As people flee war and political upheaval in Syria and Libya by the tens of thousands – and the Obama administration pledges to accept 100,000 refugees a year by 2017 – a recent talk at Dana-Farber on providing care to Arab populations was especially timely.
The September 22 talk, by Anahid Kulwicki, PhD, RN, dean of the College of Nursing and Health Sciences at the University of Massachusetts Boston, focused on cultural factors to consider when caring for people of Arab heritage, whether recent immigrants or members of longstanding Arab-American communities. Kulwicki, who spent many years working in Dearborn, Michigan – the city with the greatest concentration of Arab Americans – described how sensitivity to aspects of Arab life can avoid misunderstandings and improve the relationship between patient and clinician.
She began by noting that the Arab world is far from homogeneous.
“Arabs are a majority of the population in 22 countries, in the Mediterranean region, Asia, and Africa,” she said. “There are wide differences from one country to another, which influences people’s expectations about health care.”
Patients from wealthy Arab nations, such as those in the Arabian Gulf area, are accustomed to lavish, government-paid health programs, she said, whereas patients from poorer nations might feel privileged simply to be seen by a physician. While hospitals in the Boston area often attract patients from wealthy Arab families, many from poorer backgrounds are treated here as well.
Kulwicki, who was born in Lebanon and has studied, worked, and traveled widely in the Arab world, described some of the traditional cultural characteristics of Arab peoples, noting that many of these are changing as Middle Eastern countries race to modernize and Westernize.
Traditional Arab life is centered on the extended family and the tribe, she said, with well-defined roles for men and women.
“Children are valued and indulged, and elders are respected,” she remarked. “One’s behavior reflects on the family.”
All of these traits may be expressed in a health care setting. Women are brought up to behave modestly and quietly in public, Kulwicki noted, but clinicians shouldn’t interpret this to mean they’re subservient to their husbands or disengaged from medical issues: They speak their mind in private. In traditional Arab culture, men are expected to provide for their families. If a man isn’t able to find a job in the U.S., it’s not unusual for his wife to berate him for not meeting his responsibilities, she explained.
The practice of indulging children may lead to behavior that, to American eyes, seems overly unruly or disruptive. An aversion to providing personal information to strangers, and a hesitancy about sharing one’s concerns or needs, may make some Arab patients appear uncooperative, when in fact they are merely following cultural norms, Kulwicki said.
She urged clinicians to partner with community organizations such as mosques or cultural centers to help bridge the gap between American health care practices and the backgrounds and expectations of Arab patients.
Said Patricia Reid Ponte, RN, DNSc, senior vice president for Patient Care Services and chief nursing officer, “As our volume of patients from other countries increases in both the adult and pediatric programs, it’s vital that we be able to provide care that is sensitive to these patients and their families. Dr. Kulwicki’s talk offered some important insights in this regard for our Arab-speaking patients.”
Watch Anahid Kulwicki’s talk here.