The measles epidemic in Minnesota is now at 76 cases. It’s been growing in the last several weeks, but one nurse believes it’s going to take the messenger as well as the message to prevent another case.
Nasra Hassan visited People’s Center Health Services, which serves the West Bank community, for a routine checkup with 1-year-old Yazim and 14-year-old Mohamed. Yazim and Mohamed are two of Nasra’s 11 children. Routine visits to the clinic are part and parcel of her life.
Nasra saw pediatric nurse Deb Olson and gave her a big hug.
Olson asked Nasra, “Have you been around anybody with active tuberculosis or measles?”
It’s a question that’s become more than routine these days. The Minnesota Department of Health said 64 of the 76 measles cases are Somali children.
“All my children got all the shots,” Nasra said. “I don’t have any problems, but I heard on the news, and in our community, and I’m really scared.”
Nasra said all the parents she knows are worried the measles shot will give their children autism, but doctors said that fear isn’t based on science.
“The issue of fear is so powerful,” said Sahra Noor, CEO of People’s Center.
Noor is also a Somali mother. She said parents often tell her they are demonized or shamed when they decline the vaccine. She said her conversation with one father was a powerful window into the fear that paralyzes parents.
“The Somali father is a scientist,” Noor said. “He said to me, ‘That’s a matter of head over heart.’ As a scientist, I know there’s no proof, but my heart is telling me don’t even take the chance.”
Noor said most Somali parents are getting the message about vaccinating their children.
“If you ask any Somali, whether they are doctors or the person that just arrived from the refugee camp, they know that the Department of Health has said there’s no link (between measles and autism). They don’t believe it. They are not buying it,” she said.
Noor said Somali parents are worried that instances of autism are higher in their community, and they don’t see any research studying the reasons.
Noor said most Somali parents are vaccinating their children and that they’ve traditionally had high rates of vaccinations.
She said the answer to the measles crisis is inside the Somali community.
“We need Somali providers to speak up, we need Somali parents to speak up, we need religious leaders to speak up and policy makers who look like us to speak up. Once we own the issue, it’s easier to solve,” Noor said.
She believes Somali parents need to talk to their health care providers. Noor said vaccinations are more important for her community because many Somalis travel to visit relatives in Somalia. There are widespread measles outbreaks there as a result of famine.
Nasra decided to give her baby, Nazim, the measles vaccine on her visit, but she knows other mothers may not.
People’s Center staff are putting together a plan to reach Somali parents right after Ramadan in July. Noor said she’s recruiting Somali health care providers, parents who have vaccinated their children and other community leaders to talk to parents and their family members.
Noor also wrote a blog post about this topic on the People’s Center website. You can find it here.
Members of the Somali Minnesotan community seeking more information on the measles, mumps and rubella vaccine can find it in the following places:
People’s Center Health Services, network of Federally Qualified Health Clinics, is located in South Minneapolis.
Isuroon is a woman-led, community-driven organization in the Somali community.
Vaccination in Somalia: “It’s my job”
In Somalia, determined women are the face of polio eradication.
Somalia, polio-free since 2002, is currently at risk of circulating vaccine-derived poliovirus type 2, after three viruses were confirmed in the sewage in Banadir province in early January 2018. Although no children have been paralyzed, WHO and other partners are supporting the local authorities to conduct investigations and risk assessments and to continue outbreak response and disease surveillance.
Underpinning these determined efforts to ensure that every child is vaccinated are local vaccinators and community leaders – nearly all of whom are women.
Bella Yusuf and Mama Ayesha are different personalities, in different stages of their lives, united by one goal – to keep every child in Somalia free from polio. Bella is 29, a mother of four, and a polio vaccinator for the last nine years, fitting her work around childcare and the usual hustle and bustle of family life. Mama Ayesha, whose real name is Asha Abdi Din, is a District Polio Officer. She is named Mama Ayesha for her maternal instincts, which have helped her to persevere and succeed in her pioneering work to improve maternal and child health, campaign for social and cultural change, and provide care for all.
Protecting all young children
Working as part of the December vaccination campaign, which aimed to protect over 700 000 children under five years of age, Bella explains her motivation to be a vaccinator. Taking a well-deserved break whilst supervisors from the Ministry of Health and the World Health Organization check the records of the children so far vaccinated, she looks around at the families waiting in line for drops of polio vaccine.
“I enjoy serving my people. And as a mother, it is my duty to help all children”, she says.
