|Providing Culturally Sensitive
Healthcare to Muslims
May 1, 2008
The world population is made up of over a billion followers of Islam, which is not just a religion, but also a way of life. Islam emphasizes health with importance and respect, as health is viewed in physical, psychological, and social aspects. As members of the Muslim community, especially those in urban centers, turn further away from the traditional folk medicinal practices, the need for culturally sensitive care that is both competent and comprehensive is more prevalent than ever before. The world in which we live in today is one that is becoming increasingly globalized through travel, immigration, and the spread of ideas through business and the media.
The medical practices that we are accustomed to in the West, such as same sex care, often violate some of Islam’s cultural values and norms. Many Muslims are not receiving proper health care because of the lack of knowledge in the medical field concerning Islam and even the Arabic language, which is a problem that could be solved with some basic education of Muslim cultural values and mores as prescribed to them by the Prophet Muhammad and the Five Pillars by which Muslims live their life. Arab women especially have some unique concerns regarding their health and well being due to the multiple and sometimes conflicting roles that their culture requires of them. Diabetics need medical advice so as to avoid complications while fasting for Ramadan. Even death and dying is dealt with on a different level than the way we know, with Muslim family members often described as unusually accepting of the passing of life. It is important that the Muslim culture is supported in the medical community because “to be able to perform an accurate assessment and provide competent and sensitive care, the nurse must incorporate the patient’s religious and spiritual beliefs, as well as cultural mores” (Serour, 3).
The faith of Islam, which literally means to submit (to God), began in 610 A.D. when the Prophet Muhammad began having revelations believed to have come from the angel Gabriel, which were then recorded in the Qur’an (Denny, 3). The Qur’an is the Muslim holy book that “provides guidelines for human conduct at all times”, and “concentrates on the belief in one god” referred to as “Allah”, while emphasizing the importance of the “relationship between Allah and human beings” (Serour, 2). Islam is a religion of law that doesn’t recognize distinctions between religious and secular issues, making this faith one that consumes all aspects of a Muslim’s life through the Five Pillars of Islam. The pillars require various actions of Muslims, such as five daily prayers that include prostrations and the facing towards Mecca, fasting during the holy month of Ramadan, and a pilgrimage to Mecca, though these are required of all Muslims only to the extent of which one’s health allows.
This Muslim way of life has spread far across the globe through the travel and immigration of the world’s 1.5 billion followers (Mahmood, 295). The world’s largest Muslim concentrations are in places such as Saudi Arabia which is home to almost 23 million followers, making the nation’s population almost 93% Muslim (World’s, 719). Turkey’s population is 97% Muslim, and is home to just over 71 million followers of Islam, while 85% of Egypt practices Islam with almost 63 million Muslims (World’s, 719). Although the Middle East and Africa hold the majority of the world’s Muslim populations in various densities, 500 million of these followers live as “minorities in non-Muslim societies”(Mahmood, 295), such as China, whose Muslim population only makes up about 1.5% of the country’s population overall, and is comprised of almost 20 million followers of the Prophet Muhammad (World’s, 719). Even the United States is home to 2.35 million Muslims, of which two-thirds are adults that were born overseas (World’s, 719).
The spread of Islam began almost instantly after the Prophet’s first revelations. Armies of men spread the words of God as given to the Prophet through Arab conquests that “were not primarily religious, but economic and political, enabling the newly united Arab tribes to continue their momentum as a politically and economically feasible community” (Denny, 37). Another contributor was “the Hijra or ‘emigration’ of Muhammad and his followers from Mecca to Medina”, beginning in 622 (Denny, 3). Today the spread continues as Muslims from across the globe are emigrating far away from their homelands whether they are in search for political stability, or are forced from their native lands as refugees in war torn countries, or are just in search for a new place to live with a chance to further their education and advance their livelihood.
As Islam is considered in terms of a religion and a way of life, the faith places a cultural influence on the importance of health in everyday life, with the practice having been described as “deeply rooted in the well-being of the person’s mind, body, and soul” (Gulam, 2). Guidelines for a happy and healthy life in both spiritual and physical aspects come from the teachings of the Prophet Muhammad, as so laid out in the Qur’an. The Muslim holy book forbids alcohol, which is a major factor in the risk for high blood pressure, heart disease, and of course, alcoholism (Gulam, 2). The Qur’an also places importance on cleanliness and purity, which helps in the fight against the spread of disease and illness. The first of the Five Pillars that requires daily prayer and meditation acts as a regulator of spiritual and mental health, obligating a person to take a short break five times a day to reflect on different aspects of Allah and life. The culture as a whole values the importance of social networks for psychological help, whether these networks are comprised of close relatives or of friends and neighbors of whom they can turn to in good times and bad.
