South Asia India and Pakistan Anna Johnson Dani

South Asia: India and Pakistan Anna Johnson, Dani Meyers, Stephanie Ensign, and Morgan Garlock

Historical Perspectives

Location Southeast Asia 540, 403 square miles What kind of influences may there be due to the geographic region? Fresh fish Agricultural society Very poor

British Influence 1600’s British arrived in India for the East India trade Pakistan was part of India In 1947 Pakistan and India became independent nations Pakistan has four provinces Most speak the official language: English National language is Hindi

Religion Predominantly practice Hinduism and Muslim Others: Islam, Buddhism, Jainism, Sikhism, Zorastrainism, Christianity (introduced by Portuguese), and Judaism. Ramadan-- sunrise to sunset fasting for one month

Health Practices/Beliefs

Health Practices/Beliefs Religion has a HUGE influence on health beliefs and food choices. Hindu: Do not eat beef or pork. Islam Avoid all pork. Other forbidden foods are alcohol, the flesh of clawed animals, and the meat of an animal that isn’t slaughtered humanely.

Health Practices/Beliefs Orthodox Jains Vegetarians, avoid eating root vegetables because insects might be killed when the tubers are harvested. No blood-colored foods. Beliefs advocate moderation even when eating healthful foods. Obesity is discouraged. The laws of food consumption dictate that solid food should fill half the stomach, liquid ¼, and the remainder left for the process of digestion.

Health Practices/Beliefs Food for medicinal purposes. Believe that the body consists of five humors (phlegm, wind, bile, hot, and cold) which when kept in balance through a regulated lifestyle (including diet) can prevent illness. Hot/Cold classification for foods. Cold: rice, leafy vegetables, fruits, dairy products, honey, sugar, pickles, condiments Hot: wheat, spices and seasonings, chicken, oils

Health Practices/Beliefs Food taboos during pregnancy: Hot foods such as spices, mangoes, and papayas are avoided. Vegetables that cause flatulence and cold foods are restricted for lactating women.

Health Practices/Beliefs Diabetes Believe that diabetes is caused by divine power and is inevitable. Bitter gourd is commonly used for its hypoglycemic effect. Individuals taking an oral diabetes agent or insulin could have hypoglycemia if they also consume bitter gourd. Cancer Plant based diet Heavily pickled foods may have correlation to stomach cancer

Health Practices/Belief Ayurveda The code of life and longevity Based on the belief that humors in the body and in foods can interact to preserve a homeostatic harmony or cause imbalance. Yoga Good for the body and mind

Health Practices/Beliefs Sattvic foods: milk, milk products, rice, wheat, ghee, most legumes, and some other vegetables. They are believed to help make a person serene, enlightened, healthy, and long-lived. Rajasic foods: meats, eggs, and foods that are bitter, spicy, sour, salty, and rich. They are believed to contribute to aggression, passion, and desire for power. Tamasic foods: garlic and pickled, preserved, stale, or rotten foods and alcohol and drugs used for pleasure and in excess. They are believed to contribute to lust, malice, confusion, slothfulness, and dullness.

Traditional Foods

Traditional Foods Grains with vegetables Legumes with vegetables Milk products with vegetables or fruits Grains combined with meat, poultry or seafood Bread Dessert Most diets are high in fat Common spices: ginger, turmeric, cumin, coriander, mustard, fenugreek, curry

Traditional Foods Curry: any spicy stir-fry vegetable dish or gravy dishes with meat or vegetables Rice: the most commonly and widely consumed food in India Few foods are eaten throughout all of India

Traditional Foods Coastal India Seafood dishes including curried shrimp, crab, and clam Southern India: Fried rice dishes, semolina wheat, spiced vegetable curries, yogurt-based dishes, and deep-fried salty food Northern India: Rice served as pilaf; seasoned chicken, lamb, or beef; korma, masala, and bread

Professional Interaction in a Healthcare Setting

Professional Interaction Important information to know about your client Religious affiliation Degree of adherence to medical regimens Length of residency in the US Degree of acculturation Vegetarian or non-vegetarian food preferences Use of supplements, herbs and complementary medicine

Professional Interaction Small talk is significant, rushing is considered rude A direct “no” is considered impolite Agreement may be indicated by shaking their head back and forth, the way we indicate negative The left hand is never used in social purposes It is impolite to show the sole of one’s shoe Touching a person’s head is offensive

Professional Interaction English is spoken, written and understood, but use of regional languages is preferred Loudness is considered rude Self-control in demeanor and expression are followed Expectation of privileges, such as getting immediate appointments or service, may not be unusual Women are the primary gatekeepers of food and are responsible for food handling

Professional Interaction Don’t understand the connection between body weight and diabetes Fasting and feasting practices can be problematic with diabetes Those of Indian and Pakistani decent have a higher rates of diabetes, obesity and heart disease Important counseling objectives include carbohydrate counting, portion sizes, modification of recipes to be high in fiber and lower in fats (particularly saturated) Traditional foods may need to be adjusted

Questions?