Faith and its relationship to Health and Health Care Since the dawn of human civilization people have

looked for a meaning and purpose to their lives. Most often it has been through various religions and ideologies. To some people it seemed not too much, but to others faith and religion were the standard by which decisions in life were made. And as health care lies at the centre of human life, faith has sometimes fortunately and sometimes unfortunately interfered with people and health care. This paper will have a look at how the fastest growing religion in Europe[1], and also one of the most controversial, has affected and continues to affect, its followers and the wider community at large. Islam is an Arabic word that has five English words embedded in its meaning. It is to sincerely and obediently, submit and surrender to God in peace [2] Historically Islam has had a very good relationship with health care and the field of medicine. In fact Islamic Medicine and Physicians provided the grounding by which the renaissance occurred in Europe after the Dark Ages. Muslims believe that the Quran, and the statements of the Holy Prophet Muhammad (peace and blessings be upon him)[3] provide divine guidance for humanity until the end of time. Muhammad (pbuh) is reported to have said, There is no disease that God has sent down except that He also has sent down its treatment.[4] Health on the other hand is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.[5] So the question might arise as to how does the faith of Islam link in with health and healthcare? As the definition goes health is not merely the absence of disease. Rather it is a state of well-being. Muslims around the globe have their physical, mental and social well-being defined by their faith. Unlike most other religions, Islam provides a way of life and guide in nearly every aspect of life- from the posture of sleep to drinking water to even marriage and family. Therefore as physicians or anyone in a health-care profession should be aware of how Muslims and their faith are intricately linked to every facet of their lives. Whether it is holiday or workday at the break of dawn, even before the sunrises every single day of his life, a Muslim is up to pray. Five times a day it is done, and it has vast spiritual and practical benefits in a Muslims life. During the month of Ramadan, Muslims fast from dawn to dusk in an act of obedience to God.

[1] http://news.bbc.co.uk/1/hi/world/europe/4385768.stm [2] Estes, Y. Definition of Islam Available from http://www.islamtomorrow.com/definition.asp [3] Muslims believe that it is of utmost importance to invoke blessings upon all of Gods Prophets when their name is mentioned, and for the Prophet Muhammad the Quran explicitly states in 33:53 to invoke blessings upon him. Therefore as a sign of respect for the Muslim community and the Prophet Muhammad it will be cited to in reference to his name everytime he is mentioned [4] Al-Bukhari, M. Sahih Al-Bukhari, 9th century [5] WHO. Constitution of the World Health Organization. 2006 available fromwww.who.int/governance/eb/who_constitution_en.pd

Among the many benefits of fasting is to help eliminate harmful toxins in the body, helps keep the digestive system, balance the acid levels in the body, and helps lose weight, relieve pain in the joints as well as treating high blood pressure without medical treatment. In addition to physically rewarding, fasting is also beneficial for our mental health is improving our quotient emotional level. [6] However, at the same time fasting especially for people at old age, with diabetes etc. is actually detrimental. This is where education needs to come in. Doctors especially when treating Muslim patients must have a basic idea of the main pillars of Islam like prayer and fasting and know when it is allowable to not fast, so that they might make the right prescription and not offend a patient. For example, Muslim scholars agree that during a sickness it is allowable to break the fast when 123The sickness will be made worse by fasting Recovery will be delayed by fasting Fasting will cause intense hardship, even if it does not make the sickness worse or delay recovery The scholars also included those who fear that they may become sick because of fasting. [7]

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However, in a BMJ article it is mentioned Patients with chronic diseases often insist on fasting even though they are permitted not to by Islamic rules.[8] However as part of whole person care, one of the big ideas is Hearing the patients story is important for effective care.[9] Thus it is of utmost importance as doctors to know and understand the patients perspective in such a crucial matter such as health care. Also as part of our holistic assessment of people and their health care it is agreed that Illness and its remedies lie at many levels within a system[9]. Among these many levels is the fact that their mind being at peace, and being content with the health care they received. Therefore, as part of a survey to look at Muslims and their outlook on health care, 18 members of the University of Bristol Islamic Society were given a questionnaire to fill asking them about faith and their relationship to their faith, and also to relate between faith and healthcare. 14 of them were females and 4 of them males. All of them put faith as the most important aspect of their lives, a stark contrast to the national survey for 18-25 year olds in the UK which shows that 65% of them confess to having no religion, and among the general population 56% of them who profess to have faith do not attend any religious services.[10] [6] Hermawati, D. Benefits of Fasting, Researched essay available from http://yk-edu.org/erefleksi/sharefile/files/10122011185514_RESEARCH_ESSAY.docx4 [7] Munajjid, S. What is the sickness which permits a fasting person to break his fast? Available from http://www.islam-qa.com/en/ref/12488/breaking%20fast [8] Drug intake during Ramadan BMJ Volume 329, pp 778-82 [9] Big Ideas of Whole Person Care delivered at University of Bristol February 2012

