Sexual Dysfunction among Post Stroke Patients

Stroke is the pervasive illness with the annual prevalence rate of 800,000 among individual in the United States. Stroke increases the morbidity and mortality on a high scale, but many patients also recover from the illness with the help of appropriate health care facilities (Seymour, & Wolf, 2014). The survivors experience substantial disabilities in multiple domains including biological, psychological, social and emotional areas of life, mainly, the dysfunctions in sexuality are very common among stroke survivors. The Literature suggests that three-quarters of stroke survivors encounter sexual dysfunctions and the most frequently accounted post-stroke sexual problems among female are decline in coital frequency and libido, reduced orgasmic ability and vaginal lubrication, and dysfunction of erection, ejaculation, satisfaction has been reported by men (Akinpelu, Osose, Odole, & Odunaiya, 2013). Numerous stroke survivor manifest fear of having a stroke attack again that disturb their sexual functioning and intimate relationships with their partners. Some studies signify the disturbed sexual relationship between a post-stroke patient and their spouses (Rosenbaum, Vadas, & Kalichman, 2013).

The stroke patient reported significant apprehensions and concerns regarding the sudden attack of stroke during the sex. As a result, they avoid the intimate or sexual relationship with their spouses. Like the sex, life is an imperative component of healthy life, and the gap or disturbance further leads many psychosocial and physical problems among post-stroke patient. Therefore, it is imperative to address their apprehensions and concerns in rehabilitation centres with the help of nurses and healthcare professionals. The studies indicated that the rehabilitation centres do not provide proper facilities to address the sexual problems of their patient. As a result of the patient QOF adversely affect.

The rehabilitation and proper health care services assist the patient to control their sexual problems and apprehension regarding the stork attack. The Rehabilitation usually stressed upon achieving functional independence and regaining mobility but ignored the psychological, behavioural and sexual dysfunctions that occur after stroke (Schmitz & Finkelstein 2010). The sexuality and Intimate relationships are an integral part of achieving a quality of life standard. Despite recognition about the post-stroke sexuality problems, most post-stroke rehabilitation programs ignore the need for developing a consistent and reliable way of addressing sexuality post-stroke (Nilsson, Lalos, Lindkvist, & Lalos, 2011).

Physicians rehab centres and other health-care professional's only addressed such issues when raised explicitly by the family members or spouses of the patients. They should focus on the pre and post assessment regarding post stork sexuality problems to enhance the quality of their lives. The sexual dysfunction after stroke is widespread and needs special attention of the healthcare professional specifically the nurses (NG, Sansom, Zhang,  Anatya,  & Khan, 2017). In rehabilitation centres, the role of psychologists is imperative in promoting healthy sexual life among post-stroke patients. The psychologists provide their best services to improve the quality of life of their patient following the code of ethics and code of conduct.

Significant knowledge gap has been found regarding the stroke and sexuality from the perspective of the patient in health care.

Sexuality is a vital aspect in patient health care, but the recent literature provides significant evidence that the nurses avoid addressing sexuality unless the patient asks for it. Some studies indicate that while practising sexuality-related practices the nurses reported the feeling of discomfort, and they acknowledge their responsibility to provide best services to their patients in each area of health and refer the patients to psychologists (Yilmaz, Gumus, Yilmaz, Akkurt, & Odabas, 2017). The psychologists investigate their fear associated with fear to promote a healthy lifestyle.

Over the past few decades, the epidemiological statistics signified that the incidence of strokes has been rising considerably, claiming that in 2005, 5.7 million people suffered from stork, 6.5 million prevalence was recorded in 2015; an according to an estimate the ratio expected to raise up to 7.8 million in 2030 (Yilmaz, Gumus, & Yilmaz, 2015). In the past, the stroke was more prevalent among the elderly, but in the current times, Strokes prevalence are higher among younger generations. The people age range of 55 and below found to have 13% stroke rates rise from the 1990s to 2005 (Kissela et al., 2012).

The stroke damage the overall functioning of the individual specifically the extent of the damage fluctuate according to the kind of the strokes such as ischemic, lacunars stroke, transient ischemic attacks and hemorrhagic (Kissela et al., 2015). The literature is enriching with the evidence of the stroke significantly impact the physical and psychological well being, but significant gaps have been documented regarding the impact of strokes on sexual functioning (Rosenbaum, Vadas, & Kalichman, 2013). No study comprehensively elaborates the post-stroke effect on the sexual well being of the patients and how to address such issues. The limited but available literature documented high rates of sexual dysfunction among the stroke patients of both genders, which significantly reduce the sexual satisfaction or sexual frequency and increases the psychosexual problems among patients (Rosenbaum, Vadas, & Kalichman, 2013). It is quite imperative for patients who have recovered from a stroke the need assistance in addressing the issue during the rehabilitation (Rosenbaum, Vadas, & Kalichman, 2013; Ng et al., 2017).

