Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Frightening and depressing
- Leonard Peter (12 January 2007)
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Faith Based health Care: an oxymoron.
- Mark W Savage (14 January 2007)
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Re: Frightening and depressing
- Kate M Grantham (14 January 2007)
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Evidence based or faith based?
- ASHISH KUMAR (15 January 2007)
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Faith based health services might result in loss of freedom for Muslim women
- Serge Rozenberg (15 January 2007)
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Should Muslims have a faith based health Service?
- Sam Ramaiah, Pir Shah, Pratima Jain (15 January 2007)
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Lack of recording of patients' ethnicity
- Caroline S Flood (16 January 2007)
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male infant circumcision is unethical too
- Paul A Burgess (16 January 2007)
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Should Muslims have faith Health Service
- John L Surur (16 January 2007)
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What is the price of Faith?
- Kiaran Asthana (16 January 2007)
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Re: male infant circumcision is unethical too
- Simon A Clarke (17 January 2007)
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Re: Frightening and depressing
- Anna Popova (17 January 2007)
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Faith based health services
- sriramashetty vengopal O.B.E (17 January 2007)
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There are other issues apart from circumcision
- Tania Ahmad Syed (17 January 2007)
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Re: Lack of recording of patients' ethnicity
- Dr JK Anand (18 January 2007)
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A Reality Check Needed
- Jay Ilangaratne (18 January 2007)
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Re: Esmail vs Sheikh
- Stuart Brown (22 January 2007)
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No to faith-based health services
- Alexander D Mortimer (23 January 2007)
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Medicine and superstition
- Vija K Sodera (27 January 2007)
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A new philisophy is required
- Naseer Ahmad (27 January 2007)
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Faith based health services: Improved provision or further segregation?
- Deborah A Carr (30 January 2007)
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Evidence Based Health Care
- Abid Hussain (31 January 2007)
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A New Philosophy
- Achyut Valluri (9 March 2007)
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Urgently required:Separate services for separate faiths
- Saddichha Sahoo, Ranchi,India (20 March 2007)
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Beliefs should be respected
- MUHAMMAD KAMRAN ZAFAR (26 March 2007)
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Leonard Peter, GP Harrow 45 Enderley Road Harrow Weald Harrow middlesex HA5 3AZ
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Having just started Richard dawkin's excellent book "The God Delusion" this discourse came to me like a bucket of ice cold water thrown over my head. Rather than deal with the whole range of issues thrown up by a request from a representative of a group that their superstitions should affect the provision of health care in this country, let me deal with male circumcision. To me, and I am sure to many general practitioners, health visitors and paediatricians, the unecessary mutilation of a passive male infant's genitalia is a horror. That we should allow groups of people (however large) to inflict this legally is rather strange. However to suggest in a medical journal that the NHS commissions this practice is frightening and depressing. Dawkins points out that there are no Muslim children, no Christian children, no Jewish children. There are only children of Muslim parents, Christian parents, Jewish parents. These children need their rights protecting. If an adult choses to mutilate his genitalia then so be it but a child should be protected from adult superstition. We are all entitled to our views and free speech, but today's controversial opinion may become tomorrow's accepted practice and as a secular, enlightened, rational United Kingdom general practitioner, this article in the BMJ has frightened me. Competing interests: None declared |
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Mark W Savage, Consultant Physician North Manchester General Hospital, M8 5RB, UK
