1. Somali Muslim Case Story Deb Thomalla, R.N.

2. Deb Thomalla, personal profile Married 30 years: 4 adult children, 2 grandsons RN Case Manager for Arise Home Health Care providing client focused health care through –Patient Care Attendants –Home Making Assistants & –Home Health Aides in Stearns, Sherburne, Benton, & Morrison Counties

3. Scenario Somali widow Mother of 3 – under 10 years Post Traumatic Stress Disorder (PTSD)

4. History (1) Forced to watch rebels torture & murder husband Rebels kidnapped her Left children behind

5. History (2) Held captive 2 weeks Repeatedly raped, tortured, beaten She & children – US refugees

6. Barriers to Medical Care Language Culture Religion Education Medical system – not user friendly

7. Language Barrier Doesnt speak English Understands little Translation issues different dialects few Somali words for medical terms

8. Cultural Barriers (1) Many differences = many fears Mental illness shunned by Somalis Somali view: illness affects whole person: Body – Mind – Spirit

9. Cultural Barriers (2) Somali expectations of medical appointment Assess – whole person Diagnose – whole person Treat – whole person

10. Religious Barriers Allah (God) sends all illnesses & all cures Medical treatment should include prayer Medical treatment given is Allahs cure One bottle of pills = cure

11. Educational Barriers Levels of education vary greatly This client cant read or write

12. Medical System Barriers How will you pay? Medical professionals treat body or mind, not spirit Diagnosis differs depending on practitioner psychiatrist – bi-polar general practitioner - PTSD

13. PTSD Crisis Treatment Options Medication &/or Counseling &/or In-patient psych unit Involve Social Services

14. Social Services Crisis Intervention Options (1) Hospitalize client Put children into foster care exacerbates clients PTSD!!

15. Social Services Crisis Intervention Options (2) Home care option Patient Care Attendant (PCA) – daily visits Family stays together Finding agency with Somali staff

16. Summary of Barriers 3 main categories: –Communication –Education –Supply & demand

17. Lowering the Barriers Communication Interpreters Recruitment More time

18. Lowering the Barriers: Communication - Interpreters Need to be affordable – currently $130 per 2-hour minimum Somali community volunteers Large providers have interpreters available and free Insurance coverage

19. Lowering the Barriers: Communication - Recruitment Somalis into all aspects of medical field Somalis into social services

20. Lowering the Barriers: Communication – More Time Health care providers –Allow more time to communicate –Schedule longer appointments –Decrease production expectations

21. Lowering the Barriers: Communication – More Time (2) Nurses are trained communicators Assess clients needs and expectations Communicate info to practitioners Teach, clarify medical info to client

22. Education Barriers (1) Somali-to-Somali support One-to-one – sponsor new refugees Somali community meetings

23. Education Barriers (2) Community at large Community resources Support Somali community Inform and teach what you have to offer Somali community educate community at large

24. Education Barriers (3) Social Services Form partnership with Somali community Inform and teach purpose & process

25. Education Barriers (4) Health care providers Educate practitioners, support staff, technicians easy access to cultural, religious education mandated in-services interpreter/resource info readily available

26. Education Barriers (5) Health care providers (2) Educate Somali community – go to them How our system works Disease education Diagnostic tests Treatment options Separation of Body – Mind – Spirit