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Providing Culturally Safe Care to Afghan Refugees

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Providing Culturally Safe Care to Afghan Refugees

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Afghan refugees often practice modesty in dress, with women frequently wearing burqas, niqabs, or hijabs. Literacy rates are generally higher among men due to historical educational differences. Afghan families are typically patriarchal, with significant decisions made by the eldest male (Arizona Department of Health Services). We should be aware that Afghan refugees may prefer same-gender healthcare professionals and value privacy highly, which can affect their openness about personal health matters. Respecting these cultural preferences and family dynamics is crucial for delivering compassionate and effective care.

Office of the Refugee Health Coordinator of Arizona, Arizona Department of Health Services. (n.d.). Community profile. https://www.azrefugeehealth.org

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Essential Cultural Considerations for Treating Afghan Refugees

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Essential Cultural Considerations for Treating Afghan Refugees

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Afghan refugees, predominantly Muslim, follow Islamic practices and avoid pork and alcohol. Medications containing gelatin or pork-based ingredients should be substituted with halal alternatives. The term "Afghan" is preferred over "Afghani." Most Afghans speak Dari or Pashto. For gender-sensitive care, female patients often prefer same-gender clinicians and may avoid eye contact or handshakes with males due to modesty (American College of Emergency Physicians, 2021). We should seek permission before physical contact and ensure minimal exposure during examinations. Respect for elders and use of the right hand for interactions are important cultural norms.

American College of Emergency Physicians. (2021, September 8). Preparing to care for Afghan refugees. Retrieved from https://www.acep.org/home-page-redirects/latest-news/preparing-to-care-for-afghan-refugees

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Understanding Afghan Culture for Culturally Safe Nursing Care

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Understanding Afghan Culture for Culturally Safe Nursing Care

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Afghan culture is rich with traditions that are crucial for culturally safe nursing care. Traditional dress like the shalwar kameez and cultural dances such as the Attan symbolize community values and identity. Understanding Dari and Pashto can facilitate better communication with Afghan patients. Islam influences daily routines and healthcare practices, so sensitivity to religious observances is important. Afghan cuisine, including kabuli pulao, highlights communal meals and hospitality. Refugees might face challenges adjusting to new cultural norms, such as differing family dynamics in host countries. Awareness and respect for these cultural aspects help in providing compassionate and effective care (Core Resource Exchange, 2021).

Core Resource Exchange. (2021). Delivery of Cultural Orientation. https://www.coresourceexchange.org/wp-content/uploads/2021/12/Afghan-Backgrounder_Dec.-2021.pdf

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Culturally responsive clinical practice Working with people from migrant and refugee backgrounds Jan2019.pdf

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Reflecting on Competency Standard 1.4 (Migrant and Refugee Women's Health Partnership,2019), I understand Afghan cultural practices, such as modesty and family decision-making, are significant. Afghan women’s preference for same-gender clinicians and the role of the eldest male in decisions highlighted how cultural norms influence consent and privacy. This insight improved my approach to involving family and respecting patient preferences. I realized that respecting these cultural norms is crucial for effective and respectful care. Initially, I underestimated these cultural impacts. This knowledge has refined my approach to culturally responsive care. I will further develop my understanding of cultural practices to enhance patient support.

Migrant and Refugee Women’s Health Partnership. (2019, January). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds COMPETENCY STANDARDS FRAMEWORK FOR CLINICIANS. https://culturaldiversityhealth.org.au/wp-content/uploads/2019/02/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf

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Information as a social determinant of health

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Impact of Social Inclusion and Non-Discrimination on Afghan Refugees in Australia

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Impact of Social Inclusion and Non-Discrimination on Afghan Refugees in Australia

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Social inclusion and non-discrimination are vital WHO social determinants of health affecting Afghan refugees in Australia. Social inclusion enhances refugees' integration into society, improving their access to healthcare, reducing isolation, and supporting better mental health (Refugee Council of Australia, 2022). Conversely, non-discrimination ensures equitable access to services, which is crucial for preventing health disparities and mitigating stress (Staff, 2021). Discriminatory practices can hinder Afghan refugees' ability to access quality healthcare, leading to poorer health outcomes (Rezaei et al., 2021). By promoting inclusivity and addressing discrimination, we can improve health outcomes and support the effective integration of Afghan refugees.