The literature signifies the importance of the rehabilitation process in improving the Quality of Life for post-stroke patients concerning their sexual functioning (Ng et al., 2017). Psychologists and Nurse’s plays a significant role in addressing the sexual functioning among post-stroke patients, but recent data elaborates that the nurses alone are failed to achieve the desired goals regarding the post-stroke patient’s care. Therefore the collaboration of psychologists is imperative to control the situation. The literature provides the multiple reasons for nurse’s lack of support in promoting the healthy sexual life among post-stroke patients. The lack of knowledge and comfort issue is the most significant reason reported by Nurses to avoid the patient sexual health care.

The stroke attacks affect the psychological, physical, emotional and social aspects of life, that; some descriptive investigated that the decreased sexual activity, sexual satisfaction functions are frequent after stroke. Qualitative research suggested that negative self-concept, distort body image and dependency on a spouse leads to the negative alteration in sexuality Suffren, Braun, Guimond,  & Devinsky, 2011).

The previous data highlight that sexual dysfunction as a most common disability occurs after the stroke and more studies are needed to provide the in-depth knowledge about the nature and level of sexual dysfunction that the post-stroke patient’s encounter (Seymour, & Wolf, 2014). Furthermore, literature is a lack of comprehensive studies on stroke survivors regarding their long-term intimacy and sexuality oriented experiences. The rehabilitation centre ignores the sexual therapies or treatment due to comfort and literacy issues (Bugnicourt et al., 2014). The study indicated that stoke patient feels shyness while discussing their sex-related issues with their therapist. In contrast, some other studies indicate that the health care professionals do not discuss sex life of their patient as they consider the patient must not be literate about sex education (Clarke, & Forster 2015).

 Another reason for avoiding the counselling about sex life to post-stroke patients is lack of trained professional regarding sex life. Instead of resolving the sexual dysfunctions and conflicts of the patients the healthcare professional and nurses refers their patient to the sex therapist. The multi diagnosis and referral to another therapist mystified the client. As a result, the patient avoids taking the services of the therapist (Akinpelu, Osose, Odole, & Odunaiya, 2013).  The literature does not signify the importance of rehabilitation centre focus on sexual problems of the patients. According to literature, those post-stroke patients who received the counselling regarding sexual problems reported more mental wellbeing and QOF as compared to those patients who did not receive the counselling session (Genest, Gerard, & Courtois 2017). Another study indicated that the Nurses have the great responsibility to provide their best services to patients in each domain of life, they must address all the possible issues that affect the QOF of the patients (Dobkin, 2005).

The PLISST model is widely used to overview the role of psychologists and nurses in the health care settings concerning the treatment of sexual dysfunctions after stroke. The PLISSIT model recommends a concise way for initiating the sex-related conversation into a clinical setting, reducing the scope of a patient's apprehensions and concern offering proper treatment plan through counselling. The PLISST comprised of four levels of intervention: such as permission, specific suggestions, intensive therapy and limited information (Allen &Sheftel, 2017). The model suggests that the collaboration between psychologists and nurses may probe the sexual health apprehensions of post-stroke patients through open-ended questions. After the identification of problems, the nurses and psychologists may provide associated etiological information regarding concerns and apprehensions of sexual dysfunctions. The specific suggestions for addressing sexual the problems may discuss with the patient. The psychologists and nurses also aware the patient the other possible alternative treatment options to solve their problems. In severe cases, the patent may refer to the sex therapist or sexual health specialist, pelvic floor specialist, to provide comprehensive guidance and support. 

 

Psychological Suffering in Nephrotic syndrome and Self Care

The hypothetical case study comprised of the 32-year-old woman with the imaginary name Frank. The patient was referred with a 2-week history of symptoms such as swelled legs, eyes, and the body as well. She had a history of poor diet patterns and chronic constipation without recent illnesses, fever or hematuria. The initial diagnosis revealed mild bilateral ascites, pedal edema, low hemoglobin 79 g/L, with low ferritin or iron and marked microcytosis and hypochromia (Popko, Górska, & Kuźma-Mroczkowska, 2017).

