A Male Perspective On Marriage, Tribes And Love In Saudi-Arabia

We hardly ever hear the candid voices of Saudi men in regards to relationships, marriage and thoughts of living in a tribal society. 
The following post is written by an anonymous Saudi man. He could be anyone, his thoughts and feelings are probably shared by many others out there. I came across this post on Facebook and found it so interesting and compelling I felt it should be shared with more people. I asked the author and he agreed to share his thoughts on Blue Abaya.
In his post, which he says was written as a sort of apologetic letter to the women he hurt in his life, the writer goes through tribalism and its deeper meanings in the society while trying to explain to himself, and to the women who came across his path, the reasoning behind his actions. The piece has very insightful analysis about tribes, "meta-tribes" and the complex matter that is marriage in Saudi-Arabia.

The problems that arise from tribalism are numerous and seemingly only negatively effect the Saudi woman. In reality the strong tribal practices in Saudi-Arabia today have negative effects on everyone on all levels of society.
Read more about tribalism in Saudi-Arabia here: http://blueabaya.blogspot.com/2010/07/saudi-arabias-epidemic-tribalism.html

Another reason I want to share this post is I often feel like the western media is portraying a false image of Saudi men. The illusion is of somewhat brain washed, rather boring men going about their monotonous days without much feeling or thought about life or how it would've been had he been born without the y chromosome.

The truth is Saudi men have hopes, dreams and fears just like any man in any other country. Especially the new generation seems to have a lot of frustration toward the contradictions and hardships they face in their every day lives living in a tribal society such as Saudi-Arabia. 

What I thought makes this post special is the fact that Saudi men are usually private about these personal affairs and we hardly get a glimpse into the depths of their minds.

It's long, but a great read. Feel free to share it.

"Why am I not married, or in a serious relationship and the Meta Tribe"

Plain and simple, the reason why I am not in a serious relationship of any kinda goes back to 1 reason, reverse tribalism or Meta Tribalism. It might not be a term you can google as I have coined it lately. This is, of course, my own perception and reality might be a little different or inconsistent with it since this is not a research paper. But in this post I will try to explain what Meta Tribe means and how it affects my love life and how I chose to deal with it.

Intro to tribes

So why does the need for tribal societies to marry off their young to other “compatible” tribes exist? its kind of a known fact that tribal marriage rituals were created as a system to insure money doesn't fly far off a group of people, as well as to minimize threats on a group of people and to minimize the influence of a stronger tribes and groups of people on this said family or tribe. This is also a criteria of what is considered a ”compatible” tribe. If a family or tribe has the same power amongst other tribes, or the same financial level, this will insure that money doesn't fly to others who are greedy or that the other tribe aimed to take advantage of the other tribe's social status or power, also this makes sure that civility dictates when conflicts arise as so much more than just 2 people are involved. Of course all these hazards could be minimized if the marriage happens between two of the same tribe.

This of course rises from weak judicial systems and weak civil society institutions as well as the lack of insurance and retirement plans and social security where people are forced to huddle up in “tribes” to protect themselves. This is also why we see a high dependance on the young in a family to taking care of the elderly of these tribes. The elderly depend heavily on the young to survive. Of course these reasons might look like they disappeared now days to some or they are under a layer of ignorance and tradition, but I assure you that those are some of the reasons why marriage rituals in tribal societies exist and why they continue to exist.

Meta tribes

What is interesting in my opinion is the backlash that non-tribal families had because of this. Since tribes have a strong political and financial power, non-tribals fearing for their well being around much more powerful groups started grouping together. Non-tribals started creating Meta Tribes amongst like minded and financially compatible families around them for the same reasons that Tribals created tribes. Similar marriage and partnership rituals grew out of this too. Families will choose to reject suiters for a lady from an “incompatible” because of the family's social status, religious values, financial situation, association with other families that might or might not be of compatible nature. This is just about talking about neighboring families in the same city, imagine how it would be if a suitor was from another country. This also applies if a man decides to get married from another “incompatible” family, the family of the man would object almost as much as a lady's family would, even though its easier for a man to do what he pleases legally, but a woman would need the approval of a legal guardian. This is what I call reverse tribalism, or Meta Tribalism, and it does exist.

