“O you who have believed, decreed upon you is fasting as it was decreed upon those before you that you may become righteous.” (2:183)
Ramadan is upon us and what a delightful guest it is. A holy month in which Allah offers us the biggest opportunity for redemption. It is imperative we make the most of this chance.
Fasting is obviously a crucial part of the holy month. But fasting goes beyond simply hunger and thirst. Amongst the benefits of fasting and the hunger that it causes is the motivation to do more for others who are less fortunate than yourself. Fasting itself is a detox for us – a chance for our bodies to flush away the toxins and rid ourselves of habits of excessive consumption. As healthcare professionals we understand the need to take great care of what we place into our body and Ramadan offers the opportunity to reflect on that.
Beyond fasting, additional forms of worship are strongly encouraged. Work on your relationship with Allah (SWT). Pray the extra sunnah prayers. Take time to reflect and read the Quran and evaluate its connection to your life.
Furthermore, worship to Allah isn’t necessarily a solitary affair. Giving to charity (Sadaqa), serving others for the sake of Allah (SWT), engaging in voluntary work are all opportunities to gain good deeds.
Ramadan is a good opportunity to reflect and evaluate yourself and your relationship with Allah. Strive to organise your life to minimise waste, over-consumption and the ills that come with this.
Some people these days are too inflexible and intolerant towards others. We, as health care professionals and students should go out of our way to display the best of character to our patients and colleagues when interacting with them, following in the example of our beloved prophet (PBUH) when interacting with the people. In Ramadan it is even more crucial to do this and it is also worth reflecting more on how we can improve our levels of compassion towards patients and colleagues.
Moreover, we need to show that fasting is not affecting our work efficiency and that we are just as productive as we are when not fasting. Fasting helps concentrate our mind and soul so should help us physically too. We cannot allow our hunger and thirst to become distractions. And any hunger cannot turn into frustration or anger either.
Fasting teaches endurance, empathy, and sacrifice — three qualities all great healthcare professionals recognise and share. Let us focus on these qualities and look to embed them in our daily lives.
By Amira Shaikh, Deputy Senior Clinical Pharmacist; NHS 111 pharmacist advisor; Royal Pharmaceutical Society Ambassador
Providing tools and resources related to understanding different cultures is essential for pharmacists’ competency to provide optimal care. While serving Muslim patients who observe fasting during the holy month of Ramadan, patient autonomy should be taken into account. Where the patient chooses to continue to fast despite contrary advice they must be given the support and tools to retain their engagement in case of an emergency.
In order to advise patients and counsel clinicians on healthcare management during the month, it is very important to understand the basic physiological changes the body goes through. Understanding these changes at their most basic level will aid in better understanding on the pharmacological impact medicines may or may not have.
Early fasting is characterised by a high breakdown of blood glucose. As fasting continues, progressive ketosis develops because of the mobilisation and oxidation of fatty acids. Several hormonal changes occur during fasting, including a fall in insulin and changes in thyroid levels. Other changes to the body during fasting include a slight decrease in core body temperature.
Categorising a patient’s underlying health
1 – Stable Long Term Condition (LTC)
The advice given to patients needs to be specific to their chronic LTC and how a fasting regime may or may not have an effect. The following are common LTC’s encountered in primary care (which by no means is an exhaustive list). Clinical judgement should always be exercised to ensure that the information given relates to the patient and their condition.
Diabetes – The most obvious medical condition clinicians become concerned about during Ramadan is diabetes and the dangerous issue of erratic blood sugar control and risk of constant high blood glucose levels. The advice for diabetic patients will vary depending on whether they are taking insulin or taking hypoglycaemic drugs such as sulphonylureas. If they are taking insulin, the following should be considered:
. Regular check of their blood sugar levels to preempt action before entering into a full hypoglyceamic state
.To use less insulin before starting fast
. Possibly change the type of insulin being used as pre-mixed insulin are not recommended
. To break their fast with healthy option meals that are slow releasing, high energy meals and drink plenty of fluids
Diabetes UK have plenty of material to share with patients that can be useful to help consolidate the message.
