1. People of the Balkans and the Middle East Chapter 13

2. Cultural Perspective Balkan Nations Greece Albania Bosnia-Herzegovina Montenegro Serbia ◦ Kosovo ◦ Vojvodina Macedonia Croatia Slovenia Bulgaria Romania Middle East Bahrain Egypt Iran Iraq Israel Jordan Kuwait Lebanon Oman Saudi Arabia Syria Turkey United Arab Emirates Yemen

3. Cultural Perspective Temperate in climate and suited to agriculture Aridity limits cultivation Greek and Turkish influences throughout Very diverse in religious affiliation

4. History of People of the Balkans in US Greek immigrants came in late 1800s and early 1900s and then after WWII ◦ Early immigrants came to America for economic opportunities ◦ 1940s after a civil war and then in 1967 after a military coup

5. History of People of the Balkans in US Croatians came in 1850-60s to southern and western regions of US ◦ Oyster fisheries of the Mississippi ◦ Fruit horticulture in northern California Serbs were unskilled laborers who obtained industrial jobs in the northeast Immigration for both increased after WWII

6. History of People of the Balkans in US Slovenians arrived between 1880 and WWI but many listed as Austrians ◦ Farmers seeking economic opportunity ◦ Settled in Midwest with self-sustaining ethnic communities

7. History of People of the Middle East in US Statistics are inexact Until 1900s all were called “Egyptians” Later termed “Syrians” or “Turks from Asia” Early Arab immigrants came at the turn of the 20th century for economic opportunity Most Christians from Lebanon and Syria Settled in the Midwest and New England More came after WWII ◦ Many Palestinian Christians fleeing Israel

8. Current Demographics and Socioeconomic Status: Balkans NYC has largest concentration of Greek Americans ◦ Unemployment rates are low ◦ Families living below poverty is below average Croatians and Serbs were originally in mining regions of the Midwest Slovenians in Ohio ◦ Incomes close to the US average

9. Current Demographics and Socioeconomic Status: Balkans Bosnian refugees came in the early 1990s seeking refuge from ethnic cleansing Left homeland suddenly Most Muslim and live in Bosnian Muslim neighborhoods ◦ St. Louis Strong work ethic Lack of English skills or credentialing difficulties Average income is low

10. Current Demographics &Socioeconomic Status: Middle Easterners Demographic data problematic One of the fastest growing ethnic groups in America ◦ Most are now Muslim ◦ From 15% in 1970 to 73% in 2000 ◦ Appear to prefer to be called “Arab” as opposed to national affiliation 1/3 have settled in CA, NY, and MI ◦ Detroit has largest concentration of Muslims

11. Current Demographics &Socioeconomic Status: Middle Easterners 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 average Poverty rates are high for some ◦ “Arabs” and Iraqis

12. Current Demographics & Socioeconomic Status: Middle Easterners Iranian Americans and Turkish Americans do well with income, education 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

13. Worldview: Religion – People of the Balkans Greeks and Greek Americans ◦ Greek Eastern Orthodox Church Serbs ◦ Serbian Orthodox Autonomous Church Croatians and Slovenians ◦ Devout Roman Catholics Some Slovenians are Protestants ◦ Windish Bosnian Croats were Catholic Bosnian Serbs followed the Eastern Orthodox Recent Bosnian refugees are Sunni Muslims

14. Worldview: Religion – Middle Easterners Early Arab immigrants were Christian ◦ Eastern Orthodox  Egyptian Coptic Church Recent immigrants follow Islam ◦ Sunni Muslims  Friday Sabbath has been moved to Sunday ◦ Iranians  Shi’ite Muslims and other religious minorities  Baha’i Faith is a Muslim offshoot that renounced ties to Islam ◦ Turkish Americans are Sunni Muslims Israeli Americans typically Jewish

15. Worldview: Family - Balkans Greeks strongly patriarchal ◦ Unquestioned authority with numerous responsibilities ◦ Women focus on home, family, church Croatian and Serbian families patriarchal ◦ Extended families the norm Bosnians did maintain extended family homes but this has changed ◦ Men and women both work but women retain responsibility for the home

16. Worldview: Family – Middle Easterners Arab families have a strong patriarchal family whose honor must be maintained ◦ Demand conformity and subordination ◦ In turn family is protected ◦ Can identify with family status Extended family members live in single home or a family compound ◦ Exception in Egyptians who live traditionally in nuclear family groups

17. Worldview: Family – Middle Easterners Men and women are equal but with different roles and responsibilities Children are valued Men obligated to provide economic security for children Women are to socialize them including the preservation of religious and cultural values Women provide love and comfort in the home ◦ Strong bond between mothers and children Views in US are changing

