Muslims: Religious Observance
Some aspects of the strict religious observance are relaxed for those Muslims who are in ill health. For example, the Qur'an specifically states that those who have temporary or chronic conditions are not permitted to fast during Ramadan. There is also a special method of praying, using symbolic hand gestures (tayammum), for those who are bed-bound or do not have the strength to carry out their normal salat. Muhammad himself was often annoyed with Muslims who insisted on further injuring their health by fasting, pilgrimage and prayer when they ought to have been taking care of their health. He called this pride.
However, it is important to most Muslims that they continue to observe the five daily prayers and keep themselves in a state of cleanliness as far as possible, even during the worst of ill health. They may need some help to do this – and will certainly need privacy – but the continuance of a normal daily routine will often prove comforting.
the daily salat
The daily prayers, or salat, can be seen as a meditation on the reality of God. First, a Muslim undertakes a ritual wash – the wudu (normal ablution) or ghusl (full ritual ablution) – that cleanses their mind and soul as they wash the daily impurities from their body. Each has a series of ritual moves such as washing the face from brow to chin, rinsing the hands from wrist to fingertips and rinsing the nostrils, mouth and ears. These movements are normally performed in running water.
There is more information about wudu in this article, including how to cope with facial wounds and when tayammum becomes appropriate.
Having performed wudu, a Muslim then attends to the call to prayer, the adhan. He turns to face in the approximate direction of Makkah (Mecca) so that his prayers are directed straight to the holy Ka'ba.
Generally, Muslims will pray on their own at home or work, or wherever they find themselves. They will use a prayer mat to sit, kneel, stand and lie on while performing the intricate and precise body movements associated with prayer to avoid contaminating their body once cleansed. As Muslims move into the appropriate postures, they will repeat prayers that rededicate themselves to Allah and help to focus their mind on holy things.
Although each of the five, or three, daily prayers differs slightly in the number of prayers that are repeated, the preparation is the same for any prayer, including the Friday congregational prayers at a mosque (salat ul-Jum'ah).
prayer in hospital
A Muslim inpatient may need some help from staff to ensure that they are in the correct state of cleanliness for prayer. This will involve not just assistance with their ritual ablutions (wudu), but may also involve a change of clothing if garments have become soiled with body fluids or medications. For bed-bound patients, wudu can be reduced to a symbolic sequence of gestures (tayammum) but more orthodox Muslims may still want to use a bowl of water and a jug to complete a normal wudu. Help from staff of the same gender as the patient – and wearing gloves to prevent direct skin contact – is likely to be appreciated in this case.
When a patient is engaged in preparation for prayer, or in prayer itself, they will need a period of undisturbed quiet and privacy. If it is not possible for them to leave the ward and go to whatever quiet space is set aside for religious practices, then the curtains should be drawn around their bed and staff notified that they are not to be disturbed except in an emergency.
In some cases, individuals may request that they are woken at a specific time to prepare for prayer. Patients may also request assistance in getting to a quiet place such as the chapel complex in time for a Friday service or daily salat.
Remember that Muslim staff may also need to leave the ward during their shift to pray. During Ramadan, they may need support as they fast during the day, and many will wish to take annual leave during certain eid to spend time with their family and community.
exemptions from salat
Some individuals are exempt from having to make their five daily salat while their health may be in jeopardy. This includes women who have just given birth, and for 40 days after the birth, women who are currently menstruating or experiencing other abnormal vaginal discharge, those who are seriously ill and those who have mental health issues.
The definitions of the last two categories are not exact; some seriously ill or mentally ill Muslim patients may insist on continuing with their normal prayer routines, and will require assistance from healthcare staff or their family to do so. In these cases, prepare to be guided by the patient.
Salat ul-Jum'ah (Friday prayer)
Every Friday, the men of a Muslim community are required to attend a service in their local mosque, where they pray together in a community salat, and hear readings and sermons from their imam. Attendance is not compulsory for women, who have other duties caring for their family, but many do attend and sit in a separate part of the mosque.
Muslims of both genders who are unable to attend Friday prayer at the mosque because their condition requires them to remain in hospital will probably receive a visit from their imam or a respected community elder during the day instead. If possible, this should occur in a quiet area set aside for the purpose (and so other Muslim patients and family can attend as well). If no such area exists, then somewhere where the patient and imam or elder can be quiet and undisturbed will be appreciated.
Discuss this visit with your patient if possible (or with their family or the imam) to discover what additional requirements they may have (e.g. water for washing).
Ramadan and its effects on healthcare
Ramadan is an extremely important period for Muslims, and the vast majority will endeavour to follow the strict fasting regime even if they are technically exempt. In terms of healthcare, the fast presents three potential problems; however, they can be overcome with some thought and consideration.
The first is that some outpatients may miss their appointments if they fall within Ramadan because Muslims feel that their time is best spent with family and community during this month. The provision of a simple, multi-cultural calendar will help staff to avoid making important appointments for Muslims during Ramadan.
The second and more serious issue is with medication. Those Muslims who are not unwell enough to be exempt from the fast or those who are on daily medication to maintain their health, are not allowed to take medicines orally during daylight hours. Essentially, nothing may enter the body by a permanently open orifice (e.g. mouth, nose, intravenous line through the skin, rectum). This can cause a sudden and severe deterioration in a condition – or even a toxic reaction if a patient takes a day's worth of medication in one sitting as they break their fast after sunset.
Wherever possible, change the prescribed medication to one that requires perhaps a larger dose, but has a longer-lasting effect – sufficient to last the patient throughout the daylight hours. If a skin patch for the medicine is available, then this can be used (absorption through the unbroken skin is permissible). Consider adjusting the timing of medication to coincide with the adjusted routine of Ramadan, so that medication is taken as the fast is broken after sunset and again before the next day's fast (essentially pre-dawn). Topical creams, eye drops and sublingual medications (i.e. those that are placed under the tongue) will be considered to be acceptable by most Muslims because they are not swallowed and do not count as nutrition.
The final issue is the effect that fasting may have on a patient's system, beyond the obvious feelings of hunger during the day. For example, it may not be wise to schedule tests during Ramadan, as results may be affected by low blood glucose levels. There may also be a certain amount of sleep deprivation (caused by long family meals to break the fast, which can often last well into the small hours) and consequent reduced cognitive function, increased stress and possible mild dehydration.
Having stated the potential problems associated with fasting during Ramadan, it is important to balance the picture by saying that for most normal healthy individuals, any physical effect is likely to be slight and temporary – and more than outweighed by the positive mental, social and spiritual benefits of this important discipline.
Muslim patients and staff will require halal food from a reputable source. Eating meat from animals that have been killed in a certain way is part of the halal discipline, which also excludes pork and pork products, fish without fins and scales (e.g. shellfish) and all alcoholic and narcotic substances. A menu that excludes these foods could be prepared with help from the local Muslim community and would be acceptable to both staff and patients.
More information about the Muslim diet is provided in the 'dietary guidelines' section.
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