Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Filipino Americans
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage
▪ Almost 2 million in the United States
▪ Literally all speak English and Tagalog (Pilipino),
and many speak Spanish and another language
▪ Predominantly from Malayan ancestry with
influence and mixtures from other Asian groups,
Spanish, and Arab
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
▪ Americanization of the Philippines began after
the Spanish–American War
▪ Immigrant Filipinos make up the majority of
Filipinos in the United States
▪ Unrestricted immigration in the early 1900s then
very restricted in 1924 because of the
Exclusionist policies of Immigration Act of 1924
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
▪ Immigration and Nationality Act of 1965
eliminated the quota system for the Philippines
resulting in large numbers of middle class and
professionals coming to the United States
▪ Included relatives of Filipinos living in the United
States
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
▪ First group were primarily single men who were
brought to the United States to work in Alaskan
canneries, farms in California, and plantations in
Hawaii and endured much discrimination
▪ Most were restricted from owning or leasing land
and could not become US citizens
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Overview/Heritage Continued
▪ After WW II, many Filipino Veterans
immigrated and settled on the West Coast
▪ Now more women than men immigrate to the
United States
▪ Well educated immigrants continue to have
difficulty in finding similar work in the United
States unless they are in the healthcare field
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications
▪ Tagalog is the national language with English the
second official language
▪ Eight other dialects are spoken as well as
Spanish
▪ Taglish is common among immigrants and
American born Filipinos
▪ Highly contextual communication patterns
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
▪ Pakikisama—smoother interpersonal
relationships and sacrifice exact meaning
▪ External or outsider communication and internal
or one-of-us communication proceeds on
different levels
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
▪
▪
▪
▪
▪
▪
▪
Interacting level
Participating level
Conforming level
Adjusting level
Understanding and acceptance level
Getting involved level
Being one with level
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
▪ An exclusive “we” and an inclusive “we”
▪ Eye contact varies with age, education, and
acculturation
▪ Many ways to say yes, but how do you say no?
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Communications Continued
▪ Respect the past, enjoy the present, and hope for
the future
▪ Filipino time for social events, clock time if really
important events, business, and work usually
▪ Many names are Spanish in origin
▪ One of the middle names is the mother’s maiden
name
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Many Filipinos speak Tag-Lish, which is
a. A combination of Tagalog and English.
b. The indigenous language of the Philippines.
c. The official language of the Philippines.
d. A combination of Spanish and English.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Tag-Lish is a combination of Tagalog and English.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles
▪ Matriarchal before Spanish, then Patriarchal, now
more egalitarian in decision making
▪ Gender neutral pronouns causing confusion with
he and she in English
▪ Respect is a dominant family value and older
children may assume the role of parent
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
▪ Honor and care for parents or brings shame
to the family
▪ Nuclear family is dominant although
polygamous families exist among Moslem
Filipinos
▪ Extended family members are important
▪ Education is paramount for children and
parents sacrifice so at least one child will
become educated and help the others if
necessary
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
▪ Respect is shown to elders with deferential
behavior
▪ Grandparents become surrogate parents for their
grandchildren in the United States especially
▪ Advance degree brings higher social status
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Family Roles Continued
▪ Filipino organizations targeted to gays and
lesbians
▪ Chastity is valued premaritally
▪ Single parenting becoming more common in the
United States
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology
▪ Varying skin tones of brown and tan with dark
eyes, flat nose bridges, and mildly flared nostrils
▪ Most are of smaller stature than European
Americans
▪ More difficult to determine age than in European
Americans because of youthful face
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Biocultural Ecology Continued
▪ Endemic conditions in the Philippines include
malaria, tuberculosis, gastrointestinal disorders,
due to parasitosis, cardiovascular related
disease, cancer, respiratory diseases, nutritional
diseases, HTN, and diabetes
▪ Sensitive to the effects of alcohol and require
lower doses of neuroleptics
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition
▪ Fundamental form of socialization
▪ Any occasion is an occasion for food
▪ Wide variety of foods and prepared in a variety of
ways
▪ Outsiders are served western food
▪ Insiders are served Filipino food
▪ To help in the kitchen you are really an insider
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
▪ Rice may be served at every meal, most
common meats are fish, chicken, and pork
▪ Diet varies among urban and rural areas
▪ Lactose intolerance among adults
▪ Milk in cooked desserts is tolerated well
▪ Salt and vinegar are used frequently
▪ Moderation in food is considered important
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Nutrition Continued
▪ Considered polite to leave some food on your
plate
▪ Herbs are grown in many homes to be used for
cooking and for medicinal purposes
▪ Newer immigrants are at risk of nutritional
deficiencies if unfamiliar with American foods
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family
▪ Catholic religion influences birth control practices
—rhythm method only
▪ Abortion is considered a sin, carries a stigma,
and leads to back door abortions
▪ Pregnancy is a time for pampering and attention
from entire family
▪ Mother of pregnant woman has a very special
role
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family Continued
▪ Consult healthcare provider plus a massage
therapist for advice
▪ Reluctant to take any medicine during
pregnancy, even vitamins for fear of harming the
fetus
▪ Satisfy cravings so baby will not be marked with
the craving
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Childbearing Family Continued
▪ Should be protected from a sudden fright for fear
it will harm the fetus
▪ Mother rather than husband may be the coach
during birthing
▪ Traditional may not want to bathe but engage in
sponge bath and aromatic oils
▪ Soup increases lactation
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals
▪ Three days to week for wake after death to await
for family to come together—varies in United
States because of work schedules
▪ Plenty of food available and family support
▪ Nine days of novenas in the home or church are
common
▪ Ritualistic mourning wearing black for one year
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Death Rituals Continued
▪ Burial is the most common but cremation is okay
▪ Body or ashes may be returned to the Philippines
▪ Open expression of emotions and may include
fainting
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality
▪ 80% Christian with 90% of them Roman Catholic
▪ 5% practices Islam
▪ Many returning to Bathala, ancestral religion with
a spiritualist guide who is usually a woman
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Spirituality Continued
▪ Novenas and prayers are commonly said for the
sick person
▪ Good health comes to those who are in good
with God and is the “Will of God”
▪ Many are considered fatalistic, life is up to God,
there is little one can do to change life
circumstances and the forces of nature,
monsoons, tides, volcanoes, earthquakes, etc.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices
▪ Adhere to Western medicine and traditional
practices simultaneously
▪ Health is the result of balance and moderation
and God’s Will
▪ Adequate sleep, rest, nutrition, and cleanliness
are important for good health
▪ Aromatic baths restore balance
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices Continued
▪ In the Philippines many medicines can be
purchased over-the-counter
▪ May hoard and share medicine
▪ Many do not seek care until the illness is
advanced
▪ Many distrust the healthcare environment
▪ In the Philippines, one pays for testing before the
testing is done
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices Continued
▪
▪
▪
▪
Protect oneself from wind and cold
Avoid extremes of hot and cold—balance
Introduce changes gradually
Pain is part of life and may be atonement for
immoral behavior and leads to stoicism
▪ Mental illness carries a stigma, is hereditary and
may affect one’s ability for a spouse
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Healthcare Practices Continued
▪ Mental illness may be severe before help is
sought —take care of family member at home
▪ Somatization of symptoms is common
▪ Important to maintain self-esteem and self-image
for self and family
▪ Able to enter the sick role easily
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
ClickerCheck
Mrs. Lino, age 38 years, has been seeing a
traditional Filipino healer for her pregnancy
complications. A Filipino traditional healer is
a. Galang.
b. Utang na loob.
c. Hilot.
d. Hiya.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
A hilot is a traditional Filipino healer.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Egyptian American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.”
