middle east Flashcards
Current Demographics & Socioeconomic Status
Worldview:
Traditional Health Beliefs & Practices
Meal Composition and Cycle
Etiquette
Special Occasions
Counseling
be more familiar with these
main religion
islam, jewish, christianity
food prohibition
halal - allowed
haram- not allowed
food prohibition
halal - allowed
haram- not allowed
what are the two cultures tha historically dominated the middle east region
bisentine (in turkey), persian
climate
is temperate &
suited to agriculture but can be very dry
demographic
Demographic data problematic
One of the fastest growing ethnic groups in
America and Canada
◦ Most are now Muslim
◦ From 15% in 1970 to 73% in 2000
Recent Syrian refugees mainly Muslim (over 32,000)
◦ Those from Arab countries: Appear to prefer to be called
“Arab” as opposed to national affiliation
In US: 1/3 have settled in CA, NY, and MI
◦ Detroit has largest concentration of Muslims
where do most middle easterns settle
ontario then quesbec
socioeconomic status
Many are entrepreneurs High school graduation rate exceeds US average College graduation rate exceeds US average Median family income above average ◦ Lebanese and Syrian below (refugees) Poverty rates are high for some ◦ “Arabs” and Iraqis (refugges)
iranians- immigration
Iranian Americans & Turkish Americans do well
with income, education (medicine, art, law, business)
Iranians in US
Revolution 1979
Iranians in Canada
Sept 11, 2001
205,000 Iranians in 2015
Israel - immigration
Immigration from Israel began in the 1950s after
independence of the nation
◦ Jewish Israelis settled in established Jewish communities
◦ Arab Israelis settle in urban areas with other Arabs
◦ Come for educational and professional opportunities
◦ Some due to political unrest
◦ Average earnings and education are above the US norm
Early Arab immigrants but now they are
Early Arab immigrants were Christian ◦ Eastern Orthodox Egyptian Coptic Church Recent immigrants follow Islam ◦ Sunni Muslims Friday Sabbath has been moved to Sunday
◦ Iranians Shi’ite Muslims & other religious minorities, Sufi Baha’i Faith is a Muslim offshoot that renounced ties to Islam Zoroastrian (oldest in the world) Christian ◦ Turkish immigrants are Sunni Muslims Israeli immigrants typically Jewish WORLDVIEW:
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arabic family
Arab families have a strong patriarchal family whose
honor must be maintained
◦ Demand conformity & subordination
◦ In turn family is protected
◦ Can identify with family status
Extended family members live in single home or a
family compound
◦ Exception in Egyptia who live traditionally in nuclear family
groups
Men & women are equal but with different roles & responsibilities
Children are valued
Men obligated to provide economic security for children
Women are to socialize them including the preservation of
religious & cultural values
Women provide love and comfort in the home
◦ Strong bond between mothers and children
Views in North America are changing
Marriage contracts often arranged
◦ Many marry cousins ?? (not true but mentioned in textbook)
Egyptians and Arab Christians do not
◦ Date after engagement announced
◦ Chastity & modesty of the women related to family honor
Mother is responsible for daughter’s chastity
◦ Interethnic marriages discouraged (not anymore but try and mary someone at your level through money or education)
Not Egyptians
Turks similar to Arabs
Iranians??
familiy israelis
Israelis live in nuclear families
◦ Rural settlement cooperatives in Israel called kibbutzim
where families live and work communally
◦ Children raised by age-level
◦ Community meals
◦ Homes typically patriarchal but women are well-educated
and many employed
◦ Ethnic identity preserved by enrolling their children in
religious training and other activities
Traditional Health Beliefs & Practices:
Middle Easterners
Cleanliness, diet, keeping warm & dry maintain
health
May believe wind or air cause illness
◦ Lebanese Muslims believe women are especially
vulnerable to wind after childbirth
Avoid showers and baths
◦ Babies vulnerable through the umbilicus
Wrap babies stomach with band called zunaad
Traditional Health Beliefs & Practices:
Iranians
Iranians practice traditional humoral medicine
◦ Hot and cold only
◦ People are born with a physiological temperament
Women colder than men
Younger people hotter than older people
Influenced by diet, climate, geographical location, certain
conditions
◦ Sickness can be caused by too many hot items or
too many cold items
Iranians also concerned about how much blood
they have
◦ Thinness, weakness, irritability, lethargy, headaches,
excessive bleeding from injuries, etc.
