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The following report was prepared from notes taken during the
Refugee Community Building Conference, June 27, 2003 in SeaTac, Washington
and from other sources listed.
Prepared by: Christine Wilson Owens for
EthnoMed;
Reviewed by: Bob Johnson of The International Rescue Committee
in Seattle, January 2004
Updated: Reviewed May 2008 by: Iman Hussein,
Somali Bantu community leader and medical interpreter
Please visit Cultural Orientation for expanded information about the Somali Bantu (including Housing, Work and Finances, Health Care, Mental Health, Education, Learning English, Style of Communication, Special Needs of Women, Relationship between Bantu and Other Somalis).
Somali Bantu Refugees
It is expected that 8-12,000 Somali Bantu refugees are relocating to the United States during FY2003-004.
In the eighteenth and nineteenth century, the Bantu were brought as slaves from Tanzania and Mozambique to Somalia. They were marginalized in Somalia. The Bantu did not belong to, nor did any Somali clan or tribe protect them. In 1991 during the civil war in Somalia, 12,000 Bantu were displaced to Kenya. 3,300 Bantus, it is estimated, escaped to Tanzania, back to the lands of their ancestors.
Somali Bantus who fled to Kenya settled first in Dadaab refugee camp. They were then relocated 900 miles and a 3-day road trip across Kenya to the rural, dry environment of Kakuma refugee camp. The film The Final Exodus is a documentary of that relocation and speaks about the dangers and mistreatment in the camps, of the rapes of women and beatings of men who are Bantu. In 1999 the U.S. designated the Somali Bantu refugees as "persecuted". The process of immigration to the U.S. has been slow, due in part to conditions of insecurity and violence in the camp at Kakuma.
8 to 12,000 Somali Bantus are scheduled to relocate to various communities (suburban, urban, possibly rural) in the United States . In 2003, about 250 Bantus were expected to arrive in the greater Seattle area. As of May 2008, an estimated 500 to 600 Somali Bantu families (includes both Kizigua- and Maimai- speaking) live in the Seattle area. Many families arrived in other areas of the United States first and then migrated secondarily to Seattle (and therefore are not reflected in the numbers tracked by the local resettlement agencies.) 35 states in all, including Washington, Georgia, California, Oregon, Arizona, Utah, Colorado, Virginia, and New Jersey will be resettlement locations for Bantu refugees. The first Bantu refugees arrived in April 2003 in New York.
The need and readiness for providing assistance to the Bantus with housing, employment, literacy, youth programs, and general receptivity to a new community are factors being considered in planning Bantu resettlement in greater Seattle. Agencies and services may be needed in the cities of Burien, SeaTac and Tukwila, located south of Seattle, where housing is more likely to be affordable for newly arriving refugees. Existing Somali organizations may be able to provide assistance, a language bridge. Resettlement issues, like finding affordable housing, overcoming lack of skills and lack of employment experiences that are relevant for this job market, are concerns Bantus will likely share with many other refugees who have settled in the area. Some Sudanese refugees reportedly have plans to welcome the Bantu; potentially both groups have the Swahili and English languages in common from their time spent living in Kenya.
In Washington State, voluntary agencies in contract with the federal government are set to provide case management and other services to refugees for six months after their arrival.
Somali Bantu health in Kakuma is poor, and there are many factors related to their poor health conditions. According to a recent medical report, these factors include: lack of health care information within the community, poverty, limited utilization of public health facilities, inadequate resources and certain cultural beliefs and practices, all of which contribute to diminishing health conditions. Resettlement agencies may wish to monitor health carefully in the period after arrival. Here is a list of significant points that have been learned from the International Office on Migration's medical examinations and cultural orientation classes:
Superstitions:
Some Somali Bantus may believe that
children who have fallen ill have been cursed or targeted by an evil
spell. Instead of seeking medical assistance, some Bantus may go to a
traditional healer and request that the curse be removed or countered.
Superstitious beliefs most likely contribute to a certain degree to the
poor health practices among this group. Traditional healers may perform
ceremonies to chase out evil spirits from sick people. These rituals
often include drumming and incense.
Bone Setting:
Somali Bantus have specialist bonesetters
within their communities. These bonesetters serve as the medical
providers for anyone who has a dislocation or fracture. Such specialists
have evolved in the Somali Bantu (and other rural communities) due to the
limited access to hospitals and clinics. Once in the US, Somali Bantus
should seek out professional medical care for anyone with a dislocation or
fracture.
Burning, Cutting and Lacerating as Healing Techniques:
Somali Bantus use burning, "coining"", cutting and lacerating as
traditional ways of healing illnesses and pain. Different methods are
applied, depending on the illness or location of pain. For example, a
searing flat metal nail is applied to the foreheads of babies born with an
enlarged head due to the condition known as hydrocephalus, a common
condition involving fluid accumulation in newborns. This treatment is
believed to alleviate the condition. Children and adults have notable
burn scars on their foreheads, chests, faces and other body locations from
such healing techniques. These are common practices among various rural
cultures across the world.
Removal of Infants' Teeth:
Children under two years old
who fall sick with diarrhea, malnourishment or other illnesses are often
taken to a traditional healer, or medicine man. The traditional healer
will remove a "bad" tooth or teeth using a knife. This traditional
healing practice ostensibly cures the child of the ailment. This is often
practiced on children between six and nine months old who begin teething
and have diarrhea as a result.
Removal of Uvula:
Traditional healers will remove an
infected uvula with a sharp implement - the uvula is the small mass of
tissue suspended from the center of the soft palate above the back of the
tongue. Removal of an infected uvula is common practice among many
cultures.