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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.
Copyright © 2013 F.A. Davis Company
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 secondgeneration Egyptian Americans do not reside in
areas with an abundance of Egyptians, crosscultural 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
a. Tuberculosis
b. Filarisis.
c. Thalassemia
d. 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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Chapter 28
People of Egyptian Heritage
Afaf Ibrahim Meleis and Mahmoud Hanafi Meleis
Overview, Inhabited Localities,
and Topography
Overview
Egypt, the country of origin of Egyptian Americans,
has a landmass of 386,900 square miles (about one and
a half times the size of Texas) and a population of over
82 million people, giving it a population density of
over 177 per square mile. More than 95 percent of the
land is barren desert, resulting in 90 percent of the
population’s living on 3 percent of the total land area,
in the Nile Valley and Delta (CIA World Factbook,
2011). The Nile has been and still is significant in shaping life and living patterns in Egypt. The average annual
rate of population increase is 1.75 percent, with a birth
rate of 22.94 per 1000 and an infant mortality rate
of 25.2 per 1000 (CIA World Factbook, 2011). The
capital, Cairo, has almost 11 million people, followed
in population by Alexandria with 4.3 million people
(CIA World Factbook, 2011).
Egypt is bordered by Libya on the west, Sudan on
the south, the Mediterranean Sea on the north, and
the Red Sea and Israel on the east. The eastern region, across the Suez Canal, is Sinai. Egypt’s climate
is hot and dry most of the year. The average daily
temperature on the Mediterranean coast is 68°F with
a maximum of 88°F, and in Aswan, average temperatures are 80°F but can reach 120°F with little or no
humidity. The Mediterranean region receives most of
the country’s annual rainfall (7.5 in.). The northern
summers are balmy with moderate temperatures and
80 percent humidity. Between March and April,
khamsi winds blow in from the Western Desert at up
to 93 miles per hour. Except for a few hills outside
Cairo, Egypt has a flat terrain on both sides of the
southern Nile valley and the Sinai Peninsula. The
Nile River, a main artery for Egypt and an orientation point for its terrain, runs through the center of
the country from south to north to the Mediterranean Sea. The Nile—considered to be Egypt’s
lifeline—provides water and supports agriculture.
Egypt is considered by many politicians, historians,
and social scientists to be part of 22 Arabic-speaking
countries in North Africa. Others write about Egypt
as a Middle Eastern country and count its population
as Middle Eastern. A review of scholarly literature
about Egyptian Americans is embedded in writing
that aggregates them with Arab Americans, African
Americans, and Middle Eastern Americans, as well as
separates them out as Egyptian Americans. Scholarly
literature about Egyptians in the United States is
limited; therefore, the reader will find citations that
reflect a broader geographic territory, which in turn
reflects how Egyptians are often connected to or
embedded in many Arab, Middle Eastern, African,
and Muslim cultures.
This chapter is also based on the authors’ own
experiences. Both authors are Egyptian Americans
who came to the United States in the early 1960s and
observed many Egyptian Americans as they defined
themselves within the multiple identities generated by
the different groupings, such as generation and length
of time away from the country of origin. Both authors
have been insiders as well as outsiders to Middle
Eastern communities in the United States and globally. They have participated in different community
celebrations, experienced immigrants’ grief over the
impending or actual death of a family member, provided social and emotional support during times of
crisis, and counseled many immigrants. One of the
authors has been professionally involved with health
care for this population for over 30 years as part of a
project that was designed to provide health-care services to Middle Eastern immigrants in California.
Therefore, data in this chapter are from our lived
experiences in the two worlds Egyptian Americans
claim as their own—Egypt and the United States.
Arab Americans are estimated to number anywhere between 1.5 and 3.5 million (Shah, Ayash,
Pharaon, & Gany, 2007). Over 80 percent of Arabs
living in the United States are citizens (El-Sayed &
Galea, 2009).
1
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Aggregate Data for Cultural-Specific Groups
Egyptians reside in most states in the United States;
2.3 million of Arab Americans reside in 10 states:
1.2 million live in California, New York, and Michigan
(Arab American Institute, 2011). New York alone has
an estimated number of 405,000 Arab Americans residents (Shah et al., 2007). Michigan has a population
of 490,000 Arab Americans, and California has the
highest number of Arab Americans with a population
of 715,000 (El-Sayed & Galea, 2009). Other heavily
populated states are New Jersey and Illinois.
Approximately 94 percent of Arab Americans live
in major cities, with the top five being Los Angeles,
Detroit, New York, Chicago, and Washington, DC.
Lebanese Americans are the largest group of Arab
Americans living in the United States, comprising
37 percent of the total Arab American population.
Egyptians comprise approximately 12 percent of the
Arab American population (Shah et al., 2007).
However, Egyptian Americans are the largest Arab
American group in the State of New Jersey (Arab
American Institute, 2011).
Egyptian Americans’ religious affiliations resemble
those of others from the rest of the Arab countries.
The majority are Christians, and among the Christians are Orthodox (Greek and Copts), Catholics, and
Protestants. Egyptian American Muslims who are
Sunni are increasing in numbers and represent the
fastest-growing religious group among Egyptian immigrants (Salari, 2002). Ninety percent of Egyptians
are Muslims, and the overwhelming majority of these
are Sunni Muslims.
Egyptian Americans are diverse in other ways. They
come from urban and rural communities, upper and
lower Egypt, and diverse educational backgrounds, and
they possess a wide range of cultural characteristics influenced by colonialization, occupations, and a variety
of immigration experiences that shaped their responses.
However, only the most common patterns of responses
and experiences of Egyptian Americans with regard to
health and illness are presented in this chapter. Diversity among Egyptians is not well depicted, and this description does not represent a universal profile. By
defining the similarities among Egyptian Americans,
we hope to stimulate interest in more systematic scholarship about this unique community and their lifestyles,
health, and health-care practices.
Heritage and Residence
In spite of the many attributions of geographic belonging to Egypt, the Egyptian people have a strong sense
of identity with their country and demonstrate pride
in coming from such an old civilization. Egyptian history is inextricably connected to the Nile River and
dates back to about 4000 B.C., when the kingdoms of
upper and lower Egypt were united by King Menes,
who presented himself as a god. The ancient Egyptians
were the first to believe in life after death, mummify
bodies, and build elaborate tombs to preserve and protect these bodies for the afterlife. Egyptians also developed the plow, a system of writing, and medical skills
such as surgical operations.
