Making Health Care Accessible for Somali Women

 It’s an early Saturday evening, and nurse practitioner Muna Osman and her team are setting up a community meeting room at the Living Well Kent center for one of their health care classes. Osman has hosted these classes on health and well-being for Somali women in the metropolitan Seattle-Tacoma area for the past two-and-a-half years. 

Team Mama Ammaan works to provide women with access to better and more culturally responsive health care in the Seattle area.

This particular day in Kent—where many immigrants and refugees in the greater Seattle area live—the topic is nutrition, and Osman and her team have brought in a local Somali nutritionist to speak with the women and lead a food demonstration. Quinoa is available for the women to try, which the nutritionist explains is a healthy alternative to rice and pasta—foods many Somalis eat frequently.  There is also Somali tea and chickpea soup—a traditional Somali dish—prepared by Osman from her mother’s recipe. 

The group is led in a short prayer before the session begins. The class is mostly in Somali, but English phrases are used. Many participants trickle in late, and soon volunteers have to bring out more chairs as the room fills with about 30 women eager to learn about nutrition. The nutritionist begins talking about food groups and portion sizes. She explains that iceberg lettuce doesn’t have much nutritional value, but that many Somalis buy it because it can be cheaper. She describes further what quinoa is, because many Somalis have never heard of it.  

The most important thing is to have knowledge so that people can make their own choices,” she says. “Try to make your plate beautiful so that it feeds your eyes first. She adds that a plate should be half greens, and that the darker greens are healthier. 

The goal isn’t weight loss, she emphasizes: “We have to love our body and soul. God gave you this body, you have to love it, not think about getting thin.”

The discussion soon moves past food and into cultural norms—an underlying theme of these classes. While Osman and her team of doulas, volunteers, and educators regularly instruct the women on health-related matters, they also address negative experiences and frustrations they have with the U.S. health care system.

Researchers found in a 2010 study originally published in Social Science & Medicine Journal that Somali women’s health beliefs “related closely to situational factors and contrasted sharply with the biological model that drives Western medicine.” To alleviate their vexation, health care practitioners in largest Somali communities around the country—Minneapolis, Seattle, and Columbus, Ohio—provide services that meet their medical and cultural needs. Osman and her team work with the Mama Ammaan Project: African Mother to Mother Antenatal Assistance Network in the Seattle area to provide the women with access to better and more culturally responsive health care. Mama Ammaan, which means “safe mother” trains doulas and offers free health and well-being education to the women.

Participants of the health care class at the Living Well Kent center in Kent, Washington. Photo from Muna Osman.

In 2017, University of Washington anthropology professor Rachel Chapman was looking for someone to partner with on a health care-related project after she and a colleague secured a UW Population Health Pilot Research Grant. Chapman sat down with Osman and made a plan. Along with the nonprofit Somali Health Board, a grassroots organization of Somali health professionals and volunteers, they hosted focus groups and learned that health care education was a pressing need within the Somali community. The two formulated an initial series of classes, hiring doulas for pregnant women and new mothers, and providing stipends for the women who participated.  

The funding is coming to an end, but Osman plans to continue the classes on a volunteer basis because the community loves them so much and still needs them. 

According to Osman, many of the Somali women don’t understand what doctors tell them, and therefore aren’t able to comply with doctors’ suggestions. The women are thus read as “noncompliant” by their doctors or that they don’t care about their health. She says a lack of proper translators is one of the biggest issues Somali women face, and many of the women are immigrants who have experienced very different health systems in their home countries, and have to navigate the U.S. system without a strong grasp of English.

When translators and translated texts are available, many times translators do not fully translate what doctors say, and often, some of the women can’t read the documents given to them because limited reading skills, Osman says. 

This is why Osman and her team use mostly images to convey information in the classes. It’s just one way Osman is making health care education more accessible to the people in her community. 

Hana Mohamed, co-programs director with the Somali Health Board, says the organization wants to be sure they base its programming on the community’s needs. “The Somali community is based on oral communication and relationship building,” Mohamed explains. “By hosting various community events, the community’s needs can be heard.”

The purpose of the health care classes, which discuss everything from pregnancy to birth, and the changes women’s bodies go through between—and after, is to increase awareness and understanding around different topics related to health.  

One of the participants, Ibado Farah, has lived in Kent for 10 years. The 55-year-old came to the United States from Somalia when she was 30. Farah is a mother of seven children, the youngest age 16, and the oldest age 34. She says she felt welcomed by Osman and the other women, and her positive experiences in the classes have kept her coming back. Farah now brings friends from the Somali community with her and gives rides to many women who don’t have access to cars. She says her favorite part of the day’s class was about nutrition because she was able to learn how to prepare healthy meals as a way to take care of her body.  

Osman and her team also are addressing mental health with the women. The topic is stigmatized in Somali communities, Osman says, and so she is careful in leading the discussion in her classes. Osman says that many women choose “to suffer in silence” because of this taboo, adding that it’s important “to approach [the issue] and not be obvious” to start a conversation on how to take care of one’s own mental health. 

Members of the Mama Ammaan Project at a team meeting

The doulas who work with women through pregnancy often continue to provide care to the mothers after childbirth to watch out for signs of postpartum depression. If they see signs, they will connect the women to other resources or service providers for extra support. The doulas approach the conversation with culturally appropriate way of speaking about it with them, such as incorporating the women’s faith in their work, encouraging the women to take care of themselves because God wants them to. 

Osman and the others also encourage the women to exercise, to get out of the house more, listen to music, and do other things to help them take care of their mental health. 

At the end of her class, Osman plays Somali music and leads the group in dancing. At first, some of the women are shy and reserved, while others wait impatiently for the music to start and dance excitedly when it does. Osman dances freely, with joy, and she beckons the others to join her. Eventually, even the shyest women join in for at least one song. They clap in rhythm and some sing along to the lyrics. It is one small way they take care of their bodies and share laughter within their community.

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