18. Worldview: Family – Middle Easterners Marriage contracts often arranged ◦ Many marry cousins  Egyptians and Arab Christians do not ◦ Date after engagement announced ◦ Chastity and modesty of the women related to family honor  Mother is responsible for daughter’s chastity ◦ Interethnic marriages discouraged  Not Egyptians Iranians and Turks similar to Arabs

19. Worldview: Family – Middle Easterners 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

20. Traditional Health Beliefs and Practices: People of the Balkans Physical fitness essential to good health Necessary for development of character For Greeks ◦ Eating a good diet ◦ Relaxation ◦ Adequate sleep ◦ Keeping a positive attitude

21. Traditional Health Beliefs and Practices: People of the Balkans Most care provided by mothers or grandmothers Many kept an herbal pharmacy for therapeutic teas Cupping includes blood-letting More severe conditions by midwives and bonesetters

22. Traditional Health Beliefs and Practices: People of the Balkans Belief in “evil eye” prevalent ◦ From envy Causes accidents and illness Wear garlic, blue amulets with eye in the center When receiving a compliment will spit two or three times to keep harm away

23. Traditional Health Beliefs and Practices: Middle Easterners Cleanliness, diet, keeping warm and 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

24. Traditional Health Beliefs and Practices: Middle Easterners 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

25. Traditional Health Beliefs and Practices: Middle Easterners 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 and emotional discomfort ◦ Usually private and nonverbal Naharati qalb (heart distress) is fluttering of the heart from strong expression of anger or sadness

26. Traditional Health Beliefs and Practices: Middle Easterners Long-standing tradition of home health Folk remedies common ◦ Use ko’hl  Dark powder from antimony used in cosmetics Herbal remedies prevalent ◦ Yarrow for diabetes ◦ Khella for kidney disorders Palestinians use traditional remedies as food and medicine ◦ Mallow as a laxative, etc.

27. Traditional Health Beliefs and Practices: Middle Easterners 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

28. Traditional Food Habits Origins of dishes unknown Wheat, olives, dates Sheep Rice, chickpeas, lemons

29. Traditional Food Habits Significant differences due to dietary restrictions and 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

30. Traditional Food Habits: Staples Loaves and flatbreads ◦ Pita or pocket bread ◦ Lavash or cracker bread Wheat doughs to make pies and turnovers ◦ Phyllo or filo ◦ Makes savory pies or desserts  Baklava or paklava

31. Traditional Food Habits: Staples 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

32. Traditional Food Habits: Staples 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 Potatoes Vegetables often eaten raw, mixed together or preserved

33. Traditional Food Habits: Staples The olive Extremely important in Greek and 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

34. Olives

35. Traditional Food Habits: Staples 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 and syrups often used to flavor foods ◦ Especially lemon

36. Traditional Food Habits: Staples 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

37. Traditional Food Habits: Staples Most meat and seafood consumed ◦ Pork avoided in Muslim countries ◦ Shellfish avoided among observant Jews ◦ Lamb is most widely used meat ◦ Pork is popular in Balkans 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 occassions

38. Traditional Food Habits: Staples Numerous spices and herbs from former spice trade Dill, garlic, mint, cardamom, cinnamon, oregano, parsley, pepper Sumac is sprinkled on salads ◦ Mixed with thyme to make Arabic seasoning called za’atar Verjuice is from unripe lemons and gives sour taste to dishes Sesame seeds used frequently ◦ Crushed to make a thick paste called Tahini

39. Traditional Food Habits: Staples Fruit juice popular beverage ◦ Fruit syrups or flower extracts mixed with ice to make sharbat (sherbet) Coffee flavored with cardamom, lots of sugar ◦ Turkish or Serbian coffee ◦ Made in briki Tea also consumed

40. Traditional Food Habits: Staples Wine and distilled spirits in the Balkans ◦ Civek – a rosé served throughout Slovenia ◦ Sljivovica - A high-proof brandy made from plums available in both Serbia and Slovenia. ◦ Retsina - white wine with resinous flavor ◦ Ouzo and arak - anise flavored apertifs  Raki is a Turkish version ◦ Metaxia is orange-flavored brandy

41. Regional Variations: Balkans Combine European and Middle Eastern elements in cooking Northern nations more influenced by Europe ◦ Includes Romania Southern nations more influenced by the Middle East ◦ Greek is considered Turkish ◦ Includes Albania

42. Regional Variations: Balkans Northern Balkans Pork and veal with German-style sausages Pljeskavica are large, thin beef or lamb patties that are grilled Potatoes, cabbage, cucumbers, wild mushrooms ◦ May be stuffed with meat and rice ◦ Bell peppers, onions, potatoes, or cabbage leaves give a Balkan flavor