The Arab conquest of Egypt around A.D. 641,
which spread the Islamic and Arabic culture among
the Egyptians, has lasted to this day. The minority
(Christian) Copts, who preserved the African-Asiatic
language of ancient Egypt, now use the Arabic language and have been assimilated into the Arabic culture. The Ottoman Turks invaded Egypt in 1517,
adding it to their vast empire. While living under
Turkish rule, Egypt enjoyed religious and cultural stability because the Turks shared the Islamic and Arabic
cultures. In the last two centuries, Egypt experienced
invasions by the French, followed by the British in
1882, who remained in the country until 1954. In
1952, an Egyptian army group led by Lieutenant
Colonel Gamal Abdel Nasser took control of the government and removed King Farouk from power. Since
then, Egypt has been an independent state called the
Arab Republic of Egypt (CIA World Factbook, 2011).
An influential part of modern Egyptian history is the
Arab–Israeli conflict. The conflict between Egypt, as
part of the Arab League, and Israel ended in 1979 when
the two countries signed the Camp David Accords.
Anwar Sadat was the president of Egypt at the time.
Egypt continues to be involved in diplomatic efforts to
arrive at peace between Israel and its neighboring Arab
countries. This long history and the diversity of populations have influenced the value systems, beliefs, and
explanatory frameworks Egyptians use in their daily
lives and have contributed to the diverse thinking
processes they use to resolve issues and conflict. Another
important turning point for Egyptians, as well as
Egyptian Americans, in their identity and connection to
their cultural heritage is the February 2011 revolution
that ousted President Hosni Mubarak.
Reasons for Migration and Associated
Economic Factors
Many Egyptians immigrated to the United States in
an attempt to escape economic stagnation during
President Nasser’s regime and his failed economic
policies that nationalized all privately owned companies and enterprises. The United States offered educational opportunities, career options, and economic
incentives that rewarded hard-working individuals.
After the 1952 military revolution, Egyptians immigrated in three main waves. The first wave, in the
1950s, consisted of graduate students who came to the
United States to obtain advanced degrees. This was
followed by Egyptians who escaped Gamal Abdel
Nasser’s regime (Amer & Hovey, 2007). After the defeat of the Egyptian army by the Israelis in 1967,
many of these students, believing the totalitarian
military regime of Egypt did not offer hope for
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People of Egyptian Heritage
economic recovery, changed their status to immigrant.
For most, this ensured a promising future for their
children, even though they would have been assured
decent positions in Egypt because of their American
education.
The second wave of immigration resulted from the
heightened mass dissatisfaction, hopelessness, and
anger toward the government of the educated and
professional community after the 1967 war. A lenient
government policy made it easy and safe for anyone
who wanted to leave the country, resulting in the
largest exodus from Egypt in modern history. Included in this wave were many Coptic and other
Egyptian Christians (Shaw, 2000).
The third wave, in the 1980s and beyond, had many
more risk takers. They came to seek better lives and
forsake the security of government jobs for unknown
adventures. They sought new opportunities such as
cab driving and working at food outlets in large cities
(Meleis, 2002). Some of these immigrants are temporary, others are permanent, and still others are in
circular migration (Nassar, 2008). It is important
to note here that the terrorist attacks in New York,
Pennsylvania, and Washington, DC, and the tragic
consequences of September 11, 2001, have rendered
many newly immigrated Egyptian Americans vulnerable to profiling and stereotyping in their newly
adopted country, the United States. Therefore, a newly
acquired sense of stigma tends to influence their patterns of responses in ways that were not manifested
previously. Long-term effects of this situation on their
patterns of behaviors have yet to be studied and understood. It remains to be seen whether the youth
Tahrir Square Revolution of 2011 and the referendum
in the constitution will instigate circular migration
(Medina, 2011).
Educational Status and Occupations
Most of the first-wave Egyptian immigrants were
highly educated individuals with graduate and postgraduate degrees earned in the United States. Members of this group were able to obtain teaching and
research positions in universities or work in industries.
Some joined companies or started their own businesses in the high-technology industries.
Egyptians in the second and third waves were more
diverse in their educational backgrounds, although
most of them were college graduates. Second-wave immigrants worked as engineers, physicians, dentists, accountants, and technicians; however, some with
college degrees initially accepted employment as gas
station attendants, cab drivers, security guards, and
other blue-collar positions to ensure employment.
After improving their language skills and obtaining
degrees from American universities, many obtained
professional positions. A small minority never
achieved an occupational status equivalent to their
3
original training. Many from this group returned to
their home country or plan for such a return.
Communication
Dominant Languages and Dialects
The dominant language of Egyptians is Arabic, a
Semitic language understood by all Arab nationals,
who hear it in popular Egyptian movies, songs, and
television programs. The written Arabic language is
the same in all Arab countries, but spoken Arabic is
dialectal and does not necessarily follow proper Arabic grammar. A number of Arabic dialects are spoken
in Egypt. The Saiidis (Egyptians south of Cairo) have
a different dialect from the northerners. The Nubians
(who live around and south of Aswan) have another
unique dialect, as do the Bedouins, who live in the
desert. Despite these different dialects and their distinct vocabularies, neither Egyptians nor Egyptian
Americans have any noticeable communication barriers
among themselves.
For Egyptian immigrants in the United States, English
is the language of communication in business and
contact with American society. Within their own gatherings, they speak a mixture of Arabic and English,
switch with great ease from one language to another,
and sometimes speak a mixture of Arabic, English,
and French. Egyptian social gatherings usually involve
large numbers of people, with multiple conversations
occurring simultaneously. When they are discussing
subjects such as politics or religious issues, the level of
excitement heightens and the tone of the speech is
sharpened, so an outside observer may mistakenly
characterize the exchanges as chaotic or angry.
Cultural Communication Patterns
Several values govern interaction patterns among
Egyptians. The first is respect (ihteram), which is expected when speaking with those who are older and
those in higher social positions. Respect is demonstrated in the Arabic language by differentiation in
the words used to address those who are equal in age
or position and those who are older in age or higher
in position (see Format for Names). A second important value, politeness (adab) is related to what is appropriate, expected, and socially sanctioned. Truth
and reality may be sacrificed for what is appropriate
and polite. Politeness results in a preference for more
indirect modes of communication. Sharing negative
news directly or asking for things directly is not
polite. Therefore, a poor prognosis of an illness is not
immediately shared; calamities should be slowly and
deliberately introduced and shared in stages. It is
more appropriate and expected that such news will
be shared first with other family members who will
provide a buffer that helps those coping with and
responding to such news.
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Aggregate Data for Cultural-Specific Groups
Significant value is related to the status of insiders
and outsiders, the private and public spheres. Private
spheres are reserved for immediate family, some members of the extended family, and friends who are elevated to the status of family. The public sphere
includes acquaintances, public officials, and the rest
of the world. Those who occupy a public sphere may
get completely different communications and versions
of the same events or incidents.
Because Egyptian Americans tend to be externally
driven, they are concerned about what others think of
their behaviors, which are considered a direct reflection on their entire family. Therefore, parents tend to
be overzealous and anxious about the good or bad behaviors of children and adult sons and daughters.
