Ethiopian - EthnoMed

Author(s): Atalelegn Molakign (1995)
Contributor(s): Member of Tigray Community Association (2003), Rachel Brandon (2007), Alexandra Duncan and Molly Hayden (2008)
Reviewer(s): Ethiopian Community Mutual Association (1995), Tsehay Demowez, Harborview Medical Center (2003)
Date Authored: January 02, 1995
Date Last Reviewed: 2008

The Ethiopian population includes many ethnic and linguistic groups. For information about Tigrean culture, visit the Tigrean Cultural Profile resource.

Geography

Located in the horn of Africa, Ethiopia is the tenth largest country in Africa. The country is agrarian and the economy depends on subsistence agriculture. In recent years, crops have been poor because of drought. Approximately 85 percent of the population lives in rural areas. The settled population is scattered, making delivery of health and social services difficult.

History and Politics

Ethiopia traces its history as a country back 3,000 years and is the only African country that has never been colonized. In the mid-1970’s, the government of Haile Selassie was overthrown and a repressive regime was established. Recent years have seen internal wars for liberation and ethnic conflicts. Many families left the country as refugees.

Language

The population includes many ethnic groups with nearly 80 languages and approximately 200 dialects. Major groups include the Amhara, Oromo and Tigre. Smaller groups include Afad-Isa, Somali, Wolaita, Sidama, Kimbata and Hadiya.

Interpersonal Relationships

Names, Naming

Update: Jan 2003. This section was written by a community member of Tigray Community Association and reviewed by Tsehay Demowez (Harborview Medical Center, Seattle, WA.)

Naming in Ethiopia, in general, is different from naming in the US. The use of a first name and a family name is unknown in Ethiopia. Everyone has his/her own name and also uses his/her father’s name, which comes after the personal name. Occasionally, the paternal grandfather’s name can be added if needed. There was a lot of confusion when newly arrived Ethiopian immigrants in the US were asked for their first name and family name. When asked for a last name, many immigrants asked, ” You mean my father’s or my grandfather’s name?” Now when they have settled in the US, most Ethiopians use their fathers’ name as their last name, although some use their grandfathers’ name as their last name.

Newer generations now frequently use three names, their first name, father’s name as a middle name and the grandfather’s name as a last name.

Traditionally, American women in the US have changed their family name when they marry. If a woman remarried several times she might have to change her family name accordingly. But women in Ethiopia and Ethiopian women in the US do not change their names when they get married.

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, Oromo, Somali 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.

Marriage, Family, Kinship

Marriage

This section on Marriage, added September 2008, was written by Alexandra Duncan and Molly Hayden. It is based on information contributed by Ethiopian interpreters at University of Washington Medical Center and caseworker / cultural mediators at Harborview Medical Center.

The legal age of marriage in Ethiopia for men and women is 18. Prior to a law passed in the year 2000, the acceptable age of marriage for rural girls was 12-14 years old, but some would marry as young as age 9. In urban areas the acceptable age has always been 18 years old.

Traditionally, marriages are arranged by the bride and groom’s families. It is customary for the bride’s family to give the groom’s family gifts at the time of marriage.

There are regional variations in traditions in Ethiopia. In some regions, the groom is expected to give jewelry and the wedding dress to his bride. A woman who cannot provide the customary gifts is at a disadvantage. If her family is poor, a woman will be sequestered in her home for three months. During this time she will undergo extensive beauty rituals, such as henna decoration and herb saunas, while other women in her family and community lavishly pamper and attend to her. At the end of the three months, she will be presented to the community and her future husband’s family. The woman’s striking beauty is considered to be her gift.

It is common for a young couple to begin their marriage by living in either the husband or the wife’s family’s home. The woman’s mother or mother-in-law, depending on where the newlyweds reside, will instruct her about homemaking and caring for her husband during this time.