Me my family

So before I come to the conclusion, a little bit about me must be communicated. I am a proud person, I hate begging for acceptance. I grew up being a non-tribal geeky nerd kid in the center of all Saudi Arabian tribalism. I was called gay for having a softer west saudi arabian accent, this explains why I learned to merge accents and adapt my language. I was picked on for being different and a geek and a person of higher grades. I was also picked on for being more westernized as I grew up on lots of american TV and media. I was an easy target for everyone. When I lived alone in my college years I learned to be proud of who I am, be an individual and not care about what others think, I found acceptance between a great group of friends. I know what I want to do and who I want to be. I can't go back to that fool was begging for acceptance from a society that rejected him. I learned to be proud and bend for nobody. I also learned that I don't like most people. Dont get me wrong, I don't mind most people, I am pretty social, but the people I like close to me are very rare. It takes me on average a 2 year relationship with a person with constant hanging out to even consider them close friends., if they manage to be my friend for that long. I also have a very specific way of life and a set of beliefs that finally made me a happy person. I won't go into details as some of these believes and choices might get me killed or put one of my family members in danger. I know what I want to accomplish in live, I have specific goals in life and those goals are my compass and will bend over and down to have them accomplished. If I cant get them accomplished, then I will die trying. I want to create a sustainable game industry in the middle east, and I want that to be my legacy.

I also met many women in my life of course, some were saudi and some were from other countries, and I know my taste in women now. I know what I want in a life partner and I know what emotions to look for in myself as signs of compatibility and chemistry. I know my skills as a person and I recognized my faults as a human and I do look for a partner in life that completes these faults to create a solid unit. A person that shares my believes and enjoys being part of my way of life. A person I can be part of their lives and a best friend amongst their friends and a friend to their friends too. I am not a kid falling in love and I am not a naive brat who just wants to piss off his family. I know what I want and what I need. This being said, most of the women that meet these criteria for me are women who are not from this country, and I have met a lot too, but chose not to persue them.

My family is a simple family from a non-tribal decent. My mom is from a simple family from makkah and my father is from a simple family in Madina. Two holy cities, the pressure I feel to be a good human being. My two parents focused on their education, got scholarships to go to the US and get their higher degrees from esteemed US universities, amongst them is UCS. They both got their PHDs and during their PHD days is when I was born. They have achieved high status in the community and they are known to be trust worthy and they are respected by everyone. They provided a life that is unimaginable to a young non-tribal in saudi. The house was full of love and acceptance even though the world outside the house didn't accept me or love me. They offered me the best education, the best nutrition and care as well as everything they ever could give me to make me feel comfortable while in saudi. I have never mentioned their name is shame, EVER. I have high respects for what they have accomplished in their lives and I love them unconditionally as they loved me unconditionally. Nothing is perfect though.

The issue with my family does rise with their commitment to the Meta Tribe I spoke up earlier. Due to their experience in life they have seen many people dealing with the backlash of marrying from outside of the meta tribe as well as deal with some complicated political and sociological problems after a divorce, especially if kids were involved. They have seen the pain that people went through and have seen how much damage that has caused not to the married/divorced people themselves but also for their direct and indirect families as well as for their kids. Those negative effects do happen from time to time and solving them is never easy. They don't want their baby, me, that they have nurtured for so long to be in pain or suffer from such issues, and that is understandable. They want me to have the life they have found to be the best for me, with nice daughter of their friend's. They have expressed firmly mamy times that they would never accept a non-saudi or a girl that is not from a compatible family.

Some of my experience

As the nature of Riyadh's ultra conservative social structure (capital of Saudi where I live currently), I am not really in contact with many saudi women, except virtually online. I met people in real life that I have known virtually for a while, knowing someone virtually doesn't count in the bigger picture of “knowing them”. The social structure doesn't allow me to observe their behavior around their friends, and it wouldn't allow me to observe their behavior around my friends. I don't consider that “knowing” someone at all. Not that I judge people who do, I just know myself and know how I feel about it, it just doesn't suite me. The women that I do meet in my social circles are not really my type too, its already a rare occurrence to meet a saudi woman in my circles, and the ones I meet are not my type at all. 

So why don't I venture into other cities in saudi you say where people are dominantly less tribal? It just doesn't serve my goals, other cities just don't have the jobs or opportunities that Riyadh has. My goals come first. I tried to get to know a person that lived in another city once or twice though. For instance, I knew this one girl for a while online and we were good friends and she was from a “compatible” family, but once we hungout in another neighboring country for real and not online while we were traveling, it just didn't fit in inside my head, the whole experience was weird, I wasn't myself and she wasn't herself that I knew online. It was a complete mess, I didn't feel the relationship at all and it felt like I was digging myself a huge hole. I ended up panicking and doing something that I will always regret, I called her fat just to break up with her. I will always be a horrible human for what I have done. I don't want this type of crap to happen to her or anyone else so I will save the whole world my crap by going far away from the online saudi dating scene. If that lady was reading this, I am forever sorry. 

