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Middle Eastern and Approach to Medicine and Patient Care

Item Type text; Electronic Thesis

Authors Salim, Muhammad Omar

Publisher The University of Arizona.

Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.

Download date 24/09/2021 06:32:54

Link to Item http://hdl.handle.net/10150/146651 MIDDLE AND APPROACH TO MEDICINE AND PATIENT CARE

By

Muhammad Omar Salim

______

A Thesis Submitted to The Honors College

In Partial Fulfillment of the Bachelor’s of Science

With Honors in

Physiology

THE UNIVERSITY OF ARIZONA

December 2010

Thesis Advisor: Dr. Eugene Settle

Approved by:

______Dr. Eugene Settle

Department of Physiology Introduction and Explanation of Purpose

The of physiology and medicine in Middle Eastern society is an integral aspect of modern medicine. Especially in American society today, it is easy to prescribe to linear characterizations of the practice of healing and treatment without analyzing how these methods came to be, or if there are alternative, more efficient means. At the very least, medical philosophy of the should be thoroughly analyzed as to increase awareness and benefit those seeking an alternate view of medicine. From a physician or caretaker's standpoint, it is critical to research this topic so one can tactfully aid and maximize the efficacy of the healing process of a member of this society, respectful of custom and religion, avoiding taboo or approaches in a counteractive manner. This paper's purpose is to elucidate and analyze the easterner's mindset and mental framework on how healing is viewed, primarily through religious and cultural lenses. Case studies and current topics of debate be reported on issues where physiological advancements have created phenomenas unique to this society, bringing a greater understanding of how adherent easterners are of certain values and how advancements in society push adaptation and modernization. Overall, this thesis will bridge the understanding of the Middle Eastern convention of medicine, contributing to more effective interaction, discourse, and positivity between diverse cultures in an ever- globalizing society.

Worldview of Health and Medicine

A critical approach regarding Middle Eastern culture is through an Islamic perspective. as an institution has been prevalent in the Middle East and subsequently the world ever since its inception over fourteen hundred years ago. As such a major influence, it is considered a guide to life by its adherents and provides insight as to how health and medicine are to be utilized and viewed. There are over six million

Muslim in the United States, so the likely hood of a professional caretaker receiving one as a patient is incredibly high. Hence it is integral to ascertain a fundamental understanding of this background. At the same time, it is equally paramount to know that not every Muslim is going to be quite as particular about their religion, and not everyone is going to be so relaxed and liberal. First, it is important to know the basics and then inquire and explore the individual and their personal interpretation and boundaries on how they wish to be treated.

Islam is a faith built on a foundation of moderation. The followers of Islam are highly advised to follow through life with the mentality as though it may end today while planning for it to last many years. Called upon to be spiritually present, Muslims are encouraged to possess a peace and of mind and body for optimal worship. The lightness and clarity of the body is achieved through moderation in food, routine prayer, and physical activity. The mind maintains agreeable and optimal health through consistent worship and remembrance of , while eschewing negative and harmful processes of thoughts. This framework allows for medical intervention when necessary as our bodies are a trust to and from God and should be treated as such. Hence, excessive treatment in certain forms such as pills or using medication as an immediate alternative is discouraged, for one should seek to purge the illness within oneself if possible, or mentally break through such inhibitions in health. But of course, this is not always the case, and medicine is always an acceptable method.

The Prophet Muhammad was adamantly against Muslims engaging in excessive behavior. A prominent saying attributed to him states that one third of our stomach capacity is for food, one third for , and one third for air. Therefore, one who follows this advice never becomes overfilled, leading to lethargy. Muslims also spend the month of Ramadan every year fasting from dawn until sunset, abstaining from food, drink, sexual relations, and ill thoughts/actions. This provides the adherent with a sense of knowing what it means to go without the comforts we become accustomed to in this life, and reflect on the less fortunate. Prayer is a five time daily practice requiring a certain degree of physical fitness and flexibility in a series of bending and prostrations.

All these practices all contribute to a sense of health and spirituality, especially with actions like abstinence of certain foods and activities as well as prayer all providing ways to become not only bodily healthy and clean, but also spiritually.

The Qur’an mentions two types of diseases specifically, physical body ailments and diseases of the heart. The latter is considered the root of almost all illness, requiring a constant awareness of the of one’s soul. This is a metaphorical comparison for all diseases the disable a sound and free spirit, so by diseases of the heart, it is mean to to be an analogy for the soul and psychological well- of an individual. A sound spirit means a heart free of spiritual diseases like greed, gluttony, envy, covetousness, hatred, paranoia and insecurities of all kinds. A person who is free of these types of vices will in turn boost his immune system to help keep a healthy body. This is advice is already evident through the lessening of the sympathetic system of the peripheral nervous system and the augmenting of the parasympathetic system aiding in overall immunity and stress management to ensure stability and homeostasis. Thus, the symbiotic nature of Islam, harmony of the mind means harmony of the physical self.