For Mama Ayesha too, the desire to protect Somalia’s young people is a driving force in her work. A real leader, she began her career helping to vaccinate children against smallpox, the last case of which was found in Somalia. Since then, she has personally taken up the fight against female genital mutilation, working to protect every girl-child.
She joined the polio programme in 1998, working to establish Somalia as wild poliovirus free, and ever since to oversee campaigns, and protect against virus re-introduction. In her words, “My office doesn’t close.”
Working in the midst of conflict
The work that Bella and Mama Ayesha carry out is especially critical because Somalia is at a high risk of polio infection. The country suffers from weak health infrastructure, as well as regular population displacement and conflict.
For Bella, that makes keeping children safe through vaccination even more meaningful.
“Through my job I can impact the well-being of my children,” she says. “For every child I vaccinate, I protect a lot more”.
Mama Ayesha echoes those words when she contemplates the difficulties of working in conflict. For most of her life, the historic district where she works, Hamar Weyne, has been affected by recurrent cycles of violence and shelling. With her grown children living abroad, she could easily move to a more peaceful life. But she chooses to stay.
“This is my home, and this is where I am needed. I am here for my team, and all the children.”
Looking up at a picture of her husband, who died many years ago, Mama Ayesha considers the determination and courage that drives her, Bella, and thousands of their fellow health workers to protect every since one of Somalia’s children. Behind her thick wooden desk, she is no less committed than when she began her career. “If I had to do it again it would be my pleasure.”
Bella has a similar professional attitude, combined with the care and technical skill that make her a talented vaccinator. Returning to her stand below a shady tree, she greets the mothers lined up with their children. As she carefully stains the finger of the first small child purple, showing that they have been vaccinated, she grins.
“I am the mother of all Somali children. I am just doing my job”.
‘You have dark skin and you are beautiful’: the long fight against skin bleaching
Amira Adawe has just arrived at a Somali-American community radio station in Minneapolis where she hosts a weekly call-in show called Beauty-Wellness Talk. After peeling off her winter jacket, Adawe slides a pair of headphones over her crown of dark, short curls. “Hello? As-Salaam-Alaikum,” she says into the foam mouth of her studio microphone. An anonymous stream of listeners starts calling in to confide about a subject that is deeply personal and also taboo — skin bleaching.
Adawe is a Minnesota-based public health researcher and educator who works as a manager in Gov. Mark Dayton’s Children’s Cabinet. In 2011, while a graduate student and health educator with St. Paul-Ramsey County Public Health, Adawe proposed a study to investigate how Somali women use skin bleaching creams in their daily lives. Growing up in Mogadishu and Minneapolis, Adawe knew that skin lightening was widespread in her community.
“A lot of it ties to colonization,” Adawe says. “Certain skin colors were more accepted in the society. But through the years, it became so embedded in the culture to where it’s become normal. If you’re light-skinned, you’re more accepted,” she says.
She had trouble finding women who were willing to be interviewed. Adawe says there’s a stigma around admitting to skin bleaching. “Women don’t want other women talking about them. They want to pretend that this is their natural color,” she says.
Adawe suspected that the fast-acting creams contained toxic chemicals, and she was right to be suspicious. Out of 27 different creams tested by Minnesota researchers as part of Adawe’s study, 11 contained mercury levels ranging from 4.08 up to 33,000 parts per million (ppm). (The U.S. Food and Drug Administration only allows mercury in amounts of less than one part per million in most cosmetics.)
The FDA classifies skin whitening creams as both a cosmetic and a drug. According to FDA spokesperson Peter Cassell, the “use of mercury in skin-bleaching preparations and other cosmetics, with few exceptions has been prohibited in the U.S.” since 1973.
“The FDA has been aware of mercury as a potential allergen, skin irritant and neurotoxin for decades,” Cassell says.
The seven Somali women Adawe interviewed for her study reported mixing several different creams into one concoction and storing it in the refrigerator. Some slathered the cream mixture over their bodies multiple times a day, even while pregnant or breastfeeding. These findings alarmed Adawe. The possibility that children or developing babies could potentially ingest mercury through breast milk or contaminated food or water was especially concerning.
Skin bleaching products can also contain steroids, which thin the skin, as well as hydroquinone, a suspected carcinogen that is banned in some countries.
“That is a really huge public health issue. That mercury vapor alone can expose everybody in the home, even people who visit. That was really shocking to me,” Adawe says.
Despite FDA regulations, toxic skin lightening creams are accessible in the United States. The products get smuggled past borders through personal luggage and can be found in ethnic markets and also online.