I once met a person that I thought could have been the one here in Riyadh, geeky, intelligent, strong woman, ambitious and has high hopes and plans for herself that had the same believes that I had. We dated for a bit before she decided to break it off. Her reasons? She was tribal and she already had an experience convincing her family to be in a relationship with a incompatible tribal guy. She decided to spare herself and myself the pain of dealing with that again especially since I was non-tribal. I don't know if that was an excuse or if she was lying or not, I don't care anymore. There was other big issues with both of us that would have broken us apart regardless, but it sucks that an external force was the cause. what I do care about is the possibility of that ever happening again in Riyadh. When will I ever be able to meet someone who is compatible with me on that level? I never had in the last 5 years. 

So how about arranged marriage right? How about my family choosing and introducing someone to me right? Not that I have anything inherently against this approach. different people, different methods. Arranged marriages tend to focus on compatibility beyond anything else, it does have a high rate of success due to the reasons I mentioned way earlier in this post. On the other hand, this method does depend on the son or daughter sharing the same values as the family, which is not the case for me. Even if I did go that route just to date and get to know the person, I would be reluctant to share with them anything that is considered perverted, blasphemous and weird by the status quo, and I am full of those and all about them. They are the basis of my personal believes and personal structure. Sharing any personal information about myself would put my family in danger, physically, or maybe just socially if any of that information seeped out to their “friends”. I really want to protect my family from any harm, they have always been nice to me and I am not an ungrateful bitch. I also don't let my family buy underwear for me, its really awkward to think they are choosing where my penis will go.

I have met some non-saudi women that were amazing, and I almost fell in love with one of them as I was trying to test out the waters and see if my family would approve of someone from a neighboring country that had similar cultural background. The attempt ended in very passive aggressive fights and it only boiled more aggression and late night crying of my mother according to my own sources. I decided to save that girl the trouble of dealing with all of this, and in turn inflicted same pain that the saudi girl once inflicted on me before. The circle of paid and hurt keeps going around. It has to stop.

Dealing with it

dealing with not having a partner is becoming a huge hurdle in front of my own goals, Its really hard to focus on work when your heart is empty. You need a life partner, a cofounder, for your life, someone that would accept the things your family rejected about you. This is the source of my current depression as my emotions started to be a hurdle in front of my goals, and I feel trapped.

One might debate the usefulness of Meta tribe in a civil society that is developing in saudi, but its completely irrelevant to my believes and my way of life. I am not planning on being in saudi for a long time as I do want to move somewhere else and I do have the means to do it and plans are already in motion. In those other places, civil societies do exist and the need of a meta tribe is completely irrelevant and is instead replaced with a smaller social circle of friends that share the same values and you best of all, you get to choose them yourself. And as I am not an ungrateful brat to my family, I promised myself never to get married to anyone they don't approve of. Its the least I could do after all the great things they offered me to be who I am. That leads to never meeting anyone they approve of, hence the decision not to get married. 

Their decision to commit to the meta tribe does push me away from them, and does their inability to ever accept my way of life and my own believes, but thats another issue and I am ok with that. What I wonder sometimes about is my ability in the future to withstand dealing with them and caring for them due to giving me so much but taking away the most important thing away from me right now, the freedom to choose who to love.  I will refrain from getting married and see me go into a downward spiral of bullshit and they will feel me being pushed away from them as time goes by. We will see if they stomach to see their little boy be alone in his life due to their commitment to the meta tribe.

I am still struggling with the fact that I will remain alone the most of my life though, never allowing myself to fall in love again. Wondering if a person able to not fall in love? Am I destined to fall in love over and over again and then continue to break hearts along the way? Mine as well as others? I now live my life clinching to any piece of love I could find, any hug and kiss counts to keep me alive, every cuddle and every sigh and moan adds a day or 2 to my heart. I don't want to hurt people around me, but I need the blood of your hearts to survive. Share some with me willingly, and I will share some of mine in return before we both move on. stay around as long as you can.

