Nursesaida's Blog

Module 3 – Religion and Muslim Culture on Health Beliefs

The beliefs that influence health behaviors in most people are often carried in their culture’s folktales and passed down over centuries through family health and healing practices regardless of race or ethnic origin. Certainly, Muslims who descend from African, African American, Arab, Jewish, African, Asian and Native Indian ethnicities are examples of American cultural groups that still use natural remedies to maintain health as well as different types of poultices to cure some illnesses before turning to modern medicine, regardless of their professional occupation or level of education. Instead of capturing the essence of the health practices that have provided these minority groups with resilience in the face of continued barriers to quality healthcare services, most American clinicians reject traditional healing practices as baseless and suspicious. A clash between the differing value systems that guide traditional healing versus Western scientific inquiry increases healthcare disparities for minority people; especially children, who are left feeling ashamed and even isolated after realizing that their cultural mores regarding health maintenance, illness prevention and even death are neither accepted nor respected by the dominant, mainstream healthcare industry. School and community health education programs will only be able to positively impact lifestyle and behavioral practices of Muslims if they seek to understand and  include the cultural self-care knowledge proposed by their patients in all healthcare activities (Ben-David & Amit, 1999, ¶ 1).

Impact of Religion and Culture on Accessing and Using Healthcare

Muslims are one of the largest and most unique cultures in America, but few healthcare clinicians possess adequate knowledge and experience to interact appropriately with the various aggregate ethnic subgroups that make up Muslim culture. The majority of Muslims descend from generations of people who passed their traditional self-healing practices down to subsequent generations through family and community stories. These stories can provide clinicians with a realistic glimpse into cultural practices that reinforce and strengthen health habits associated with specific ethnic groups within Muslim culture (Ben-David & Amit, 1999, ¶ 7).  Though generally thought of in terms of its application to politics and worship, culture of Islam is really a way of living that covers every aspect of a Muslim’s daily life including marriage, birth, burial rites at death, health and most social discourse. Western healthcare practitioners often mistakenly limit the culture of the Muslims to the mores of the people from the Arabian Gulf, which will limit their reception and the effectiveness of any treatment options or interventions devised. Cultural beliefs about getting sick, getting better and staying healthy are intertwined and enmeshed with the religion of Islam through language and centuries of social exchange based on the ethnic subcultures and the regions from which the Muslims’ originated. For instance, almost all Muslims believe that no practice considered authentic by the majority can ever be erroneous. Healthcare personnel should be cautious about assumptions in providing Muslims care, the most prudent course of action is to start with principles that are common to all Muslims regardless of their ethnicity or country of origin and then build upon those commonly shared values by exploring ethnically specific traditions.

Exploring the Shared Values of Muslim Cultural Traditions

How Muslims view and seek healthcare can be clustered around several cultural themes, but the one that they refer to most often which confronts healthcare professional who try to intervene in their lifestyle choices is qadr or destiny. When viewed from a Western perspective, qadr is considered fatalistic. However, the Muslim considers this belief a defining idea about the power of man versus the power of God. Through qadr, the Muslim understands that after one has done everything possible, if circumstances do not lead to a desired outcome, then that outcome was not ordained by God who knows best about all things. Such a belief seems contradictory for a people who value education in order to improve and better manage individual and community life. However, for every principle in Muslim culture there is a balancing principle that seeks to establish and reinforce, centrist living and thinking, as the prescription for maintaining health and facilitating healing. For qadr, the balance is individual responsibility to strive to achieve the best possible outcome in all that is undertaken. A saying goes, if you knew you would die tomorrow and intended to plant a tree, plant the tree.