Narahati is term used for feelings of physical &
emotional discomfort
◦ Usually private & nonverbal
Naharati qalb (heart distress) is fluttering of the
heart from strong expression of anger or sadness
Narahati
is term used for feelings of physical &
emotional discomfort
◦ Usually private & nonverbal
Naharati qalb
b (heart distress) is fluttering of the
heart from strong expression of anger or sadness- or heart desease
ko’hl -Folk remedies common
Dark powder from antimony used in cosmetics- eye liner- - thought to increase vision of the baby
Herbal remedies prevalent
◦ Yarrow for diabetes
◦ Khella for kidney disorders
Palestinians use traditional remedies as food and
medicine
◦ Mallow as a laxative, etc
other health beliefs
Cupping to cure chronic leg pain, paralysis, headaches, obesity
Wasm or cauterization
◦ Heated rod places symbolic burn marks on a patient
Below anus for diarrhea
◦ Burns then treated with herbal poultices
Evil eye is feared
Mental illness may be possession by the devil
Place health in the hands of God
Illness may be seen as punishment from God
Biomedicine well established
antibiotics are over hte counter
Traditional Food Habits
Origins of dishes
unknown
Wheat, olives, dates
Sheep
Rice, chickpeas,
lemons
Significant differences due to dietary restrictions &
proximity to other cuisines
Pork popular in Christian populations that neighbor Europe
but not in Christian areas in Greece where lamb is
preferred as in the Middle East
Alcoholic beverages banned for Muslims but widely
consumed in Turkey possibly because of proximity to
Russia
Traditional Food Habits: Staples
Loaves & flatbreads ◦ Pita or pocket bread ◦ Lavash or cracker bread Wheat doughs to make pies & turnovers ◦ Phyllo or filo ◦ Makes savory pies or desserts Baklava or paklava Burghul or bulgur ◦ Cracked whole wheat steamed and crushed ◦ Tabouli Rice ◦ Pilaf or pilav ◦ In Iran called polo and has a crunchy crust ◦ Basmati, a fragrant rice Many legumes ◦ Ground chickpeas for hummus ◦ Fava beans in pita bread with raw vegetables Falafel ◦ Lentils
Many vegetables
Popular cooking method is called yiachni
Eggplant is most popular
Thinly sliced cucumber or tomato for salads
Vegetables often stuffed with meat or rice
◦ Moussaka minced lamb, eggplant, onions, tomato sauce
Stuffed grape or cabbage leaves
Dolmeh
Potatoes
Vegetables often eaten raw, mixed together or preserved
Traditional Food Habits: Staples
olive
The olive Extremely important in Greek & Middle Eastern dishes ◦ Stronger flavor ◦ Accompany meal or served as an appetizer ◦ Source of olive oil ◦ Generally in dishes to be eaten cold ◦ Used to deep fry fish, not other foods
Traditional Food Habits: Staples
fruit
Fruits preferred fresh Used as desserts or snacks Add fruits to savory dishes Served dried or as jams or compotes Slatko is fruit simmered in thick syrup ◦ A Balkan specialty Fruit juices &syrups often used to flavor foods ◦ Especially lemon
Traditional Food Habits: Staples
dairy
Fresh milk not widely consumed ◦ Used in puddings or custards Dairy products fermented into yogurt or cheese ◦ Yogurt is a side dish ◦ Cheese made from goat s, sheep s, or camel s milk Feta Numerous others
Traditional Food Habits: Staples
meat
Most meat & seafood consumed ◦ Pork avoided in Muslim countries ◦ Shellfish avoided among observant Jews ◦ Lamb is most widely used meat Grilling, frying, grinding, stewing ◦ Kabobs ◦ Souvlaki is thin slices of lamb layered onto a rotisserie, grilled, carved, served May be made into gyros Whole roasted lamb/sheep prepared for special occasions
Traditional Food Habits: Staples
spice
Numerous spices & herbs from former spice trade
Dill, garlic, mint, cardamom, cinnamon, oregano,
parsley, pepper
Sumac is sprinkled on salads
◦ Mixed with rosemary to make Arabic seasoning called za atar
Verjuice is from green lemons and gives sour taste to
dishes
Sesame seeds used frequently
◦ Crushed to make a thick paste called Tahini
Traditional Food Habits: Staples
drinks
Fruit juice popular beverage ◦ Fruit syrups or flower extracts mixed with ice to make sharbat (sherbet) Coffee flavored with cardamom, lots of sugar Tea also consumed
