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Doctor seeks to ease vaccine fears in Somali-American community amid Minnesota measles outbreak

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Weeks into Minneapolis’ worst measles outbreak in more than 25 years, public health experts are still struggling to get some families in the Somali community to vaccinate their children.

Currently, 51 people have been infected with measles in Minnesota, 46 of whom are Somali-Americans. For years, public health officials have been trying to increase the vaccination rates in the Somali community, which dropped precipitously in the mid 2000’s over fears about the now-debunked theory that vaccines were linked with autism.

In 2008, the Minnesota Department of Health found that Somali children in Minneapolis were more likely to take part in services for autistic children, although it was unclear if that was because more children in the community had the disorder or because there was better outreach to the community.

Amira Hassan, of Burnsville, Minn., plays in the waiting room at the specialty clinic at Children’s Minnesota in Minneapolis, May 2, 2017.more +
Dr. Mahab Ururshe, a pediatrician at Park Nicollet Methodist Hospital in St. Louis Park, Minnesota, is originally from Somalia and says he still sees many parents afraid of vaccines, even though numerous studies have shown no link between autism and vaccines.
The parents say, “I know measles, I have had it and my mom had it — better to have measles than autism,” Ururshe told ABC News.

In order to convince some parents that vaccines are safe, Ururshe has spent long periods of time explaining that studies have found no link between vaccines and autism. He also has to point out that the disease can be deadly and that, in Somalia, there was no accurate data compiled about measles complications.

Severe complications from measles include pneumonia and inflammation of the brain and a condition called subacute sclerosing panencephalitis (SSPE) that is fatal and more common in infants, according to the Infectious Diseases Society of America.

The U.S. Centers for Disease Control and Prevention (CDC) estimates one to two of every 1,000 infected children dies from the disease.

Ururshe also tells parents that despite dramatically lowered rates of vaccination in the Somali community in recent years, rates of autism have continued to rise. While parents often believe him, Ururshe said some remain too frightened to act.

“They say ‘OK, I know they think it doesn’t cause it,'” Ururshe recalled. “[But] I cannot gamble on my son or daughter.'”

While the overall vaccination compliance rate for Minnesota kindergartners is around 90 percent, it is only about 40 percent in the Somali community, according to Kris Ehresmann, director for infectious disease at the Minnesota Department of Health. Ehresmann said with such low levels of vaccination, public health officials have been worried about an outbreak for some time.

“We’ve known it’s going to be a matter of time before something happens,” she told ABC News in an earlier interview.

Ururshe said he’s seen more and more parents are coming in, asking for their children to be vaccinated. Some other parents come in worried, but are willing to consider vaccination.

That last group “is undecided and confused” Ururshe said, explaining that some parents waffle between accepting the vaccine and fearing it.

“They decide to come in the morning and in the morning they’ve changed their minds,” he said.

Ururshe said it’s an asset to be from Somalia when talking to these patients, since he understands the culture and language. When some parents argue that autism only happened when they arrived in the U.S., Urushe has answered that there wasn’t a vocabulary to identify the same condition in Somalia.

“There is more trust between the parents and a Somali-speaking or Somali doctor than non-Somalis,” he said. “They say ‘OK, I trust you, should I give my son or daughter [the vaccine]?”

At least 11 patients have been hospitalized during this most recent outbreak, which is the largest since 1991. The measles virus is spread through infected mucus and is often transmitted to others through coughing or sneezing, but can also live in infected airspace for up to 2 hours, according to the CDC. It is a highly contagious diseases, able to infect 90 percent of unimmunized people who are exposed to it, the agency says.

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Somali woman researches health risks of skin-lightening practices

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Ibrahim Hirsi

For some Somali women, having lighter skin tone is the ultimate beauty goal and they use skin products containing dangerous chemicals to reach that goal, according to a new University of Minnesota study.

“To be a beautiful Somali woman, one has to have lighter skin color,” Amira Adawe, co-author of “Skin-Lightening Practices and Mercury Exposure in the Somali Community,” said in a recent interview describing the attitude of some women.

