The Middle Eastern Community

It is estimated that there are over 5 million Arabic immigrants now living in the U.S. Most of whom, still adhere to the values, traditions and belief system of their own culture. What we as nurses must be aware of, is that their unique cultural outlook and social behavior may cause communication problems when they enter the American health care system. The following aspects of Arab/Islamic behavior lead to the greatest misunderstandings: The involvement of the Arabic male in all aspects of health care for his wife and children. The great significance of female modesty and their low threshold to pain; The significance of the traditional female role and their subordinate status. their low threshold to pain; The importance of procreation of male heirs.

Nurses who care for Arabic women must seek to understand their cultural background. We must also be aware of the fact that there are millions of Arabic Americans whom must observe prayer 5 times a day, even during times of hospitalization.

PRIVACY:
Muslims, as a whole, tend to be reluctant with "sharing" or disclosing detailed information about themselves with strangers, including medical professionals.

Being a conservative culture, they are generally uncomfortable and embarrassed by questions regarding their sexual relationships and other personal questions. Seeking out medical attention for sexually transmitted diseases or other issues that are sexual in nature is difficult for all Arabs, but it is especially difficult for the Arab woman to deal with. Because of their extremely private and shy nature, Arab women will only seek out help from women practitioners.

RELIGION:
The majority of Arabs are Muslims. Many Muslims are conservative in their religious beliefs. They do not eat pork or drink alcohol. They observe a fast in the daytime during Ramadan. Some Muslim women living in the U.S. still wear long dresses and scarves to cover their body.

HEALTH PRACTICES:
Some will wear amulets for protection against "the evil eye", while others burn incense to keep "the evil eye" away from the sick. These practices, although steadily declining, are still used primarily to avoid illness and to protect a healthy individual from enduring sickness. Also, prayer readings from Al Quran or the Bible help enhance the patient's recovery in addition to providing comfort to family members. Arab culture and Islamic religion emphasize maintaining good health, especially through personal hygiene practices and a healthy diet. They place great value in modern Western medicine and have confidence in the medical profession. The patient and family will not wait long to seek professional help and are usually anxious to receive a medication as soon as possible. They will listen carefully and adhere strictly to the health care provider's advice, explanations and warnings, and will follow the provider's directions, except for the fact that many Arabs, once symptoms have improved, believe there is no longer any need to continue with a medicine regime so they will stop taking the prescribed medication or will not return for a scheduled follow-up appointment. An individual who becomes sick will turn first to the family elders for support, comfort and medical advice, because elders carry a very prestigious status in the Arab family because of their wisdom and experience. Elders prefer to recommend safe, simple home remedies. Arab Americans, who makes a visit to the doctor for any reason, expects to

receive treatment in the form of medication. For example, an Arabic patient who goes to the doctor in pain expects to receive medication for pain relief. If they have not been prescribed any medications, they expect an explanation as to why they are not being treated with medication. They also expect to know the reason for any labs or diagnostic tests that have been ordered, and please note, these explanations are only well-received from doctors themselves and not by nurses. Nurses are perceived as helpers only, they are not seen as care professionals, therefore any suggestions or advice from a nurse is not taken seriously. Doctors may need to explain the importance of the nurse's role to the patient. In addition, generally both male and female Arabs prefer to be seen by male doctors only. In addition they are not accustomed to the profession of psychiatry or social workers. They prefer to rely on their families and close friends for mental health support. It is common for a family member to stay with the patient in order to help answer questions regarding the patient's health. In Arab countries, people who are sick are told only the good news regarding their illness. In severe or terminal cases, the doctors will report the seriousness of the illness and its likely consequences to a chosen close member of the patient's family, not the patient.

Birth & Woman's Health:

For pregnancy or gynecological needs, Arab women do prefer a female doctor, because in the Arab culture, women are very reluctant to discuss female issues or concerns with any man, even a Doctor.
Most Arabs consider childbirth to be a female issue only. A woman in labor is usually surrounded by female relatives and friends. Traditionally, men are not admitted to the labor room but female relatives and friends surround women in labor. Midwives play an important role in prenatal, delivery and postnatal care. In more recent times in the U.S., men are beginning to be present at the time of the baby's birth, not necessarily during the woman's labor. Christians prefer to be seen by a female health Care Professional but can be seen by a male. Muslim women will refuse to see a male Health Professional because of modesty. Baby Care: Arabic mothers prefer to breastfeed their newborns. Newborn

babies may be wrapped with several blankets as it is believed in their culture to straighten the backbone. It is traditional for Arabic families to circumcise newborn boys. Contraception: Arabic mothers may not approve of abortion and although they are of the Christian religion they do believe in contraception. In the Arab Culture there is a strong sense of Paternalism what most Westerners call "Male Dominance". What is so important to the balance of the subject is to understand that the females role is equivalent and she is the maternal powerhouse in the home. Men by culture give orders, but by the faith of Islam they are the "protectors" of their families. They do take orders from their womenfolk but within the construct of the family but it would be disrespectful to do so socially. 1

