Community Health Nursing: Saudi Arabia and Hypertension

Community profile

Social-economic profile

Saudi Arabia is thought of as the origin of all the Arabs in the world and is also regarded as the center from which the religion of Islam sprang up. Currently, Islam is the only allowed religion and individuals who are caught practicing another religion are subject to dire consequences which may at times include death (Mufti, 2000). Islam strictly forbids the consumption of alcohol and this is clearly emphasized around the country. Religion is taken very seriously in the country and by the doctrines of the religion, every individual is expected to fast during the holy month of Ramadhan aside from praying five times a day. Individuals visiting the country in an expatriate capacity are however not expected to observe the stringent rules of the religion but they must not be seen eating in public during the holy month (Zuhayar, 1984).

In Saudi Arabia, the family is not only the basic functional unit of society but is also the unit that is most seriously taken. Whenever individuals are in one need or another, they can depend on the family for guaranteed support. Saudi Arabians usually meet and eat at restaurants and hotels only when they are meeting individuals with who they are not familiar. However, once they are well acquainted, they are required by cultural rules to invite them to their households for meals (Al-Madani, 1995). Entertainment amongst members of different genders is discouraged and actually outrightly illegal. The dress code is usually long white robes for men, though they can wear suits if the situation demands that they do (Al-Naif, 1995). Women are not expected to appear in public outside the hijab (Long flowing dress usually black in color). Their heads must be always covered when outside their homes and clothes that fit the form of the body are also not allowed. Women visiting the country from other parts of the world are expected to follow this dress code.

Saudis have an unwavering belief in traditional medicine and most ailments are treated by the use of concoctions made of various herbs. Other methods of healing traditional ailments especially the physical one includes the pressing of a hot iron rod on the particular part of the body (Faraidy, 1982). This to Americans may appear crude but is a universally accepted treatment method in Saudi Arabia. Psychological and other mental problems are taken care of by the use of specific readings from the Islamic holy book, the Quran (Marsh, 1984). However, with relaxation in cultures, modern medicine has in recent times come to be appreciated and is generally used in the treatment of ailments. In the urban regions, several modern hospitals have been constructed and some Saudis even travel abroad to seek medical assistance. (Al-Mazrou, & Farid, 1991).

With over 25% of the known oil reserves in the world being located in Saudi Arabia, the economy of the country is dependent on the petroleum business with the government controlling most of the stakes in the business. The government also plans and dictates the direction that the economy of the country will take by owning virtually all the businesses in the country. However, there are some businesses that are not exclusively under the control of the government though they also receive some form of regulation from the central government (Al-Tuwaijiri, 1986).

Public Health care system

Primary health care services are provided in health centers. These health centers are for most of the people living in Saudi Arabia the only link to the national health care system. The health centers work in tandem with general hospitals which in turn work by referral alongside tertiary health care providers. Health centers like in any other developing country are tasked with the responsibility of providing basic health care services (Mathews, 2003). Aside from promoting proper health care practices, treatment of existing medical conditions, and provision of rehabilitative healthcare services they are also charged with the job of carrying a population of the community that they serve as well as random surveys to assess the medical requirements of the population. The health centers within a particular region usually vary depending on the size of the region in terms of the number of inhabitants (Al Baaz, 1992). The number of specialized services per region including x-ray services also depends on the number of people living within the region with most of such facilities being concentrated in urban regions. Hospitals pick patients for secondary health care services from particular catchment areas formed by groups of health centers. These secondary health care services include deontological, gynecological and optical health care. A number of these hospitals are affiliated with the various medical colleges dispersed around the country (Dossary, 1991).

The government of Saudi Arabia has dedicated a substantial sum of its annual budget to making medical care more available to the citizens. It actually has gotten so better that the government is considering providing medical care for free to everybody in the country. By the year 1990, there were a total of 258 hospitals in the country operated by both the private and public sectors (Sulaiman, 2000). Sixty-four of these hospitals are exclusively run by private organizations while the rest are managed by the ministry of health. There were about 36,099 spaces for in-patient services in these hospitals. Aside from these, some of the government departments including the ministry of defense run health facilities to address the needs of their employees. Teaching hospitals in the country by that time were over thirty in number.

