People of Egyptian Heritage. People of Filipino Heritage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian American Culture

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Overview/Heritage

The Egyptian people have a strong sense of identity with their country and demonstrate pride in coming from such an old civilization.
The Arab conquest of Egypt around 641 AD spread the Islamic and Arabic culture among the Egyptians.
This long history and the diversity of populations have influenced the value systems, beliefs, and explanatory frameworks Egyptians use in their daily lives.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Overview/Heritage

More than 1 million people of Egyptian ancestry live in the United States.
The highest concentrations are in New York, Los Angeles, Washington, DC; Chicago, and San Francisco.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

The dominant language of Egyptians is Arabic.
The written Arabic language is the same in all Arab countries, but spoken Arabic is dialectical and does not necessarily follow proper Arabic grammar.
For Egyptians in the United States, English is the language of communication in business and contact with American society.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Respect is expected when speaking with those who are older or in higher social positions.
Politeness, adab, is related to what is appropriate, expected, and socially sanctioned.
Truth and reality may be sacrificed for what is appropriate and polite.
Sharing negative news directly or asking for things directly is not polite.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Egyptians tend to be in touch with their inner feelings and are highly expressive of them.
Egyptians tend to share problems and the most minute details about their lives with their trusted circle of insiders.
Because their personal space tends to be small, Egyptians stand and sit very close to each other.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Men, whether strangers or acquaintances, touch each other.
Similarly, it is acceptable for women to touch each other.
Women tend to keep male friends as far away as male strangers.
Traditionally, it is unacceptable for women and men to touch each other unless they are close family members.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Touch between the sexes is accepted in private and only between husbands and wives, parents and children, and adult brothers and sisters.
Devout Muslim men and women do not touch each other, even a handshake is not practiced. In these situations, a nod of the head substitutes for a physical greeting.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Egyptians speak with their mouth, face, hands, and their entire bodies communicating the meaning of their language.
Their facial expressions are mirrors of their internal processes and reflections of their inner evaluations of their situations. A wide-eyed gaze to a child means “stop it now.” A wink to an adult means “watch what you are saying.”

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Egyptians think of those who do not maintain eye contact or who have shifty eye contact as people who should not be trusted.
Among the more traditional, women and men who are strangers may avoid eye contact out of modesty and respect for religious rules.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Most older Egyptians cherish the past, whereas most younger Egyptians live in the present.
Social time takes a high priority, and engagements are not concluded because of other scheduled appointments; therefore, guests are expected to arrive 1 to 2 hours late.
However, they are punctual for business engagements and meetings.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Communication

Children are given a first name; the father’s first name is used as the middle name; the last name is the family name. A person is called formally by the first name, such as Mr. William.
Respect is demonstrated in the use of titles. Older people should never be called by their first name without an adjective or title.
The accepted U.S. custom of addressing clients by their first name may be insulting to Egyptians.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and
Organization

The demands of life on immigrants and nuclear families promote sharing responsibilities and decision-making.
To preserve traditional roles that contribute to a more egalitarian family organization, family roles change considerably after immigration.
The absence of an extended family results in greater fluidity in roles and participation in all family matters.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and Organization

Social status is gained through professional accomplishments, financial success, and involvement in Egyptian community affairs.
Children are treasured in the present and viewed as security for their parents’ future. During their early years, they are expected to be studious and goal-oriented, respectful, and loyal to the family.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and
Organization

When children become adults, they are expected to take care of their elderly parents.
Religious beliefs and teachings forbid premarital sex and adultery for both Egyptian Muslims and Christians.
The greatest calamity that may happen in an Egyptian household is to have a daughter lose her virginity before marriage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and Organization

This fear stems from a potential lack of marriageability of the daughter, loss of face for the father, and gossip within the community.
Egyptian children are expected to marry Egyptians. However, because many second-generation Egyptian Americans do not reside in areas with an abundance of Egyptians, cross-cultural marriages are becoming more common.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and
Organization

As Egyptians grow older, they are treated with gentleness and are never made to believe that their usefulness is limited because of retirement.
Their children and extended families are obligated to care for them.
Women gain status with age and with childbearing.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and Organization

