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Running Head: WELL CHILD CARE FOR A REFUGEE SOMALI BANTU FAMILYWell Child Care for a Somali Bantu Family CommunityThis project consisted of the Somali Bantu refugees living in the Tennessee Village Community in Nashville, TN. Within this population set, the subset includes families with children aged 12 months and younger. It is estimated that 8-12,000 Somali Bantu will to arrive in the US in the 2003-2004 year (USDS:IIP, 2003). Of this 8-12,000 refugees, the students of Belmont University were able to interact with approximately 200 of them. Of these 200, about 1/2 have children under the age of 12 months. This is consistent with the findings of the International Organization for Migration, (IOM) which reports that there is a high birth rate experienced by the Bantu culture, with most married women either lactating or pregnant and that there is little concept of family planning (2003). Although members of the Somali Bantu culture come to America dealing with health problems like Tuberculosis, infection related to genital mutilation, HIV and syphilis; well baby care presents challenges for this culture as well. In fact, (50%) of newly arrived Somali Bantu children experience preventable injuries related to immunizations, safety, and hygiene which are effected by their cultural practices (Eno et al., 2002).
These are issues that need to be addressed in order to provide advancement in the quality of well baby care; care that is provided to the child who is without illness in order to prevent illness or maintain health. Within this first group of problems are those that related to increased risk for communicable diseases: o Lack of immunizations and knowledge deficit of the need for immunizations,o close living spaces,o lack of access to medical care,o a high incidence of Low Birth Weight infants, o poor nutritional status related to maternal nutritional status,o High Crude Birth Rates creating oversized families, ando Poor infant feeding practices. While these problems seem easily preventable within the framework of American society and values, many times, these are not available in Kakuma or other Somali Bantu camps. In addition, Americans have a more proactive approach in utilizing the above measure, while the Somali Bantu take a more reactive approach to health care (U of W, 2003). Immunizations that are available in the particular camp in Kenya mentioned in this article are OPV, oral polio vaccine and the MMR, measles, mumps and rubella. While all the vaccines that are required in the unites states would be necessary and are high on the list of what would be necessary in the camps in Kakuma, additionally the Hepatitis B vaccine would be a valuable asset to those living in close spaces (IRC, 2004). The second item in this group is close living spaces.
In both the refugee camps and in America, the large families are placed in small spaces and apartments. Close living spaces are a risk factor for both communicable and non-communicable diseases (AGDHA, 2004). In America, these small apartments provide more affordable housing which allows a refugee resettlement agency like Catholic Charities, to provide more help for more families and allows the refugee family a better chance to become self-sufficient. In the camps, there is limited access to medical care (IRC, 2004).This affects the health of the children who immigrate to America and creates a need for health assessments once the infants become American citizens. The infants born in America are affected differently by the limited access to medical care because of the public health facilities available in each county. Facilities like the Lentz Public Health Center Provide free access to basic well child check-ups and immunizations.
The fourth item of this group is the high incidence of Low Birth Weight (LBW) babies, which refers to the incidence of the birth of infants born less than 2.5 kilograms. In fact, (19%) of infants born since July of 2002 have been categorized as Low Birth Weight (U of W, 2003). Many of these babies have a poor chance for survival past infancy. The babies that do survive are almost always stunted for life and may experience complications from other congenital problems that are associated with children who are born with Low Birth Weights and malnourishment (U of W, 2003). In a class at Belmont University's School of Nursing, it was required that pairs of students each assess a Somali Bantu family for health and wellness. One of the findings from this class was that 100% of Somali Bantu children fell below the 3rd percentile on the Center for Disease Control's "Length-for-age and Weight-for-Age" chart, for infants up to 36 months old, and the "Stature-for-Age and Weight-for-Length" chart, for children between the ages of 2 - 20 years.
Women with poor nutritional status, who are admitted to the Supplementary Feeding Program; a program in the refugee camp in Kakuma which admits those underweight or severely malnourished, (62%) of the total admissions are those of pregnant or lactating mothers (1). There is a distinct connection between the LBW infants who survive and mature into stunted adolescent women, and the malnourished women who are giving birth to LBW babies. This cycle perpetuates itself and should be broken when these families relocate to America. There is also a High Crude Birth Rate that has been assessed at the camp in Kakuma. The numbers indicate that, between January and March of 2003, there were 368 babies born. There are approximately 3,000 women of child bearing age in this community and assuming that the rate of the first quarter had continued, it would have yielded a child born to almost half of the women who were of child bearing age (U of W, 2003). Poor infant feeding practices occur because of the multiple and frequent pregnancies of the Somali Bantu women.
