Author(s): Dorothy Cooper; Aisling Underwood
Reviewer(s): Astier Alem; Michael Neguse; Tsega Woldetatios
Date Authored: January 01, 1996
Date Last Reviewed: June 16, 2010
Dorothy Cooper authored the first version of this article in 1996. In 2010, Aisling Underwood contributed substantial updates, and added new sections: Family and Kinship Structure; Infancy, Childhood and Socialization; Adolescence, Adulthood and Old Age; Drinks, Drugs and Indulgences; Holidays; Death; Chronic Disease, Mental Health, HIV/AIDS; and Further Reading.
Geography
Eritrea is an east African country located in the Horn of Africa. It is about the size of the state of Mississippi, roughly 120,000 square kilometers. Eritrea borders Sudan, Ethiopia, Djibouti, and the Red Sea. The region is dominated by a south-central highland with an average elevation of 2,100 meters. The southern region has extinct volcanoes and fields of broken lava. The west is mainly rivers and fertile plains. The east, bordering the Red Sea, is a narrow strip of barren scrubland and desert. Eritrea’s coastal location has long been important in its history and culture—a fact reflected in its name, which is an Italianized version of Mare Erythraeum, Latin for “Red Sea.”
History and Politics
Eritrea’s history goes back to the days of the Pharaohs in Egypt, when they conducted trade with the chiefs of the Red Sea coasts. The region was invaded not only by Egypt, but also by the Turkey and Italy. Italy lost the colony to the British in 1941 and after World War II, the United Nations made Eritrea an autonomous region of Ethiopia.
In 1961, the Eritrean war for independence began. The following year, under Emperor Haile Selassie, Eritrea was annexed and not only was its flag discarded, but the people were forced to speak Amharic, the official language of Ethiopia. The armed struggle continued until 1991 when Eritrea was able to gain its independence. During the thirty years of fighting, the country was in a state of civil war.
As Eritreans were fighting for their freedom, their country was devastated. The countryside was in ruins and many Eritreans left to escape the intense fighting. Many went first to refugee camps in neighboring countries such as Sudan and Zaire (now the Republic of Congo). Health conditions in the refugee camps were terrible and many suffered from hunger and disease. From the refugee camps, some Eritreans went to countries such as Germany, Sweden, Italy, the United States, and Canada. For many Eritreans in Seattle, the United States is their second, third, or even fourth home.
There are two, and more recently three, main waves of Eritrean refugees: those from the 1980s and 1990s and recent immigrants escaping mandatory national service that can go on indefinitely. Most recent immigrants are young males because it is easier for them to physically leave the country. Many come illegally across the Mexico border, seeking asylum here. Some come from Egypt, Malta, and Ethiopia through resettlement programs as refugees.
Cultural Orientation Resource (COR) Center reports in December 2010:
“The United States is currently in the process of resettling approximately 6,500 Eritrean refugees from the Shimelba Refugee Camp in northern Ethiopia. The refugees are mostly ethnic Tigrinya and Kunama who cannot safely return to Eritrea or settle permanently in Ethiopia. Those accepted for U.S. resettlement are joining a group of 700 Kunama refugees from Shimelba who were resettled in the United States in 2007.”
See COR’s Refugee Backgrounders about the latest wave of Eritrean refugees: Eritrean Refugees from the Shimelba Refugee Camp (December 2010)
Language
The traditional language for more than half the population of Eritrea, and now the official language of Eritrea, is Tigrinya (also spelled Tigrigna). Eritreans over the age of 50 may also speak Arabic, Amharic, and Italian, because they lived during the Italian and Ethiopian occupations. A report on the website Ethnologue, lists 12 individual languages spoken in Eritrea, and includes English and Standard Arabic as national or official languages, along with Tigrinya.
Eritreans strongly believe that Eritreans understand one another and prefer not to be equated with Ethiopians, even though some Ethiopians speak Tigrinya. However, since the end of the Ethiopian occupation, there is as strong a preference for a strictly Eritrean interpreter in the health care setting. With easing tensions between the Ethiopian and Eritrean population, an Ethiopian interpreter who speaks Tigrinya is an acceptable option for non-English speakers.