A global market
Globally, skin bleaching is a multibillion-dollar business. According to a 2017 market research study by Global Industry Analysts, the market for skin lightening products is anticipated to exceed $31 billion by 2024, with the Asia-Pacific region representing the fastest-growing market.
Adawe was surprised to learn that skin bleaching is such a global phenomenon. “I was so focused in the Somali community and other African communities that I didn’t know this was happening in other places,” she says.
Seventy-seven percent of women in Nigeria use skin lighteners, more than anywhere else in the world, the World Health Organization reported in 2011. In 2004, nearly 40 percent of women surveyed in China, Malaysia, the Philippines and South Korea reported using use skin lighteners, and in India, 61 percent of the dermatological market is comprised of skin lightening products, according to the same WHO report.
As Adawe continued to sound an alarm about skin bleaching, she realized that warning people about the health risks of toxic chemicals wasn’t necessarily enough to change behaviors. So long as the belief that lighter skin is inherently preferable persisted, women would likely keep bleaching, she thought. So she decided to tackle the issue from another direction.
Adawe launched her radio show, Beauty-Wellness Talk, in November 2017. It’s a platform where the Somali community can talk openly about skin lightening without fear of being outed or stigmatized. From the beginning, Adawe made it clear that listeners could call in anonymously.
On a recent wintry Saturday afternoon, Adawe’s in-studio radio guest is Hibat Sharif, an educator and outreach worker with St. Paul-Ramsey County Public Health. They’re discussing how parents can build healthy self-esteem in their children, especially girls.
“We’re African, we’re Somali, we have dark skin,” says Sharif in a mix of Somali and English. “Our skin is melanated. It provides us with a lot of benefits. Why are we telling our girls: You’d look so much better if you were lighter? It’s important not to put those toxic stereotypes in your child’s head.”
Sharif cautions listeners about words that reinforce harmful stereotypes, such as cadey, a Somali expression of endearment.
Questioning word choices
“That word is really heavy,” explains Salma Ali, 19, a Somali-American college student who grew up in the Twin Cities area. Her friend, Yusra Abdi, also 19, agrees.
“It means whitey. Like white girl,” Abdi says. “You will never hear anybody say madoowey, which is ‘darky.’ If anything, that would be an insult in the Somali language.”
Colorism is personal for both Abdi and Ali, who describe themselves as dark-skinned. “Growing up, if somebody in my family was mad at me, they’d call me koor madow, which means, ‘Hey darker-skinned,’ ” explains Ali. “And it was an insult,” she adds.
Family members pressured Ali and Abdi to use lightening creams. When Abdi was in middle school, her mother gave her a lightening gel to help with acne scars. After about a month, she noticed her complexion had lightened and her acne marks had worsened. She decided to stop.
“When women use these products, it comes from a very deeply ingrained place of insecurity,” Ali says. “It’s because of what society pushes on us to believe. Across all cultures, darker-skinned people have self-esteem issues.”
Both Ali and Abdi say that they’ve seen Somali women obfuscate their use of skin lightening products by describing the practice as cleaning their skin or helping it to glow.
“I’ve had my aunts come up to me telling me, ‘Salma you’re not ugly, it’s just that your skin is just a little dirty. You need to clean it up. I got some products from China. I’mma hook you up.’ I’m like, ‘How is my skin dirty? I’m taking care of myself.’ But because of the fact that I have darker skin, I’m seen as ugly. And that’s just part of the way we’ve all been socialized.”
Adawe wants to disrupt that socialization, but changing ingrained behaviors and perceptions takes time. She sees medical providers as key partners in actualizing systemic change. Over the past six and a half years, Adawe says she and her colleagues have trained more than 100 clinic systems, with a focus on pediatric care.
She advises doctors and nurses not to ask patients about skin bleaching directly, but instead to probe slowly and with sensitivity about the different lotions women use. Nurses who conduct home visits with pregnant women can play an especially important role since they build a relationship with mothers over time and can see if skin lightening products are being kept in the home.
On a Thursday afternoon in mid-February, Sharif, the outreach worker, stands in front of a class of Somali, Hmong, Nepalese and Karen adult students and their translators. The students are all new arrivals to the United States. The class hums with a staccato melody of different languages.
“The No. 1 thing you can do is to stop using these products,” Sharif tells the students in English and Somali. “The biggest takeaway from this presentation is that every shade is beautiful,” she says.
A Somali man in the class says it’s been ingrained in him to gravitate toward lighter-skinned women.
Sharif laughs and says, “The change needs to start with you. It really does.”
She asks him if he has dark-skinned daughters, and the man says he does.
