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Somalia is Not India: The Importance of Cultural Competency

Spirit Catches You

I have started reading the book The Spirit Catches You and You Fall Down, a story of a Hmong child and her encounters with the American medical system. As I read about the loyal social worker and her above and beyond commitment to Lia Lee’s family, I can’t help but think about my own experiences with a refugee.

For confidentiality reasons, I’ll call him Nadif, which means “between seasons” because in many ways, Nadif was always in a liminal stage. He escaped his war-torn country of Somalia through a sponsorship, along with his sister. Little is known about his mother and father — whenever I’ve asked him, he would go on a tangent about a blind man and suddenly start speaking both French and English.

Nadif was intelligent: he was trilingual (he spoke English, Somali, and French fluently), he had dreams of becoming a water engineer in Somalia and he followed American politics religiously (although he said he’d vote for Mitt Romney, not realizing what that means to the welfare he was receiving).

He became a client in our program sometime in the early 2000s, following a psychiatric hospitalization, aggressive behavior landing him in jail and then being diagnosed and put on psychiatric medications. Although he had been in the mental health system for several years, it wasn’t until he was transferred to my caseload that I realized he ought to be diagnosed with PTSD and not schizophrenia. I had no idea he was from Somalia until his green card fell out of his chart, with “country of origin: Somalia” written on it.

He had always been adamant about becoming a citizen. He knew the process full well, having applied and been waiting for someone to walk him through the process. His previous case manager, though both compassionate and sensitive to Nadif’s needs, wasn’t able to spend the time Nadif sought to reach this dream of his, hence transferring Nadif to my caseload. I decided that “taking medications regularly” wasn’t as big of a priority to us as “become an American citizen.”

Somali refugees source: http://www.unhcr.org

The mental health system has told Nadif repeatedly that he must take his medications and has gone as far as belittle him like a child for missing medications or refusing to take them. I don’t know about you, but I’ve never taken psychiatric medications and I know I would hate to take them since the list of side effects is endless. I don’t blame him for not wanting to take his medications, just like Lia Lee’s family struggled to find the benefits of giving their baby seizure medications.

I still remember someone in the office saying, about Nadif, “That Indian guy?” which really left me shaking my head. Nadif doesn’t even look Indian, on top of the fact that his last name is Arabic, which again is NOT INDIAN. How ignorant could we be to assume that he is something he was not! On top of that mishap, his chart indicated that he was Muslim; however, through my many conversations with Nadif, I discovered he attended church and had become Christian through the woman who sponsored him to the States. He talked about Jesus Christ with such awe, but often struggled with the thought that Jesus was white (don’t get me started) and equated his injustices with the fact that he himself is black.

My favorite memory with Nadif was after our gruesomely long process of getting him prepared for his citizenship test. With the help of a pro-bono attorney who specializes in assisting immigrants and refugees with obtaining their citizenship, we were able to get Nadif all the way up to his citizenship test. In that large and crowded waiting room, I sat with Nadif as he kept reading and re-reading his citizenship study packet (do you know who your senator is or what the Bill of Rights says? Nadif does).

He passed with flying colors and with the utmost confidence. We were told because of his criminal background (around the time of his first “psychotic” breakdown) that even though he passed, they would have to screen his results but that we should anticipate a notice in the mail for his oath ceremony. I am pretty sure I cried tears of joy. I know Nadif did. We walked out of that office and he tried to grab my cheeks, saying, “My little sister! Thank you! I love you!”

Because I had to leave my agency to focus on graduate school, I don’t know if he ever received his letter about his oath ceremony. Through my old coworkers, it sounds like he may not have and might be back at square one, struggling to get enough cash for cigarettes and sodas. I don’t know if maybe he was hospitalized again and quickly treated as yet another zombie, walking the halls of inpatient psychiatric care.