These behaviors reflect a measure of how well or how
badly parents have raised their children.
Egyptian Americans tend to be in touch with their
inner feelings and are highly expressive of them; however, this expression is governed by external orientation, spontaneity, and the differences between private
and public spheres. Egyptians in America tend to
share problems and the minutest details about their
lives with their trusted circle of insiders. However, because they are externally oriented, they tend to look
outside for explanations of their feelings, rather than
to focus on their own actions. Egyptians tend to be
comfortable and generous in sharing ideas and giving
advice to others who might be family members or
friends. This behavior stems from close family ties and
trust that ensures the family will always be there to
provide help. Advice is offered (even when not requested) out of love, care, and a sense of loyalty to
friends or relatives. They do not shy away from becoming involved in the problems, trials, and tribulations of
those in their private sphere. The extent and depth of
involvement is less for those in the public sphere. Although these behavior patterns are a part of the lifestyle
of first-generation immigrants, second-generation immigrants may not necessarily maintain them.
Egyptian Americans’ nonverbal communication
patterns are expressive. Because their personal space
boundaries tend to be small, they stand and sit very
close to each other. In spite of their preference for
closeness, women and men use personal space boundaries differently during interactions. Women tend to
keep male friends as far away as male strangers.
Egyptian Americans speak with expressive words and
facial expressions, gesticulating with hands and using
body movements. They communicate with their entire
body as much as with verbal language. Their facial expressions are mirrors of their internal processes and
reflections of their inner evaluations of their situations. They tend to touch each other frequently and
easily, and touch is both reflexive and deliberative. For
example, they tend to touch others while speaking to
solicit attention, concentration, and emphasis.
REFLECTIVE EXERCISE 28.1
Eshe Halabi, age 74 years, lives near Cairo, Egypt. She speaks
an Arabic dialect, Saiidis, some French, and a little English.
While visiting her son and daughter-in-law in the United
States, she suffered a bowel obstruction and underwent
surgery. She is now 2 days postoperatively and has been progressing without complications. Her son and daughter-in-law
have graduate degrees from the United States and speak
English well. When her son visits, she complains of fire-like pain
in her abdomen. Her son immediately contacted the nurse demanding pain medicine for his mother. The nurse explained
that Mrs. Halabi had received an injection for pain control
about 20 minutes previously and that she should give the medicine time to work. He said this was unsatisfactory and that she
should have the pain medicine intravenously right now.
1. Is the description of fire-like pain common among
Egyptians?
2. What other descriptions for pain are used by Egyptians?
3. What response should the nurse give when Mrs. Halabi’s
son demands intravenous pain medicine?
4. What else might the nurse do to assist with pain control?
5. Do you think the son is an adequate interpreter for his
mother in this scenario?
To demonstrate trust, increase trust, or emphasize a
point, they tend to touch each other on the hands, arms,
legs, and shoulders. Men, whether strangers or acquaintances, touch each other. Similarly, it is acceptable for
women to touch. Family members and friends of the
same gender always hug and kiss on both cheeks.
Friends of different sexes normally shake hands. However, traditionally, it is unacceptable for women and men
to touch each other. Touch between the sexes is accepted
in private and only between husbands and wives, parents
and children, and adult brothers and sisters. Levels of
religiosity govern the protocols about touching between
males and females. The more religious are the individuals, the more prohibitions exist about touching between
males and females.
Devout Muslim men and women do not touch each
other; even a handshake is not practiced. In these situations, a head nod substitutes for a physical greeting.
Among devout Muslims, only mahrams, those individuals who are not permitted to marry (e.g., sisters and
brothers) are permitted to greet each other with hugs.
Among Christians and Westernized Egyptians and
Egyptian Americans, greetings usually include formal
courteous hugs and kisses on the cheeks. In Egypt, it
is very common to see Egyptian men or women walking in public places holding hands or embracing each
other. In the United States, Egyptians are more selfconscious about touching members of the same sex,
touching non-Egyptians only on the arm or shoulder
as an expression of caring, assuring them that one is
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People of Egyptian Heritage
a friend. Some Westerners may be uncomfortable with
these gestures.
Egyptians have their own nonverbal facial expressions. A momentary wide-eyed gaze to a child means
“stop it now.” A wink to an adult means “watch what
you are saying” or “change the subject because you
are treading on dangerous ground.” Dissatisfaction is
demonstrated by intentionally looking through the
person or by avoiding eye contact. Egyptians think of
those who do not maintain eye contact or have shifty
eye contact as people who should not be trusted. Because Egyptians tend to stand in close proximity to
each other, eye contact is automatic for them. However, among those who are more traditional, women
and men who are strangers may avoid eye contact out
of modesty and respect for religious rules. The situation is different if the communication is between men
and women related by marriage or by blood. Children
are taught not to tebarrak (stare), which denotes disrespect for those who are older or higher in status.
Egyptians tend to be congenial and personable,
injecting humor to lighten stressful encounters or
business meetings. There are differences in the nature
of humor between Americans and Egyptians, and
these differences may create communication issues.
For example, Americans tend to have self-enhancing
and self-defeating humor styles. This humor style may
be misinterpreted and leave a negative impression on
Egyptian Americans. Health-care providers or managers using self-defeating humor may be perceived as
weak (Kalliny, Cruthirds, & Minor, 2006). They may
may exaggerate and overly assert judgments of events
and situations for the sake of emphasizing a particular
point of view.
An Egyptian greeting involves every person in a
room standing and shaking hands within gender
norms. Not standing can be considered an insult. A
greeting may be just a nod or a few words. Similar
greetings are practiced in the United States among
immigrants.
Temporal Relationships
Older Egyptians cherish the past, remembering the
days when life was simple and easy. Reminiscing is a
cultural pattern that becomes more prominent with
age. Younger Egyptians live in the present, with its decreased availability of options, and in the future, with
its potential, realizing that acquisition of goods comes
with a high price tag. Thus, this generation is preoccupied with maximizing their incomes, often working
two or three jobs to afford luxuries. For professional
Egyptian immigrants, working hard has been their
ticket to upward mobility and living the good life. It
is this generation of young adults living for the present
and the future who decided to organize using modern
technology to demand more representation and voice
in a government that has not been responsive to them.
5
While social time takes a high priority, engagements
are not concluded because of other scheduled appointments, and guests are expected to arrive late, they
showed up in masses in Tahrin Square to make their
united voices heard.
It is important to note temporal relations in Egyptian Americans regarding appointments. If a friend
drops by as another is getting ready to leave for an appointment, the appointment is missed and the friend
is not told about the prior engagement. Arrival at a
social gathering, such as a lunch or dinner, as much
as 1 or 2 hours late and to be late for business appointments because of heavy traffic and unanticipated and
uncontrolled delays is common. A social custom is to
offer coffee, tea, or a soft drink to business visitors.
Therefore, a planned 10-minute office visit usually
takes more time. Egyptian Americans’ perception of
time is in the context of the nationality of the group.
