Somalian patients

[Zhlake]

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!

[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.

[KellNY, RN]

Again, there is a difference between cultural practices and RELGIOUS LAW. What may be an inconvenience to the RN (having to switch patients, take time to get a female doctor, etc) can mean the difference between this woman being traumatized and shamed-possibly permanently. (I had a christian pt who explained to me that having an internal exam is equal to intercourse--as far as rules go--and she was not allowed to have intercourse with any other man besides her husband. He would have been allowed to divorce her if she had gotten a gentle cervical exam from a male resident. That's how serious this can be).

[deehaverrn]

Sometimes cervical exams are very necessary..like when the pt just arrived and is screaming and holding her belly, and won't answer questions, and you have to figure out what is going on

When you have 12 postpartum pts with just yourself and a male CNA, and you have to assess all of them and give meds and ONE pt is constantly ringing for water, pads, juice, fix my pillows, another blanket, and the entourage comes into the hall and yells if you aren't into the room within a minute...yeah..its a problem, especially when you explain that you will return but have to see other pts, explain where the kitchen is to the others, and politely ASK the woman before leaving the room if she needs anything else..these women in the entourage would even come into other rooms to find me..sorry but it was completely unreasonable,

And I guess that when the fetal heart tones are in the 60s, I should refuse entrance to the male doc and anesthesiologist that SAVED the baby's life by performing an emergency cesarian (triple nuchal cord), I really thought the baby was going to die..and how scary is that,,more than divorce or dishonor because of a religious belief? I dont know how they feel about it, but I do know how I feel, and if I had that kind of religious belief, but lived in this country, I would make sure to go to a female doctor who was fully aware of the situation and prepared to be on site, I would somehow contact the hospital's anesthsia dept. to arrange appropriate coverage, and I would have an entourage prepared to help me, or be willing to wait a few minutes for my nurse to get more ice for my soda or an extra straw!

And I'm not talking about spanish speakers who just came here (even if it was just so they could have a little American at our expense), I'm talking about people who have lived here for years, sometimes even born in this country. Its not even so much that they don't speak my language, but that they expect me to speak there's. If I moved anywhere where the main language was different than Engllish, I would make it a high priority to learn it!! Why was English somehow good enough for every other immigrant group that came here? And I guess it doesn't mean I have a heart when I sat with a mom, newly come from Mexico, and her husband when she delivered 17 week twins due to an incompetent cervix, while her babies died in our arms, I couldn't speak their language but I think that my "heart" showed through my arms around them and the tears I shed with them. And with the new dad who only spoke Chinese when he collapsed in my arms when the neonatolgist told him through a translator that his baby could not survive his spinal deformity. Or the parents of a baby born with an overwhelming infection whose whole family told them that maybe it was for the best and they werent' meant to be parents (after 2 miscarriages, infertility treatments and this tragedy) when I sat with her through the night in the NICU until he arrived from his Naval base, to the parents of a baby who died after three weeks in Nicu who was bloated and intubated beyond recognition who cried sentimentally when I said what a beautiful child He was..they said that I was the only one who had ever told them that he was beautiful...yeah...i'd say i have no heart wouldn't you?

[kukukajoo, LPN]

I applaud the nurses on here willing to learn about another's culture and beliefs and to honor those during the miracle of childbirth.

We should not expect people to become like us no matter how many years in this country. Everyone has a right to their own culture and does not necessarily have to absorb ours.

Yes, it is handy when they can speak English to communicate, but maybe there are many other reasons they have not had learned it yet such as that they are working in a sweatshop somewhere with only workers from their country.

[SmilingBluEyes]

My interactions with women of Islamic faith have all been pleasant and I have been treated with much respect and as a professional in nearly every case, by both male and female family members. I guess I have been lucky? I have never gotten the sense I was "low class" from any of my patients of Arabic/African origin yet.

[SmilingBluEyes]

Here are a couple of resources to help those who are interested in transcultural sensitivity and nursing practice:

http://www.tcns.org/ (Transcultural Nursing Society)

and a book I myself own and keep at work:

Culture and Clinical Care

by Juliene G. Lipson, Suzanne L. Dibble, Suzanne L. Dibble (Editor)

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&EAN=9780943671222&itm=18

Really, I recommend these two resources highly as no one can assume anything when it comes to human intraction across cultural lines. Particularly as nurses, it's encumbent upon us to do what we can to learn about the populations we serve and respect their practices as long as it is safe and practical to do so.

[SharonH, RN]

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).

Oh no no no NO no, let's stop that right now. Do not try to equate religious or cultural issues with what the KKK believes and practices, it is not even the same. Don't even try to clean it up like that. That's the lousiest analogy I've ever read on this board. You can disagree with the Muslims' desire to be cared for males and it is quite natural to feel frustration with the change in workload this may cause but don't even try to address your problems with cultural sensitivity by equating it to what a racist domestic terrorist group practices and believes.

[SmilingBluEyes]

I have to agree with you Sharon, 100%!

[imenid37]

I think the "rudeness" is the hardest to deal with. I have had some patients and support people from other cultures who seem ungrateful. It is a little disconcerting. I don't know that they are truly ungrateful. They do not have the same expectaions as an Anglo or African American ob patient.We do not have the same expectations of them as they would have in their own culture as a new mother. The screaming down the hall thing always got me. I worked nights a number of years ago in mother-baby. I hated when our other patients' rest was interrupted by a demanding family member or wailing patient. Assimilation is a long process. That is for sure. On the flip side, I have met some very interesting people from other cultures. Any chance someone from their community could come into to educate your staff?

[medsurgnurse, RN]

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.

good points.

[Belinda-wales, RN]

Well some points that have been discussed by nurses on this thread have shocked me even have come across as racist- I am a visitor in your country no I am a permanent resident who will be working paying taxes invited by your government- although I will not be able to vote my skills and taxes will be warmly welcome. I speak english but at times are not understood. If allowed travel and travellers can broaden the mind and enrich countries.

[imenid37]

Do you think some of their acting out w/ being unco-operative for exams, etc. takes them back to the female circumcision issue? I can't imagine being held down as a child and having this done. In our culture, we'd consider this sexual assault. If you have several of these ladies, can they be put together if you must combine patients? I'd think they would rather be w/ someone who was abiding by similar religious rules and customs. How about (I know there is a language barrier, in many cases) showing the ladies who accompany the patient how to do things like where to get the patient a drink, etc. I dpn't think people are necessarily racist. I think they don't know what the expectations of these ladies are and they don't know how to accomodate them while not infringing on the other patient's rights. Like I said, the noise making at night is upsetting when others are trying to sleep. In some facilities, the desire to have multiple family/visitors in the room after visiting hours have ended presents a problem. I think a liason from the Somali community would be helpful. I do think some compromise on the part of the Somali patients may be necessary. Maybe they really don't realize their expectations and priorities differ significantly from the mainstream population. They might think the nurses don't "wait on them" because they are spending their time "waiting on" the American patients, not realizing we just don't "wait on" our patients. Do they go to classes, to clinic?