Heart Failure (HF)- Patients have a limited daily intake of fluid to less than two litres and sodium to less than 2500 mg. Medications include angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, diuretics and digoxin. Research has started to emerge supporting HF patients fasting as long as adhere to fluid and salt restrictions and ensure compliance with their medication schedule. For those who are two daily dose, would be advised to take each dose during their non fasting hours with as big a gap as possible. Where possible, to change the drug to modified release preparations. However, due to the narrow gap we will experience this year, it must be discussed with relevant consultant physicians.
Chronic Kidney Disease – For patients with kidney disease, discussions should always be sought with their consultants. There have been several studies that have confirmed safety in fasting for CKD patients, however, limitation with these studies is that they have been carried out in Ramadan during the cold seasons. As Ramadan is in the summer season with longer fasting hours, management will be deemed more complex.
Asthma/COPD There is limited evidence available for a direct link between fasting and asthma exacerbation. There is however, physiological evidence that dehydration, can lead to drying up of airways which may induce acute exacerbations. The ruling of asthma inhaler use is mixed amongst scholars, which makes it difficult to direct patients. However, patients need to be made aware that they need to use their relievers during acute periods in order to avoid deterioration or hospital admissions.
2 – Unstable Long Term Condition
General advice may be provided to patients or clinicians. However, due to complexity of certain drug regimens for unstable patients generally, the safer advice would be to avoid fasting if it is likely to make their condition worse in the short or long term. This may also apply to patients who are on specific medicines, such as insulin for diabetes or where they are on multiple dosing (due to small gap between fasting and non-fasting hours) it would not manage their condition or increase risk.
3 – Acute illnesses
The Shariah (Islamic
ruling) does allow exemption from fasting for patients with severe or acute
medical conditions who are either at risk of getting worse or if fasting would directly impede their health in
any way. This is particularly important for patients who require immediate
antibiotics for acute infections.
Creams, ointments, and eye drops are permitted by many people, although there are differences of opinion and understanding regarding inhalers and nose sprays. Oral tablets, capsules, or liquids are almost always considered to be breaking the fast. Patients should be advised to consult with their local imams to confirm their theological standing especially for patients suffering from asthma.
And that man shall have nothing but what he strives for (Surah An-Najm 53:39). It is interesting to note that Allah says that man shall have in accordance to his efforts rather than just his actions. Striving is what is essential. All thanks to the Almighty and kudos to BIMA for providing us with the platform for holding cancer screening awareness talks. I was part of two of these talks in Peterborough, targeting female audiences.
Participation on the day
If someone had asked me on the day of the talks, how I rated their success, I would have admitted to a smidgen of disappointment. There was a lukewarm response to the first talk with a turnout of just 15 sisters. The second event was relatively better attended by double the number of audiences, and we had a more interactive session. The attendance of men, however, was a lot more and I had this disquieting feeling that we had not managed to reach out to all the sisters for whom this message is of paramount importance. Within a week after the talks, I had revised my opinion.
Positive impact and survival stories
In the successive week, I saw three ladies who came with concerns regarding some breast symptoms based on the information they had acquired during the talks. A 56-year-old sister wanted to refer herself for the screening bowel scope, the invitation to which she had failed to respond to last year. Another sister contacted me regarding her smear result. I would always be grateful to the sister who asked questions regarding the safety of the HPV vaccine. After listening to our discussion, another sister asked me about primary immunisations and their safety. She expressed her intention to get her three children immunised for whom she had refused vaccination in the past. In all, I had come across six sisters personally who felt empowered to make better decisions for themselves and their children as a result of our efforts.
During the talk, there were tears in the eyes of a lady with a close family member who has cancer. There was a sister, who as a breast cancer survivor, had made a special effort to attend this event and another sister, who asked several questions and wanted to know if we could hold talks for people who undergo cancer treatment. Not surprisingly, she herself was a cancer survivor. Although they were not the target audience, our message resonated even more strongly with these brave sisters and helped others to understand the reality of this dreaded condition and that it could be overcome.