Most Eritreans under the age of 50 will probably speak some English, as it is now being taught in Eritrean schools. Some recent immigrants speak English quite well.
Although some Eritreans speak English well, medical terminology may not be understood or be directly translatable. Consequently, it is important to use an interpreter when explaining technical medical information.
Interpersonal Relationships
Names, Naming
Traditionally, children are given their names when baptized. They receive both a given name and a Christian name, which is used on religious occasions. The Christian name is often derived from the Saint’s Day on which the child is born. Children, both male and female, are given their father’s first name as their surname and will keep this name throughout their life.
Greetings
Phrases of Courtesy in Nine Languages: A Tool for Medical Providers
This language learning tool features videos of native speakers saying phrases of courtesy in nine languages, including Amharic and Tigrinya. Phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a learning speed. The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. View Amharic videos | View Tigrinya videos.
Marriage, Family, Kinship
Gender Roles
Traditionally, the girls are taught to perform household tasks, but with family roles changing due to immigration, the boys in the family also help out with housecleaning and dishwashing. As both spouses begin to work more outside the home, household duties are more frequently shared by men and women.
Family and Kinship Structure
Eritrean immigrants generally prefer that their children date and marry other Eritreans, because they feel that they will better understand each other’s culture. As time goes on there is more inter-cultural dating, although this is still generally discouraged.
Extended Families
Eritreans help one another and many send money back to family members in Eritrea.
Traditionally, Eritreans care for elder family members at home and view this as an important duty. This cultural value is embraced by younger Eritrean refugees, though most have not yet needed to care for elders. This younger generation will likely find it challenging to care for elders at home due to the need for both men and women to work. As the Eritrean community ages, there is debate about the need for an Eritrean retirement home. The community feels strongly that a facility where Tigrinya is spoken is essential to caring well for elders.
Reproduction
Pregnancy
In Eritrea, birth control is commonly practiced. Although birth control is not religiously acceptable and is a taboo topic, most couples practice it because they see the practicality of having smaller families. The Eritrean government promotes birth control and most Eritreans know what it is.
Sex education is becoming more prevalent in Eritrea, and students learn about birth control, STDs, and female circumcision. Although sexuality is often a taboo topic, the Eritrean community is becoming more open and informed on the subject.
Eritrean women in Seattle seek prenatal care from community clinics and plan delivery in a hospital. In Eritrea, home deliveries performed by midwives are the norm. There is a current push to retrain midwives to include modern sterile techniques in their practices.
In the U.S. and in Eritrea, there is a high value placed on natural childbirth and women generally try to avoid using pain killers during birth. In the U.S., Eritreans strongly feel that American doctors perform too many unnecessary cesarean deliveries. Women would prefer the doctor wait for the baby to come naturally. Women often wait to come to the hospital hoping to avoid interventions. Traditionally men do not enter the birthing room, and only the female family members are present. There is a slow shift towards the husband being present, but this varies greatly from family to family depending on their level of education.
Infancy, Childhood and Socialization
Women may be afraid of exposing their infants to too much sun. As a result, women rarely take their children out of the house during the first year. They will also heavily bundle their children in order to protect them from sun exposure. There may be a lack of understanding regarding the positive aspects of sun exposure, such as the absorption of vitamin D, and the negative aspects of overdressing and infant. (See patient education handout in Tigrinya about prevention of rickets: Pediatric Health Topics)
There is an Eritrean notion that a fat baby is a healthy baby. This idea may lead to overfeeding or unhealthy eating habits. Education is needed about the health risks associated with being overweight or obese.
Infant Feeding, Care
Eritreans highly value breastfeeding and as a result, most Eritrean women breastfeed their babies. Women generally breastfeed for up to a year and may stay home for the first 3 to 6 months of their infants’ lives in order to accommodate breastfeeding.
There is often a push to introduce solid foods to infants at 4 months, which is a few months earlier than recommended by American pediatricians.