However, even with all these developments, the future of primary health care in Saudi Arabia has remained an issue that has been dogging the administration of the Saudi Arabian kingdom (Hashim, 1988). At one point, Dr. Al-Mazrou (2002), the deputy prime minister for health, expressed his concern about this problem stating that:

The future of PHC depends on a continuous revision and appraisal of all programs implemented in PHC centers. In the course of this revision, certain priorities must be considered including significant changes in the morbidity patterns in the Saudi community. The definite shift from infectious to non-infectious diseases requires an emphasis on certain programs, the most important of which is a lifestyle, balanced nutrition and extensive use of health education as an important component of the PHC program implementation (p.56).

Geographic profile

Geographically, Saudi Arabia is mostly arid, though there are a number of oases scattered around the country. The country has two coastlines, especially along the Red Sea. The climate is mostly the typical hot arid climate. The regions bordering the coastlines have exceptionally high amounts of humidity (Mufti, 2000). There are some regions of the country such as Asir which receive just enough amounts of rainfall to sustain rain-fed agriculture. However, the country’s agriculture is dependent on irrigation from water in underground stores. The minimal rainfall that falls in most regions of the country is enough to sustain the growth of some wild desert plants which in turn serve as food for goats and camels. The people who live along the coastline get the opportunities to interact with people from different parts of the world and as such support, open-mindedness approaches as regards other cultures (Knauerhase, 1975).

Community assessment and engagement plan

Planning

In order to do a proper community assessment, a proper plan should be developed. Because hypertension is mostly an age-related condition, the plan should be drafted in such a way that individuals in the age bracket 40-60 years are assessed. The gender factor should also be considered in order to give a comparison between the prevalence of the condition in men and that in women.

Assessment team

Community assessment involves studying large groups of people within a particular test environment. Because of the large number of people that have to be studied, the procedure cannot be carried out by one person. A well-structured team should be established for conducting the research and the team should also have sub-teams and each should have specially assigned roles. This will ensure that the procedure is carried out effectively and that the required information is picked from the society in analysis.

Pre-trials

In order to test the efficacy of the plan in the field, a trial run should be conducted in the community of Saudi Arabians living around. This will help tweak all the minute issues that may result in complications if they are not properly taken care of.

Resources

Once the team has been set up resources should be acquired to be used in the project. The persons funding the research should provide enough resources to cater to the sustenance of the team in the field. There should be enough money to handle the transport costs as well as the boarding and lodging of the team members. Communication expenses such as mobile phone airtime purchases should also be factored in in the budget.

Community partners and stakeholders (Who to target and why)

Community health research is a process that is targeted at ensuring that health issues of the region being studied are adequately addressed. Therefore, it is only necessary that individuals from the community be involved in the procedure especially because consulting them will provide a first-hand account of the details on the ground. The established assessment team and its sub-teams should be actively involved in identifying individuals from the community whose participation in the project would make the eventual results even more meaningful to the community itself.

Department of health officials

For this particular case, the government officials involved in health provision should be the first to consult because securing their goodwill would ensure that access to other sectors in the community is assured. These health officials will also give a general perspective of what the government is doing to secure the health of the citizens.

Medical practitioners

Other partners from the Saudi community include medical practitioners. These are the likes of doctors, nurses and attendants. Consulting medical practitioners would give a medical perspective regarding the issues plaguing the community as well provide a brief explanation on the health-seeking trends of the Saudis.

Average Saudis

It is impossible to conduct a research on community health in the Saudi Arabian kingdom without involving typically Saudis. These are actually the people who are targeted by the assessment process because their actions dictate the health care trends of the entire country. Within this group the community leaders both administrative and religious should be consulted to give explanation regarding the cultural influences on the health seeking trends of the populace. The cultural practices of the community will be properly explained and put into perspective especially in relation to the modern trends. Eating and exercise patterns of the community should be properly studied as this will provide an explanation to the prevalence rates of hypertension amongst the Saudis.

Collection of data/Execution

Once the study team has arrived in Saudi Arabia, the collection of data should begin immediately. A systematic approach should be employed whereby the teams and the sub-teams all identify one section of the community and carry out interviews in order to obtain usable information for the research. This data should then be properly analyzed and interpreted in relation to the topic at hand; in this case the community health practices of the Saudis that predispose older members of the society to ailments such as hypertension.