The lessons we learn from The Spirit Catches You and You Fall Down is applicable not just to doctors and social workers; as human beings, we need to constantly learn about other cultures and increase our cultural competency. I chose to not pressure him to “do as he’s told” and focus on his dreams and his goals. Why did he want to become an American citizen so bad when he already had a green card? Because he wanted to be able to vote, because he followed our political process so closely, because he didn’t want the threat of deportation looming over his head if ever he was found guilty of God-knows-what, because he was done with Africa and because he thought America was the land of opportunity.

Refugees are seeking refuge. Refuge is defined as a place of protection from danger, a shelter and a place of safety. I can’t say that Nadif felt any safer or protected from danger here in America. Granted, he has food and shelter and a bit of money thanks to welfare, but what baffles me the most is one of the last things Nadif said to me before I left the agency.

“I am going to go back to Africa. White man is god in America.”

My hope is this: that American institutions — schools, medical offices, mental health agencies, social service organizations, even coffee shops and retail stores — will be filled with much more culturally competent people, who seek to meet newcomers where they are at, be driven to understand where people come from, and be committed to embracing the diversity that makes up this country.

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136 thoughts on “Somalia is Not India: The Importance of Cultural Competency

  1. I haven’t read your blog in a while, but I saw this because I am subscribed to the email updates. This story is so deep, so painful. Father in heaven! May your kingdom come, your will be done! May we seek your kingdom and your righteousness with all our heart, soul, mind, and strength! How long will we wait for you?

    I truly am moved by this. Thank you for teaching us, opening our eyes and our hearts to have Christ’s compassion.

    • Thank you for reading and for sharing in his story! I think we all need to continue to expand our knowledge of other cultures and countries, breaking out of our American bubble! That is my challenge to you :)

  2. This was fascinating. Thank you!! Forgive me if you’ve shared this somewhere else in your blog, but what exactly do you? How did you get where you are? And what are you studying in graduate school? It just seems like you are doing incredible work, and I’d love to learn from your experiences. You can respond on here, or message me in the ‘ask me’ section of my own blog: http://www.wheninrishon.wordpress.com. Thanks a lot. Best of luck, and congrats on getting Freshly Pressed!

    • Hi Sam,
      Thank you for reading! During my time with Nadif, I was a case manager for a mental health outpatient clinic. My undergrad was in psychology, and I did some work in crisis intervention with Suicide Prevention for a bit. I’m currently studying social work in graduate school, aiming to get my LCSW. Thanks again for stopping by and I’ll definitely check out your blog!

  3. I really liked “The Spirit Catches You and You Fall Down”. I didn’t come away with the feeling that the US- institutions were right or that the family was right… it was really complicated. Nadif’s story is complicated as well. I flinched at your cowokers assumptions that he was Indian (dude, get the basics right). At the same time, you need to gather a lot of knowledge to really understand a culture. To what extent were Nadif’s traits cultural, to what extent were they personal? You knew him well, but I’m sure there was a limit to what you knew about Somalia yourself. I definitely agree with your point, but I think that cross-cultural competency is a much harder skill than we think.

    • I agree! I felt as if I didn’t understand enough about Nadif’s past or even what was going on in Somalia. I happened to be reading a great book for school during that time called “What is the What” by Dave Eggers, following the Lost Boys of Sudan. It was my only window into the life of a refugee at the time but again, Sudan is not Somalia either :) And so much of Nadif’s experience is a mix of both personal and cultural! Thank you again for reading my post!

  4. Poor addicts and submissive, the psycho-political slaves …

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    But it is interesting to see how many behaviors, whether councilors, ex-councilors, secretaries (political office) and allies, end up being similar to that of gambling addicts.

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    To create a bond of affection, with MACHINE, and when the affection weakens, moving to a kind of …

    continues in: http://wp.me/p1iO2Q-DA

  5. Your post was very touching and heartfelt and I agree that we cannot assume that we know it all and that our way is best. Our cultural and personal backgrounds feed our perceptions of others and that in itself causes misunderstandings and unneeded suffering. I think the need is more universal in that we all should treat others with respect and kindness, no matter how they look, act or speak or where they were born. We have so much to learn from each other. Don’t give up in frustration. One pebble in a pond can make a lot of ripples which travel far. Thank you for a thoughtful post.

