ROMA - ROMANI - ROM

Roma migrated from India to Europe around 1000-1200ad. They were seen in Europe as a people of colour and suffered from cultural isolation throughout their history there.

Roma are not an homogenous group of people - about 12 million Roma live in Europe, with the majority living in Romania and Slovakia. Some groups do not identify themselves as Roma but are identified as such by the majority populations where they live.  All groups have suffered from discrimination and exclusion. During the Second World War Roma were persecuted along with Jews and between 500.000 and 1.5 million were murdered.

Most Roma continue to maintain social and ethnic separation through conscious and asserted effort but this is compounded through prejudice from non-Roma. In Europe, large Romani ghettos exist at the outskirts of many urban areas. In all Eastern European countries Romani communities are subjected to significant discrimination and in many cases intolerable repression. This has become even more prevalent with the rise in Nazism and particularly since the fall of the communism in Eastern Europe as food rations and employment are no longer guaranteed and discrimination has led to mass unemployment.

An individual Romani household consists traditionally of three generations of six to fifteen relatives. Further social structures involve unrelated family groups living cooperatively in a given geographical region. Families who live apart often unite during transitions such as marriage, serious illness and death.

Roma strive to sustain their way of life. Loyalty to the family is maintained at all cost. Education and technology are not significant factors within the culture and are not traditionally considered important; though there are indications that this is changing. Many older Roma are not literate. Traditionally Roma occupations included fortune-telling, copper-smithing, tinkering, mechanics, horse dealing, and music.

Culture

There is an extensive and complicated social structure among the Romani people. Generally, an extended family will travel and reside together and will maintain economic control over a particular territory. Families are male dominated, with a group of male elders within the family being the major decision makers. Romani women are often not included in the decision making process and generally have a much more subordinate role within the family.

The Roma tend to demonstrate a sense of moral superiority and contempt toward the Gadje. They have a strict taboo code that classifies all outsiders as soiled or unclean. This code prevents interaction with the Gadje and further limits integration. Some refuse to use the English language to record births, participate in census or other surveys, or to record deaths. They maintain enough of a link with the outside world to meet their primary economic and cultural needs. Very few are employed by Gadje except as contractors and then nearly always on a temporary basis.

Important Romani concepts related to health care are "wuzho" and "marimé". Wuzho is the Roma word for pure while marimé is a broad term referring both to a state of pollution or impurity or a sentence of expulsion imposed for violation of a ritual or moral nature. Other terms for marimé are moxadó, melali, mageradó, mokadi, kulaló, limaló, prastló, palecidó, pekelimé, gonimé or bolimé.

The Romani culture has strict rules about anything considered polluted. A person can be found to be marimé for violations of sexual conduct, not following Romani rules for food preparation, clothes, washing or cleaning, or other activities involving pollution. Women are particularly associated with marimé, with any part of a woman's body above the waist being wuzho or pure and below the woman's waist being marimé or polluted - especially the genitoanal area and its secretions. Secretions from the upper half of the body are not polluting or shameful. Washing hands after touching the lower body before touching the upper body is required. Separate soap and towels are used on the upper and lower parts of the body and they must not be allowed to mix. To the Roma, failure to keep the two sections separate in everyday living may result in serious illness. For this reason, most Romani women will not agree to a gynecologic examination unless the procedure is clearly explained as being essential to her well being. Certain food or animals (birds and cats) may also be considered marimé.

When a young women begins menstruating, she is introduced to shame and must begin observing the washing, dressing, cooking, eating and behavioural rules of adult women for her own protection as well as the protection of others. Her clothes must be washed separately from those of men and children because of the impurities of her body. She cannot cook food for others during menstruation. She must show respect to men by not passing in front of them, stepping over their clothes, or allowing her skirts to touch them. Pre-pubescent girls and older women are placed in a different category because they do not menstruate. This allows them freedom, and they are allowed to socially interact with fewer restrictions.

The Roma are supposed to wash only with running water, with a shower acceptable but a bath looked upon as sitting or lying in dirty, stagnant water. Dishes cannot be rinsed in the same sink or basin that is used for washing clothing. The kitchen sink is used only for washing dishes and cannot be used to wash hands.

Because they do not observe body separation, Gadje are seen as a source of impurity and disease. The impure public places where Gadje congregate are also considered potential sources of disease. These places are considered less clean than the Romani home or open outdoors. The Roma generally avoid touching as many impure surfaces as possible. They will attempt to lessen the pollution by using disposable paper cups, plates and towels.

