When Fardousa Jama and her father, Hussein, surveyed 400 Somalis last year in Mankato, they found many misunderstood and mistrusted the American health-care system.
Some weren't taking their prescribed medicine, they found, and some with diabetes were testing their blood sugar too frequently. Others faced language barriers and didn't know how to access prescription medication.
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"There is a huge gap and mistrust that happens with doctors and Somalis," Fardousa Jama said. "We just want to help bridge the gap."
That desire led to the Somali Health Literacy Project through Mayo Clinic Health System. The project will consist of 18 classes during the next 18 months on health topics ranging from defining health to diabetes and depression.
Mayo doctors said they hope the project can improve trust between providers and the Somali community and decrease emergency-room and urgent-care visits.
"When people come into the doctor, we assume a certain understanding of health," said Dr. Erin Westfall, who led the effort to coordinate the project. "Those assumptions aren't accurate, and it leads to a lot of safety issues."
Minnesota is home to about 45,000 Somalis and their children, according to state demographer Susan Brower. There isn't an exact count of the greater Mankato Somali population, she said, though 327 kids in the Mankato Area school district reported speaking Somali at home in 2014-15, according to the state Department of Education.
Despite the relatively small numbers, Somalis have the poorest health-care outcome rates among all Minnesota minorities, according to a 2014 MN Community Measurement report. In colon cancer screening, for example, patients born in Somalia were screened at a rate of 22 percent compared to the 70 percent state average. Somalis also had the lowest health-care outcome rates in diabetes, vascular and asthma care.
The report doesn't say why Somalis have such poor outcome rates, but Anne Snowden, who directed the report, said it sometimes can take foreign-born populations time to learn the U.S. health-care system.
Westfall said chronic diseases and mental illness are rare in Somalia. She noted that people without access to health care, such as those in refugee camps, aren't used to talking about preventive efforts.
"For someone that comes from that culture, prevention efforts are looked at with suspicion because doctors may find something wrong when they feel fine," she said in an email. "This is a difficult concept to grasp for everyone — Americans and Somali Americans alike."
Better, but different
Jama, an interpreter at Mayo Clinic Health System, came with her family to Mankato in the late 1990s. She said her family was the first Somali family in Mankato.
Last year she and her father founded the Somali Community Barwaaqo Organization in an effort to help Somalis transition into the community. The organization has an office on Madison Avenue and offers no-cost citizenship classes, employment and housing assistance, and tutoring, among other services.
Jama said the medical system in America is better but a lot different than her home country. In Somalia people go the pharmacy to get their medicine, she said, whereas in America you need a prescription first.
"If you have the money, you can buy whatever you want," she said. "The risk is on you."
Abdikarim Abdulle can attest to that. He arrived in Mankato with his wife and five kids last month after spending 15 years as a refugee in South Africa. He said the hospitals in Somalia were dismantled once civil war broke out in the early 1990s.
"Once the health system gets dismantled, it goes away," he said, with Jama interpreting. "It's hard for the clinic to open up again."
Westfall directs the osteopathic program for the University of Minnesota's Mankato family medicine residency program. She secured a $5,000 grant from Enventis for the project.
Resident Dr. Vicki Zbikowski will be leading the classes. Zbikowski, who has a master's degree in bioethics, said she is interested in cultural diversity and exploring how to best serve underrepresented health-care populations.
"It's important to understand where this particular population is coming from in terms of what health means to them," she said. "If we can't understand where they're coming from, then we're unable to kind of meet them where they are at."
The sessions will cover a range of topics, from defining what health is to diabetes, heart disease, immunization and more. The goal, Westfall said, is to affect at least 100 families.