The Prophet has been quoted saying that “for every disease, God created a cure” (Abuoleish), and for this reason, Muslims emphasize the importance of quality health care and the treatment of any ailment that stands in the way of living the life that the Qur’an prescribes. Unfortunately, there are Muslims all over the world that face challenges in receiving proper health care that is both efficient and more importantly, culturally sensitive. A major concern in for Arab Muslims is the problem of trying to receive medical help from a practitioner that is also Arab speaking, especially if they are one of the two thirds of the foreign born Muslims in the United States.
This language barrier often results in misdiagnosis because patients are either misunderstood or patients misunderstand the practitioner’s further inquiry, which often leads to questions being answered incorrectly, resulting in misdiagnosis and poor health care. Another problem that comes with improper translation between patients and practitioners is that of poor understanding of treatments due to poor education of health and proper health care of the general public. A substantial issue in misunderstanding of treatments is when medicines are taken incorrectly, as the use of contraceptives, as discussed by anthropologist and author Erika Friedl in her ethnography about life in the Iranian village of Deh Koh. The problem with women using birth control pills was that it was common for women to think that they only needed to take the pill when they were going to engage in sexual activity. Women in the village also expressed concerns of taking an unnatural substance such as a pill, providing a horror story of a woman whose birth control pills supposedly collected and formed a mass in her stomach.
Arab women in general have a variety of overall health concerns in all aspects ranging from psychological to physical help. One of the most prevalent concerns of Arab women is that of early marriage. At a young age, sometimes before the age of even twenty years, young women are not only expected to maintain a household for their husbands, but they are also expected to bear children. As if the burden of raising children while being so young does not provide a sufficient amount of stressors in these young women’s mental health, but they are also having children frequently, almost one right after the other, especially if a couple has not bore a son yet, which is a major factor in “physical and psychological exhaustion” (Winslow, 293). The use of contraceptives have been gaining popularity, though great concentrations of Muslims live in parts of the world where it is a cultural norm and tradition to have numerous children.
In a culture where marriages are commonly arranged by the families of these young women, it is not uncommon to marry within the family, often times to first or second cousins. The issue with consanguineous marriage is the risk of hereditary diseases such as mental retardation that is associated with reproducing within close blood lines (Winslow, 295). In the West as we know it, the common solution would be to simply not marry within close bloodlines, though Arab women run into the problem of it being “difficult to disregard social norms and parental expectations” (Winslow, 295).
Another common concern for their mental health is that there are multiple roles which they are obligated to fulfill in their everyday lives. It is becoming increasingly common for these women to work outside of the house, though they are still expected to do the same amount of housework, such as the shopping, cooking, cleaning, and child rearing. Fortunately, some of this psychological burden is lifted with the help of social networks, those being either close relatives or good friends and neighbors who will offer help with children or running errands, as discussed in Homa Hoodfar’s ethnography titled “Between Marriage and the Market”, a story of life in Cairo. Adding to the burden of marriage is the stigma of divorce, a topic also discussed in “Marriage and the Market”. If for some reason the marriage is beyond repair and becomes unbearable, it is generally considered culturally unacceptable to for a woman to divorce her husband. Also adding to stress of being an outcast in the community is the financial burden that a woman would have to deal with to go along with her pre-existing duties of household chores and child rearing.
In addition to the physical health that Muslims emphasize and work so hard to maintain, there has been an increased importance on mental health as well, though receiving psychological help for many Muslims, namely Arabs Muslims in particular, has proven difficult. Receiving overall professional medical advice has been complicated for Muslims, more commonly in settings where they stand as minorities. “Certain aspects of the care of the Muslim patient may present challenges to health care professionals if they are unaware of their significance” (Gulam, 2). These problems are more prevalent in Western nations, where the Arabic language is one of minority, though Middle Eastern Muslims have expressed the same concerns of their own health care systems. The problems in the health care system mentioned previously, regarding language barriers and cultural insensitivity may not be so obvious to a Western practitioner, though unfortunately these problems have surfaced in a time that more people than ever before are seeking professional medical help.
A simple solution to the language barrier is that of translators, whose availability has become more widespread, thanks to certain factors such as immigration. This spread of people and ideas, more specifically culture, which has brought numerous medical practitioners to western nations to share their knowledge of the medical field, as well as an understanding of a language that is very foreign to any dominant English speaking institution. More difficult than the problem of the language barrier to solve, is the problem of the lack of culturally sensitive care for Muslims, because Western practices are not always conscious or consistent with Islamic cultural integrities.
