Aug. 2, 2022

Somalis—Can you name that supplement that everyone is taking? (Ahmed Ali, S1, Ep 3.2)

Somalis—Can you name that supplement that everyone is taking? (Ahmed Ali, S1, Ep 3.2)

This is part II of our conversation with Ahmed Ali about Somalis in Washington. To hear the introduction to this topic and the full guest intro, please listen to the previous episode. Ahmed Ali is a pharmacist by profession and the executive director of the Somali Health Board. 

In Part II of this conversation, we talk about 

  • what to be aware of during a patient encounter like naming and traditional clothing
  • counseling about nutrition in a culturally appropriate way
  • review a common supplement used in the community
  •  being careful about complimenting too much and bringing on the evil eye 
  • the numerous programs that the Somali Health Board runs to care for the community. 

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Transcript

 

Greetings/Interactions

  • Naming: Understand names so you can recognize related family members
    • The first name is the given name. The second name is the child's father, get it. And then the third name is the child's grandfather, paternal grandfather
  • Clothing: Recognize that patients in hijab need to be prepared to be examined.
    • After examination patients need to often cleanse themselves again if they follow the tradition of 5 prayers a day.  
  • Complimenting: If you're complementing something or someone, like a newborn, say Mashallah to not bring on the evil eye. The word is used to acknowledge a feeling of awe or beauty regarding an event or person that was just mentioned
  • Vague Complaints: Consider PTSD with somatic symptoms and non-specific illnesses. 
    • It's a community that has gone through trauma, it's gone through displacement has gone through refugee process, and settled here.
    • Some have settled here and fluently speaking English and contributing members of society. But they're still all the ones that still are healing. I think a lot of times that reflects on mental health in PTSD, untreated PTSD within the Somali community

PMH/FH:

  • History of Scarcity: Acknowledge the prior trauma of living in refugee camps and how that may inform what it means to "diet" or limit food. 
    • Some people lived in refugee camps for over a decade, barely surviving on one or two meals a day. 

Social History:

Substance Use

  • Shisha: Ask about shisha and other substances, not just cigarette use and household use, not just individual use. 
    • If a questionnaire asks,  "Do you smoke?" An individual that actually uses who can shisha will most likely say no to that
    • In a household, the wife may not, but the husband is which is affecting the asthmatic child
    • Khat is a stimulant and as a chemical is actually similar to amphetamines. It's a green leafy substance that gets chewed.

Nutrition:

  • Halal: Modify your counseling, if a patient is halal
    • Food is halal depending on the way the meat or animal is slaughtered. It's forbidden to eat pork or consume alcohol
  • Vegetables: Recognize that due to the environment, some parts of Somalia did not have vegetables as part of the traditional diet
    • For example, some parents have said, "Listen, we feed goats and camels, vegetables, I don't think that's something we consume."

Medications/Supplements

Black Seed/Habit Soda: Ask if patients are taking a supplement, like Habbat Sauda, to build rapport and support their health decision making

  • Habbatus Sauda or nigella sativa is the scientific name for black cumin seed, which comes from fennel flowers native to Asia
  • Many patients take this for anti-inflammatory effects. No known adverse effects or drug-drug interactions
  • It is described in the Quran and Islamic Hadith by the Prophet Muhammad, that it helps with a lot of different ailments. 

A&P:

  1. Patient Expectations: Consider prescribing rather than suggesting over the counter alternative to build rapport when establishing care.
    • There is a perception that when this patient goes in, they really are expected to leave that place with some sort of medicine
  2. Inshallah: Recognize that this is a response to any event and does not mean health advise won't be followed
    • This means God willing, because in the realm of the Muslim individual, everything is preordained. God is the only one that determines the outcome of what's going to happen.
  3. Family Advice: Before creating a plan, ask, "What have you learned so far from your family about what's going on and what you should do?
    • Many people consult with their family members before coming to the doctor’s visit
  4. Disease Explanation:  Explain the etiology of illnesses clearly before getting to a treatment plan
  5. Motivational Interviewing: When talking about nutrition, consider focusing on the value of the body as God-created rather than simple need to "stay healthy"
  6.  Community Engagement: Consider how skepticism and mistrust may not be addressed unless local community leaders, clinicians and sometimes the local Imam endorses the intervention
  7. Community Interventions: Recommend partnering with Somali Health Board for Community Interventions
    • Whole Child Care Initiative: Clinicians can refer to child care providers that have questions about how to make sure that children that they take care of are kindergarten ready
    • Centering Pregnancy program that works closely with HealthPoint and other clinics that primarily determined how do we ensure that prenatal /postnatal care is given to Somali pregnant women. We have a mental health program that encompasses both behavioral health with autism, as well as mental health for youth.
    • Senior Project for our elderly seniors that meets weekly basis, and has this meeting spaces for them to talk about their challenges.
    • Soccer Team: Includes over 100 Somali kids that won several championships. Clinicians could also refer kids to be physically active
    • Nutrition: Program includes tours of markets and stores to understand options for cooking and food
    • BLS: This program includes CPR and Stop the Bleed trainings

