Sudan

In general, healthcare in Sudan is very limited. Wars in the South have almost obliterated health services outside urban centres, and in the North economic drain has diminished these. In 2008 although a Disability Act was passed by the National Council there remains a lack of legislation to cater for the interest of the disabled and most of this population are marginalised.

Attitudes to disability

As with other countries in the Horn of Africa region, cultural traditions and religious attitudes determine how people with disability are regarded. A sizeable majority of the population (70%) is Muslim, only 5% Christian, and about 25% of people follow traditional beliefs including tribal and animist religions.

There is general stigmatisation particularly about mental health and intellectual impairments. Mental health is impacted by the prevalence of armed forces.

In both the Southern Christian communities and Northern Muslim ones disability and mental illness is generally considered to be the responsibility of the family, and the community are expected to support the family. Those who are mentally ill typically remain in the community if they are considered harmless, otherwise they may be taken to a mental hospital in the cities or a jail if a hospital is not available.

Implications for practice

Differences in treatment of mental illness, and disability in general will need careful explanation and a cultural case worker will be helpful in this regard.

Beliefs about causes

There is limited literature on beliefs about disability in Sudan. However, general Islamic and Christian attitudes apply as well as beliefs in witchcraft (including spells and curses), evil eye, and actions of the mother during pregnancy in creating a disability (and resulting in blame). Beliefs in spirit possession proliferate although different tribes have different beliefs about which spirits and the importance of possession. Some believe that jinn cause epilepsy, madness and paralysis. Others refute these.

An important difference about Sudanese and other people from the Horn of Africa is that more resettled Sudanese are likely to speak English; it is the official language of education in the Christian South from where most of the refugees coming to New Zealand originate. English language proficiency should not however be mistaken for familiarity with the NZ health system, nor with medical terminology.

Because of such variation in beliefs and practices, it is imperative to ascertain from each family their understanding of disability, its causes and their expectations for treatment. It is likely that they will need information on New Zealand healthcare approach and services.