Despite living life in balance and moderation, it is natural and expected that people will fall ill from time to time. Life is considered a trust from God and a person is thus required to ensure its well-being using whatever appropriate treatments are medically available. There is a consensus of Muslim jurists on the necessity to seek medical treatment when necessary, only prohibiting that which would cause more harm than good. So even if there are offsets in treatment or side effects, this is still permissible provided one has weighed the beneficial versus the harmful beforehand. Being followers of a faith built on moderation, Muslims are obliged to treat physical diseases, psychiatric diseases, and manage to the extent possible. While certain conditions such as psychiatric illness are taboos subject from the cultural perspective of some Easterners, such as being possessed by spirits or having peculiar physical or psychiatric manifestations due to sinning or an unfortunate family reputation or legacy, religiously they are obliged to treat it.

In the Middle East, the concept of healing and being healed is quite differently, mostly through abstract thought, especially due to the cultural or religious nature of the inhabitants. It is not just Islam, but all the major Abrahamic faiths have decisive influence, especially in terms of acknowledgement of God and His reverence. One of the

99 is “the healer” or provider of cure. Muslims believe all ailments, whether physical or psychological, are a test from God, who is all-knowing. Through enduring the difficulties faced in this life with strength, calmness, and resolve, our are erased. That is not to say there is an inherent blessing in pain or suffering so that one should prefer that over medication, but this is a reassurance that hardship and pain are recognized and rewarded, not simply existing for their own sake or to be felt for no purpose. There is also a mercy in the fact that those who are unable to adhere to their religious obligations due to issues regarding mental or physical faculties are absolved of any wrongdoings. This extends to, for example, fasting where someone who is unable to fast due to required medications, being elderly or pregnant/breastfeeding is excused.

Abrahamic faiths in and of themselves essentially emphasize practicality, even if their adherents do not always follow suit.

For those who are devoted to such an of God being the source of healing and sickness, a major aspect of being healed is being at peace with whatever happens for better or worse. God knows best what will happen and will allow to course in the best possible manner, so it is important to acknowledge His decisions and accept them with faith. So someone who is dying from cancer, for example, but graciously faces death with calmness and serenity will at the very least feel healed in the sense that the heart is free of disease such as anger over the saddening predicament. This would be true for living with long term disability as well; if the heart is sound everything else falls into place and everyone will be compensated and rewarded accordingly in the future.

To heal is to participate in day to day activities including worship with attention and awareness. It is integral to bear in mind that no person is required to pray beyond their physical capacity. If a person is unable to go through the rigor of prayer, they may pray sitting, lying down, or simply gesturing if the situation calls for it. Through sickness, people learn of their own mortality and appreciate the frailty of human life. It also gives them a sense of rebirth and renewed vigor in that they have of former sins evaporating through their struggle to recover. Moreover, recovery from illness is seen as a second chance to be a better person; and who would pass up a second chance in this life?

There is an understood cultural tradition that for every malady there is a cure. As a result, treatment is something that should be approached enthusiastically. Most

Easterners see their bodies as a loan from God to be returned upon their death. Protecting this trust necessitates seeking treatment wherever it may be found. Refusing to accept or seek treatment due to pride or stubbornness is a breach of this trust.

As a clinician or caretaker, it is imperative to understand the all-encompassing manner in which religious and cultural ideology permeate the Eastern life. There is a method and rule for every aspect of life. Illness and suffering are seen as opportunities to purify one’s heart of ills and free one from past wrong doings.

It is also important to understand that Islam, Judaism, and are faiths to over three billion people from very different cultures, and even in the Middle East itself there are varying attitudes which will affect treatment. Many cultures in which

Muslims live have taboos about mental illness, for example, and attribute it to the individual having received the “evil eye” and may as a result resist medicinal treatment. They may believe someone has used witchcraft against them and try to use traditional healing methods such as writing verses from the Qur’an on a cloth and wearing it to ward off evil. All these issues and practices are not at all condoned or supported by the Qur'an or sayings of the Prophet, but people do still believe in them. The line separating faith and culture often gets blurred for many Easterners, which is why it is imperative to maintain an open dialogue with one's patients and refrain from dismissing those who believe in the metaphysical. For those Easterners, the in the root of theirs or a loved one’s illness is very real. It may be part of the Abrahamic faiths or stem completely from cultural norms, but regardless it needs to be taken into account to appreciate the unique sensitivities of each patient, as is required not just for Easterners, but for people in general.

Issues of prohibition pertaining to alcohol or pork for example, should be in the general awareness of your staff, but understood as a continuum and not a definite ruling.

Alcohol for medicinal use is considered acceptable since its purpose is to heal and not intoxicate, yet many Muslims still may avoid alcohol derivatives at all costs regardless of the view of jurisprudence. Likewise, pork is forbidden to eat, but the use of its derivatives in general is a of dispute. And the taboo on pork is by no means a Muslim or

Jewish aspect exclusively, for it has also embedded itself culturally, as the majority of

Christians in the Eastern countries will also avoid it as well. There is unanimity on the permissibility of the pig in substances such as insulin or heart valves for medical necessity. Notwithstanding this fact, a client may be completely against anything related to pig at all. Islamic jurists stipulate that in the absence of the alternative, forbidden substances in medicine are not only permissible, but may be obligatory, depending on the severity of the disease and the chances of survival. Stances on these issues will be largely based on cultural norms as the average Easterner will not have spent an adequate amount of time studying the various rules of jurisprudence according to their beliefs.

