What does God have to do with it?:
Cultivating spiritual and religious needs of Muslim patients to
empower change toward building culturally safe healthcare
Dr. Sylvia Reitmanova
Ms. Khadija Haffajee
Imam Ahmed Limame
(University of Ottawa)
(CAIR-Canada)
(Gatineau Mosque)
Workshop outline
Part 1:
▪ Rationale for developing culturally safe care (video)
▪ Two models of cross-cultural care
Part 2:
▪ Demographic profile of Muslims in Canada
▪ Religious and spiritual needs of Muslims in mental and maternal healthcare
Part 3:
▪ Islamic medical ethics
▪ Religious and spiritual needs of Muslims in palliative care
Part 4:
▪ Insights from chaplaincy work with Muslim patients
▪ Tips for healthcare providers
Part 1
Cross-cultural care:
Why, how and for whom?
Rationale for the provision of culturally-safe health services
The lack of culturally-responsive care
Misunderstanding and miscommunication
Patient general dissatisfaction
Poor adherence to therapy and care
Poor health outcomes
Health and care disparities
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Socially responsible healthcare
▪ Association of Faculties of Medicine of Canada:
the Social Accountability Initiative to address and advocate the changing needs of the communities
▪ Liaison Committee on Medical Education:
“… demonstrate an understanding of the manner in which people of diverse cultures and belief
systems perceive health and illness and respond to various symptoms, diseases, and treatments.”
“… to recognize and appropriately address gender and cultural biases in themselves and others, and
in the process of health care delivery.”
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Nurturing cultural competence in nursing:
Promising practices for education and healthcare
Which term to use?:
Two models of cross-cultural care
Cultural competence model
culture = fixed patterns of learned beliefs, values, practices, ways of interacting and
communicating shared among groups and passed between generations
▪ all patients in one cultural group present the same health beliefs and behaviours
▪ eliciting patients’ health beliefs, concepts of time, space and physical contact, communication styles,
the role of family and gender, social expectations, and decision-making preferences
▪ a list of “do’s and don’ts”
▪ tolerance, inclusion, and appreciation
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Cultural safety model
culture = flexible system of values and world views that people live by and recreate
continuously depending on larger social, economic and political circumstances
▪ the role of the social, economic, political and historical context in health outcomes and healthcare
delivery (variations in socioeconomic status, employment, and housing patterns, the effects of war,
torture, and abuse)
▪ intersectionality of culture, ethnicity, skin colour, gender, class, ability, age or sexual orientation in
production of health
▪ exploration of personal biases, fears, emotional reflexes, and psychological defences
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Part 2
Health-related religious and spiritual
needs of Muslims in Canada
Changing demographics of Muslims in Canada
▪ Census 2011:
Muslims
579,640 (52 % men)
250,000
200,000
150,000
100,000
50,000
0
0-4
years
5-19
years
20-39 40-59
years years
over
60
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2nd generation:
31,785
3rd generation:
3,525
Canadian-born
137,835
Immigrants
415,840
Non-residents
25,970
300000
250000
200000
150000
100000
50000
0
Number of
Immigrants
19
19 6 1
61
-7
19 0
71
19 8 0
8
19 1-9
91 0
-2
00
1
376,205
Be
fo
re
1st generation:
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Visible minority
497,270
English
422,250
French
37,135
Both languages
87,175
No official language
33,085
Oceania &
other
1%
Asia
62%
USA
1%
Central &
South
America
3%
Caribbean
1%
Europe
6%
Africa
26%
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1. A very diverse ethnic and cultural
group
2. The majority are Sunni (following
the Prophet’s tradition)
3. Substantial numbers belong to
groups such as Shia, Ismaili, and
Ahmadiyya
4. Diverse levels of dedication to
teachings and practice within each
group
Many commonalities in beliefs and
practices
Health needs and requests for
religious accommodation in the
healthcare setting
Prayer
Fasting
Dietary requirements
Clothing
Physical contact
Spiritual therapy
Dealing with a deceased body
Grieving process
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Mental health services
spiritual life, moral values, family ties, and a non-materialistic approach to life
internal strength, support, and understanding of the purpose of life
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Barriers
▪ Lack of information, long wait times, financial constraints, linguistic concerns
▪ Cultural and religious considerations
1. Cultural incongruency: misunderstanding and ineffectiveness
They [Canadian-born doctors] would never understand what I was going to say. I know that. There are a lot of
things that I say to Canadian friends or neighbours and they just don’t know what I am talking about.
Maybe understanding can be attained between the patient and the mental health provider, but after the
understanding, there is treatment and help itself. I am not sure if there is a single recipe for everyone from
different cultures.
2. Cultural insensitivity
I am not expecting from my family doctor to ask me to go and pray. One should admit it there is a difference
[between cultures]. I do not expect him to ask me to recite my Holy Book. But I remember when I got
cured from my condition and I said that “I want to thank God and you,” he asked me “Why do you put
God in this one?” I told me that we always thank God for everything. It is a simple thing you do. But he
did not understand why I [first] thank God and then to him. He expected maybe to thank only to him.
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3. Cultural validity of diagnostic methods
Psychological testing:
▪ Do you believe that the man should be the head of the family?
▪ Having fits, Blue spells, Raw deal
4. Culturally inappropriate health promotion leisure activities
Dance or drink: these are things we are offered to do and they [non-Muslims] will criticize us why we are
not doing these things.
Maternal health services
▪ Lack of information, lack of emotional and practical support, linguistic concerns
▪ Cultural and religious considerations
1. Underutilization of prenatal classes
They told me you can go. But I knew that other husbands
will be there, so I didn’t go. When it is only for women I can go…
but when men are there…[unfinished sentence].”
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2. Sex incongruency
Yes, it was important for me [to have a female attendant] and I told them about this
but they said: “Whoever is available.” They can’t guarantee a female doctor during
labour. I just had to accept it…sometimes when the male doctor has a background
about our culture and religion and he respects it that it’s good. Once I went before
the delivery for a check up and it was a male doctor… and I found that he can
understand it. He suggested that he will let a nurse to check me and she will tell him
what she found. He was very helpful. But I want to say that there should be more
female doctors here. And they should be flexible to come for a delivery when any
woman needs. It’s the most important moment to have a female doctor during the
delivery… if she is not there as if I did nothing [to protect my modesty].
4. Lack of privacy
5. Lack of dietary accommodation
6. Lack of specific services (male circumcision)
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7. Stereotypes and prejudice
She [a nurse] asked me, “And do you have cars in your country? Do you have electricity?” I think she
thought we ride on camels, so I told her about my country
You see their faces, you feel it that they think you are stupid and you don’t know anything about this world.
8. Cultural insensitivity and misunderstanding
If some Muslim physician can tell them about our culture that would be excellent. So they don’t think I have
silly ideas or the nurse doesn’t tell me, “Oh, my God, you are beautiful, why you are wearing this scarf?”
There was a male who entered my room. I asked nurses if they can knock before they enter so I can get
dressed. I also put a sign on the door but they didn’t respect it. This man came and saw me [unveiled]. I was
very upset and crying. One nurse came and she said, “Oh, why you are crying? You are beautiful! You don’t
need to cover yourself.”
They [nurses] made me very sad. I stopped asking them for anything.
Culturally safe health services for Muslim patients
Physical environment, materials and resources
Communication styles
Social interaction
Cultural conceptions of health, illness, and end of life
Variations in diagnostic and treatment approaches
Expectations from health professionals
Cultural assumptions, attitudes and values
Social determinants of health
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Part 3
▪Islamic medical ethics
▪Religious and spiritual needs of Muslims in
palliative care