3/8/17 Timothy Myrick MD, DTMH University of Missouri Kansas City Family and Community Medicine Nothing to Disclose History There is a long history of Christian medical outreach to Muslims 1889 Dutch Reformed Church set up the “Arabian Mission” serving in Basra, Iraq, and later in Bahrain and Saudi Arabia Numerous Christian hospitals served Muslims in the Arabian peninsula until the present With around 1.7billion Muslims in the world, healthcare providers anywhere are likely to care for Muslim patients. 1
3/8/17 Outreach to Muslims Muslims will come to Christian hospitals They trust Christians to tell them the truth They trust Christians to provide quality care Many know of Jesus’ healing miracles Religious distinctives Muslims believe that God is one, and that Muhammad is God’s prophet Islam is an all-encompassing system stressing submission to Allah, and peace with other believers Through the Hadith and Sharia, Islam provides a framework for personal and corporate religion, family, social structures, political life, health, finance, philosophy, and a way of thinking about science The Pillars Shahada- The Testimony Salat- Prayer Zakat- Gifts to the Poor Sawm- Fasting Hadj- Pilgrimage 2
3/8/17 Health beliefs In illness, Muslims ought to: Be patient Seek Allah’s help in prayer Increase “remembrance” of Allah Increase giving to charity Read or listen to Qur’an ispi-usa.org "Guidelines for Health Care Providers Interacting with Muslim Patients and their Families” Fatalism February 2004 stampede killed at least 244 hajji s in Mina, near Mecca, Saudi hajj minister Iyad Madani responded: "All precautions were taken to prevent such an incident, but this is God's will.” A building crane fell into Mecca's Grand Mosque Sep. 11, 2015, killing 114 and injuring 394, the mosque's Imam Abdul Rahman Al Sudais visited the injured and, as he met each one, told them, "This is God's will.” meforum.org "Are Muslims Fatalists?" Fatalism Allows many Muslims to peacefully accept illness or death Allows avoidance of responsibility for unwanted outcomes for a family member May promote inertia regarding health care that leads to worsening of outcomes 3
3/8/17 Death Muslims accept death as a “transformation from one life to another” They live in “hope and fear” under the prospects of being questioned by angels, weighed in a scale, and walking a razor-thin bridge over hell Muslims fear death, but are not angered by it ispi-usa.org Islam and medical issues Abortion “not advised” with exceptions Mother’s life at risk Medical or fetal indications in early pregnancy Some believe soul enters body at 20 weeks An elder whispers Islamic prayer call into the baby’s right ear soon after birth Circumcision of boys is universally practiced Blood transfusions are allowed Medical issues Artificial reproductive technology is permitted only within heterosexual marriage Organ transplantation is allowed Porcine grafts, and products derived from porcine sources like heparin are controversial Alcohol and drugs of abuse are not permitted, but are often problematic Alcohol in cough syrup is generally accepted 4
3/8/17 Medical Issues Genetic engineering is acceptable to cure disease, but human cloning is prohibited Muslim physicians are permitted to care for patients with HIV or other sexually transmitted infections Euthanasia and assisted suicide are prohibited Prolonged life support in a “vegetative state” is not encouraged Autopsy is not encouraged, but permissible when a legal requirement Ramadhan Goal is purification, amplification of good deeds, and forgiveness Dawn to dusk denial of food, drink, cigarettes, sex, and certain medications Invalidated by menstruation, leading to an extra week of fasting for women Pregnant women, travelers, and soldiers exempt if “imminent danger of harm” Fasting Cycle of fasting in day and feasting at night via fitour after sundown and sahour before sunrise Severe dehydration during summer work Calorie intake may double Sleep deprivation Increased family pressures and stress 5
