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Afghanistan lies in the north-western part of the Indian subcontinent, north of Pakistan. The main languages are Dari, Pashtu, and Persian. Islam is the predominant religion, with up to 84% of the population belonging to the Sunni sect, 15-20% percent to the Shiite sect and 1% affiliated with other religions. There are 19 distinct ethnic groups in Afghanistan, each with their own language.
Afghanistan's history has been one of incessant conquest and conflict. Afghanistan has been invaded by international forces throughout its history all of whom were competing for control of Afghanistan's invaluable trade routes and natural resources. By the early 19th century it had fallen under the administration of England despite heavy resistance from the Afghani people. It finally gained its independence in the early 20th century but it failed to become politically stable. Afghanistan entered a darker phase during the 10-year Soviet occupation of the country from 1979 to 1989 when one-third of the population fled the country. It was during this time that the Muslim influence of the Mujahidin who were supported by America foreign policy became embroiled in the politics of Afghanistan. However, after the Soviets withdrew in 1989, the country entered yet another period of political turmoil ending in 1996, when the Taliban declared control. However, under the Taliban the people became increasingly subjected to the strictest forms of Islamic practice and political suppression. The Taliban was overthrown during another international conflict when American forces attacked Afghanistan in 2001 because it was perceived to be the stronghold of the terrorist group Al Queda and its leader Osama Bin Laden. The onslaught resulted in increased civilian loss of life and vast numbers of Afghanis were forced to seek asylum abroad. Since the American forces withdrew the country has sought to re-establish political and economic stability. Throughout its turbulent history, Afghanistan has been dominated by clan based and ethnic rivalries which have led to frequent civil wars and it is these rivalries that have made it difficult to forge lasting political stability.
A growing number of Afghanis fleeing persecution in Afghanistan are living in Ireland. Most will have experienced trauma and torture. In addition to post-traumatic stress disorders resulting from war, dislocation, oppression, and torture, many immigrants face other stressful events such as economic hardship, introduction to a new culture, and racism. Many immigrants will have held professional occupations in their home countries but they are often unable to find comparable employment in Ireland.
While a great deal of diversity within Afghanistan exists, Afghanis do share many common cultural elements with their neighbours in South and Central Asia. Due to their strong adherence to the Muslim faith they also have similar beliefs and cultural practices as the Muslim countries to their west (Pakistan, Syria, Jordan, Iran, Iraq and Saudi). These cultures are all strongly rooted in the family and extended family. The role of each family member is well-defined. Elders are respected. Elderly parents quite often live with and are looked after by their children. A strong system of support and co-dependency develops naturally in families. Most decisions are made in light of what is best for the family. The vast majority of Afghanis in Ireland are male and they have come alone so therefore they have no family support. This can cause additional distress during periods of illness.
Strict Muslims pray five times a day during which the head must be facing towards Mecca and the forehead touches the ground. Friday is a religious day and men attend the mosque. A sick person may need privacy during the day at prayer times, and assistance in facing Mecca and the pre-prayer washing of face, feet, hand and forearms. Muslims are not allowed to pray before thorough cleaning with water.
Islam permits the consumption of `halal' meat only. This is meat which has been killed according to Islamic law. Pork products are not eaten and a few seafoods may not be allowed. Alcohol is not allowed in Islam. Water is traditionally taken with meals.
Fasting is required during Ramadan, the ninth lunar month, with no food or drink being consumed between sunrise and sunset. The ill are considered exempt, but for some believers, fasting may include not taking medications, including injections, during this important period.
It is important not to use the left hand in touching or giving materials to Afghanis. The left hand is used for toilet hygiene.
Many Muslims do not like their head being touched. This is not a religious but a cultural preference.
In Islam, the rhythm method and coitus interruptus are acceptable if both the husband and wife agree. Tubal ligation and vasectomy are not desirable in Islam, but other reversible contraception is allowed if there are medical grounds to avoid pregnancy.
In Islam abortion is not permitted unless there are very strong medical reasons, and it is not permitted after four months unless the mother's life is threatened.
Pregnant and lactating women are exempted from fasting during Ramadan. Childbirth may be considered a strictly female issue, and the father may not be involved in the birth process at all. However, if the pregnant woman does not have a female support network in Ireland, the health service provider may make a stronger attempt to include the father in the care of the expectant mother. Soon after birth the newborn Muslim child has the call to prayer recited in each ear. Some Muslims remove the hair of the newborn after birth.
Babies are named traditionally on the sixth day when their birth is celebrated and gifts are given.
Education levels are relatively low in Afghanistan especially for females. The literacy rate is one of the lowest in Asia. This is slowly improving.
Circumcision is performed on all male children before puberty - the specific age at which it occurs relates to the cultural norms of the parents.
The health care system in Afghanistan has been underdeveloped and for women in particular there has been no health care provision under the Taliban regime due to a ban on female doctors treating women and a ban on female health care providers. Health is therefore poor amongst Afghanis - life expectancy is only 46 years.
In the absence of an adequate health care system traditional methods of health care have flourished. Many Afghanis practice a system of medicine called Unani which uses herbs and diet to control disease. Sometimes Islamic leaders will be called on to recite prayers to assist in healing.
The system of obtaining a referral before having a consultation with a specialist may be quite a new experience for Afghanis. To make an appointment to see a doctor can also be a struggle due to language barriers.
Expectations of the health care provider are generally high, and this can lead to "doctor shopping" if a doctor does not fulfill a patient's expectations by prescribing pills, giving injections, or performing minor procedures. Providing a careful explanation of a diagnosis and the appropriate treatment is, therefore, very important. Also Afghanis may not be familiar with the importance of continuing prescribed treatments after symptoms are relieved. Similarly, preventative health care may be given low priority.