For instance, here in America, whether a person be male or female, and unless there is a prior request, patients are commonly treated my doctors of the opposite sex. It is an important code of ethics to Muslims that if they should be treated by the opposite sex, that the practitioner should avoid unnecessary touch, as this is a cultural expectation for all non-related people of the opposite sex. It is also very important that female patients receive proper privacy, such as never sharing a hospital room with another male of whom they are not related to (Winslow, 297).
General caring for the Muslim patient can be made less difficult if the Qur’an and the Five Pillars that it prescribes are taken into consideration, as they hold great significance in the everyday life of a Muslim. As earlier mentioned, the Qur’an also calls for cleanliness and purity, and the left hand is considered to be unclean, so practitioners and other medical staff should avoid administering medications or food with their left hand. Also considered unclean are pigs, and any food that has been made from pig meat or pig products are considered haram, or forbidden (Gulam, 2). Prayer traditions are also an important aspect in the care for anyone of such a devout religious practice. The first of the Five Pillars requires that Muslims pray at a certain time five times a day while facing Mecca and engaging in an array of prostrations. It is customary for Muslims to have their own sacred prayer mat, though a clean sheet or towel set aside on the floor will suffice (Halligan, 1568). If the patient is not well enough to engage physically in their prayer, it is considered respectful and courteous to face their hospital bed in the general direction of Mecca, if at all possible.
Fasting is another major requirement prescribed by the Pillars, and is one that health care practitioners often times find themselves struggling to get patients through. Muslims are required to fast throughout the month of Ramadan, which begins in mid-September (Barnett, 44). The fasting lasts throughout every day from sunrise until sunset, sometimes creating problems for those with certain health conditions. For instance, a person that is diabetic and regularly takes prescribed medications at certain times of the day can run into problems during Ramadan if their medications require food to be taken with them. The health risks associated with the lack of food on certain medications can be prevented by practitioners changing doses, or changing the times of day in which the medication is received (Barnett, 44).
Dehydration is a common ailment experienced while fasting not only among Muslim diabetics, but the fasting population overall (Barnett, 44). Part of the fasting obligations includes the ingestion of any liquids, including water between the hours of sunrise and sunset. Dehydration can be avoided if a large fluid intake is taken advantage of during the dark hours. Other health risks associated with fasting while managing diabetes is that of heightened blood glucose levels known as hyperglycemia, which can occur when a person eats more than would be expected (Barnett, 44), such as trying to get half a day’s worth of eating in before sunrise. If these hyperglycemic episodes are not managed properly, the patient then runs the risk of ketoacidosis, which is a diabetic coma that can happen when the body cannot produce enough insulin to fuel itself with energy (Barnett, 44)
Diabetes patients receive complementary advice from both the medical and religious communities that simply don’t recommend fasting during Ramadan (Barnett, 44). The Qur’an itself rules that fasting is not obligatory if it is a health risk (Gulam, 2). While other ill people have the option of participating in the fast at a later day, which is an option that is widely accepted by the Qur’an and Muslim community, followers of Islam take pride in living life by the way of the prophet, and would rather due their duties as Muslims and participate in the holy month of Ramadan (Barnett, 44).
As there are numerous concerns in patient care regarding health and sickness, there are also cultural expectations of death and dying. It is Islamic custom to face a body towards Mecca once it becomes unconscious, and the family will expectedly be close by reciting from the Qur’an and praying over the patient (Gulam, 3). If a patient should die, the face must also be turned towards Mecca, with a sheet covering the entirety of the body. As with same-sex expectations in live patient care, it is also expected that only a person of the same sex may be able to handle the body of the deceased (Gulam, 3). The grieving responses from Muslim families may seem “inappropriately calm” compared to Western standards. The grieving period allowed in Islam is typically three days, and then the family is expected to go on with life. In both ethnographies of “The Children of Deh Koh” and “Three Mothers, Three Daughters”, the cultural norm was to repeat a phrase meaning “God willing”, the idea of moving on is that of which everything happens according to Allah, and so should be accepted.
From the beginning of life to the very end, Muslims place great importance on the interaction of their health and faith. It is important that Islam is respected in the medical community because it is a religion that encompasses all aspects of life, which is an art that should be highly respected. It is the duty of any health institution that claims to be culturally accepting and aware “…to develop competencies to care appropriately” for the Muslim patient (Winslow, 287).
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