Many older people have a morbid fear of being forced to move into a nursing home.
Many consider returning to their home country to avoid the humiliation of aging in America.
Divorce is not considered a stigma but an unfortunate situation and one in which the children pay the greatest price.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Family Roles and Organization

Communal and same-sex families are a concept that does not exist in Egyptian societies.
Same-sex relationships are rarely disclosed.
To be gay or lesbian is considered immoral and is not accepted by any Arab or Middle Eastern religions.
To discover a gay son or lesbian daughter is akin to a catastrophic event for Egyptian Americans.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

An older Egyptian man comes to the Emergency Department with acute abdominal pain. He is unable to speak English. What language will you request from the language line?

a. Spanish.

b. Arabic.

c. Farsi.

d. Urdu.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: B

Although the patient’s language is not know at this point, most Egyptians speak Arabic.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Workforce Issues

Egyptian expect detailed and careful explanation of all aspects of their job.
Egyptians are inclined to an oral tradition; therefore, the need to document in writing what can be shared verbally seems foreign to Egyptian American nurses.
Egyptians are usually punctual and follow work rules and procedures.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Workforce Issues

For Egyptians, the work environment is their social environment.
The emphasis on privacy and separating work and social life expected in American work settings seems artificial to Egyptian Americans.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Biocultural Ecology

Most Egyptians have olive skin tones; some are fair-skinned; and others are dark-skinned.
Northern Egyptians exhibit a fairer complexion than most other Egyptians.
Southern Egyptians (Nubians) are generally black, with very fine facial features.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Biocultural Ecology

Egyptians health concerns, primarily from environmental cause from the Nile and lifestyles include schistosomiasis, filariasis, trachoma, typhoid and paratyphoid fevers, streptococcal disease, rheumatic fever, tuberculosis, cardiovascular disease, and thalassemia.
Some evidence indicates that Egyptians are poor metabolizers of beta blockers.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian High-Risk Health Behaviors

Although some Egyptian Americans may overindulge in alcohol, the teachings of Islam prohibit its use.
Many who drink alcohol tend to do so socially and in limited quantities.
Exercise is not part of the daily lives among most Egyptians in America.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian High-Risk Health Behaviors

Overeating food delicacies that are high in fat, sodium, and sugar; sedentary lifestyles; and an entertainment style based on eating contribute to obesity and immobility.
Egyptians are at risk for stomach and intestinal problems, which include heartburn, flatulence, constipation, hemorrhoids, and fecal impaction. These conditions result from limited roughage, lack of fluids, and rapid consumption of food.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian High-Risk Health Behaviors

Pap smears and mammograms tend to be new preventive health practices for Egyptians.
Pap smears for unmarried women are discouraged and are considered totally unacceptable in unmarried females due to the value of virginity until marriage.
Gynecologic examinations are given only to married women, usually during the check-up for a first pregnancy.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Food is an important component of Egyptian social life and represents friendship, generosity, and nurturing.
The more food a person eats, the greater the potential expectation for health.
Thus, children tend to be overfed. Food is also associated with the ability of the head of the family to provide for family members.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Egyptians prefer not to drink water or fluids with meals because they believe that fluid displaces the volume that could be used for food, decreasing their appetite for solid nutrients.
Some believe that fluids dilute the stomach “juices,” making digestion difficult and causing indigestion.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Most Egyptians consider meat dishes as main dishes, complemented by vegetables and rice.
Preferred meats are lamb, chicken, beef, and veal.
They drink strong tea with hot milk or mint leaves with several teaspoons of sugar several times a day. Those who prefer tea without milk drink it with mint leaves.
Coffee, a habit acquired from Turkish rule is thick, strong, and served in small demitasse cups with or without sugar.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Hostesses insist on giving guests excessive amounts of food and act insulted if guests refuse the food.
Those who understand the ritual may insist on refusal or may take the food and not eat it.
Completely emptying the plate may be seen as an indication that the guest did not have enough to eat.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Whether in Egypt or in America, devout Muslims do not consume pork or drink alcohol.
Egyptians do not mix hot and cold or sweet and sour foods at the same meal.
Egyptian Christians fast for a varied number of days for several major religious celebrations. For them, fasting constitutes not eating any animal products.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Nutrition

