Making room for faith

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.

Follow Ashok Selvam on Twitter: @MH_aselvam