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Faith Based Health Care? Catholic hospitals in Australia do not give out the morning-after pill; Jehovah’s Witness hospitals would ban blood transfusions. Goodness knows what the hospitals run by the Church of the Great Flying Spaghetti Monster (1) or the Jeddi Knights (2) would do, spaghetti-only meals and light sabres to be used for surgery? It was with initial horror that I saw the front cover of the BMJ of the 13th January 2007: should Muslims Have Faith Based Health Services?”. However, the article by Professor Sheikh (3) is riddled with so many holes it is with pride that I am able to say that I am a member of the BMA; congratulations to the Editor for allowing these pernicious arguments to see the light of day. This will allow all to see what a harmful and dangerous viewpoint this is. I wonder, will the first Muslim hospital be Shia or Sunni? My fellow Mancunian, Professor Esmail (4), has highlighted with great eloquence that the main problem is racism and not religious bigotry. There are some truths in life: we cannot choose our race; we are all born atheists; and we chose our religion (or occasionally have it forced upon us). Addressing racial issues is clearly paramount for a liberal society in the 21st century. The problems of poor Muslims has nothing to do with religion. Present poor health outcomes are similar, in relative terms, to those which were found in centuries past in populations of poor Irish, poor Jews etc. The very real problems of the heterogeneous Muslim populations will be solved in the same ways: by hard work; the speaking of the majority tongue; acceptance by the majority population (already happening to a great degree); and the passage of time; not by separation and special treatment. Moreover, if Professor Sheikh really believes Muslims are oppressed by both their fellow citizens and the British State, then separate hospitals will permit even more discrimination; and lead to a self-fulfilling prophesy allowing him to declare “I was right!”. With regard to the phrase “There is...not one British academic grouping...researching the health needs of Muslims”; does this mean: Indonesian Muslims; Chinese Muslims; French Muslims; Muslims from Arabia; American Muslims; or Turkish Muslims? Some clarification would be grand. Personally, I am not aware of any academic groups researching the needs of any specific religions, but there are many groups analysing racial differences as 1 minute on Google® will demonstrate. We must all strive for equality in health care, not separation; at least that is what my Medical School taught me. Was I brain washed? 1. http://www.venganza.org/ 2. http://news.bbc.co.uk/1/hi/uk/1589133.stm 3. Sheikh A. Should Muslims have a faith based health service? BMJ 2007 334:74 4. Esmail A. Should Muslims have a faith based health service? BMJ 2007 334:75 Competing interests: Dr Savage has been a victim of religious bigotry in Northern Ireland and is a member of the National Secular Society. |
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Kate M Grantham, Gp Wymondham Medical Centre, NR18 0RF
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I believe in at least attempting to obtain informed consent before any procedure, and I don't believe a baby is able to give informed consent. I especially find the idea of circumcision (male or female) abhorrent due to its irreversibility; if as an adult the victim decides it was a bad idea, they can't have the bit that was chopped off sewn back on. I appreciate that babies and children have all sorts of procedures performed on them, without giving their consent, and I think it' s ok to fix broken legs and remove burst appendices - presumably, circumcision is seen as equally vital by some people. So I'm back to disliking people chopping bits off babies. Competing interests: None declared |
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ASHISH KUMAR, Registrar Medicine St. Peters Hospital Chertsey. KT16
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I was always taught that practice of medicine should be evidence based guided by knowledge and wisdom. So where is the place of faith in medical practice? And if we decide to consider faith in NHS why only muslim faith should be given the privileged treatment. There are hundreds of faiths (not religions) which should also be respected. Being the largest minority would not make you more privileged. Why should NHS provide these faith based treatments (male infant circumcision) from hard working tax payers's pocket. Frankly it would be disgusting. Can government afford to fund for 'mundan (first hair cut) ceremony' of hindu kids?. Faith is some thing very personal and private and should be funded privately. There is no need to brandish religion and faith in hospitals. Please practice all faiths at home and at your own expenses. There are more important priorities for the NHS. Competing interests: None declared |
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Serge Rozenberg, MD, Head of unit CHU ST PIERRE Free univesity of Brussels, Belgium