Issues that may arise during the assessment

The major challenge that I would wish to address would be the issue of hypertension in the country. This is because like any modernizing society today, hypertension and other diet-related diseases have become so commonplace to the extent that such ailments are now gradually forming the greater percentage of the cases being reported in hospitals.

The data should be presented in a format that will make it easy for later analysis and compilation. Some of the challenges that may be experienced in this part of the process include the fact that some of the individuals’ targets may not be as cooperative as expected as well as the fact that some individuals may grossly exaggerate the information, they give to suit the circumstances.

Critical analysis and recommendations

Community health has in recent times received acquired unprecedented support especially in the Middle Eastern countries. This is especially noticeable in how individuals regard the influence of practitioners in the control of conditions such as hypertension. Its benefits are gradually being appreciated in the public eyes and any challenges that come with its application are easily circumvented by combining modern medical practices and traditionally accepted methods of disease control (Joseph, & Najmabadi, 2003). The average Saudi is currently able to understand the concept of health maintenance and people are at a position where they know what services they can expect from health care providers as well as demand that their expectations be met (Bodeker, 2005). However, like with any modern-day service being tried out on a hugely traditionalistic society, newer and newer challenges are coming up in the health sectors.

Traditional Saudi medicine has always fronted the idea that one person can have the skill to effectively handle each and every ailment in society. Mostly, these healers also double up as religious leaders (Serenius, 1979). Modern medicine has however entrenched into society the idea of specialists and the reception in the country has been more than impressive. The collaborative approach in diagnosing, treating and nursing patients has been well accepted and individuals can now visit hospitals of their own volition (Sebai, 1985).

The concept of community involvement in the provision of proper health care has also been embraced. Individuals are willing to take precautionary measures to keep illnesses at bay and this includes proper diets and adequate sanitation. People have begun to realize that it is their responsibility to take care of their health and not necessarily assume that sickness is some form of punishment for wrongs done on earth as has been fronted by religion.

Still, in the aspect of community health nursing, it should be noted that this approach should target identifying with the community members and be in a position to make the connection between health problems affecting the people and the social structuring of the society. Providers targeting the Saudi community should ensure that they act in such a way that they live what they teach; i.e. they should ensure that they put into practice the things they are advising the people in the society to do. For instance, it will not make much sense for a health care provider to eat grossly unhealthy foods in the presence of a patient he is advising to eat organic foods (Al-Swilim, 1985). These practitioners should also be well dedicated to ensuring that the changes they implement in society serve to reflect well on the general health of the population (Daggy, 1998).

Hypertension and other diet-related complications are increasingly becoming common in the Saudi Arabian community. This is particularly due to change in eating habits especially with the influx of fast food joints in the country and the increased use of unhealthy cooking methods. The disease is even more prevalent particularly in people in the age bracket of 40-60 years. This has also been compounded by the fact that tea, coffee and nicotine are consumed in large amounts in the community.

Saudis have an unwavering belief in traditional medicine and most ailments are treated by the use of concoctions made of various herbs. Other methods of healing traditional ailments especially the physical one includes the pressing of a hot iron rod on the particular part of the body (Faraidy, 1982). This to Americans may appear crude but is a universally accepted treatment method in Saudi Arabia. Psychological and other mental problems are taken care of by the use of specific readings from the Islamic holy book, the Quran (Marsh, 1984). However, with relaxation in cultures, modern medicine has in recent times come to be appreciated and is generally used in the treatment of ailments. In the urban regions, several modern hospitals have been constructed and some Saudis even travel abroad to seek medical assistance. (Al-Mazrou, & Farid, 1991).

Community health nursing application in Saudi Arabia should target the promotion of proper health care practices, the treatment of ailments that arise in society due to misapplication of preventive measures and the rehabilitation of individuals recovering from ailments (El-Zahrany, 1989). From the definition of community health nursing, the practice should be maintained and not just regarded as a one-time affair. This is also the aspect of community that cuts across the board in the sense that it can be applied to all individuals irrespective of age, gender or social status. While applying the principles of this practice in Saudi Arabia, it is of prime importance that the persons involved realize that community health nursing has the basic foundation at the individual level before it spreads to the immediate family and finally to the community at large (Wickler, 2005). This, therefore, means that if success has to be achieved in Saudi Arabia and actually in any society in the world, the individual should be the primary target. Saudi Arabia being a traditionally religious society demands that the application of community health nursing take into consideration the beliefs of the inhabitants as well as a focus on the particular needs that face the communities should be addressed in the plan. If properly applied community health nursing can easily take care of all the major ailments that have been predominant in the country.

