Saudi Arabia: Culture versus Sharing

 

My late husband and I both began our journeys and treatments for cancer in Saudi Arabia.  At the time we had very little knowledge on the treatment, side effects or overall feeling of what changes the patient and family go through emotionally when faced with cancer.  We both had excellent doctors and team of medical professionals taking care of us.  But because we were in Saudi Arabia, we were taken care of in the “Saudi way.”

 

We were administered our medications, chemotherapy and shown how to do exercises.  This was all done in the privacy of the hospital room.  We were encouraged when we felt up to it to move and walk around although again this was most confined to within the hospital room.  During the times when either me or my husband would receive an outpatient treatment we would go to the cancer center’s outpatient treatment department.  Once there, the patient would be settled in a small bed or chair with white curtains all around for privacy.  The caregiver would be able to sit on a small chair within this confined cubicle.

 

Other patients did not see each other and the staff ensured that privacy was maintained.  Hospital room doors remained closed instead of open.  Cubicles had opaque curtains which kept in heat and kept other patients out of sight.

 

  By comparison when we arrived to the States for continued treatment the approach was as different as the night from the day.  Patients and caregivers are encouraged to talk and interact with one another.  They are encouraged to share tips, techniques, frustrations and feelings of their journey against cancer.  Patient room doors should be closed only when the patient desires privacy.  Patients were encouraged to come out of their rooms and walk the ward floors.  There were also sterile safety zones where patients could go in and relax, sit on a chair on couch and watch television or play games.  Exercise programs were available for all patients to take as a group.

 

When a patient needed to receive treatment on an outpatient basis in the United States physicians and clinics usually have a ‘great room’ setup where the patient is treated.  The great room is a largehttp://www.scr.org.sa/reports/SCR2003.pdf room with comfortable chairs, television and openness.  It is typical for patients and caregivers to interact with one another sharing how they are doing and feeling.

 

The sharing and reaching out is part of both the healing process and battle against cancer.  Keeping feelings and fears inside oneself while facing the battle for life is neither good nor healthy.  Sadly Saudi Arabia still maintains the culture of privacy in regards to illness.  Support groups are rare and many (family members and patient) choose not to disclose their illness.  Keeping all of these emotions pent up inside is not healthy for the patient or anyone around the patient.  It leads to an atmosphere of depression.

 

Children are smart and can see when something is different about those they love. It is equally important to talk to a child in a manner he or she can understand and allow the child to help.

 

But again, the culture of privacy continues to protect most family members from knowing what is happening with the loved one.  The patient and especially if a husband or wife, believes he or she is doing what is best by not talking about their disease.  They are protecting the ones they love.  Yet eventually this misplaced protection can instead lead to such shock and a greater sense of loss after their passing because the family members were totally unprepared.

nb: photo above is American Bedu with members of her breast cancer support group.

 

I hope that through media awareness, public health campaigns, special programs in schools and other initiatives will change the private culture of Saudi Arabia when it comes to serious illnesses like cancer.  Although dated (2003), this report produced for the National Cancer Registry of Saudi Arabia clearly illustrates the upswing of cancer in the Kingdom.

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18 Responses

  1. I have lived in Tabuk since April 2002. I have learned there is a very fine line separating privacy and secrecy. I have also learned there is a strong mentality of out of sight, out of mind. It is almost as if something is not shared and discussed, then it is not yet real. There is a pervasive attitude of denial here. And it is all in the name of protection. For someone from my field, behavior specialist, it can get bizzare.

  2. As a western nurse working in Saudi this was one of the most difficult things to get used to in the culture. I took care of many patients with end stage cancer and saw them slowly fade away on the ward.

    Mostly they would remain positive and hopeful and cancer was not discussed, as if they were in the hospital for a minor mishap.

    What was difficult to accept was how sometimes the patient was not told their diagnosis, let alone prognosis. This happened sometimes with elderly patients, especially females.
    The culture here sees that the best interest for the patient is ignorance of their condition.
    As if knowing they are going to die soon will somehow make matters worse.
    The relatives try to protect the patient this way. They even specifically ask the drs and nurses not to tell the patient what is going on.

    It’s really hard to take care of a patient you know is going to die soon, and he/she asks you questions about their condition and you must lie just because the family decided it to be so. I noticed this attitude was generally accepted by the Saudi physicians and they would not usually intervene.