Family members are usually involved in treatment decisions. A hospitalized patient is not told his or her diagnosis, only the family is told. Many Afghanis believe that a patient who knows the truth may lose hope. Where an Afghani is terminally ill the health service provider should consult with the family. Elders have prestigious status in Afghani society, and thus may be consulted when health problems arise. Elders may suggest home or natural remedies, which may be viewed as complimentary to western medicine.
When a person is sick, it is usual for the family to notify all relatives. The sick person is usually happy to receive many visitors. Families may see themselves as care providers for hospitalized family members. In addition to bringing the patient food and other personal items, family members might want to extend their visits and include other relatives in the visits. Culturally responsive providers should recognize that this type of family support is part of the healing process.
Avoidance of shame and maintaining family honour are important concepts for Afghanis. Health service providers should be very conscious of this where the illness in question could be viewed as shameful by the client. In these cases absolute privacy and confidentiality must be maintained.
Like South Asians, Afghanis generally do not discuss personal, physical or mental problems with anyone outside the family. Given that many Afghanis in Ireland will have experienced torture and trauma and are likely to suffer from PTSD this is particularly pertinent as it may be difficult to persuade clients to use services that deal with mental illness. This can be compounded by associated feelings of shame and guilt that the person may burden themselves with which can further prevent disclosure of past experiences.
When dying, a Muslim patient may prefer to face Mecca. After death the body
is traditionally covered with a sheet. According to Islamic law the body must
be buried within 24 hours of death. The body must be thoroughly washed prior
to burial.
Many Muslims believe in life after death and believe that the soul stays near
the body until burial. Some families may prefer to take a body home or to the
mosque for preparation for burial. Public grieving lasts, depending on the situation,
for 3, 7 or 40 days, with remembrance memorials held on anniversaries.
If post-mortems are legally necessary, this must be explained in detail to the relatives. It is not a common practice in Afghanistan and it may interfere with the requirement for a body to be buried within 24 hours.
Transplantation of human organs is permissible under Islam. Organ donation is up to the individual's preference.
Marriages are traditionally arranged in Afghani society and usually within the ancestral group. It is normal to marry young - usually in the late teens. Women and men usually live in separate social and domestic spheres but women can work outside the home in Ireland.
Traditional Muslims follow Purdah where the women are clothed from head to foot in a burq'a or chaderi. This is particularly the case in Afghanistan where the Taliban enforced the full Purdah practice for women. Some Afghani women in Ireland can be expected to continue this practice. Women traditionally were not permitted to work outside the house or drive.
Touching between men and women in public is prohibited but it is normal for people from the same sex to touch each other. Men are especially affectionate with each other. Women will usually lower their eyes when speaking with a man.
It is to be expected that a husband or male relative who accompanies his wife to a health clinic will speak for her even if she is able to speak English herself.
In hospital women may wish to remain as fully clothed as possible and many will choose to be seen only by female health professionals and vice versa for men. Similarly many Afghanis will be upset by having to use interpreters of the opposite sex, especially when dealing with urinary or gynecological matters. Use of the extended family or friends as interpreters may also cause embarrassment and disgrace.
Women from Afghanistan may never have had a Pap smear or mammogram, and may not understand the importance of these investigations. They may avoid these services due to reluctance to undress in front of a health care provider, even when the provider is female.
Men may prefer to keep covered from waist to knee and be cared for only by male staff.
Both men and women will generally want water for washing before and after meals as well as for toilet hygiene.
The largest ethnic group is the Pashtuns, comprising 38 % of the population. The next most populous groups are the Tajiks, Hazara, and Uzbeks. Over half of all Afghans speak Afghan Persian (Dari), and 35 % speak Pashtu.
This very readable Canadian site gives a short account of the county's geography, history, sports, arts, work, family and health. It is socially orientated rather than health focussed, as it is designed to initiate communication and integration between habitual Canadian residents and newly arrived immigrants. It will therefore not explain aspects of culture to a depth that some health care providers would need. However, it does offer avenues and ideas that could be used to open up a productive communication process between health care providers and clients that would lead to relevant information being exchanged. ۞ ۞ ۞
This reliable UNICEF site gives background information and health related statistics that could prove especially useful for health care providers who need to determine the health and social history of their clients. Some cultural information can also be deduced relatively easily from the statistical detail. There is an emphasis on children's and women's health due to UNICEF's focus on children. ۞ ۞
This 2005 cultural profile is an American `library of congress' government file. As such it is concise and factual and it offers sections on health, education, and human rights. However, it is lacking in any data on traditional health seeking practices and cultural beliefs that would increase opportunities to develop cross cultural understanding. ۞ ۞
This BBC site will give you a brief overview of the current political situation in each country. This may help you to know what political situation your client may have left behind and what their relations are currently living with. It also gives a brief overview of statistics - population, religions, languages, life expectancy and exports. ۞
This WHO site gives statistics on a number of health issues that may be of importance to health care providers who need to determine the health history of their clients. Additional cultural information that may apply to the client can only be deduced from the statistical details presented on the site. The sites' value is limited due to this high speciality factor. ۞
This site gives you basic facts and a map of each country. It gives basic demographic details that include religion, ethnicities, health risks, mortality rates etc. which may be useful, especially if comparative material is required. A short synopsis of the political situation in the country is included. ۞
SPIRASI does not necessarily agree with the facts and opinions presented in this guide or any linked websites.
This Cultural Profiles web-site was designed to be fully compliant with modern standards for web publication (as specified by the W3C). The pages will be accessible and readable on any display using any web browser, old or new.