Maybe things will change in the future, maybe it won't. I don't want to over think it when I am with someone, but its completely unfair for the other party not to know the truth about what goes on with me. I know this post started very informative, but then turned into a sappy bs whiny story, I just really had to get it off my chest. I also know that women have it worst 10 folds but that doesn't mean it doesn't still hurt for us men. I know you feel even worst and that you get the shit card, but that doesn't mean that the source of our issues is not the same. Regardless, women problems are worst by far, just having a legal guardian is messed up enough. With this attitude, if I was a woman, I would have committed suicide a long time ago. Bravo for being so strong." 

By Anonymous Saudi man

If you wish to contact the man who wrote this post, please send me an email and I will forward it to him. blueabaya @ gmail.com

The Eternal Veil

Imagine a man that has never seen the face of his wife, ever. How about a son or a daughter that does not know how their mother looks like?

Such men and women still exist in Saudi-Arabia.

Recently in the news was the story of a Saudi man that had never seen his wife's face. After 10 years of marriage the man had become too curious to control his desire to look at the woman he married. He had made the mistake of trying to sneak a peak under the veil at night. The wife had however woken up and now wanted a divorce. She had "lost face" so to say.

The women that practise this custom of never revealing their faces come from a very small majority from certain tribes of the Najdi region.

What's most peculiar is that some of these women refuse to remove their veils even in the company of female relatives including their own daughters, sisters and mothers!
How does this effect the child?

This reminded me of how I found out about this custom through a patient of mine.
She was being treated for cancer and was on the ward with her two daughters who acted as her sitters (caretakers). The daughters were perhaps 7 and 15 years old, hard to say because of the veil.

I remember going about my normal routines measuring her blood pressure and asking her some questions and making a note to myself that I had not yet seen their faces. I wondered why the patient and daughters all sat in the room eating in their colorful dresses without abayas but they hadn't removed their niqabs (face veils).

I then requested for the patient to remove her veil for me to check her and made a gesture with my hand indicating she lift her niqab. She went ballistic!
She shouted "haram" at me and I could see I had upset her but I still didn't realize what I had done.
On the side note, some Saudi patients might be a "bit" demanding or like some nurses say "crazy" so I just thought of her behavior as the norm, smiled and left her.

Later on a female physician told me that these bedouins (she referred to them as nutters) never removed their veils, not even in presence of women. She said it has nothing to do with Islam, it's just their tribes that have these weird traditions of hiding the women's faces. The permanent veil imposed a huge problem as to how to treat this woman and it was driving the doctor crazy.

The patient had demanded an all female medical team and none of the male doctors were ever allowed to enter the room. The major issue was that she needed surgery and it didn't look like it would be possible to accomplish with her remaining veiled the whole time.
The veil would of course be in the way of surgical procedures and it would be an infection risk but the patient insisted she keep it on.

The next time I saw the patient I asked her why she always kept the veil on. At that time my arabic was still very basic and I was not able to understand her funny accent either. She kept repeating "lazim" which means "have to". So I never really understood what were the reasons behind it nor was I able to find out at what age they started veling the daughters. Did they actually veil babies?

The woman and her daughters seemed very comfortable with the veil and at night when I entered the room all three had them securely on. I wondered do the veils come off when they are in the bathroom or shower? It was as if it was a part of their bodies.

In the end the patient was discharged with her eternal veil and no procedures were done. She had refused life saving surgery rather than removed the veil.

Saudi-Arabia: Changing Genders

In a previous post I wrote about Saudi-Arabia and its raging epidemic of tribalism. Read more about it here.

The 'inbreeding' which results from tribal thinking can sometimes be devastating or even fatal to children that are born into families who practiced first cousin marriages for centuries. I've seen the most peculiar and rare genetic disorders birth defects in the pediatric patients I've taken care of in the Kingdom. The prevalence of certain genetic diseases is very high in Saudi-Arabia compared to the rest of the world because of high rates of consanguinity reaching up to 80% of all marriages in some regions.

An example of such a disorder are the children born with ambigious genitalia. "A child may be born with genitals that are not clearly male or female (ambiguous genitals, or intersex state). Most children with ambiguous genitals are pseudohermaphrodites—that is, they have ambiguous external genital organs but either ovaries or testes (not both). Pseudohermaphrodites are genetically male or female."
Read more about the condition here: http://www.merck.com/mmhe/sec23/ch265/ch265d.html
 http://www.nlm.nih.gov/medlineplus/ency/article/003269.htm

The metabolic disorder causing it is called congenital adrenal hyperplasia (CAH). Most of the cases in KSA are caused by this inherited condition. Unfortunately accurate data on the nationwide prevalence does not exist or it's very scarce. This is typical to KSA, statistics on certain "hush hush" topics are either withheld, do not exist or at least have a nice thick sugar coating on them.

