Mak­ing room for faith

Hos­pi­tals work­ing to bet­ter serve Mus­lim pa­tients

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Sel­vam

Khlood Sal­man be­came a strong ad­vo­cate for bet­ter health­care for Mus­lims in the U.S. af­ter find­ing out shortly af­ter grad­u­at­ing from nurs­ing school that three of her young Mus­lim friends had breast can­cer.

In her na­tive Iraq, there is lit­tle fo­cus on preven­tive screen­ing, and women have scant aware­ness of the need for screen­ing. Plus, it was cul­tur­ally chal­leng­ing for U.S. health­care providers to talk with Mus­lim women about tests for breast and cer­vi­cal can­cer. Such tests are con­sid­ered sen­si­tive in a cul­ture that shields women’s bod­ies from dis­play or ex­am­i­na­tion.

Sal­man, a de­vout Mus­lim who now teaches nurs­ing at Duquesne Univer­sity in Pitts­burgh, vowed to ad­dress the is­sue. She wants hos­pi­tals to work more closely with mosques and Is­lamic com­mu­nity groups to reach out to Mus­lims so they’re more aware of the im­por­tance of preven­tive care. “I be­lieve in God, in Al­lah,” she says. “Al­though this is their faith, I said to my­self, ‘They did not know any­thing about how to take care of their breasts,’ and I talked with th­ese peo­ple and thought, how do we do this, where do we go from here?”

Her wishes are com­ing true. U.S. health­care providers in­creas­ingly are fo­cus­ing on how to bet­ter serve the na­tion’s grow­ing Mus­lim pop­u­la­tion, a sig­nif­i­cant per­cent­age of which fol­lows re­li­gious rules that can pose chal­lenges in health­care set­tings.

Ac­com­mo­dat­ing Mus­lim pa­tients is par­tic­u­larly a con­cern for providers in com­mu­ni­ties with greater con­cen­tra­tions of Mus­lims, such as ar­eas in and around Chicago, Detroit, Hous­ton, Los An­ge­les and New York City. Sys­tem lead­ers see a fi­nan­cial op­por­tu­nity in be­com­ing known as cul­tur­ally sen­si­tive, high-qual­ity providers for the Mus­lim com­mu­nity. That’s be­cause the U.S. Mus­lim pop­u­la­tion had swollen to 2.6 mil­lion by 2010, up 53% from 1.7 mil­lion in 2000, ac­cord­ing to a re­port from the Pew Re­search Cen­ter. The num­ber is pro­jected to in­crease to 4.2 mil­lion in 2020 and 6.2 mil­lion in 2030.

Hos­pi­tals in­creas­ingly are serv­ing food that meets Mus­lim di­etary rules, par­tic­u­larly no pork prod­ucts. They’re of­fer­ing Mus­lim pa­tients al­ter­na­tives to med­i­ca­tions that con­tain al­co­hol or pork-de­rived gelatin. They’re im­ple­ment­ing sen­si­tiv­ity train­ing to bet­ter ed­u­cate work­ers about tra­di­tions and cus­toms. Ad­dress­ing Mus­lim rules for fe­male mod­esty is also part of the train­ing. Of­fer­ing mod­esty gowns is a sign of cul­tural sen­si­tiv­ity. Th­ese gowns are longer than nor­mal gowns, ex­tend­ing to the an­kle, with snaps in­stead of ties in the back.

One ex­am­ple of the chal­lenge of ac­com­mo­dat­ing Mus­lim pa­tients’ re­li­gious prac­tices comes dur­ing the month-long hol­i­day Ra­madan, which re­quires fast­ing from dawn to sun­set. That could be prob­lem­atic for di­a­bet­ics if they can’t take in­sulin dur­ing the day. Ed­u­cat­ing care­givers about Mus­lim prac­tices en­cour­ages clin­i­cians to de­velop treat­ment plans that al­low the pa­tients to ob­serve the hol­i­day. Dur­ing Ra­madan, which ends Aug. 7 this year, hos­pi­tals are sched­ul­ing more early morn­ing or night ap­point­ments to ac­com­mo­date pa­tients.

But hos­pi­tals can’t make as­sump­tions about what all Mus­lim pa­tients and fam­i­lies want. So they’re hir­ing more staff mem­bers who speak Ara­bic and Urdu. Some are mak­ing prayer rugs avail­able and set­ting space aside for prayer rooms. In ad­di­tion, more hos­pi­tals are mak­ing Mus­lim chap­lains avail­able to pa­tients.