This is of utmost importance as we should remember that effective relationships are central to effective care [9], and thus one should remember that in building an effective relationship with Muslim patients that they have a very strong attachment to faith in general and to be extra cautious not to hurt their feelings in any way, shape or form. Another interesting observation was that each and every one of them also agreed that there is certainly no connection between religion and culture. To the Muslim mind, Islam is a revelation from God and culture has no part to play in the rulings and beliefs of Islam. Amazingly enough, this same response came from a White Caucasian convert to Islam, people from the Indian subcontinent, African origin or South East Asian origin, thus showing that Muslims from whichever part of the world they maybe, have lots in common between them especially in issues of faith and its practice. It is probably as Hamza Yusuf Hanson from America put it, As time has passed, I have realized that wherever Islam went it did not divorce the people from their land, from their culture from their people, but rather it purified them. [11] However many different types of opinions came when the questions were asked as to how faith was linked to health care. When quizzed about how faith asks them to reflect on illness, or anything related to health care all of them replied with patience and prayers to God. Reference was made to the verse of the Quran Seek help in patience and prayer..[12]. Also made mention of was to have trust in God, in reference to whosoever puts his trust in God, then He will be sufficient for him. Verily, God will accomplish his purpose. Indeed God has set a measure for all things. [13] On a different note some have even commented that illness are tests from God to test who is best in his dutifulness to God, as referenced from [He] who created death and life to test you [as to] which of you is best in deed - and He is the Exalted in Might, the Forgiving [14]. Some also mentioned that they take illnesses as expiations for sins they have committed in this world as mentioned by the Prophet Muhammad (peace be upon him), No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that." [15] [10] Abdul Bari,M. Is Religion on terminal decline in Britain? http://www.aljazeera.com/indepth/opinion/2011/12/201112189292367590.html, Also on Huffington Post [11] Hanson, H.Y. A Message to Humaity delivered at the ISNA Convention 2004, United States of America [12] Quran, Surah Al-Baqarah Ch-2 V-45 ( Chapters in the Quran are called Surah literally meaning an enclosure of knowledge and guidance and Al-Baqarah is the name of the Chapter literally meaning the calf in reference to the Calf that the people of Moses fell into worshipping) [13] Quran, Surah At-Talaq Ch-65 V-3 [14] Quran, Surah Al-Mulk Ch-30 V-2 [15] Al-Bukhari, M. Sahih Al-Bukhari Volume-7, Book-70, Number- 545

These are very important points that doctors should know and ponder over when dealing with a Muslim patient, especially when we think about the mind-body connection. Many a times Muslims in terrible distress feel ease and calm if reminded that their sins are being expiated and they are just being tested by God and on passing of that test they are confirming themselves are better believers. This is something that would give a much need boost for the doctor in understanding the perspectives of a Muslim patient. However, looking at only this part of the survey would be a bit misleading and might lead to one having the wrong conclusions about Muslims and their relationship to health care. When asked the question pertaining to an emergency whom would they turn to- God or the hospital, only 2 people answered God, while the others mentioned both, and they believe it is part of faith to go to a hospital and seek necessary treatment. Worship (Ibaadah in Arabic) according to Islamic texts means every good that God loves and is pleased with[16] Therefore it is argued that it is beloved to God that one takes care of himself as the body is considered a gift and a trust from God which should be taken care of. Based on this, and also based on the saying of the Prophet Muhammad (peace be upon him), "God sends down both disease and cure. For every disease He provides a cure. Therefore seek cure but do not use in that any items that are forbidden"[17] The last part of the narration is very important at least according to the survey, because when asked if they would deny any form of treatment on the basis of health care, many of the 18 responded positively. 9 of them responded that they would not, however the other 9 responded in various ways. Some responded that they would not like to use anything that would have alcohol (specifically ethanol) or pig ingredients in it, unless it was a dire necessity in a life-threatening situation. With regards to the five daily prayers Muslims responded in various ways as well. All of them agreed that it does a lot to stabilize their mental health, give them a comforting arm during illness and any kind of grief, and also give them a time out from daily chores. One of them actually mentioned I feel mentally sick when I dont pray. Prayers also supposedly make them lead productive lives and helps build a routine in their lives on a daily basis, especially waking up early, most probably referenced to a TED video by Mohamed Faris. [18] Some of them also responded with physical benefits such as increased bloodflow to the brain especially during prostration, and other various health benefits, referring to a lecture by Dr. Zakir Naik. [19] There was unanimous no to the question Is your faith responsible for any negative influence on your health? When asked if you were not a Muslim, do you think health care, health illness and everything related to your bodily needs would have been different?, many interesting answers came up. Most of them agreed there would be a difference. [16] Green, A.R. What is the purpose of life? Delivered at the Unitesity of Glamorgan, Wales [17] Dawud, A. Sunan Abu Dawud [18] Faris, M. Can Religion teach us productivity? On TEDxArabia [19] Dr. Naik, Z. Salaah, delivered in Mumbai, India

Some mentioned that smoking and drinking were not among their habits because they were Muslims., and the hazards associated with them would probably have affected them if they were not Muslims. The British Medical Journal seems to agree as it mentions in one of its articles that Islam would likely be the reason to help Muslims quit smoking [20]. Most scholars of the era have ruled it to be forbidden and an act of slow suicide which is one of the gravest sins in Islam. Others argued that they would not have the mental peace they have now had it not been for the prayers and the fasting and the various rituals teaching them patience and perseverance. Some said that Islam gives purpose to their lives and thus life would be purposeless and worthless without it. Some say that the ablution they do before they pray (washing of limb,face etc) is of utmost importance in maintaining hygiene and thus they would not have had that in their lives had it not been for Islam. Overall, it can be concluded that Islam plays a vital role in the lives of Muslims worldwide. Therefore, as physicians and taking care of the whole person element of medicine, it is of utmost importance to know and understand more about Islam and Muslims to understand Muslim patients. More often than not their choices and preferences link to their own understanding of faith, understanding which could be correct or incorrect. Therefore, doctors should make an attempt to clarify the patients choices and will especially if they are Muslims. In fact one article even proposed having faith centred approach for Muslim patients.[21] These conclusions are based on the following Big Ideas of Whole Person Care Illness and its remedies lie at many levels within a system People have intrinsic abilities to gain and maintain health Effective relationships are central to effective care Hearing the patients story is important for effective care

[20] Influence of Islam on smoking among Muslims BMJ Volume 332 pp 291-294 [21] Head to Head: Should Muslims have faith based health services? BMJ Volume 334, pp 74-5

Reflection

I Bow Down