In Saudi-Arabia the majority of the cases caused by CAH are type 46XX which means the child is a genetic female with male genitalia. Some are not easy to define at birth and need testing to define sex. Sometimes gender is not properly investigated and the outcome is assigning the sex as the preferred gender in Saudi: MALE.

According to this study "There was an obvious preference to assign male sex."

This, despite the evidence from studies conducted in western countries:
"It is often technically easier to treat (and therefore raise) the child as female (it is easier for a surgeon to make female genitalia than it is to make male genitalia), so in some cases this is recommended even if the child is genetically male."
"we conclude that the assignment to the female gender as a general policy for 46,XX patients with CAH appears justified, even in severely masculinized cases"


So why are so many Saudi families that have children with ambiguous genitalia assigning male sex for clearly genetical females?

I guess it's obvious what the preferred gender is in Saudi-Arabia. If you had the chance to live as a woman or as a man in KSA, I bet most would choose the latter because of all the restrictions imposed on a woman's life here. Life as a man in Saudi-Arabia is easy and privileged. For a woman it's hard with many restrictions and never earning the right to be a full citizen, rather treated as a legal child for the rest of her life.

Sometimes the patients will need gender reassignment which means they need to decide whether or not to change the official sex of the child as recommended by the doctors. Saudi parents often refuse, especially when it is suggested to change from male to female. The best for the child would be naturally to determine the sex when they are very young. It happens though that sometimes the diagnosis or decision is made late, and the child already identifies as female or male. Despite this the sex is changed which causes many emotional problems and identity crisis for the child.
http://www.ncbi.nlm.nih.gov/pubmed/15573851

So this means that Saudi patients will come in for sex change operations, which otherwise are strictly prohibited in Islam. Changing God's creation is not allowed by plastic surgery.
I tried to search regarding the Islamic ruling on this type of sex change surgery and it seems to be viewed as a deficit which therefore can be repaired.

I found this ruling for a surgical operation (removing male organs) in order to turn him into a girl:

"It is permissible to perform the operation in order to reveal what was hidden of male or female organs. Indeed, it is obligatory to do so on the grounds that it must be considered a treatment, when a trustworthy doctor advises it. It is, however, not permissible to do it at the mere wish to change sex from woman to man, or vice versa."

Interestingly, children with ambiguous genitalia are actually mentioned in old Islamic texts, they are referred to as "khunutha".
Paula Sanders, "Gendering the Ungendered Body: Hermaphrodites in Medieval Islamic Law," in Nikki R. Keddie and Beth Baron, eds., Women in Middle Eastern History (New Haven and London: Yale University Press, 1991), pp. 74-95.

"Although the marriage to a khuntha woman, for example, could not be regarded as valid as long as the sex of the khuntha was unknown, it was still considered to be mustaqim, meaning that it did not involve anything forbidden."

"The jurists reasoned that if the khuntha turned out to be a woman, this meant only that two members of the same sex had seen one another and that the marriage itself was merely a blunder. If it turned out to be a man, this constituted the gaze of a woman upon her husband, and there was no prohibition against it."

I recently had a patient that came in for sex change surgery. She had been brought up as a girl and was genetically female, but apparently had decided she wanted to become a boy after all and the surgeons were OK with performing sex change operation on her at the mature age of 19. This girl was very petite and had a short stature but she had cut her hair short and arrived at the hospital in a thobe. It was all very strange. Her medical records had to be altered because her name was to be changed to Mohammed.

After her (or his) operation in which they constructed male genitals and removed the female parts, the girl turned boy seemed quite happy and all the friends that visited him were young Saudi men that didn't seem phased by the change whatsoever.

Congenital adrenal hyperplasia could be mostly avoided by simple prenatal screening, especially for the high risk families. That way the pregnant mother could get treatments to minimize the risk of genital ambiguity. It's common for the same family to have more than one effected siblings.

Saudi-Arabia has does have a premarital screening program, in which they screen for the three most common hereditary diseases, including one metabolic disorder (but not CAH). However like I mentioned in my previous post on tribalism, the sad fact remains that even if the screened couple is deemed to be at VERY HIGH RISK for having children with the mentioned hereditary diseases, 90% of them will marry anyway and genetic diseases will continue to flourish in Saudi-Arabia.