Several Somali women who were interviewed for the study published in July said they mix products that include lemon herbal whitening cream, lulanjina, diana and dermovate — some of which have mercury, a poison that can damage the nervous system, according to the study.

“These chemicals are proven neurotoxins and have been linked to birth defects if used by women during the prenatal period,” stated the study. “Inorganic mercury exposure is associated with rashes, skin discoloration, scaring, secondary bacterial and fungal infections, and even renal impairment and damage to the nervous system.”

The study added: “It should also be noted that mercury … can be transferred from mother to infant through breast milk.”

The Minnesota Department of Health recently tested 27 bleaching products, 23 creams and four soaps. The department found that 11 products contained mercury levels ranging from 135 to 33,000 parts per million. “This has prompted both state and federal health officials to issue warnings about the use of these products,” according to the study.

Although Minnesota law bans beauty products that contain mercury, the study said that immigrants have been smuggling the cosmetics from Latin America, Asia, the Middle East and Africa. The products are then secretly sold in Twin Cities-area stories.

“This is not practiced by only Somali women,” said Adawe, a health educator at St. Paul-Ramsey County Department of Public Health. “It’s widely used by Hispanics, Asians and African-Americans.”

Skin-lightening practices

There are various reasons some Somali women rub their body twice a day with skin-bleaching substances, the study stated. Some of them use the chemicals to get rid of the facial masks of pregnancy, which are pigments women develop during pregnancy.

These pigments often appear on cheekbones, forehead, nose, forearms and other parts of the body that are exposed to the sun. Women with darker skin are more prone to skin pigmentation than those with fair skin tone, health reports suggest.

The study indicated that women also use skin-lightening products to attract men. “They see having light skin as more socially acceptable and believe it will increase their chances of finding a husband,” according to the study.

Adawe, who was born in Somalia, said she knows many Somali women who use the products. “You can tell who uses it and who doesn’t,” she said. “You can’t mistake it with naturally light-skin people. These creams give people more of yellowish color.”

Adawe said the women who use the products often aren’t open about the practice. “Actually, they’ll deny when you ask them,” she said.

How study began

Growing up in Mogadishu and in Minneapolis, Adawe said she encountered many women who regularly used the skin-lightening products. She said became involved in the study a few years ago after coming across an article about bleaching cosmetics that reportedly contained mercury. Adawe said he began to worry about the health of women she knew who used these products, so she started investigating the issue in 2011.

After several interviews with Somali women in the Twin Cities, Adawe learned that some of the women used products containing mercury. Adawe then took her findings to officials at the St. Paul and Ramsey County health department. Soon after, the FBI raided stores in Minneapolis and found Minnesota-banned skin-lightening products and took action against owners, said Adawe, a public health graduate student at the University of Minnesota.

Adawe’s investigation prompted the study, thanks in part to her professor and mentor, Charles Oberg, who co-authored the research paper.

Public awareness efforts

Adawe’s is working to tell others about the dangers of skin-lightening practices by speaking out at community and educational forums, appearing on radio and television shows, and meeting with leaders and activists of the Somali community.

Adawe also engages in conversations with 244 members of the Somali community on a Facebook page she created named “Skin-lightening practices & chemical exposure among Somali women.”

Members share articles, videos and studies about the risks of skin-lightening practices, and they discuss ways they can help limit such practices.

On June 11, Adawe posted on the page: “To those of you who are scholars or know the Islamic religion well, can you please educate us about what Islam says about skin-lightening practices?”

Awil Egal, a group member, replied: “Islam has forbidden men or women to change the creation of Allah: Skin color, hair color and the likes. ”

Egal added: “Using cosmetics, creams and other things that are made from chemicals or impure substances and which may have dangerous side effects is definitely haram [forbidden]. It is also another form of deceiving that can create mistrust between people.”

Other members wrote simple lines of encouragement. Khadijo Abdi, for instance, posted: “Beautiful people, leave your skin as God intended!”

