The Arab World: Society, Culture, and State

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The Middle Eastern Community

The "Arab World" includes 22 countries in the Middle East and North Africa, with a population of 180 million.  Arabs are inhabitants of the Arab World who speak various dialects of the Arabic language and share the values and beliefs of the Arab culture. 

Religion The majority of Arabs are Muslims. There are a large number of Arab Christians in Lebanon, Syria  Palestine, Iraq and Egypt. Many Muslim Arabs who are conservative in their religious beliefs do not eat pork or drink alcohol. They observe a fast in the daytime during Ramadan. Some Muslim women wear long dresses and scarves to cover the body. 
We as nurses should recognize that there are over 7 million Muslims in America, and over 1.5 billion world wide all of whom must observe prayer 5 times a day. 

Health practices : Some people wear amulets for protection against the evil eye or will burn incense to keep the evil eye away from the sick. Such practices are declining and are used primarily to avoid illness and harm to a healthy person.  Also, prayers and reading from Al Quran or the Bible help give comfort to patients and family members and enhance the patient's recovery. 

Arab culture and Islamic religion emphasize maintaining good health, especially through personal hygiene practices and a healthy diet. They place a high value in modern Western medicine and have confidence in the medical profession. 
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 answer questions, will listen carefully to the health care provider's advice, explanations and warnings, and will follow the provider's directions carefully. Once symptoms have improved, many patients will stop taking the prescribed medication or will not return for a scheduled follow-up appointment.

An Arab patient seeing a doctor expects relief from pain and to receive a medication on the first visit. Patients like doctors to explain the reasons for not getting medications and for all laboratory testing. Nurses are perceived as helpers, not health care professionals, and their suggestions and advice are not taken seriously. Doctors may need to explain the nurse's role to the patient. Arabs are not accustomed to the profession of social workers. They rely on their families, other relatives and close friends for support and help. 

Generally, both male and female Arab patients and their children prefer to be seen by male doctors. For pregnancy or gynecological needs, women prefer a female doctor, however. In Arab culture, women are reluctant to discuss these concerns with men. It is common for the family member to stay with the patient and to help answer questions about the patient's health. In Arab countries, patients are told only the good news about their disease. In severe cases, the doctors generally report the seriousness of the illness and its likely consequences to a selected family member.
Arabs believe that recovery from illness has to do with seeking a professional treatment and submission to God's will.  They consider death to be a destiny decided by God. Family members need to be with the body until it is ready to be removed from the hospital. Muslims prefer to bury the body on the day death occurs. 

Social customs :  Elders have a prestigious status in the Arab family because of their experience. Family members look to elders for advice. An individual who becomes sick will turn first to family members, especially elders, for support, comfort and advice. They may recommend safe, simple home remedies. 
When a patient is admitted to the hospital, it is a social obligation for friends and family to visit and bring presents such as flowers, cookies or chocolate. 
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 her 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 for it would be disrespectful to do so socially. 1

Maternal and child health : Most Arabs consider childbirth to be a female issue only. A woman in labor is usually surrounded by female relatives and friends. Fathers are not admitted to the labor room. Midwives play an important role in prenatal care, delivery and post delivery consultation and are held in high regard in society and in the medical profession. Arab women prefer to breasted their newborns. Arabs in general do not approve having an abortion. 
It is an Arab tradition to circumcise newborn boys. 

Privacy :  Some Arabs are reluctant to disclose detailed information about themselves and their families to strangers. They tend to give as little information as possible and may not give enough for a proper diagnosis. Being conservative, they may be embarrassed by questions about their sexual relationships and other personal questions. 
Sexual problems and venereal diseases are difficult for Arab patients to deal with. Women are shy to talk about their private lives and may feel more comfortable with women doctors. 
Typically, Arabs look down on people who are mentally ill. Patients with mental health concerns do not like to share this information with their relatives or friends and are shy of seeking professional help.

Diet :  Diet may be an issue for Muslim patients. During Ramadan, many patients resist taking medications or eating during the daytime. Since Muslims do not eat pork, patients may not eat all hospital meals. Some eat only Halal meat (meat from animals slaughtered according to Islamic tradition). Because of shyness, fear of rejection, or lack of knowledge, many Arab patients will not ask for different meals. 

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. 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 pt. observes modest dress and requires the announcement of your presence."  This would help communicate to the pt. and her husband that 
we understand and wish to honor your modesty.  This is empowering for the family.  The rudeness or sense of oppression of the pt. the nurses might have felt would be understandable.  However, when ever patients. or their families are rude or pushy we only need ask ourselves .... What is the underlying motive behind rudeness .... The answer is fear. 

2- When the nurse entered the room of her Iranian patient, she found the patient huddled on the floor, mumbling. At first she thought the patient had fallen out of bed, but when she tried to help her up the patient became visibly upset. She spoke no English and the nurse had no idea what the problem was. The patient had been praying. 
She was practicing her religion in the traditional manner. Since she was scheduled for surgery the next day, she thought it was especially important to pray. 
Devout Muslims believe they must pray to Mecca, the Holy Land, five times a day. Traditionally, they pray on a prayer rug placed on the floor. If the nursing staff had some understanding of Muslim customs, they could have arranged to provide the patient some privacy during certain times of the day so she could pray. 

3- A nineteen-year-old Saudi Arabian woman had just given birth. Her husband moved into the hospital room with his wife immediately after she gave birth. He kept the door to the room shut, and questioned everyone who entered, including the nurses. The nurses were not happy but felt they had no choice but to comply. 
Although the patient could speak some English, the only time she would speak directly to the nurses was when her husband was out of the room. Otherwise, he answered all questions addressed to her. He also decided when she would eat and bathe. As leader of the family, he felt it was his role to act as intermediary between his wife and the world. 
The truth is Labor hurts like hell, and technology is scary as hell, the idea of an epidural is often misunderstood, and many women fear it therefore don't opt for it.  In the faith of Islam,  heaven rests beneath the feet of mothers .....Strange isn't it for a male dominated society.  The truth is women are sacred and revered, often protected, not because she can't handle herself or has no voice, but because the solidarity of the family unit depends on her well being. 1

Nurses need to be culturally competent in the prenatal care of women from Saudi Arabia. A basic understanding of the Arab culture, attitudes, values, beliefs and practices is addressed.

References :
Laffrey, S.C., A.I. Meleis, J.G. Lipson, M. Solomon and P.A. Omidian. "Arab-American Health Care Needs." Social Science and Medicine 29(7): 877-83 (1989). 
Lipson, J.G., A.E. Reizian and A.I. Meleis. "Arab-American Patients: A Medical Record Review." Social Science and Medicine 24(2): 101-07 (1987). 
Meleis, A.I. "The Arab American in the Health Care System." American Journal of Nursing 81(6): 1180-83 (June 1981). 
1 Najah Bazzy R.N.



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