People of Egyptian Heritage and People of Filipino Heritage People of Egyptian Heritage.People of Filipino Heritage.Read chapter 13 and 28 of the class tex

People of Egyptian Heritage and People of Filipino Heritage People of Egyptian Heritage.People of Filipino Heritage.Read chapter 13 and 28 of the class textbook and review the attached PowerPoint presentations. Read chapter 28 in Davis Plus Online Website. Once done, write an essay discussing the health beliefs of both heritages and if there is any similarity in both culture beliefs. Also, discuss how their beliefs influence the delivery of evidence-based healthcare focusing on the nursing care. Your assignment must have a minimum of 700 words, 3 evidence-based references no older than 5 years (excluding the class the class textbook, 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.
2780_BC_Ch28_001-022 03/07/12 9:54 AM Page 1
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
2780_BC_Ch28_001-022 03/07/12 9:54 AM Page 2
2
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 Ar…
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