43. Regional Variations: Balkans Fruits are cooler weather ◦ Desserts such as dumplings and strudels, compotes Buttermilk frequently consumed Fresh cheese often combined with herbs Cream in soups, stews, casseroles Sour cream or whipped cream tops many dishes Treat is a sweet yeast bread rolled with walnut, butter, cream and egg filling called potica ◦ With dried fruits or savory

44. Regional Variations: Middle Eastern 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

45. Regional Variations: Greece and Turkey More meat, fish and seafood, cheese, butter and olive oil Use flatware instead of fingers Common dishes ◦ Filo dough with spinach & feta: Spanakopita/ ispanakli ◦ Caviar dip – taramasalata/tarama ◦ Salads with fresh greens, tomato, cucumbers, olives, lemon juice-olive oil vinaigrette Greeks like pastries while Turks like fruit compotes or rich custards and candy Fasting rules vary drastically between Eastern Orthodox and Muslim

46. Regional Variations: Arab 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

47. Regional Variations: Arab 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

48. Regional Variations: Iran 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

49. Regional Variations: Israel Food and culture probably most varied Blends Middle Eastern with the many Jewish immigrant groups Many adhere to kosher laws of the Jewish religion

50. Exploring Global Cuisine: Romanian Fare Romania is between the West and East Food has Turkish and Hungarian overtones Also Italian and central Europe influences Most Romanians are Eastern Orthodox Regional discord and shifting boundaries Influence of Greece, Turkey, Italy, Armenia and Russia

51. Exploring Global Cuisine: Albanian Fare Poorest areas farmers and shepherds live on cornmeal bread, cheese and yogurt with lamb or mutton when affordable Vegetables are only pickled as side dishes Fruits are only eaten fresh as desserts or preserves Always prepared separately and not mixed

52. Exploring Global Cuisine: Moroccan Cooking Part of the Maghreb, a region of North Africa Cooking is Berber in origin Notable for exquisite seasonings ◦ Spices, herbs, medicinal herbs Flavored by the preferred fats of the region Couscous is a staple ◦ Crushed grains of semolina Foods eaten with first three fingers of right hand

53. Meal Composition and Cycle: Daily Patterns – The Balkans 3 meals per day Light breakfast Main meal at midday ◦ Short nap afterwards in hotter climates May have afternoon visitors for sweets, coffee, or ouzo Dinner is lighter and later in the evening Snacking is prevalent ◦ Mezze are small dishes of various items widely available from street vendors and cafes

54. Meal Composition and Cycle: Daily Patterns – Middle East Coffee or tea served early about 7 or 8 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

55. Meal Composition and Cycle: Daily Patterns – Middle East 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

56. Meal Composition and Cycle: Daily Patterns – Middle East 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

57. Meal Composition and Cycle: Daily Patterns – Middle East 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

58. Etiquette 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

59. Etiquette 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

60. Etiquette 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

61. Etiquette 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

62. Etiquette Lick your fingers Eating noises express appreciation 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

63. Special Occasions Eastern Orthodox Church has many feast and fast days Most important Greek holiday is Easter ◦ Red-dyed Easter eggs ◦ Easter bread called lambropsomo decorated with eggs ◦ Easter soup called mayeritsa made of lamb’s intestines ◦ Easter cookie called koulourakia ◦ Roast lamb Also celebrate Greek Independence Day in US

64. Special Occasions Croatians celebrate Easter similar to the Greeks Christmas Eve features meal of cod, stuffed cabbage and sauerkraut Serbians celebrate Patron Saint’s Day ◦ Each family honors its self-chosen patron saint with feasting and dancing Also celebrate St. Nick’s Feast and St. Martin’s Feast

65. Special Occasions 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

66. Special Occasions 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

67. Special Occasions In Turkey, Seker Bayram is Eid-al-Fitr ◦ Sugar Festival ◦ Gifts and sweet treats exchanged 10th day of the first lunar month Turks celebrate the martyrdom of Mohammed’s grandson and the day Noah was able to leave the ark ◦ Noah’s pudding (asure) made from fresh and dried fruits, nuts, legumes Kurban Bayram is day of remembrance for when Abraham almost sacrificed his son National Sovereignty and Children’s Day

68. Special Occasions Iran’s most significant holiday is Muharram ◦ Commemorates the martyrdom of Mohammed’s grandson Time of communal mourning and penitence for Shi’ites Nau Roz is a spring festival with a special meal and ceremonial table setting ◦ Seven foods that start with “s” ◦ Then a traditional meal