Gender Roles

Women are considered to be subordinate to their husbands and girls receive less education than boys. Families tend to be large (seven or eight children). Knowledge and use of family planning is extremely limited.

Extended Families

Family structure typically includes the extended family. Family ties are strong. Households in the Ethiopian community include from one to six persons, half of whom are children under age 10. In the U.S., the divorce rate is high and mothers have a hard time raising children as single parents. In times of crisis, the family will take full responsibility for the family member’s problems, whether it is financial, health or social.

Disputes are settled by elders of the community. The society respects elders and accepts their admonitions or advice. Interaction is personal, informal and intimate; a great deal of interdependence is needed to accomplish a task or solve a problem.

Reproduction

This section on Reproduction, added September 2008, was written by Alexandra Duncan and Molly Hayden. It is based on information contributed by Ethiopian interpreters at University of Washington Medical Center and caseworker / cultural mediators at Harborview Medical Center.

Pregnancy

Pregnancy is usually not discussed until it is noticeable. In Ethiopia, women are helped through pregnancy by their mothers and other female family members, friends and neighbors.

Women do household chores and work as usual until they give birth. There is a belief that keeping active will quicken labor.

If the baby is a woman’s first, she will go to her parents’ home in the eighth month to relax and prepare for the birth. Rural and urban women observe this custom.

It is considered bad luck to buy items for the baby until it is born. It is also considered impractical to buy clothes for the baby before the gender is known.

Urban women have recently started taking vitamins during pregnancy. Only a small percentage of rural women take vitamins. In the U.S., there has been some resistance to taking vitamins due to the misconception that not taking them will help keep the baby small for an easier delivery.

It is not culturally acceptable for a woman to be pregnant and unmarried, because it will bring shame to the family.

Hot mustard is avoided during pregnancy, as it is rumored to cause miscarriage. During pregnancy and postpartum, warm foods are eaten as they are believed to aid in healing after birth.

Celebrations

In anticipation of the birth, there may be a “tasting day,” where the expectant mother and her mother’s friends celebrate the upcoming birth. The expectant mother is entertained and cooked for by her friends. Only women attend this joyous event, engaging in special dances and sampling or “tasting” the food that the mother will eat after the baby is born. In particular, the women will cook and then sample the porridge genfo. This celebration is akin to a baby shower without gifts.

In the U.S., this tradition continues; however, the American custom of bringing gifts for the baby is being adopted.

Child Birth

During labor, friends and family of the mother-to-be ritually roast and drink coffee and burn incense.

Men are not present during labor. If a woman is in labor she might notify her mother or a female friend, but not her husband. Men aren’t involved in the delivery process.

In rural areas, babies are born with the assistance of a midwife, who is a member of the mother’s community. Other women can be present up until the point of labor, when it is just the woman, her mother, the midwife, and her helpers – such as neighbors who are especially experienced with childbirth. In the cities, women may have prenatal care if affordable, provided by a clinic or a hospital. Caesarean sections are done in the cities, but are not common and are never performed by a midwife.

In Orthodox Christian communities, women will gather outside the home to pray. When the mother’s painful screams are heard, the women begin to say special prayers to the Virgin Mary. When the baby is born these women will make a series of loud sounds to broadcast the arrival and gender of the baby: five times to announce a boy; seven times to announce a girl.

Experience in the U.S.

In-hospital treatment and physician interactions have generally been well received. Ethiopian husbands generally attend childbirth classes with their wives and are usually present during labor.

Immigrants may experience homesickness because practices can be drastically different than those back home, and physicians should be aware that mothers may need more emotional support.

In the U.S., some Ethiopian women have concerns about childbirth, because they may be uncomfortable with male doctors and interpreters and may dislike being cared for by medical residents due to fears of being practiced on. It is helpful to explain to patients that residents are licensed physicians and work under supervision from specialists in their field. In addition, most women are afraid of C-section delivery, as it is perceived to be an unsafe procedure. Many think that American doctors are too quick to perform Cesarean sections for what Ethiopians consider to be normal variations. For this reason, they may wait at home until well into labor in order to avoid unwanted procedures.