See also: Peripartum and Infant Care Issues and Practices Among Refugee Groups in Seattle
Child Rearing Practices
Toilet training is often begun as early as 5 to 6 months of age. Bowel training can be accomplished as early as 6 to 7 months and bladder training after one year. This is done by the mother and requires close attention to the child’s elimination patterns.
In Eritrea, children often sleep with their parents until they are a year old or beyond. In the United States, it is common for Eritrean children to sleep in separate beds much earlier in life.
Adolescence, Adulthood and Old Age
There is a cultural disconnect between young Eritreans in the U.S. (primarily born and raised here) and their parents. Eritrean parents in Seattle generally have concerns about raising their children in American society.
For example, parents may not readily accept teens dating, nor do they discuss topics like relationships and sex with their children. As a result, there may be poor communication between parents and children. In Eritrea, dating is not allowed and teenage pregnancy is considered shameful. Parents in the U.S. may not approve of dating until children are engaged and may worry that dating will interfere with a child’s education or will result in an unwanted pregnancy. So, children are strongly discouraged from dating and the subject is fairly taboo. Consequently, some teens secretly date.
The importance of parental guidance through constructive and open communication should be stressed to members of the Eritrean community.
Nutrition and Food
In Eritrea, being full-figured or even overweight is considered attractive and a sign of status. The ability to eat enough to be overweight is an indicator that a family is wealthy enough to afford excess and is therefore an aspiration for many Eritreans.
In the U.S., many families still eat in the traditional way of eating from a communal platter, which is often replenished during the meal. Consequently, it is difficult to assess how much one has eaten. However, the ability to control the amount and quality of food is often dependent on a person’s level of education and socioeconomic status.
Culturally, it considered rude for guests to reject food when being hosted by another Eritrean, so they are obliged to eat food when it’s offered, even if they are not hungry.
These cultural practices regarding food and nutrition often translate to obesity and disease when Eritreans move to the United States. The decrease in exercise and change in familiar foods leads to a rise in obesity, diabetes, high cholesterol, and high blood pressure. There is a need to explain the concept of a healthy diet, portion control, and exercise. It should not be assumed that everyone has a good understanding of “healthy” American eating habits. Immigrant Eritreans may have little knowledge about healthy diet and exercise because weight related health issues were not a problem in Eritrea.
Drinks, Drugs and Indulgences
Alcohol
On special occasions such as weddings, Eritreans may drink the traditional homemade alcoholic beverages, suwa and miyes. Suwa is more commonly consumed as it is less costly to make. It is made of barley, finger millet, or sorghum (whatever is most available) and hops is added for fermentation. Miyes is considered to be higher class of drink, as its ingredients, which include honey and spices, are more expensive.
Alcohol abuse among adults is reported to be rare among members of the Seattle-area community. Substance abuse of any kind is generally frowned upon by the Eritrean community.
Drugs
Some youth are exposed to and use drugs without the knowledge of their parents.
Religious Beliefs and Practices
The predominant religion of Eritreans in Seattle is Coptic Christian Orthodox. Some Eritreans are Catholic and some are Muslim. There are two Eritrean Orthodox churches in Seattle: Debre Genet Kisdisti Sellasie Eritrean Orthodox Church and Eritrean Kidisti Selassie Orthodox Tewahedo Church. Both have community centers. See Community Resources Section below for more information.
Eritreans often use church as a venue for community discussion. The church serves as a place to talk about community, social, and health issues. Youth receive cultural training in Tigrinya. The church is the driving force in maintaining Eritrean culture.
Major Coptic Christian Orthodox Holidays Observed in the U.S.
The Julian calendar is followed by Orthodox Church. Some dates are fixed. Others vary.
2010
January 7 Leddet (Christmas) – same date every year
January 19 Epiphany – same date every year
April 2 Good Friday – date varies year to year
April 4 Easter – date varies year to year
September 11 New Year – date varies depending on if it is a leap year
September 27 Meskel (Finding of the True Cross) – same date every year
Eritrean National Holidays
May 24 Eritrean Independence Day
June 20 Eritrean Martyrs Day
Death
When someone is diagnosed with a life threatening illness or is dying, it is advisable to first tell a family member or next of kin. This person will be able to offer advice on how to approach the person, or may serve as the informant. Often a group of close friends or family will go to the house of the person whose relative/spouse has died to inform them of the death and provide support and comfort.