Saudi-Arabia's Epidemic: Tribalism

Tribalism is alive and deeply rooted in the Saudi culture. Read more about what tribalism actually means here.

Tribalism can have some positive aspects to it. It creates close family ties and high respect of elders. Knowing ones roots and the names of ancestors hundreds or even thousands of years back can be educational and inspiring.
However tribalism should NOT create such pride and arrogance in people that they begin feeling supreme to others based solely on lineage. It should NOT cause the society to become racist and hateful. Tribe should NOT determine marriage suitability. Tribalism should NOT effect negatively the health of a whole nation.

But in Saudi-Arabia, unfortunately it does.

Islam does not support tribal mentality
Ironic perhaps that tribalism is against the teachings of Islam, yet it seems to be what the national identity is based on.
Islam teaches that all human beings are equal in the eyes of the Creator as far as their status of human beings is considered.
"O Mankind, We created you from a single (pair) of a male and a female and made you into nations and tribes, that you may know each other (not that you may despise each other). Verily the most honored of you in the sight of God is he who is the most righteous of you" (Quran 49:13).

Prophet Muhammed despised tribalism
Tribalism was practiced before and during the times of the Prophet Muhammed (pbuh). Interestingly he belonged to a very prominent tribal family called Quraysh which at the time ruled Mecca.
Despite his high status Prophet Muhammed tried to eradicate this backward and racist practice.

The Prophet used to say about tribalism (Asabiyah): "Leave it. It is Rotten " narrated by Bukhari and Muslim.
He said on pride and boasting of lineage:
"There are indeed people who boast of their dead ancestors; but in the sight of God they are more contemptible than the black beetle that rolls a piece of dung with its nose. Behold, God has removed from you the arrogance of the Time of Jahiliyyah (Ignorance) with its boast of ancestral glories. Man is but an God-fearing believer or an unfortunate sinner. All people are the children of Adam, and Adam was created out of dust." narrated by At-Tirmidhi and Abu Dawud.

So according to this Hadith, these proud tribalists are worse than dung beetles in the eyes of God? Interesting.

In his final sermon the Prophet stressed the importance of equality among all humans which in modern day Saudi-Arabia has been long forgotten:
"O people, Remember that your Lord is One. An Arab has no superiority over a non-Arab nor a non-Arab has any superiority over an Arab; also a black has no superiority over white, nor a white has any superiority over black, except by piety and good action (Taqwa). Indeed the best among you is the one with the best character."

Ignoring and ignorance
Many more examples of anti-racist and anti-tribal Hadith exist.
So why do the Saudis continue this practice and choose ignore such teachings? I guess you can call it pride, keeping the "goods" in the family, racism, prejudice, closed-mindedness, ignorance.

Somehow I can understand the uneducated Bedouins being tribal since they know of nothing else let alone ever heard of genetics. That said I've never met a single proud or arrogant Bedouin, on the contrary they seem humble and never discriminate or look down upon others of different races.

However the educated, rich Saudis including the Royal family are very engaged in tribalism, despite surely being aware of the above Hadith, as well as the consequences of inbreeding and impact of hereditary diseases. Generally speaking (but not generalizing) I've noted the richer the Saudi family is, the more they will have a sense of supremacy toward others.
http://www.unl.edu/rhames/courses/212/arab_inbreed/arab_inbreed.htm

Consanguinity has dire consequences
In tribal families marriages between cousins are very common. I was aware it's common to marry first cousins, but after recently attending a "Hereditary Diseases Workshop" I learned the rate is a staggering 60%. Inbreeding like this causes alarming rates of hereditary diseases. Some disorders are 20 times more common in Saudi-Arabia compared to the rest of the world. There are tribes that have distinctive malformations that are recognizable from their appearance:
http://www.wnd.com/?pageId=30246

 
Tribal Infection
So what is the impact of  this disease "tribalismitis" on the nation? In short, it is making Saudis more sick by every generation and slowly weakening the their gene pool. Previously those born with metabolic diseases and blood disorders would die soon after birth, or never reach reproductive age. Modern medicine has enabled most of them making it to adulthood, only to be married off to a cousin and producing a new even sicker generation.

Saudis infected with "tribalismitis" present with congenital disorders, malformed babies, high infant mortality rates, high prevalence of mental retardation and hereditary diseases that significantly lessen the quality of life and are a huge financial burden for the government to treat.
http://www.bmj.com/cgi/content/full/333/7573/831

Everyday in my work I encounter patients that are admitted to the hospital either directly or indirectly because of an inherited condition. Some of them need expensive medical care frequently, not being able to live normal lives. Many patients require blood transfusions every month to survive. Some face death without a set of new lungs.

