Section III - Horn of Africa (Somali, Sudanese, Ethiopian, Eritrean) and other African cultures

The countries in the Horn of Africa although culturally distinct, share beliefs of Islam and Christianity. Conjoined with these are pervasive traditional African beliefs and practices around health and illness, as well as colonial influences in each country. There is a proliferation of ethnicities across these countries as well as many tribal affiliations leading to markedly heterogeneous cultures. This makes generalising particularly difficult. Ethiopia, Eritrea and Sudan are part Islam and part Christian whilst Somalia is predominantly Muslim with strong clan affiliations. Islamic beliefs apply along with ethnic beliefs. (See Section I for Islam and disability).

The countries in the Horn of Africa all suffer extreme poverty and have been ravaged by war and famine for decades. Because of prolonged wars, landmines and violence there is a high incidence of disability. However, healthcare for these countries is a scarcity, with even less support for disability. Although in the larger cities there are hospitals offering regular biomedical services, there is little healthcare in rural areas and people may have great difficulty in accessing hospitals. Many of the services and resources that are available in New Zealand will be provided by health workers (e.g. nurses, birth attendants, traditional healers) in the communities in countries of origin and people are unlikely to be familiar with the concept of a family GP. As a result re-settled people from many parts of Africa may take time to familiarise themselves with the concept of rehabilitation, support from agencies and healthcare, and to be motivated to access these.

Engage a cultural support worker to link people to community elders and leaders, key resources and networks.

In much of Africa 'disability' is not a term used by people in communities. Different terms are used for types of impairment with some forms seen as illness, some as gifts (these people sometimes become the 'medicine wo/man' and seen as having special powers), and some as severe abnormalities for which each culture has its own explanations and strategies for coping. Many terms to describe disability and impairments are derogatory (mad, crazy, evil, stupid etc.) but as one woman pointed out to a researcher, although she didn't like them herself, they were the only terms available to her in her language (Shaw & Hughes, 2006).

Implications for practice

• Clients may not be familiar with an organised health system, about available assistance, or formalised appointments. Ask how they received care back 'home'. Explain:How the health system works in New Zealand;
• About appointments and appointment times;
• What health practitioners expect of them in the treatment relationship;
• How disability support and rehabilitation works;
• About technical assistance that is available.