While traditionally the mourning period may last up to two weeks, modern mourning periods may last only a weekend due to practicality.
The mourning ritual includes wearing black garments and gathering at a central community location. Male and female family members will sit on the floor in separate sections of the room. Visitors may come and go during this period, sitting around the family as they mourn. As visitors leave, they may express their condolences to the family and offer money to help defray burial costs. Often one visitor will cry loudly in order to spark emotional responses from others and move the grieving process along. This person is usually designated by someone in the community to fulfill this role. At a certain point, the family will announce closure and the mourning ritual will be over.
Eritreans do not practice cremation but bury their dead. Often families wish to send the deceased back to Eritrea for burial. This is expensive, sometimes costing over $20,000. The trend of sending the deceased back to Eritrea is slowly fading due to financial constraints, increasing acculturation, and immigration (fewer elders remain in Eritrea and since the deceased are generally returned to Eritrea in order for elders to have closure, this is no longer necessary).
If a spouse dies, Eritreans generally do not remarry; although they are more likely to if they did not have children from the marriage.
Traditional Medical Practices
Eritreans believe in the healing powers of different plants, although they generally see a medical practitioner first. If Western medicine does not work, Eritreans may return home as a last resort to utilize natural native remedies. Eritreans may not realize that large quantities of some plants may interact with pharmaceutical drugs and therefore it should be explained that although herbs may not seem like medication to the patient, doctors should be informed if the patient is using them.
Another traditional practice in Eritrea is therapeutic burning, which is now illegal but may be evident in older generations.
See also : Ethiopian Traditional Medications and their Interactions with Conventional Drugs
Circumcision
Female circumcision is practiced in Eritrea and traditionally performed by lay healers. The type of female circumcision varies from region to region. Eritreans wish to have all males circumcised.
Experience with Western Medicine
When living in Eritrea, most Eritreans used hospitals in much the same way as here in the United States.
In the United States
Eritreans generally try Western medicine first for treatment and believe that doctors in this country are able to help them.
However, some are troubled by certain practices. They may be concerned that too much blood is drawn for testing and would prefer to avoid this unless absolutely necessary. They may be resistant to blood transfusions but also understand that if absolutely necessary they will comply. If blood is being drawn, providers should explain exactly what the purpose is and what tests are being done on the blood. It should also be explained that blood tests do not necessarily provide a total medical overview and sometimes blood tests are looking for one specific variable.
Gender concordance between the health care provider and the patient is considered important by many Eritreans. Eritrean men would prefer to be cared for by male health care providers. Eritrean women strongly wish to be cared for by female providers and if an interpreter is needed, a female is preferred.
If an Eritrean is diagnosed with a life-threatening illness, they first follow the Western medical plan. Eritreans strongly wish that the family be informed first of a serious illness or poor prognosis rather then the patient, this way the family can inform the patient.
If the patient is expected to die, it should be explained to the family that organs will not be harvested without consent. This information is especially important if an autopsy is to be performed.
Chronic Disease
Chronic illnesses such as diabetes and hypertension are common in the elderly Eritrean population due to advancing age. Medication adherence for these conditions is often poor among the elderly, as most do not understand the purpose of supportive treatments like cholesterol-lowering drugs. They do not understand the purpose of taking medication for conditions that do not present symptoms. Education about this issue, diet, and exercise is needed. See also: Diabetes in the Eritrean and Ethiopian Community: Recommendations for Diabetes Educators.
Members of the Eritrean community in the Seattle-area primarily seek treatment at Harborview Medical Center even when having to travel a great distance. Though some may not be aware that they can seek care at other medical centers or neighborhood clinics closer to home, others continue to travel to Harborview due to the comprehensive health services provided in one facility.
Mental Health
Post-traumatic stress disorder (PTSD) is an issue in the immigrant Eritrean community. Anyone over the age of 20 who immigrated to the U.S. is potentially at risk, especially if they were in the army.
