Ramadan began this past Sunday, May 5, which means our Muslim patients and providers will be fasting from sunrise to sunset for the next month. Islam is currently the 3rd most common religion in the United States, with 3-4 million members, and the NAFC serves 20 Muslim clinics. Ahead of Ramadan, Dr. Yosef Khan, National Director for Healthcare Quality Research and Bioinformatics with the National Heart Association, led a webinar for NAFC members about culturally competent care of Muslim patients on behalf of the Islamic Medical Association of North America (IMANA).

Having an understanding of Islam helps providers to better understand Muslim patients’ beliefs and solve practical considerations for care. “Cultural competence” is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.

“Islam is a way of life that really aims to maintain human dignity in all practices, and most importantly it aims to preserve life at all costs,” said Dr. Khan. He added that in his experience, many patients gravitate towards their faith during a hospital stay or illness.

Dr. Khan provided a variety of important guidelines, ranging from not walking in front of someone who is praying because it could invalidate the prayer, to attitudes in Islam towards death and dying. Here, we explain 3 big concepts to understand when caring for Muslim patients as the holy month begins and beyond it: Ramadan, dietary restrictions, and modesty.

Ramadan

Ramadan is a holy month that requires fasting from sunup to sundown, meaning nothing of nutritional value can enter the body, including water. Because of how the Muslim calendar works, the timing of Ramadan shifts over the years. This year, it falls in May as days grow longer. As a result, fasting can last 15-17 hours in some parts of the US. This makes fasting particularly trying. Dr. Khan gave a reminder to practice empathy and patience with Muslim coworkers and patients who may be more tired or irritable due to hunger. Islam makes exception for sick people, travelers, pregnant and menstruating women, and children (typically children start fasting around age 10). These people do not need to fast.

Ramadan has several implications to patients’ healthcare. Medication timings may need to be adjusted. Diabetic patients with insulin pumps will need adjustments. Nicotine patches and other aids like it are also not allowed. Vaccinations, blood transfusions, and other injections are allowed. However, a glucose IV would not be, due to its nutritional value. Dr. Khan reiterated that a patient can break fast if it is necessary to their health, and that open conversation is important during this time.

Dietary Restrictions

Eating pork is always forbidden in Islam.  Many antibiotics come in gel capsules, which are made of pig-based gelatin. Some patients will not feel comfortable consuming it because of that. Dr. Khan said that alternatives should be used if possible, and one option is for a patient to crack open the capsule and only consume its contents, which prevents time release but does allow consumption of the medication. However, if there is no alternative to a necessary medication, consumption is allowed. Muslims believe that the body is a gift from God and must be maintained. Preserving life is a very important goal. Dr. Khan said providers should encourage patients to consult with their spiritual advisor and discuss with their faith community if they are concerned about or resistant to a necessary treatment.
Modesty

In Islam, physical contact between genders (non-married people and non-family members) is discouraged. Dr. Khan explained that one way to be sensitive to this is not to extend a hand out first to shake hands and force contact.  While not required, some patients will feel more comfortable with a provider of the same gender, or, if that isn’t possible, having a member of the same gender in the room with them during the exam. Additionally, if a woman’s face is covered and the covering must be removed to verify identity, this should be done in private without men present.

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Overall, Dr. Khan explained that starting a conversation about faith with patients is important to providing the highest quality of care for them and improving outcomes. He suggested either asking about religion on a patient intake form or simply asking a patient in introductory conversation, starting by asking if they have a religious preference, and following up with, “Is there anything that I need to know as a clinician that you want to tell me about your faith related to your healthcare?”

The Islamic Medical Association of North America (IMANA) has further resources on providing culturally competent care for Muslim patients.