Many rituals are revived during the month of Ramadan.
Fasting during Ramadan precludes taking anything by mouth or intravenously and abstaining from sexual activities during the day.
Most Egyptian Muslims eat only well-cooked meat and do not touch rare meat.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Pregnancy and
Childbearing Practices

Although Egyptians in America may practice family planning and birth control, these practices are not used before conceiving the first child.
A couple is not complete until they have a child.
Pregnancy brings women a sense of security and their husbands’ and in-laws’ respect.
Giving birth, particularly to a son, considerably strengthens the status and power of women.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

A genetic condition common among Egyptians is

Tuberculosis

Filarisis.

Thalassemia

Hemophilia.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

Thalassemia is a common genetic condition among Egyptians. Filarisis and tuberculosis are not genetic.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Pregnancy and
Childbearing Practices

Women are expected to curtail physical activities during pregnancy for fear of miscarriage.
Women are also advised to eat more because they are feeding two.
Some women have waham (strong cravings) for certain foods. If these foods are not consumed, babies may be born with the imprint of the needed foods.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Pregnancy and
Childbearing Practices

When a woman goes into labor with only her husband in attendance, it is considered an emergency.
Acculturated Egyptian men want to be included in the birthing experience, which may offend Egyptian newcomers.
The cold and hot theory for health and illness may prevent women from bathing during the postpartum period. Bathing or hair-washing could expose them to colds and chills.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Pregnancy and
Childbearing Practices

The postpartum period lasts 40 days during which new mothers are expected to rest, eat well, be confined to the house with their babies, and not engage in any sexual activities.
They are usually cared for by family members and are not expected to have any demands put on them. Chicken and chicken soup help women during their postpartum transition.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Death Rituals

Most Egyptians react vigorously and dramatically to the loss of a family member, expressing their grief outwardly.
Wailing and public crying occur on first learning of death.
This public reaction is an expected demonstration of their grief for the deceased.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Death Rituals

Older people speak calmly about their own impending death.
Egyptians with a strong religious foundation do not fear the nearness of death; they consider it a journey to another world that is believed to be better.
Egyptian Muslims and Christians believe in an afterlife and expect rewards for good deeds accomplished in their first life.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Death Rituals

Among Muslims, Islam calls for burial of the deceased as soon as possible.
The burial ritual includes cleaning the body and wrapping it in a white cotton wrap.
Verses from the Qur’an are read, and a special prayer is recited at the mosque before the body is buried underground in a simple tomb.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Spirituality

On the night of the burial, friends and family gather to give their condolences and respect to the grieving family.
Some Muslim families insist on having the deceased buried in Egypt.
Forty days after the burial, another mourning ritual takes place in the home of the deceased’s family. Family members listen while passages from the Qur’an are read by a religious man to console the family.
A ritual also takes place on the anniversary of the death.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Spirituality

Prayers, even for the nondevout Muslim or Christian, are significant during times of illness.
Egyptians may bring the Qur’an or their Bible to their hospital beds and usually put it under the pillow or on the bedside table.
Prayers may be recited by the individual, in groups for Muslims, or in religious settings such as mosques or churches.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Spirituality

Muslims who can afford the expense and are in good health make the pilgrimage to Mecca sometime during their lifetime.
The journey is thought to provide Muslims with a source of inner fulfillment.
Before praying, Muslims must engage in a purification ritual, which consists of washing every exposed body part.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Spirituality