 

  • Timespan: 38:34 Min
  • Transcription Type: Cleaned Verbatim
  • Speakers: 2 (Ahmed Ali & Raj Sundar)

00:00

Ahmed Ali: For instance, you've got an infant, it's like, wow, they're healthy, and they're doing well. There's a good chance that parents might feel a bit uncomfortable with all these compliments because they feel like then something terrible is going to happen to them. But if you say Ma Sha Allah, then that clears up for you. They will often say internally to themselves, maybe giving them a look like, stop talking about my child in this context.

00:22

Raj: Hey, everyone. Welcome to the healthcare for humans podcast, the show dedicated to exploring the history and culture of Washington's diverse communities. So, clinicians are equipped with the right knowledge to care for all patients.

This is Part-2 of our conversation with Ahmed Ali about Somalis in Washington. Please listen to the previous episode to hear the introduction to this topic and the full guest intro. Ahmed Ali is a pharmacist by profession and the Somali Health Board executive director. In this conversation, we talk about what to be aware of during a patient encounter, like naming in traditional clothing. We cover counseling about nutrition in a culturally appropriate way. We review a common sample event used in the Somali community that I certainly have not been asking about and then end the conversation by covering the numerous programs that the Somali health board runs to care for the community. Here's Ahmed Ali.

Okay, I wanted to touch on a few things relevant to a clinic visit for clinicians. The aim, for example, is standing how Somali individuals are named because they think there's a lot of confusion when we immigrated here, especially for my family. But I think it's similar in the Somali community, where the first name is the given name. So, for example, for me, my given name is Raj. And the second name is the name of the child's father. So, Sundar is my last name because it’s my dad's first name. And when we came here, people were so confused, and they made our whole family name Sunder. So, my dad's name is now the last name for everybody, as you know, that confusion around what people are doing with the names, but I think it's similar in a similar community, right? That's a given name and then the child's father's name. But there's also a third name, the name of the child's paternal grandfather.

02:14

Ahmed Ali: Correct? Yes, absolutely. The first name is the given name. The second name is the child's father. And then the third name is the child's grandfather, the paternal grandfather. And there's a lot of confusion right now. Wherever we go within the non-Somali spaces, I am Muhammad Ali because Ali's my grandfather's name. Still, if you meet other Somalis, they will say Ahmed Abdullah because Abdullah is my father's name. And everybody knows me as Ahmed Abdullah because they identify me with my father. So, there is a bit of confusion, especially with kids born here, because you have to maintain specific names for them to be picked up from school to be identified with who they are, to avoid confusion, and so forth. But the Somalis have a particular way of identifying within the lineages, and it's also a unique way of identifying. I can name up to probably 30 grandparents, from my first grandfather to the last 30 grandparents, in a single rhythmic name because we keep track of those because the lineages and sub-clan system that we use maintain that cultural aspect. It's also important to understand that women keep their names even when married, so they don't change their names based on who their husband is. A girl keeps her first name, her dad's, and her grandfather's.

03:37

Raj: Yeah. The names are important for clinicians to know how to call people what they want to be called appropriately. Okay. I think I have one more thing about clothing. But I'm not sure how to best discuss it. I know there's a traditional clothing for men too. But I think most men here don't wear traditional dress as I've seen.

