ACEP ID:

September 8, 2021

Preparing to Care for Afghan Refugees

As Afghan refugees are relocated to various countries, ACEP members have provided notes to assist with delivering care to Afghan patients. Please note that Afghanistan is a large country with a complex, diverse culture, so these broad descriptors may not apply to all patients. The following are suggestions that might assist your patient interactions.

ACEP will continue to refine these resources as we receive more information. We welcome contributions from any ACEP members who have relevant expertise.

General & Religious Information

  • Most Afghans are Asian, not Middle Eastern.
  • Most Afghans are Muslim, meaning they practice the religion of Islam. 
    • There are two sects: Sunni and Shia 
  • Be aware that Afghans avoid pork and alcohol.
    • Medications that contain gelatin or pork-based are forbidden. If possible, use gelatin-free alternatives such as antibiotic liquids or halal gelatin tablets.  
  • After death, Muslims prefer to bury the death as soon as possible, as a result, attempts should be made to have the death certificate signed quickly to facilitate the process.
    • Autopsy is permitted only for legal or medical reasons.
  • Haji is an earned term for completed the ‘Haj’ to Mecca.

Language & Communication 

Download this Quick Communication Guide - Afghan Patients with translations for common medical terms.

  • The proper term for those from Afghanistan is ‘Afghan’ – not ‘Afghani," which can be misinterpreted as condescending.
  • Most individuals will speak either Dari or Pashto. Dari is very similar to Farsi, but has a different dialest. Most Afghans speak and understand both.
  •  Ideally, it is best if they are cared for by a clinician and nurse of the same gender.
    • This is especially important if the patient requires obstetric or gynecologic care.
  • If gender-specific care is impossible for a female patient, it will be better if a female staff member or patient relative is present during examinations.
  • If a male provider is examining a female patient, it is of the utmost importance for the provider to explain the steps of the physical exam to the female patient and, if clothing must be removed, to be removed for as little time as possible.
  • In many circumstances, a female patient may avoid eye contact or shaking hands with male healthcare professionals. This should not be interpreted as a lack of trust or a sign of rejection. As in Muslims, this is a sign of modesty.
  • Request permission before touching or uncovering any part of the body, and perform the exam sequentially, exposing as small an area as possible with each step.
  • Muslim dress varies differently depending on the country of origin. Some dress in a manner that is similar to their Western counterparts, although more conservative. Some Muslim women will cover their hair, arms, and legs. More orthodox Muslim women may choose a long wide black dress that covers their entire body, and some may wear a veil.
  • Female clinicians may experience resistance from male patients who are not used to seeing female doctors and may be hesitant to share medical information.
  • ‘Docktor’ = Doctor; ‘Dokhtar’ = girl

Cultural Considerations

  • The elders are highly regarded and often make final decisions for the household.
  • Muslims prefer to use right hand for eating and handing things to others. Try to use the right hand for medication administration, handing objects to patients, and assisting with feeding.
  • Avoid showing the bottom of your shoes (i.e. sitting with your leg crossed over your other knee) as this implies you think they are below you.

For additional information: Cultural Competence in the Care of Muslim Patients and Their Families

Clinical Concerns

COVID-19
All refugees have been given a rapid COVID test, and those who are positive will be quarantined. All will be vaccinated on arrival.

Pediatrics
There are a lot of children arriving, and many of them are malnourished. We will likely be seeing these children for months. Note that most refugees, particularly children, have not received basic vaccine series – so no tetanus, polio, MMR, etc.

Tuberculosis
Afghanistan has a significant amount of infection with TB. Isolation precautions may be warranted if a patient presents with respiratory illness. Review CDC’s tuberculosis overview.

Malaria
Malaria is also prevalent in Afghanistan. Review the CDC’s malaria resources.

Polio
Afghanistan is also affected by ongoing endemic wild poliovirus transmission. Review the CDC’s polio resources.

Leishmaniasis
Afghanistan also has a significant amount of infection with leishmaniasis.

  • Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers
    • Presents as papules, nodules, plaques or ulcers on exposed skin. They may change in appearance over time but heal very slowly over 6-18 months leaving scars. There is lymphadenopathy. In rare cases it may be diffuse. It also may recur years after the initial infection. It can spread to the mucus membranes where it presents as nasal congestion and recurrent epistaxis.
  • Visceral Leishmaniasis in Afghanistan

Immunizations
While all are receiving the COVID vaccine, many individuals have not been immunized to other diseases such as tetanus, MMR, polio. They will likely be fully immunized at the military facilities. However, tetanus in particular does not provide full immunity after the first dose. 

 

Disclaimer: This information was provided by ACEP members. ACEP cannot guarantee its accuracy.

 

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