Somalia is Not India: The Importance of Cultural Competency

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.