Serving the Canadian Afghani Origin Client

Health care providers may benefit from being aware of the following characteristics specific to the Afghani population: but please note these are findings from research papers. They refer to groups in general but it is clear that they may not reflect the culture or communication style of the individual. The aim is not to offer a cookbook stereotype of the typical person of Afghan heritage in Toronto, but an indication of some of the issues that may be important.

North American lifestyle

There is a mismatch between the nuclear family system of North America and the extended family system in Afghanistan. There are lower levels of interpersonal contact and social interaction with family and friends in North America. This may be contributory to increased rates of depression and perceived social isolation especially among older people of Afghan heritage in Canada (Morikoka-Douglas et al., 2004). A cultural norm in many countries including Afghanistan is that older people are respected and cherished. They may not be expected to work or contribute to household maintenance duties. In North America, older people are often expected to contribute to the work and costs of the home (Omidian, 1996). Afghani elders regularly describe the younger generations of Afghan Americans as disrespectful (Omidian, 1996).

For Afghani elders, interacting with American health systems can be difficult and confusing. There are differences in the availability and use of technology in Canadian and Afghan health care facilities (Morioka-Douglas et al., 2004). Language barriers further intensify these differences.

There may be differences in non verbal communication styles. Some argue that in Afghan custom, “nodding” indicates politeness not necessarily understanding. This can lead to confusion. (Crawley et al., 2002).
The most frequently reported symptoms of elderly immigrant Afghan women are headaches and asabee — loss of sleep due to nervousness, weakness, diabetes and heart difficulties. Afghan origin elderly men generally report feeling unwell and/or weak all over (Morikoka-Douglas et al., 2004).

Religion

Cultural practices are an integral component of one’s health. Like many worldwide, some people of Afghani heritage place a high emphasis on personal daily hygiene, including the ritual of ablution before prayer – cleansing with water or other liquid, of the hands, arms, feet, face, nose and throat (Morikoka-Douglas et al., 2004). Also, getting enough exercise, eating fresh foods, staying warm and getting proper rest is important (Lipson et al., 1995 in Morikoka-Douglas et al., 2004).

People of Afghani heritage may consult religious figures to seek relief and/or psychological strength against pain or illness. Some say that the Qur’an is considered medicine for illness — the best method of psychological and physical therapy (Morikoka-Douglas et al., 2004).
Some Afghani immigrants (especially the elderly) understand and make sense of their health status, and choose treatments based on the faith and practice of Islam (Morikoka-Douglas et al, 2004).

Accommodation of Islamic practice within the hospital or care centres may be important for the continued and effective treatment of this population. For instance, being able to wash before daily prayers, avoiding pork products (e.g. gelatin), and having the patient’s bed face Mecca (Southeast) for prayers (especially for a dying patient) are meaningful accommodations for the Afghani patient (Morikoka-Douglas et al, 2004).

Traditional gender roles

Many Afghan Canadians place a strong emphasis on gender roles. This may include a preference to receive health care from providers of the same sex (Morikoka-Douglas et al., 2004).

End of life care

In the Afghan culture, upon death, it is compulsory that the dead body be handled by the same sex as the dead.

Incorporating a Mula, a Muslim religious leader when assessing the patient’s preferences for end of life care may be useful, to ensure that Afghan specific practices are acknowledged, adhered to, and/or modified where appropriate (Morikoka-Douglas et al., 2004).

Communication

Most Afghanis prefer seeking assistance from professionals for English translation services thus, adequate interpreter services in Pashto or Dari are critical. (Morikoka-Douglas et al., 2004).

However, such patient preferences are not always accounted for by the Afghan family. In traditional family networks, it is the responsibility of the head of the household (as long as they are educated), despite the preference of the client, to make all health-related decisions (Morikoka-Douglas et al., 2004).

References:
Crawley, L.M., Marshall, P.A, Lo, B. & Koening, B.A. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136, 673-679.
Lipson, J.G. & Omidian, P.A. (1992). Cross-cultural medicine a decade later: Health issues of Afghan refugees in California. West Journal of Medicine, 157, 271-275.
Morioka-Douglas, N., Sacks, T. & Yeo, G. (2004). Issues in Caring for Afghan American Elders: Insights from Literature and a Focus Group. Journal of Cross-Cultural Gerontology, 19, 27-40.
Omidian, P.A. (1996). Aging and Family in an Afghan Refugee Community: Transitions and Transformations. New York & London: Garland.