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The Purnell Health model consists of four rings with the outer most ring representing the global society, the third ring represents the community, the second ring the family while the innermost ring represents the individual (Purnell and Paulanka, 1998). From the person ring there are twelve wedges that represent cultural concepts and domains. The focus of this paper is a description of two of these wedges (health care practices and health practitioners) with regard to a group of Somali immigrants.
Most African immigrants are very modest and private. It is necessary that care is taken that during procedures that require undress there is adequate explanation and only the area that requires examination is undressed (Pavlish, Noor and Brant, 2010).The notion of seeing a health practitioner for prevention purposes may not occur to a Somali. Since pregnancy is not an illness many Somali’s may not value antenatal care. Thus most Somali women may not attend all the necessary antenatal visits
Somalis from the city and those from the more rural areas have differing ideas about illness and disease. The ones from the city are more receptive to modern care while the ones from rural areas will be more receptive to traditional medical care. Additionally the ones from rural areas generally view illness as the inability to continue with one’s work. Thus they seek care rather late in biomedical illness. It is also easier for those who came from urban areas to make the transition to seeking medical care from hospitals and clinics as opposed to those who have come from rural areas as these may be less familiar with the medical care available in the city (Pavlish, Noor and Brant, 2010)
Generally home remedies are usually used first before outside medical help is sought. These remedies range from herbal preparations, over the counter prescriptions and massage. The use of herbal preparations is usually passed on in the family and in several cases some ingredients will be sent over from Somali to make the preparations. When a Somali decides that the illness warrants a visit to the doctor, the doctor will usually be a person who has been recommended by a friend or family member (Srivastava, 2007).
Some of the barriers to healthcare include different perceptions of illness. Legal issues also affect the healthcare seeking behavior of the immigrants as some of them who are in the country illegally will be reluctant to seek healthcare for fear that they will be deported (US Department of Health and Human Services, 2000). Additionally, some of them may not regard healthcare as a priority when they have to pay for it due to poverty.
Mental illness is not very well accepted in the Somali community thus their utilization of the mental health system is very low (Srivastava, 2007). A person who sees a psychiatrist may not believe he has been treated unless a physical exam was done. There are almost no reported cases of depression in the community. This could be due to the stigma attached to mental illness. Body organ donation and rehabilitation are not common practices among the Somali community.
Heath care practitioners
The Somali are more likely to seek health care from those health care practitioners that they have seen before. They at first try to seek out their own. Gender is an issue of concern when seeking healthcare. Often women will not allow a male health practitioner to examine them especially for reproductive health issues (Purnell and Paulanka,1998; Srivastava, 2007). The same applies to men. Medical practitioners are generally held in high esteem. Health care practitioners are usually sought depending on what the problem is, that is, a midwife will be sought for a pregnant mother. Ethnomedical care and magicoreligious healthcare practitioners are not very common now as there is a growing preference for biomedical care. The use of traditional birth attendants in their country of origin was very prevalent but is now changing.
Compliance with medical treatment is often dependent on the perceived severity that the patient has. Some illnesses are considered severe in themselves such as diabetes or cancer. If the doctor states that the condition is severe, then the patient will be more compliant with the course of treatment.