 

03:56

Ahmed Ali: Correct? Yes, most men do not wear traditional Somali clothing because it's called Maoists and shout, and you wouldn't be able to function in this society if you wore modes. It's a beautiful, unique attire. Most folks do wear it when they are back home. Men do wear kameez, which is like the Middle Eastern garment, and during the Friday prayers. For women, it's a sense of modesty to cover themselves with anything beyond their hands and face. Others will go a little above that and put in a jilbab that covers the entire body minus the eyes, nose, and mouth. But that's another option as well. From a clinician’s perspective, the only things to be cautious of and culturally appropriate is to excuse themselves if they're going to be changing into the garment for them to be examined. And at the same time, also have that communication, that discussion, or at least point out that if you're going to be touching someone, that you're actually going to be touching someone because before you pray the five times a day, you have to do a certain type of ritual, which is washing your hands washing your face washing your feet. Before you do offer any of the five daily prayers, you have to cleanse yourself. And if a male, who is not your husband, brother, or father, touches you, then you must go back and redo that ritual again. But most Somalis understand that when you go to a doctor, you will talk to them about your needs, and they will examine you. And the other thing is that I think a lot of times for the Somali community, there's always been an aspect of when you go to the provider, when you go to your doctor, there are certain things that they are expecting because of the availability of certain resources, and more of a treatment aspect of medicine. So, someone goes to the doctor, they get examined, they get blood drawn, and they prescribed some medication to take them home with them. So, there's always some sort of perception that I went to that doctor and expected to get something when I lived there. And often, providers are not communicating well with this patient, saying, " Hey, you got a common cold; just go home, get soup, relax, sleep, and you should be okay. But there's a good chance this patient was expecting some sort of antibiotic treatment. And for them not getting that, they assume that I didn't get the best treatment I could, or probably the doctor didn't know exactly what they were doing. So that is something I want to make sure that providers are aware that there is a perception that when this patient goes in, they are expecting to leave that place with some sort of medicine to an extent.

 

06:33

Raj: That's a good point. Because I think one thing that people struggle with is how to deliver preventive care, like breast cancer screening or vaccines, because it happens in the Indian community, too, at least in India. Where if you go to the doctor, you're going to get medicine, and if they're not giving you treatment, why did we waste our time? So that's one thing, I'm not sure what a good solution to that is. But the second part is that in sha Allah, God willing. Clinicians struggle with having a conversation when that is a response to necessary care. I'm not sure what your recommendation would be to deliver preventive care appropriately when both cultural aspects exist.

07:16

Ahmed Ali: Yes, let me talk about the context of the Inshallah. That is a common phrase most Muslims utilize, particularly the Somali community. Regardless of what you decide or the conversation you are having with a small individual, if it's not happening right now. And it potentially will happen at different times. There has to be that phrase that often uses in sha Allah, which means God willing. because in the realm of the Muslim individual, everything is preordained. God is the only one who determines the outcome of what will happen. You could decide, okay, tomorrow, I'm going to be playing tennis, but you don't know if you will make it tomorrow. Only God knows that. So, I think a lot of times you will a lot of clinicians do is hear that, okay, we're going to start this treatment, and we're going to do this and that. And then your patient will say, Inshallah, from that aspect. But with the prevention, we've come a long way for the Somali community, especially within the Somali Health Board. The work that we've done over the last eight or seven years has always relied primarily on how we educate our community to understand what it is that you need to prevent certain chronic diseases, including cancers and diabetes, cholesterol, hypertension, and for collusion. I think it's important for them to skip some sort of context to the patient. Give them some tap because what happens nowadays is they know that at the end of the day, the medical doctor, the MD, or the nurse practitioner, has the last word, the last see in terms of the treatment. But before they see their doctor, they spend half an hour, 30 minutes plus, with other people taking notes, right? And that's not how things happen in Somalia. you go in, see your doctor, show your issues, and that doctor treats you, and you go and live. This provider here has only about 10 minutes with you at a maximum. And that's the reality because they're spending some time reading your notes before they walk into the room. And they come in and tell you what to expect and how to go about things. I think the doctor needs to spend a few minutes explaining to the patient what it is to have chronic diseases, what causes chronic diseases, and how to prevent them. Because a lot of times, I see pre-diabetic and borderline diabetic patients, and what they've got is, “Okay, if you become diabetic, then you can start this medication, or they get metformin.” They're told if they start checking blood sugar three or four times a day, if they notice something, then start this medication, but there is not a lot of conversation going into what happened for you to be in this stage at this point. How has your diet been? Do you exercise? Are there other stresses in your life? What kind of food are you eating and so forth? And it's also really important to understand that the dietary aspect of the Somali community has drastically changed for people who were doing fine and then went to refugee camps for over a decade, barely surviving on one or two meals a day. And then now the fridges are full of food. So, you can imagine what that will do to your patient. Because now, all of a sudden, you've got every food you can lay your hands on, and you're not conversing with them. As far as a balanced diet. I think a lot of times, even conversations about balance meal is so foreign to the Somali community that you need to sit down with a dietitian to understand, okay, you are eating your meals in a certain way. You need to understand what kind of food they eat and what that means for them to have a conversation about chronic disease management. Breast cancer has come a long way for screenings as well. I can tell you that this year will be our ninth or 10th, and you have an annual health fair. There often draw 1000 people, and we've got about 40 or 50 providers and clinics participating in that. During the first three years, I used to have these conversations with the Swedish and Harborview mammography team just to bring the mammography bus to our health fair clinics. And I remember the emails, and I used to go back and forth and say we only saw two or three patients. Is it really worth the investment that we're putting into this? My take was, listen, I understand that we're only so four or five, but I want people to come and see the bus day, every single year, I needed a 40 or 50 plus mother to come in and put her head inside that bus and figure out what's in it. Because next year, when she comes back, she will understand what is happening there. And I can tell you right through that process. Three, or four years down the road, we're doing 15 to 20 mammography screenings in each of the health fair settings to a point whereby we couldn't keep up with them. And that is essentially what comes with the prevention aspect and the compensation we adopt.

