Liberian

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.

• 37 percent of women with HIV in Minnesota are African-born.

Social determinants of health are economic and social conditions that influence the health of people and communities.

• 91 percent of Liberians in Minnesota are high school graduates, and 28 percent have bachelor’s degrees or advanced degrees, according to a Wilder Research study.
• In Minnesota, Liberian women earn $0.51 cents on the dollar compared to white men. Gaps remain even when education, hours worked, and occupations are considered.

More data on social determinants for Liberians:

• Liberian Population Minnesota, 2013-2017. Data on demographics, economy, health, housing, transportation, and workforce about these Minnesota residents, including native- and foreign-born residents. Cultural identification is based on a combination of race, ancestry, and birthplace. Minnesota Compass

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.

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.

• Healing the Hurt: A Guide for Developing Services for Torture Survivors. A primer for delivering care to survivors of torture, including mental health and medical care. Centers for Victims of Torture, 2005.
• Liberian Health Initiative. An organization that wants to bring real change to community health in the Minnesota African diaspora and rural health in Liberia.