The innocent children
Innocent babies are born malformed and diseased and suffer immensely.There is unfortunately a very high prevalence of babies born with congenital malformations in Saudi-Arabia. These innocent children suffer because of the ignorance of their parents. It is absolutely heart breaking to see these children in the hospital.
http://www.ncbi.nlm.nih.gov/pubmed/12521776

There are couples I encountered that had seven sick children in a row. When the child reached a certain age, they would pass away. Regardless of the tragedy the woman was pregnant again. Another family had nine children that were all affected and died before they reached 10 years of age.

Strong roots are hard to weed
Tribalism is so deeply rooted that some families have even taken things into their own hands and turned to the courts. Here's an example of a Saudi tribal marriage that was nullified by a judge based on tribal incompatibility.
http://gulfnews.com/news/gulf/saudi-arabia/tribal-ties-weigh-heavily-on-saudi-marriages-1.186154
After 4 yrs of legal battles the Supreme Judiciary Council in Riyadh overruled the decision and ordered that the couple be reunited in matrimony.
http://www.wluml.org/node/5916

Hope for the future
Not all Saudis are brainwashed and fall into trap of tribalism. Here's an insipiring article from Saudi Gazette about two very brave Saudi men Hussein Abdullah Al-Mansour and Ali Hadi Al-Hamzan, who embarked on an extraordinary road trip throughout the Kingdom to promote the message "No to racism. No to tribalism."
  http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentID=2009031832472
 May God reward them and may their mission be a success.

Prevention is the cure
Saudi health officials have become more concerned about high rates of consanguinity and a few years ago launched a premarital screening programme for the most common hereditary diseases (thalassemia and sickle cell anemia). Couples wanting to get married have to go through mandatory screening.

While this might sounds promising, tribalism still effects peoples minds so much that 90 % of the screened high risk couples get married anyway. The rate is astounding.
The workshop for Hereditary diseases wisely concluded that prevention is the only cure for hereditary diseases.

Signs from God?
Perhaps hereditary diseases and genetic disorders are a sign from God to stop this nonsense. Maybe they are punishments for arrogance and pride and going against what God teaches humans.
Hopefully in the future Saudis will be more aware of the dangers of tribalism.

Bedouin Patients

The hospital I work in gets quite a few bedouins coming in for treatment from all around Saudi. It's a large tertiary referral hospital, which means many patients were referred there because they could not be treated elsewhere or their cases were so difficult or rare it needed special care. Which makes these patients even more interesting! Bedouins come to our hospital from all over Saudi-Arabia, but mainly from the tribes that originate around the Najd area. Read more here  http://en.wikipedia.org/wiki/Najd

What is generally meant by the term "Bedouin" is the nomadic Arab people who dwell in the desert areas reaching from Western Sahara to the Arabian Peninsula. Bedouins used to follow water and pastures and were nomadic, not staying in one place for a long period of time. Nowadays many of them have settled in certain areas and formed small towns cities like Dammam on the east coast of KSA.

The Bedouins are divided into tribes of which the largest ones are Al-Shammari (everywhere!) Al-Harbi (Mecca area), and Al-Mutairi, Al-Qahtani, Al-Subaie, Al-Dossary all originally from Najd valley and around. Most patients will have one of these very common surnames, kind of like mr. Smith or in Finland mr.Virtanen.

I work on an inpatient ward where nurses are typically assigned to 3-5 patients at a time. We look after them the whole 12 hour shift, usually for a few days in a row. This enables a lot of one on one time with the patients and since the patients will always have private rooms, women will be relaxed and at ease. I feel very lucky to have been able to take such an intimate look into their lives, culture and traditions.

In my opinion Bedouins are generally the nicest patients in all aspects. I've found them to be friendly, genuine, warm, curious, easy-going (hardly complain), they have excellent sense of humour, are talkative and just about the most hospitable people you will ever meet. Hardly any of them speak English though, and sometimes their Arabic accents are difficult (sometimes impossible!) for even our Saudi nurses to understand. So basic Arabic language skills are really essential for more interaction with them. But actually even before I learned Arabic I found it was easy to get along with them by using sign language! They were always in for a little fun!