I had started my talk by asking my audience what
they thought was the cause of different Cervical Cancer prevalence rates in the
UK and some other countries. It is the 14th most prevalent cancer in women in
the UK as compared to most common in
Kenya, the second most common in Romania and the third most frequent in
There was a prolonged silence before someone asked in a hesitant voice: “Is it due to screening?”.
By the end of our talk, the answer was clear to all, that countries with low screening coverage have higher cancer incidence and mortality. Many of the attendees came up to personally confirm their commitment to attend all screening programmes. May Allah keep them firm in their intention.
From ripples to waves
The process of improvement in health care is also a highly social one, driven not just by organisational, but also individual initiative. We had witnessed the impact of a single pebble in the form of a few ripples. Imagine, our hundreds of other brothers and sisters who attended these events in mosques all over the country, and the waves they would create. Therefore, no matter how small the steps, let us continue to strive Inshallah. May Allah bless our efforts to spread our message and help our communities to attain better health.
Talks were held at the Faizan-e-Madina and the Ghousia Mosques with colleagues, Dr Nausheen Anwar and Dr Shabina Asad Qayum. Dr Azhar Chaudhry presented to the male participants.
Every healthcare student and professional starts their journey starry-eyed and keen to make a good impression on colleagues. Potential conflict with supervisors or disciplinary procedures would definitely be on the list of things to dread! So what do we do when a hospital policy is at odds with our religious identity and faith that we hold so dear?
This is a dilemma almost all hijabi healthcare professionals working in a hospital environment face due to the Bare Below the Elbows (BBE) policy and lack of consistent policies on head coverings in theatre from hospital to hospital.
Research published in the BMJ Open recently found that 51.5% of respondents had experienced problems wearing a headscarf in NHS theatres. Some women felt embarrassed (23.4%), anxious (37.1%) or bullied (36.5%). Of the respondents, 56.3% felt their requirement to cover their arms was not respected by their Trust.
The BBE policy arguably has little evidence to prove it has reduced the spread of infection. Yet it has become part of hospital culture and enforced almost in a military manner by infection control nurses, especially when Care and Quality Commission (CQC) inspections loom! As an extension of this culture, many female healthcare professionals can be asked to remove their head coverings in theatre, even though there is no evidence to show head coverings are harmful. If healthcare professionals refuse to roll up their sleeves or remove their head coverings, they risk being seen as belligerent and disobedient – especially if others of the same faith have complied!
Under the spotlight…
Most at risk of being intimidated into compliance are the students and junior healthcare professionals new to the hospitals or theatres. Regarded as ‘the bottom of the chain’, they are less likely to speak up for themselves and may be scared to challenge policies in the same way as registrars and consultants.
However, the premise of the BIMA Hijab and Bare Below Elbows (HBBE) project is that all these feelings of intimidation and harassment that Muslim female healthcare professionals experience are unnecessary, and the project exists to try to encourage a change in culture at both the policy and grassroots level.
What are the solutions to the HBBE policy we advocate?
• As per Appendix B of the 2010 Uniform and Workwear policy, Muslim women should be either provided with disposable oversleeves or should be allowed to keep their sleeves down when not engaged in direct patient care activities.
• Muslim women should be allowed to bring in their own freshly washed hijab at 60 degrees.
• Orthopaedic hoods that cover the neck fully should be made available or be purchased.
• Muslim women should be allowed to use 3/4 length sleeves and single use disposable head coverings
Join our campaign!
We urge everyone to get behind our work in the following ways:
1. Share our research, published in BMJ Open. This research, which has taken 4 years to plan, conduct and write up, provides evidence that dress code policies and implementation in hospitals is a problem that needs to be taken seriously by policy makers and hospital managers.
2. If you are a student or junior healthcare professional working in hospitals, download our online toolkits that provide a step by step guide on how to proactively deal with the BBE policy and the hijab in theatre issue before you are reprimanded by ward staff!
Let’s change hospital policy and culture, hospital by hospital, and make sure disposable oversleeves and suitable head coverings in theatre are readily provided and not questioned.
None of our junior sisters should be forced to make career choices on the basis of feeling they have to compromise their deen if they pursue a hospital specialty.
