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Over the past 10 years, Minnesota clinicians have noticed increased resistance to MMR vaccination among Somali Minnesotans. Misinformation about a discredited study asserting a link between the MMR vaccine and autism has permeated this community as parents have increasingly become concerned about the prevalence of autism spectrum disorder among their children. As a result, MMR vaccination rates among U.S.-born children of Somali descent are declining. This article reports findings from an investigation by the Minnesota Department of Health, which was undertaken to better understand vaccine hesitancy among Somali Minnesotans. Based on these and other findings, we propose a multi-pronged approach for increasing vaccination rates in this population.

Ramadan is a month-long period of heightened self-reflection about one's religion and one's relationships with others. During Ramadan, fasting during daylight hours is required. The fast is typically followed by a feast after dark. Although Muslims with certain medical conditions are allowed by Islamic law to abstain from fasting, many choose to fast during Ramadan for personal reasons. Diabetes is one of the most challenging conditions to manage during this time, and physicians and clinics with Muslim patients who have diabetes will need to be prepared if they are to support their patients who desire to fast. This article provides a general overview of Ramadan and offers practical guidance for managing adults and children with diabetes who are fasting during this important time in the Muslim calendar.

Somali women often use creams and soaps to lighten skin tone, fade freckles or get rid of age spots. Use of these products raises a health concern, as some have been found to contain mercury. This article describes an investigation that involved interviewing Somali women about skin-lightening practices and the products they use and then testing those products for mercury. Twenty-seven samples of products purchased at markets in Minneapolis and St. Paul were analyzed bythe Minnesota Department of Health for specific mercury levels. Eleven of the 27 (47%) were found to contain mercury. Some exceeded the current FDA threshold of 1 part per million. This has prompted both state and federal health officials to issue warnings about the use of these products.

Given the large number of Somali refugees living in Minnesota, it is likely that Minnesota physicians will encounter Somali patients, some of whom will have serious illnesses. Although our knowledge of Somali expectations about health care is growing, little has been written about the Somali people's views of treatment for life-threatening illnesses or their ideas about end-of-life care. After encountering a Somali man with advanced cancer in our practice, we attempted to learn about the Somali view of death and dying and the kind of treatment Somali patients might want during their final days. We share what we learned so that others might provide more culturally competent end-of-life care for Somali patients in the future.

For millions of people around the world, tuberculosis (TB) is a cause of significant morbidity and mortality. It continues to affect the well-being of Minnesotans as well. This article reviews one Minnesota hospital's experience withTB. Through retrospective reviews of charts at the University of Minnesota Medical Center, we found that patients who tested positive for TB were more likely to be foreign-born than U.S.-born, that foreign-born patients who tested positive for TB were younger than those who tested positive and were born in the United States, and that foreign-born patients were more likely to have extrapulmonary disease than pulmonary TB.

Staff at a hospital emergency department (ED) located in an urban neighborhood densely populated by Somali immigrants and refugees have observed that a large number of Somali patients use the ED for care that is normally provided in a clinic setting. This article reports on the Somali population's use of the ED for such care. It also explores Somali traditions and culture in order to shed light on this population's health care practices and attitudes toward the medical system in this country, and it makes recommendations consistent with those findings for more effectively meeting the health needs of Somalis.

A growing number of Somali refugees are calling Minnesota home. Health care providers need to understand how best to serve these newcomers, many of whom are accustomed to a very different health care system and have a variety of expectations when it comes to the care they receive and the way it's delivered. This study sought to gain insight into the health practices and health care preferences of Somali refugee women living in the United States, as well as their experiences with the U.S. health care system. In focus group discussions, participants expressed their preference for seeing women physicians, distrust of interpreters, and willingness to follow their physician's advice. They also shared stories about incidents during which they felt they had been the victims of stereotyping. Increasing the number of qualified translators and providing cultural competency training for clinic staff are recommended first steps for improving the provision of care to Somali refugee women.

The Minnesota Department of Health recommends a health assessment for all refugees within 1 to 3 months of arrival, including screening for enteric parasites. Little information exists, however, to help clinicians decide whether to screen asymptomatic persons who have lived in the United States for a year or more. We questioned 71 immigrants from East Africa now living in Minnesota's Twin Cities about gastrointestinal symptoms and duration of residence in the United States and asked for stool specimens for ova and parasite examination. Fifty-one patients (72%) returned specimens. The prevalence of symptoms was no different in the 14 patients with pathogenic parasites than in the 37 without (71% vs. 76%). Patients with pathogens were likely to have lived in the United States for less time than those without pathogens (median 17 months vs. 32 months), but the groups were not discrete. Clinical data did not identify a group unlikely to have parasites or need screening.

Somalis are one of the newest refugee groups to settle in Minnesota, first arriving in 1993. The largest number of Somali refugees in Minnesota live in Hennepin County, which received 85% of the state's Somali refugees in 1996. In this population, tuberculosis, parasitic diseases, and malaria are of particular concern. In 1996 Somalis accounted for 27% of the foreign-born cases of tuberculosis in Minnesota. Before entering the United States, all refugees are given an overseas health assessment, which focuses on identifying conditions that might be contagious. The examination is limited and is valid for one year. Domestic refugee health assessment is very important, since it provides a comprehensive medical evaluation and treatment plan for health conditions that may interfere with successful resettlement.