Typically the Bedouin patient will have one or two sitters present at all times. Read more about the way Saudis visit the sick in hospitals here. They will have large families and it wouldn't be strange to see ones with over 10 children. Visitors often come every evening and they will enjoy a meal or coffee and dates together.

Bedouin patients tend to have a few peculiarities compared to other Saudis. Especially the really nomadic ones have habits that they continue in the hospital, like sleeping on the floor rather than the bed! They will take the sheets off the bed and put them on the floor. Not even the pillow is needed. The sitters have a sofabed available but it's hardly used. Bedouins like to keep things simple and they don't like "modern day luxury" such as bedding.

When the patient has guests they will usually eat on the floor and with their hands. A sheet is spread on the floor and people will gather around it. Chairs and tables might be regarded as unnecessary luxuries. The youngest son or daughter will serve the food and tea or coffee out of respect to the elderly. They will most likely have their own tea or coffee pots with them in the hospital.

Guests will typically bring along dates, arabic sweets, camel milk or date filled small cakes called mammoul. The nurse will be invited to have a taste of their coffee and foods, sometimes they insist that the nurse joins them on the floor. If I have time on my hands I will sometimes join them for their dinner which they tend to eat very late. Usually long after ishaa prayers, near midnight!

I've encountered Bedouin patients that didn't know how to use the western style toilet. Some even made their business on the floor next to it. It's the first time they see a toilet seat and they don't know what to do with it.

The male Bedouins will often chew on miswak,which is a stick used to clean the teeth. Unfortunately some of them also spit on the floor after using it!

Another thing I've noticed is that Bedouins don't like to "waste" water. In other words take showers or wash their hair too often. I guess this comes from living in such harsh environments with constant lack of water. They use the water very sparingly to wash themselves, mainly it's used for performing ablutions (washing before prayer). It takes a lot of convincing or sometimes even doctors order to get them to wet themselves totally under running water!

Since they've been living all their lives in the desert, I figure their bodies have become accustomed to being warm all the time. The Bedouin patient will usually ask for the airconditioning to be turned off because they feel cold. It's actually not possible to turn it off, so then they will ask to get extra blankets even during hot summer months. The men wear thobes made out of thick wool in the winter, which for them seems to end around May when the temperature starts raising above 40. Especially in the winter months they will have layers after layers of thick clothing even though the heating is on max in the room. The women and the men like to keep their own clothing on instead of changing to hospital gowns.

When a Bedouin patient has fever he/she will be very afraid of "cooling" themselves. The more they have fever, the more the clothing and blankets will be on. Sometimes an offer of applying an icepack will result in surprises and suspicious looks. They might politely take it, but when the nurse leaves off it comes! This is sometimes a bit frustrating because the patients are convinced that warm is good cold is bad!

Bedouins love henna. Older men will sometimes color their beards with it, resulting in an orange tinged tone. Older ladies with grey hair use henna which results in the same orangy tone as the mens beards. The women will color their long naturally coal black hair with it resulting in a nice dark red tinge. Additionally they might apply decorative patterns on their hands for special occasions like Eids and weddings. The everyday henna for the hands is applied to the palms and tips of fingers so that it looks like they have very dark orange nail polish on. First time I saw this I thought to myself boy are those some dirty hands! The women will do the same with the soles of their feet and toes.

Some elderly women have tattoos on their faces sort of look like map signs. I'm not sure what they use to do them but the color is usually dark blue. It will look like small markings resembling X's or T's around her cheeks, forehead and temples. I found out this is a sign that the lady in question is of high status within her tribe. She might be the eldest woman of her tribe.

Most elderly patients will likely not know their exact age and might only be able to give you an estimate. Older generation Saudis didn't register births and they also count age according to the Hijri calendar. Also Saudi-Arabia didn't register female births until the 1970's. Estimating their age is not easy because of the harsh weather and constant exposure to sun, Bedouin often look older than their actual age. I've had very old Bedouin patients, some reaching over 100 years. They might have been healthy and never visited a hospital up to that day they come in.

Another peculiar thing which I've noticed is some of the older generation have a thin thread tied to their waists. First time I encountered one I immediately wanted to cut it off because of infection risk. They strictly refused and seemed horrified of my suggestion to remove it even though it was already harming the skin because it had become too tight. I've seen this on both men and women.
The reason for this is that they don't want to get fat so it's a weight control belt! The thread is there to remind you that you've eaten too much when the thread feels uncomfortably tight.
I wonder would this be worth patenting? The Bedouin weight loss belt!