Providers see those steps as ways to at­tract more pa­tients to their fa­cil­i­ties. “This is an un­der­served pop­u­la­tion that doesn’t have ac­cess, so I’m think­ing about how I’m go­ing to beat the com­pe­ti­tion,” said Vir­ginia Tong, vice pres­i­dent of cul­tural com­pe­tence at 393-bed Lutheran Med­i­cal Cen­ter in Brook­lyn. “They’ll choose me in­stead of the guy next door, be­cause I have ha­lal meals, I have mod­esty gowns.” (Ha­lal foods are those per­mit­ted un­der Mus­lim di­etary laws.)

Some providers are even mov­ing to­ward Mus­lim-cen­tric fa­cil­i­ties. A $5.5 mil­lion, 11,000-

square-foot surgery cen­ter fo­cused on Mus­lims was pro­posed in Or­land Park, Ill., fea­tur­ing a mul­ti­lin­gual staff sen­si­tive to cul­tural needs, a Mus­lim prayer room, pri­vate pa­tient rooms and space for rit­ual wash­ings. State of­fi­cials re­jected the plan, say­ing the area was ad­e­quately served. The physi­cian back­ing the pro­ject is re­sub­mit­ting the plan, drop­ping all ref­er­ences to Sharia law.

Khizer Hu­sain, pres­i­dent of Amer­i­can Mus­lim Health Pro­fes­sion­als, based in Pala­tine, Ill., doubts that pro­ject’s eco­nomic vi­a­bil­ity. “You don’t want a hos­pi­tal to be only Mus­lim,” he said. “You need to cre­ate a space open and wel­com­ing to all faiths and peo­ple who have no faith.”

Ad­di­tion­ally, Mus­lim be­liefs and prac­tices vary. The needs of a pa­tient from Pak­istan could be dif­fer­ent from those of one from Saudi Ara­bia.

Mean­while, of­fi­cials at many hos­pi­tals and health­care fa­cil­i­ties have im­ple­mented cul­tural sen­si­tiv­ity train­ing for staff in deal­ing with Mus­lim pa­tients. Ameena Jan­dali, con­tent di­rec­tor for Is­lamic Net­works Group, a not-for-profit group based in San Jose, Calif., con­ducts such train­ing ses­sions across the coun­try. She started do­ing this in 1997 with Kaiser Per­ma­nente, cov­er­ing diet, pri­vacy and gen­der is­sues.

Jan­dali re­called a per­sonal ex­pe­ri­ence with hos­pi­tal staffers’ lack of un­der­stand­ing of Mus­lim pa­tients’ needs when she gave birth 12 years ago at Alta Bates Sum­mit Med­i­cal Cen­ter in Berke­ley, Calif. She was hun­gry af­ter the de­liv­ery, and waited and waited for the staff to bring her food. But it turned out a mem­ber of the hos­pi­tal staff had posted a sign on her hos­pi­tal room door say­ing, “No men al­lowed.” So the male food ser­vices staffer on duty, fear­ful of of­fend­ing her and her fam­ily, didn’t de­liver her meal.

“This is not what I meant, but maybe there were some Mus­lim fam­i­lies that would think this was ap­pro­pri­ate,” she said with a laugh.

Since then, some hos­pi­tals have be­come more com­fort­able serv­ing Mus­lim pa­tients and fam­i­lies. Some of the most ob­vi­ous and sen­si­tive is­sues in­volve con­tact be­tween men and women who are not re­lated. Hos­pi­tals and clin­ics strive when­ever pos­si­ble to have fe­male physi­cians and providers care for fe­male pa­tients, and for male providers to care for male pa­tients. Since it’s not un­com­mon for non-Mus­lim pa­tients to also ask for same-sex providers, hos­pi­tals are rea­son­ably well-pre­pared to meet that de­mand.

Mary De­Sana, OB/GYN nurse man­ager at the Henry Ford Wyan­dotte (Mich.) Hos­pi­tal, says more than half its providers now are women. “That’s made it eas­ier for us. We can re­as­sure (women) that we have fe­male providers for (fe­male) pa­tients,” she said.