Join us in this campaign, even if you are male or an established senior female clinician. Get in touch with us at [email protected]
We at the British Islamic Medical Association (BIMA) recognise there are challenging dilemmas facing patients, their families, and their physicians at the end of life. However, we are opposed to the concept of assisted suicide. The recent efforts to change the Royal College of Physician’s stance from one of opposition to one of neutrality are troubling, and we are concerned about the many implications that this will have on doctors, their patients, and a relationship that has always been predicated on “first do no harm.”
As Muslims, we inherently believe in the sanctity of life. Even in the most difficult of circumstances, we feel that the focus should be on better pain relief, communities coming together and supporting the sick, investing in research for cures, and supporting our world-leading palliative care services. As God says in the Quran: “Do not kill yourselves, for verily God has been to you most merciful” (Quran 4:29). The opposition to assisted suicide is a position that has unanimous consensus from Islamic scholars and jurists across the globe.
Any shift away from the current stance of professional opposition to assisted suicide may have far-reaching consequences for patients and healthcare professionals, especially those who are opposed to it on the grounds of their faith or conscience. Questions remain as to what neutrality actually means in practice, and how patient trust in physicians who may ‘treat’ them with death will be maintained. In an increasingly austere environment, we are concerned that the narrative will paint those who are made vulnerable by ill health as burdens on their families and taxpayers, pressurising them to take this route.
For these reasons and many more, we strongly and respectfully oppose attempts by professional associations to change their current stance of opposition to assisted suicide.
It is our duty as professionals to speak in the interests of our patients, even if it goes against prevailing and evolving norms. We must continue to safeguard the interests of patients, healthcare professionals and the community as a whole. BIMA is working with an alliance of faith and civic bodies to articulate our strength of feeling on this issue, and lobby our representatives to this end.
 The Royal College of Physicians (RCP) recently held a poll for its 35,000 members on assisted dying. It was framed in an unusual way, requiring a supra-majority vote of 60% – an unprecedented move from the RCP Council which was a marked changed from previous polls on the issue.  The RCP defines assisted dying as: “The supply by a doctor of a lethal dose of drugs to a patient who is terminally ill, meets certain criteria that will be defined by law, and who requests those drugs in order that they might be used by the person concerned to end their life.”  The British Islamic Medical Association (BIMA) is the national organisation for Muslim healthcare professionals in Britain, aiming to unite and inspire members to serve patients and professions. Visit www.britishima.org for more information or see their social media channels at www.facebook.com/britishima or www.twitter.com/britishima.
There are a range of opinions present within the Muslim community as to the permissibility of organ donation after death. While there is evidence that a majority of Islamic scholars and Muslim health care professionals are proponents for it (with varying conditions needing to be satisfied), there is unfortunately relatively little clear evidence on how an “opt-out” system would influence or change these views.
The reality is that the Muslim scholarly, Muslim healthcare and general Muslim community are not homogenous. Therefore, we are likely to encounter a range of opinions for a variety of reasons. For example, there are those who are in favour of organ donation after death, but are concerned by the lack of express consent inherent in an opt-out system. Also, we cannot overstate the desire to expedite burial as a perceived practical reason to opt out of organ donation. Finally, it is likely that personal and non-religious cultural factors will be as influential as religious motivation when it comes to this sensitive issue for the bereaved.
BIMA has previously and is also currently running various seminars and workshops to address and facilitate this discussion. There is certainly an appetite within the Muslim community to engage with this process. This will require sustained engagement in order to achieve whatever outcome the community feels is correct.
The Government should be commended for taking proactive steps to increase the number of available organs available to those who need it most. We are acutely aware that ethnic minorities tend to be under-represented when it comes to donation but are over-represented when it comes to needing organ donation. However, there is concern that legislating an opt-out system without education and engagement may have adverse and unintended consequences. We would recommend taking the following measures to help mitigate for these potentialities.
1. To help launch an education and awareness campaign for the Muslim community in their places of congregation (e.g. mosques) and in their native languages (e.g. Bengali, Somali, etc.).
2. To allow flexibility for those who object to their relatives organs being donated on religious grounds.
3. To engage with Muslim healthcare professionals and Islamic scholars to help address caveats/concerns around organ donation.