The reduced serum protein and hypoalbuminemia evaluated with triglycerides (454 mg/dL). The final diagnosis was given to her as a Nephrotic Syndrome (NS) with anemia, iron deficiency and poor diet based on laboratory and clinical findings. The patient was treated with iron, oral and intravenous methylprednisolone supplements. For the management of thromboembolism, Antiplatelet therapy with dipyridamole was instituted and furosemide & albumin used to treat the elevated worsened edema and blood pressure. The treatment and management plan was given to her for a particular time of 18 months when she was discharged to follow up monthly session. Renal biopsy was done as it is an essential aspect for the diagnosis of Nephrotic Syndrom and helps to design the management and treatment plans for patients (Souvannamethy, 2017).

The diagnosis of Nephrotics Syndrome in the early adolescent has had a dramatic emotional, behavioral psychological and physical effect on Frank. The social, occupational and personal functioning deteriorate due to the ‘'being sick'' thought (Peng, Li, Hu, Yang & Yang, 2015). Frank encountered with stressful automatic negative thoughts, as she would die soon (Nourbakhsh, & Mak, 2017).

The obsession of thought enhanced the apprehension about the recovery and treatment positive sign made her isolated from the family and society. Furthermore, he developed the symptoms of persecution as people do not have any concern regarding my health and life and it makes no difference to them if I would die (Bierzynska, & Saleem, 2017). Healthcare practitioner gave her psychological and moral support, and then she showed a little interest in self-care and managing his dialysis treatment.

The literature recommends that numerous factors impact the Quality of Life among patients, such as psychological, physical, behavioral and emotional well-being (Souvannamethy, 2017). Patient personal experience, beliefs expectations, and outcomes play a significant role in developing the positive and negative attitude towards health care system and individual self-esteem and self-concept (Schijvens et al., 2017). The unplanned hospitalization, medication, oral drug intake, formal assessment, changed dietary plan psychologically and emotionally affect the patient. As a result, they manifest behavioral and psychological dysfunctioning. 

The renal biopsy was a prolonged process that causes fear, a frustration of the patient towards the treatment process. Although the results of the renal biopsy were positive, and the patient recovered to some extent, but the more session was required for the complete recovery. The frank was prescribed by the Registered Nurse to visit the hospital regular with the strict dietary plan.

Frank reported that while taking antiplatelet therapy with dipyridamole and oral supplements to reduce the symptoms of nephrotic syndrome, she felt herself death near to her. The fear of death was affecting his self-esteem and self-concept and the self-worth as well. The literature also suggests that the patient with Nephrotic Syndrom found to have depressive symptoms and elevated mood. Some studies grounded in the results that the patients with Nephrotic syndrome manifest anxiety after the exposure with the management procedure.

According to Beanlands, et al. (2017) the quality of life of Nephrotic Syndrome patients has investigated dramatically low regarding physical, behavioral and psychological functioning. Frank also reported the itching, loss of hearing, clay color stool, and jaundice after taking furosemide dosage for the management of edema. Furthermore, she accounted for suspicious attitude towards her recovery. The psychosocial apprehension towards treatment method and the positive outcome made the patient reluctant toward health care system. The collaborative work between the patient and healthcare practitioner may bring positive result and alter the attitude towards illness.

Frank developed the negative attitude towards the treatment modalities of Nephrotic Syndrome and due to the side effects of medication and unfamiliarity with advance treatment method. As a result, he showed reluctant and non-adherent behavior for treatment and skipped the regular consultation for Nephrotic treatment. Nakata et al. (2017) elaborated that through education and healthy relationship between healthcare practitioners and patient, the adaptive functioning of the client may enhance. The patient will and support is an integral part management plan for gaining positive outcome from treatment. For the better health recovery, the patient needs to learn the necessary skill of self-care and coping strategies against stressors.

According to Korpershoek, van der Bijl, & Hafsteinsdottir, (2011) Self-care is the fundamental strategy to independently adapt with day to day stressors, improve the self-efficacy and healthy behaviors, reduce the patient's vulnerability to developing the psychological symptoms and apprehensions. Self-care comprised of multiple tasks of daily living including the personal hygiene, mobility, sitting and moving, making up, wearing clothes, eating, and bathing (Vining Radomsky, & Trombly Latham, 2008). Research shows that despite the proper treatment plan and self-care precautions of the patient, the caregiver's inadequate skills and lack of knowledge may worsen the condition of the patient (Gholamzadeh et al., 2015).