For additional information, see Peripartum and Infant Care Issues and Practices among Refugee Groups in Seattle.

Postpartum Practices

Activity

The mother rests in the house for 40 days after the birth. She is usually separated from her husband and is sexually inactive during this period. The husband, family, friends and neighbors are in charge of making sure that there is sufficient food and comfort for the mother during this time. In the U.S. this period devoted to the mother’s rest usually cannot be observed due to work and lack of community and family support.

In some regions, mothers are encouraged to take cold showers after giving birth, as it is believed to help strengthen the body and aid the healing process.

Food

After birth, a thick, hot porridge called genfo is eaten by the new mother. It is believed to help her gain back strength and heal quickly. Friends and family make the genfo. It is made with barley, whole wheat flour, and spiced ghee (clarified butter). A drink made with flax seed, oats, and honey is also given to the mother. This drink is believed to produce breast milk quickly and help with constipation resulting from pregnancy.

Rituals

On either the seventh or the twelfth day, depending on the region, the mother and child go outside to be in the sun. This is done for the baby’s health. Neighbors come on this day to clean the house. In preparation for this day, the mother is pampered. She is given beautiful clothes, is decorated with henna, is fed special food, and is seated in a special chair. Her husband may bring her gifts.

A son is also circumcised on either the seventh day or the twelfth day, depending on the region. If the family is Christian, a priest blesses the child with holy water. If the child is a boy, he is christened at 40 days. If the child is a girl, she is christened at 80 days.

At one time, circumcision for boys and girls was mandatory for health, religious, and cultural reasons. Female circumcision is phasing out as people become educated about its negative health effects. Circumcision for males is available in U.S. hospitals. Ethiopian families understand that in the U.S., only boys get circumcised (with parental consent), but not girls.

Infant Feeding & Care

The child sleeps either in a crib by the mother’s side or in bed with her, but the child is always in the same room during the 40-day resting period. During this period, new mothers are never left alone. They are watched carefully to protect them from the “evil eye.”

New mothers are taught how to care for their babies by their mothers and the elder ladies.

Breastfeeding is much more common than bottle feeding, especially in rural areas. Almost all rural mothers breastfeed, and special attention is given to the mother’s diet as it is understood that a malnourished mother may not produce enough milk. Most women breastfeed until they are ready to have another child or until the child is two to three years old.

In urban areas, there has been a gradual preference for bottle feeding because most women are working mothers. It is rumored that formula may be healthier for the baby. In rural areas, some babies are given the herb, fenugreek, and in the cities, some are given chamomile tea to cleanse their stomachs because it is believed that when a baby cries, he or she may be having stomach problems. Babies are introduced to solid food about six months of age.

In the U.S., breastfeeding in public with the breast covered is an accepted practice. Often women cannot breastfeed as long as they would like due to changes in lifestyle (e.g., a mother who works outside the home may be apart more often from her baby). Formula supplementation is common when mothers continue to breastfeed for the first year of life and transition to the cup in the second year.

In Ethiopia, the baby’s body is massaged with lotion, baby oil, or butter (rural areas). In rural areas, babies are normally carried on their mothers’ backs in a leather or cotton wrap.

Family Planning

In rural areas family planning is not common due to religious reasons and couples normally have children soon after marriage. Contraceptive use is more common in metropolitan areas. Breastfeeding often serves as a natural form of birth control. For married couples in urban areas, the most common methods of birth control are oral contraceptives, IUDs, and condoms. In Ethiopia, abortion is illegal under most circumstances and the death rate from it is high. (Getahun & Berhane, 2000) It is not considered a form of family planning.

In the U.S., many Ethiopian families use family planning. Families with a working mother tend to limit their families to 2-3 children.

Sexuality is not openly discussed. However, abstinence is generally taught by parents.

