Most Afghanis who seek health care at American or Coalition hospitals in Afghanistan are extremely sick, severely injured, or near death. Many end up at these hospitals after being turned away from (or treated unsuccessfully at) Afghani hospitals—in most cases, due to lack of equipment or expertise to treat their conditions. Those who seek medical care at American facilities (whether in Afghanistan or the United States) are vulnerable to misdiagnosis, mistreatment, and misunderstanding because they’re unfamiliar with Western medical practices.Afghanistan’s healthcare infrastructure is one of the poorest in the world. In many rural areas, nearly two decades of war have rendered health care virtually nonexistent.
Barriers to improving Afghanistan’s healthcare infrastructure include:
• lack of educated physicians and nurses to staff the few medical facilities that exist
• poor roads and transportation, which pose obstacles for Afghanis in rural areas who seek care
• an extremely weak economy and lack of money to initiate new healthcare programs
• too few universities to educate healthcare professionals.
Whether Afghanis seek care in their native land or in the United States, cultural considerations for healthcare workers center on religion (Islam) and family. Afghanistan’s culture is deeply rooted in Islam. Even in times of sickness, prayer is an extremely important part of daily life. Inability to pray can cause much anxiety and stress.
When an Afghani patient seeks health care, the father, the eldest son, or an elderly uncle serves as family spokesperson. Traditionally, Afghani women are considered the primary caregivers outside the hospital environment—but this wasn’t always the case when patients were admitted to the 14th CSH. In Afghanistan, males act
as primary caregivers for family members admitted to American hospitals. (In the United States, Afghani women may take on this role.)To properly recognize the family’s role in Afghan culture, allow one family member to stay with the patient to act as caregiver. If a female Afghani is admitted to the hospital, be aware that a male chaperone may need to stay with her as an escort throughout her hospitalization.
Certain Afghani cultural beliefs may inhibit self-care and healing—and healthcare providers must consider these when formulating the patient’s plan of care. For instance, some patients may not want to ambulate, believing they need to preserve their energy for healing. In this case, encourage physical therapy exercises, but be sure to explain why they’re important to recovery.Also, try to arrange for the patient to go outdoors. Many Afghanis believe the sun has healing properties and enjoy sitting in the sun to absorb its energy.
When caring for Afghani patients of either sex, keep their bodies covered as much as possible. For Afghanis, bodily exposure is embarrassing and shameful. Although such exposure is necessary in an extreme emergency or trauma, be sensitive to the patient’s feelings about this and cover the patient to the extent possible.Also try to keep your own skin covered when caring for Afghanis so as not to offend them. Although this may be somewhat inconvenient for hospital personnel, it shows Afghani patients that the staff is dedicated to cultural sensitivity.
When an Afghani patient died in the 14th CSH, we went to great lengths to ensure culturally correct preparation of the body. First, we notified an interpreter and a chaplain, who recited an Islamic prayer and provided guidance for preparation of the body. We turned the patient’s head toward the direction of Mecca, tied the large toes together to prevent the legs from spreading, closed the mouth and eyes to prevent evil spirits from entering, and kept the body covered at all times. Family members then claimed the body and completed the remaining burial preparation. By taking the few extra moments to carry out these steps, caregivers can influence the family’s perception of the quality of care their loved one received.
Healthcare practitioners preparing to deploy to or work in countries outside the United States need to learn everything they can about local customs and cultures. One way to ensure they’re well informed and able to provide culturally correct care is to form cultural committees or focus groups that research the local culture and create appropriate policies. Another way is for those who’ve worked overseas to publish articles describing their experiences so other healthcare workers get the message.The concept of cultural competency applies to all aspects of nursing care, including inpatient and outpatient settings, research, home health, and even nursing management. As U.S. societies throughout the world become increasingly multicultural, all nurses should strive to gain cultural competence, regardless of their practice setting, role, or specialty.
Giger J, Davidhizar R. Culturally competent care: emphasis on understanding the people of Afghanistan, Afghanistan Americans, and Islamic culture and religion. Int Nurs Rev. 2002;49:79-86.Leishman J. Perspectives of cultural competency in health care. Nurs Stand. 2004;19
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Daniel J. Yourk, First Lieutenant in the U.S. Army, served as an Emergency Room Nurse at the 14th Combat Support Hospital in Bagram, Afghanistan. The views expressed in this article are the sole responsibility of the author and do not reflect the official views of the Army Medical Department, Department of the Army, or Department of Defense.