“What does that say to your daughter?” Sharif says when reflecting on the exchange after class. “Do you want a guy to treat your daughter that way where he tells her she’s not beautiful because she’s dark?”
“You have dark skin and you are beautiful”
Salma Ali says she had low self-esteem when she was younger. It’s something she thinks a lot of darker-skinned young women experience. Things shifted in high school when she started reading books by black women writers and found inspiration in seeing black women actors play strong leading roles on television.
Social media helped Ali and Abdi to find affirming messages about black beauty as well. Both of them are fans of black women beauty vloggers like Jackie Aina and Alyssa Forever whose YouTube channels attract millions of views. They credit Rihanna for leading the way with releasing a makeup line with many different shades for darker-skinned women.
“It can really change the way you think about yourself and the way you see the world,” says Ali about social media. “I really do have hope for this next generation of darker-skinned women who want to be represented. Who want to be uplifted and celebrated for our skin. You have dark skin and you are beautiful. I really want that to be a cultural norm,” she says.
Adawe says that after working on this issue for nearly seven years, she’s starting to see hints of change. More people are talking, disagreeing and questioning colorism out in the open. “All of that didn’t exist before,” she says. “All of that helps.”
Adawe is now writing a curriculum for teachers. Her next step is to take the conversation into the schools.
“This is going to need systemic change,” says Ali, who is studying sociology with a focus in health care and a minor in public health and neuroscience at the University of Minnesota. “I feel like it’s something that’s so within us that it’s going to take a while. It’s going to take some work.”
Somalia’s first forensic lab targets rape impunity
AFP — Garowe – The new freezers at Somalia’s only forensic laboratory can store thousands of DNA samples, although for now there are just five.
The big hope is that they could be the start of a revolution in how the troubled Horn of Africa country tackles its widespread sexual violence – provided some daunting hurdles are overcome.
The first sample arrived at the start of the year taken on a cotton swab from the underwear of a woman, a rape victim from the village of Galdogob.
It was wrapped in paper and driven 250km to the Puntland Forensic Centre in Garowe, capital of semi-autonomous Puntland, slipped into a protective glass tube and placed in one of the three ultra-low temperature fridges.
If DNA ID can be teased from the sample, this would be a crucial step in convicting the woman’s rapist.
No longer would it be a case of he-said-she-said, in which the survivor is less often believed than the accused. Two decades of conflict and turmoil have made Somalia a place where lawlessness and sexual violence are rampant.
“Now, people who have been raped hide because they don’t have evidence,” said Abdifatah Abdikadir Ahmed, who heads the Garowe police investigations department.
But with the lab, he said, “it’s a scientific investigation. There are biological acts you can zero in on.”
Not yet, however.
Abdirashid Mohamed Shire, who runs the lab, has a team of four technicians ready but is awaiting the arrival of the final pieces of equipment.
Their work to provide the evidence that might convict or exonerate is yet to begin.
And the pressure is on. The freezers mean the DNA samples can be safely stored for years but Somali law allows a rape suspect to be held for a maximum of 60 days. Shire needs the analysis and identification machines urgently so that, as he put it, “justice will be timely served”.
The laboratory, partly funded by Sweden, was launched last year after the Puntland state government enacted a Sexual Offences Act in 2016, which criminalised sexual offences and imposed tough penalties.
But technology alone will not solve Somalia’s many judicial weaknesses.
The DNA sample from Galdogob, for example, was stored in unclear and unrefrigerated conditions for five days before being sent to the lab, meaning a defence counsel could potentially argue the DNA evidence had been tampered with.
Human rights lawyers worry the new lab might backfire for this reason.
“A lot of thought needs to be given to how the chain of custody can be preserved in these kinds of cases,” said Antonia Mulvey of Legal Action Worldwide, a Kenya-based non-profit organisation.
More fundamental still is the failure of Somalia’s police to take sexual assault cases – and their jobs – seriously.
Corruption is rife, with a legal advisor to Puntland’s justice ministry saying officers “meddle” in cases, undermining them for personal gain.
“My concern is that the corrupted system could not make a sure success of the lab,” the advisor said, requesting anonymity to speak candidly. “Investing in the lab is good, but we need to think about the preconditions.”
The UN Population Fund (UNFPA) which helped pay for the lab is trying to address this by running training programmes for dozens of the Garowe police on sample collection, gender violence investigations and documentation.
But, the legal advisor cautioned that donors can only do so much.
“The issue is more complicated than training police. It relates to the political commitment of the government. UNFPA can train police but who will pay those you train? Are they given power to do the work?”