day. 5 women came in to a patient's room after delivery. They were brining hot tea, food and of course an incredible amount of support.

    I said, "I wish I had an entourage after I had my babies!"
  8. by   RN BSN 2009
    Quote from Zhlake
    Oh they are very modest even with us also. And it is nearly impossible to do a fundal check. They grab our hands and say no. And I don't mean the aggressive massaging to get blood to flow, I mean just a quick check to see where it is at.

    I had a c/s patient the other day and we told her that the CRNA would be a man. She asked if we had a female available and we said no. She was flexible with that and it wasn't even an issue. We recieved some information from the Muslim Center in KC that they will prefer female caregivers but in emergencies or if none is available they will accept a male.
    This is true... Islamically it is acceptable to have a man replace a woman when a woman is not available.
  9. by   Faeriewand
    Quote from Belinda-wales
    . We did have some who had under gone (gfc) gential female circumcision now you will have to discuss with your team how.
    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.
  10. by   KellNY
    There are a great deal of people who view male circumcision as mutilation as well. By definition, it is. But that's OT. Semantics, really.
  11. by   deehaverrn
    I have had pts with this same type of thing, not necessarily from Somalia, but from other Muslim countries. They were very loud also, and even screamed, wailed, closed their legs and grabbed the caregivers hands with extremely gently cervical exams. They would refuse male caregivers which sometimes meant a very increased workload if the only female available was a postpartum nurse because the other was a male CNA. They will refuse even for males to enter their rooms. And here they don't move or do things for themselves either.
    My problems with this "cultural" diversity issue are these: It is a form of discrimination against male caregivers. If we were to accede to the pts request in all cases it would be one thing. For example, when a pt who was a KKK member from the South refused minority workers, this request was at first honored, however, minorities complained that the hospital was discriminating by giving in and filed suit against the hospital. The hospital than said that it would no longer do so and in future would assign caregivers without pt input. But we still allow the women to refuse males. I certainly DON"T agree with the KKK, but it is definitely a "cultural" issue to them also, and if you don't think it is also a religious one for them, then you haven't visited certain areas of the Deep South. If it was up to me, I'd let the pt decide, unless there was no one else available or it would impact others care (as in my spending hours with one demanding pt).
    Nextly, we try to keep all our moms in private rooms but sometimes have to overflow to semiprivat. These women, even those with no insurance coverage, think that they deserve the private rooms. I think its wrong to move others to these rooms to accomplish this. They have even refused to room with others when there will be no male visitors.
    Finally, it would be fine with me if the "entourage" would in fact, help care for the woman. It has been my experience that they mostly stand around and watch. They will call for the nurse, often by coming into the hallway and yelling, and we are expected to wait on her hand and foot. We are also expected to care for the entire entourage--they will ask for water, juice, towels for themselves, and even whole meal trays. They will go to our unit kitchen and empty it of snacks intended for pts and fill paper plates to pass around with juices to the entire roomful of guests.
    I'm sorry to be blunt but, this is the USA now people, the melting pot, not Somalia part 2, if you wanted things to stay the same you should have stayed over there. And you can pass that on to all those who think I should learn Spanish too. There is a limit to how much we should have to adapt to them. Why don't some of the bleeding hearts complain about how in Saudi Arabia and other Muslim countries, our American service women are made to act subservient, including in their dress? If we have to change when we're over there...
    Also, I find that due to that culture, the women and entourage are extremely disrespectful to nurses..its considered really low class in Arab countries to be a nurse due to the nature of our work. Sorry, but no one should be required by ones hospital to be treated badly in the interests of "cultural sensitivity". Get over it.
  12. by   KellNY
    Do you have any proof that it's considered low class in "Arab" countries to be a nurse? Because I've found that my "Arab" pts have been some of the kindest.

    Also, I disagree that it's discriminatory against males. In their religion, it is often COMPLETELY inappropriate for a male to see their uncovered hair or legs and arms, let alone vaginas or breasts. It's beyond a KKK member being prejudiced and ignorant. It's part of their religious law. We've had some strict Christian and Jewish mothers who were the same way.

    Lots of times cervical exams are not necessary-I'd refuse even a gentle one too.

    Regarding the language barrier....I'd like to see you move to Mexico and be fluent in Spanish within a few months.

    What a shame you refer to "bleeding hearts". A bleeding heart serves me better than no heart at all.
  13. by   RN BSN 2009
    Quote from KellNY
    Do you have any proof that it's considered low class in "Arab" countries to be a nurse? Because I've found that my "Arab" pts have been some of the kindest.

    Also, I disagree that it's discriminatory against males. In their religion, it is often COMPLETELY inappropriate for a male to see their uncovered hair or legs and arms, let alone vaginas or breasts. It's beyond a KKK member being prejudiced and ignorant. It's part of their religious law. We've had some strict Christian and Jewish mothers who were the same way.

    Lots of times cervical exams are not necessary-I'd refuse even a gentle one too.

    Regarding the language barrier....I'd like to see you move to Mexico and be fluent in Spanish within a few months.

    What a shame you refer to "bleeding hearts". A bleeding heart serves me better than no heart at all.
    :yeahthat:
  14. by   jmtndl
    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.

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