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Features: May-June 2016

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Upcoming Fasting Holiday: Ramadan

Happy RamadanIt is anticipated that Ramadan will start in North American on Monday, June 6th and last for 30 days until Tuesday July 5th. 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 Sunday, June 5th. 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 16 hours.

There can be medical and scheduling implications of fasting for some patients. 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.

Pre-Ramadan Planning for Diabetes Management:
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. When in the judgment of a provider, a patient’s health status is considered fragile, the provider can remind the patient about exemptions.

Read More
Including: Muslim Religious Observances and Diabetes | Breastfeeding in Ramadan | How Foods Affect Blood Sugar: A Guide for Somali Patients with Diabetes

Recent Features

What are mammograms and Breast Cancer - a Guide for Somali Women

Somali Mammogram Provider Patient

This 18-minute video slideshow presentation, narrated in Somali with optional English subtitles, is intended to be used by clinicians during discussion with patients about mammograms and breast cancer. It is culturally tailored to reflect common questions and concerns, with a focus on addressing major barriers to screening. It includes images of the various stages of the mammogram process and signs/symptoms of breast cancer.

How Foods Affect Blood Sugar: A Guide for Latino Patients with Diabetes


This bilingual presentation is intended to be used by clinicians during discussion with patients about carbohydrates and blood glucose. It is culturally tailored to reflect foods commonly consumed by Latino Americans and includes photos of foods, meal comparisons, and portion sizes. Also, includes tips for eating healthily during holidays, and cooking tips. Authored by Elizabeth Hulbrock.

Hepatitis B Research and Immigrant and Refugee Communities

By: Margaret Shuhart, MD, MS, Medical Director, Liver Clinic at Harborview Medical Center

Vietnamese Hep Brochure imageHepatitis B research traditionally has been underfunded, as diseases such as HIV and hepatitis C have been given higher priority by funding agencies. More recently, the NIH has established the Hepatitis B Research Network (HBRN), a group of 28 clinical sites across the US and Canada designed to address important clinical questions pertaining to hepatitis B in both children (7 sites) and adults (21 sites). Seattle has both adult and pediatric sites. Broad questions being asked by the HBRN include why some develop severe liver disease and liver cancer while others have inactive disease, how to improve the response to current treatments, and whether indefinite treatment is really required in those who have e antigen-negative disease. Most Southeast Asian/Asian adult persons have e antigen-negative hepatitis B, and many of these have active disease that places them at risk for cirrhosis and liver cancer. Despite the well-known benefits and excellent safety records of hepatitis B oral treatments, those with active disease are often reluctant to be treated, particularly if it is expected that such treatment will be lifelong. Identifying those for whom shorter duration treatment may be successful is critical if we are to engage more in treatments that can prevent the development of significant liver disease and liver cancer.

African-born individuals also have a high prevalence of hepatitis B infection. Through the HBRN studies, which to date have enrolled nearly 175 people from East and West Africa, we are able to explore risk factors for disease in these less frequently studied populations and include them in ongoing treatment trials. African Americans enrolled in our study, whether African or US-born, recently were found to be at increased risk for diabetes. Diabetes is known to further increase the risk for liver disease and liver cancer in people with chronic liver disease.

Additional HBRN studies in progress include the effects of hepatitis B on quality of life (in both children and adults), maternal knowledge of children’s hepatitis B infection and vaccination status, the impacts of alcohol and tobacco use on liver disease, the impact of pregnancy on hepatitis B activity, the role of the immune system in hepatitis B disease, and several others. While new enrollment into HBRN studies is now closed, investigators continue to follow people in these studies and to publish their findings.

For more information about research studies, see:

  • Hepatitis B Research Network (this site includes related links to CDC, clinical, American Liver Foundation, Immunization Action Coalition, among others)
  • Registered Clinical Trials (nationwide) 
  • Other hepatitis B research studies are currently planned at Harborview Medical Center. For questions, please contact Dr. Margaret Shuhart, 206-744-7054,

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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.

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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.

Scams Targeting Refugees and Immigrants

The U.S. Citizenship and Immigration Services (USCIS) and Federal Trade Commission (FTC) provide information about common immigration services scams and other kinds of scams targeting refugees and immigrants. To find information about recent scams, tools and education about avoiding scams, and to learn what victims should do if targeted, read more...