IRANIAN CASE STUDY #1

Mustafa E., aged 46, brought his wife, Mina,

aged 39, and his three children to the United

States in 1983. Their son Hamid was 12 years

old; their daughter, Maryam, was 11 years

old; and their son Ali was 7 years old. In

addition to economic difficulties imposed by the

Iran-Iraq war, they feared that Hamid would

be drafted and sent to the front. Mustafa

preferred not to leave Iran; he spoke no Englis

h and was afraid he would feel isolated in

the United States. Mina, conversely, was somewh

at eager to leave th

e social constraints

that were becoming permanent; she had always

hoped that their children, especially their

daughter, would have the opportunity for more

 than her own ninth

grade education and

for a successful professional life.

Mustafa graduated from high school and wo

rked in Iran’s Ministry of Education.

He held a bookkeeping job on the side, which allowed him to save money for the journey.

Mina’s brother, who immigrated to the Unite

d States in the early 1970s, encouraged the

family to go to Turkey, and he arranged for an attorney to obtain a visa for the family.

They were granted a tourist visa and flew to

 Dallas. Mustafa quickly repaid his brother-

in-law $5000 for legal fees.

Mina’s brother and his wife, an America

n, welcomed the family into their house,

but language and cultural differences made

Mustafa and Mina uncomfortable. After 2

months, they rented an apartment nearby. With

 the help of her brother’s acquaintances,

Mina enrolled the children in school and regi

stered herself in an adult-learning center.

Because they had a tourist visa, neither parent could get a work permit. With no

knowledge of English or the local economy, Mu

stafa relied on the advice of everyone

round him, such as an Iranian businessman

 who helped him look into purchasing a

business. Within a few months, he had

bought a gas station. Mi

na began sewing and

doing alterations for their small ci

rcle of Iranian acquaintances.

Whereas the children were adjusting well,

 Mina and Mustafa were beginning to

feel the strains of social a

nd cultural alienation. The news of

 war and family affairs in

Iran was getting more intense. Mustafa still s

howed no desire to learn more English than

he needed to do the bookkeeping for the gas

station and deal with customers. Deep

inside, he believed that he would return

home as soon as the children started college.

By 1990, Mustafa’s business had gone ba

nkrupt and the family’s savings had

dwindled. Their only sources of

 income were Mina’s earnings and Hamid’s part-time job

while attending the local juni

or college. Relations at home were extremely tense, with

emotions always on the edge. Mustafa had

increased his smoking to three packs of

cigarettes daily, and he had fr

equent bouts of bronchitis. Mi

na had lost nearly 20 pounds

since their arrival in the United States,

and her migraine headaches had increased,

occurring almost daily, particul

arly since she lost her mother

 without having been able to

visit her in Iran.

Mustafa found a bookkeeping job in an acc

ounting firm owned by an Iranian, but

his excessive smoking and occasional shortne

ss of breath and heartburn continued. Mina

made several visits to the lo

cal hospital emergency room with complaints of fatigue and

sleeplessness. Mustafa and Mina had treate

d some of their symptoms with herbal

remedies, but their problems persisted to the point at which Mustafa was admitted to the

hospital with chest pain to

rule out myocardial infarcti

on. The two older children were

attending school and working, leaving the young

est son to act as cultural and language

interpreter for their parent

s during this hospitalization.

Study Questions

1.

Identify three major emotional and

physiological problems commonly seen

among Iranian immigrants.

2.

Identify significant socioeconomic factor

s that limit access to health care for

Iranian immigrants.

3.

Identify the family spokesperson and di

scuss salient issues in establishing

effective communication with this family.

4.

How should prevention be taught to this

 family? What would be appropriate

goals?

5.

Name three major risk factors

that this family experienced.

6.

What mechanisms for coping with stre

ss were predominantly used in this

household?

7.

Identify the family’s social support system.

8.

What hospital policies and constraints might negatively or positively affect this

family’s dynamics?

9.

Compare and contrast the three wave

s of Iranian immigra

tion in terms of

educational status, reasons for migrati

on, and occupations in the United States.

10.

Explore assertiveness tactics for female

 Iranians in the American workforce.

11.

What are the most common health probl

ems of Iranian immigrants? What are

some implications for health-care providers?

12.

large Arab community.

Four of the Said children attend public el

ementary schools, participating in the

Identify characteristics of a healthy Iranian diet

 

 

 

.

