Cultural values that impact on the health experience of the patient are derived from the Arab worldview. There are many values and beliefs within the Arab culture. Highlighted here are the values and beliefs that impact on the health experience. These values include the centrality of the family unit in society, cultural health beliefs about health, illness and healing; and the importance of maintaining modesty and dignity of the patient. The values are general in perspective, and traditions will vary in different cultural and social contexts.
Cultural Beliefs: Evil Eye and Jinn
Cultural beliefs exist alongside medical and religious explanations for disease and illness in many societies. The belief in the evil eye as a cause for disease is an Arab cultural belief. Belief in the evil eye as a supernatural cause of disease or misfortune is common to many cultures including parts of Asia, Europe, the Middle East, and North Africa. Belief in the evil eye predates Islam, however there is reference to the evil eye in the Qur’an (113:1-5), so this belief is both religious and cultural. It is believed that the evil eye is cast through jealousy or admiration of another person and may or may not be intentional. Newborns, children, and pregnant women are more vulnerable to harm from the evil eye than adults and the elderly. The evil eye may cause illness, misfortune or even death.
The words Masha‘allah’ (what God has willed) provide protection from the evil eye. For example, the admiring person will say ‘Masha’allah’ when congratulating a new mother on her healthy baby. In some Middle Eastern cultures, blue beads or a blue stone such as lapis are worn as protection. Other cultures, such as in the Mediterranean, will use a blue circle with an eye in the middle. To cure the effects of the evil eye (such as sickness, mental illness), a religious person prescribes actions that will always include reading from Qur’an and use of “ruqyah” which are Islamic prayer formulas.
Belief in the jinn as causing illness is another form of blending religion with cultural beliefs. The Qur’an identifies jinn as good or bad spirits and teaches that Allah created humans and the jinn to worship Him. It is believed that the jinn are always around the humans, but cannot be seen. It is believed that jinn may cause abnormal physical or mental behavior, and illness such as epilepsy and schizophrenia are often attributed to possession by the jinn. Curing will require a special religious healer to read from the Qur’an or use of psychology to get rid of the possession. In other cases, a patient or family member may identify the presence of the jinn within a room (such as a hospital room, perhaps where a death has occurred) and request that the religious healer clear the room of the spirits
Traditional medicine and folk remedies are used alongside western medicine in many cultures. Traditional medicine is based on ancient Arabic medicine is a source of traditional medicine in the Middle East. This traditional medicine uses a variety of plants, herbs and healing methods. Although modern pharmaceuticals are available, many people, regardless of educational level, depend on herbal remedies used alongside with modern drugs. Common remedies include use of honey, black cumin seeds, olive oil, dates, with many traditional remedies found in Islamic teachings.
Some folk healing methods may cause harm to patients. Healers may use cutaneous cautery, (referred to as ‘arabic burns; or ‘Al Kowie”) where hot iron rods are applied to the skin. The areas for cautery may include the back neck, back, abdomen, bottom of the foot; often the site of pain. Cautery is generally chosen when conventional medicine has failed, or a chronic medical condition exists. Use of cautery is cultural folk practice not supported in the religion.
Cupping (Hijama) is a pre-Islamic practice from China, Egypt, Greece and Roman times. “Hijama”, meaning sucking in Arabic, is considered a traditional healing method supported in Islam. Suction cups are applied to the skin and the air drawn out to create a vacuum (dry cupping) or a small incision made in the skin and suction applied to suck out blood (wet cupping). Cupping is used for range of conditions from minor aches to treatment of chronic conditions..
Protection of Modesty and Dignity
There is a strong cultural value to maintain modesty and dignity; and this is further emphasized in the religion. The need to protect modesty and dignity in the health care encounter arises from the religious requirement to preserve chastity and purity. Hejab, meaning separation is the Islamic value that underpins expectations for gender-specific caring and gender separation as interpreted through a cultural lens.
Some Muslim women wears a scarf (hijab) covering their hair. The hijab must be handled with respect (e.g. not to put it on the ground). Before entering the room of the patient, in particular if a male person will enter the room, it is important to knock on the door, asking the patient’s permission and allowing the woman enough time to cover herself before the male person enters the room.
Chastity is a fundamental value for both genders, but of greater significance for females. Sexual relations outside of marriage are prohibited, and the need to protect ‘aura’ (meaning parts of the body to be covered) is important. For a man, aura includes parts of the body from the navel to the knee while a woman must cover all the parts of her body except the hands and face. During examination of patients, the patient (male or female) must never be uncovered or left exposed and privacy (e.g. closing curtains or doors) must be maintained.
There is no religious or cultural requirement for gender separation in all caring encounters, with patient expectations for gender-based caring dependent on the degree of conservatism within the culture. In some cases, same-gender caregivers may need to be assigned; alternatively the care plan altered if this is not possible.
Cultural values around gender impact on the caring interaction and use of touch, a fundamental aspect in caring. Islamic teachings restrict or prohibit touching between unrelated males and females in order to prevent immoral behavior, however does not preclude physical contact where there is justification and need. Gender-specific caring is more important in maternity or gynecological care.
Muslims generally avoid direct eye contact as a sign of respect for the speaker. Touching between members of the opposite gender, including shaking hands, hugging or patting the shoulder are generally not acceptable. Eye contact between same genders is acceptable. When providing care to a patient, especially of the opposite gender, it is important to use gloves, or keeping a layer of cloth between the nurse and the patient to minimize direct skin-to-skin contact with the patient.
A cultural belief is the preference for using the right hand for procedures, giving medication, handling of food. It is a cultural belief that the right hand is ‘clean’ and the left hand is disrespectful. However, if a person is left-handed, it is acceptable to use the left hand for doing procedures (with explanation), for example, giving an injection.