Ex­perts say, how­ever, that even the most or­tho­dox Mus­lims rec­og­nize that in med­i­cal emer­gen­cies, sav­ing a fe­male pa­tient’s life takes prece­dence over find­ing a fe­male physi­cian and that hav­ing a male doc­tor treat her is ac­cept­able in that sit­u­a­tion.

The staff at Cal­i­for­nia’s Lu­cile Sal­ter Packard Chil­dren’s Hos­pi­tal at Stan­ford gath­ers in­for­ma­tion about re­li­gious pref­er­ences dur­ing the in­take process, and gives free copies of the Qu­ran to Mus­lim fam­i­lies af­ter child­birth. That’s the kind of cul­tural aware­ness that more hos­pi­tals are dis­play­ing, said the Amer­i­can Mus­lim Health Pro­fes­sion­als’ Hu­sain.

There are ar­eas where dif­fer­ences among Mus­lims in be­liefs and prac­tices can be tricky for health­care providers, such as end-of-life care. Keep­ing a pa­tient on life sup­port could present a fam­ily with an un­af­ford­able fi­nan­cial bur­den, which the Qu­ran says should be avoided, ac­cord­ing to ex­perts in­ter­viewed for this ar­ti­cle. But at the same time, there’s a duty to pre­serve a pa­tient’s life and pre­vent pre­ma­ture death. Those be­liefs could come into con­flict. Sim­i­larly, the per­mis­si­bil­ity of or­gan do­na­tion is de­bat­able in Is­lamic be­lief be­cause tra­di­tional Mus­lim prac­tice is to bury the de­ceased’s body in­tact.

It’s eas­ier now for hos­pi­tals to buy sup­plies and food to ac­com­mo­date Mus­lim pa­tients and fam­i­lies. Tong re­mem­bers it was hard 16 years ago to find a ven­dor that sold hos­pi­tal gowns ap­pro­pri­ate for Mus­lim pa­tients that more fully cov­ered their bod­ies. But now there are a num­ber of com­pa­nies mak­ing th­ese gowns.

To com­ply with ha­lal di­etary rules for­bid­ding pork, hos­pi­tals are ex­pand­ing their veg­e­tar­ian menu of­fer­ings. That’s what Wyan­dotte is do­ing. Cen­sus fig­ures for Wayne County, where Wyan­dotte is lo­cated, show Arab-Amer­i­cans—many of them Mus­lim—rep­re­sent 4.3% of the county’s pop­u­la­tion, com­pared with less than 0.5% in the U.S. as a whole.

Wyan­dotte’s lead­ers took a big step seven months ago when they con­verted a re­cy­cling room into a Mus­lim prayer room. The hos­pi­tal’s large num­ber of Mus­lim physi­cians drove that de­ci­sion, said Rand O’Leary, the hos­pi­tal’s chief op­er­at­ing of­fi­cer. “We wanted to be re­spect­ful to the needs of the med­i­cal staff and try to ac­com­mo­date the re­quest,” he said. “I didn’t see it any dif­fer­ent for any other com­mu­nity or physi­cian re­quest.”

Hos­pi­tals also have taken steps to ac­com­mo­date the wor­ship needs of Mus­lim pa­tients and fam­i­lies. Lutheran Med­i­cal Cen­ter has imams from lo­cal mosques on call to serve as vol­un­teer chap­lains to min­is­ter to Mus­lim fam­i­lies in end-of-life sit­u­a­tions. Though the con­cept of a chap­lain is un­fa­mil­iar in Is­lam, Jan­dali said she has seen more hos­pi­tals with Mus­lim chap­lains over the past seven years.

Since 1996, Lutheran also has set aside a prayer room for de­vout Mus­lims, who pray to Al­lah five times a day. Af­ter the Sept. 11, 2001 ter­ror­ist at­tacks, Tong re­calls that the hos­pi­tal re­ceived let­ters ex­press­ing anger over this. “Where’s the Ir­ish unit?” was one com­plaint.

But such ex­plicit pub­lic hos­til­ity has re­ceded. Now Tong is con­cerned about whether the cur­rent prayer room is large enough to ac­com­mo­date the grow­ing Mus­lim pop­u­la­tion.

Henry Ford Wyan­dotte Hos­pi­tal’s prayer room ac­com­mo­dates pa­tients as well as hos­pi­tal staff.

Ten coun­ties with the largest Mus­lim pop­u­la­tions

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