4. To ensure a holistic and sensitive approach to this matter and prevent vilification of any particular community.
The Medical community:
1. To organise and participate in more “outreach” sessions and public health campaigns on organ donation, particularly within ethnic minority communities where there may be a shortage of organ donors.
2. To highlight the possibility of organ donation to patients / family members at an early stage so that they can make an informed choice.
3. To respect the views of those who still refuse to donate their / their relatives’ organs.
The Muslim community:
1. For the range of Islamic scholars, Islamic organisations and Islamic medical associations to provide clear guidance on this to the Muslim public.
2. To invite healthcare professionals to their mosques / places of congregation to speak to them about organ donation and its benefits as well as address any concerns.
3. To make an informed and documented choice at an early stage to prevent difficulties later on.
The British Islamic Medical Association (BIMA) is compelled to add its voice to the growing body of concern regarding the prosecution and erasure of Dr Hadiza Bawa-Garba, following the tragic death of Jack Adcock in 2011.
We extend our heartfelt sympathies to Jack’s parents who have suffered an unimaginable loss and we respect the legal process and the General Medical Council’s (GMC) role in protecting the public. However, the process of reducing a series of complex, systemic failures involving many institutions and individuals to a single trainee is concerning.
We are concerned that the entire case will have unintended consequences that will adversely impact patient safety, healthcare training and morale. We call on our members and all stakeholders to engage with the British Medical Association (BMA), Health Education England (HEE), the GMC and others to address the many concerns raised by this case.
Working in healthcare is hectic. Patients and administrative tasks, among other things, occupy a substantial amount of our time. At times these duties seem to be never-ending, and as a result we may miss praying our Salah (prayers) in the appropriate time.
Salah is an important part of a Muslim’s daily routine. It helps us take a break from what can seem like a rat race, and allows us to remember Allah, the ultimate bestower of all our successes. As His creation we have a duty to remember and praise Him, and to realise that Salah acts as a medium to directly communicate with our Creator, seeking His forgiveness and asking for His blessings.
“Take care to do your prayers, praying in the best way, and stand before God in devotion.” [2:238]
As our lives become busier, it can appear difficult to juggle our duties to our Lord as well our patients, but it is of the utmost importance as Muslims to tend to, alongside our patients and administrative tasks, our spiritual needs and the purification of our hearts.
An article this month in the journal Developing World Bioethics argues against the prohibition of surrogacy by many Islamic scholars, challenging the arguments against surrogacy which include concerns over gene mixing and the involvement of a third party.
Read “Reexamining the Prohibition of Gestational Surrogacy in Sunni Islam”here
A study in the journal Religions exploring the problem of OCD washing subtype (repeating Wudu several times) suggests an increase in awareness by Imams of OCD symptoms and signposting for professional psychiatric help, since the patients interviewed for the study recognised the importance of the Imam being the first point of contact in dealing with religious obsessions.
Read “Exploring Professional Help Seeking in Practicing Muslim Women with Obsessive Compulsive Disorder Washing Subtype in Australia” here
We are always looking for relevant articles and news to include in our monthly newsletter. Please send any items to [email protected]
1. In preparation for Lifesavers 2017, regional training days were held in 8 locations around the country, with an attendance of over 120 mosque leads & volunteers. More on the list of 60+ mosques involved in delivering Lifesavers involved here.
2. BIMA East Midlands held a well-received social in Leicester, giving local Muslim healthcare professionals a chance to network and enjoy some fantastic Turkish food.
Firstly this month, a study in the Journal of Religion and Health identifies the different trust issues among American Muslims regarding their attitudes and behaviours towards healthcare, which could help healthcare professionals (and others involved in designing health intervention programs) gain the trust of the Muslim patient population.
Read “The Types of Trust Involved in American Muslim Healthcare Decisions”here
A review paper in the Annals of General Psychiatry outlines the history of psychiatry in the Islamic world (both in the past and the present) and summarises different aspects of forensic psychiatry in the Shari’a and compares them with ancient Greek and modern European law.