11:57

Raj: So maybe the takeaway is, as clinicians, focusing on the why and the how before prescribing or talking about the next steps, and a lot of work has to be kept in the community to gain people's trust in these new medical interventions like mammography. And you just must keep showing up and showing people that it's okay. And it's good for the community. And you mentioned something about diet, which is a good transition to nutrition. I think you talked about the change in diet as people have immigrated here. One thing about the Somali diet that's really interesting to me is that a lot of food has similarities to Indian food. I think it's like sambosas (samosas); if people don't know what they are, how do I explain them? Like fried dumplings filled with meat or vegetable? And you also have things like ohwa, which has sugar, cardamom, nutmeg, key based dessert, right? So, I think people don't know what the Somali diet entails compared to Ethiopian food because Ethiopian restaurants are so distinct in people's minds. But I think one of the main things to know about the Somali diet is the idea of halal. We talked about Islamic tradition being a significant influence on the culture. So, Halal means no pork, no alcohol, and no smoking. But what does halal mean to you when eating?

13:15

Ahmed Ali: So, the term halal, as you have described, encompasses almost every single Muslim and not just particularly for the Somali community. When it comes to food itself, the way the meat or the animal is slaughtered determines whether it's halal or not. For it to be halal, it has to be slaughtered in a traditional Islamic manner. You have to call out that you're sacrificing this animal in the name of God. And you also have to make sure that you're not yielding the knife and be as humane as possible. I don't know how I can explain slaughtering and be humane in the same context. But there are ways to ensure you slaughter this animal as fast as possible. And not necessarily just using a blunt edge knife to a certain extent.

14:06

Raj: The Part of it is reducing the suffering in the world, even when you're eating meat.

14:10

Ahmed Ali: Absolutely. Yes. The rest of the aspect of Halal is to make sure that there is no pork or alcoholic beverages in any of the food that you're serving. It is forbidden for Muslim individuals to eat pork and also consume alcohol. That does not mean they are Muslims or Somalis who don't consume alcohol. So that's something that one to make sure that clinicians also have a conversation with their patients because they are Muslims and Somali individuals who consume alcohol. And that's a conversation you will also need to have with them. Cigarette is also something that is forbidden. in Islamic contexts, anything that is harmful to your body is something that is often prohibited for a person to consume. Our bodies are seen from a religious perspective as God-given, so we must protect them. And individual Muslims, if you have that conversation with them from a spiritual perspective and tell them to listen, you've got to take care of your body. You need to exercise something they will understand faster than if you ask them to go and find yourself at the YMCA or LA Fitness with northern Somali cuisine.