  6. You write with such honesty & eloquence. Thank you for sharing his story, your story… Ultimately, it is our story. We are all connected – whether we choose to acknowledge it or not. It’s what Thich Nhat Hanh often speaks about, interbeing. I am now following your blog. Again, thank you. We must continue shining a light in the darkness.
    Live In Color – E

  7. Despite all the indignities, misadventures, and misunderstandings, Nadif still felt that being in the US was a gift. We here so often take our blessings for granted. Thank you for reaching out, one person to another.

  8. Thank you so much for sharing this. When my son gets all steamed because he has to play his Xbox upstairs because I want to watch the Big Screen TV, I have a WONDERFUL story to share with him to shame him for not being ungrateful and spoiled. I’m sure he never thinks about how fortunate that he, my son, Max, is to live with his MOTHER and stepfather who love him very much and always try to do best by him in a country where genocide and war have not touched its citizens. Max grew up being able to visit his father whenever he wanted before he passed away when Max was 13. It sounds as though Nadif doesn’t even know if his parents are alive or dead because he has no communication with them. And this child was basically taken in by strangers and would probably laugh his derriere off if he could hear some of the trivial and unimportant things that Max and many Americans complain about while Nadif seems to be thriving in impossible and painful odds! And he has such incredible goals! Nadif should be an inspiration to us all!

    Thank you, again, and I look forward to hearing more about Nadif! :)
    TB

    • Thank you so much for reading and glad that Nadif’s story can hopefully inspire your son to think outside the box…and the X-box ;)

  9. I’m an Esl teacher (a frustrated ESL teacher). I pursued English education to assist refugees, but haven’t been able to find a position yet. Instead I’ve only found jobs in higher education which caters to a mostly spoiled, rich, young adult clientele. Thank you for reminding me why I got into English education.

    • Thank you for reading this blog! I hope to continue to pursue what you were passionate about; being an ESL teacher is so great because instead of traveling the world to meet so many different people, the world comes to you in your classroom. Kudos!

  10. Your experience w Nadif is so heartfelt. I hope that people come to realize that mental health is one aspect of our overall health which should be respected like any other. May people be compassionate if they work in the psychiatric field and only be hired if they genuinely care about others who have meltdowns. In an entire person’s lifetime, there is bound to be period in one’s life with stress which can break us, no matter how successful or not we are. Failure just like success are lessons in life for becoming enlightened, if the people who surround us when these setbacks occur show sacred love and compassion.

    i am so happy that you suggested PTSD as years back Schizophrenia was more diagnosed and perhaps misdiagnosed in some cases. These diagnoses only serve to help doctors to better find treatment alternatives and therapy correctly designed for the suffering individual with medication if really needed. Other than that, the diagnosis are like death sentences…until people learn to not ascribe a disease to the entire aspect of a person.

    May you be blessed in your service towards humanity as the great deeds you do build wonderful karma for you! G-d bless you.

    i plan to buy this book. i have been very interested in the Hmong culture. Have you published any books?

    ssb

    • Thank you for reading this post! Luckily I worked for an agency whose philosophy was that their diagnosis is not their destination; unfortunately, not all mental health institutions operate that way. I have not published any books, but it definitely a goal of mine one day!

  11. Reblogged this on Kevin Brooks and commented:
    Refugees often go from “fire to fire:” displaced from their war-torn homes, stuck in dangerous refugee camps until they are resettled (very few), return home, or die. Coming to America, Canada, Australia, Norway, etc., leads to its own set of complications and dangers, as told here and it the book I will have to read.

  12. I am a nurse with a background in social work. The fact that you were able to meet your client where he was and to see him for who he was, simply because you didn’t pigeon hole him rings true for me in both practices, as does losing track (for lack of a better expression) of a patient or client because you had to move on professionally. Great post.

  13. Wonderful article…it is really touching, and you have explained such complex things in such a clear, simple way… I cannot help but sigh at this; in a way I can totally relate to it as I have met people in the States and elsewhere who have absolutely no clue about other cultures and people, and at the same time, I know people like you who are sensitive enough to realize that these ‘small’ things can actually be significantly affecting lives different from our own. Truly amazing article…it made my day.