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I totally agree with Aneez Esmails’ point of view regarding the organising of faith based health services. Working in a large, multicultural public hospital, we face daily, specific demands that Muslim women should be treated by female health care providers only. While, this is to a certain extent, feasible for consultations by appointment, (and in this case it is no different from a patients’ preference for nonreligious reasons), it remains inadmissible during hospitalisation, during surgical procedures and in emergency situations. The most shocking is that these demands are generally not expressed by the patient but by her husband, or another male relative, who will sometimes even jeopardise her health or her life by doing so. The organisation of such services would also lead to sexual discrimination in some professions (for instance male nurses). Finally, the generalised organisation of faith based health services, might also result in a loss of choice for young women who want to express themselves freely in reproductive related issues (such as contraception, abortion, domestic violence or rape). Competing interests: None declared |
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Sam Ramaiah, Director of Public Health Medicine and Medical Director Jubilee House, Bloxwhich Lane, Walsall, WS2 7JL, Pir Shah, Pratima Jain
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Professor Aneez Esmail is right in saying that compartmentalised health care based on faith groups will increase stigma and we believe such a move will destroy tolerance and trust which are basic tenets of a multi- cultural and multi-religious society (1 & 2). Instead we should be trying to understand the needs of all communities and then commission and provide services which are aimed to meet all these multiple needs. Here in Walsall we have commissioned National Health Service (NHS)to provide circumcision services for religious purposes for males. This service can be accessed by Muslims and others, alike. However not all parents who need this service access NHS provision instead we presume seek circumcision elsewhere. This scenario opens a major conundrum for the NHS- Faith based service is a first step but how do we encourage these groups to access the service. Our surveys of Walsall people have consistently indicated that women of all backgrounds would like to see female obstetricians and as a result the local hospital has 3 female consultants making sure that women have a choice. However, the experience so far seems to suggest that male obstetricians also receive referrals from all groups irrespective of faith and religion. It’s generally acknowledged that the NHS often doesn’t provide appropriate services to all communities that it aspires to serve and this includes disadvantaged communities- be it socio-economically deprived or faith based or indeed groups that have a particular way of life such as travellers. Therefore the priority is to make the health service responsive to all these peoples aspiration rather than a discerning service based on faith and religion. Reference: 1) Should Muslims have faith based health services? Aziz Sheikh BMJ 2007;334:74 (13 January) 2) Should Muslims have faith based health services? Aneez Esmail BMJ 2007;334:75 (13 January) Competing interests: None declared |
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Caroline S Flood, Specialist Registrar, General Adult Psychiatry Millbrook Unit, Kingsmill Hospital, Mansfield, NG17 4JT
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The article by Professors Sheikh and Esmail (1) raised some interesting points regarding the recording of patients’ ethnic groups, particularly in light of the recently publicised Race for Health programme (2). Insufficient data regarding the health profile of Muslims (and other minority groups (3)) unfortunately comes as no surprise. In an on-going service evaluation carried out in our psychiatric Crisis Resolution and Home Treatment team only 44% of patients had their ethnicity recorded on the assessment form. Nearly 70% of the patients included were previously known to services (where it may have been assumed that ethnic origin had already been documented), but of those previously unknown to mental health services, ethnic origin was noted in only 40%. 19% of patients passing through the service left with their ethnicity unrecorded. True figures for the recording of patients’ ethnicity may be even lower as team members carrying out the assessments were aware that their work was being audited (albeit for the purpose of service evaluation rather than documentation of demographic information). Gathering data on ethnicity seems to be considered an unimportant part of direct patient care. Ethnicity may be regarded as “an abstract concept used for monitoring” rather than “an important part of their self”(1), but the implications for the individual patient, wider service delivery and future inequalities in healthcare of this lack of recording are vital. References 1 Sheikh A, Esmail A. Should Muslims have faith based health services? BMJ, Jan 2007; 334: 74-75. 2 Duffin C. Race is on to close the healthcare gap. BMA News, 2006; December 23: 3. 3 Department of Health. The race equality agenda of the Department of Health. London: Stationery Office, 2000. Competing interests: None declared |
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Paul A Burgess, General Practitioner Gosport PO12 3PN