Foundation for Cultural Practices

The foundation for every Muslim’s lifestyle is the traditional Islamic value system taught in the Holy Qur’an and exemplified in the lifestyle of Prophet Muhammad (عليه السلام [Peace Be Upon him-AS]) as explained in collected works called Hadith. Muslims believe that the Holy Quran is the unaltered word of God, protected because it has been passed down over centuries through memorization and oral recitation with a similar tradition protecting the Hadith. Insulting any aspect of those scaffolding beliefs will shut all doors that might allow the development of a respect/ trust bond, an essential ingredient in the patient-provider relationships.  While the clinician is not expected to share the beliefs of the Muslim, he or she is expected to avoid behaviors that demonstrate disrespect. One example of demonstrating respect is to maintain respect towards their Holy Book, which they themselves only touch in a state of ritual cleanliness. Healthcare personnel should be careful to avoid touching the Qur’an or placing objects on top of any religious books except as requested by the patient. Many Muslims believe that the prayers and activities legislated in this book offer miraculous powers for healing when applied under the correct circumstances.

Touch

American nurses suffer from a lack of experiences that would prepare them to understand and predict the needs associated with Muslim culture because in addition to being far different from the dominant value cultural mores, they are actually an amalgamation of traditional Islamic values combined with the mores of the ethnic groups that practice this lifestyle.

Touch is one of the most common aspects of Muslim culture that a clinician will encounter when caring for Muslim students because it is a critical element in the healthcare delivery process. Every culture has clear boundaries about touch that can positively or negatively impact a clinician’s ability to care for his or her patients and most Muslims follow a very defined code of behavior regarding touch. Since the majority of Muslims are generally from minority ethnic and linguistic populations and the majority of nurses are predominantly white American Christians, a disconnection in communication between these two groups can easily occur, especially in areas related to touch. Touching and the restrictions placed on touching are intended to underscore respect in Muslim culture. For instance, many Western clinicians know that there is a need to take care when touching Muslim women; but, most are unaware that they should avoid touching the opposite gender even by attempting to shake hands unless the patient extends the hand first or permission is obtained. Additionally, nurses probably also do not know that women, who practice the strictest code of separation in Islam related to touching, will not uncover in front of or be touched by even other women who are not Muslims. A simple demonstration of respect can be achieved by insuring that the entire body except the part that needs to be examined remain covered for both men and women, even if the patient is deceased and especially the sexual organs are the area of concern.

The clothing worn by Muslim men and women is a reflection of how much value this culture attributes to respect and to touch whether through physical awareness or by using any of the other senses such as the eyes. Healthcare practitioners and nursing clinicians should be cognizant that regardless of the gender a decision not to adhere to wearing the traditional cultural dress code of Islam in no way indicates that the individual has abandoned all of the other cultural rules that dictate social discourse surrounding touch. Whenever possible, establish clear communication using a translator if necessary to identify preferences and comfort level before touching occurs. In the case of American Muslim converts, they may apply the most stringent forms of religious legislation to social discourse as they struggle to establish a Muslim cultural identity that defines their emergence within the broader Muslim cultural presence.

Food

Most cultures share the belief that there is a critical relationship between food and health. Food is almost always used as the first line of treatment for some illnesses such as soups for the common cold and some food types are highly valued as preventative and curative for a variety of illnesses. For centuries, many Muslims have maintained a steadfast belief that black seed has medicinal properties that can cure all illnesses if eaten or distilled properly. It is narrated by hadith that the Holy Prophet (AS) said: “Use the black seed because it has a relief of all diseases, but death (A. N. Muhaimin, personal communication, November 28, 2009; Islamic Bulletin, 1999; Al-‘Ani, 1985, p. 274).” That belief has spurred Muslim medical scientists and nutritionists to use black seed in a search for cures to such diseases as cancer and respiratory diseases. Muslims are also less likely to drink milk and consume foods that are fortified with vitamin D because of traditional food preferences or lactose intolerance, which increases their risk factor of having vitamin D deficiency. Another highly valued practice related to food is abstinence from oral sustenance, also viewed as having healing properties by Muslims. Although Muslims practice several optional fasts, the most commonly known fast is the obligatory fast of Ramadan, which is mandated in the Holy Qur’an and should be assumed by every able-bodied male and female beginning by puberty, the formal age for adulthood in Islam. However, Muslim children typically begin fasting in solidarity with their families at around seven to nine years of age. The fast of Ramadan requires abstinence from all oral intake from 1 hour before dawn to sunset, unless an illness might be worsened or harm might befall an unborn fetus if a pregnant woman fasts. Women are not permitted to fast while menstruating, but they must make up the missed days during the succeeding year. Although there are many benefits associated with fasting, there are also associated risks. An example provided by Anwar Muhaimin, President of Quba, Inc (Personal communication, November 28, 2009), a Muslim community in Philadelphia, PA was that during a blood drive sponsored by his community in 2006, the hemoglobin level was so low in 20 out of 50 men and women who fasted the month of Ramadan and came to donate blood. Since that time, he recommends that pregnant women who fast are sure about their health before assuming the fast of Ramadan. His advice was essential for their compliance.