  14. When I read, “The Spirit Catches You and You Fall Down” in an anthropology class I almost immediately wanted to become a medical anthropologist. What a brilliant book and I loved your blog post. It gave me goosebumps

  15. Thanks for this beautiful post. I’m fortunate enough to work and live in a very diverse community and yet I constantly need to be mindful of an undercurrent of those little inbuilt assumptions in responding to the real needs and aspirations of others.

  16. What a sad and touching story. How sad that he returned to his country but even sadder that he couldn’t find a home there in the States- that despite the ‘freedoms’ we have in the West, he still didn’t feel free. I do hope he finds what he’s looking for…

    • Thanks for reading! He is, fortunately, still in the States and I don’t know how much closer to his dreams he is, but definitely closer to them here than he would back in Somalia.

  17. A book rec: The Pirates of Somalia. It’s really quite good for giving insight into how much local culture are even cultural problems impact issues that the US wants to deal with abroad.

  18. Fadiman’s book is a wonderful read. I learned so much from it. You might also enjoy Shirley Brice Heath’s book Ways with Words. It was an eye-opening ethnography about the far-reaching effects of cultural differences and how they impact communication.

    Great post!

    • Thank you for reading this post! I’ll definitely add that book to my list! I’m currently taking an international social work course in my master’s program and gladly welcome more books in this area!

  19. Absolutely! I worked to help Somalian refugees the past year. They are some of the best people I know and treated like they are invisible. I think Americans could learn more about other countries, earlier. I remember learning about pilgrims and “Indians” and forefathers again and again. I didn’t learn a drop of world history until I was much older.

  20. Such a great book. Really had a profound impact on the way I viewed my work with tibetan refugees. One of the reasons American’s in general have such a difficult time understanding or being sympathetic to others cultures, is that os few of us travel outside of the U.S. Only 37% of Americans have passports, and we rarely have enough vacation time to devote to foreign travel that would allow us to immerse in a culture not our own.
    A sad fact for a country built by immigrants…

    tibetstruth.com

  21. This is such an important post. Thank you for writing it. I read The Spirit Catches You some time ago, and it created a permanent place in my brain. I still think of it often. Another book that affected me this way was What is the What by Achek Deng, one of the Lost Boys of the Sudan.

    • Thank you for reading this post! I also read “What is the What” for one of my classes, around the same time I was working with Nadif. It was definitely reading that book that helped me look at Nadif with a new pair of eyes.

  22. I read “The Spirit Catches You and You Fall Down” a few years ago and it was so moving. It was one of the books I read that made me want to study psychology and particularly peaked my interest in international and cross-cultural mental health issues. I also did volunteer work with African refugees through a student group at my former university. What these people have been through is mind boggling and their struggles don’t end once they get to a new country – they just face a different set of problems with little resources or support. This population is virtually invisible and most Americans are unaware of the challenges they face. Most of the people I talked to in my hometown didn’t even know there was a newly arrived refugee population in their city. And cultural sensitivity? Sadly, it’s a rare thing to find in the US – the general consensus seems to be that refugees should assimilate completely when integration into the dominant culture would be more beneficial for both the immigrants and society as a whole. However, most people don’t even know the difference between assimilation and integration. Nothing will change until more Americans take an interest in social issues and stop being elitist about culture.

    • Such true words! Thank you for reading this blog post! The stories of some of my encounters with cultural ignorance would break your heart…

  23. what you wrote is right, it is wise and sweet.
    The important thing is that you say it again and again.
    I live in Italy, a nation that knows the value of different cultures but now is forgetting.
    and I’m really sad.
    Anyway……è stato un piacere leggere il tuo post.
    Buona giornata a te!

  24. I loved this.
    Cultural ignorance always amazes me, but I suppose I am lucky in that first of, world wide news is available at the click of a button or on TV…and London is one of the most cosmopolitan cities in the world.
    Your blog post was wise and sensitive. Nice :)

    • Thank you for reading this blog post! We are fortunate to be able to learn about other cultures so easily…the question is whether we choose to!