Adawe is optimistic the Somali community will understand the risks of the chemicals. And with social media, she said, she’s even more hopeful that the people will be informed faster.

“Everybody is on Facebook and Twitter these days,” Adawe said. “Social media is a great tool to use for spreading awareness on issues like this one.”

Adawe said there are significant numbers of Somali women satisfied with their natural skin tone and don’t consider using the skin products.

“It all depends on their confidence and level of education,” Adawe said. “Uneducated people tend to use these products more often.”

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Somalia, UN seek to vaccinate over 700,000 children against polio

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XINHUA — Somalia’s health ministry and two United Nations agencies on Sunday launched a three-day oral polio vaccination campaign, targeting 726,699 children under five years of age in two districts.

A joint statement issued in Mogadishu said the campaign backed by the World Health Organization (WHO) and UNICEF is taking place in Banadir and Lower and Middle Shabelle regions.

Ghulam Popal, WHO Representative for Somalia said the campaign will be conducted in two rounds through house-to-house visits by vaccination teams, noting that no cases of polio have been detected in Somalia since August 2014.

“However, as a preventative measure; it is imperative that all children under five years of age in targeted locations, whether previously immunized or not, receive two drops of oral polio vaccine,” Popal said.

Banadir region reported the highest number of wild poliovirus cases in Somalia (72 out of 199) during the Horn of Africa outbreak in 2013-2014.

“We urge all families to get their children vaccinated to protect them against this dangerous disease,” he added.

The UN health agencies said the first and second round will involve the use of oral polio vaccine for children under five years of age.

Inactivated polio vaccine (IPV) will be used in the third round to boost immunity among children between 2 and 23 months of age.

According to the UN, conflict and insecurity in South and Central Somalia especially has continued to hinder access to children during polio immunization campaigns in 2017, with about 240,000 children under five years of age reported as not accessible for more than a year.

“This campaign has been carefully planned to make sure that all children in the chosen areas, particularly those who have been missed in previous vaccination campaigns, are reached this time,” said UNICEF Somalia Representative Steven Lauwerier.

The UN agencies said over 4,400 vaccinators and monitors, and around 800,000 doses of vaccine have been mobilized to conduct the activity.

The Horn of Africa nation has been polio free since August 2014, when the last case of polio was reported from Hobyo district of Mudug region.

The declaration by WHO two years ago keeps Somalia outside the last group of countries which still record cased of polio in the world.

WHO has however warned Somalia remains at risk of importation of the virus from these countries.

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Can your blood not be moved for Somalia?

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On Oct. 14, I was participating in “Somali Studies in Canada: Resilience and Resistance,” a multidisciplinary colloquium held at Carleton University.

It was the first of its kind in Canada, and more than 50 brilliant, bright and eager academics, artists, frontline workers, and grassroots activists from Ontario and Quebec gathered to discuss the Somali diaspora’s resilience and resistance over the past 30 years in Canada.

But that was abruptly interrupted as attendees began to hear news of a massive explosion in Mogadishu, Somalia. Two hundred casualties were immediately reported; in just a few hours, more than 300 people were believed to be dead. It is being described as the deadliest attack to take place in the region.

Just two weeks later, on Oct. 28, a car bomb detonated in front of a busy hotel and restaurant as gunmen took hostages inside; later that day, a vehicle carrying government troops triggered a roadside bomb planted by the militant group al-Shabaab. In the end, at least 23 people were declared dead in Mogadishu.

For those of us in Canada who arrived in the early 1990s and who left family and people behind, stories of death and violence have become achingly familiar.

Families that have made difficult decisions to leave loved ones and a homeland behind are constantly forced to relive them in the immediate moments after horrific events have taken place.
It felt like I had barely been given a moment to breathe before I began to call family members and friends to make sure everyone was accounted for. This in-between place—of frantic calls, racing hearts, guilt for the relief that everyone is just fine, frustration, anger and fatigue—was eerily familiar.

Since the explosion, the question at the top of the general public’s mind is: “will your community mobilize?”

