Our long-term vision for this pilot project was to: 1) strengthen community continuity, resilience and research-capacity; 2) develop and deliver a culturally congruent (meaning what patients and families need and want through attention to relevant cultural knowledge, meaning and strengths) perinatal care service for refugee and immigrant households in underserved South Seattle; 3) bolster healthy starts for children through increased peri-natal empowerment and care coverage to moms; and 4) improve maternal and family mental, emotional, psychological and social well-being by improving mental health screening built into doula and midwife-run group perinatal activities and home visit points of care.

The project received a UW Royalty Research Fund (RRF) grant for ethnographic study partnering with the Somali Health Board, Health Alliance International, Somali Doulas Northwest and Parent Trust for Washington Children to illuminate maternal/infant health disparities in Seattle’s growing immigrant and refugee communities.  A UW Population Health Initiative grant brought together Somali researchers and care providers and UW faculty from Anthropology, Global Health, Social Work, Pediatrics and Psychiatry to pilot the Mama Amaan mother-to-mother perinatal groups and doula visits for Somali families.

Decolonized Anthropology Matters in a Community with Deep History and Commitments

This project would not have been born, if not for the energy and leadership of a vibrant team of Somali women researchers and care providers, most of whom are either University of Washington (UW) alumna or current UW undergraduate and graduate students.  The bottom line for the team was that direction of the project, control of the data, use of resources and representations of Somali people must always center and be responsive to community needs – what we started to call “decolonizing university/community relationships.”  The team insisted that we not just address the short term requirements of university research that is sometimes in and out, spreading participant incentives, taking data, but not staying for the long-term support.  For a community in which many have experienced war, migration, family separation, language barriers, institutional violence and lack of power and resources in their new home setting, trust-building was key.  The team strove to identify community resources and strengths already being engaged by Somali families to optimize and determine their own health outcomes, navigate healthcare options and bridge service gaps in ways that are empowering, appropriate and sustaining for them.  We worked hard to attend to the complexity of community perceptions and histories, and to tread carefully on the well-worn path of disappointment and low-expectations of research projects on the part of the community who had been paid something to give information they never heard back about or received longer-term commitment or benefits from.  We did not rush any phase of the project.

We also learned that information about participating in Mama Amaan perinatal groups had to travel by trusted word of mouth, and that many women were very isolated and too encumbered with family and work duties to leave home and small children for an extra event every month without having childcare and assistance with transport.  When we provided these supports, the sessions were full and lively.  Women brought friends and family members, made smoothies, danced Zumba, discussed infant vaccinations and laughed and cried recounting their stories of war and migration, childbirth, family life and health challenges.  Babies were born, and moms celebrated.

Safe Motherhood in the Time of COVID-19

A decolonized, community-led and engaged medical anthropology is needed, especially now, when culturally congruent responses to COVID are more important and potentially life-saving than ever.   Somali team members are delivering care on the frontlines as essential workers, and being community-based researchers means seeing effects of the pandemic up close.   Vulnerability to job, food and housing insecurity, as well as social isolation and lack of access to health care, especially with language interpretation available, has only intensified.

Further, a core shared value across the Somali community, and in fact, throughout the Muslim faith, is daryeel – Somali for an abiding commitment to helping others in need and visiting those who are sick and suffering to bring sustenance and comfort.  It has seemed at times, as if COVID policies of sheltering in place, social-distancing, quarantine for those with symptoms and aggressive test-seeking was falling by the wayside.

Recently, tragic news circulated of a Somali mother and grandmother in one family dying of COVID within 48 hours.  This sounded an alarm that is passing by trusted word of mouth.  Community leaders have guided the outpouring of community care by suggesting alternatives to visiting, like contributing to a Go Fund Me.

In this urgent time, the team turned to a project activity that is needed right now.  Ubalbalaadhi hooyo – the project’s What’s App and FaceBook accounts were initiated to allow women to attend our peri-natal groups in Somali from home, and even send in questions Somali care providers answer online or during a session.  Today, a social media gathering trusted and enjoyed by Somali women is perfect to share COVID-related information.  Here are three messages for our communities and for caring providers to take time to convey:

1. Protect yourself, family and community. Wash hands often, especially after going out on an errand or work, and stay home whenever possible. Wear a mask if you have one when going out or even at home if you have symptoms of dry cough, fever, tiredness, shortness of breath.  Covering the nose and mouth wearing hijab helps to protect yourself and others.
2. Take good care of yourself. Build your immune system by taking your Vitamin D, C, and Zinc.  Make sure you eat fruit and vegetables, and get plenty of rest.  Mental and emotional health matters, so tune into your feelings.  Start or continue exercises, like a 30 minute walk or dancing with your kids.  And lastly, reach out and tell someone when you cannot cope with stress and anxiety.
3. Seek medical care. If you have COVID early symptoms – dry cough, fever, tiredness, shortness of breath,(may include loss of appetite, smell or taste, sore throat, head or body aches) – get medical attention.  If interpreter services are not provided, please make a request.  You have the right to be understood in your language.

Remember, takawal A’ala allah – do your best and trust Allah.  Thank you!  Mahansanid!