Primarily there is dominance in terms of meats, a lot of rice, spaghetti, or pasta. You mentioned a samosa, and halwa Somalia, as mentioned early on at the beginning of this podcast, has always been at a strategic location. And because of the trade routes in the Indian Ocean, there have always been other cultures of influence. The pasta and spaghetti came into because of Italian colonizers and our trade routes along the Indian Ocean. In Southern Somalia, on the other hand, is the breadbasket of the Somali community.. Other aspects of food are very much vegetable based. So, there's a good chance that you might discuss this with a patient who's never had a salad as a meal in their life. Because the assumption is that Kim was the one that ate vegetables, not human beings. And there's always been a joke within the Somali community when we started to have that conversation where one parent did say, listen, we feed goats and camels, vegetables, I don't think that's something we consumed. But I believe that narratives are changing so much now that some of our Healthy Eating nutrition class has been around our YouTube channel, our Facebook channel, and other means of communication to reach a large number of the Somali population across the globe. That's a changing aspect in terms of the cuisine. But at the same time, many conversations are to be had to ensure that you include fruits and vegetables in the diet.

16:49

Raj: Yeah, you were talking about in northern Somalia, camel is very respected. Both the milk and the meat. Camel was harder to find here. But I think people substitute it with Goat,

17:00

Ahmed Ali: goat and cow, it's harder to find a camel, but it still gets imported here from Australia. Australia has a large number of camels. Even though Somalia is considered the only country with more camels than human beings in the world, it exports many camels, goats, and sheep to the Middle East. But some restaurants do offer camel meat in the Seattle area. And you can also buy from Saint Somali groceries as well.

17:27

Raj: Yeah. When you said you are holding these events to educate the Somali community on a healthier diet, what are one or two things you tell the community? For example, if they have diabetes, they ask you what they should eat.

17:41

Ahmed Ali: Absolutely; our Healthy Eating nutrition team does terrific work. In terms of the programs we've had over the years, we partner with the city of Seattle's new Bucks program to ensure that the family has access to fresh fruits and vegetables. And one of the things that we've done pre-pandemic times as we used to take families, and seniors, for tours, a Pike Place Market and some of the local markets, Beacon Hill and toquilla. In the Kent area, we would have a group of five to 15 women go to the markets and explore other options for fruits and vegetables. And many of them were pleasantly surprised to find different types of vegetables and fruits that they were not accustomed to back in Somalia. I think when it comes to certain patients with, let's say, hypertension or diabetes. It often is making sure that they are substituting certain fruits and vegetables that they're either familiar with or even giving them options instead of sugary beverages and things to that extent. And this is something that I don't personally do it. But my team at the new practice program has done an excellent job on that. And more importantly, emphasizing on a plate of, let's say, lunch. What does that include? Often, because of where families are from in limited food supply, a plate full probably has three-quarters of a will have rice and then meat. So now we're asking them to divide that into four sections. You need carbs, rice or pasta, and then meats, fruits, and vegetables on the site. And that is a picture we often share with families for them to understand that it's important that you can make juice out of fruits and vegetables. But at the same time, it needs to change that image of where you just consume a bunch of carbohydrates in one city.

19:33

Raj: Yeah, yeah. And then the last part of this segment is about substances. We said no smoking, no alcohol.. In India, there are beta leaves that I think are similar to that of a stimulant, but also huqa and shisha. I think people shouldn't know about that because we often just talk about cigarettes, but people consume these stimulants in different forums. Anything specific we should know about those substances?

20:05

Ahmed Ali: Absolutely. I think it's essential that clinicians understand that when you're talking mainly with cigarettes in the questionnaire, you've got here screening a patient asking, do you smoke? An individual that uses huqa shisha will most likely say no to that because they don't consider who can see it as nicotine. We all know it contains some form of nicotine, if not more. As a matter of fact, I think sitting in a one-hour setting enjoying that huqa-flavored nicotine is equivalent to smoking two or three packs of cigarettes. So, it's a much higher nicotine content than a person who smokes a cigarette. That essentially comes down to how you ask those questions. How do you culturally appropriately ask those questions? If you're going to be checking a box that says no smoking? And this patient consumes huqa shisha, and then you did not? Do your work efficiently for that patient?

It's also important to ask another question: Is anybody smoking huqa and shisha in the house? Because the wife might not be, but the husband might be smoking huqa and shisha, and they've got an asthmatic child in the house. So that is another conversation we always have with our committees about ensuring that you are not consuming these things in the house.

