ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

sources to be used in the sessions working with Arabic patients, even if the patient is non-Muslim (Battle, 2000). Customs n Handshaking – For people from a Muslim religious back­ ground, handshaking is forbidden between male and female. Arab men shake hands when greeting or parting (Battle, 2000). To greet a woman, the man should not offer his hand for a handshake unless the woman extends hers first (Bahaa-Eddin, 2006). n Kissing – There are at least four common types of kiss: a) head kissing, indicating respect and in a wedding context where a groom kisses his bride’s head while giving her a gift and saying maasih- ? aleeki bil maal wil h- alaal (to show that this is a legal bond for which the groom has paid a dowry); b) cheek kissing, commonly between females; c) nose touching involving two or three nose-touches is an unmarked greeting; and d) hand kissing is another indication of respect and deference (Bahaa-Eddin, 2006). n Visiting – A visitor may be expected to take off their shoes before entering a home (Bahaa-Eddin, 2006). There is a very elaborate etiquette of coffee-offering in most Arabic countries. It is very embarrassing and disgraceful not to offer coffee to a guest and it could be regarded as inappropriate not to accept it. Normally, the one who is on the right will get coffee first. Once s/he is done, s/he should shake the cup if s/he does not want any more coffee (Bahaa-Eddin, 2006). Non-verbal communication n Distance – People from an Arabic background usually maintain a conversational distance of a bit more than half a metre between speaker and listener, but prefer to keep greater interpersonal distance when communicating with the opposite gender (Battle, 2000). n Touch –Men frequently touch each other (but do not touch women) (Battle, 2000) n Smiling – It is appropriate for an Arabic female to not smile when meeting a stranger (Bahaa-Eddin, 2006). n Pointing at someone with a finger can be perceived as rude (Bahaa-Eddin, 2006). Avoid sitting in such a way that your feet are pointing directly at someone else (Bahaa-Eddin, 2006). n Using the right hand is always more acceptable than using the left in giving and receiving (Bahaa-Eddin, 2006). n Gestures – Arabic speakers use many gestures during conversation (Battle, 2000). n Eye contact is generally avoided in most cross-gender encounters (Bahaa-Eddin, 2006). During conversations, people from an Arabic background tend to maintain steady eye contact with the listener, but pious Muslim males will seek not to maintain eye contact when talking to a female. n Silence may have a number of unexpected meanings. It may indicate a lack of understanding, respect for what the speaker has said, or respect for the older status of the other person. For Arabic women, silence may indicate embarrassment if talking with males present. Verbal communication n Religious expression – El-Sayed (1990) has noted the importance of religious expressions in expressing politeness in Arabic. One example of this can be seen in the use of such expressions as discourse management resources, for example, in turn-taking, or as fillers. The Arabic language is characterised by repeating some

traditional common words and phrases automatically such as: enshalla, Ishallah (if God wills it), elhamdulillah, hamdillah, kattirkairallah and ishkorallah (thanks be to God), and sm’allah (in the name of God) (Feghali, 1997; Bahaa- Eddin, 2006). Note that such words may be used unconsciously by the Arabic person who has severe speech or language disorders. Such phrases may be preserved as automatic, stereotypic phrases in cases of severe or global aphasia. Also, Ishallah is used frequently by the Arabic population, which can reflect various meanings, i.e., it may mean ‘“yes’”, ‘“no’”, or ‘“I promise’”, with its meaning depending on the intonation associated with its production. n Indirectness – Feghali (1997) noted that the following are features of a general communication style in Arabic: indirectness (hiding of the speaker’s intents and needs), elaborateness (rich and expressive language use), and effectiveness (persuasion of the listener of the speaker’s beliefs, thoughts and ideas). In general for the Arabic- speaking population, the use of an indirect request as a form indicates politeness. Isaac( 2002) notes that the use of a direct request may put the user at risk of being interpreted as impolite in a culture where politeness forms are commonly used and expected. n Prosodic features – Many Arabic speakers use very rapid and loud speech, especially when discussing their emotions or stress, and many may use these stress patterns even when talking in another language such as English. This may cause misunderstanding between the Arabic speaker and a partner who does not share this cultural background. n Word choice – Some English words sound similar to vulgar words in Arabic and should be avoided if possible, such as: zip, zipper, air, tease, kiss, cuss, nick, unique, and biz (Wilson, 1996). Cultural communication roles The speech pathologist needs to respect the value placed by the particular family they are working with as to the role of the nuclear and extended family, and the role hierarchy within the family (Schwartz, 1999). Some Arabic families also may be unwilling to discuss their disorder or disability with people from outside the extended family, which might affect the accuracy of the case history obtained (Sharifzadeh, 1998). In some Arabic families there may be a preference for the father or the older son to discuss other family members’ problems rather than the mother, while the mother ’s responsibility might be to carry out the treatment suggestions (Battle, 2000). However, not all Arabic families follow this role division, since for most Arabic modern families there is an equal balance between the male and the female responsibilities within the family. Gender roles need to be considered in relation to service provision. Some people from an Arabic background believe that women are to be separated from men (Battle, 2000), although modern Arabic families respect the role of the female in different jobs, and the importance of being involved in mixed gender situations. Female clinicians may be preferred in work with Arabic females, rather than with male clinicians (Wilson, 1996), although when a female clinician is not available, it would be acceptable to work with a male clinician. Naturally, the above summary is only a brief introduction to a wide range of diverse cultural communication issues. There are an increasing number of resources that might help speech pathologists who are working with Arabic patients to know

S p eech P athology A ustralia

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