South Asia: India and Pakistan

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

2. Historical Perspectives

3. 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

4. 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

5. 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

6. Health Practices/Beliefs

7. 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.

8. 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.

9. 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

10. 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.

11. 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

12. 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

13. 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.

14. Traditional Foods

15. 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

16. 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

17. 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

18. Professional Interaction in a Healthcare Setting

19. 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

20. 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

21. 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

22. 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

23. Questions?