Somali women who fled their war-ravaged homeland are finding compassionate, "culturally competent" health care at Daryel, an exercise, massage-therapy and social support group in Seattle.

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The Harborview Medical Center nurse faced a conundrum.

Several doctors had told Bria Chakofsky-Lewy that a group of Somali women patients had aches and pains they could not treat successfully. Chakofsky-Lewy, who supervises a program for immigrants and refugees, reasoned the trouble could be a combination of physical trauma and emotional pain from fleeing war and relocating thousands of miles from their homeland.

One solution could have been a regimen of pills.

Chakofsky-Lewy had another idea: massage therapy.

So, on a Sunday morning in 2009, about a dozen Somali women in loose-fitting Islamic garb arrived at a South Seattle community center. They drank tea. And volunteer massage-therapy students kneaded the knots out of their backs.

The women soon added yoga to the agenda — with a Jane Fonda tape. The program, called Daryel or “wellness” in Somali, was a hit.

For many who attended Daryel, the pains started to lessen.

“It’s different from going to the hospital and getting medicine,”said Ibado Hassan, 42, a single mother of four who started attending several months ago. “You’re not using a drug, but it’s still a medicine.”

Chakofsky-Lewy had addressed the pain, but she also had dragged health care out of the clinic.

Her group at Harborview Medical Center tries to deliver “culturally competent care.” That is, health care sensitive to the diverse cultural backgrounds of patients, many of whom are unfamiliar with Western medicine.

Many of the Somali women had witnessed death and violence in their homeland, a legacy of two decades of civil war that continues to leave much of Somalia in anarchy.

Many fled to refugee camps before making their way to this country. By the end of 2009, about 680,000 Somalis had fled the country and registered with the U.N. High Commission on Refugees, according to UNHCR statistics.

Somali women have played a central role in keeping their often large families together during their migration out of Somalia, placing lots of stress and strain on their bodies.

“A lot of these women would put aside their physical pains because they have to be strong for their kids and their families,” said Aisha Dahir, a Harborview staffer who translates for a Somali woman in the program.

When the women arrived in the United States, they had to find employment and learn a panoply of new skills: banking, paying rent and utility bills, buying insurance, learning English.

“When I came here, I used to cry like a child, really,” Hassan said. “I didn’t know the language, I didn’t know the culture, I was so young. It was another new life. It was so hard.”

The strains of immigration to a strange culture, coupled with past trauma, could have contributed to the pains the women were feeling. The rates of depression and post-traumatic stress disorder increase among populations that have experienced war.

But Somali culture stigmatizes those who seek mental-health treatment. A woman taking pills to treat depression might be called crazy. To persuade a patient to begin a mental-health regimen — medications, counseling, regular checkups — isn’t easy.

So Chakofsky-Lewy skirted the problem. Rather than fight the stigma directly, she proposed treatment without cultural taboo.

Zoe Abigail Bermet, a licensed massage practitioner who has volunteered with Daryel for two years, originally was interested in the program because she thought massage could be a great treatment for trauma.

But she has realized over the past two years how it has grown beyond just massage and yoga.

“Honestly, it’s what health care should look like, you know, where it’s not just one person going to see a doctor for 15 minutes, and they tell you what to do,” Bermet said. “It’s a place where you can talk and ask other people what’s going on with them.”

Yoga classes and massage still are at the heart of the program, but the effects go beyond immediate pain relief. The program offers health education. The women also have a rare opportunity to focus on themselves for a few hours Sunday.

“The main thing they teach a Somali woman is how to take care of herself,” Hassan said. “Mostly, including myself, we don’t take care of ourselves.”

Unlike American women, these women cannot go to a gym, at least not without considerable anxiety because of concerns about modesty. The Somali women say they feel at ease exercising together, all speaking the same language and wearing Islamic garb, which requires them to cover most of their bodies.

On break between a communal yoga class and individual massage sessions, they chat among themselves. They drink Somali chai and sometimes bring Somali food.

Many of the women discovered the program through Harborview, where they receive their health care. But word of the program has spread throughout the community. One woman now brings her mother to the classes.

Chakofsky-Lewy has accommodated the program’s popularity by shifting the venue, finding more volunteer massage therapists and emphasizing the yoga class, which can accommodate more women.

Around a half dozen Somali women gathered in a circle a few Sundays ago to learn yoga postures from their instructor.

While practicing the tree pose, a couple of the women remarked how the stance was reminiscent of the way they used to milk camels. Because the camels are too tall for the women to milk while sitting down, one woman, wearing a deep blue hijab, explained she used to stand on one foot and balance a bucket on her other thigh.

For many, Daryel offers a rare opportunity to gather and enjoy social time. Hassan said she rarely sees other adults during the week, when she cares for her children, runs a day-care center out of her home, shops for groceries and cleans the house.

Now, she said she’s learned to “put everything behind, forget the job, forget the house, forget the children, forget it all and just drop yourself here and enjoy it.”

“The women they talk and they get relief, it’s really … I have to say that I hope this program stays forever,” Hassan said.

Andrew Doughman, a recent University of Washington graduate, originally wrote this story for a global-health reporting class. He can be reached at