1- A 27 year old Arab man refused to allow a male lab technician to enter his wife's room to draw blood. She had just given birth. The staff finally convinced the husband of the need, he reluctantly allowed the technician in the room. However, he took the precaution, of making sure his wife was completely covered. Only her arm stuck out from beneath the covers. For Arab families, honor is one of the highest values. Since family honor is dependent on female purity, extreme modesty and sexual segregation must be maintained at all times. 2- Male nurses should not be assigned to female Muslim patients. In many parts of the world, female purity and modesty are major values. In this instance his sense of responsibility and need to protect her modesty from very much an "intrusive" health care experience

for the most part could be curbed by a simple sign placed on the door that says "Please Knock before entering. This patient observes modest dress and requires the announcement of your presence." This would help communicate to the patient and her husband that we as healthcare professionals, understand and wish to honor their modesty. This is empowering for the family. 3- Whenever patients or their families are rude or pushy we need to ask ourselves.... What is the underlying motive behind rudeness?
4- Muslims. http://islamicweb.com/begin/population.htm 5- Other helpful resources: http://www.freep.com/legacy/jobspage/arabs/index.htm

Building Cultural Competencies and Dispelling Myths - 10 Questions to Foster Understanding of Arab and Muslim Americans Submitted By: Laurie Trousil, Multicultural Development Center - The Multicultural Center is a community partner of Northwestern Health Sciences

University. For more information visit www.mcdc.org. With the beginning of the school year as well as the start of the Ramadan fast we designed this quiz for you to assess your knowledge of Arab culture and of Islam, and to provide you with resources and information that will help you to better understand and interact with Arab and Muslim colleagues, clients, students and friends. Keep track of your score; answers will be given at the end of the quiz. True or False: Ramadan always begins on September 1st. Which of the following is NOT considered an Arab country? a. Iraq b. Iran c. Oman d. Kuwait True or False: Most Arab Americans living in the United States are Muslim. True or False: Arab Americans are largely uneducated, employed in lowpaying, low-skilledjobs. During the daylight hours of the Ramadan fast, Muslims are not supposed to Drink water Smoke Eat All of the above The largest number of Americans with Arab heritage originate from this country Egypt Lebanon Iraq Saudi Arabia Which of the following is NOT one of the five pillars of Islam? Hajj - the Pilgrimage to Mecca Salah - prayer 5 times per day Hijab - wearing the veil

Sawm - the Ramadan fast True or False: Maronites, Copts and Chaldeans are all Arab Christian groups. Name three famous Arab Americans _______________________________________ _______________________________________ _______________________________________ True or False: In terms of population, the largest Muslim country in the world is Saudi Arabia. ANSWERS: 1.Ramadan always begins on September 1st - FALSE. Ramadan is the 9th month of the Islamic calendar. Because the Islamic calendar is based on the moon/lunar cycles, it does not directly coincide with the Gregorian calendar used in Western countries. The lunar calendar is about eleven days shorter than the solar calendar; thus, Ramadan is approximately eleven days earlier each year. In 2008, Ramadan began on September 2 (September 1 in some Muslim countries, depending on the sighting of the moon). In 2009, Ramadan is scheduled to begin on August 21. http://www.islamawareness.net/Calendar/Ramadan/qanda.html 2. Iran is not considered an Arab country. 3. The majority of Arab Americans are Christian: Roman/Eastern Catholic (35%), Eastern Orthodox (18%) and Protestant (10%). Only 24% of Arab Americans are Muslim. The Arab world is culturally rich and complex, as well as diverse; it includes 22 countries. Arab people share commonalities such as language, history, culture, food, law, traditions and values. http://www.adc.org/index.php?id=1172 Because Iran is a Persian country, having a different language, history, and traditions, contrary to popular belief, it is not an Arab country. http://www.persiansarenotarabs.com/persian-culture/ 3. Most Arab Americans living in the United States are Muslim - FALSE. The majority of Arab Americans are Christian: Roman/Eastern Catholic (35%), Eastern Orthodox (18%) and Protestant (10%). Only 24% of Arab Americans are Muslim. http://www.aaiusa.org/arab-americans/22/demographics 4.Arab Americans are largely uneducated, employed in low-paying, low-skilled jobs - FALSE.