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Professor Esmail rightly states that female circumcision is 'morally and ethically unacceptable' but it would be preferable to use a term such as 'female genital mutilation' (A recent BMJ leader writer down-played the gravity of this practice and failed to address the key issue of consent) Male infant circumcision also contravenes the cornerstone of ethics, namely informed consent. Religions can and must alter their teaching on the age for male circumcision to bring it in line with accepted medical ethics and human rights. The latest research that male circumcision reduces the transmision of HIV should not alter this view as the age when young men might begin to be sexually active would likely correlate with the age when informed consent for circumcision could be given -and the operation might concentrate the mind! Competing interests: None declared |
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John L Surur, SHO University hospital Lewisham
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Response to BMJ article 13/01/07: Should Muslims have faith based health services Prof Aziz Sheikh suggested that Muslims should have faith based health services because Muslims have the poorest overall health profile in Britain and religious discrimination that the health professionals at large are in denial. I disagree with this suggestion whether it is a Muslim or other faiths based health services. Religious discrimination is not found only in the NHS but in society at large. This should be resolve at the level of society as a whole and there have to be a political will, but not by creating a different health services for Muslims. Instead this will create further discrimination. When we were trained as health professionals, we were not trained based on faith or to treat patient based on their faith. As health professionals we have to give care to all patients irrespective of their faith, race, or gender. If UK Muslims should be granted a faith based health service will lead to break down of the NHS because the different faiths (Christians, Jews, Hindus, Sikhs, Non-faith etc) in the country will demand the same. In addition health professionals will also work based on their faith. Is this the kind of health service we want? The answer is no. We need a health service that will care for everyone irrespective of their religion, race, or gender. Having a Muslim faith based health services is not going to solve the poor health profile within the Muslim community. Just look at countries where the majority are Muslims, are their health profile better than UK Muslims? I don’t think so, UK Muslims health profile is much better compared to some of these Islamic countries. Therefore how can creating a Muslim faith health services improve their health profile? Health education and awareness is the answer to improve health profile not only in the Muslim community but in society at large. The Muslims and other faiths should remove the turbo that certain health aspects should not be discussed. As health professionals we need to encourage health education and awareness not creating health services based on faith. Competing interests: None declared |
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Kiaran Asthana, GP Lakeside Medical Centre, Perton, Wolverhampton WV6 7PD
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As an atheist, I regard the dilemmas of the religious with more sympathy than understanding. Thus I worry a bit when medical intervention is proposed for a particular group on the basis of a strongly held faith. Healthcare needs exist in competition for communal resources, and everyone deserves their fair share. The process of reconciling competing demands involves dialogue and tolerance - politics, in other words, and not so easy when one voice has God on it's side. Maybe there is benefit for everyone in the public funding of faith- based medicine. Perhaps there is robust evidence for this, and in time NICE will tell us the premium to allow for beleif. In the meantime, let's stick to reason. Competing interests: None declared |
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Simon A Clarke, Consultant Paediatric Surgeon Chelsea & Westminster Hospital, London
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Male cultural/ religious circumcision has been the subject of much debate amongst the paediatric surgical fraternity for some time. We as surgical practitioners regardless of have until recently been able to accept or refuse a child referred for circumcision for religious or cultural beliefs. The ethics behind the decision to operate for many surgeons, is either a respect for the beliefs of others and / or a process of damage limitation against unknown non registered 'practitioners' within the community. In London, non medically indicated circumcision is no longer possible on the NHS due to financial constraints. The practice throughout the country is very divided but I feel will follow suit in most regions. The real problem is where it is being done, how and by whom. There needs to be a government supported list of registered affordable practioners endorsed by a team of representatives from all sections of the community currently providing this service as well as paediatric surgeons within the NHS. There needs to be a close monitoring of standards (www.BAPS.org.uk - documents in the public domain) of such practices if we are no longer able to accept such children within the constraints of an NHS trust. Competing interests: None declared |
