Cultural Misunderstandings at the Sick Bed

Karim Ötztürk is lying with a femoral neck fracture in the local hospital and having heated debates with the nursing staff. The topic is the cafeteria's fare. Ötztürk would like to follow the dietary laws of Muslim holiday month of Ramadan, even while lying in the hospital. The nurse, overwhelmed by the conflict, calls on the doctor for help.

Fourteen million Muslims live in Western Europe today, and over three million of them in Germany. Some doctors' offices handle a patient load which is about 30 percent Muslim. That linguistic and cultural confusion results is perhaps not so surprising.

Ilhan Ilkilic, teaching assistant at the Institute for History, Theory, and Medical Ethics at the University of Mainz, has been researching typical conflicts between Muslim patients and German doctors for many years.

He explained that while the linguistic misunderstandings were well known, the deeper, cultural differences were not.

"Even today, ethical problems in the care of Muslim patients are often neglected," Ilkilic said.

From pious to irreligious

The fact that Muslims are not a homogenous group in Germany makes dealing with Muslim patients more complex. Some are highly devout, while others have assimilated and abandoned their religion.

Ilkilic described three conflict areas where conflicts between patients of Islamic faith, and doctors and nurses occur. One of the greatest problems is that of communication. Often it is a German-speaking family member who accompanies the patient at the bedside.

Here the question remains open, if the family member tells the patient the truth. Sometimes the family members want to protect the sick from the truth and therefore purposefully mistranslate the doctor's statements.

Hamideh Ünal, psychotherapist at the Center for Victims of Torture in Cologne, described a situation in which a translator at the bedside became a great difficulty for both doctors and patient.

"In such a situation it is nearly hopeless to build up any trust," she said.

A touchy subject: body contact

Ilkillic sees a further problem in the crossing of intimate boundaries in medical examinations. Muslims avoid body contact with the opposite sex. Women of faith shield their bodies from the gaze of men.

The Iranian gynecologist Dr. Khosravie from Bergisch Gladbach told of patients who had gotten undressed for the examinations but not removed their head scarf.

"Traditional Muslims don't even consider my medical practice," he said Khosravie. For some men, getting a sponge bath from a nurse is worse than the sickness itself. Therefore, the medical care should, when possible, be provided by doctors and nurses of the same sex.

The third conflict area, as shown by Karim Ötztürk's example, is the dietary restrictions of Islam. Most German hospitals today do offer an alternative to pork, however some medications do contain pork products or alcohol.

Furthermore, Islamic fasting laws dictate not only the types of food fit for consumption, but also the times of day that one is permitted to eat. In the month of Ramadan, from dawn until dusk, both fluids and solid foods are taboo.

Ramadan in the hospital?

The Koran explicitly pardons the sick from the fasting rite, but leaves open just when the individual is officially sick. This is often a difficult decision for the patients. In such a case the patient could seek the counsel of an Imam. In this way he could be enlightened about not only the medical, but also the religious consequences of his decision.

Arif Ünal, head of the Health Center for Migrants, would prefer a prayer chapel for Muslim patients in German hospitals. "Every Christian in Germany has the opportunity to retreat to a prayer chapel in the hospital. Why can't it be offered to Muslim patients as well?"

Ünal believes that doctors must deal with Islam more intensively, in order to avoid misunderstandings and conflicts. At the same time, patients can only be helped when they explain to the doctors their values and needs.

A small step which could lead to better understanding between doctors and foreign patients is the translator pool, introduced in Berlin two years ago.

The project was initiated by the European Union, to enable medical and social institutions to hire translators in an emergency. The costs must be borne by the respective institution.