ARAB CASE STUDY Mrs. Ayesha Said is a 39-year-old Muslim Arab housewife and mother of six who immigrated to the United States from a rural town in southern Iraq 2 years ago. Her mother-in-law and her husband, Mr. Ahmed Said, accompanied her to the United States as participants in a post–Gulf War resettlement program, after they spent some time in a Saudi Arabian refugee camp. Their relocation was coordinated by a local international institution that provided an array of services for finding employment, establishing a household, enrolling the children in public schools, and applying for federal aid programs. Mr. Ahmed, who completed the equivalent of high school, works in a local plastics factory. He speaks some English. He plans to attend an English-language class held at the factory for its many Iraqi employees. Mrs. Ayesha, who has very little formal schooling, spends her day cooking and caring for her children and spouse, with the assistance of her mother-in-law. She leaves their

ARAB CASE STUDY Mrs. Ayesha Said is a 39-year-old Muslim Arab housewife and mother of six who immigrated to the United States from a rural town in southern Iraq 2 years ago. Her mother-in-law and her husband, Mr. Ahmed Said, accompanied her to the United States as participants in a post–Gulf War resettlement program, after they spent some time in a Saudi Arabian refugee camp. Their relocation was coordinated by a local international institution that provided an array of services for finding employment, establishing a household, enrolling the children in public schools, and applying for federal aid programs. Mr. Ahmed, who completed the equivalent of high school, works in a local plastics factory. He speaks some English. He plans to attend an English-language class held at the factory for its many Iraqi employees. Mrs. Ayesha, who has very little formal schooling, spends her day cooking and caring for her children and spouse, with the assistance of her mother-in-law. She leaves their

ARAB CASE STUDY

Mrs. Ayesha Said is a 39-year-old Muslim Arab housewife and mother of six who immigrated to the United States from a rural town in southern Iraq 2 years ago. Her mother-in-law and her husband, Mr. Ahmed Said, accompanied her to the United States as participants in a post–Gulf War resettlement program, after they spent some time in a Saudi Arabian refugee camp. Their relocation was coordinated by a local international institution that provided an array of services for finding employment, establishing a household, enrolling the children in public schools, and applying for federal aid programs.

Mr. Ahmed, who completed the equivalent of high school, works in a local plastics factory. He speaks some English. He plans to attend an English-language class held at the factory for its many Iraqi employees. Mrs. Ayesha, who has very little formal schooling, spends her day cooking and caring for her children and spouse, with the assistance of her mother-in-law.

She leaves their home, a three-bedroom upper flat in a poor area of the city, only when she accompanies her husband shopping or when they attend gatherings at the local Islamic center. These events are quite enjoyable because most of those using the center are also recently arrived Iraqi immigrants. She also socializes with other Iraqi women by telephone. Except for interactions with the American personnel at the institute, Mr. Ahmed and Mrs. Ayesha Said remain quite isolated from American society. They have discussed moving to Detroit because of its large Arab community.

Four of the Said children attend public elementary schools, participating in the English as a Second Language (ESL) program. Mr. Ahmed and Mrs. Ayesha are dismayed by their children’s rapid acculturation. Although Muslims do not practice holidays such as Halloween, Christmas, Valentine’s Day, and Easter, their children plead to participate in these school-related activities.

Mrs. Ayesha is being admitted to the surgical unit after a modified radical mastectomy. According to the physician’s notes, she discovered a “lump that didn’t go away” about 6 months ago while breast-feeding her youngest child. She delayed seeking care, hoping that inshallah, the lump would vanish.

Access to care was also limited by Mrs. Ayesha’s preference for a female physician and her family’s financial constraints—that is, finding a female surgeon willing to treat a patient with limited financial means. Her past medical history includes measles, dental problems, headache, and a reproductive history of seven pregnancies. One child, born prematurely, died soon after birth.

As you enter the room, you see Mrs. Ayesha dozing. Her husband, mother-in- law, and a family friend, who speaks English and Arabic and acts as the translator, are at her bedside.