Features: June/July 2015
Summer: Seasonal Safety Issues
Summer safety issues include heat-related illnesses, sun exposure, water safety concerns, and use of fireworks or concern about fire. Extremely hot weather can cause sickness or even death. Read more...
Fasting Holiday: Consider Medical & Scheduling Implications for Some Patients
Ramadan will last for 30 days until Friday, July 17th. Many Muslims, including many in the local community, will follow dates established by the sighting of the moon in Muslim countries such as Saudi Arabia. Ending dates may therefore vary. Ramadan is the ninth month of the year in the Islamic calendar.
Clinical Considerations: During Ramadan, Muslims will abstain from food and drink from sunrise to sunset. In northern locations like Seattle, the days this year will be long, around 15 hours.
There can be medical and scheduling implications of fasting for some patients. For those who fast, the diurnal pattern of caloric intake is obviously reversed and diabetic schedules will have to be adjusted to accommodate this significant change. Sometime in the month prior to Ramadan a discussion between provider and patient should take place to plan medication schedules. Blood draws, anticoagulation, breastfeeding regimens, TID regimens, surgeries and other procedures may also merit special consideration during Ramadan. Senior doctors might consider bringing this to the attention of new interns who may not be in the habit of thinking about Ramadan when prescribing medication, scheduling procedures, and arranging follow-up on discharge from the hospital.
Health care settings might consider providing support for patients to maintain their religious practices. Islamic patients are more likely to keep their clinic appointment if they know a room is available to maintain their prayer times during their month long Ramadan observance. Eid-al-Fitr is a day of celebration marking the end of Ramadan, and clinics may want to take steps to avoid scheduling possible no-shows on this day in particular. Throughout Ramadan, Muslims gather as family and community in the evenings to break their fast. Inpatients may receive an increasing number of visitors during this month.
Fasting Exemptions and Extra Fasting: Based on the Quran, those who are sick, on a journey, or women who are menstruating, pregnant or nursing are permitted to break the fast and make up an equal number of days later in the year: [2:185]. Such persons as the sick elderly and chronically ill for whom fasting is unreasonably strenuous are required to feed at least one poor person for every day in Ramadan for which he or she has missed fasting, and are then not expected to make up the fast later. There are provisions made for paying back missed fasting days as practical aspect of the faith. It can be useful for providers to remind patients of this option; it sometimes allows one to negotiate important compromises. Muslim patients may still choose to fast because, to most, Ramadan is believed to be the most blessed and spiritually-beneficial month of the Islamic year.
Some people will choose to fast an additional 6 days after Ramadan, beginning the day after Eid-al-Fitr (celebration marking the end of Ramadan). This extra fasting is accepted by some Somali scholars as the equivalent of fasting for one entire year, while other Islamic scholars may say it is equal to 60 months (one day being equivalent to ten months). This type of fasting is called sunnah fasting.
- Clinical Pearl: Ramadan - Reminder to Health Care Practitioners
- Ramadan: taking a patient history from history
- Diabetes during Ramadan
- Breastfeeding in Ramadan
- Muslim Religious Observances and Diabetes
- Report on Somali Diet
- Food and fasting in Somali Culture
- How Foods Affect Blood Sugar: A Guide for Somali Patients with Diabetes
Migrant Children Health
of the hyped claims and concerns over health risks from unaccompanied
migrant children stem from ignorance, if not racial prejudice. The
answer to responding to disease challenges is not scaremongering, not
pointing fingers at migrant children, but rather ensuring that
appropriate treatment is in place for them, regardless of where
geographic borders lie. The following resources provide background
information on the problem, factual information to help educate, and
ongoing initiatives to address the misinformation.
Caring for Survivors of Torture - Selected New Resources
Obtaining Survivor Histories - Video Clips and Clinical Pearls
These videos are part of a series of short clips giving examples of issues to be aware of when obtaining a patient history. The clips are from interviews with patients of Dr. Carey Jackson (used with permission) demonstrating aspects of torture histories commonly encountered among torture survivors. New clips:
- Witnessing the Torture of Others: An Example of Mass Torture in Cambodia under Pol Pot
- Catastrophic Illness Triggers
- The Experience of Reactivation
Sequelae of Torture: Traumatic Brain Injury - Video
40 minute video presentation by Dr. Carey Jackson about working with torture survivors. Topics include mechanisms of traumatic brain injury, symptoms of TBI, and how to assess and treat.
Ritual Female Genital Cutting: Promoting Cultural Versatility and Safety in Medical Practice
Originally presented or referenced at an event organized by Seattle
University Students for Sexual and Reproductive Justice on December 5,
2014, materials include a video of the presentation given by speakers
Drs. Elinor Graham, Anisa Ibrahim and Anab Abdullahi, presentation
slides, intake form used to document patient history and exam, and links
to related journal articles.
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