Extra Credit: Culture Shock in Iraq - 04/11/13

Culture shock is the "state of disorientation or inability to respond to the behavior of a different cultural group because it holds sudden strangeness, unfamiliarity, and incompatibility to the newcomer's perceptions and expectations" (Nies & McEwen, 2011, p. 227).  Culture shock can occur in any transition to a new environment.  It can be as simple as visiting a new place, such as a hospital, or as radical as visiting or moving to a new country.  CPT Rene De La Rosa and CPT Kevin Goke, registered nurses of the United States Army, describe the themes of suffering and healing while serving at Abu Ghraib Internment Facility in Iraq and the mutual cultural shock experienced by both sides of the war effort. 

From the perspective of the nurses, there were many cultural differences from that of the United States culture.  First, the Hospital at Abu Ghriab was assigned to take care of detainees with acute and chronic conditions, a finite number of beds, and limited supplies.  Because the hospital risked attacks, the hospital personnel "had to wear a flak vest, Kevlar helmet, and carry a weapon at all times during times of increased danger level in the area" (p. 54).  The healthcare of the Iraqi people is also as poor. 

In 2005, the infant mortality rate was reported to be 48.64 deaths per 1,000 live births, as compared to 6.43 deaths in the United States.  Additionally, 30% of the children were affected with diarrhea, measles, respiratory infections, or malaria due to lack of immunizations, healthcare centers, and hospitals.  With death and illness of infants and children, mental illness such as depression is bound to occur.  25% of the Iraqi people suffer from mental illness, however "a large stigma exists for the whole family of psychiatric patients" as Saddam Hussein believes that "depression doesn't exist in Iraq, depression is a sickness derivative of western societies, we are all happy here" (p. 54).  The long years of war and torture have affected individuals mentally and physically.  Iraqi citizens who refused to serve in the army had their ears cut off. 

Secondly, it was a shock to the nurses was the lack of record keeping when individuals did seek healthcare.  American patients have a chart that notes the visit, history, recommendations, diagnoses, and treatment.  The Iraqi physicians keep a record of the care, however it is takes place in their own record books.  If the individual sees a different provider, there is no record of their prior care.  This lack of record keeping has caused an increase in self-medicating and drug abuse.  It was "common for prisoners under Saddam's regime to receive all the Artane and Valium along with all the cigarettes they could handle" during their 7 day punishment period (p. 55).  Overall, the nurses found that the medical system was not set up for the modern medications available to the rest of the world.

The Iraqi detainees also experienced a culture shock.  Because they were detained for suspicious activity, they had to learn the ways of the camp.  Many did not know how to react to receiving superior healthcare while in the prison.  The Iraqi people do not go to their local provider for an evaluation and for most of them, it was the first time they received a thorough checkup (p. 57). 
Many were astounded that males could be nurses and how smooth their skin was as the "skin on the men's faces could be considered like shoe leather" (p. 54, 57).  The men also joked with the American nurses about how many wives they had.  When they would respond one, they would press as to why and they would respond that "the first wife spent all of our money" (p. 57). 

Overall, although the American nurses were shocked to find so many cultural differences, they were able to assist in completing their mission and "use the most disarming tactic known to mankind: the human smile" (p. 58).  It didn't matter that they had a different culture or language; they were still able to provide care. 

Reading the account of the nurses opened my eyes to the differences of other cultures.  Even though I have experienced culture shock, I have never experienced it to this extent.  Working in healthcare, we will come across individuals of different cultures who have different values, beliefs, and attitudes than us, like the Iraqi people.  In some cases, it may not alter the approach to their healthcare needs but in other situations an alternate approach needs to be taken to accommodate.  As nurses, it is important to be aware and educated of the cultural differences in the area we are providing care.  Doing so will make the patient and their family comfortable and allow you to provide optimal care.

So I ask you: Have you ever experienced a culture shock?  How did it make you feel?  Did you gain a valuable insight from the experience?  How can you apply the experience to your future career as a nurse?

Link to article:  Reflections on Suffering and Culture in Iraq: An Army Nurse's Perspective

References:

 

De La Rosa, R. , & Goke, K. (2007). Reflections on suffering and culture in iraq: An army nurse perspective. International Journal for Human Caring, 11(2), 53-58.

Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promotion the health of
populations (5^th ed.) St. Louis, MO: Saunders/Elsevier.