To me, the question isn’t worth asking. Over the summer, thousands in Somalia were displaced and put at risk of starvation due to a rapidly escalating drought. According to the UN Office for the Coordination of Humanitarian Affairs, Somalia is facing a humanitarian crisis and is at risk of a severe famine—all of this coming just six years after the last deadly drought.

They note that between November 2016 and May 2017, an estimated 739,000 people were displaced by the drought; more than 480,000 of the displaced, or 65 per cent, are younger than 18.

Shortly after learning this information, a vast majority of the Somalis I knew in Canada mobilized. Elders added extra remittance payments to their monthly spends; young people coordinated events and fundraised money. Even those who could not give money retweeted, shared statuses and ensured the public was aware of the dangerous situation Somalia was in. Young Somalis became #FamineResistors with many in our city doing the work to garner attention, collect donations and forward to the appropriate hands in Somalia.

The question, then, is not whether we will mobilize. The question is: will you?

On Oct. 8, just six days before the horror in Mogadishu, 16-year-old Zakariye Ali was killed in a Toronto junior high school parking lot; three days before that, 29-year-old Abdulkadir Bihi was shot to death in Etobicoke: Allahu naxariisto. Mustafa Mattan, 28, was fatally shot through the door of his apartment building on Feb. 9, 2015; no killer has been apprehended.

He is just one of at least 100 young Somali men between Toronto and Alberta whose deaths continue to go unsolved by local police despite active work by community members and agencies such as Positive Change that have worked to address the lack of information provided by RCMP and other authorities. Somalis continue to be deported by the Canadian government by Immigration Minister Ahmed Hussen. Despite Hussen’s identification as Somali, it’s important to remember that representation does not always mean we are allowed to stay.

On top of this, Somalis continue to face negative media depictions that work to present the general public with correlations to terrorism, piracy, and gangsters. Media narratives like Vice’s documentary This is Dixon and the now-discontinued CBC drama Shoot the Messenger which looked to fictionalize the Rob Ford crack scandal.

This scandal saw “Project Traveller” come to a head in June 2013 when police stormed an apartment building on Dixon Road in pre-dawn raids that resulted in more than 60 arrests of primarily young Somali men. When the Canadian public and media only know us through the analysis of violence and terror—a characterization all too frequently and easily deployed—there is only attention granted to us in our deaths.
Why do you only want us when we are dead?

In early October 2017, our mothers cried on camera for the kids they raise here. In July 2017, they wept while they watched Abdirahman Abdi be brutally murdered by police. This week, they weep silently for the family they have lost back home. This middle place they’ve come to reminds them they are not wanted—and still, all everyone offers is prayer.
What happens when the prayers are not enough?

After every death, every drought, every instance of violence, I am hard-pressed to feel grateful that Somalis are granted prayers. We did not get here all by ourselves. We get up and face the onslaught: “Your community again? But how are you feeling?” The answer does not change, and the emotions are the same each time: grief, relief guilt, fatigue, rage, frustration.

We will pray for Somalia, politicians tell us; we will not forget you. But you can not forget those you do not remember. The City of Toronto may light the Toronto sign blue and white, but Mayor John Tory rarely makes commitments to address the violence that lies at the doorsteps of Somali communities.

Somali-British poet Warsan Shire reminds us that “in Somali, when we see injustice, we say ‘dhiiga kuma dhaqaaqo?’ which translates into ‘does your blood not move?’ ”

Can your blood not be moved?

For those of you who are willing to pray and willing to gather in vigil, try something different. Call out false narratives of terror and deficit when you see them. Ask the Ontario Ministry of Children and Youth Services what specific long-term and sustainable services they are allocating to Somali youth in Ontario. Pressure the Toronto Police Services, Ontario Provincial Police and the RCMP to appropriately investigate the deaths of young Somali men.

Stand in the streets when we tell you the Minister of Immigration has deported us. Pay attention to the counter violent extremism programs that criminalize Somali youth that are being funded by Public Safety and Emergency Preparedness Canada.
Prayer is an act of empathy; action is an act of solidarity. We need both if any of us are to survive.

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