Religion

There is not a separate Romani religion. Since they are generally a nomadic people, they have traditionally adopted the dominant religion of the country in which they live. Many of the cultural practices of the Roma can be traced to other religious beliefs. For example, Roma practices of ritualistic cleansing can be traced back to ancient Hindu customs. If Roman Catholic, they will also celebrate the days of the Saints believed to have helped the family. Roma also maintain several strong faith practices and beliefs in the supernatural, omens and curses. They believe in charms, amulets and talismans which they will carry in their pockets for safety, good luck and to prevent illness. They also have female healers, who prescribe traditional healing rituals and cures. One traditional means of healing is to carry a mole's foot as a cure for rheumatism or a hedgehog's foot to prevent toothaches. Interestingly, the Roma do not believe in fortune telling. This practice is used only to earn money from the Gadje.

Marriage

Gypsies tend to marry young. Some tribes practice arranged marriages while others allow courtship. If the marriage is arranged, the groom's father selects and pays for a daughter-in-law through the help of a marriage arranger. Marriage may be arranged or undertaken according to practical, economic, and/or social considerations of the family or clan. Marriage in the Romani culture has occurred as early as age nine but usually does not take place before the age fourteen. Outside marriage is considered a serious transgression in some clans and may be grounds for expulsion. In other clans, if a Romani male marries a female Gadje his community may eventually accept her provided she adopts the Romani way of life.

Newlyweds traditionally live with the groom's parents until they have several children of their own, and the family is satisfied with their adult behaviour and skills, at which time they are allowed to establish a semi-independent nuclear household. The daughter-in-law must prove herself to her new family and is expected to perform services with little in return. She is expected to care for her in-laws and produce grandchildren. With the birth of her first child the daughter-in-law moves from the child  status to mother-of-the-child status.

Pregnancy, Childbirth and Child-rearing

A woman is considered to be marimé (polluted or unclean) during her menses, pregnancy and for six week after the birth of the child. Childbirth should not occur at the family's usual home lest the home lose its purity. For this reason, there is increased acceptance of hospital births.

A new baby is immediately swaddled tightly and should only be handled by his/her mother. When a baby is delivered in a hospital, the mother should be allowed to practice ritualistic cleansing and the father not pushed to visit during this marimé time. There are rituals (that vary with tribe) involving the formal recognition of the infant by its father. In some cases, the child is wrapped in swaddling on which a few drops of paternal blood are placed. Other rituals involve the child being covered by a piece of clothing that belongs to the father. In some tribes, the mother puts the infant on the ground and the father picks up the infant and places a red string around its neck, thereby acknowledging that the child is his (Patrin Journal, 1999).

At night time during the first weeks postpartum no member of the family is allowed to go in and out of the mother's room, and all the windows and doors are kept shut lest the `spirit of death' enter and harm the baby. If a baby dies, it is bad fortune and the parents must avoid the baby's body. Traditionally, the body is buried in a secret place by the grandparents. Another way to avoid bad luck after the death of a baby is to leave the funeral and burial to hospital authorities. Bad luck in the life of the Roma is life-altering for individuals, families, and clans.

Children are a major focus of Romani culture and are believed to bring good luck. Child rearing is the responsibility of everyone in the family. Due to the large and complex social structure, most of the children are raised and cared for my many different people including extended family members and clan members living in the same residential area. Infant care tends to be both permissive and protective. Infants and young children enjoy freedom from most social restraints and are not expected to understand or demonstrate shame. It is not until puberty that they are introduced to the concept of shame and expected to observe marime. Children are not expected to take many of the precautions that adults do to ensure cleanliness in their daily lives, and contradiction to adults they may eat food prepared by Gadje. They are weaned and toilet trained in a very gradual fashion as these are not considered important events in the Romani culture.

In Romani culture older children act as miniature adults. Teenagers do not experience a carefree adolescent period as with many Western cultures. They are expected to begin adult socialization and to start a profession by ten years of age. Separation is by gender to learn the skills of the adult. Children are expected to respond with respect to multiple parent figures.

Death and Dying

Romani belief in the supernatural and fears about death play a significant role in their rites and customs related to dying and death. When a Rom is about to die, there is an extensive ritualistic process that must initiated. Through an elaborate communications system, relatives from other geographic areas come to be with the dying or dead. If the person is dying, it is essential that relatives be allowed to be present at the moment of death. When the person is near death, a special candle is brought into the room. At the time of death this candle is lit and a window opened. It is believed that the candle will light the way to heaven for the deceased person's soul. The body is rubbed with holy oil, and the family displays intense grief. For three days, all Roma must grieve by remaining in the presence of the dead. During this time they do not bathe, shave, wear jewellery, change clothes or prepare food. They are allowed to drink coffee, brandy or other liquors. Mirrors may be covered and vessels containing water may be emptied.

