Purnell Model for Cultural Competence

Introduction

Afghanistan is a country that has been repeatedly plagued by war and conflict including invasion by the U.S.S.R, the takeover of the Taliban, and the invasion of U.S. military sources. Decades of conflict have left this country devastated and struggling to rebuild.

Afghanistan is a country in the middle east bordered by Iran on the west, Turkmenistan, Uzbekistan and Tajikistan on the north, China on the northeast, and Pakistan on the east and south.

(Reference.com)

1. General Overview- Ancestry

1. General Overview- Ancestry

The largest ethnic group in the south of the country, while Tajiks and Uzbeks are concentrated along the norther borders, and the Hazara in the central highlands.

Pashtun people are also referd to afghans

Tajiks are believed to have Iranian origins, and are also referred to as Farsi.

Uzbeks form the largest Turkic group in Afghanistan

Hazaras are said to be descendants of Genghis Khan

1 Pashtun (Pashto) 42%

2 Tajik 27%

3 Uzbek 9%

4 Hazara 8%

5 Aimaq 4%

6 Turkmen 3%

7 Balochi (Baluch) 2%

Other Groups 5%

(Sawe, 2016 )

2. Communications

2. Communications

Non Verbal

The left hand is for cleaning and should never be used for eating or offering gifts.

Eye contact is avoided unless having a conversation with someone of the same age gender or status.

It is ok to touch friends or family within the home however outside of the home affection between genders is not allowed.

Personal space does not apply as strictly between people of the same gender.

The thumbs up and ok sign are both offencve as well as showing the soles of your feet and winking.

Verbal

“Afghans tend to speak both directly and indirectly depending on who they are interacting with.”

“Raising one's voice at someone in public is very disrespectful and is likely to make everyone around feel intensely uncomfortable”.

(Cutural Atlas, 2018)

3. Family Roles and Organizations

The single most important aspect of afghan life is the family unit, whether nuclear or multigenerational.

Family matters are strictly private and they are often reluctant to share personal issues outside of family because public knowledge would bring them great shame.

3. Family Roles and Organizations

Their family organization is made up of an age hierarchy where the elders are treated with the utmost respect. The family is also organized as a patriarch with the authority given to the eldest males. The senior male of the household usually controls all of the spending.

(Cultural Atlas, 2018)

4. Workforce Status

4. Workforce Status

Afghanistan is unforuntaley illed by a workforce gap between the number of Afghans who possess mid-level technical and business management skills and the market demand for these skills.

(Creative Associates International, 2017)

Generally, all adults in afghanistan work very hard and many children also have to work.

(Cultural Atlas, 2018)

5. Bio-Cultural Ecology

Referring to the ecological cultural practices of this culture, it is believed that physical ailments are classified by warm or cold and treated with foods that have opposite properties to restore equilibrium

5. Bio-Cultural Ecology

Another way to cure disease is to undertake a metaphorical journey that is pilgrimage to a shrine or place of great importance

(Everyculture.com, 2018)

6. High Risk Behavior

An example of this is observed in a study by Todd, Abed, And Earhart that has a sample size of 463 males

50.4% shared syringes

76.2% paid women for sex

28.3% had sex with men or boys

All of these habits could lead to the spread of HIV and Hepatitis c and b.

(Todd et al, 2007)

6. High Risk Behavior

The World Bank states that have HIV/ Aids epidemic is caused or worsened by injecting drug users, large numbers of refugees and displaced people, high levels of illiteracy, competing health priorities, low status of women, and a weak health system.

(World Bank, 2012)

7. Nutrition

Within Afghanistan culture, many drink tea throughout the day and interestingly enough only add sugar to their first tea of the day.

(EveryCulture.com, 2018)

Unfortunately...

7. Nutrition

Malnutrition in pregnant and lactating women remains a critical public health problem

As well as the major underlying cause of child mortality

(World Health organization, n.d.)

8. Pregnancy and Birth Applications

Startling facts such as that "there are an estimated 396 maternal deaths for every 100,000 live births”

(Dr. Clair Fotheringham, 2007)

8. Pregnancy and Bir...

"About 18,000 Afghan women die during childbirth annually."

(Afgan Health Ministry; Kabul, 2011)

Resulting in the shocking conclusion that

"Afghanistan is ranked as the worst place to give birth”.

(Kabul, 2011)

9. Death Rituals

Inheritances

When A father dies the sons living in the household choose to stay united or to divide the family's assets. Authority among brothers is determined by ability, economic skill, and person prestige more than age. also sometimes sometimes a brother may ask for his share of the family wealth and leave while the father is still alive. Woman may not inherit land, real estate, or livestock.

9. Death Rituals

Burial

The dead are buried rapidly in a shroud. Most graves are just piles of stones but wealthy families may put a headstone. The family of the deceased opens its home for three days for condolences. Forty days after burial the family meets at the gravesite for prair. After one year a ceremony takes place to mark the end of mourning.

(Everyculture.com, 2018)

10. Spirituality

A way to cure disease is to undertake a pilgrimage to a shrine or place of great importance

(Everyculture.com, 2018)

The government is an islamic republic meaning the moral code of islam dictates many political, economic and legal aspects of an Afghan's life.

99.7% of Afghans are muslim

85 to 95% are sunni and 10 to 15% are shi’a

Although, not everyone in Afghanistan is strictly religious, many Afghans who do not pray regularly. This may allude that spirituality plays a larger role than referenced or discussed.

(Cultural Atlas, 2018)

11. Healthcare Practices

Afghanistan sadly has some of the worst health indices in the world

Many infectious diseases such as acute respiratory infections, diarrheal diseases, measles, and malaria contribute to the burden of disease.

11. Healthcare Practices

Modern medical facilities are limited meaning people often rely on traditional practices using herbs and animal products

(Accerra et. allI)

12. Healthcare Workers

Afghanistan is a very dangerous place to be a healthcare worker.

12. Healthcare Workers

Accoring to the World Health Organization, from 2014 to 2015 attacks on healthcare facilities has more than doubled.

Evolving to such extent that it has been reported that in the past two years, attacks on healthcare facilities and healthcare workers have become more common throughout the country

(World Health Organization, n.d.)