‌Refugee Council of Australia. (2022, December 13). Refugee Response Index (RRI) Australia Review - Pillar 4: Refugees become self-reliant. https://www.refugeecouncil.org.au/rri-refugees-become-self-reliant/

‌‌Rezaei, O., Adibi, H., & Banham, V. (2021). Integration Experiences of Former Afghan Refugees in Australia: What Challenges Still Remain after Becoming Citizens? International Journal of Environmental Research and Public Health, 18(19), 10559. https://doi.org/10.3390/ijerph181910559

Staff, A. (2021, December 13). Afghan refugees face discrimination, employment and social challenges in Australia. ANMJ. https://anmj.org.au/afghan-refugees-face-discrimination-employment-and-social-challenges-in-australia/

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Health Issues and Treatment for Afghan Refugees in Australia

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Health Issues and Treatment for Afghan Refugees in Australia

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Post-Traumatic Stress Disorder (PTSD) and other mental health issues are prominent among Afghan refugees resettling in Australia. The severe trauma experienced during prolonged conflict in Afghanistan often leads to symptoms such as intrusive memories, severe anxiety, and emotional numbness (Australian Institute of Health and Welfare, 2023). Stressors in the host country, including language barriers, social isolation, and fear of asylum application rejection, further exacerbate these issues (Li et al., 2016).

Context from Afghanistan: The ongoing conflict in Afghanistan has resulted in widespread trauma, significantly impacting the mental health of refugees. Research indicates that PTSD, depression, and anxiety are prevalent among these populations, with symptoms persisting even after resettlement (Turrini et al., 2017; Alemi et al., 2014). Post-migration stressors often continue to affect mental health, sometimes exacerbating the impact of pre-migration trauma (Porter & Haslam, 2005; Schweitzer et al., 2011).

Andisha, P., & Lueger-Schuster, B. (2023). Afghan Refugee Populations’ Mental Health: Exploring Pre-migration Environmental Differences and Post-migration Stressors. Journal of Loss & Trauma, 1–28. https://doi.org/10.1080/15325024.2023.2262929

Health of refugees and humanitarian entrants in Australia, Mental health. (2023, November 3). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/cald-australians/health-of-refugees-and-humanitarian-entrants/contents/case-study-humanitarian-entrants-born-in-afghanist/mental-health

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In honor of Disability Employment Awareness Month, the Office of Special Services (OSS) is working to raise awareness of disabilities by offering daily facts and tips about people with disabilities and living with disability. Please take a minute to read and broaden your understanding.

What is Post-traumatic Stress Disorder (PTSD)?
When in danger, it's natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This "fight-or-flight" response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they're no longer in danger.

PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

Signs & Symptoms
PTSD can cause many symptoms. These symptoms can be grouped into three categories:

Re-experiencing symptoms

Flashbacks-reliving the trauma over and over, including physical symptoms like a racing heart or sweating

Bad dreams

Frightening thoughts.

Re-experiencing symptoms may cause problems in a person's everyday routine. They can start from the person's own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Hyperarousal symptoms

Being easily startled

Feeling tense or "on edge"

Having difficulty sleeping, and/or having angry outbursts.

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

It's natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don't show any symptoms for weeks or months.

Do children react differently than adults?
Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children, these symptoms can include:

Bedwetting, when they'd learned how to use the toilet before

Forgetting how or being unable to talk

Acting out the scary event during playtime

Being unusually clingy with a parent or other adult.

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For more information, see the NIMH booklets on helping children cope with violence and disasters. (from Post-Traumatic Stress Disorder (PTSD) )

Who Is At Risk?
PTSD can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families.

Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.

Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD.

Why do some people get PTSD and other people do not?
It is important to remember that not everyone who lives through a dangerous event gets PTSD. In fact, most will not get the disorder.

Many factors play a part in whether a person will get PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.

