Hepatitis B carriers are common among Somali adults seen at Harborview Medical Center but prevalence data is not available.
The recognized clinical features include jaundiced skin, icteric sclera and dark urine. Other symptoms include nausea, and even pain at the site of the liver. Some do associate the disease with the liver. The prognosis varies from full recovery to severe illness that may result in death. There is knowledge that one can have asymptomatic disease, but complete understanding is difficult.
Translation or Language Equivalents
The literal translation of the disease is agarshu which means green or yellow skin. Another word is used by some people is indhacsete (pronounced inda- asaye in English) which means red eyes.
Cultural Knowledge and Traditional Treatment
The disease is believed to “just come” and is not known to be communicable. The specific cause is unknown, but some people believe it is related to constipation. People who are constipated for a long time are thought to be more susceptible to hepatitis. Sometimes garash, stomach flu, is thought to be related to hepatitis.
Hepatitis is known to be related to the liver. There is knowledge that it can recur and damage the liver. In mild disease, hepatitis is thought of as a disease process similar to the stomach flu that will resolve. In this variation of the illness, the treatment is to be rid of what is causing the flu. Laxatives are thought to be helpful to get rid of waste products and are used often. The Somalians know that some call it “bird disease” and those living near the Ethiopian border may believe that a bat causes it.
The treatment of disease can be divided into three categories. The first is avoidance of certain foods, which include caffeine, cow products and fatty foods. The patient is to eat soft, plain foods, such as porridge or white rice cooked with water. Camel milk is also thought to be very beneficial. These dietary treatments are to induce faster moving bowel movements since hepatitis is associated with constipation. The second treatment category is herbal medication, which are given by traditional healer. The third category is fire burning. A stick from a special tree is heated till it glows, and then is applied to the skin in order to cure the illness. In hepatitis, it is applied once to each wrist and four times on the abdomen if the disease is very active and affecting the liver. Other areas that may be marked with these burns include the temple, the parietal area, or behind the knees. It is very important to have the combination of all three aspects of treatment. The jaundice takes about two weeks to resolve.
Currently in Somalia, the use of western medicine for hepatitis is limited to multivitamins. Many still use fire burning and go to a traditional healer. It is also believed that early treatment improves the chances for cure and prevention from severe disease.
In the United states, traditional treatment of hepatitis would be preferable but is unavailable. The roots used for treatment and camel milk are not readily accessible. The fire burning alone is not thought to be helpful. Many patients are frustrated because they believe that if they used traditional medicine, they would be cured. The understanding that western medicine offers no treatment is a source of frustration for Somalians. As one person put it, “They don’t even try.”
The most effective way to alleviate the frustration with western medicine is education. It is important to educate people about the disease and its transmission and that the virus can still be in your body even though you do not feel ill.
Amharic Speaking Hepatitis Cultural Profile***