Therefore, they follow “American time” and are punctual for business engagements and meetings with non–
Egyptian Americans but prefer to use Egyptian time
for Egyptian American gatherings.
Format for Names
In all Arab countries, both male and female children
are given a first name, and the father’s first name is
used as the middle name; the last name is the family
name. In the Middle East, a person is called formally
by the first name, such as Mr. William.
Respect for individuals is demonstrated in the use
of certain titles. Inta (you) is saved for those in equal
or lower positions, and hadretak (you) is reserved for
those in higher-ranking positions or for older people.
More flowery and more exaggerated variations of
both of these appellations are used, such as seyadtak,
which is reserved for the highest-level officials. Inta,
used in place of hadretak, is an insult to older people
and, more important, a reflection of bad manners and
the poor upbringing of the young. Older people
should never be called by their first names without an
adjective or title attached to the name. The accepted
custom in the United States of addressing patients by
their first name may be insulting to people from other
countries. An adjective, such as aunt, uncle, ostaz
(Mr., Madame, Mrs.), or an adjective that denotes a
profession, such as bashmohandes (engineer, doctor,
physician) or a doctoral degree, may be used with the
name. Family friends are addressed by both younger
and adult children as uncle and aunt. Parental relatives are called either aunt or uncle or a special designation such as ammeti (sister of father), ammy
(brother of father), khalty (sister of mother), or khali
(brother of mother). Some Egyptian Americans, particularly those from rural Egypt, are addressed by the
first name of their son, preceded by “Abu,” which
means “father of.” This is more of an Arab custom
adapted by Egyptians (Haddad & Hoeman, 2000).
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Family Roles and Organization
Head of Household and Gender Roles
The man is formally considered the head of the household; however, the demands of life on immigrants and
nuclear families drive couples to share responsibilities
and decision making. Many Egyptian American men,
however, tend to control family budgets, which gives
them more power in the family and causes many interpersonal conflicts and much distress for Egyptian
American women.
Egyptian American family roles change considerably after immigration. The fast pace and complexity
of life in America, the many demands of child rearing,
and the absence of an extended family to preserve traditional roles contribute to a more egalitarian family
organization. Husbands and wives experience greater
fluidity in their roles, substitute for each other when
needed, and participate fully in all family matters.
Egyptian American women tend to work both in temporary occupations and in career positions. Many
who do not work outside the home consider their situation temporary, are between jobs, or are retooling
their skills to become congruent with American job
opportunities. Women who are not working outside
the home tend to be more stressed than those who are
employed. Unemployment brings with it economic
limitations, social limitations in terms of developing
a support network, or both. In the absence of extended families, lack of this support network increases
vulnerability, isolation, and stress. Immigrant women
in general are at risk of not having a network of supporters, and this is particularly true for women who
do not work outside the house (Aroian, Templin, &
Ramaswamy, 2010). Women are expected to maintain
Egyptian values and simultaneously ensure the integration of the family in U.S. culture. This may increase
the demands more for women than men, although
some research findings indicate women and men do
not differ in their stress and depression levels (Amer
& Hovey, 2007). While some couples may share
daily household chores, the norm is similar to that of
other educated middle-class families in America. The
woman is responsible for the daily management of
family affairs. The man is the major breadwinner for
the family. Husbands, however, participate in shopping, cleaning, and activities related to entertaining
with their wives. Fathers also participate proactively
in activities and education with their children.
Prescriptive, Restrictive, and Taboo Behaviors
for Children and Adolescents
Children are central to Egyptian families; they 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. When they become adults, they
are expected to take care of their older parents. However, second-generation Egyptians tend to blend with
other Americans. Their sense of responsibility toward
their parents is a topic of major concern among
Egyptian Americans. Egyptian children are not permitted to use foul language or swear in the home or
in front of parents, although this is true to a lesser degree in the United States. Answering back to parents
is not condoned and is seen as rude and disrespectful.
Some families adjust better than others to the Western
style of child rearing, which permits and encourages
the children’s rights to question their parents’ instructions. Families that allow their children more freedom
to express their opinions and ask questions often end
up with better-adjusted children and better-preserved
family unity as their children grow into adulthood. Religious beliefs and teachings forbid premarital sex and
adultery for both Egyptian Muslims and Christians.
Gender is an important variable in parenting adolescents. Female adolescents in Egypt tend to report more
psychological disorders than male adolescents perhaps
due to authoritarian attitudes that exist toward girls
(Dwairy & Menshar, 2006). Whether these findings
hold true for Egyptian American adolescents would
warrant more research in the United States. What we
do know is that as girls reach puberty and questions of
dating, courting, and prom night arrive, some parents
cannot cope with the freedom allowed within American
society. They worry more about the consequences of
dating and their daughters’ getting pregnant and fleeing
the home than about raising a healthy and welladjusted young woman. In the extreme, a few families
send their daughters with their mothers back to Egypt
to complete their education through college under more
restrictive conditions or to get married. Some families
opt to return for good rather than raise their daughters
in the American culture. Egyptian Muslim and Christian
families usually have a hard time giving their young
daughters enough space to grow (Meleis, 2002).
Hattar-Pollara, Meleis, and Nagib (2000) found
that Egyptian American parents fear their daughters
losing their virginity, representing a major stress in
their daily lives. The greatest calamity that may happen in a Christian or Muslim Egyptian American
household is to have a daughter lose her virginity prematurely. This fear stems from a potential lack of
marriageability of the daughter, loss of face for the
father, and gossip within the Egyptian American community. Therefore, parents tend to be restrictive about
their daughters’ movements and to monitor their
whereabouts carefully. Similar restrictions are placed
on teenage sons, although they are allowed more freedom and more autonomy in decision making. Most
parents prefer that their sons not date and discourage
sexual activities. However, if sons disobey the rules of
the household, the incident is not regarded as gravely
as when daughters do.
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Second-generation Egyptian Americans are rather
philosophical about these restrictions. The open communication in the family allows children to see restrictions as temporary or to devise ways to do what they
want without their parents’ knowledge. Whereas similar situations may occur in their original country, the
difference is that an extended family in the homeland
may help mediate when confrontations between parents and children become inevitable. Without extended families, Egyptian Americans are at a loss for
help in resolving family issues. The option of going to
counselors or health-care professionals for advice is
rarely exercised. Preserving family secrets and honor
is more important than external support. Just as families have a strong need for virginity to be preserved,
teen pregnancy is not openly discussed in the community. Because of the many restrictions placed on
daughters’ movements and the limited opportunities
for teenage daughters to go out without chaperones,
such pregnancies rarely occur. Birth control is not usually discussed in families until marriage, and Pap
smears are not sought or accepted until after marriage. Egyptian American children are expected to
marry Egyptian Americans. However, because many
second-generation Americans do not reside in areas
with other Egyptian Americans, cross-cultural marriages are becoming a trend. Many first-generation
Egyptian Americans return to their home country to
get married. Intermarriages among second-generation
Americans are increasing.
