Trust and Mistrust in Traditional and Modrn Ophthalmic Treatments: A Qualitative Study Among Somali Patients

Background The prevalence of avoidable blindness is also high in the Somali population against the backdrop of a fragile health system and a widespread use of traditional eye remedies. What patients experience during transitions between modern ophthalmology and traditional eye practices remains unclear Methods The study used a qualitative exploratory approach and took place in Mogadishu, Somalia (June and September, 2025). Semi-structured interviews were undertaken with a sample of 30 participants (15 patients, 10 traditional eye healers, and 5 ophthalmic care providers), with additional data garnered through three formal focus group discussions stratified for the different categories of participants. The data consisted of translations into English and analyzed using the NVivo 12 program. Results Findings are presented in the form of three overarching themes. (1) “Cultural legitimacy of traditional eye care” : The herbal and Islamic treatments were presented as a cultural inheritance that is “divinely ordained,” thus creating a degree of authenticity and “externality” of the hospital modality. (2) “ Efficacy and distrust of modern eye care practices” : Participants showed concern over eye surgery and “powerful chemicals” used in eye drop formulations, and doubted the sincerity of the providers and the consistency of the system at the Somali hospital. (3) “Barriers and facilitators of eye care at the Somali hospital and beyond” : The distance, insecurity, and lack of capacity within Somali ophthalmology led to a persistence of local traditional practices even when patients were aware of the advantages of the modern system. Conclusions The final conclusions are that decisions relating to eye care for Somali patients are complex and interlink closely with cultural, religious, relationship, and structural issues. The following are required if avoidable blindness is to be alleviated: (i) traditional eye healers must be drawn into the early referral and diversion away from harmful practices, and (ii) culturally specific counseling must be undertaken, taking into account religion and custom but also seeking to demystify surgery and medications. Trust and infrastructure are essential and must be addressed if eye care success is to be achieved in Somalia.