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Anna Popova, SHO in Psychiatry Green Lane Hospital, AWP NHS Trust
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When I offer my patients to tick their nationality and religion at their outpatient appointments I feel rather embarrassed. Why should that matter? Well, it doesn’t matter to me as I strongly believe that in illness we all hurt the same. I am aware of the fact that this piece of paper should actually ensure all the patients are equally treated… but… is it the right way? I also very strongly agree with the author of this response (as a person, as a doctor, and, as a mother of a boy) that boys should not be allowed to be mutilated by circumcision. Will this time ever come? Competing interests: None declared |
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sriramashetty vengopal O.B.E, retired G.P.past president O.D.A. BIRMINGHAM B16 9JT
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Professor Aneez Esmail's article is true in many ways, the health services we provide need to be culturally sensitive and individually orientated. We as GPS are trying to meet the needs of multi racial and multicultural population, albeit there are many examples of overt and covert racism in delivery of health care by some members of medical profession. I distinctly remember early sixties when immigrant patients had to face lots of problems to get GP services and more particularly in Hospitals. We have come long way from that scenario, many overseas doctors opted for general practice in mid sixties in the innercity and deprived areas where high percentage of immigrant population lived. These overseas doctors started providing culturally sensitive and faith orientated services to their patients. These Doctors were well versed with the languages and expectations and faiths of their compatriates. For many first generation Immigrants the major problem was that of communication and lack of understanding as to how to use NHS facilities. The overseas doctors have given yeomen services to their compatriates, and no one can deny this aspect of services, and effort. Even today it is only the overseas doctors who man the innercity practices. Now things are changing, the second and third generation British Immigrants are well informed, can avail the NHS services and help their families. What we really need is proper and continuous training of medical staff on cultural awareness and basic faiths of our multicultural population in the UK. Any essential service that does not meet the individual needs of patients is not worth its salt. Let us not waste our time on dicussion of faith based services but to provide a culturally sensitive and competent health service to cater to the needs of a plural community in the UK with diversity in their lifestyles and expectations. Competing interests: None declared |
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Tania Ahmad Syed, Clinical Registrar Royal Liverpool Hospital, l6 7pg
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I am amazed that everybody is more or less just talking about circumcision. The reality of the situation is there are many issues. As a woman even if not muslim I would like a female doctor. Things like lack of advice or knowledge about the insulin requirements for diabetics in Ramadan, pharmacies ignorance about the presence of gelatin or alcohol in drugs are just the tip of the iceberg. It is not about faith or religion, it is about understanding and respecting somebody who is different than you are and treat as equal. The first thing about being a doctor is the ability to empathasize with your patients. There are certain issues that people of different faiths can't understand about each other but when you are treating a patient rather than thinking that their views is wierd or utterly non understandable, we all should make extra effort just to know their priorities a bit better and never force our own prejudices & beliefs on them. For example, a doctor who persuaded a Sikh patient to cut his beard, unnecessarily, before a procedure seems to me the height of faith prejudice... Competing interests: None declared |
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Dr JK Anand, Retired Not applicable
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I would be grateful if Dr Flood could define ethnicity. JK Anand Competing interests: None declared |
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Jay Ilangaratne, Founder www.medical-journals.com