And by the way, the huqa and shisha are not Somali traditions. It's become a tradition here in the West because young folks needed something of a pastime. They needed other places to enjoy themselves and go and socialize. They can go to bars and drink alcohol. And therefore, they figure to huqa bars and shisha bars at this place where we can relax, chill and smoke this stuff. So I am always out there upfront indicating that this is not a Somali culture. If you go to Somalia, there's a good chance you're not going to see any huqa bars and shisha bars, chaat, on the other hand, is a stimulant. And chemical is similar to amphetamines. It's a green leafy substance that gets chewed. And someone could be sitting from, let's say, noon to 4 am, just chewing those green leafy vegetables. I call them vegetables, but they're not actual vegetables. It's widely consumed in Somalia. It is predominantly men who use the cart. Some women also use the cart as well. It is illegal here in the United States, as well as the European countries. Some people bring them illegally. It's also good to ask whether someone is utilizing that because it damages your teeth and leads to impotence from the studies we've seen. Sometimes consuming this product would have some sort of depression, anxiety, and other things that most times cannot describe to you. But they will also tell asthmatic, physical ailments, my head hurts or my back hurts, or they can slip to a certain extent. But I think it's important that clinicians have that conversation, especially with men. And you can see that by looking at the teeth as you talk to your patient.

23:11

Raj: Yeah, I have two more questions if you get it in India. So, the next question is about traditional medicine. And if we need to know anything specific about that. I often think with my patients and see actual scars. I think it's from fire burning when they were younger. And there is this idea of the evil eye too. I think it's important because there's this idea that directing praise comments can cause harm or illness to befall them. And I think those are things we need to be careful about.

23:39

Ahmed Ali: I think both of those are really good points. With regard to traditional medicine, there are some herbal products that the Somali community consumes a lot. And one of them is the black seed. It's called a habbat soda. So that is described in the Quran and Islamic Hadith by the Prophet Muhammad (PBUH) that it helps with many ailments. And there are a lot of studies that have been done to show that it does help with certain things. But there's a perception that it helps with every single ailment that is out there. And that's not the case. So, people use it for almost everything they can think of. You will have patients who are on your diabetic medicine, but at the same time, they are taking habbat soda or the black seed. They've managed to infuse it into oil forms that you can rub onto the body for, let's say, pains and things to a certain extent. I have done my drug-drug interactions through a lot of things. I have not encountered a single issue with black seed, especially with common therapeutics that we utilize for different diseases. But that's something that often the Somali community consumes in use, particularly seniors of the elders, members of the community. Other things like Kok Manoca often say Habbat Kaf and common cold and things to that extent. A lot of other things are Based on garlic and different things. It was prevalent during the beginning of the pandemic with COVID when many folks were just doing cocktails of different things, especially when there were no vaccines and there were no other ways to check what you got it so forth.

Concerning the evil eye and excessive compliments. It's something that, often culturally, is encouraged, with the symptom discouraged to a certain extent. Well, you can complement someone and say all great things about them as long as you say Ma Sha Allah. That is the key word right there. Ma Sha Allah that means God blessed. For instance, you've got an infant in his like, wow, they're healthy and doing well. There's a good chance that parents might feel uncomfortable with all these compliments because they feel like something terrible will happen to them. But if you say mashallah, then that clears up for you. Often, they will say internally with themselves, maybe given another look like, stop talking about my child in this context. I think it's humility, and you can give people compliments, but don't overdo it. At the same time, if people are aware of the good things that happened in their life, many people will not post on social media about their meals. Nowadays, everybody puts in Snapchat, okay, listen, I'm in this restaurant, look at my Starbucks latte and take a picture of the Lisa sending over. This is a large population of the Somali community who will not do that because they understand that there's somebody else on the other side of social media who doesn't have what you have. And you might end up losing what you have because of an evil eye.

26:33

Raj: Yeah. Okay, so let's do the podcast's last segment, which is about community support. I think this is a core part of what you do with the Somali Health Board, and it may be a good time to review all the work you've done in COVID. Because COVID has shown how much mistrust the community has about healthcare institutions. So, where do people turn to health information? And how has it been part of the Somali Health Board communicating with patients?

