Cultural Misunderstandings at the Hospital
Karim Ötztürk is lying in a local hospital with a broken leg, deeply engaged in a heated debate with the orderlies. The issue is the menu. Mr. Ötztürk would like to observe Ramadan despite the fact that he is laid up in the hospital. The nurse, clearly overwhelmed with the situation, asks the doctor for help.
Fourteen million Muslims live in Western Europe today, more than three million in Germany. And at some medical practices, up to thirty percent of the patients are Muslim. It is no surprise that cultural and linguistic misunderstandings abound in this context.
For years Ilhan Ilkilic, research associate at the Institute for Medical History, Theory and Ethics at the University of Mainz, has been studying the typical conflicts between Muslim patients and doctors in Germany.
He explains that many people are aware of the problems that occur due to language difficulties, but he also notes that "up until today, ethical problems in the treatment of Muslim patients have been neglected."
From strictly observant to nonobservant
The fact that Muslims are not a homogenous group in Germany makes it even harder to approach the special needs of Muslim patients. Some are strictly observant and others are more or less nonobservant.
Ilkilic describes three different areas in which problems arise between patients of Muslim faith and the doctors and nurses who treat them. One of the biggest problems is language difficulties. In most cases family members will accompany a patient to a doctor's visit.
But the question remains open whether or not the relative—for whatever reason—will faithfully interpret what the doctor says and tell the patient the truth. Sometimes family members want to protect their loved ones from the truth and thus translate incorrectly.
Mrs. Hamideh Ünal, a psychotherapist at the Center for Trauma Victims in Cologne, describes the situation in which a translator mediates between the doctor and patient as extremely difficult: "In such circumstances it is almost impossible to build trust."
Touchy issue: Bodily contact
Another problem that Ilkillic sees is the transgression of the patient’s personal space during exams. Muslims try to avoid bodily contact with those of the opposite sex. Devout women cover their body from the view of men.
The Iranian gynacologist Dr. Khosravie from Bergisch Gladbach reports that some women patients will undress for an exam, but they will still not take off their headscarf. "Traditional Muslims won't even come to my practice."
For some men, being washed in a hospital bed by a nurse can be an even worse experience than the illness itself. For this reason, whenever possible medical treatment and nursing should be offered by doctors, nurses and orderlies of the same gender.
The third point of conflict is the one demonstrated above by Karim Ötztürk: the Muslim prohibitions related to food. In most hospitals today alternatives to pork are offered, but for example many medicines contain alcohol or are derived from pigs.
In addition, fasting is not only related to different kinds of food, but also the time of day during which it may be eaten. During Ramadan, foods in both solid form and fluid are prohibited from sunrise to sunset.
Ramadan at the hospital?
The Koran explicitly exempts the sick from fasting but leaves open the question as to when someone is considered ill. This often creates internal conflicts for a patient. In this case it may be helpful if he or she is able to consult with an Imam. In this way, the patient can learn not only about the medical aspects of a certain treatment but also about the religious implications.
Arif Ünal, director of the Health Center for Migrants, would like to see a prayer room for Muslim patients in hospitals: "Every Christian in Germany has the possibility of retreating to a chapel while in the hospital. Why shouldn't this also be possible for Muslim patients?"
He thinks that doctors must be more knowledgeable about the Muslim faith in order to avoid misunderstandings and conflicts. At the same time, it will help patients if they are able to openly communicate their religious values and special needs.
A small step meant to promote better understanding between doctors and foreign patients is the Interpreter Pool in Berlin, which was established two years ago. The project was initiated by the European Union in order to provide interpreters for medical and social organizations. The interpreters are hired for pay by the respective institutions.
© Qantara.de 2005
Translation from German: Christina M. White
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