  25. Congratulations on being Freshly Pressed! I read the book as part of my graduate school curriculum and was fascinated. Thank you for bringing Nadif’s story to us, which you write so eloquently.

  26. thanks so much for sharing…in a lot of ways, its also nice that you shared that you aren’t sure how things have turned out and its likely that Nadif still has not gained citizenship as its much more “real” than a story with a perfectly neat ending. cultural dynamics are complicated and complex, and the realities of american citizenship and the american dream can be very sadly intangible for some. cultural competency is indeed crucial to better understanding ourselves and appreciating and loving others, and its always important to remember that the world is composed of a lot of shades of gray, not black and white, neat boundaries. thanks again for sharing!

    • Thanks again for reading! Although my chapter with Nadif has ended, I am hopeful that someone somewhere will eventually help him get where he wishes to be. :)

  27. Pingback: Educating students to be global citizens « Loving Language

  28. Great post. As a high school teacher, I try to emphasise the importance of cultural and global awareness. My opinion is that racism and ignorance is rife in Australia and whenever I express defensive opinion or take offence, I get asked ‘why do you care? You’re not black/Muslim/Aboriginal/gay…’ Frustrating.

    • Thanks for reading and for educating young minds! I have yet to visit Australia (I will be there end of this year!) and I agree that racism is still very real all around the world.

  29. Thank you for a great post.
    I’m currently teaching hilltribe kids English in Thailand. The educational and health impediments that so many of these kids face as a result of statelessness is infuriating.
    I’m only 20 and probably really naive, but feel free to follow my blog. If you have the time to offer me advice from time to time, I’d be humbled.

    • Thanks for reading! I spent a summer in Chiang Mai and we visited a hilltribe village during my time there as well. Where in Thailand are you currently?

      Thank you for what you are doing in Thailand! I will definitely have to follow your blog.

      • I’ve spent about 5 weeks all up in Chiang Rai, primarily with Akha and Karen, and now I’m in Sansai, just out of Chiang Mai at an orphanage. I’ve been here for four weeks and have another two to go before I return to Chiang Rai for one last week this holiday.

        It’s good to hear someone else knows about the hilltribes!

  30. Intercultural competency is so important, especially for professionals. As a social work, I have often been shocked how ignorant and incompetent people can be. If you don’t know, you should at least be willing to learn!

  31. Very true, the wounded or the refugees would respond much better to a helper who is culturally prepared and sensitive to their need as it creates an initial bond between them. Very good writing.

  32. Kinda strange I ran into this blog, Im publishing the Ambassador of Somalia to Switzerland and Canada’s Biography right now on my Blog, The situation there is so far worse than people know. Such a sad situation. Nice post !!

  33. Thank you for sharing! I am majoring in nonprofit human services and international relations, and this article really spoke to me. So many people are lumped together with characteristics that don’t fit them, just because they may be different from the stereotypical American. I’m always glad to see someone who is open minded, passionate, and articulate.

    • Thank you for reading and I wish you the best in what you are studying! We need more people working in this field :)

  34. That’s awful that he was diagnosed as schizophrenic, when he really probably just had PTSD! I feel that people are so ready to slap a label on things here, regardless if the person is really schizo (or has ADD or is depressed). The comment about him being Indian is also awful–and I’ve had a coworker once refer to a blatantly Indian guest (his accent was a giveaway) as a terrorist. I was like what??? Why Americans can’t get the grasp of international relations-not just pointing a gun at someone, as is the ahem American way-is beyond me. Kudos to a great post!

  35. Thank you for your heartfelt acount which gives voice to so many,many similar stories out there. My blog has pictures of refugees seeking solace in my community. So many similar stories. Thank you for your kind service to human kind. -renee

    • Awesome that they are reading it in high school! I didn’t get to it until graduate school! Great read and thanks for reading my blog!

  36. It does not stop there, there are myths about how people should be perceived as well. In your example, I find people don’t generally explore other peoples cultures, and don’t care to.

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