Prayer, required five times daily, consists of elaborate bending and kneeling movements in systematic ways, increasing a person’s range of movements, limbering stretches, and meditative poses.
Religion and prayers are believed to provide protection from illnesses.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptian health care is influenced by ancient Greek, or unani, medicine, and by humoral systems.
The principles behind the humoral system are based on dividing many aspects of life into four: the year into four seasons; matter into fire, air, earth, and water; the body into black phlegm, black bile, yellow bile, and blood; and the environment into hot, cold, moist, and dry.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians believe that cold and moist environments cause illnesses by changing from cold to hot or vice versa; the opposite humor is used for treating the illness.
Egyptians believe that suddenly being presented with bad news without preparation causes illness.
Although a person’s mental and physical health is intricately interwoven, treatment sought from the health-care system is focused on physical or biomedical treatment.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Once in the health-care system, they prefer immediate, personalized attention.
They value tests and prescriptions for their illnesses and follow medical regimens and prescriptions carefully.
The family expects and prefers to be involved in all health-care decisions.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians usually handle mental health problems outside the health-care system.
Egyptians tend to manifest symptoms of mental health problems somatically and seek medical care to deal with the physical manifestations of mental conditions.
Most Egyptians in America join an HMO or have private medical insurance. Even though they may refuse to have life insurance (Islam does not condone insurance), they realize the importance of quality health care.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians practice self-medication and tend to share medications freely.
They use Western medications as well as home remedies such as herbs, hot compresses, and hot fluids and foods.
Egyptians in America frequently get their supply of medications from their home country or friends.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

A person who is trying to get rid of an illness wears the hegab, an amulet with sayings from the Qur’an.
Some also use the amal, which is designed to bring bad luck or illness to an unloved person. Egyptians believe the “evil eye” is responsible for personal calamities.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

The evil eye is more easily cast by those who have light colored eyes, by those who tend to speak of an admired person or object in a boastful manner, or by the mere description of beauty, wealth, or health without saying some verses from the Qur’an or Bible.
These verses protect the person from losing whatever good they possess.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Some use blue beads or religious verses inscribed on charms to protect them or their children from the evil eye.
Children are particularly at risk for the evil eye and need more protection than adults.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians tend to be verbally and nonverbally expressive about pain.
Although they tend to be more constrained in front of health-care professionals or other “strangers,” they are quite expressive in front of family members, using grunting, pushing, screaming, or guttural sounds or gasping for air.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians present a more generalized description of pain, regardless of whether it is localized.
They usually describe general weakness, dizziness, or overall tension and stress associated with pain. They also use metaphors reflecting humoral medicine such as earth, rocks, fire, heat, and cold to describe their pain.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Psychosomatic interventions are more effective than psychologically-based interventions such as counseling or psychoanalysis.
Egyptians prefer to seek therapy and counseling, they prefer to seek the advice of family members or trusted friends rather than strangers.
They also do not like to refer to treatments as psychotherapy or analysis.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians tend to hide their disabled family members from others for fear of evoking reactions of pity.
They are open with health-care professionals in the hope of receiving better health care.
Rehabilitation programs that include drastic changes in lifestyles are less appealing if the programs are not scientifically supported

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Sick people are not expected to participate in programs to enhance their self-care capabilities. Rather, they are expected to preserve their energy for healing.
Sick people are also relieved from making major health-care decisions; their families make these decisions for them.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practices

Egyptians have no taboos against blood transfusions or organ transplants.
Their trust and respect for the health-care system and health-care professionals facilitate their decision-making.
They are hesitant, however, to pledge their own organs to others or to permit an autopsy because of their belief in the afterlife.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practitioners

Egyptians believe that physicians and nurses are experts and are caring and responsive to the needs of their community.
Using the services of acupuncturists, podiatrists, chiropractors, and physical therapists is foreign to those not integrated into the American culture.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practitioners

First- and second-wave Egyptian Americans may not consider gender as an important criterion in the selection of their health-care providers.
Third-wave immigrants may prefer same-gender health-care providers, although this preference may be mitigated by their respect for Western medicine.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Egyptian Health-care Practitioners

Physicians are highly respected.
Egyptians prefer physicians affiliated with large, respected organizations because they believe them to be more experienced.
For some, the physician’s age, years of experience, and position in the organization may indicate better qualifications.

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People of Egyptian Heritage. People of Filipino Heritage.

People of Egyptian Heritage. People of Filipino Heritage.

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