Growing up as a Muslim and Egyptian in the post
9/11 era in the United States may contribute to the
development of identity issues for children and adolescents. It could put their psychological well-being at
risk. Formation of identity is influenced by peer group
interaction, school environments, and media portrayal
of Arab Americans. If these influences convey negative stereotypes leading to discrimination and isolation, children and adolescents may face a dislocated
sense of identities (Britto, 2008). The youth revolution
in February 2011, which ousted President Mubarak,
may support restoring a positive identity and sense of
pride in Egyptian Americans, which was lost due to
the 9/11 terrorist attack in New York.
Family Goals and Priorities
The family is the most sacred institution to Egyptian
Americans, and members of families are involved in all
aspects of family members’ lives such as raising and educating children, finding work opportunities, and maintaining a moral code (Singerman, 2006). Although
Egyptians in their own country have extended families,
Egyptian American families tend to be more nuclear.
Compared with other Arabs in the United States, most
Egyptian Americans immigrated individually, were
joined later by a bride, or immigrated as nuclear families.
In some families, brothers, sisters, nephews, and nieces
7
may arrive later. Even when extended families arrive
later, they tend to live apart.
Job opportunities dictate living choices and patterns of living among Egyptian Americans. Egyptians
in their own country view the relocation of sons or
daughters for education or an occupation with trepidation and concern. However, once children move,
though not bound by their extended family’s geographic location, they remain connected with them.
In their home country, Egyptians tend to include the
extended family in social activities and consult them
for advice in all matters pertaining to health, employment, and family. In the absence of such a family in
the United States, they either resort to close Egyptian
American friends or seek counseling from extended
families in their home country. Christian families may
resort to religious leaders in their church or community for assistance. Imams, who are Muslim religious
leaders and therefore devout Muslims, who belong to
a mosque may choose to consult with other Imams regarding marital, family, or mental health problems
(Ali, Milstein, & Marzuk, 2005).
The most important goal for Egyptian American
families is to raise children who are well educated,
employable, and able to secure occupations that allow
career mobility, financial security, and an acceptable
social status. To that end, many other goals are subordinated. Because of this goal, parents may move to
areas with better school systems and are willing to
withstand financial or other hardships for the sake of
their children.
Another goal of Egyptian American families is to
keep children geographically close, if not living at
home, until they get married to the right partner.
Parents consider it their responsibility to assist their
children, especially daughters, to find a suitable marriage partner, and they support children financially
through wedding preparations. Raising children who
are considered moaddabeen by Egyptian standards is
important. A child who is moaddab is one who respects parents, defers to them for decisions, is mindful
of older people, does not drink or indulge in immoral
acts, listens to parents’ advice, and does not answer
back during conflict. One final goal of Egyptian families is to maintain a good face in public. This goal is
achieved when children do not bring shame by engaging in activities forbidden by their parents, such as
drinking, smoking, or going somewhere without their
parents’ permission.
As Egyptians grow older, they are considered richer
in experiences and wiser and command more respect.
They are treated with gentleness and never made to
believe that their usefulness is limited just because of
aging or retirement. Their children and extended family are expected to care for them. Older people prefer
to do less management of their own affairs and expect
more services, respect, and reverence from family
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members and subordinates. Women gain status with
age and with childbearing. Young women know that
inequities they may suffer as young brides are more
than compensated for when they get older. Older
women, however, are expected to care for older men
in the family.
Because most of the Egyptian American community
immigrated as young adults, as they advance in age they
are the first generation to experience growing old in the
United States. Many parents have a morbid fear that
they may be forced to move into a nursing home. Many
consider returning to their home country to avoid the
humiliation of aging in America, with the potential loss
of home, family care, and respect. Egyptian Americans
do not believe that they can expect or hold their children responsible for becoming their caregivers during
old age Growing old in America is surrounded by many
images of abandonment, humiliation, loss of respect,
and above all, loneliness. Those who adapt to a life
without extended family and create an extended family
will likely establish a new means to deal with their old
age. Health-care professionals may consider alternative
ways to support this community and enhance their selfcare activities to help them avoid feelings of loneliness
and a sense of abandonment in old age.
Many Egyptian Americans are part of a network of
friends with whom they share their celebrations and
calamities. Where mosques or Middle Eastern Orthodox churches exist, these organizations are used to promote social gatherings, maintain cultural norms,
reinforce culturally driven restrictions on children’s
behavior, and promote historical continuity. In the
absence of such organizations, Egyptian cultural clubs
promote meetings, discussions, and sharing news from
the homeland. Comparative analyses of life in Egypt
and the United States often dominate these gatherings.
During social gatherings, Egyptians are recognized by
their elegant clothes, the hustle and bustle of children
playing, adults chattering, and fine Egyptian food.
Egyptian Americans prefer family gatherings to
adult gatherings for celebrations such as Ramadan (the
month of fasting), the Eid feast celebrations, Christmas,
and New Year’s. Most often, they include extended
family and their new networks of friends. Social networks are connected by their heritage rather than by
their occupations. Without these large gatherings, loneliness and a sense of deprivation are exaggerated at
times of crises or during normal developmental events
such as the birth of a baby or the death of a family
member.
In Egypt, extended family members play a strong
role in the life of a family. It is an important goal of
family members to live in the same city. Extended family members provide backup and support for working
women by providing child care and for nonworking
women with multiple children as they need tangible
support. Families raise children, not mothers or
fathers. All family members freely give advice on child
rearing. In the United States, Egyptian immigrants do
not usually have extended family members living with
them, but they continue to consider the extended family living abroad as their support network. For those
who have extended family members and professional
careers, the relationship tends to be more limited by
time, responsibilities, and other demands.
Social status is gained through professional accomplishments, financial success, and involvement in
Egyptian community affairs. Respect is given to community leaders who give of themselves and share life
experiences. No caste system exists based on color,
familial lineage, or ancestry among Egyptians or
Egyptian Americans. In some communities, Egyptian
Americans are divided by religion (Muslims and
Copts) and by professional status, with clubs for professionals, blue-collar workers, and other white-collar
workers.
Alternative Lifestyles
The divorce rate among Egyptian immigrants is low,
a pattern similar to that in Egypt. Most Egyptian
Americans who are divorcing try to follow Egyptian
and U.S. laws simultaneously because Egyptian laws
have created many difficult issues for women as they
do not have balanced views between men and women
seeking to end their marriage (Bernard-Maugiron &
Dupret, 2008). In cases of divorce in which one parent
raises the children, the Egyptian community supports
the single parent, including his or her own children.
Divorce continues to be seen as a stigma and an
unfortunate situation in which the children pay the
greatest price. Who keeps and raises the children are
governed by Egyptian laws which some Egyptian
Americans continue to want to follow. In second marriages, partners work hard to make a new life together
and are committed to raising their stepchildren.
Communal and same-sex families are concepts that
do not exist in Egyptian societies. Although a community of gays exists, homosexuality is rarely disclosed.