Nutrition and Food

The preferred staple in the Ethiopian and Eritrean diet is engera (pronounced en-jer-a, and sometimes spelled injera), a flat sour-like fermented pancake that is used with “wot”, a stew made with spices, meats and pulses, such as lentils, beans and split peas. In Ethiopia and Eritrea, teff is the most common cereal crop used to make engera.

Religious Beliefs and Practices

There are two dominant religious: The Ethiopian Orthodox Church (Christian) and Islam. Some estimates put the Orthodox at just over half the population, while other estimates suggest that the Muslims are in the majority.

See: Abiy Tsom – The Great Lent

Death

Ethiopian Orthodox Christian Encounter offers a perspective about death taken from conversations with community members.

Traditional Medical Practices

Illness is often considered a punishment from God for a person’s sins or as the anger of spirits. Rural Ethiopians depend primarily on traditional healers, who treat illnesses with local herbal and animal remedies. See Ethiopian Traditional Medications and their Interactions with Conventional Drugs. Spiritual healing, such as prayer, is the preferred treatment for many diseases. Mental illnesses are seen as the result of evil spirits and are treated with prayer. Rural Ethiopians who come to the city often keep their traditional beliefs and attitudes towards health.

Experience with Western Medicine

In the Country or Origin

Where Western-style medical care is available, antibiotics are used frequently. Ethiopians who consult doctors usually receive a medication for every illness.

In the United States

Most Ethiopians in Seattle get health care at Harborview, Providence, Group Health and Swedish medical centers. Refugees from urban centers in Ethiopia have experience with Western-style medicine, but rural people have trouble understanding the concept of disease and the causes, means of transmission and methods of prevention. They also don’t understand the practice of withholding treatment until diagnostic work is done. Because Ethiopians are accustomed to receiving antibiotics or other medications for every illness, they feel it is a waste of time to go to a doctor if no medication is given, even for a minor illness. This is a common point of dissatisfaction with health care in Seattle.

The businesslike and direct approach of Western doctors is in contrast with the more interpersonal approach of Ethiopian doctors. For example, an Ethiopian doctor will never inform a patient of a terminal diagnosis. Instead the doctor will tell a close relative. This protects the patient from being discouraged; encouragement from relatives gives the patient hope and protects him or her from despair. See also: Medical Disclosure and Refugees – Telling Bad News to Ethiopian Patients

Language is also a problem. Ethiopians who come from rural areas have very limited English language skills. Although interpreters may be provided, the interpreters are not always appropriate. Patients are not comfortable with interpreters because of gender differences (women prefer female interpreters; men prefer male interpreters) or political/ethnic differences (for example, some Amharic- speaking Ethiopians are not comfortable with Oromo interpreters, some Oromos with Tigreans, and so forth). Because of these differences, patients often feel they cannot express all their needs and may not trust the medications prescribed.

The cost of health care is a problem for many Ethiopians. Those who cannot afford to pay are afraid to use the health care system. Little information is available about the Basic Health Plan or other options.

See 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

The Ethiopian Community Mutual Association (ECMA) is an organization representing all Ethiopians in the Seattle area. The ECMA’s Board includes individuals from various ethnic groups, including Tigray, Oromo, Amhara and others. The ECMA uses the languages of these three groups as well as smaller ethnic groups for its programs. Programs include ESL and literacy classes, referrals for employment and social services, legal advice, and counseling for families with dependent children.

Other Seattle organizations serving families from Ethiopia include the Oromo Community Organization, the Tigray Community Center, and the Horn of Africa Services.

Seattle Community Life

Ethiopian refugees began arriving in the Seattle area in the 1980’s and increased from 1989 to 1993. The total Ethiopian population in the greater Seattle area is estimated at between 6,000-7,000 with women and children highest in number.

Most of the Ethiopians settling in Seattle came from rural areas and have had little formal education. Those from urban areas are educated and worked as health professionals, engineers, teachers and social workers. Unemployment or underemployment are leading problems for many Ethiopians in Seattle.

