Isuroon CI Report – Interim

What has been most instrumental to your progress?

Creating the Female Genital Cutting Steering Committee to address the issues experienced by East African women experiencing access and service difficulties with healthcare systems responding to their FGC-related complications.
Considered the best health outcomes for women who have experienced FGC.
• Examined ways of shifting the narrative about FGM in healthcare settings to get more respect, compassionate care, and more culturally competent care for women experiencing FGC.
• Gave attention to both mental and medical health in addressing FGC.
• Prepared to provide ongoing information and outreach.
• Considered responses needed to assist men in being more supportive to FGC women.
• Helped develop 24 survey questions for healthcare professionals.

Engaging East African women in conversations on FGC
Isuroon has engaged 20 Somali and 5 Oromo women in discussions about FGC issues. We held 5 interviews with Somali women and they talked about menopause and how that plays out when there has been FGC. Talk is important because women are traumatized. Women also expressed lots of shame related to FGC. They shared that doctors often do not know how to best respond to their needs. Some of the women cared so much that they wanted to go back to their own small towns and open FGC clinics. Somali and Oromo women have been meeting every other week for several months. Isuroon staff has interviewed most of the women individually to further respond to their specific needs. The women are highly engaged, sharing numerous stories, including bad experiences with healthcare and their need for mental health supports. They have come to trust Isuroon as a healthcare partner and community-based resource where they can share their experiences and co-create solutions.

Surveying healthcare professionals (RNs and OB/GYN physicians) on their knowledge and resources related to FGC.
Isuroon distributed a 24-question survey that queried healthcare professionals about FGC care in Minnesota; 182 healthcare workers, primarily registered nurses responded. Survey questions asked about their medical knowledge related to FGC, how they described their FGC work experience, what types of FGC they encountered, the number of FGC patients they treated, what type of FGC medical complications they’d experienced, how they would rate their professional experience of FGC healthcare, why they believed FGC patients came to see them, and if patients shared concerns regarding specific FGC issues. Other questions were how they rate their knowledge of various FGC services, supports, and procedures covered by healthcare insurance; their rating of their facilities’ referral processes to mental health resources, whether they had done any professional development related to FGC; how they viewed culture as contributing to ongoing FGC practices; if their facilities have FGC patient support resources, and if they know about external FGC resources.

Key lessons learned

By completing this work, we have been able to increase engagement of the local East African FGC population to advocate and participate in decision making regarding FGC health care and in their own communities. And, we have substantiated our hypothesis that the women themselves know what resources they need to improve their physical and mental health. The women with lived-experience can co-create necessary responses to FGC-related health complications. The healthcare systems should learn from women with FGC experience regarding the resources that best meet the variety of physical and mental health needs.

With physicians and specialists who are often agnostic to sex, gender, or population-specific differences, the collective health system is failing to recognize just how different women’s healthcare is from one-size-fits-all healthcare which appears to be designed in large part by the men who have set existing standards. We’ve learned that the culturally-specific needs of East African women who have experienced FGC are specific and the women themselves have to be included in co-creating healthcare responses designed and decided for them.

Even though our FGC survey for healthcare professionals is still open, preliminary findings suggest that few healthcare respondents had above average or high levels of knowledge about FGC procedures, insurance coverage, and community resources. The results show:
• A majority of the respondents rated their knowledge of medical FGC services and supports; their understanding of FGC-related procedures and supports that are covered by health insurance; and the adequacy of their facility’s referral processes to mental health resources as very low to average.
• About a third had done no reading, study, or continuing education.
• Over half of the respondents did not have resources within their facilities to support patients dealing with FGC issues and even more did not have a list of community resources within driving distance that could offer support to women dealing with FGC.
• A majority of all respondents said they could use information on types of resources that may be helpful to women dealing with FGC issues; training on FGC related issues; lists of books to read and CEU events on FGC issues; FGC research findings; and information on professional groups

Reflections on inclusive, collaborative or resourceful problem-solving

Inclusive. FGC is a complex issue which was mostly addressed medically and legally, without cultural, gender and racial consideration. Isuroon focused on those aspects exploring both Somali and medical community culture, cultural bias resulting in dismissing women with FGC from conversations. Isuroon fully included women in a judgement free environment, generating ideas through ongoing group discussions expanding their understanding of FGC and on the other hand surveying medical workers. Our survey findings will show additional “lessons learned” and provide next steps for future action.

Other key elements of Community Innovation

We identified the need; increased understanding of the issue; and will generate ideas from survey results that will allow us to “test and implement solutions” in the next phase of our work. We believe that Isuroon being a Somali led organization and the Somali staff engagement was instrumental in building the level of trust needed to obtain good information from one-on-one interviews and group discussions with women who have experienced FGC. Somali groups then informed the questions to pose to the medical community and find the areas which need to be improved.

Understanding the problem

When we proposed the project, we were working off limited work we conducted before and community input. This project allowed us the time and resources to ‘dig deeper’ and explore the nuances of women’s needs, emotional effects and the level of their understanding of FGC. As much as timing was unfortunate with COVID, the racial conversation in MN, opened the door for reviewing medical approach to FGC in the light of culture. ‘otherness’ and gender. That conversation along with the the ideas from surveys that let us know what knowledge and experience healthcare professionals have and the type of resources they need for systems change in the ecosystem to decrease access and service barriers will bring us closer to a breakthrough in addressing a community need.

If you could do it all over again…

As with many other projects, COVID-19 created an obstacle and we do not know that we could have done much about it. It delayed our project and FGC is a tricky subject to pivot to virtual conversations. Our community was overwhelmed with basic needs and it was difficult to focus on FGC under those circumstances. The same with medical community. Still we conducted the group sessions because of our ties to East African culture, but had to make a lot of assurances to support participants feeling comfortable. Our most successful sessions were in-person meetings where we practiced social distancing and wore masks.
Also FGC is a topic that many feel uncomfortable discussing so we spent considerable time developing survey questions in a way that does not blame or shame the healthcare responder for what they know and understand or don’t know and understand.
Overall, considering the circumstances, it is hard to answer this question in a substantial way.

One last thought

The project was supported by NORA HALL, PH.D. | MANAGING PARTNER
Nora D. Hall has experience in communication, collaboration, management, education, media, program evaluation, organization and leadership development and was the founder of a leadership program that was housed at the University of Minnesota for 11 years. She has served in central administration for a large complex organization, and worked as a department head, division manager, project leader, researcher, evaluator, teacher, and trainer for service agencies, both profit and non-profit. Dr. Hall has published a variety of articles/chapters in scholarly journals, newspapers and five books; and is the recipient of a leadership initiatives award and first place scholars recognition for research she conducted on nineteenth-century journalists.
KAREN GRAY, M.S. | SENIOR PARTNER
Karen D.Gray has extensive experience in the research, design, development and evaluation of projects for a variety of clients. She has years of experience in consulting, planning, evaluation and research for new business development in entrepreneurial and established firms.