SAUDI ARABIA

SAUDI ARABIAMAP of SAUDI ARABIA

SAUDI ARABIALocation:The Middle East, bordering Iraq 814 km, Jordan 744 km, Kuwait 222 km, Oman 676 km, Qatar 60 km, UAE 457 km, Yemen 1,458 km

Capital:Riyadh

Climate:harsh, dry desert with great temperature extremes

Population:25,795,938 including 5,576,076 non-nationals (July 2004 est.)

Ethnic Make-up:Arab 90%, Afro-Asian 10%

Religions:Muslim100%

Government:monarchyLanguage in Saudi Arabia

Arabicis the official language of Saudi Arabia, but English is widely spoken. It is used in business and is a compulsory second language in schools. Among the non-Saudi population, many people speak Urdu, the official language of Pakistan, and other Asian languages such as Farsi andTurkish.

Arabicis spoken by almost 200 million people in more than 22 countries. It is the language of the Qur'an, the Holy Book of Islam, and of Arab poetry and literature. While spoken Arabic varies from country to country, classical Arabic has remained unchanged for centuries. In Saudi, there are differences between the dialects spoken in urban areas and those spoken in rural areas.

Family Values

The family and tribe are the basis of the social structure.As is seen in their naming conventions, Saudis are cognizant of their heritage, their clan, and their extended family, as well as their nuclear family.Saudis take their responsibilities to their family quite seriously.Families tend to be large and the extended family is quite close.The individual derives a social network and assistance in times of need from the family.Nepotism is considered a good thing, since it implies that employing people one knows and trusts is of primary importance.ETIQUETTE AND CUSTOMS IN SAUDI

Meeting Etiquette

Men shake hands. Good friends may greet each other with a handshake and a kiss on each cheek.Women generally hug and kiss close friends.Men and women would not greet each other in public I from outside the family.When Saudis greet each other they take their time and converse about general things.

Gift Giving Etiquette

Gifts are not the norm as in many other countries.

If you are invited to a Saudi's house bring something small as a thank you.Flowers do not make good gifts from a man, although a woman could give them to her hostess.Never give alcohol unless you are positive they partake.Gifts are not opened when received.

Dining Etiquette

Saudis socialize primarily in restaurants and international hotels when entertaining expatriates whom they do not know well. After some time you will be invited to the home.Entertainment will generally be same-sex only. If both sexes are included, they will be in separate rooms.

If you are invited to a Saudi's house:

You would usually remove your shoes.Dress conservatively.Try to arrive at the invited time. Punctuality is appreciated but not crucial.Show respect for the elders by greeting them first.Accept the offer of Arabian coffee and dates even if you do not normally drink coffee.If you are invited for a meal, understand that there will be a great deal of socializing and small talk before the meal is served

Table manners

If the meal is on the floor, sit cross-legged or kneel on one knee..Eat only with the right hand as the left is considered unclean.Try a bit of everything that is served.Meals are generally served family-style.Honoured guests are often offered the most prized pieces such as a sheep's head so be prepared!There is often more food than you can eat. Part of Saudi hospitality and generosity is to shower guests with abundance.There is little conversation during meals so that diners may relish the foodPatients of Arab and/or Muslim Origin Dietary issues are important for Muslim elders, because traditionally they do not drink alcohol, eat pork, or eat blood products. Lard is another avoided ingredient; baked goods and crackers are therefore examined for their content before consumption. Hospitalized Muslims may prefer to eat food prepared by their families in order to maintain dietary standards. Muslims may also resist eating or taking medications during the daytime hours of Ramadan, a holy month whose timing varies from year to year. Sick and elderly believers may be exempt from fasting during Ramadan, as some exceptions are made for frail individuals. Elderly persons of Arab origin may subscribe to folk remedies and beliefs. Beliefs may include concern about the evil eye - those who are envious may have the power to inflict injury on the family. Folk prevention measures, which include religious measures, are taken to divert the evil spirit to prevent harm. Mental illness is one of the most feared medical conditions among Arab Muslims. Psychiatric issues are thought to arise from a loss of faith in God or possession by evil. Those suffering from madness are likely to seek the help of a religious intermediary or a fold healer and may neglect formal medical care. Among elderly persons of Arab origin and their families, mental illness may be considered a secret to be minimized, covered up, or denied. Traditionally, the young adult offsprings chances of marriage are believed to be affected if family medical secrets are disclosed. Preventive medical treatment may be seen less important than treatment of acute symptoms of illness and injury.