They do have meeting places that are frequently ignored,
intentionally overlooked, and more recently, raided,
with jail as a result for those suspected of same-sex activities. The Web site GayEgypt.com includes stories of
gay men who have been imprisoned, facing hard labor
and torture. To be gay or lesbian is considered immoral
and is not accepted by any Arab or Middle Eastern religion. To discover a gay son or lesbian daughter is akin
to a catastrophic event for Egyptians and Egyptian
Americans.
Workforce Issues
Culture in the Workplace
Egyptian American nurses, who usually hold a minimum of a bachelor’s degree, cope well with the demands
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inherent in providing nursing care in the United States.
In the beginning of their careers in the United States,
however, they encounter three challenges. First, Egyptian American nurses frequently expect detailed and
careful communication of all steps and aspects of
nursing care. This expectation is inherent in both their
cultural patterns and their educational preparation.
Although interactions and communications come naturally to Egyptian Americans, this naturalness is usually
reserved for family and close acquaintances. In addition,
their professional preparation does not emphasize communication skills for interacting with patients. Because
Egyptian patients do not expect detailed information
from physicians and nurses, the routine of informing
patients about the rationale for interventions may
challenge Egyptian American nurses.
The second challenge relates to the systematic and
careful recording and documentation of nursing care.
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.
The third challenge involves the work environment.
For Egyptians, the work environment is also their social environment in which friendships are built and life
experiences and personal issues are shared with a select few. The emphasis on privacy and separating work
and social life expected in American work settings
seems artificial to Egyptian Americans. Therefore,
they tend to view American work relationships as superficial and often experience a sense of loss in terms
of close, meaningful work relationships and a supportive collegial network. This feeling is similar to
how women in other professions view satisfying and
stressful aspects of their work situation.
The fourth challenge is similar to the challenge that
all nurses face, which is the integration of technology
in their daily nursing care. With the implementation
of electronic health systems and recording of nursing
care notes in hospitalized patients’ notes, immigrant
nurses in particular will face English and computer
language challenges.
Many Egyptian communities in the United States
form Egyptian cultural clubs to which a small percentage of these immigrant nurses belong. Such clubs help
to decrease their sense of marginality. Activities usually include parties, dinners, picnics, and dances. Some
of these clubs offer Arab language classes for the children. The more religious socialize around their local
mosques and churches, which are good and safe forums for their teenage sons and daughters to meet
prospective marital partners.
Egyptian American nurses, like other Egyptian
workers who work internationally, most likely will
have the ambitions to learn new knowledge and master new skills on the job. They seek new job opportunities and work hard to reach the next levels in their
positions (Sidani & Jamali, 2010).
9
Egyptian immigrants to the United States work
hard at becoming integrated into the Western work environment. They thrive on professional satisfaction,
defining success in terms of advancement. They tend
to be team players and effective contributors to the society at large. They are usually punctual and follow
work rules and procedures. Being well assimilated,
they create a close network of colleagues.
Issues Related to Autonomy
Most Egyptians prefer to work in a job setting in
which they are employees of an organization. They do
not experience difficulty in reporting to a superior and
following instructions. These cultural patterns do not
preclude their being professionally motivated to work
hard and advance their careers within respective organizations (Sidani & Jamali, 2010). As managers,
leaders, or supervisors, they bring a personal touch
and demonstrate human interest in their dealings with
subordinates and coworkers. They demand loyalty
and respect. On the whole, their religious affiliations
do not pose problems for them when dealing with
coworkers outside their own religions. However, the
long history of Egyptian and Arab Israeli animosity
causes some of them to approach their dealings with
Jewish coworkers cautiously. Egyptian immigrants
tend to be respectful of female coworkers, and often,
their protective responses may be interpreted as patronizing by some women. They treat women as sisters
or daughters.
International market competition, economic changes,
and transitions to free market in Egypt have provided
new opportunities for Egyptians to embrace risk taking
and become entrepreneurs (Farid, 2007). Few Egyptian
Americans are entrepreneurial in developing their own
businesses. Those who opt to start their own businesses
tend to struggle to make them successful. Egyptian
Americans in general value job and economic security
over the risk taking inherent in operating a business.
Therefore, they join established organizations with longterm goals. Yet when they cannot find employment in
organizations, the third wave of young immigrants have
populated New York street corner food carts and developed their driving skills for cab and limousine driving
in some of the major U.S. cities such as New York City.
Egyptians learn British English in schools and universities. On immigrating to the United States, they
are confronted with unfamiliar slang and idioms.
When viewed from an immigrant’s point of view and
with only basic knowledge of British English, some of
these expressions are hard to interpret and could be
construed as insults. An example of this type of misunderstanding happened to one of the authors
(MHM). As he narrates it:
When I arrived in the United States (over 30 years ago)
as a graduate student in engineering, I had an occasion
to be studying at a University of California Los Angeles
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Aggregate Data for Cultural-Specific Groups
library on a weekend day with my wife, a graduate student in nursing. When we decided to go to the local
school cafeteria for a cup of tea, we noticed one of her
psychology professors in the library whom we knew very
well inside and outside of the school. I approached him,
greeted him, and asked if he would like to join us for a
cup of tea. He responded by saying, “No, I don’t care
to have a cup of tea now.” This, of course, is a very simple and totally acceptable American response. For me,
a recent Egyptian immigrant (less than a year), this
was a personal insult. The words “I do not care” meant
to me that he did not care about me, not the process of
having tea. We discussed this conversation a year later
as he and I became close friends and laughed about it.
He obviously meant no insult, and I just did not
know enough about the idioms and commonly used
expressions to “get it.”
With increasing exposure to the media and life in
the United States, it does not take long for a new immigrant to understand and accurately interpret idioms
and commonly used expressions. The media is also a
useful tool that helps Egyptian Americans and others
to learn the English language and idiomatic and slang
expressions.
Biocultural Ecology
Skin Color and Other Biological Variations
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. Upper Egyptians have a darker complexion. The average height of
Egyptian men is about 5 ft 10 in., whereas women average 5 ft 4 in.
Diseases and Health Conditions
Several risk factors are peculiar to life along the banks
of the Nile. Egyptians suffer from a host of parasitic
diseases; the most common is schistosomiasis, known
as bilharzia in Egypt. Schistosomiasis has been endemic
in Egypt throughout history and has been found in
mummified bodies from the pharaonic era. A high percentage of the Egyptian rural population is infected
with Schistosoma mansoni or S. haematobium. The life
cycle of schistosomiasis includes snails and human beings as hosts. Microscopic cercariae leave the snail in
the warmth of the midday sun and penetrate the skin
of humans who enter the shallow canals to irrigate
crops, wash dishes or clothes, or swim. The cercariae
migrate to areas near the liver, in the case of infection
with S. mansoni, or near the bladder, in the case of
infection with S. haematobium. The parasitic worms
mature, mate, reproduce, and are expelled with urine or
stools. If urine or stools are deposited in or near freshwater canals or rivers where snails live, the eggs seek out
a snail to begin the cycle again.
In human hosts, as the female worm expels the eggs,
some of them flow with the blood and become lodged
in the liver or around the urinary tract. The body,
treating the eggs as foreign irritants, surrounds them
with granular tissue, leading to cirrhosis, liver failure,
portal hypertension, esophageal varices, bladder cancer, and renal failure. Filariasis is another challenging
parasitic disease endemic to Egyptians.
