Somali Muslim Case Story Deb Thomalla, R.N.. Deb Thomalla, personal profile Married 30 years: 4 adult children, 2 grandsons RN Case Manager for Arise.

Somali Muslim Case Story

Deb Thomalla, R.N.

Deb Thomalla, personal profile• Married 30 years: 4 adult children, 2

grandsons

• RN Case Manager for Arise Home Health Care providing client focused health care through– Patient Care Attendants– Home Making Assistants &– Home Health Aides in Stearns, Sherburne,

Benton, & Morrison Counties

Scenario

• Somali widow

• Mother of 3 – under 10 years

• Post Traumatic Stress Disorder (PTSD)

History (1)

• Forced to watch rebels torture & murder husband

• Rebels kidnapped her

• Left children behind

History (2)

• Held captive 2 weeks

• Repeatedly raped, tortured, beaten

• She & children – US refugees

Barriers to Medical Care

• Language

• Culture

• Religion

• Education

• Medical system – not user friendly

Language Barrier

• Doesn’t speak English• Understands little• Translation issues

•different dialects•few Somali words for medical terms

Cultural Barriers (1)

• Many differences = many fears

• Mental illness shunned by Somalis

• Somali view: illness affects whole person: Body – Mind –

Spirit

Cultural Barriers (2)

• Somali expectations of medical appointment

Assess – whole person

Diagnose – whole person

Treat – whole person

Religious Barriers

• Allah (God) sends all illnesses & all cures

• Medical treatment should include prayer

• Medical treatment given is Allah’s cure

One bottle of pills = cure

Educational Barriers

• Levels of education vary greatly

• This client can’t read or write

Medical System Barriers

• How will you pay?• Medical professionals treat

body or mind, not spirit• Diagnosis differs depending on

practitionerpsychiatrist – bi-polargeneral practitioner - PTSD

PTSD Crisis Treatment Options

• Medication &/or

• Counseling &/or

• In-patient psych unit

• Involve Social Services

Social Services Crisis Intervention Options (1)

• Hospitalize client

• Put children into foster care

exacerbates client’s PTSD!!

Social Services Crisis Intervention Options (2)

• Home care option•Patient Care Attendant (PCA) – daily visits

•Family stays together

•Finding agency with Somali staff

Summary of Barriers

3 main categories:–Communication

–Education

–Supply & demand

Lowering the Barriers

•Communication•Interpreters

•Recruitment

•More time

Lowering the Barriers: Communication - Interpreters

• Need to be affordable – currently $130 per 2-hour minimum

• Somali community volunteers• Large providers have

interpreters available and free• Insurance coverage

Lowering the Barriers: Communication - Recruitment

•Somalis into all aspects of medical field

•Somalis into social services

Lowering the Barriers: Communication – More Time

• Health care providers–Allow more time to communicate

–Schedule longer appointments

–Decrease production expectations

Lowering the Barriers: Communication – More Time (2)

• Nurses are trained communicators

Assess client’s needs and expectations

Communicate info to practitioners

Teach, clarify medical info to client

Education Barriers (1)

• Somali-to-Somali support•One-to-one – sponsor new refugees

•Somali community meetings

Education Barriers (2)

• Community at large• Community resources

• Support Somali community

• Inform and teach what you have to offer

• Somali community educate community at large

Education Barriers (3)

• Social Services•Form partnership with Somali community

•Inform and teach purpose & process

Education Barriers (4)Health care providers

•Educate practitioners, support staff, technicians

• easy access to cultural, religious education

• mandated in-services• interpreter/resource info readily

available

Education Barriers (5)

Health care providers (2)• Educate Somali community – go to them

• How our system works

• Disease education

• Diagnostic tests

• Treatment options

• Separation of Body – Mind – Spirit