Arab family with the little boy

The incident

I was bringing an Arab woman to the emergency ward with abdominal pain. I called a female doctor and a nurse for the examination as we were informed that an Arab woman cannot be examined by a male physician.

Despite this, I could not convince the husband to leave the examination room  with their little son, who is about 3 years old. They stayed in the examination room. The boy started to run around all over the place. The mother did not try to stop him. We asked her to hold him, to keephim in one place, so that he does not hinder us in our work. She said something to him but nothing happened. We tried to reason with the father, telling him that the little boy might be traumatised be watching us prick his mother with a needle and he might cause problems by pushing our hands involuntarily. The man did as if he had heard nothing. We could have called the security guard but it would have taken a lot of time and as there were many patients waiting, we did not want to cause a scene.

We wanted it to be over but the situation really hurt us a lot.  “We could have refused the treatment”, or at least threatened them that we will not be giving a painkiller until they make at least a small compromise.  However, we did not have strength to play this game. All we wanted was to finish.

1. Identities of the actors in the situation

Paramedic, female in her 40s with many years of experience, lower middle class, high school, born in a country town, recently moved to Budapest with her husband and children (3 children). Hungarian as mother tongue, English (basic level)

Patient’s husband, man in his 30s. “Arab”= Iranian (SIC), means Persian in reality. No other detail about his identity ,“well dressed”, Speaking Arabic and poor English.

This is a purely professional situation involving an outpatient examination. The patient does not exist through her personal identity, just in her role as a patient. She and her husband have only one identifiable feature: their otherness (“Arab”).

There is little in common between the paramedic and the husband, except for their momentary roles – health professional and family member of a patient – that creates a frame for their encounter.

2. Context of the situation

The situation happens in an examination room – a familiar environment for the health professional, a hostile and threatening environment for the patient and the husband. The patient is sitting, the husband is standing (there are no more chairs). In the room, there is a female doctor, a female nurse, the female paramedic and the family.

3. Emotional reaction

Frustration, irritation, “what a bad education!” – she thinks –“ They are disturbing the treatment”; it is disrespectful towards the staff who feel they are lacking authority.  Exasperation: there is no solution, “Just let’s finish with it”.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
  • Examination (and treatment): there is a special place for that, the examination room –this is a professional place where only the patients and the medical staff can legitimately stay. This is not a place where children are allowed. Highly professional work is taking place, demanding precision and calm. Examination (and treatment) is a private (individual) matter of the patient; no other person should be involved in the process.
  • Patients: are required to leave at home their social identities, that is why their gender is irrelevant, as much as the gender of the doctor does not matter.
  • Arab cultures: are known to be oppressive towards women, deprived of their freedom. The man’s presence is the proof of such oppression.
  • His no-reaction vis-à-vis the child: is felt as a provocation, as an expression of his arrogance, non-respect of the professional.
  • The child: a nuisance, an obstacle out of place.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Negative, based on little knowledge of his identity.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
  • The family: is a basic social unit, the wife cannot be alone in a stressful situation, this would mean abandoning her, denying support, it would be cowardice.
  • The presence of the child is not necessary but there is nobody to watch over him. His presence is also not particularly inconvenient as sickness is part of life, as much as child birth and death and children of the family are as much part of these events as adults.
  • The situation: he is told that the child should not “shove” the woman so he should be watching him. He does not understand why the staff does not trust him.
  • Suspecting prejudices: He is more nervous, in that he feels growing hostility towards them. He suspects it is because they are foreigners.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
  1. The medical staff should to be prepared to deal with the “otherness”: they were prepared for an Arab female patient, but they were not prepared for the additional difficulties. It is good to have knowledge of cultural patterns but it does not exempt the professional from analyzing each situation – demanding relevant action.
  2. If people feel that they are threatened, they are much less creative in finding solutions to the problem. Professionalism also means being able to amicably deal with the subject of the conflict.
  3. It is ok to be embarrassed.
  4. Double check to ensure that a foreigner understands the communication / instructions.
  5. It is acceptable to bend some rules to solve a conflict situation that has too many unknown parameters.

Those rules that cannot be broken must be clearly communicated.