It is recommended that the cultural and religious viewpoints of the community be given a lot of consideration before the assessment process. This will ensure that the community members actively and willingly participate in the project hence making the results even more credible and more usable. It is also desirable that at least one member of the team be very well conversant with culture and it will be even better if he or she comes from the Saudi Arabian community.

Reference list

Al-Ammari, A. (1974).The role of health in the development process of Saudi Arabia. Iowa city: University of IOWA.

Al Baaz, R.S. (1992). Patient satisfaction with primary health care services in Saudi Arabia: a case study of Alriyadh City. St. Louis: Washington University.

Al-Madani, M.E. (1995). Primary health care and the contradictions between enlightenment philosophy and medieval sovereignty: a case study from Jeddah-Saudi Arabia. Florida: University of Florida.

Al-Mazrou, Y., & Farid, M.S. (1991). Saudi Arabia child health survey. Saudi Arabia: Kingdom of Saudi Arabia, Ministry of health.

Al-Mazrou, Y. (2002). Family and Community Medicine. Journal of Family & community Medicine, 9(2), 16.

Al-Naif. M. (1995).An exploratory study of primary health centers administrators in Saudi Arabia. Los Angeles: University of Southern Carolina.

Al-Swilim, A. (1985). Health manpower in Saudi Arabia: projection of needs of Saudi. New York: Syracuse University.

Al-Tuwaijiri, K.M. (1986). Delivery of primary health care services in rural Saudi Arabia. California: California State University.

Bodeker, G. (2005) WHO global atlas of traditional, complementary and alternative medicine, Volume 1. Switzerland: World Health Organization.

Daggy, R. (1998). Health and disease in Saudi Arabia: The Aramco experience, 1940s-1960s. USA: University of California.

Delaney, F.M. (1979). Low-cost rural health care and health manpower training, International Development Research Centre.

Dossary, M. (1991).Health and development in poor countries with particular reference to Saudi Arabia. United Kingdom: University of Aberdeen.

Elzahrany, R.A. (1989). Health services utilization in Makkah, Saudi Arabia. Ohio: Kent State University.

Faraidy, A.A. (1982). A theoretical model of health planning in Saudi Arabia. Los Angeles: University of Southern California.

Hashim,T.J. (1988). A health knowledge test for male college freshmen in Saudi Arabia. Indiana: Indiana University.

Joseph, S., & Najmabadi, A. (2003) Encyclopaedia of women & Islamic cultures: Family, body, sexuality and health. Netherlands: BRILL.

Knauerhase, R. (1975).The Saudi Arabian economy. Connecticut: Praeger.

Lundy, K., & Janes, S. (2009).Community Health Nursing: Caring for the Public’s Health. Massachusetts: Jones & Bartlett Publishers.

Marsh, F.C. (1984).The Western medical model of heathcare in Saudi Arabia.

Mathews, C.M. (2003). Self-rated health in a population of expatriates in Saudi Arabia. Australia: Monash University.

Mufti, M.H. (2000). Healthcare development strategies in the kingdom of Saudi Arabia. United Kingdom: Springer.

Sebai, Z.A. (1985) Health in Saudi Arabia. Yemen: Tihama publications.

Serenius F. (1979) Health and nutritional status in rural Saudi Arabia. Australia: Monash University.

Sulaiman A.J. (2000). Name of place family health survey: Saudi Arabia family health survey. Gulf Health Survey.

Wickler, O. (2005). Arab political demography: Population growth and natalist policies. United Kingdom: Sussex Academic Press.

Zahrani, S.A. (1983). The education of allied health personnel in Saudi Arabia. Pennyslavania: University of Pittsburg.

Zuhayar. A.S. (1984). Community health in Saudi Arabia: a profile of two villages in Qasim region. California: University of California.