An awareness of normative gender rules is important as well. Gender segregation is quite a common phenomena, and subsequently, a woman will prefer to be seen by another woman and a man will prefer to deal with men. Though from a legal standpoint, receiving medical care takes precedence over modesty even if care is provided by a member of the opposite gender. Some Muslims will still consider it unacceptable, however. Even with an appropriate gender match, modesty is considered a hallmark of our faith for men and women. Therefore, patients should not be asked to expose anything more than absolutely necessary. Many people come from reserved cultures so they will not be likely to offer personal information without an in-depth consultation from their medical professional. The caretaker will need to be willing to take the time to talk with his/her patients to get the information required. Should death be imminent, the caretaker should understand that there needs to be time and space alotted for the family or spiritual leader to perform “taqleen”, which is to spend quality time with the patient and constantly remind him or her to be mindful of the articles of faith, most importantly, that there is no God but God and to believe in his singularity and power. The ritual varies, but often the patient will benefit from listening to Qur’an through another person's recitation or constantly immerse oneself in worship till their time ends.

Now that a general overview of the mental framework has been conveyed, it would be more useful for an observer to see how these ideas apply in a real life case scenario, utilizing physiological innovations with the Eastern sociology and implications thereof. One such physiological innovation is hymenoplasty used for artificial virginity, or utilization of an artificial virginity hymen kit. This is a procedure or device that restores artificial tissue which will subsequently bleed fake blood to present the illusion that the woman is a virgin upon impregnation. It is like a small plastic package which contains a liquid made with natural albumin and a water-soluble base which would not trigger an allergic or immune reaction. Once inserted within the vagina, it will expand and feel tight. Once the partner penetrates, the will be broken and some “blood” will ooze out. William Saletan is harsh and oversimplified in his analysis of Eastern thought, attributing a “virgin fetish” at the heart of this controversy when in all that is not true, but he does bring up a point of how unsettling it is for these people to cope with such a novel device that allows the feigning of virginity. Why would a device that allows one to appear to bleed as virgin be a focal point of controversy in the ?

Before that question is answered, it is integral to understand the concepts of virginity and modesty as it is understood in Eastern culture. Virginity in and of itself is not a matter of a piece of tissue that is broken on the wedding night, but the fact that a woman can preserve herself till marriage. This institution of marriage is incredibly pivotal in the role of family as the fundamental unit of society, which ensures stability and prosperity for any nation. Any movement to jeopardize the family structure would be synonymous with threatening the nation as a whole. Virginity is a symbol of self-respect and trust which are ideal qualities in a spouse, respecting the institution of marriage and putting sexual relations in its proper priority. Conversely, more free-ranged sexual relations and openness in society is usually associated with unfaithfulness, condemnation of the value of family structure, and high divorce rates due to marital distrust and other such issues.

These qualities which virginity represents are where the true value lies, for if virginity was valued in and of itself for its own sake, then how would widows or divorcees marry?

This is obviously not true, for they can remarry, and they are not judged for participating sexually in a legal previous marriage as that is a natural stage in life and human nature.

“Only with their spouses, or those who are rightfully theirs do they have sexual relations; they are not to be blamed. Those who transgress these limits are the transgressors." (Quran, 23:1-7) So naturally, especially with this technological innovation to feign virginity, it may appear to an Easterner as a blatant attack on the family institution and a deception of the veracity of marriage. That is not to say this view is correct, acceptable, or meant to be furthered, but it is a reality in which these people feel, and hence it needs to be responded to and dealt with on their terms, not by retorts of “virginity fetishes” and more antagonism. Taking the time to understand the issue and the true ideals behind this opposition of hymenoplasty is the first step in ensuring balanced relations and community. Knowing this, it helps inventors avoid wasting time, effort, and marketing to an audience that may not buy into the product, and even if there was an audience, the will most likely have an issue and create bans or economic barriers. All this consideration contributes to bridging the gap between caretaker, scientist, innovator, patient, Westerner, and Easterner.

Overall, an integral understanding is required to ensure more effective care for

Eastern patients.

BIBLIOGRAPHY

Hedayat, M.D., Kamyar. “When the Spirit Leaves: Childhood Death, Grieveing, and Bereavement in Islam.” Journal of Palliative Medicine. 2009. Volume 6

Gallup Poll 2009. http://www.gallup.com/poll/125312/Religious-Prejudice- Stronger-Against-Muslims.aspx

Interviews from: Dr. Islam Abudayyeh, M.D.; Sheikh Hanif Seedat, and Dr. Mujahid Salim M.D.

The Quran