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Common health equity issues for Liberian populations
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
Liberians in Minnesota
Minnesota is home to 20,000 to 35,000 Liberians. According to the 2010 U.S. Census, 96 percent of the Liberian population in Minnesota live in the Twin Cities, largely in the suburban cities of Brooklyn Park, Robbinsdale, Richfield, and the Logan Park neighborhood in Northeast Minneapolis.
Liberia is located on the west coast of Africa. The continent’s oldest republic, it was founded in 1828 by freed slaves from the U.S. and Caribbean nations. About 5 percent of the population of Liberia is descended from the founders; the majority are indigenous people. In 1993 Liberia descended into a civil war that lasted 14 years. At least 750,000 Liberians were displaced by the conflict, with an estimated 200,000 coming to the U.S.
In 2018, an estimated 3,000 to 4,000 Liberians in Minnesota worked in various healthcare-related fields.
English is Liberia’s official language and used by approximately 20 to 30 percent of its people. Some 20 indigenous languages are spoken in Liberia. A large majority of Liberians in Minnesota speak English as their primary language.
Disaggregated data on African populations is often not available. Data on African-Americans in general may not apply to Liberian Minnesotans. Some health issues could be biologically tied to race; many are tied to social inequities, including poverty. When included in the data for African Americans, the true picture of Liberian-American health may be missed.
Social determinant disparities
Social determinants of health are economic and social conditions that influence the health of people and communities.
Many aspects of the Liberian Minnesotan culture today reflect the culture of the general U.S. population and generational differences impact social practices. Traditional Liberian culture is patriarchal and in general women have less access to education, health care, employment, and property ownership than men. Liberian parents may rely on other community members for support, such as picking children up from school or sending a child to live with a relative who can provide better support.
Approximately 85 percent of Liberians in Minnesota are Christian, nearly 15 percent practice Islam and a small number are of other religious groups, including traditional African religions.
Rice is a staple food in the traditional Liberian diet. Cassava is also a common source of calories, cooked into a mash called fufu. Liberian cuisine features spicy stews, with habanero (scotch bonnet) chilies, vegetables and meat or fish. Many acculturated Liberians have replaced traditional meals with fast food, contributing to an increase in obesity, diabetes, and hypertension.
Major health concerns for Liberian Americans who have lived in this country for 10 or 20 years are related to hypertension, Type 2 diabetes, high cholesterol levels, stroke, and heart disease. Physicians suggest the increased risk is due to Liberian Americans eating a less healthy diet, with less fiber and more fat, and exercising less in America than they did in Liberia.
Undiagnosed post-traumatic stress disorder (PTSD) is a concern. Civil war victims and aggressors both suffer from PTSD. War experiences have created ongoing mental health issues for victims who still come into daily contact with some of the same people who tortured and raped them or tortured and killed their family members in Liberia.
A secondary health concern is increased risk of infections for people who travel regularly to and from Liberia. According to the World Health Organization, infectious diseases in Liberia, including yellow fever, Lassa fever, malaria, typhoid, polio, tuberculosis, and diarrhea, are widespread.
Approximately one in five of all adults in the U.S. experiences mental illness in a given year. The Liberian civil war, which lasted 14 years, was noted for extreme brutality, civilian torture and slaughter, child soldiers, rape as a weapon of war, and other atrocities. More than 40 percent of Liberian refugees are thought to suffer from post-traumatic stress disorder (PTSD). This disorder affects both victims and perpetrators—many of whom were forced into armies as children, given drugs, and ordered to commit atrocities. As a result, health care providers should consider screening Liberian patients for PTSD. The effects of historical trauma are being studied. Older immigrants are less likely to have English skills which may increase loneliness, isolation, and depression.
End of life
When discussing end of life issues with any patient, health care providers need to understand preferences based on personal and family views. At end of life, Liberian individuals may be visited by clergy and prayed for by members of a religious congregation. Funerals are important, often elaborate, and may go on for days or weeks. A Liberian funeral is a time for both grief, since the departed will be missed by loved ones, and a time for joy, since it is believed the deceased has gone on to a better life among his or her ancestors. On the night before the funeral, a wake is held in the family home where the extended family and friends of the deceased gather for a feast, with drinking, singing of spiritual songs, and often a Liberian drummer. The purpose of the wake is to be jovial, to console the immediate family, and to wipe away the grief.
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