Tip for Nurses: -Explore these issues gently with elderly patients and incorporate an understanding of traditional remedies into an overall care plan.

Older patients may expect prescription drugs to address their symptoms, but once the symptoms subside, they may discontinue their prescribed regimen. There is a belief in individual responsibility to obtain medical care but ultimately most believe that recovery from illness is in the hands of God. In Arab tradition, family members are obligated to visit and bring gifts to hospitalized elderly persons, and therefore may not wish to adhere to visitation restrictions in the hospital. Muslims practice and expect high standards of modesty and may also be embarrassed by personal questions. Cleanliness is another important aspect of Islamic tradition. After death, family members may have specific wishes regarding what is to be done with the patients body such as the ceremonial washing of the body by the family, wrapping the loved ones body in sheets and immediate burial. Good families traditionally are considered capable of handling any health crisis older family members may be hesitant to accept help from outsiders. Males in the family may be considered to have more authority with regard to medical decisions than females. In Arab countries, patients are typically told only the good news about their diagnosis.

Tip for Nurses:Provide an explanation to patients about why extended medication use is necessary. Negotiate with the patient may be necessary to promote adherence to long-term drug regimens. Ask older patients of Arab ancestry if they prefer to maketheir own health decisions or if they would prefer to involve or defer to others in the decision-making process.When there is a terminal or serious diagnosis, explore each patients preferences regarding disclosure of clinical findings early in the clinical association and to reconfirm these wishes at intervals.COMMON DISEASESIschaemic Heart DiseaseAlthough in many Arabs, multiple risk factors are present, and retrosternal symptoms are complained of, ischaemic heart disease is less common. Thus an Arab who is obese, leads a sedentary life, suffers from diabetes mellitus, has mild hypertension, smokes cigarettes and consumes alcohol, yet he is found to have chest pains of "non-ischaemic" origin.Ischaemic heart disease is also seen in patients coming from Saudi, Qatar and Oman. But one Arab community where this disease is very very rare is Yemenis. Here I must hasten to add that there are a few Yemenis whose constitution is like Saudis. In fact they have been doing business or are living in Saudi for years together. The health problems e.g. hypertension, diabetes, ischaemic heart disease in these Yemenis are like Saudis.Congestive cardiomyopathy is more likely to be the cause if an Arab is diagnosed as 'ischaemic heart disease' and has a gross cardiomegaly and chronic congestive cardiac failure.Finally, following heart diseases which may "appear" to be common, are very rare in Arab patients:Diabetic heart diseaseHypertensive heart diseaseObesity - Pickwickian syndromeAlcoholic cardiomypathy

HypertensionHypertension is a common disorder amongst Arab patients. The incidence of this disease is highest in Bahrain, followed in decreasing order by Saudi, Qatar, Oman and U.A.E. (in U.A.E. highest in Abu Dhabi). It is rare in Yemenis (except "Saudi" type of Yemenis as described above).Compliance is at its worst with Arab population. They just do not believe in any "long-term" therapy. Many of my patients come for a yearly check-up. Yet at the next examination they have been "off" their tablets for at least few months! They do not comply with low salt diet. They do not lose weight. They continue smoking though fewer cigarettes. But curiously enough, I often do not find their condition deteriorating!The Arab population tolerates hypertension much better than many others in the world. Hypertensive retinopathy, nephropathy and cardiopathy are rarities. Strokes do occur, but less frequently in spite of the high incidence of hypertension in this population.

Peripheral vascular diseaseis rare in Arabs. The symptoms of ischaemia are very uncommon even when peripheral pulsations are not palpable. Calf pains, when present are more due to tension and anxiety.In spite of heavy smoking the entity of thrombo-angiitis obliterans is relatively rare.

Deep vein thrombosisI am surprised to find a low incidence of deep vein thrombosis in Arab ladies who undergo, on an average, half to one dozen deliveries!! As mentioned earlier, this condition is more common in Bahraini females. In Arabs, the veins (and their valves) behave definitely better than those of Indian or western population ! !

Raynaud's phenomenonMany Arab patients, especially females, complain that their hands and feet, ("Yad" and "Rijley") become cold ("Baraad") when they are in air-conditioned rooms. Now ask the patient if she also feels the limbs hot ("Haar") off and on. The answer is always "yes". Also the limbs do not become blue. The burning complained of does not follow immediately the feeling of cold. Thus, you can exclude Raynaud's phenomenon.

Incidentally collagen disorders like Scleroderma or S.L.E. which are etiological factors of this symptom, are very rare in Arabs.

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