69. Special Occasions 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

70. Therapeutic Uses of Food 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

71. Therapeutic Uses of Food 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

72. Therapeutic Uses of Food 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

73. Therapeutic Uses of Food Special foods with childbirth ◦ When a woman gives birth to a girl in Iran, coldness is neutralized with a diet high in hot foods to ensure a male child in the next pregnancy Division between food and medicine blurred Many foods will have multiple therapeutic uses ◦ Turnips good for the kidneys and urinary tract ◦ Cauliflower good for the respiratory system ◦ Palestinians consider garlic good for many, many things

74. Contemporary Food Habits in the US: Adaptations of Food Habits Very little data available Assumed that length of stay correlates with Americanization of the diet Traditional meals prepared and eaten for main meal or special occasions Religious dietary practices probably do not change significantly

75. Contemporary Food Habits in the US: Ingredients and Common Foods Greeks still use lots of olive oil ◦ Consumption of beef and pork increased ◦ Consumption of legumes decreased ◦ Consume more milk ◦ Dinner now main meal Egyptians continue traditional wheat bread consumption ◦ Intake of legumes, fava beans lower ◦ Snacking and eating out more prevalent ◦ Soft drinks more popular

76. Meal Composition and Cycle Greeks maintain traditional meal patterns ◦ Main meal is now dinner in the evening Recipes adapted to be less time consuming, to include fewer fats and spices Assume that Americans of Croat, Serbian and Slovenian heritage are similar Many Arab American still eat meal at mid-day Extended family dine together daily, women at home cook for other employed women ◦ Egyptians now have main meal as evening dinner

77. Nutritional Status: Intake Traditional diet of nations bordering the Mediterranean ◦ Low in saturated fats ◦ High in monounsaturated fats ◦ High in omega-3 fatty acids Lowered risk of CVD and cancer Diet is becoming more westernized Role of alcohol consumption not fully understood

78. Nutritional Status: Intake Obesity rates for Greeks ◦ 50% for women, 75% for men Lebanese young adults eating fewer fruits, vegetables, legumes ◦ Eating more meat, sugar, soft drinks, alcoholic beverages Bosnian immigrants need counseling for diet and exercise ◦ Dental problems and alcohol abuse ◦ Hypertensive disease in refugees

79. Nutritional Status: Intake Arab men in Arabian Peninsula ◦ Metabolic syndrome High prevalence of undiagnosed problems ◦ Type 2 diabetes ◦ Hypertension ◦ Insulin resistance ◦ Low HDL ◦ Tendency towards abdominal obesity

80. Nutritional Status: Intake US Arab research shows similar trends ◦ Obesity and central obesity ◦ High blood pressure ◦ Type 2 diabetes ◦ Metabolic syndrome ◦ Low HDL Leading cancer deaths in Arab Americans are lung, colorectal and breast

81. Nutritional Status: Intake Effects of Ramadan fasting ◦ No significant changes in body weight ◦ Increases in uric acid blood level noted  May correlate with high rates of kidney stones and angina pectoris ◦ Pregnant women without medical risk factors can probably safely go through Ramadan ◦ Immigrant women fast on average more days than those born in the US

82. Nutritional Status: Intake Exclusive breastfeeding rates very high ◦ Strong social network of support ◦ Turkish women nurse sons longer than daughters as breast milk believed to increase strength Celiac disease considered primary cause of diarrhea in Iran ◦ May contribute to iron deficiency, malnutrition, rickets, short stature in children ◦ Thalassemia syndrome may be prevalent

83. Counseling 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

84. Counseling 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 Greeks may smile when angry Head nods may be opposite of what is expected

85. Counseling 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

86. Counseling Proper posture shows respect Do not cross legs, point with foot, or show sole of shoe In Turkey, 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

87. Counseling Speak kindly, soft, respectfully Keep options to a minimum Family members may insist on participating in all conversations Value biomedicine Have respect for authority figures May be hesitant to answer questions or give answers to please provider

88. Counseling 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

89. Counseling 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

90. Counseling Muslim client may feel most comfortable with providers of same gender Bosnian clients may not understand importance of taking prescribed medicines ◦ May use traditional therapies

91. Counseling 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

92. Cultural Controversy: Is Coffee Beneficial to Health? Still suspect in ◦ Bladder cancer ◦ Spontaneous abortion ◦ Impaired fetal growth ◦ May aggravate some GI disorders These groups most susceptible to adverse effects: ◦ People with hypertension ◦ Children ◦ Elderly ◦ Pregnant women

93. Cultural Controversy: Is Coffee Beneficial to Health? Coffee does not cause GI disorders, cardiovascular conditions, or cancer Coffee may reduce the risk of ◦ Metabolic syndrome ◦ Coronary heart disease ◦ Type 2 diabetes ◦ Several cancers ◦ Rheumatoid arthritis ◦ Possibly Alzheimer’s disease