Common Chronic Disease Patterns in Arabian Gulf, Saudi Arabia & YemenDr. O. P. Kapoor
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Introduction

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The population in the Arab countries comprises mainly of two categories of people
  1. The Arabs
  2. The Expatriates.

The Arabs should again be distinguished as 'Locals' (Vatni) and 'White' (Abiyadi). The local Arab is the son of the soil viz. the Qatari in Qatar, the Bahraini in Bahrain etc., while the white Arab refers to the Lebanese, Palestinians and Egyptians. Being better educated but insecure, the white Arab's problems differ from those of the contented well-provided local. The Expatriate (who is in the majority) hails either from India, Pakistan, Bangladesh, Sri Lanka or the U. K., Canada, U. S. A. etc.

The local or Vatni Arabs were originally nomadic totally, a few indulging in fishing and 'pearl diving'. With the advent of oil, a fair number of these people took up to business. Those who stayed away from the towns continue to this day, living their lives as their forefathers did and they are known as 'Bedouins' (Badu). It is interesting to note that there are many similarities in the Bedouin's way of thinking and that of our Indian villager. Firstly, he is resigned to his fate, and once his mind is made up that his illness is providential, he will make no attempt to obtain relief.

Then he attributes most of his ailments to "wind" ("Reha") just as his Indian counterpart would (Vath or Vaayu). Another sensation that the Bedouin Arab experinces is 'Heat' ("Harara"). just as many rustic Indians do (Garmaish).

Though the saying is true that 'Influenza' will remain the same in regard to its symptomatology, treatment etc. whether one is in China or the South Pole, there are certain conditions peculiar to the Arab way of life.

Diet
The local Arab is mainly a meat and rice eater. He looks down upon pulses and vegetables and is very reluctant to introduce these in his diet. Hence constipation and conditions related to it like haemorrhoids, fissures, etc. are commonly met with. The white Arab, however, has a mixed, well-balanced diet and hence the incidence of constipation is lower.

Habits
Of late, because of affluence and association with Western society, alcoholism is on the increase. The Bedouin has not yet taken up to this vice. The successful Arab businessman is more of a social drinker and mostly knows his limit.

The Arabs in general love to eat and thus obesity is a very common condition which does not seem to bother them.

Drug abuse is very common among the younger set of local Arabs, who, like their counterparts all over the world, are out for kicks. Mandrax (Parke Davis) though banned in the Gulf, is illegally smuggled and eagerly sought after. Other hypnotics and tranquillisers that are frequently peddled are Mogadon (Roche), Valium (Roche), Atwan (Wyeth), Moditen (Squibb) and Nobrium (Roche). Hashish addiction is on the increase.

Anti-obesity agents like Apisate (Wyeth) and Dinnital (Dlamant) are also freely taken at night parties for their C. N. S. stimulating effect.

Sex
The dilemma of the Bedouin, married more than once, is to satisfy all his marital partners one after another in a single night's session or else suffer the embarrassment of being called (by his wives) sexually inadequate.-Another problem is the failure of the aged Arab (average age 55 years) to cope with the sexual needs of his newly acquired young bride (average age 17 years).

Neurosis and Psychosis
There is an increase in both these conditions, but, limited to particular sections of the community. The highest incidence is met with among the homeless Palestinians and Yemenis. Next come the poor Asian Expatriates, who are promised much when signing the contract back home, but are duped by agents and given a raw-deal.

It is still a matter of great pride for the Arab brothers to have their sons or daughters marry one another. Such a marriage within the family members is the possible etiological factor responsible for the occurrence of idiocy and such other recessive (chromosome linked) abnormalities and diseases found among the local Arabs.

Then there are diseases like hypertension and ischaemic heart disease, both of which affect the local Arab less commonly. They are, however, met with in good measure among the white Arabs and Expatriates.

Formerly for the health care, Arabs used to visit Beirut and Cairo. Since the wars brought discredit to these places, they started visiting Europe, especially London. For the last fifteen years, Bombay has also attracted them. I feel that the climate, food habits, cheapness (as compared to European countries), entertainment, cosmopolitan nature of the city and the best medical talent of the country available here has increased Arab traffic to Bombay at a very fast rate. How long will this last is anybody's guess. Incidentally 'Miraj' was the first 'town' in India to attract Arab population more than twenty years back. Till today many a "poor" Arab still visits that place and the scars on their body remind us of the name, fame and respect which the Miraj missionary doctors had created in their minds.

Since my experience is based only on Arabs who come from Gulf [Bahrain, Kuwait, Qatar, Oman and U.A.E. (including Dubai, Abu Dhabi, Ras al Khymah and Sharjah)], Saudi Arabia and Yemen (especially Democratic Yemen) I have not generalised the diseases as those seen in the Middle East. Also I have the least experience of Kuwaitis because most of them like to go to London for treatment. Throughout the text I have put into brackets a few important Arabic words which are not found in the books, but which are used by these patients or easily understood by them. Since Arabic language spoken by Yemenis is different from rest of the Arab countries, I have often used more than one Arabic word—the second one being used by Yemenis.

Finally an advice to all doctors looking forward to seeing Arab patients. When an Arab enters your clinic ("Aiyaada"), be careful and prepare for the following:

  1. All Arabs like to greet you by shaking hands. The difference between the English and the Arab handshake is the "repeatedness" of the act of shaking the hand. An Arab shakes hands from moment to moment even during the examination.
  2. Basically Arabs are very shy ("Hayaa") patients. When you request them to remove ("Sheel") their clothes ("Libaas"), please remember to close ("Siq") the door ("Al Baab"). Even a grown up son of twenty will not like to remove his shirt ("Kameez") and trouser ("Patloon") or his Arabic dress (of course with underwear on) in front of his father! I have never witnessed this much shyness to expose the body! (May be a few more public swimming pools in Arab countries will change this attitude.) If a few friends come together, you can see the ticklish attitude of the friends, when the patient is removing his clothes.
  3. Never take credit for anything with an Arab, who firmly believes that everything in life from moment to moment is done by God (Allah). Therefore, in every sentence, you must learn to join him in saying "Insha Allah".

 

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