27:02

Ahmed Ali: So, when the pandemic hit, Somali Health Board was how do we respond to this pandemic? This is what we sign up for? How do we ensure that our communities get the real information and correct real-time information from the Department of Health and Public Health? There was a lot of misinformation about COVID-19, not just from mainstream media. The president United States also shared much misinformation at that time. That's an authoritative figure that, a lot of times, many immigrants and people who will come from certain parts of the world look at that as “wait a second, if the individuals who are at the very top of this society are questioning what the pandemic is, then maybe we need to start to think through if this is a reality.” So, we needed to combat this misinformation about the pandemic itself. So, we established a committee, the COVID response team, that included other public health professionals, Somali Health Board members, and me. We made sure that we established a page within our website, or hub, whereby we're sharing real-time, correct information, that we're debunking misinformation, in its essence, from the beginning. If any information comes from the Department of Health, within an hour, we translate the materials in Somalia, and we ship them right away. And that's something we did very frequently; we did it very fast. We also partnered very well with other ethnic media, including Somali TV, which gets aired all across the globe. It's based in Minnesota, but we've worked closely with them. One of the aspects of the pandemic was determining the correct information to share. And how do we share that? Is it relevant? Or is it irrelevant? And the COVID response team determined that early on, we're going to have a weekly conversation called the COVID conversations every Friday, and we'll bring three people in each of those. he has to be a medical doctor or someone in the health field. And he had to have a Somali Health Board staff member and a religious leader from the committee. because we understood that I could see everything I could about COVID, a sizable population and the community would listen to me. But there are pockets of individuals who would not pay attention to anything I say. Unless Sheikh Ahmed Noor, the Imam of the largest mosque in Seattle, says, Hey, this is correct. And this is the way we're going to go about it. And they will follow that thought process. So early on, we're very adamant about making sure that we have the right people sitting at the table making those conversations with the committee. We held this ongoing basis every single Friday throughout the entire pandemic. When we lost a couple of lives at the beginning of the pandemic within the Somali community. We made sure that we were going to the mosques and making sure that families and our communities understood the importance of social distancing and the importance of making sure that they shouldn't come to the mosque for prayers when the pandemic was at its height. We also ensured that families understood that the burial ceremonies changed drastically during the pandemic. And nobody should be there except the immediate families and the religious leaders. It took a long time. We set up our zoom meetings for mourning families going through death, so their families could meet and see what was happening simultaneously. As a trusted messenger within the Somali committee, it was tough for us to do the work, but it was also calling simultaneously. we established COVID testing sites in almost every site in Aquila, particularly in the mosques. And we're unable just to do this ourselves. But we made sure that we worked closely with King County Public Health. Our first COVID testing site was a two-day long weekend in Federal Way and Renton, where we tested over 2500 people. And that was the very first pop-up site in South King County during the pandemic. And this was a partnership we established early on with the Be Good Foundation, a Buoyancy foundation that was able to support us with almost three truckloads of COVID, supplies, and BPS from Texas. early on to make sure that families have the supplies that they need. Then came the vaccination phase. And we decided we needed to ensure that we were out there and vaccinated. we need to ensure that when I take the vaccine, I produce a short video clip that families can share. And people can see that I am being vaccinated and doing okay. and then a week later, an interview, how I was feeling, and so forth. And we made sure that every single image that goes out there, whether it's the mask that we have Dr. Anis Ibrahim, a pediatrician at Harborview, they see her face putting a mask on. We're not just taking images from Public Health; the Department of Health just putting her logo on it. But people they can relate to, we have the Imams at the forefront. And during the vaccination process, I think we're happy to report that we've almost 80% of the Somali population in King County through various clinic sites, including every single school in Southeast Seattle as a middle elementary school through the Seattle Public Schools.

32:24

Raj: That's awesome. So Somali Health Board has done all this impressive work. Are there anywhere else clinicians should know that people go for services or community services that we should learn to refer to?

32:38

Ahmed Ali: Aside from the COVID response, we have eight different programs. Those eight different programs include the whole childcare initiative program. Clinicians can refer to care providers that have questions about how to ensure that the children that they take care of our kindergarten ready, they're healthy. We have a mental health team that works with them, social workers, and so forth. We have a Centering Pregnancy program that works closely with Health Point in the other clinics. That primarily determined how we ensure that prenatal and postnatal care is given to Somali pregnant women. We have a mental health program that encompasses both behavioral health with autism and mental health for youth and the general population.

