Nadeen Sarsour Dr Maya Hammoud MD MBA Overview Provide background information on Arabs and Muslims Discuss the effect of culture and religion on health Learn about how health care providers can provide culturally competent care for this population ID: 1047767
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1. Providing Culturally Competent Care to Arab and Muslim Patients Nadeen SarsourDr. Maya Hammoud, MD, MBA
2. Overview Provide background information on Arabs and Muslims Discuss the effect of culture and religion on health Learn about how health care providers can provide culturally competent care for this population
3. Who are Arab-Americans?1AlgeriaBahrainComorosDjiboutiEgyptIraqJordanKuwaitLebanonLibyaMauritaniaMoroccoOmanPalestineQatarSaudi ArabiaSomaliaSudanSyriaTunisiaUAEYemen*22 Arab Countries in the World*
4. Who are Arab-Americans?3~3.6 million Arab Americans in the United StatesU.S. Census data shows a 72% increase in Arab-Americans between 2000-2010*Note that Arab Americans are not officially recognized as a federal minority groupLargest population of Arab-Americans are found in Los Angeles, Detroit, New York, Chicago, and Washington D.C.
5. What is the Most Common Religion Practiced among Arab-Americans?A) IslamB) ChristianityC) Judaism
6. Not all Arabs are MuslimNot all Muslims are ArabArab Christians can identify as Catholic, Orthodox, ProtestantReligion2
7. American Muslim Population4,5Islam is 1 of the 3 monotheistic religions in the world 1.5 billion Muslims in the world and 3.5 million in the U.S.An estimated 20% of Arab Americans identify as Muslim
8. The Impact of Arab Culture on Healthcare
9. Arab and Muslim Health Considerations5Patient provider relationshipFamily plays a large role in decision making for a patientVerbal and nonverbal communicationTranslators of the same gender are idealMale provides should avoid greeting the female patient with a handshakeInformed consent and patient confidentiality
10. The Impact of Islamic Faith on Healthcare
11. There are 5 Pillars of IslamBelief and Submission to one GodPrayerFastingZakat (Charity)Hajj (Pilgrimage to Mecca) Islam
12. Which of the Following is a True Statement?A) The month of Ramadan follows a lunar calendar so the date changes each year B) Water and medications are permissible while fasting during Ramadan C) Women who are pregnant must fast during Ramadan
13. What is Ramadan?6Ramadan is the 9th month of the Islamic year and one of the five pillars of IslamFollowing a lunar calendar Ramadan moves back each year by ~10 daysRequirements: refrain from food, water and other beverages, smoking, and sexual intercourse from dawn till sunset for 29-30 daysTypically Muslims eat 2 meals per day: one when they end their fast at sunset (aka iftar) and the other is a meal before the break of dawn (aka suhoor)Sleep habits may change during Ramadan either with staying up through the night, or waking up multiple times throughout the night
14. Who is Exempt from Fasting7,8Prepubertal childrenWomen during their menstrual period or postnatal bleedingTravelersPregnant or breastfeeding women *Some may still fast even though it is not requiredElderlyMentally disabledPatients with medical conditions (acute or chronic) whom fasting will aggravate their condition>40% of TID and >70% of TIID in Middle Eastern Country still report fasting *Do not assume that your patient is/is not fasting- always ASK!