                                     

 Beliefs about Illness

Health is believed to be lost through a lack of balance and moderation in one’s lifestyle. Muslims believe that there are three types of beings that were created above animals. Those beings are man, who was created from the earth; angels, created from light, and jinn, created from fire. Men and jinn have free will, but angels do not. In the case of mental illnesses, most Muslims believe that jinn, who with angels live on a plane invisible to man and have the power to possess the minds of people. Both good jinn and bad jinn exist. Bad jinn can cause mental illness through possession. However, they also believe that certain prayers over the ill person can exorcise the jinn and purify the environment from the bad jinn (A. N. Muhaimin, personal communication, November 28, 2009). This information is rarely known by young people but it may impact the willingness of older people to allow participation in certain treatment modalities.

Body Image

Cultural groups often vary in their definitions of an acceptable and desirable body size. In addition to touch, body image is a dimension of social exchange that Islamic attire was intended to help address. The appearance of the human form even in Muslim culture seems to be far more related to the level of affluence of the individual. Traditional Indian, Chinese and Arabic cultures have been cited as examples where at the very least thinness was not emphasized as a requirement for feminine beauty (Khandelwal, Sharan, & Saxena, 1995; Nasser, 1988); however, historically the non-medical literature suggests that although a certain degree of fullness in the body may have been traditionally desirable, being ‘fat’ was not universally admired” even in those ethnic subgroups. Muslim body image is definitely associated with the mores of geographic regions and according to various Hadith, Prophet Muhammad (AS) advised that gluttony is not a desirable trait for any aspect of a Muslim’s life and his recommendation is that the stomach should be filled with 1/3 food, 1/3 water and 1/3 air. Additionally, drinking fluids should be avoided for ½ hour after food has been consumed. Such habits promote a slender physique (A. N. Muhaimin, personal communication, November 28, 2009; Al-‘Ani, 1985, p. 21; A. N. Muhaimin, personal communication, November 28, 2009).

Conclusion

In summary, the United States has drastically changed as a result of the influx of a wide range of ethnic and linguistic cultural groups over the last century. However, despite the increased diversity, American healthcare practitioners are still largely non-Hispanic whites; whose heritages and backgrounds have provided them with little if any of the knowledge, skills, and experiences that are necessary to effectively communicate with the vastly differing patient populations that make up this new culturally rich healthcare frontier (Tucker, Mirsu-Paun, A., van den Berg, & et al, 2007). A clash between the differing value systems that guide traditional healing versus Western scientific inquiry increases healthcare disparities for minority people; especially children, who are left feeling ashamed and even isolated after realizing that their cultural mores regarding health maintenance, illness prevention and even death are neither accepted nor respected within dominant, mainstream healthcare. American nurses are ill-prepared to understand and predict the needs of a culture that is far different from their own, especially since that culture is actually an amalgamation of traditional Muslim values and the mores of many ethnic groups that practice this lifestyle. Of all interactions that are required in the patient-healthcare provider exchange, touch is the most encountered, but least understood. Touch is highly regulated in Islam and it is an example of a cultural phenomenon that must be better understood if quality healthcare is to be delivered.

Left click for Vitamin D Quiz-Cultural Factors that Affect Vitamin D

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