Skip to content. | Skip to navigation

Personal tools
You are here: Home

Features: May 2018

Ramadan 2018

Upcoming Fasting Holiday: Consider Medical & Scheduling Implications for Some Patients

It is anticipated that Ramadan will start Wednesday, May 16th and last for 30 days until Thursday, June 14th. Note that in the Muslim calendar, a holiday begins on the sunset of the previous day, so observing Muslims will celebrate Ramadan beginning on the sunset of Tuesday, May 15th. 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. Ramadan is the ninth month of the year in the Islamic calendar.

Clinical Considerations: During Ramadan, Muslims will abstain from food and drink from dawn to sunset. In northern locations like Seattle, the days this year will be long, around 15-16 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 medication 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 adjustments. Consider scheduling visits with primary care provider and with a dietitian to establish a Ramadan meal plan (and pharmacist if needed for medication consultation). Consider asking the patient to practice with their new regimen prior to Ramadan and have a plan if additional adjustments are needed.

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 providers should be vigilant and ask their patients whether they intend to observe regular or modified fasting. Engage in a full discussion of the degree of the individual’s risk from fasting with the patient who intends to fast. For patients who prefer to fast, individualization of care and frequent monitoring is highly recommended. Patients often have experimented and developed their own regimen. Exploring this with the patient helps build a partnership between patient and provider, capitalizing on the knowledge of both parties.

Patients’ decisions to fast may need to vary year by year, and their participation in the fast may need to become modified as they become more fragile and unable to do the entire fast without risk of dehydration, hypoglycemia, or exacerbation of illnesses requiring daily monitoring or medications. Advise patients with diabetes to monitor BG more frequently during fasting periods. Take into account how long the fast will last. Incorporate the patient’s experiences with control of chronic disease when fasting in previous years into current treatment recommendations.

When in the judgment of a provider, a patient’s health status is considered fragile, the provider can remind the patient about exemptions. It is important to remember that this is a total fast during the long daylight hours of mid-May to mid-June. This means people are NPO for 15 or more hours. For example, if a patient has renal insufficiency, is hypotensive, or is dysautonomic and being mildly dehydrated may compromise their fluid balance or other underlying state, a conversation about fluids and food consumption and the wisdom of an exemption is in order.

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 in order to avoid no-shows, clinics may want to take steps to avoid scheduling appointments on this day. 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]. Persons who are sick, elderly or 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 combined with the 30 days of Ramadan fasting is accepted by some Islamic scholars as the equivalent of fasting for one entire year. This type of fasting is called sunnah fasting.

Read more on EthnoMed: including information about management of diabetes and breastfeeding during Ramadan.

See also Avicenna J Med article: Muslim patients in Ramadan: A review for primary care physicians

Recent Features

2018 North American Refugee Health Conference In Portland, Oregon

NARHC image

Healthcare Advocacy

Excerpt from EthnoMed Newsletter, February 2018: "The trust between physician and patient is a core tenant of the medical profession. By extension, trusting relationships with nurses, technicians, hospitals and clinics are where this relationship plays out. This trust is now threatened by U.S. Immigration and Customs Enforcement (ICE). In a startling breach of precedent, ICE agents have begun to target clinics and hospitals to enforce immigration policy. It is our opinion that these enforcement actions actively jeopardize patient care." Read more...

Making a Case for Sanctuary Hospitals
Saadi A, Ahmed S, Katz MH. Making a Case for Sanctuary Hospitals. JAMA. Published online October 16, 2017. doi:10.1001/jama.2017.15714

Advocating that health care professionals support and advocate for health care facilities to be sanctuary places that protect the undocumented and vulnerable.

Care for Deferred Action for Childhood Arrivals (DACA) Community

In the midst of the harsh political climate EthnoMed is reminded we are part of a larger educational and health system that supports and cares for all people.  Our Harborview Medical Center mission statement includes priority care to persons who are non-English speaking poor, persons who are uninsured or underinsured, and many other vulnerable populations.  The words of the University of Washington President Ana Mari Cauce provide us with a reminder that the work is important and a call to action: 

"...Ending DACA diminishes us all. It breaks the promise our country made to these students when we urged them to enroll in the program, to be proud and unafraid. We join with leaders in higher education, industry, government, religious institutions and humanitarian agencies across the nation in calling for congressional action to restore the program quickly.

Discontinuing the program doesn’t just threaten the security and futures of Dreamers. It also threatens to erode our nation as a democracy that has embraced the diverse talents and contributions of generations of immigrants, including our country’s founders."  Read the entire letter 

Northwest Immigrant Rights Project (NWIRP) has compiled a list of important resources in light of the President’s September 5th announcement that the DACA program is being terminated. Update February 14, 2018: USCIS is currently accepting DACA renewal applications, as well as applications from DACA eligible community members whose DACA status has expired. NWIRP and partners at Perkins Coie will be holding free DACA renewal clinics in Seattle, Wenatchee and Granger offices.    


Evidence shows that the risk for development of diabetes and associated complications among immigrants increases in the years after arrival to the United States. 

Find information on EthnoMed about diabetes (Clinical Topics and Patient Education) and other external resources of education materials in multiple languages: National Library of Medicine's HealthReach and Medlineplus websites.    

FaviconjpegQuick Links:

DSM-IV Diagnostic Codes
Tests / Procedures Radiology Communication Phrases Translated
LTBI Treatment
Welcome to EthnoMed

EthnoMed contains information about cultural beliefs, medical issues and related topics pertinent to the health care of immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world.

EthnoMed Newsletter & Twitter

Subscribe to our e-Newsletter to receive updates about what's new. Read more...

Follow EthnoMed on Twitter twitter

Make A Gift

Donations made to the EthnoMed Community Outreach Fund support the development of this website and creation of its educational content. Please consider making a gift online. Read more...

Refugee Health Weekly Roundup

This summary is compiled by the Washington State Department of Health Refugee Health Program. The Weekly Roundup highlights upcoming events and opportunities, resources and news relevant to refugee health. Some information is local to WA, but also what's on the national agenda. Read the latest edition of the Refugee Health Roundup.

Migrant Children and Health

The Migrant Children and Health Campaign has created a video featuring leaders in immigrant and refugee health advocacy introducing the facts about migrant children health and the continued history of racial and ethnic disease scaremongering in the U.S. For more information about this Campaign and to view the video "Migrant Children and Health: Borders, Boundaries, and Bigotry" click here.

Torture Resources

Resources for clinicians and advocates around issues of torture, often related to warfare and political repression.  Includes information about Northwest Health and Human Rights (NWHHR) coalition serving refugees, asylum seekers, and immigrants in Washington State.  Visit Caring for Survivors of Torture page for additional information.