Therefore, the Nephrotic Syndrom patients report inability to manage their daily life independently when discharge and lacking caregiver support to regain former. Thus, educational interventions may empower Nephrotic patient capable of self-care and coping. Psychologists can also change the negative attitude of the patient towards condition and train them how to overcome the negative consequences of illness (Wang et al., 2017)

The self-help care that is imperative to look after by the patient after discharge is comprised of physical activity, diet control, optimistic mood and timely consultation with a doctor. Majority of the patient with Nephrotic Syndrome report such experience, the proteinuria, and hematuria increased after excessive physical activity, and prefer bed rest (Nakata et al., 2017). They need to educate that long-term bed rest is not suitable for patients with Nephrotic Syndrome. The excessive physical activity for an extended period may cause decline the recovery, but the moderate level of physical activity is positive for Nephrotic patients. The frank was also suggested to maintain the average level of physical activity by the Psychologist and Counsellor.

The appropriate diet pattern is also the fundamental aspect for the recovery of a patient. The diet pattern for Nephrotic Syndrome patients should be low fat, low salt, low protein, and high fiber diet oriented. The food directly affects the treatment of the Nephrotic syndrome. Therefore precautions in a diet are mandatory for fast recovery (Hjorten, Anwar, & Reidy, 2016). Frank was given prescribed dietary plan to follow the basic instructions.

The long-term treatment of Nephrotic Syndrome causes the irritability, pessimism, despair, and elevated mood and emotions, which directly damage the psychological physical and behavioral health of patients adversely, affect the disease. The patient encouraged developing an optimistic attitude, and expectation from recovery may enhance the likeness to recover fast. The frank was also suggested to be optimistic for her better health. As the patient of Nephrotic syndrome develop low body resistance and immunity and become more vulnerable to infections. Therefore, the patients need to consult their doctors frequently and avoid the outdoor activity in winter to escape from the oral cavity and perineal skin. The frank was advised to follow the session after discharge for better health.

Furthermore, due to the unfeasibility of Frank biopsy from a hospital, he was taught the self-needle to his fistula. He was educated to insert the long needle into the renal cortex; the buttonhole technique proved beneficial for him. As Frank was right handed he felt that he could manage this task independently.

The Psychologists honor the individuality or uniqueness of the patient, respecting their culture, choice, specific needs and social context (Iijima, Sako, & Nozu, 2017). This document demonstrates the vision for patient-centered Nephrotic Syndrom services that include education programmes to encourage people with long-term Nephrotic Syndrom patient. The psychologist evaluates the competency and compliance of the patient towards management plan and self-care practices after instructional delivery.

Although the Frank showed the adherence and compliance to the treatment process and self-care process, he is still under the nurse's care. Hopefully, she will get the full recovery if he continued his self-help care with the collaboration of the Nurses.

The code of ethics enforces some responsibility to Psychologists that the information delivery about the assessment, management diagnosis should be précised and authentic. The easy to understand terminology can bring positive consequences ad mistakes, difficult vocabulary or inaccurate information could come into question. In that respect, the psychologist should ensure that the given information is accurate or comprehensible to the patient (Papakrivopoulou et al., 2016). 

The patient suitability refers to the capability of a patient to competently regulate all the given instruction and accurately follow the self-care for the maintenance of good health (Lee et al., 2016).  As the frank was assessed to be pessimistic, depressive and apprehensive in the initial stages, therefore it was uncertain to analyses if he would follow the self-care instructions or not. Furthermore, the self-esteem and self-concept were also found to be negative; the nurses tried to develop the optimistic attitude towards recovery. The frank indicated his motivation for a healthy life, that was a pinpoint towards positive consequences.

Frank pursues the instruction after discharge, which legitimates us to progress to the next step, which was to provide a suitable learning environment and support. She was introduced to the group therapies, individual therapies, and awareness related workshops to adopt decisive and optimistic lifestyles. Frank expressed the positive behavioral, emotional, psychological and social attitudes.

    The self-care or self-management involves various challenges, including timely identification of symptoms and follow up of a comprehensive management program. Literature confirms that those patients enjoy more quality of life in term of health who can take care of their self. The self-management emphasizes the empowerment and active engagement of patients before, during and after treatment with the healthcare professionals (Galdas et al., 2015). 

Ogunbayo, Schafheutle, Cutts, & Noyce (2015) supported the benefits of patient self-management by stating that the self-management the mental and psychological well-being of the patient and promote the healthy behaviors such as eating healthily, exercising regular visit to the medical rehabilitation center. De Silver, (2015) indicated that self-management develop a sense of responsibility among patient and enhances the positive self-concept and self-esteem that promote a positive approach to deal with stressors.

