Nothing to Disclose History There is a long history of - - PDF document

3/8/17 1

Timothy Myrick MD, DTMH University of Missouri Kansas City Family and Community Medicine

– Nothing to Disclose –

™ 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.

History

3/8/17 2

–

™ 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

Outreach to Muslims –

™ 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

Religious distinctives –

™ Shahada- The Testimony ™ Salat- Prayer ™ Zakat- Gifts to the Poor ™ Sawm- Fasting ™ Hadj- Pilgrimage

The Pillars

3/8/17 3

–

™ 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

Health beliefs

ispi-usa.org "Guidelines for Health Care Providers Interacting with Muslim Patients and their Families”

–

™ February 2004 stampede killed at least 244 hajjis 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.”

Fatalism

meforum.org "Are Muslims Fatalists?"

–

™ Allows many Muslims to peacefully accept illness or death ™ Allows avoidance of responsibility for unwanted

• utcomes for a family member

™ May promote inertia regarding health care that leads to worsening of outcomes

Fatalism

3/8/17 4

–

™ 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

Death

ispi-usa.org

–

™ 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

Islam and 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

Medical issues

3/8/17 5

–

™ 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

Medical Issues –

™ 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”

Ramadhan –

™ 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

Fasting

3/8/17 6

–

™ Terrible traffic, and increase in thievery ™ Change in medication schedule and diet leads to loss

• f control of blood sugar and blood pressure and

exacerbations of asthma and COPD ™ GI and mood disturbances common

Fasting –

™ 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

Hajj

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.

–

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.

Hajj

Al-Orainey, I.O,Tuberculosis infection during Hajj pilgrimage. Saudi Med J 2013; Vol. 34 (7): 676-680

3/8/17 7

–

™ 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 Incidents –

™ 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

Hajj preparation

Saudi Arabia: Hajj Pilgrimage- Chapter 4- 2016 Yellow Book

–

™ 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

Hajj preperation

Al-Orainey, I.O,Tuberculosis infection during Hajj pilgrimage. Saudi Med J 2013; Vol. 34 (7): 676-680

3/8/17 8

–

™ 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

• f 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.

Principles of Caring

ispi-usa.org

–

™ 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.”

Christian Ministry

3/8/17 9

–

™ 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.”

Christian Ministry