ARAB CASE STUDY 

Mrs. Ayesha Said is a 39-year-old Mus

lim Arab housewife and mother of six who

immigrated to the United States from a rural town in southern Iraq 2 years ago. Her

mother-in-law and her husband, Mr. Ahme

d Said, accompanied her to the United

States as participants in a post–Gulf War resettlement program, after they spent some

time in a Saudi Arabian refugee camp. Thei

r relocation was coordinated by a local

international institution that provided an

array of services for finding employment,

establishing a household, enro

lling the children in public

schools, and applying for

federal aid programs.

Mr. Ahmed, who completed the equivale

nt of high school, works in a local

plastics factory. He speaks some English. He

 plans to attend an English-language class

held at the factory for it

s many Iraqi employees. Mrs. Ayesha, who has very little

formal schooling, spends her day cooking and

caring for her children and spouse, with

the assistance of her mother-in-law. She l

eaves their home, a three-bedroom upper flat

in a poor area of the city, only when she accompanies her husband shopping or when

they attend gatherings at the local Islami

c center. These events are quite enjoyable

because most of those using the center are

also recently arrived Iraqi immigrants. She also socializes with other Iraqi women by

telephone. Except for interactions with the

American personnel at the institute, Mr. Ah

med and Mrs. Ayesha Said remain quite

isolated from American society. They have

discussed moving to De

troit because of its

large Arab community.

Four of the Said children attend public el

ementary schools, participating in the

English as a Second Language (ESL) progr

am. Mr. Ahmed and Mrs. Ayesha are

dismayed by their children’s rapid acc

ulturation. Although Muslims do not practice

holidays such as Halloween, Christmas, Va

lentine’s Day, and Easter, their children

plead to participate in thes

e school-related activities. 

Mrs. Ayesha is being admitted to the surgical unit after a modified radical

mastectomy. According to the physician’s not

es, she discovered a “lump that didn’t go

away” about 6 months ago while breast

-feeding her youngest child. She delayed

seeking care, hoping that

inshallah

, the lump would vanish.

Access to care was also

limited by Mrs. Ayesha’s preference for a fe

male physician and her family’s financial

constraints—that is, finding a female surg

eon willing to treat a patient with limited

financial means. Her past medical hist

ory includes measles, dental problems,

headache, and a reproductive history of

 seven pregnancies. One child, born

prematurely, died soon after birth.

As you enter the room, you see Mrs.

Ayesha dozing. Her husband, mother-in-

law, and a family friend, who speaks English a

nd Arabic and acts as

 the translator, are

at her bedside.

Study Questions

 1.   Describe Arab Americans with respect to

 religion, education, occupation, income,

and English-language skills. Compare the Sa

id family with Arab Americans as a

group.

 2.   Assess the Said family’s risk for experi

encing a stressful immigration related to their

isolated lifestyle

 

  Describe the steps you would take to

develop rapport with Mrs. Ayesha and her

family during your initial encounter. Include

nonverbal behavior and social etiquette

as well as statements or questi

ons that might block communication.

 4.   Identify interventions that you woul

d employ to accommodate Mrs. Ayesha’s

“shyness” and modesty.

 5.

  You notice that, although Mrs. Ayesha

is alert, her husband and sometimes her

mother-in-law reply to your questions. Inte

rpret this behavior within a cultural

context.

 6.

  Although Mrs. Ayesha is normothermic and

states her pain is “little,” Mr. Ahmed

insists that his wife be covered with se

veral additional blanke

ts and receive an

injection for pain. When you attempt to r

eassure him of his wife’s satisfactory

recovery, noting as evidence of her stable

 condition that you plan to “get her up”

that evening, he demands to see the phys

ician. Interpret his behavior within a

cultural context.

 7.    Discuss Arab food preferences as well

as the dietary restri

ctions of practicing

Muslims. If you filled out Mrs. Ayesha’s menu, what would you order?

 8.   When you give Mrs. Ayesha and her fam

ily members discharge instructions, what

teaching methods would be most effective? What content regarding recovery from a

mastectomy might most Arab Amer

icans consider “too personal”?

 9.

Identify typical coping strategies of Arabs.

 What could you do to facilitate Mrs.

Ayesha’s use of these strategies?

 

10.  Discuss predestination as it influences th

e Arab American’s responses to death and

bereavement.

11.

Discuss Islamic rulings regarding the

following health matters: contraception,

abortion, infertility treatment, autops

y, and organ donation and transplant.

12.  Describe the Arab American’s culturally

 based role expectations for nurses and

physicians. In what ways do the role res

ponsibilities of Arab and American nurses

differ?

13.  What illnesses or conditions are Arab Am

ericans unlikely to disclose because of

Islamic prohibitions or an attached stigma?

14.  Compile a health profile (strengths ve

rsus challenges) of Arab Americans by

comparing beliefs, values, behaviors, a

nd practices favoring health and those

negatively influencing health.