Read “Islam, mental health and law: a general overview” here
We are always looking for relevant articles and news to include in our monthly newsletter. Please send any items to [email protected]
1. BIMA Trainees organised the the national FY1 Induction event took place on Saturday 22nd July nationwide in 4 locations- London, Birmingham, Leicester and for the first time in Leeds, Yorkshire. The event was a huge success with over 150 signups nationwide.
2. BIMA sent 12 delegates from all over the UK to attend the Federation of Islamic Medical Association’s (FIMA) Youth Summer Camp 2017 in Istanbul, a week-long program of camp activities, educational seminars, project development sessions, networking, and a tour of Istanbul. BIMA’s President also attended the FIMA Annual Congress and Council Meeting, and the main headline was an address by President Erdogan of Turkey.
3. BIMA North East organised a talk with Dr Arif Moothadeth, consultant in occupational medicine, in association with Newcastle Central Mosque on coping with traumatic eventsafter the recent freak accident outside the mosque on Eid day, during which local healthcare professionals helped look after those injured.
4. BIMA Professional Development organised a webinar with Dr Deen Mirza, a GP and self-help author for GPs, on avoiding diagnostic errors and medical mistakes in general practice.
BIMA delegates at FIMA’s Youth Summer Camp 2017 (above) and attendees at the BIMA FY1 Induction (below)
Firstly this month, a study in the journal Aging & Mental Health examining the association between refugee mental health, past traumatic experiences, and religious observance found that refugees with a higher level of religiousness did not show higher levels of PTSD after exposure to war trauma compared to those with a lower level. The authors argue that religious observance provides a buffering effect to refugees’ mental health from severe war trauma.
Read “Mental health among older refugees: the role of trauma, discrimination, and religiousness”here
The Born In Bradford cohort study is an ongoing study following 12,500 pregnant women and their children recruited over a 3 year period from 2007 to 2010 at Bradford Royal Infirmary. A study this month in the Journal of Epidemiology and Community Health used the data from this study found that infants conceived by Muslim mothers fasting during Ramadan were not significantly smaller than infants conceived by Muslim mothers outside of Ramadan.
Similarly, there was no difference between the two groups in premature birth rates. From the results, the authors conclude that “Muslim women and their partners can be advised by doctors that Ramadan fasting around the time of conception appears unlikely to have a detrimental effect on the size of their infant at birth or result in premature birth.”
Read “Are babies conceived during Ramadan born smaller and sooner than babies conceived at other times of the year?” here
And finally, a review published in the Journal of Obstetrics and Gynaecology Canadaexplored the preference of female obstetricians/gynaecologists among immigrant women.
The identified reasons for preference of female providers include religious beliefs, modesty, and comfort. The review also briefly discusses the Islamic factors Muslim patients consider when preferring gender-concordant care such as ‘awrah (modesty) and khalwah (close proximity).
Read “Gender of Provider – Barrier to Immigrant Women’s Obstetrical Care” here
We are always looking for relevant articles and news to include in our monthly newsletter. Please send any items to [email protected]
2. Our team in the North East hosted an iftaar in Newcastle. Attendees had the opportunity to network with fellow Muslim healthcare professionals and students, and we look forward to bringing more of our activities to the North East.
The highly successful ‘BIMA F1 induction’ event is back! This year, our events will take place on Saturday 22 July from 11am – 3.30pm in the Midlands, London, North West and South West!
Delivered by current foundation doctors who have excelled through training, this is a must for all newly-qualified doctors about to start work this August. The event will make you feel more confident about starting work and hopefully enable you to sail through your F1 year!
What will be covered?
Top tips NO ONE else will tell you!
How to conduct the perfect ward round
How to own your on-calls! The most common bleeps
The Eportfolio and passing the ARCP with flying colours
Career tips to get you ahead of the career ladder
Islamic advice: how to deal with issues which may affect you in the workplace. How to maintain your Imaan whilst working in a busy job.
Learn about basic laws of fasting, the spiritual and physical benefits of Ramadan, and a chance to ask questions with the speaker.
Dr Shaykh Rafaqat Rashid is a traditional Muslim scholar, GP and professional trainer and educator. He is an academic in the field of Islamic medical ethics and medical law, and is also a honorary lecturer at the University of Leeds.