The self-care or self-management of the patients provides numerous benefits to psychologist enlists the abundant advantages of patients self-care, such as if patients can identify and manage their symptoms that may help in saving the time of nursing to pay specific care to each patient. It would be also beneficial for the economic growth of health care system; there would be no need to hire maximum psychologists and health care staff  (Gulati, Sinha, Jordan, & Hari, et al. 2010). The education about self-care, dialyzes, diet plan, psychological management enables a patient to cope with the symptoms in the initial stages. It is also beneficial for the health of the community as each member of the society should be aware of necessary precautions of the diseases and help each other in the time of emergency (Pereira., Wade, Brito-Melo, Guimarães, 2014). The education of the patient about the illness does not merely help him in a recovery process.

Dorthea Orem (Simmons, 2009), believed, that people have a natural tendency for self-care and that psychologist should polish that tendency of the patients. The patient can learn the Self-care skills after getting credible and knowledgeable to provide this teaching service (Hudson and Macdonals, 2010). The preferences of the patient need, and desires by the psychologist can develop a healthy relationship between patient and psychologist. As a result, the patient develops the positive outlook towards treatment modalities.

The prolong sickness and non-adherence to treatment may alter into a compliant behavior with the optimistic approach. According to Hjorten, Anwar, & Reidy, (2016) the empathic, neutral and kind attitude regardless of gender, racial, lingual, and ethnic classification rule out the oppressions and anxieties of the patients towards health care system. Also, the easy to understand medical terminology also helps the patient overcome their fears towards diseases.

The education and proper information about the disease and treatment reduce a feeling of vulnerability and depression makes the patient courageous to deal with the illness realistically and positively (Hjorten, Anwar, & Reidy, 2016).  The health educators work in diverse settings including formal, informal lectures, group work, select, and implementation of appropriate strategies for different educational goals. The literature showed that people have the rigid attitude toward renal biopsy and the self-care management of psychological symptom associated with the illness (Ravani, Ponticelli, Siciliano, et al., 2013).  The fundamental reason for patient's non-adherence and apprehension about the biopsy was related to fear of inserting the needle or cut in the skin oriented. Tibbles et al. (2009) have proposed in their study that clinicians must consider the latest models of self-care to deliver patient-centered service and promote hemodialysis.

Frank was given a self-care management plan, and he effectively follows up the education program instruction and knowledge. The complete compliance to medical treatment enables to Frank to access his buttonhole fistula, and perform dialysis treatment by inserting a long needle into the renal cortex. The frank has undergone the depression and anxiety due to the prolong disease duration and relapses in disease with the medication and follow up session. The psychologist and the educational program helped him to cope with stressor and building tolerance level for recovery. 

His attitude towards disease and treatment has altered dramatically, he is showing compliant, and adherent to all instruction related to following up session. The positive outlook towards treatment and self-management improved his social, occupational and personal functioning.

Although the self-management is very common in contemporary health care system, the actual implementation of the educational program by keeping in mind all the code of ethics and code of conduct is significant for the improvement of the patients. The patient-center approach is very much useful that only prefers the patient, wants, need, desire while implementing treatment modalities, and overcome all the related apprehension (Zhang, Wang, Liu, Zhong, Yao, & Xiao, 2017). The all above target may achieve only with the help of psychologists, their knowledge, experience, and ethical responsibility may evoke the significant positive change in the attitude of the patient. As mentioned by De Silver, (2011) the positive outlook of a patient towards illness develop the optimistic approach towards recovery and the patient productive take part in the management process.

 

Etiology and Intervention Modalities for Drug Epidemic

    The Drug Epidemic is a pervasive and enduring issue that has gained worldwide attention in the American society. In addition, the problem has reached to its zenith in the current time and known as a drug epidemic (Volkow, 2014). According to an approximation, in the U.S due to drug overdose or misuse, almost 170 citizens die every single day. Predominantly Opioid overdose is significantly widely used the drug in the United States as compared to other drugs. According to Hawk, Vaca, & D’Onofrio, (2015) in the recent 25 years, the Opioid use in the U.S has improved from 75 million to 208 million until 2013. 