It is culturally acceptable for relatives to be deeply absorbed in their grief. Displays of grief may include moaning and shouting out to the deceased, scratching their faces, pulling their hair out and throwing themselves to the floor or into a wall. There is great fear among the survivors that the dead might return in a supernatural form to haunt the living. For this reason the name of the deceased should not be mentioned, the body is not touched and all objects belonging to them destroyed. After a three day wake, the funeral is held, which is followed by a death feast in honour of the deceased. For this feast, food is always prepared in units of three (three chickens, three pots of potatoes, etc.). Additional feasts are held to mark the three days, nine days, six weeks and one year intervals after the death. Close relatives of the deceased wear mourning clothes for a full year. It is believed that after one year the deceased soul enters heaven.

Communications

The language of the Roma is called Romani and is derived primarily from Sanskrit; with strong influences from Persian, Greek, and Slavic languages. There are customs in communicating with non-Roma (known as Gadje). In the healthcare setting, only the elder males are likely to communicate with healthcare personnel. Women are not permitted to interrupt men nor to be alone with a man who is not her husband or relative.

Health Care

Roma who enjoy good health are believed to be blessed with good fortune, and those who are ill are said to have lost their good luck. Roma believe that actions (e.g., clean or polluting) can promote health or result in illness. To return to a state of purity, cure, and good health one must conform or correct the polluting social behaviour.

The Romani people tend to use the national health care system only in crisis situations when there is an acute and/or unresolved condition for which folk medicine has failed. Romani may request specific "famous name" physicians and demand specific treatment even if the treatment or physician is inappropriate. There also is preference for older physicians over younger ones. Sharing medications is common and Roma have also been known to request a specific colour of medication for a specific illness.

For the Roma, illness is not just the concern of the individual but a problem shared by the entire clan. When a clan member must enter a hospital, family members are expected to remain with that person day and night to watch over, protect, and perform caring and curing rituals. This cultural coming together is one of the strongest values of the Romani culture. Accommodation of this group kin presence is a major factor to be considered in planning and providing health care for the Roma people. Roma are especially fearful of any surgical procedure that requires general anaesthesia because of a belief that a person under general anaesthesia undergoes a "little death". For the family to gather around the person coming out of the anaesthesia is especially important.

Health Risks among the Roma

Poverty, isolation, and prejudice, contribute to an appalling life expectancy that can be under 50 in some countries. The Romani culture in itself can sometimes increase risk for certain illnesses. For example, the belief in their own purification rituals and ritualistic cleansing to prevent illness menas that Roma are often resistant to immunizing their children. Social isolation can be carried to such extremes (refusal to register births and deaths) that significant trends in morbidity and mortality may be hidden. Isolation also results in lower participation in health screening, and beliefs about pollution mean that cervical and colon cancer screening are especially difficult to promote.

Dietary habits include high fat and salt content in foods. A large percentage of Roma smoke and are obese. These practices put the Roma at increased risk for hypertension, diabetes, occlusive vascular disease, strokes and myocardial infarctions. Again, social isolation and resistance to screening result increased health risk such as end-organ damage from undiagnosed hypertension or diabetes, especially among women who are even less likely than men to be screened.

Social (or societal) isolation also leads to an increase in consanguineous marriages, and thus an increased risk for birth defects. Crowded living conditions lead to an increased incidence of gastrointestinal infections, respiratory infections and hepatitis. Romani infants are more likely to be born prematurely and low birth weight due to a lack of prenatal care. In some clans, the infant mortality rate and abortion rates are high. Romani babies also have an increased risk for the development of phenylketonuria.

SOURCES and FURTHER RESOURCES

Roma - Charles_Kemp & Baylor School of Nursing

This is a very good American site that describes traditional health seeking practices as well as giving useful facts (i.e. outlining prevalent diseases amongst the target community). It specifically looks at refugee populations and includes excellent links to other sections that give more detail on issues such as women and health, refugee experiences and health, infectious diseases etc. Recommended. ۞ ۞ ۞ ۞ ۞  

Roma - Wikipedia

This site gives an up to date encyclopaedic account of each country. It covers the history, politics, demographics, economy, languages, regional aspects and culture but it gives virtually no information on health, health seeking practices, or traditional beliefs. ۞

LITERATURE

Access Ireland, Dominick Court, 41 Lower Dominick St, Dublin1, 

In 2002 Access Ireland produced a directory aimed at assisting those who are working with refugees and asylum seekers. The directory opens with a comprehensive and valuable account aimed at improving cultural competency, especially in relation to health.  Topics include: Intercultural communication; Developing inclusive, intercultural policies and service provision: Refugees health and well being. Also included are 5 cultural profiles relating to refugee communities in Ireland (Angola, DRC, Nigeria, Roma, and Romania). Unfortunately they are not available on their website but the directory can be obtained from the above address. ۞ ۞  ۞ ۞  

SPIRASI does not necessarily agree with the facts and opinions presented in this guide or any linked websites.