Cultural Considerations when Working with Arab Families and their Children with Complex Communication Needs (Part I)

Diana Deaibes

9/23/2018 1:31 AM

                                                                 “I wonder why the family has more than one child with a disability.”
                                                         “Her mother wouldn’t shake my hand when I tried greeting her in the lobby.”
                                           “The family invited me over for dinner after work. How do I say ‘no’ without offending them?”

As an Arab-American speech and language pathologist, my colleagues often ask me questions about the traditional Middle Eastern culture in attempt to have a better understanding of the clients and families they work with. I have also advised colleagues on how to improve their interactions with their clients, such as when I observed a colleague attempt to greet a family member of the opposite sex with a handshake, and observed the Arab family member kindly place their hand over their heart and bow.  There are various differences between the Arab and American cultures beyond greetings.  Taking the time to educate yourself on the Arab culture will allow you to build rapport with your families. 

Marriage within the Family
There are many differences between Arab and American cultures. These differences extend from traditions, social interactions, and marriage practices. For example, in some places in the Middle East, it is not a social taboo for an Arab man and woman from the same family to enter into a consanguineous marriage (Obeidat,Khadar, Omarin, Kassawneh, & Omari, 2010; Pedersen, 2002; Grant & Bittles, 1997). Men and women in the Middle East marry first or second cousins for various reasons. Some believe in marrying within the family to expand the number of family members with the same surname. Others may marry within the family because they have in depth knowledge regarding the partner’s reputation and their family values. Marrying within the family may also ensure that property and businesses remain within the family. It is well known that having children within the family increases the chances of having children with genetic disorders (Morton, 1958). For this reason, the tradition of marrying within the family is likely to fade; however, in some Middle Eastern countries, families may still follow this tradition (Hosseini-Chavoshi, Abbasi, Shavazi, & Bittles, 2014). Due to immigration and relocation of refugees from the Middle East to the United States, you may at some point work with an Arab client born from a consanguineous marriage.


Communication Style and Personal Space
Communication styles differ across Arab and American cultures. For example, the concept of personal space in Arab families is different from that of mainstream culture in the United States. In general, most Arabs tend to stand closer to their communication partner of the same sex. It is not uncommon for men to set their hands on each other’s shoulders, or for two females engaging in conversation to stand within close proximity and use gestures including touching the other’s hand during conversation. Much greater distance is expected between members of the opposite sex including married couples. In Arabic culture, a man should not stand too close, stare at, or touch a woman in public. Even a slight touch on the woman’s back or arm is considered inappropriate for many conservative Arab families (Feghali, 1997). When working with Arab families, it may be safest to assume that your Arabic client’s family follows this rule, especially females who wear a hijab (head covering).


Hospitality
Social interactions with treating clinicians also present differences between Arabic and American cultures. Many Arab families enjoy inviting guests over for dinner, and it is common for Arab families to invite their treating clinician. In the Arab culture, it may be considered offensive if you decline an invitation. If this occurs with a family you are working with, it will be important to explain to the family the reasons for declining their dinner invitation. In most work places, there may be policies related to conflicts of interest and rules against meeting your clients and their families outside of therapy. In this scenario, keeping an open dialogue with the family will create a better understanding which will allow formal work relations to resume.


References and Works Consulted: 

Feghali E. (1997). Arab cultural communication patterns. International Journal of Intercultural Relations, 21(3), 345-378.

Grant, J. C. & Bittles, A. H. (1997). The comparative role of consanguinity in infant and childhood mortality in Pakistan. Annals of Human Genetics, 61(part 2), 143-149.

Hosseini-Chavoshi, M., Abbasi-Shavazi, M. J., & Bittles, A. H. (2014). Consanguineous marriage, reproductive behavior, and postnatal mortality in contemporary Iran. Human Heredity, 77, 16-25.

Keeping it in the family. (2016, February 25). Retrieved September 15, 2018, from https://www.economist.com/middle-east-and-africa/2016/02/25/keeping-it-in-the-family

Lipson, J. G., & Meleis, A. I. (1983). Issues in the health care of Middle Eastern patients. The Western Journal of Medicine, 139(6), 50-57.

Morton, N. E. (1958). Empirical risks in consanguineous marriages: Birth weight, gestation time, and measurements of infants. American Journal of Human Genetics, 10(3), 344-349

Obediat, B. R., Khadar, Y. S., Omarin, Z. O., Kassawneh, M., & Omari, M. A. (2010). Consanguinity and adverse pregnancy outcomes: The north of Jordan experience. Maternal and Child Health Journal, 14(2), 283-289.

Pederson, J. (2002). The influence of consanguineous marriage on infant and child mortality among Palestinians in the West Bank and Gaza, Jordan, Lebanon, and Syria. Community Genetics, 5, 178-181.

Speech-Language Pathologist,Educator,Parent/Family Member,Occupational Therapist,Physical Therapist,Researcher,Developer Vendor,Other,Arabic

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