Clinical Pearl: Ramadan - Reminder to Health Care Practitioners
*It is anticipated that Ramadan in 2013 will start on Tuesday, the 9th of July and will continue for 30 days until Saturday, the 7th of August Based on sightability in North America, in 2013 Ramadan will start in North America a day later - on Wednesday, the 10th of July.
The fourth requirement of Islam is fasting during Ramadan: the 9th month of Islamo-Arabic lunar calendar. Ramadan is considered a month of community because religious practices such as prayers, fasting, charity, and self-accountability are often practiced within community setting. During fasting, Muslims avoid eating, drinking and smoking from sunrise to sunset. Muslims gather as family and community in the evenings to open their fast by prayers and read the Qur'an in the evenings. Patients may receive an increasing number of visitors during this month.
Abstention from food and drink may bring problems for Muslim patients who wish to fast. They may wish to fast because, to most, Ramadan is believed to be the most blessed and spiritually-beneficial month of the Islamic year. Based on the Quran, those who are sick or on a journey, and 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 every day in Ramadan for which he or she has missed fasting, and are then not expected to make up the fast later.
"The month of Ramadan is the one in which the Qur'an was revealed, as guidance for humanity, and demonstration in the way of guidance and discrimination. So whoever among you is present that month should fast. If anyone is ill or on a journey, then the prescribed term is to perform other days. God wishes ease for you, not hardship; and that you fulfill the prescribed terms, and that you celebrated God for guiding you, and to express your appreciation."
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 for the month of Ramadan.
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.
*Note that in the Muslim calendar, a holiday begins on the sunset of the previous day, so observing Muslims will celebrate Ramadan beginning at sunset of Monday, the 8th of July.
Note that these are dates adopted by the Fiqh Council of North America for the celebration of Ramadan based on astronomical calculations to affirm each date, and not on the actual sighting of the moon with the naked eyes. 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. Beginning and ending dates may therefore vary.