Treatment of Infected Tonsils:
Traditional healers
commonly treat infected tonsils by burning the corresponding area on the
upper neck.
Home Child Birth:
Somali Bantus commonly give birth at
home, often with a traditional Somali Bantu birth attendant to assist.
Recently in Kakuma camp a Somali Bantu woman passed away in childbirth at
local hospital from a Caesarian Section. This incident and other similar
incidents have created a fear of hospitals among some in the Somali Bantu
community. They prefer to give birth at home.
Female Circumcision:
As with many African cultures, Somali
Bantus in Somalia have traditionally practiced female circumcision.
However, camp-based NGOs have implemented awareness campaigns surrounding
the negative health effects of female circumcision. Somali Bantu
community leaders say that female circumcision is no longer being
practiced within the community. Incidentally, before Somali Bantus
arrived in Somalia (some two hundred years ago) their communities
apparently did not practice female circumcision.
High Prevalence of Low Birth Weight (less than 2.5 kilos)
Infants:
The health statistics indicate that 19% of the infants
born since July 2002 had a low birth weight (LBW). LBW infants are born
undernourished and are at far higher risk of dying in later infancy. If
they survive, they are unlikely to catch up on this lost growth later and
are thus more likely to be underweight or stunted in early life.
Therefore, the high prevalence of LBW infants may significantly contribute
to high rates of chronic malnutrition as well as acute malnutrition when
these infants are exposed to disease.
Poor Maternal Nutritional Status:
Pregnant and lactating
mothers of Somali Bantu origin represent, on average, 62% of the total
admissions in the Supplementary Feeding Program [in Kakuma]. The high
number of admissions suggests... that Somali Bantu mothers are
nutritionally more vulnerable than the rest of the camp. Their poor
nutritional status is also related to the high rates of LBW infants. When
poor nutrition starts in-uteri and extends, particularly for girls and
women, well into adolescent and adult life, mothers have a greater chance
of becoming stunted and thus giving birth to LBW infants.
High Crude Birth Rate:
Health statistics indicate that
29% of the deliveries [in Kakuma] since July 2002 arose from the Somali
Bantu community. However, the Somali Bantu represent only 12% of the
total population in the camp. On average, the crude birth rate is 2 times
higher in the Somali Bantu community. Frequent pregnancies in women
affect their nutritional status and thus increase the already high chance
of having LBW infants.* (IOM note: Between January and March 2003, 368
babies were born within the Somali Bantu community. If this birth rate is
maintained throughout the year it's possible that close to half of the
child bearing age women will give birth in 2003)
Poor Infant Feeding Practices:
Close deliveries interfere
with breast and complementary feeding practices. Women often stop
breastfeeding as soon as they are pregnant and start weaning their
children before the recommended age of 6 months. This exposes their
children to high risk of disease and malnutrition. There is a close link
between appropriate infant feeding practices and the health, nutrition and
survival of young children. In addition, the quality of care a mother can
give to her children is affected when she has to attend to a high number
of young siblings.
Health Problems:
The high mortality rate of children below
five years is mainly related to health problems. Also, it is possible
that malnutrition may primarily be the result of chronic diseases coupled
by inappropriate food intake and caring practices. The leading health
problems for Somali Bantu children are pneumonia (41% of the deaths),
malaria (24.5% of the deaths) and watery diarrhea (16.9% of the
deaths).
Poor Health-Seeking Behavior:
As compared to the rest of
the camp, pneumonia is significantly more prevalent amongst the Somali
Bantu community. This may be attributed to poor health-seeking behaviors.
It has been observed that mothers do not seek medical care in good time.
This observation is equally true of the feeding programs, where it has
been noted that mothers bring their children when they are already at a
critical stage.
"PTSD" and other mental health concerns:
Some Bantu
refugees may suffer from hopelessness, depression, and nightmares. There
may be new trauma or hardship experiences in the U.S.
Hygiene:
Hygiene may be influenced by a history of little
access to water.
The International Organization for Migration, Cultural Orientation Africa Program is collecting various reports on Somali Bantus in order to pull out relevant information that can be incorporated into and inform cultural orientation classes.
Punctuality:
Explain importance of being on time for
medical and all other appointments.
Health Care:
Different kinds of health care available:
Emergency care, urgent care, and routine care.
Explain the importance of scheduling regular check-ups for pregnant mothers and children. (Emphasize the importance of well-baby check ups.)
Prescriptions:
Importance of following prescriptions and
finishing medication even if symptoms of sickness have disappeared.
Where to buy Medications:
Explain prescription medication
and over-the-counter medication and where to buy these.
Interpreter:
Explain that refugees have a right to a
medical
interpreter. Before any medical exam, refugees should make arrangements
to have an interpreter available.
Insurance:
Explain insurance and how to pay for health
care.
Information for Doctors:
Explain how American doctors
require information on the background of the patient. American doctors
often ask questions about medical history and personal background. These
questions might not appear to have anything to do with the immediate
health of the patient. However, American doctors like to collect a range
of information on the patient in order to more properly understand what
medical problems exist and what medical problems could arise in the
future.
Proactive Approach to Health Care:
Explain that Americans
normally take a proactive approach to their health. This includes
scheduling regular yearly check-ups for adults, even if an individual is
not sick, and well-baby check ups following childbirth. Somali Bantus,
along with many other cultures, often take more of a reactive approach to
their health, only planning to see if a doctor if an individual is
sick.
Nutrition Classes:
Somali Bantus will not recognize most
of the food in the US. Provide a basic overview of nutrition and of
healthy foods.
See also: