middle east

Question 1

 Current Demographics & Socioeconomic Status
 Worldview:
Traditional Health Beliefs & Practices
 Meal Composition and Cycle
 Etiquette
 Special Occasions
Counseling

Answer 1

be more familiar with these

Question 2

main religion

Answer 2

islam, jewish, christianity

Question 3

food prohibition

Answer 3

halal - allowed

haram- not allowed

Question 4

food prohibition

Answer 4

halal - allowed

haram- not allowed

Question 5

what are the two cultures tha historically dominated the middle east region

Answer 5

bisentine (in turkey), persian

Question 6

climate

Answer 6

is temperate &

suited to agriculture but can be very dry

Question 7

demographic

Answer 7

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

Question 8

where do most middle easterns settle

Answer 8

ontario then quesbec

Question 9

socioeconomic status

Answer 9

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)

Question 10

iranians- immigration

Answer 10

 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

Question 11

Israel - immigration

Answer 11

 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

Question 12

Early Arab immigrants but now they are

Answer 12

Early Arab immigrants were Christian
◦ Eastern Orthodox
 Egyptian Coptic Church
 Recent immigrants follow Islam
◦ Sunni Muslims
 Friday Sabbath has been moved to Sunday

Question 13

◦ 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:

Answer 13

h

Question 14

arabic family

Answer 14

 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??

Question 15

familiy israelis

Answer 15

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

Question 16

Traditional Health Beliefs & Practices:

Middle Easterners

Answer 16

 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

Question 17

Traditional Health Beliefs & Practices:

Iranians

Answer 17

 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

Question 18

 Narahati

Answer 18

is term used for feelings of physical &
emotional discomfort
◦ Usually private & nonverbal

Question 19

 Naharati qalb

Answer 19

b (heart distress) is fluttering of the

heart from strong expression of anger or sadness- or heart desease

Question 20

ko’hl -Folk remedies common

Answer 20

 Dark powder from antimony used in cosmetics- eye liner- - thought to increase vision of the baby

Question 21

 Herbal remedies prevalent

Answer 21

◦ Yarrow for diabetes

◦ Khella for kidney disorders

Question 22

 Palestinians use traditional remedies as food and

medicine

Answer 22

◦ Mallow as a laxative, etc

Question 23

other health beliefs

Answer 23

 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

Question 24

Traditional Food Habits

Answer 24

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

Question 25

Traditional Food Habits: Staples

Answer 25

 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

Question 26

Traditional Food Habits: Staples

olive

Answer 26

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

Question 27

Traditional Food Habits: Staples

fruit

Answer 27

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

Question 28

Traditional Food Habits: Staples

dairy

Answer 28

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

Question 29

Traditional Food Habits: Staples

meat

Answer 29

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

Question 30

Traditional Food Habits: Staples

spice

Answer 30

 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

Question 31

Traditional Food Habits: Staples

drinks

Answer 31

 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

Question 32

Regional Variations: Middle Eastern

Answer 32

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

Question 33

Regional Variations: Arab

Answer 33

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

Question 34

Regional Variations: Iran

Answer 34

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

Question 35

Regional Variations: Israel

Answer 35

Food and culture probably most varied
 Blends Middle Eastern with the many
Jewish immigrant groups
 Many adhere to kosher laws of the Jewish
religion

Question 36

Daily Patterns – Middle East

Answer 36

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

Question 37

Daily Patterns – Middle East

turkey

Answer 37

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

Question 38

Daily Patterns – Middle East

Answer 38

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

Question 39

Daily Patterns – Middle East

israeli

Answer 39

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

Question 40

Etiquette

Answer 40

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

Question 41

Special Occasions

ramadan

Answer 41

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

Question 42

Special Occasions

iran

Answer 42

 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

Question 43

Special Occasions

israel

Answer 43

 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

Question 44

therapeutic uses of food

Answer 44

 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

Question 45

Therapeutic Uses of Food

hot and cold

Answer 45

 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

Question 46

Therapeutic Uses of Food

food combos

Answer 46

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

Question 47

Counseling

Answer 47

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