Regional Variations: Middle Eastern
Three (or five) culinary areas ◦ Greek/Turkish ◦ Iranian ◦ Arabic Plus ◦ Israeli ◦ North African (Moroccan) Every region has unique recipes and cooking methods Similarity is striking
Regional Variations: Arab
More grains, legumes, and vegetables
National dishes
◦ Kibbeh from cracked wheat, onion, lamb in Syria and Lebanon
◦ Mansef in Jordan – flatbreads layered with yogurt and then
topped with rice pilaf, lamb or chicken
◦ Ful medames in Egypt - cooked fava beans with oil, lemon,
garlic, parsley, and hard-boiled eggs
◦ Tharid - a casserole of layered flatbread with meat stew
Reportedly Mohammed s favorite dish
All areas use variety meat
◦ All parts of the animal
◦ Breads, heads, feet, chitterlings are a specialty
Pacha an Iraqi soup
◦ Sheep heads, stomach, trotters (feet) served with
bread and pickled vegetables
Syrian food is spicier
Regional Variations: Iran
Well suited climates for many fruits and vegetables
◦ Spinach, pomegranates, saffron
Area dominated during Persian Empire
Trade brought rice, tea, eggplants, citrus, tamarind, garam
marsala (for curry)
Called Persian cuisine
◦ Sophisticated rice dishes and use of fruits for flavoring
Bread called nan
National Dish: Chelo Kebbab
Regional Variations: Israel
Food and culture probably most varied Blends Middle Eastern with the many Jewish immigrant groups Many adhere to kosher laws of the Jewish religion
Daily Patterns – Middle East
Coffee or tea served early about 7 or 8 AM
Then a light meal of bread, cheese, beans, eggs, olives, jams,
yogurt
Lunch is main meal eaten early afternoon
◦ Bread, rice or bulgur, casserole, stew, salad, desert of fresh fruit or
pastry
◦ Dilute yogurt drink or water to drink followed by sweet tea or coffee
Dinner in early evening is light
◦ Foods similar to those eaten at breakfast, soup or leftovers from
lunch
Served all at once except in Jordan, Lebanon, Syria where
courses are served
Daily Patterns – Middle East
turkey
Turkish meals vary slightly Breakfast is served a little later but is often substantial Lunch eaten about noon Dinner between 6 and 8 ◦ Dinner is main meal of the day Served in courses
Daily Patterns – Middle East
Iranian breakfast includes flat breads with cheese, whipped cream and jam Lunch and dinner are similar ◦ Stew often served over rice Fruit is typical dessert Yogurt drink or tea as beverages Dishes served all at once Eaten communally
Daily Patterns – Middle East
israeli
Israel breakfasts are light
◦ Sabbath breakfasts are heartier
Traditional breakfast buffet associated with Kibbutz life offered at
some restaurants
Midday meal is largest
Evening meal is light with cheese, yogurt, salads, eggs
◦ Eaten at 8 or 9
May serve all at once or in courses
Street stands are popular
Fruit juices, soft drinks, beer are popular
Etiquette
Hospitality is a duty
Family s status measured by how guests are treated
Guests are always made to feel welcome and
automatically offered food and drink
Refusal is an insult
Invited guests bring a gift which will be served
Hospitality offered even in an office setting
What food and in what order food is served
expresses the recipient s status
Guests entertained first in a separate room
Hands washed with scented water
Status based on sex, age, family, social rank
◦ Honored seat
◦ Best portion served to dignitary or head of household
◦ Women may eat separately from men
Dining table
◦ Large round metal tray low on a stool or platform
◦ In Iran, food served on a rug
◦ Western-style dining is found
After the meal, all leave the table, wash
hands, have coffee or tea
give tea two hours after dinner
phytates in the tea decreases absorption and releaxes sphinter and increases acid reflux
Always wash hands before eating
In Muslim areas Allah will be thanked before and after
the meal
3 fingers of the right hand used if forks and spoons are
not offered
◦ NEVER use the left hand to eat or pass
Women should never? touch food that is to be eaten by
a Muslim man who is not her immediate family member
Rice taken from communal bowl and rolled into ball
then dipped into sauce
Lick your fingers??
