Fostering Inclusivity in the Somali Community Through Culturally Competent Care

To experience civil war is to experience fear in the place you call home. It means facing political instability, violence and famine, and living in constant uncertainty about one’s safety. The Somali Civil War, which began over 30 years ago and continues today, has forced many Somali from their homes, their homeland, and all things familiar, in search of safety and security. This is part of the story for many members of the Somali community in Minnesota.

Before 1992, only a few Somali people resided in Minnesota. The community then grew rapidly as people sought refugee status to escape the violence of civil war. Suddenly, every Somali Minnesotan was seemingly tasked with becoming an educator and ambassador, introducing their culture to a mostly white population with little to no familiarity with Somalia.

This burden of educating others about different cultures is a familiar one. All too often, dominant culture expects Black, Indigenous and communities of color to contribute their time and emotional labor to providing this education – over and over again.

Cultural Humility

This reality is the motivation behind Blue Cross and Blue Shield of Minnesota’s Cultural Humility video series – a series rooted in the belief that cultural competence is a journey, not a destination. It’s a lifelong commitment that can only be advanced through the humbling experience of self-evaluation and self-critique.

The most recent addition to this series highlights the stories and traditions of the Somali people, offering valuable perspectives on providing culturally competent care and creating inclusive communities.

The video is available now, and offers some key takeaways:

Why Minnesota?

Many Somali people migrated to Minnesota as refugees from civil war in 1992. Minnesota had a history of welcoming refugees, such as Hmong refugees resettling in the 1970s after aiding the U.S. military during the Vietnam War. Humanitarian and faith-based organizations, including the International Institute of Minnesota, World Relief Minnesota, Lutheran Social Services, Catholic Charities, Somali Family Services, and the Confederation of Somali Community in Minnesota, provided essential advocacy and support for Somali refugees.

Now, the Somali community in Minnesota is the largest Somali diaspora community in the United States. Minnesota remains a popular state for Somali migrants to relocate to after arriving elsewhere in the U.S., whether to be closer to family members, other community members, or for work and educational opportunities.

Community Cultural Health

The Somali community comprises different ethnic groups, each with their own beliefs surrounding health and healthcare. Certain cultural customs and beliefs are widely held and bear directly on providing culturally competent care.

For many Somali households, the family structure is patriarchal, with husbands often accompanying their wives to doctors’ appointments and expecting to be the primary communicators. A cultural value of modesty impacts treatment preferences, with a strong preference for being treated by a doctor of the same gender and undressing only as necessary.

Many members of the Somali community practice Islam, influencing many aspects of healthcare. Some also practice traditional healing, a fusion of medicine and spirituality.

Key Challenges

Many Somali Minnesotans are refugees, or their parents were refugees, significantly influencing overall community health. Chronic conditions such as anemia, lead toxicity, and viral Hepatitis B are common due to living conditions in refugee camps.

The Somali community has a history of being targeted by anti-vaccine activists, leading to undervaccination and a measles outbreak in 2017.

Additionally, the Muslim community in Minnesota, many of whom are Somali, have faced anti-Muslim hate crimes, such as the April 2023 arson attacks on two mosques in the Twin Cities. These attacks, even when not directly affecting individuals, cause physical and mental stress within the community. This stress has also been exacerbated by drastic and discriminatory changes to immigration law enacted in 2017, which further damaged the feelings of security the community sought when they claimed refugee status nearly thirty years earlier.

The combined stressors of immigrating and processing the trauma of civil war have led to high use of commercial tobacco among the Somali community as a form of stress relief and community bonding. Approximately 24% of East African Minnesotans use cigarettes or hookah, compared to 13.8% of the state’s total population, increasing risks of nicotine addiction, heart conditions, and cancer.

Culturally Based Solutions to Health Challenges

Gaps and contradictions exist between Somali cultural values and Western medical practices. Healthcare providers must bridge these gaps to offer culturally competent care.

Align Care with Islamic Faith

Practitioners should respect the Islamic faith of Somali Muslims, considering practices such as fasting during Ramadan, which affects medication intake, and abstaining from pork products and alcohol, which can be present in certain medications.

Respect Traditional Healing Practices

Some traditional healing practices that the Somali community practices are massage, cupping, and prayer. Culturally competent healthcare providers can encourage Somali patients to pursue these practices while respectfully offering western medication and care.

Building Connection and Community

As the Somali community in Minnesota continues to navigate challenges and build a vibrant and resilient community, understanding their cultural heritage and unique experiences is crucial for fostering empathy and support. Watch the video Cultural Humility Series: Somali to gain deeper insights and learn how to engage with cultural humility.