Rates of blindness in Egypt are among the highest
in the world. Trachoma and other acute eye infections
affect both rural and urban populations. Trachoma, a
chronic infection of the lining of the eyelids caused by
infection with Chlamydia trachomatis, is most common among children and can have severe disabling
consequences in adulthood. Gel-like lymphoid follicles that subside over time, leaving residual scarring
of the inner eyelids, characterize the active inflammatory stage. In the most severe cases, trichiasis, an endstage complication of chronic trachoma, occurs when
scarring shrinks the lid lining and turns the eyelashes
inward, scratching the cornea. This painful condition
often leads to corneal ulceration, opacity, and eventual blindness. Injuries and corneal ulcers secondary
to other infections are also common causes of blindness in Egypt.
Other infectious diseases include typhoid and
paratyphoid fevers, which are more frequent in urban
than in rural areas. Streptococcal disease and rheumatic fevers are frequent among children, and tuberculosis continues to be a major problem in Egypt.
Egyptian Americans who have positive tuberculin
tests should be questioned about a history of Bacille
Calmette-Guérin (BCG) vaccination.
Diarrheal diseases result from environmental conditions and family lifestyles. Heat contributes to the development of bacterial diseases, and dehydration results
from diarrhea and vomiting caused by bacterial infections. Programs and campaigns using rehydration packets with water, salt, and sugar have drastically decreased
mortality rates caused by diarrheal diseases. These endemic diseases are more common in rural areas than in
urban areas. Egyptian immigrants come mainly from
urban areas and, therefore, do not usually suffer from
these diseases. However, some may have family members who come to the United States for treatment with
complications caused by one of these diseases. Kidney
diseases, lack of proper hydration, and eating habits
may contribute to kidney failure and the subsequent
need for kidney transplantation. Clinicians in the
Middle East suspect that fasting during Ramadan increases the potential for dehydration, contributing to
kidney problems.
The people of Egypt also suffer from diseases common to developing countries, such as undernutrition and
malnutrition, and diseases resulting from overindulging
in foods with high-fat and high-sugar contents. Modern
diseases such as obesity, hypertension, and lower back
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People of Egyptian Heritage
pain affect a high percentage of Egyptians. Similarly,
cardiovascular diseases resulting from stress, obesity,
lack of exercise, and hypertension are on the rise.
Egyptians who immigrate to the United States are
more likely to become victims of these diseases of
modernization than of rural diseases. Whereas breast
cancer does not appear to be a uniformly manifest pattern among immigrant populations in an Australian
study, rates were somewhat higher among the Egyptian
born (McCredie, Coates, & Grulich, 1994). Type
2 diabetes is of concern to Egyptians and is further
complicated by obesity. In addition, Egyptians are at
a genetic risk for thalassemias, which can be detected
from a molecular genetic standpoint through carrier
screening and prenatal diagnosis.
In spite of the increasing numbers of Arab Americans
and Egyptian Americans among them and the available
evidence that they may differ from other ethnic groups
in the United States, there is still very little research to
document the evidence related to prevalence and incidence of diseases and illnesses (El Sayed & Galea, 2009;
Shah et al., 2007). In one study, the conclusion was
that nativity status was not associated with diabetes
and hypertension (Dallo & Borrell, 2006). However,
others have determined that Arab Muslims in the
United States are at an increased risk for heart diseases,
diabetes, and cancer due to marginalization, stereotyping, levels of acculturation, lack of knowledge needed
for prevention, and barriers to health care systems
due to their cultural beliefs such as modesty, gender
preference in health-care providers, and illness causation misconceptions (Yosef, 2008).
Variations in Drug Metabolism
The literature reports few studies related to variations
in drug metabolism and specific drug interactions
among Egyptian Americans. Some evidence indicates
that Egyptians are poor metabolizers of beta-blockers
(Levy, 1993). More research is needed in this area to
provide better health care to Egyptian Americans.
High-Risk Behaviors
There is very limited research about Egyptian American
risk factors and little consensus about the burdens of
such diseases as cardiovascular diseases and diabetes
among Arab Americans in general (El-Sayed & Galea,
2009). Certain behaviors may increase the risk of illness
for Egyptians in America. One of these is a sedentary
lifestyle and lack of regular exercise (Salari, 2002). Information about exercise has just begun to appear in the
media in Egypt, and health clubs and gyms have begun
to spring up in Cairo and Alexandria. This new phenomenon began after many Egyptians immigrated to
America. Although exercise and fitness are regularly included in the curricula of schools and colleges, exercise
is not part of the daily lives of adult Egyptians and, even
less so, among Egyptian Americans. Recent studies tend
11
to report Egyptian Americans as being healthier than
in earlier studies, having fewer health problems and
higher activity scores (meeting the minimum public
health guidelines for activity); yet they still have a
long way to go to attain the level of physical activity
that Healthy People 2010 calls for (Qahoush, Stotts,
Alawneh, & Froelicher, 2010). It is important to note
that as with other minorities, Arab Americans’ acculturation, immigration, and discrimination associated
with stress may trigger cardiovascular diseases, diabetes,
mental illness, or adverse birth outcomes (El-Sayed &
Galea, 2009).
Overeating food delicacies high in fat, sodium, and
sugar; sedentary lifestyles; and an entertainment style
based on eating contribute to obesity and immobility.
Although no data exist on health risk factors for
Egyptian Americans, the authors suspect that if such
data were obtained, they would demonstrate an increased risk for coronary artery diseases, diabetes, and
esophageal hernias. The premature deaths in Egyptian
American communities are due to massive heart failure. There are also indications of an increase in risk
factors for different types of cardiovascular diseases.
Hassoun (1999) demonstrated that Arab Americans suffer from hypertension, high cholesterol levels, and diabetes more than other immigrants. These findings
suggest that a similar pattern may exist among Egyptian
Americans (Hatahet, Khosla, & Fungwe, 2002). Many
Egyptians came to the United States as young adults;
as the community of Egyptian Americans ages, questions related to sedentary lifestyles, overindulgence in
food, and genetic makeup should be of interest.
Egyptian Americans are at risk for stomach and intestinal problems that include heartburn, flatulence,
constipation, hemorrhoids, and fecal impaction. These
conditions result from limited roughage, lack of fluids,
and rapid consumption of food. Another factor contributing to constipation may be their expectations and
the meaning they attach to regularity, which prompts
them to push and strain to force a bowel movement
prematurely. Egyptian Americans are also at risk for
diabetes. Jaber, Brown, Hammad, Zhu, and Herman
(2003) found that a decrease in acculturation to the
United States is an important element in the increase
in risk factors for Arab immigrants.
Like many less-developed countries, Egypt responded with zeal to campaigns launched by the cigarette industry. Cigarette smoking is on the rise in
Egypt, mostly among men, but it is also increasing
among women. Those who smoke, smoke heavily and
are unwilling to quit. Rice, Templin, and Kulwicki
(2003) reported that 17 ...
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