Along with that, we have a senior project for our elderly seniors that meets weekly and have this meeting spaces for them to talk about their challenges. And with this, we'll start with predominantly during the pandemic because we've been asking our seniors to stay at home, don't leave. You're going to be impacted by COVID. So we decided that we were going to give them tablets at home. We're going to start zoom classes for them. We're going to start exercise classes for them. And we're talking about medicine and their health needs. And that has been ongoing now for the last two years. We've got a very active soccer team that includes over 100 Somali kids that won several championships, not just recreationally but several titles within the Seattle area in King County. And that is something that I think the clinicians could also refer to kids as being active, physically active. The other thing we have done well is nutrition and healthy eating. But the program manager did CPR and stop-the-bleeding training for families, daycare providers, and individuals. Because many questions come along from the committee, hey, listen, what if I help this person, and then they die? Am I going to be responsible for that, and there we have that conversation about listening? You are now accountable, and you need to be able not to leave somebody who is in need. But these are the tools you need to ensure you help and save a life during these times. So those are some of the programs we've been able to implement along with that. I think the aspect of the organization is not just to create programs. Still, we are also socially responsible for ensuring that we participate in policies and decision-making processes within the County, the state, and the city where we are.

Right now, we've got a good team in Minnesota that has decided that they want to replicate this model within the Somali Population in Minnesota. Very soon, we'll call ourselves Somali Health Board Washington. And then we'll have another Somali Health Board Minnesota. But we're also working with the University of Washington on various research and published multiple research. We're currently working on prenatal and postnatal research called Marwaha fi mat in Somalia. And our team will be heading to Somalia to complete the observation of that particular project and come up with the next phase in terms of what that means. Because I think Raj is really important for us as an organization, as the committee that has done a lot of work here in Washington State. We have an obligation to have an impact on where we came from. And that is the next phase of our work; we want to be able to give back in rebuilding the health system in Somalia. So, any clinician who wants to be part of that journey is welcome to join us. And that is something that we hope will impact the global aspect of our work.

36:10

Raj: Awesome. Okay, the last question is, what is one thing you recommend to the clinician, or do you want your doctor to know?

36:20

Ahmed Ali: I think one thing I can consider is that the Somali community is remarkably resilient. It's a community that has gone through trauma; it's gone through displacement. It has gone through the refugee process and settled here. And now, also at the same time going through the same process as any other community, whether it's institutional racism, black lives, and so forth. At the same time, it has come together and been resilient every step of the way. I love for every clinician to understand that some of them have settled here and are fluent speaking English and contributing members of society. But they're still all the ones that still are healing. I think many times that reflect on mental health in PTSD, untreated PTSD within the Somali community towards an extent. And I talk about this because not much treatment goes into that. There are a lot of patients who would often go to the doctor and talk about physical ailments. But a lot of times, it's the way they describe it. If you ever have a patient that says, every part of my body hurts, and you cannot pinpoint anything. I think it's time to start Screening for Mental Health, PTSD, and other stigmatized health diseases within the community.

37:43

Raj: Yeah, that's a great takeaway, Ahmed. Thank you again for coming on the podcast. We appreciate you. I know that was a marathon, but I'm sure our audience members have learned a lot from this episode. Thank you.

37:54

Ahmed Ali: Thank you, Raj, for having me. It's been a pleasure being on this podcast with you.

38:00

Raj: Thank you for joining me, Raj Sundar, in this episode of the healthcare for humans podcast. If you enjoyed this episode and would like to support this work, please share it with others and leave a review. Show Notes can be found over at healthcare for humans.org. I'll see you next time.

Disclaimer:

This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participant's past, current, or future employers unless explicitly expressed, so always seek the advice of your physician or other qualified healthcare providers concerning your personal questions about medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land and makes a regular commitment to Real Rent Duwamish.

The transcript ends here.

Ahmed Ali Profile Photo

Ahmed Ali

Ahmed Ali is a pharmacist by profession, one of the founders, and the current executive director of the Somali Health Board (SHB), a nonprofit organization that works to address health disparities within the Somali/East African community.

He is an active member of the Somali community, with an emphasis on immigrant/refugee health issues both locally and abroad. He also serves on diverse boards, including the King County Immigrant/Refugee Task Force, city of Seattle's Sweetened Beverages Community Advisory Board, as well as the Fred Hutchinson Health Disparities Community Advisory Board. Along with the SHB team, Dr. Ali is also a recipient of the 2016 Molina Healthcare’s Community Champions Award.