Many people do not understand the concept of depression but will see the doctor with complaints of physical symptoms that result from depression. Some may “doctor shop” to find a provider who can help with the physical symptoms but the depression is what needs attention. Education needs to be done in the community about depression and stress.
There is stigma associated with mental illness. Members of the community may distance themselves socially from a person who is depressed or mentally ill though they will acknowledge that it is not the individual’s fault and will sympathize with them. Family members of a depressed or mentally ill person will usually recognize the problem and are supportive in helping the patient seek treatment.
HIV/AIDS
There is stigma in the community associated with having HIV/AIDS. Issues such as HIV/AIDS are not openly discussed in a community setting, and Eritrean individuals who find out that they have HIV/AIDS will often keep this information to themselves. In rare cases, a person will refuse treatment for fear of being discovered while visiting a clinic that specializes in HIV/AIDS.
Some members of the community say that individuals will not be singled out for having the disease. Often it is only at the person’s death that the community finds out that the person had HIV/AIDS.
See also this Seattle Times article about efforts in the Seattle area to help African immigrants learn to talk openly about HIV/AIDS. The article includes information about a trend toward higher rates of disease in African immigrant women compared to African immigrant males.
Community Structure
Seattle Community Life
Most Eritreans in Seattle came as refugees, but some originally came as students, applying for political asylum when their student visa expired. Eritreans have settled throughout the United States, though they are particularly concentrated on the East and West Coasts. There is a network of Eritreans in the U.S. and they are supportive of one another.
One of the many ways that the Eritrean community in Seattle differs from the Eritrean community in Africa is that Eritreans in the United States come together for mutual gain through networking as opposed to simply for celebrations. Though this is a cultural shift, it allows Eritreans to share knowledge about jobs, health issues, and other practical matters.
Eritreans generally come together at their church or community center for community- building activities. This is also the place where youth gather and interact the most.
Seattle Area Eritrean Churches
Eritrean Kidisti Selassie Orthodox Tewahedo Church
12327 15th Ave NE
Seattle, WA 98125-4819
Debre Genet Kisdisti Sellasie Eritrean Orthodox Church
2401 E. Spruce St.
Seattle, WA 98122
Eritrean Community Organizations
Eritrean Community Center
2401 E. Spruce
Seattle, WA 98122
(206) 323-6627
Eritrean Association in Greater Seattle
1528 Valentine Pl. S.
Seattle, WA 98144
(206) 548-6385
Neighborhoods
There are currently 6,000 to 8,000 Eritreans living in the greater Seattle area, and this number continues to grow. Immigrants generally live in concentrated groups when they first arrive and then disperse throughout the area. Some particularly concentrated areas are Northgate, West Seattle, Burien, Lynnwood, and Renton.
Common Acculturation Issues
The Eritrean community keeps itself quite separate from other Seattle-area communities and there is a fair amount of resistance to assimilate. This is exacerbated by the language barrier.
Much of the older Eritrean generation had little access to education, as the state of education was poor during the war. The majority of Eritreans in the United States work blue collar jobs. There needs to be more of a focus on financial management, an area where positive mentorship could be very helpful.
In Seattle today, many Eritreans are enrolled in the community colleges to learn skills, so that they can get better jobs. They are hard workers and often both husband and wife work. Eritreans strongly encourage their children to get a good education and go on to college.
Overall, Eritreans are proud to be Eritreans. They have fought hard and suffered much to establish their freedom. Although many have come to the United States as refugees and do not plan to return, they have strong pride in their homeland.
It is important to keep in mind that there are often striking differences between the older and younger generations of Eritreans. There is a lot of pressure from elders for youth to adhere to cultural practices and participate in Eritrean traditions. As the Eritrean population continues to grow in Seattle, there is increasing stress over whether to comply with local practices, or those of Eritrea.
Further Reading
Settled in Seattle, Eritreans hang onto a heritage that sustains them. Article about the local Eritrean community published in The Seattle Times on July 6, 2008.