    Often nurses that took care of end stage cancer patients can tell when the end is near from certain signs, and narrating this to the family would help them to all come say their farewells before it’s too late. For example, the patients tend to have a sudden “boost of energy” a day or two before they quickly pass away.In Saudi-Arabia the nurse can’t be honest with the relatives and tell them the truth. The family would get very upset.

    Then there were cases were the whole family was in denial until the very end, and then got extremely upset when the patient died. They would blame nurses for the death or doctors for not prescribing a medicine or vitamin to cure the patient..

    I could go on and on about this..

  3. Btw I love your hat!

  4. Interesting post. I love the picture of your support group!

    What struck me is that we in the West are often described as very individualistic. I saw a funny YouTube video of how blacks (Africans) see white (Alpine area Europeans) culture and one thing noted was the fences. They were not large enough to keep out big animals, but just there to say – according to the African host – “leave me alone…you are not welcome.”

    So with that on my mind, I read this post first thing in the morning and see Saudis have this mindset somewhat with their privacy concerns. I guess we are all individualistic in our own ways and we are all communal when we want to be. For Saudis it may be when they share a huge plate of lamb and rice with all the guests. For us, it may be when we come together to support each other during an illness or when we struggle with addictions (thinking AA) or offer Divorce and Grief Share groups at our churches.

    People are so complex – neither entirely individualistic in the West, nor entirely sharing in the East.

  5. Is it medically ethical not to tell a patient the truth about their condition -but to tell others? I’m not asking to criticize, but it seems you shouldn’t be able to tell others and that you must tell the patient.

  6. Cancer is something that affects the entire family even if you don’t want it to. I have been fortunate to have lived with it four 15 years and I do expect it to return someday, but you never know what will come along. I had a son who died this past June who was always worried about me along with his sister and brother so when he was not feeling well he ignored it. He was 43 years old and because of his age they never suspected Colon cancer. When he finally came to me and told me how he was feeling and I took him to my doctor he was stage 4 ceolon cancer.. They kept him in the hopital for 3 weeks for treatment and finaly sent him home on mothers day. He only lived 4 more weeks and I will tell you I wish I had insisted that they send him home earlier. He was happier at home where he could be visited by his family and he died here with us with him. To keep you away from others when you are ill with cancer is in my mind not a good thing. You are not protecting anyone. i brought my daughter with me when she was 6 years old to show here that there was nothing to fear. It is up to the individual but you mind can make up things much worse than the reality of it.

  7. Oh! Dolores, I am SO sorry for your loss. I lost my son 11 months ago so I know what it feels like. There is no pain like the pain of losing your child. In case you don’t already know about them, here is a link to a group that you might find some comfort from. http://www.compassionatefriends.org/home.aspx

  8. Thank you Lynn I will check them out. You are correct it is an awful thing to loose your child . I think part of me feels guilty that I am still here. Again Thank you for your thoughts.

  9. Dolores, you will find that that is a very common feeling for those of us who have lost children. Perhaps you will find a meeting of Compassionate Friends near you. I think it helps to see that you are not crazy, ok, well, maybe we ARE crazy but at least it doesn’t appear too bad when you are surrounded by others that are the same kind of crazy. 🙂 If you have a FaceBook account you can also ‘friend’ them on there. I guess they also have live on-line chat rooms at certain times but I have never logged on to any of those.

  10. Dear Lynn, I am sorry that i was so self absorbed that i did not tell you how sorry I am that you lost your son. Again thank you for your kind thoughts and the web site.

  11. Oh, Dolores, don’t think anything of it. I understand. Be gentle with yourself and those around you and make sure you keep up your strength so that your own cancer DOESN’T return on you. {{{hugs}}}

  12. For Sandy: From my experience here in Saudi, the same rules/ethics for medicine do not necessarily apply.

  13. Medical ethics in Saudi vs in my home country are like night and day.
    A western nurse has to learn a whole new set of rules here.

  14. everything about saudi is bs

  15. oh and saudi is just a part of this bs world with all its bs religions

  16. […] husband.  I’ve talked about the loss of my own husband to this dreaded disease.  I’ve written comparisons about distinctions in cancer care between Saudi Arabia and the […]

  17. […] I’ve talked about the loss of my own husband to this dreaded disease.  I’ve written comparisons about distinctions in cancer care between Saudi Arabia and the […]

  18. […] I’ve talked about the loss of my own husband to this dreaded disease.  I’ve written comparisons about distinctions in cancer care between Saudi Arabia and the […]

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