15. Why is this Important for Healthcare Providers?7Spirituality, religion, and personal beliefs are important components of the social determinants of health that affect a patients’ health behaviors and adherence to treatments.You WILL have Muslim patients in the inpatient and outpatient setting; they may or may not tell you that they are fastingMedications can invalidate fastingIntentional eating or drinking with medications, PO medications, and parenteral nutrition invalidate fasting- leads to medication non compliance or grouping of medications to the evening or early hours of the night
16. Considerations for healthcare providers5Dress/HijabThere is some variation in dress by culture Privacy/modestyProviders should announce their arrival before entering a room Staff GenderMay prefer female health care providers
17. Considerations for Healthcare ProvidersDietary requirementsSome Muslim patients may only eat Halal food Considerations during Ramadan
18. Exam of Female in Hijab“Not comfortable with male providers trying to shake hands”“Talk about what you will be doing during the physical exam before starting”“Treat us like any other patient”“Only uncover the areas that need to examined”“Display cultural competence by demonstrating knowledge about the hijab and its limitations and value”“Do not make assumptions about sexual history just because a woman is wearing hijab”
19. Refugee Health
20. Definitions9Refugee: A person who has been forced to flee his or her country because of persecution, war, or violence. Asylum seeker: a person who fled their home country because of war or other factors harming them or their family, enters another country and applies for asylum, i.e. international protection, in this other country.
21. Demographics10,11,12 >30,000 refugees have resettled to the U.S. in 2019~13,000 Syrian refugees were resettled in the U.S. 2016Michigan is one of the top destinations for Syrian and other refugees
22. Social Determinants of Health13 Challenges of ResettlementHealth insuranceFinancial barriersMental HealthEducation
23. What can we doProvide culturally sensitive care-EDUCATIONImplement cultural programsOvercome generalizing and stereotypingAddress and study specific health concernsBe aware of available resources for helpInitiation of specific programs when needed
24. Sources for help CCHMC Office of Diversity and InclusionInterpretersBilingual educational materialsHealth care providers from within the communityLocal churches and mosquesLocal and National Middle Eastern health organizations
25. CitationsArabamericanstories.org. 2020. History - Arab American Stories. http://www.arabamericanstories.org/arab-americans/history. Accessed 16 October 2020. Zogby J. Zogby international’s Arab American demographics report. Washington (DC): Zogby International; 2002.Censuscounts.org. 2020. https://censuscounts.org/wp-content/uploads/2019/03/National_Demographics_SubAncestries-2018.pdf. Accessed 16 October 2020.Pew Research Center's Religion & Public Life Project. 2020. Demographic Portrait Of Muslim Americans. https://www.pewforum.org/2017/07/26/demographic-portrait-of-muslim-americans. Accessed 16 October 2020.Hammoud, M. M., White, C. B., & Fetters, M. D. (2005). Opening Cultural Doors: Providing Culturally Sensitive Healthcare to Arab American and American Muslim Patients. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2005.06.065Islamic Networks Group (ING). 2020. Ramadan Information Sheet From Islamic Networks Group (ING). https://ing.org/ramadan-information-sheet. Accessed 16 October 2020Al-Arouj, M, Assaad-Khalil, S, Buse, J, et al (2010). Recommendations for management of diabetes during Ramadan: Update 2010. In Diabetes Care. https://doi.org/10.2337/dc10-0896Abolaban, H, & Al-Moujahed, A. (2017). Muslim patients in Ramadan: A review for primary care physicians. Avicenna Journal of Medicine. https://doi.org/10.4103/ajm.ajm_76_17Unrefugees.org. 2020. What Is A Refugee? Definition And Meaning | USA For UNHCR. https://www.unrefugees.org/refugee-facts/what-is-a-refugee. Accessed 16 October 2020
26. Citations10. Pew Research Center. 2020. Where Refugees To The U.S. Come From. <https://www.pewresearch.org/fact-tank/2017/02/03/where-refugees-to-the-u-s-come-from. Accessed 16 October 202011. Freep.com. 2020. https://www.freep.com/story/news/local/michigan/2017/01/26/michigan-refugees-syria-elsewhere/97079664. Accessed 16 October 2020.12. Pew Research Center. 2020. Key Facts About Refugees To The U.S. <https://www.pewresearch.org/fact-tank/2019/10/07/key-facts-about-refugees-to-the-u-s. Accessed 16 October 2020.13. Unrefugees.org. 2020. Refugee Statistics | USA For UNHCR. https://www.unrefugees.org/refugee-facts/statistics. Accessed 16 October 2020.