Risk factors for PTSD include:

Living through dangerous events and traumas

Having a history of mental illness

Getting hurt

Seeing people hurt or killed

Feeling horror, helplessness, or extreme fear

Having little or no social support after the event

Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

Resilience factors that may reduce the risk of PTSD include:

Researchers are studying the importance of various risk and resilience factors. With more study, it may be possible someday to predict who is likely to get PTSD and prevent it.

Diagnosis
Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the person who has symptoms of PTSD.

To be diagnosed with PTSD, a person must have all of the following for at least 1 month:

At least one re-experiencing symptom

At least three avoidance symptoms

At least two hyperarousal symptoms

Symptoms that make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.

PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Treatments
The main treatments for people with PTSD are psychotherapy ("talk" therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Psychotherapy
Psychotherapy is "talk" therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy.

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person's needs.

One helpful therapy is called cognitive behavioral therapy, or CBT. There are several parts to CBT, including:

Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.

Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way.

Other types of treatment can also help people with PTSD. People with PTSD should talk about all treatment options with their therapist.

How Talk Therapies Help People Overcome PTSD
Talk therapies teach people helpful ways to react to frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

Medications
The U.S. Food and Drug Administration (FDA) has approved two medications for treating adults with PTSD:

sertraline (Zoloft)

paroxetine (Paxil)

Both of these medications are antidepressants, which are also used to treat depression. They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Taking these medications may make it easier to go through psychotherapy.

Sometimes people taking these medications have side effects. The effects can be annoying, but they usually go away. However, medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately.

The most common side effects of antidepressants like sertraline and paroxetine are:

Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.

The above information and more can be found here.

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Disability Awareness Month Tip for Thurs., Oct. 29: What is PTSD?

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In honor of Disability Employment Awareness Month, the Office of Special Services (OSS) is working to raise awareness of disabilities by offering daily facts and tips about people with disabilities...

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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective, evidence-based treatment for PTSD. It involves several key components:

1. Assessment and Engagement: Initial sessions focus on understanding the individual’s trauma history and building trust.

2. Psychoeducation: Educates patients about PTSD and the benefits of TF-CBT, helping to normalize their symptoms and reduce stigma (Australian Refugee Health Practice Guide, n.d.).

3. Cognitive Restructuring: Targets and challenges negative thoughts related to trauma.

4. Exposure Therapy: Gradual exposure to trauma-related memories helps process and confront these experiences.

5. Skills Training: Teaches coping strategies and relaxation techniques to manage symptoms effectively.

Recent updates to the diagnostic framework, such as the introduction of Complex PTSD (CPTSD) in ICD-11, provide a more nuanced understanding of trauma-related disorders and may enhance the effectiveness of interventions like TF-CBT (Andisha & Lueger-Schuster, 2023). Research supports TF-CBT’s efficacy in reducing PTSD symptoms and improving mental health outcomes (Australian Institute of Health and Welfare, 2023; Smati et al., 2024).

Andisha, P., & Lueger-Schuster, B. (2023). Afghan Refugee Populations’ Mental Health: Exploring Pre-migration Environmental Differences and Post-migration Stressors. Journal of Loss & Trauma, 1–28. https://doi.org/10.1080/15325024.2023.2262929

Health of refugees and humanitarian entrants in Australia, Mental health. (2023, November 3). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/cald-australians/health-of-refugees-and-humanitarian-entrants/contents/case-study-humanitarian-entrants-born-in-afghanist/mental-health

Mental Health» Australian Refugee Health. (n.d.). https://refugeehealthguide.org.au/mental-health/

Smati, H., Hassan, N., Mohammad Yasir Essar, Fawzia Abdaly, Noori, S., Grewal, R., Norrie, E., Talavlikar, R., Bietz, J., Kimball, S. L., Coakley, C., Chatterjee, A., & Fabreau, G. E. (2024). Health status and care utilization among Afghan refugees newly resettled in Calgary, Canada between 2011-2020. MedRxiv (Cold Spring Harbor Laboratory). https://doi.org/10.1101/2024.06.21.24309182

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Trauma Focused Cognitive Behavioral Therapy | Portland, ME 04102

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Renew Counseling Center LLC provides trauma focused cognitive behavioral therapy in Portland. Call today for help with anxiety, relationships, OCD & more.