Eating noises express appreciation?? (not really- try to be as quiet as possible)
Don t fill your cup but do refill your neighbors
Don t stop eating until everyone else is finished
Leave a little food on the plate to indicate you are full
Conversation before and after the meal
Compliment the host and hostess
Special Occasions
ramadan
Ramadan
◦ Month Muslims fast from sunrise to sunset
◦ Break the fast with iftar
Dine with relatives and neighbors
Water, odd number of dates, coffee, tea
Then a large meal
◦ Dawn meal is light
Avoid salt as water is not allowed during the fast
Eid al-Fitr
◦ Follows end of Ramadan and is a cross
between the feasting of Thanksgiving and
the festivity of Christmas
Eid al-adha
◦ Feast of Sacrifice held with the annual
pilgrimage (Hadj) to Mecca
Special Occasions
iran
Iran s most significant holiday is
◦ Nowruz (New Year)
◦ Muharram, Commemorates the martyrdom of Mohammed s
grandson (feeds everyone
◦ Time of communal mourning and penitence for
Shi ites
Nau Roz (Nowruz) is a spring festival with a
special meal and ceremonial table setting
◦ Seven foods that start with s
◦ Then a traditional meal
Special Occasions
israel
Israel observes traditional holidays of the Jewish
calendar
Sabbath is from sunset Friday to sunset Saturday
◦ All businesses close and work prohibited
Friday meal served on white linen and serves a
traditional cup of wine
All foods on Saturday must be prepared Friday
Also celebrate Independence Day with barbecues
therapeutic uses of food
Fresh foods considered best ◦ Canned and frozen may be avoided Amount of food of special concern ◦ Ample meals prevent illness ◦ Poor appetite is a disease itself ◦ Food deprivation causes illness
Therapeutic Uses of Food
hot and cold
Hot cold shift may cause illness
In Iran:
◦ Too many hot foods may cause a headache, cured by
cold foods
◦ Too many cold foods may cause dizziness, cured by
hot foods
◦ Temperature, not spiciness, causes shift in body from
hot to cold, and vice versa
◦ Digestive system must have time to adjust to one
extreme
◦ Certain conditions are not hot or cold
Therapeutic Uses of Food
food combos
Certain food combinations are damaging to
health
◦ Egyptians won t eat fish with dairy
◦ Others avoid eating sour foods with milk or legumes
with cheese
◦ Iranians won t consume melon with yogurt as it
causes wind in the stomach and GI disorders
Counseling
Cultural differences contribute to considerable
discomfort and irritation between health care
practitioners and Middle Eastern clients
Language and communication problems may be
significant
Body language and general atmosphere as important
as words
Misunderstandings are common
High context relationship that is time consuming and
intensive
Get to know each other before discussing business
◦ Ethnic background, socioeconomic status, religious
affiliation, etc.
Coffee or tea offered establishes a warm and
hospitable atmosphere
Direct eye contact expected
Personal space further with strangers
Head nods may be opposite of what is expected
touching between same sex frequent
Touching between opposite sex prohibited
No extended eye contact between opposite
sex
Left hand not used for ANY social purpose
including passing things
Wait for them to extend their hand in greeting
Proper posture shows respect
Do not cross legs, point with foot, or show sole of
shoe
In Turkey and Iran, stand when an elder enters the
room
May be more receptive to verbal information than
written
Allow for questions about family, general interests,
etc., at beginning of interaction
Provider may have to assess and give advice without much input
from client
Privacy strongly protected
Confidentiality concerns
Suspicion about questions regarding religion or socioeconomics
Shame about certain conditions may cause noncompliance in
public
◦ Diabetes associated with impotence, infertility
May expect provider to make decisions for them
Female health care providers may have problems
due to gender
May believe the more intrusive the procedure the
more effective
Poor prognosis discussed first with family
◦ Only God can make final decision about death
Muslim client may feel most comfortable with
providers of same gender
Concerns with therapeutic ingredients in home
remedies
◦ Ko hl used on umbilical cords of newborns is high in lead
◦ Foxglove used by some Iranians is where main ingredient in
digitalis comes from
May need to pray during medical visit
◦ Don t walk in front of them while praying
◦ No talking