3/8/17 Fasting Terrible traffic, and increase in thievery Change in medication schedule and diet leads to loss of control of blood sugar and blood pressure and exacerbations of asthma and COPD GI and mood disturbances common Hajj World’s largest gathering with 2-3 million Public health issues Cholera epidemics in past Meningococcal outbreaks in 2000, 2001 New latent TB cases in 10% in 2005 Crowding to 6-7 people/sqm Lingappa, J.R., et al., Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis, 2003. 9(6): p. 665-71 Wilder-Smith A, Foo W, Earnest A, Paton NI. High risk of Mycobacterium tuberculosis infection during the Hajj pilgrimage. Trop Med Int Health 2005; 10: 336-339. Hajj These sites are very crowded, and pilgrims move slowly in tight masses in rituals that take hours to complete. Physical exhaustion, heat, over-crowding, and sleep deprivation tax the health of most pilgrims. Many of them are middle-aged and elderly people with co-morbid conditions that make them susceptible to infections. Al-Orainey, I.O, Tuberculosis infection during Hajj pilgrimage. Saudi Med J 2013; Vol. 34 (7): 676-680 6
3/8/17 Hajj Incidents July 2, 1990: Stampede inside a pedestrian tunnel led to 1,426 deaths April 15, 1997: 343 pilgrims were killed and 1,500 injured in a tent fire September 11, 2015 A crane fell in the grand mosque ten days before Hajj. 118 people died and 394 were injured. September 24, 2015: At least 2,236 pilgrims were killed during a stampede Hajj preparation Vaccination: Hepatitis A and B, Typhoid, Polio, Influenza, Meningococcal A/C/Y/W-135 >10dy and <3yr before arrival. Diarrhea prevention, oral rehydration strategies, antimotility agents, and emergency antibiotics Skin care to prevent chafing, blistering, and especially injuries from walking barefoot Clean razors for head shaving at end of Hajj Bottled water for nasal ablution to avoid Naegleria Saudi Arabia: Hajj Pilgrimage- Chapter 4- 2016 Yellow Book Hajj preperation More than 50% of Hadjis are coughing. Pneumonia is the commonest cause of hospitalization, and TB isolated in 5-6% of pneumonia patients. Hormonal suppression of menstruation Preparation for diabetes and blood pressure control Al-Orainey, I.O, Tuberculosis infection during Hajj pilgrimage. Saudi Med J 2013; Vol. 34 (7): 676-680 7
3/8/17 Principles of Caring Respect modesty and privacy Limit eye contact. Do not touch while talking. Islam does not ban treatment by the opposite sex. Providing the patient with a nurse and/or physician of the same sex when possible is recommended, Principles of Caring Take time to explain tests, procedures and treatments to the patient and appropriate family members. For domestic violence toward Muslim patients, you may contact Hamdard (630/860-9122) or Apna Ghar (773/334-0173) in the Chicago Metropolitan area. They provide specialized shelter and counseling for Muslim victims. It is an Islamic cultural and religious practice to visit the sick. Be open and understanding of visits by family members and well wishers when practical. ispi-usa.org Christian Ministry Carry the healing ministry of Christ-John 6:2 “and a great crowd of people followed him because they saw the signs he had performed by healing the sick” Dedication to truth and quality- Ephesians 4:15 “Instead, speaking the truth in love, we will grow to become in every respect the mature body of Him who is the head, that is, Christ.” 8
3/8/17 Christian Ministry Trustworthiness- 1 Tim 2:12 “I thank Christ Jesus our Lord, who has given me strength, that he considered me trustworthy, appointing me to his service.” And Luke 19:17 “‘Well done, my good servant!’ his master replied. ‘Because you have been trustworthy in a very small matter, take charge of ten cities.’ Genuine affection- 2 Cor 5:14 “Christ’s love compels us because we are convinced that one died for all, and therefore all died.” Christian Ministry Compulsion to pray for the patient- James 5:15 “The prayer offered in faith will make the sick person well” Opportunity to represent Jesus- 2 Cor 5:20 “We are therefore Christ’s ambassadors, as if God were making His appeal through us. We implore you on Christ’s behalf: Be reconciled to God.” 9
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