Approximately 85% of Arab Americans have at least a high school diploma. More than four out of ten Arab Americans have a bachelor's degree or higher; significantly higher than the national average (24%). Seventeen percent of Arab Americans have a post-graduate degree, which is nearly twice the national average (9%). Seventy-three percent of working Arab Americans are employed in managerial, professional, technical, sales or administrative fields. The median income for Arab American households in 1999 was $47,000, compared with $42,000 for all households in the United States. http://www.aaiusa.org/arab-americans/22/demographics 5.During the daylight hours of the Ramadan fast, Muslims are not supposed to - D. ALL OF THE ABOVE. Muslims who fast abstain from eating, drinking, smoking, swearing, bad thoughts and intimate relations with their spouse during the daylight hours of Ramadan. It is a time for Muslims to contemplate their faith by actively increasing in worship, prayer and reciting the Qur'an. It is an opportunity for spiritual as well as physical purification. Many Muslims also feel that the Ramadan fast gives them greater understanding and compassion for those less fortunate who do not always have food to eat or clean water to drink. http://www.imuslimz.com/?p=135 6.The largest number of Americans with Arab heritage originate from this country B. LEBANON Lebanese Americans constitute the greatest part of the total number of Arab Americans residing in most states, except New Jersey, where Egyptian Americans are the largest Arab group. Americans of Syrian decent make up the majority of Arab Americans in Rhode Island, while the largest Palestinian population is in Illinois. The Iraqi and Assyrian/Chaldean communities are concentrated in Illinois, Michigan, and California. http://www.aaiusa.org/arabamericans/22/demographics 7.Which of the following is NOT one of the five pillars of Islam? C. HIJAB WEARING THE VEIL (FOR WOMEN) The 5 Pillars of Islam are - Shahada/Iman (Declaration of Faith) - Salah (Prayer five times per day) - Zakah (Giving Alms) - Sawm (The Ramadan Fast) and - Hajj (Pilgrimage to Mecca). http://www.islam101.com/dawah/pillars.html 8.Maronites, Copts and Chaldeans are all Arab Christian groups - TRUE.

Contrary to popular stereotypes, not all Arabs are Muslims. Arab Christians are people who are ethnically Arab but are followers of Christianity. Large numbers of Arab Christians can be found in Egypt, Syria, Iraq, Lebanon, Israel and the Occupied Territories, and in the United States. The largest concentration of Arab Christians is found in Egypt (Coptic Christians), numbering over six million and comprising 10% of the population. Lebanon contains the highest percentage of Arab Christians; the country is approximately 48% Christian (over 1.8 million mainly Maronite, with sizable numbers of Greek Orthodox, Syrian Catholic and other churches). In Syria, Christians form just under 15% of the population at about 2.7 million. About 6% (over 192,000) of all Palestinians are Christian. There are significant Christian populations in Iraq, including Assyrian and Chaldean Christians. There are many communities of Roman Catholics in Tunisia, Algeria and Morocco. http://www.nationmaster.com/encyclopedia/Arab-Christian 9.Name three famous Arab Americans There are many Americans of Arab descent that have made significant contributions in a variety of fields. Some of the more well-known are: Paula Abdul (singer-dancer-choreographer and American Idol judge) General John Abizaid (head of U.S. Central Command in Iraq) Dr. Michael DeBakey (Houston surgeon who invented the heart pump) Shannon Elizabeth (actor in "American Pie", "Scary Movie" and "Tomcats") Jamie Farr (Corporal Klinger on the TV show "M*A*S*H") Doug Flutie (San Diego Chargers quarterback and 1984 Heisman Trophy winner) J.M. Haggar (started Haggar Clothing Co.) Lisa Halaby;aka Queen Noor (married King Hussein of Jordan and became the only Arab American to be queen of a foreign country) George Latimer (former Mayor of St. Paul, MN) John Mack (Chairman of the Board and CEO of Morgan Stanley) Christa McAuliffe (schoolteacher and astronaut who died in the space shuttle Challenger disaster)

Kristy McNichol (co-star of the series "Empty Nest") George Mitchell (former U.S. Senate Majority Leader) Ralph Nader(consumer advocate and Green party presidential candidate) Kathy Najimy (award-winning comic actress starring in "Sister Act" and "Hocus Pocus") Paul Orfalea (founder of Kinko's) Bobby Rahal (all-time earnings champ among Indy car racers) Joe Robbie (former owner of the Miami Dolphins) George Shaheen (founder and CEO of Andersen Consulting, now called Accenture) John H. Sununu (Former Governor of New Hampshire and White House Chief of Staff under President George Bush, Sr.) Vic Tayback (portrayed Mel in TV's "Alice") Andrew Thomas (President and CEO of Heinekin USA) Danny Thomas (comedian, actor and founder of St. Jude's Children's Research Hospital) Helen Thomas (correspondent for United Press International and dean of the White House press corps) Vince Vaughn (actor in "Wedding Crashers", "Psycho", "The Break Up") Frank Zappa (composer, electric guitarist, and film director) For a comprehensive list of famous Arab Americans, visit http://www.aaiusa.org/arabamericans/23/famous-arab-americans 10.In terms of population, the largest Muslim country in the world is Saudi Arabia - FALSE. Home to a total of 196,281,020 Muslims, Indonesia is the largest Muslim country in terms of population. Second place goes to India, having 133,295,077 Muslims and third place goes to China, with 133,100,545 Muslims. http://islamicweb.com/begin/population.htm Other helpful resources: http://www.freep.com/legacy/jobspage/arabs/index.htm {Copyright 2008, MultiCultural Development Center (MCDC)}.