Feature: June/July 2014
It is anticipated that Ramadan will start Saturday, June 28th and last for 30 days until Sunday July 27th. Based on sighting of the moon, Ramadan will start in North America a day later - on Sunday, June 29th. Ramadan is the ninth month of the year in the Islamic calendar. A fast, held from sunrise to sunset, is carried out through this period. Beginning and ending dates vary depending on country location.
Clinical Considerations: During Ramadan, Muslims observing the fast will abstain from food and drink from sunrise to sunset. In northern locations like Seattle, the days this year will be long, more than 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.
Phrases of Courtesy in Nine languages:
A tool for medical providers
By Benji Perin, MD Candidate (2015), University of Washington School of Medicine
In the provider-patient relationship, the path to positive health outcomes begins with a human connection. Developing rapport lays the foundation for each successive stage of the visit — from agenda setting and gathering information, to sharing information and involving patients in creating their treatment plans.
Language barriers make each one of these steps more difficult. Professional interpreters play a crucial role in helping providers and patients communicate, but the important work of making a connection still falls to the caregiver.
The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. Using phrases of courtesy in a patient's own language shows interest and respect, allows at least a few moments of direct connection between patient and provider, and hopefully sends the conversation for a brief sojourn into social waters with the interpreter as navigator. This language learning tool features videos of native speakers saying phrases of courtesy in nine languages. These phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a slow speed. Making a connection in this way is not just courtesy, but lays the foundation for the highest standard of care, a standard we wish to see extended to all patients, regardless of their English proficiency. Read more...
Multimedia Patient Education Highlight: Cancer
EthnoMed and Healthy Roads Media, in collaboration with the Community House Calls Program at Harborview and its community partners, produced a series of handouts and Flash video slideshows in seven languages (Amharic, English, Khmer, Somali, Spanish, Tigrinya and Vietnamese) that provide introductory information about several topics: biopsy procedures, cancer chemotherapy, prostate cancer and surgeries for breast cancer.
Cancer education was identified by the Community House Calls staff as a major area of need for EthnoMed content development. The program's Caseworker / Cultural Mediators (CCMs) served as advisors and narrators, community members provided linguistic/cultural input, and health care providers gave clinical input to develop the new education materials. The project also supports CCMs in utilizing iPads for delivering health education to patients and community groups.
The new materials are available for web viewing via both the EthnoMed and Healthy Roads Media websites. Healthy Roads Media is also hosting audio and mobile video formats and an online survey to gather feedback for assessing the utility of these materials.
This project was funded in whole or in part with Federal funds from the Department of Health and Human Services, National Institutes of Health, National Library of Medicine, under Contract No. HHS-N-276-2011-0008-C with the University of Washington. A special thank you to Safeway Foundation for its support to Harborview Medical Center’s EthnoMed for the development of cancer-related content.
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