Social structure
Ethiopia is a nation of many ethnic groups and religions
with strong cultural similarities, but political and language differences. The
Oromo people represent 40 percent of the Ethiopian population and the Amhara
people represent 25 percent of the population. In U.S. communities, the Oromo,
Amhara, and other Ethiopian ethnic groups live and work together, although each
group speaks its own language and relationships are often strained because of a
long history of political differences. Most young people in the United States
speak English.
Ethiopians tend to speak softy and politely. Bowing and
offering a polite greeting using the formal title of Mr., Mrs., or Miss is
appropriate for elders and authority figures. Hugging, kissing cheeks, and
touching are acceptable forms of greeting among family and friends. Modesty is
especially important to Ethiopian immigrants—matching the gender of a patient
with that of the provider and interpreter can address this issue.
Unlike Western society, Ethiopians do not have family names.
A person’s first name is their given name; the second name is the father’s
given name.
Diet
Ethiopians place high importance on cleanliness and in
eating and drinking moderately to stay healthy. The Ethiopian diet includes
various meats with different types of spicy sauce, peas, lentils, cabbage, and
green beans—all eaten with injera, a pancake like bread made of teff grain.
Injera is a major food staple, and provides approximately two-thirds of the
diet in Ethiopia. Teff contains high levels of calcium, phosphorous, iron,
copper, aluminum, barium, and thiamine.
Religion often dictates nutritional habits. Ethiopian
Orthodox Christians do not eat meat, eggs, or dairy products on Wednesdays and
Fridays, and fast on a number of occasions, including 55 days at Easter.
Religion
Nearly half of the population in Ethiopia is Muslim, and
half Christian, with Ethiopian Coptic Orthodox accounting for most Christians.
Christian churches in Minnesota that offer services for Ethiopian immigrants,
include the Minnesota Ethiopian Evangelical Church in St. Paul, and the Bethany
Lutheran Church and Ethiopian Orthodox Church in Minneapolis.
Medical care
The health care system of Ethiopia is among the least
developed in sub-Saharan Africa, with lack of access to basic health care
facilities in rural areas. With widespread poverty, poor nutrition, low
education levels, poor access to health services, and an increase in HIV
infection rates, the current life expectancy of 54 years is expected to decline
to 46 years in the near future. The median age in Ethiopia is currently 16.9
years.
Malnutrition and vaccine-preventable diseases, including
tuberculosis, diphtheria, whooping cough, tetanus, polio, measles, hepatitis B,
and cervical cancer are widespread.
Common health issues for Ethiopian immigrants in the U.S.
are the long-term effects of malnutrition, physical and psychological trauma
from war, and infectious diseases, including sexually transmitted infections.
Changes in lifestyle and diet in the U.S. have brought western diseases, such
as diabetes, hypertension, and high cholesterol to this population. A common
belief among Ethiopians is that well being is based on a balance of spiritual,
physical, social, and environmental forces. Illness can be attributed to God,
destiny, nature, demonic spirits, emotional stress, or a breach of social
taboos or vows. Ethiopian medicine relies heavily on magical and supernatural
beliefs, such as the belief that miscarriages are the result of demonic
spirits. Mental illness and some physical illnesses, such as epilepsy, are
commonly attributed to evil spirits—with the view that these types of illnesses
are a stigma. Many families do not disclose information to the community about
family members with such illnesses for fear of being shunned. Men and women
avoid marrying into families with members who are mentally ill or have other
disabilities, and they generally resist psychiatric treatment for themselves
and other family members.
Ethiopians often use home-based therapies and herbal
remedies to heal common ailments. They may use healing ingredients from
animals, minerals, and plants, such as eucalyptus leaves, oil seeds, and
spices.
Providers should be explicit about the importance of
completing a full course of antibiotics and explain conditions such as diabetes
and hypertension. Patients may question illnesses with no apparent symptoms. Patients
should be reminded not to double or triple dose if they miss a medication. This
is especially important because many Ethiopians frequently fast for religious
reasons and may not take their medications during these times.
Family members usually attend to the needs of the sick. They
can overindulge the patient—rather than encourageing self care and attempts at
recovery. Providers need to encourage movement, rehabilitation, and self care
to stimulate recovery from an illness or surgery. Trust is important in the
patient-provider relationship. Some patients may fear surgery and the process
of blood donation, and require additional information and reassurance.
End of life
End of life in the Ethiopian community is marked by
religious traditions, rituals, prayers, and gatherings. A religious person may
be called to administer a sacrament to the patient. After a person dies,
Ethiopian men may cry out loud and grow a beard as a sign of respect. Some
women may wear black for at least a year and shave their heads or cut their
hair very short. Women often cry uncontrollably, tear their clothes, and beat
their chests.
Autopsy, organ donation, and cremation are generally
unacceptable within this population.
Culture in context
Culture is essential in assessing a person’s health and
well-being. Understanding a patient’s practice of cultural norms can allow
providers to quickly build rapport and ensure effective patient-provider
communication. Efforts to reduce health disparities must be holistic,
addressing the physical, emotional, and spiritual health of individuals and
families. Also important is making connections with community members and
recognizing conditions in the community.
Get to know your patients on an individual level. Not all
patients from diverse populations conform to commonly known culture-specific
behaviors, beliefs, and actions. Generalizations in this material may not apply
to your patients.
Source: www.stratishealth.org
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