Women Status in Barahvi Culture and its Psychological Impact

Pakistan has been divided into five provinces, Punjab, Sindh, Srahad, Khyber Pakhtoon, Baluchistan and each province keep a unique cultural diversity and ethnic composition. Among all the five provinces Baluchistan is significant as it covered the 347,190 kilometers southern part of Pakistan and considered a backward area as well. The population of Baluchi people has been reported 12.34 million and 2.2 million people belong to Barahvi ethnic group (Ahmad & Khan, 2017). Baluchistan relocates the people belongs to a multicultural background, and they speak different languages (Ahmad & Khan, 2017). Numerous tribes make up the population of the Baluchistan, and three significant tribes are known as, Baluch Pashtoon and Barahvi.

The most common languages of Baluchistan are Baluchi, Urdu, Pashtu, and Brahui. Brahui is Dravidian language usually spoken in the central Afghanistan and Baluchistan. The Ethnology Report (2013) stated that 4.2 million people speak Barahui throughout the world, and 4 million lives in Pakistan, particularly in Baluchistan. According to Uneso Report (2007), the Brahui language is one of 27 languages of Pakistan who is facing an adverse danger of extinction (Naseer, & Gul Khan 2010). Baluchistan cultural land escape portrays the diverse ethnic composition, social and cultural groups ( Janmahmad 1989).

 Although the multi-ethnic composition of Baluchistan depicts the diversities in linguistic, and sects oriented aspects, on the other hand, similarities in, belief, religion, and literature kept them united and maintained the social order in the land escape of Baluchistan (Jahani, & Carina et al., (2003). The fundamental characteristics of Barahvi culture are their ritual, hospitality, traditions, and living standards. In particular, Barahvi culture is prominent due to the hospitality and open-heartedness of its inhabitants. Guest is considered as a blessing of God, and their accord is held and celebrated in high esteem (Jelty, & Rajsheer, 2004).

Some people who belong to high socioeconomic status slaughters animals specifically sheep's and cow to serve their guest with the belief that people would descend their blessing upon them. Furthermore, the Brahui people respect the guests of their tribe as their family members, i.e., the guest of one house considered as a guest of the whole village. The women had to take care of all the arrangements to entertain the guest regardless of their mental or physical health. The Barahvi culture depicts the honesty and open-heartedness and purity of people in a very alluring way that is hard to find in the other modern civilized culture. In contrast, the place of Women is not up to the mark; women treated very brutally like machines or slaves in this culture due to their fragile structure.

The modern men are mechanical in advance areas of Pakistan, they do not have time for hospitality, and their social life has limited to their blood relation circle. Nobody knows what is happening in the next door, or the participation in the neighborhood function has become so formal and superficial. 

The status of Women has been a topic of debate for many researchers due to the so-called rituals. The women had been a victim of old tradition throughout the history, which suggested that the low self-esteem, negative self-concept, and emotional problems ratio has been high among them. The marriages are solemnized similarly as in other culture in religious connect, e.g., in the presence of the witness and Molvi (Baluch, & Khan, 1958). The love marriage concept is forbidden and purely love marriages considered secular. Like Baluchistan, the Barahvi tribe also follow the marriage ritual of ‘'Valver'' in which the groom had to pay some money to the parents of the bridal. Currently, some studies suggest that the Valver ritual is decreasing gradually, after several adverse social incidents (Dames, & Longworth, 1891). The ritual of Valver adversely affected the mental status of women, and they consider themselves nothing more than the slaves. When a female born she was taught to obey their husband like a slave, the equality and the status that Islam has assigned to women has no importance in Brahvi culture. The females have accepted that fact and feel like the slave as a normal part of life. They do not raise their voices in response to cruelty or injustice.

The Baravi people express high pride and esteem after a boy baby birth while they still exhibit lamenting reaction for female childbirth (Baloch,  & Marri,1974). The firing gunshots in the air celebrate the celebration of male childbirth. The female child feels rejected and manifests psychological disturbance, but on the other hand, studies reported that the Barhvi females and child indicated the high level of acceptance for their place. According to Literature the consistent exposure to trauma decrease the intensity of grief and people start considering the situation as a normal part of life (Marī, 1973). There are other unique aspects of barahvi culture that distinguishes it from other cultures such as their dressing sense, belief system regarding education, religious inclination, profession, economic status and judicial systems (Marī, 1973).

Does all the traditions and rituals are still the same in the 21st century or they celebrate the male and female childbirth similarly? If the valver ritual has weakened, or still commemorate currently in Brahvi. The hospitality of Brahvi culture is still the same as it has been described in the literature or they have developed some latest trends in the 21st century. These all aspects are imperative to investigate to promote the Women Status to update the Nation about Brahvi culture.