Mobile patients, local healers:

By: Marja Tiilikainen

“I have had this problem since 1990. Mostly I have pain in my head and also I have something, I don’t know, turning around my body. All over the body. …Doctors [in the US] did not find anything. Most of the time they ask you if you have any stress about the home or from work. Some of them give you advice to go home, to take a vacation, a long vacation, or to change the job, or what is wrong with your house and family problems and something like that. But I told them, everything is correct. And then I have some problem. But they could not find anything to tell.

When I heard that they have here [in Hargeysa] the medical place, I came to the doctor. And, in fact he showed me what is wrong with me. I realised what is wrong. I realised the problem is not a medical problem, they told me this problem is the jinn. You know, jinn is ancient creature, right? …

And this is the first time for fifteen years I know what is wrong with me. If you don’t know what is wrong with you, but you are feeling sick, this is another sickness, right? So, when I came here, I found the problem. And, actually, most of my problem left as I know the problem… Still I am feeling something now, but I can say, 80 percent of what I was feeling is already gone. I am feeling very good now, and more healthy than when I came here. So, Alhamdulillah, I continue now to read the Koran and whatever medicine they have here. So I am very much hoping I am at the end soon.”

Ahmed, a pseudonym for a Somali man from the United States, is one of the patients whom I met during fieldwork in Somalia. His journey back to the Horn of Africa to consult a popular Islamic sheikh, whom he calls a ‘doctor’, is an example of African migrants’ illness experiences and health-seeking behaviour in a transnational context. It is well known that patients in general search for various alternative or supplementary therapies in addition to biomedical treatments. In the case of migrants the search for a remedy crosses not only borders between different health care sectors but also national borders. These therapeutic journeys can be approached from the wider framework of transnational studies, which have highlighted the importance of transnational networks for immigrants living in today’s globalized world: at the same time as immigrants are integrating into receiving countries, they remain connected to the countries and relatives they have left behind. Hence, a focus on transnationalism and diaspora may provide us invaluable views for understanding today’s African societies.

But what do ill Somali migrants look for in Somalia, a country with poor health facilities? And what kind of impact may Somalis returning ‘home’ have on local, ‘traditional’ healing traditions? I try to explore these questions in my on-going postdoctoral study having its roots in comparative religion and medical anthropology. I carried out fieldwork in Northern Somalia, often referred to as Somaliland, in the summer of 2005 and 2006, a total of 3.5 months. The fieldwork was concentrated mainly in the Hargeysa area. The data was gathered by ethnographic methods including observations and interviews of several healers and patients from the diaspora. I also attended healing and religious rituals organized mainly by women, interviewed doctors and nurses, and visited mental wards.

Travelling home
The infrastructure of Somaliland, including public health services, which were weak even before the civil war, was ruined during the war. Post-war conditions and needs, extreme poverty and lack of control on the part of the government have contributed to flourishing entrepreneurship in the health sector. In addition to private clinics run by medical doctors, there are several clinics run by Islamic and other healers who use different techniques to give a diagnosis and treat the patients. For example, they recite the Koran, give herbal medication, arrange spirit possession and other healing rituals including animal slaughtering, consulting spirits, doing cupping and burning, and treating fractures.

It is very difficult to know, how many of those Somalis who visit Somaliland in particular during summer time, actually visit local healers. According to Sheikh Mahamed Rage, who is one of the most popular healers, he receives around 1,000 patients a year from abroad, and about half of them come from the Middle East, United States, Australia and Europe, including the Scandinavian countries. Based on my data, Ahmed’s case is a typical one among patients returning from the diaspora. Despite continuous, vague symptoms, a doctor in the resettlement country did not manage to give him a diagnosis or prescribe proper treatment. In another category are those returning Somalis, who have been diagnosed in the diaspora, but do not (or whose family does not) accept/trust the diagnosis, treatment or medication. In particular, Somali families seem to find psychiatric and neurological diagnoses such as schizophrenia, psychosis, depression, autism and epilepsy difficult to accept, because symptoms related to these conditions have traditionally been understood in the framework of spirits, evil eye and witchcraft. The third group of Somalis who visit healers in Somaliland are those who accept the diagnosis and use the medicines given by a doctor, but search for alternative treatment in order to restore health or stop taking (chemical) medicines regularly. Diabetes patients, who wish to get rid of insulin injections by drinking camel milk, provide an example. The fourth group are migrants whom the medication or treatment given by a doctor does not help, or for whom the treatment is too expensive. For instance, I met a woman who searched for treatment for infertility, because she could no longer afford the hormonal treatments in Canada.

The fifth category consists of people whose problems are seen to be tied to the way of living in Europe and other diaspora countries. The problems are typically connected to drug and alcohol abuse, sometimes followed by crimes and jail sentences, or hospitalization in mental wards. Often families bring them back to Somaliland, hoping that they will recover and get rid of bad habits in the midst of their own culture and religion, combined with herbal and other treatments. Some migrants also return to Somaliland when doctors give them no hope, telling them that their disease is incurable, possibly leading to death. Finally, healers may be visited in order to have a health-check, to prevent illnesses and get protection from harmful agents. In addition to physical visits, healers are contacted from abroad by telephone, e-mail and fax.

Healers and transnational networks
Healers in Somaliland are an important resource for ill Somalis in the diaspora: they provide migrants with meaningful explanations, certainty, and alternatives in particular in the field of mental distress and chronic disease, where biomedical diagnosis may be difficult to accept. The sense of being at home and the element of hope are clearly important for the experience of being healed. But mobile patients are also a resource for healers in Somaliland, whose mobility with Somali passports is restricted. Patients from abroad are for them an opportunity to build personal transnational networks. Satisfied patients may bring further contacts, medical equipment, gifts, money and new patients to healers in Somaliland, or maybe even arrange an invitation and visa to enter Europe or the United States.
Different healers have different resources. It is already quite common to have a mobile phone, but the poorest healers, who do not have many patients (at least not from abroad), may not be able to afford one. In addition, a new generation of healers, who have better education than the older sheikhs and other healers, has better access to and more interest in modern technology that may help them to develop their practice, and also attract patients from the diaspora. The arrival of transnational patients to Somaliland probably also motivates healers to develop their practices to better serve this client group.

Healers in Somaliland also have access to the global flow of information through radio, television and internet, and in an interesting way new, modern elements and tools such as blood pressure meters, anatomic pictures and x-rays are increasingly being adopted as part of Somali healing, alongside herbal medication, exorcism by reciting the Koran or diagnosing witchcraft from eggs. Globalization and modernization, together with mobile Somali patients open up new possibilities and horizons to healers, and change their practice towards ‘glocalized’ Somali medicine.

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Acknowledgments: I am grateful to the Nordic Africa Institute, which provided me with a travel grant for fieldwork in Somaliland in 2006 and a Nordic Guest Researcher’s Scholarship for two months’ visit at the Institute in spring 2007.

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