Community Resources

Ethiopian Community in Seattle, 8323 Rainier Ave South, Seattle, WA 98118 (206) 325-0304. Website: http://ecseattle.org/index.php

Oromo Community Organization, 2718 S. Jackson St., Seattle, WA 98122, (206) 324-7039.

Tigray Community Center, 1902 E. Yesler, Seattle, WA 98122, (206) 328-8307.

Horn of Africa Services, 7500 Greenwood Ave N, Seattle, WA 98103 (206) 784-4144.

Neighborhoods

Most of Seattle’s Ethiopian population lives in central and south Seattle (Rainier Valley, Yesler Terrace, Holly Park and in High Point in West Seattle. But a number of families also live in north Seattle, Ballard, Redmond, Bellevue and Kent.

Common Acculturation Issues

Access to Healthcare

Some suggestions from the community that would help smooth the acculturation process in terms of access to health care:

Community organizations and health care providers should work together to avoid bias and break down cultural barriers through discussion. Health care staff should have training on cultural sensitivity.
The health care system should provide education about prevailing health problems and methods of prevention and treatment, and information about family planning.
Health care facilities should assign interpreters who are appropriate in gender and from the patient’s own language/ethnic group.
Community organizations and agencies should work toward making ESL classes available to all Ethiopians so they will not always be dependent on interpreters.
Information about health facilities and health plan options should be available through community organizations.
Use of child care centers for patients at health care facilities should be encouraged.

Acculturation

The following two sections were written December 2007 by Rachel Brandon, based on information contributed by Ethiopian medical interpreters and caseworker cultural mediator at Harborview Medical Center.

Language is probably the largest hurdle that Ethiopian immigrants face in American society. Ethiopians who do not speak English are often limited to low–paying jobs. This is particularly pronounced among older members of the community who have more trouble with language proficiency. Many immigrants lose their professional status after coming to the U.S. Medical and law degrees received in Ethiopia are not entirely transferable to the U.S. job market. Because of this, even educated immigrants may end up in low paying jobs. Additional economic pressure is placed on immigrants through demands made on them by the extended family back home. Ethiopian immigrants in Seattle view monetary remittances as a duty to poorer family members in Ethiopia. Many work two jobs in order to meet their financial needs.

Older members of the community express the desire to one day return to Ethiopia, although for many this reality is becoming increasingly unlikely. Some are reluctant to return to Ethiopia due to political circumstances. Oppression and poverty are two of the many reasons members of the Seattle community cite for ongoing emigration from Ethiopia. Ethiopia’s population growth – the highest of the entire African continent – will likely contribute to continued emigration.

Second Generation Issues

Second generation Ethiopians are those born to immigrant parents. There is also a 1.5 generation – those born in Ethiopia who migrated at a young age. Both the second and 1.5 generation immigrants experience similar issues in American society. In general, the issues faced by all East African youth are quite similar. This is most likely due, in part, to the homogenizing influence of American racial categorization.

Children of immigrants often have the family’s burdens and expectations placed on their shoulders. They are expected to do well in school and become a living example of the family’s “American dream.” Immigrant parents are concerned about their children’s assimilation into the greater society, but most accept it as inevitable. Parents try to keep their children in touch with their tradition and with their families back home. This includes trips back to Ethiopia (most children are eager to go) and involvement in religious activities. In Seattle, Ethiopian youth have organized for language and cultural education programs.

The youth pick up the language quickly and are often cultural mediators between their parents and the larger society. This can potentially breakdown the established generational hierarchy of the family unit. On the other hand, children often help their parents navigate through difficult cultural transitions.

One of the biggest concerns for parents is that their children may end up in the wrong crowd.

References

Getahun, H. & Berhane, Y. (2000). Abortion among rural women in north Ethiopia. Int J Gynaecol Obstet, 71(3), 265-266.