Many times the infant, who may be malnourished from in-uteri, is weaned early, at 6 months, from the breast because of another pregnancy. This practice puts the child at risk for infection, malnutrition and dehydration. The most common causes of death in children below five years old are pneumonia (41%), malaria (24.5%), and watery diarrhea (16.9%) (U of W, 2003). Well child care can provide close monitoring of the child's growth patterns and rates and advice or counseling is available at pediatric offices. Because well baby care focuses primarily on the first year of life, it is important to note that supplementation of foods other than breast milk and cereal is unlikely in this cultural group. The second set of problems deals with safety in the home and in the community. Some problems that pertain to safety creating a Risk for Injury are:o Unfamiliar environment,o the lack of previous access to technological advances (Electricity, automobiles, modern appliances, etc.) ando the cultural outlook on childcare and oversized families creating a lack of supervision.The following is a statement taken from a Belmont University nursing student.
The excerpt describes some things that were assessed in the kitchen of a Somali Bantu apartment: "We were teaching her to cook in the oven because, up until we opened the door, she wasn't aware that the oven was anything more than the four burners. It was then that I observed the large, circular burn on the floor. When I pointed to the burn and looked at her, she smiled and said "too hot" and pointed at her pot with which she was currently cooking. This could have started a fire. I also noticed a can of bug spray on the floor right next to some food that had been opened-noodles and flour, some bananas - those types of things, It looked like she had just openly sprayed it on the floor next to the food - especially around the food. I wanted to tell her that it was not safe to have the bug spray on the floor nor was it safe to spray it near her food, but I didn't know how. I just took the can, held my stomach and made a sick face and pointed to the scull and crossbones on the back of the can.
I gave it to her and she immediately put it on top of her refrigerator. It was my evaluation that she got the point." Most Somali Bantu people have neither lived with electricity nor have they been exposed to other parts of western culture (Burgess, 2004). This means that there is no knowledge of how to use a light switch, a stove, a telephone or an electrical outlet. Furthermore, depending on the ages of the children in the household, someone may fall in a dark room, experience injury from a burn on the stove or a fire started by a misplaced hot cooking pot, choke on a telephone cord while curiously playing with it, or suffer electrocution from an electrical outlet while inserting a foreign object into it. Although most of them do not own cars, most of them of their children will either be in one or own one at some point. In Tennessee Village, where there were at least 10 Somali Bantu families, consisting of an average of 6 members, it was assessed that (90%) of them had used the bus. The last set of problems deals with hygiene which presents a Risk for Impaired Skin Integrity and Risk for Infection.
Contributing factors to this are:o Lack of previous access to hygiene and skin care products,o poor hygiene practices like the use of pit latrines and communal bathing, o lack of diaper and skin care knowledge and practices,o cultural practices like therapeutic burning creating a break in skin integrity, ando limited access to medical care. In the refugee camps, there is no access to Western methods of hygiene or skin care products. Communal bathing is an example of the type of hygiene control that is practiced in the camps. Many Somali Bantu have never seen a shower or a bathtub and have little concept of a faucet. Long lines for water and bathing, cholera warnings, and sharing water with cattle are common conditions at certain camps in Sudan (Oxfam, 2004). The Bantu use pit latrines for bowel and urinary needs.
They are unfamiliar with typical American bathroom facilities and common sanitation items such as diapers and feminine care products (Burgess, 2004). In the camps, diapers are not used and therefore diaper rash is not an issue of concern however, once the refugees are placed in America, they are provided with diapers and have little knowledge about their use and associated problems such as diaper rash and candidiasis. Therapeutic burning is a practice that is done among the Somali Bantu people. It is the process of burning the area that is afflicted, such as the chest area if there is a cough present, and burning the evil spirits out. These burns create a break in the first line of defense for the body; the skin; ....
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