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This question raises only an academic argument as many sensible people would realise that proposed faith-based services are neither practical nor affordable in the current NHS. However,on the face of it, there is some force in the argument that such exclusive services may be funded entirely by non-governmental sources. But,even if the funding-hurdle could be crossed,the legality of such faith-based services would come into question as promotion of such a service could effectively fall under unlawful 'segregation' and may amount to 'aiding an unlawful act' per Race Relations Act 1976(as amended).Moreover, it is more than likely if not inevitable that providing an exclusive service for one religious group would open the floodgates for further similar demands from other groups; so there is also a strong public policy argument for not granting such services in a multicultural & multireligious society. I suggest,those who advocate such impractical and unaffordable luxuries,spend their time campaigning against the real evil that ethnic minorities face in our society including the healthcare system, which is racism. 17.1.07 Competing interests: None declared |
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Stuart Brown, Locum Lincoln
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Professor Esmails article highlights some of the problems arising from faith based allocation of healthcare (1) but leaves unquestioned the role of the hospital chaplain. A quick scan of pubmed reveals that hospital chaplains have been subjected to little scrutiny in the UK. A recent survey of hospital chaplains has suggested that only 26% felt that they had received appropriate training in pastoral support techniques (2) Health professionals and the public are more aware of the issue issue of funding for hospital chaplains than ever before. A report from Worcestershire Acute Trust found that excluding the cost of the upkeep of hospital chapels, chaplains cost £50,000 per year each (3). When asked in parliament recently the Health Minister said that the government kept no record of the number of chaplains in UK hospitals (4). Estimates have put the total cost to the NHS at £20 million pounds a year (3). Perhaps now the time is right to subject hospital chaplains to a rigorous audit, not only to find out how many there are and how much we are paying for them, but also to find out what demand there is for this service, how this service is requested, what proportion of patients see a chaplain and for what reason. Not least we should to attempt to evaluate the impact that chaplains have on patients physical and psychological health. 1. Should Muslims have faith based health services? BMJ 2007; 334: 75 2. How well trained are clergy in care of the dying patient and bereavement support? J Pain Symptom Manage. 2006 Jul;32(1):44-51 3. http://www.secularism.org.uk/editorialbyterrysandersonperhaps.html 4. http://www.theyworkforyou.com/wrans/?id=2006-12-18b.105334.h&s=chaplaincy+staff#g105334.q0 Competing interests: None declared |
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Alexander D Mortimer, Medical Student Newcastle University
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I read with interest Aziz Sheikh’s arguments in favour of faith based health services. Faith based health services would segregate Muslims from the rest of the community. Riots in Oldham and terrorist attacks have increased sensitivities to race and religion in this country and segregating Muslims in this way would surely isolate them at a time which could not be more unhelpful. Sheikh mentions Muslims in Britain often but only once refers to British Muslims. Is it not more important to value the former as the latter? If that is the case, and I believe it is, then Muslims’ healthcare needs should be met in the same way as those of their fellow Britains. Some of those needs, however, are different. Arrangements around the Hajj and Ramadan are unique to Muslims, but some healthcare needs of Muslims are not as unique as Sheikh claims. For example, wanting to see a same sex physician is not exclusive to Muslims. Similarly, dietary requirements are not restricted to Muslims. Should there be separate health services for other faiths, vegetarians, and people with Coeliac disease? Sheikh states that “religious discrimination is … endemic” in this country, but would the faith based health services he advocates not fall foul of this. Would anyone be able to work in such faith centres or would employers discriminate applicants on a religious basis? Furthermore, Sheikh’s proposals would balance one inequality at the expense of another; many non-Muslim women have difficulty finding a female doctor and under Sheikh’s proposals, religious discrimination would have an adverse effect on their healthcare experience. These arguments should not, however, be mistaken as complacency - Muslims’ healthcare needs are not being met to the optimum standard. Efforts should be made to meet these needs but the key is integration not segregation. Competing interests: None declared |
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Vija K Sodera, Private Surgeon White Lodge Clinic, PO21 3BX
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If medicine is supposed to be evidence based, and if we all evolved by chance from slime, and if there is no God, then there can be no basis for Sheikh’s position (1) at all i.e. there is no reason to accommodate something imaginary. If, however, God exists (for which premise the evidence is undeniable), then Sheikh’s position is only tenable if the evidence supports the premise that Allah is that God (for which premise the evidence is unequivocally against). Regarding circumcision for religious reasons, this is absolutely not a health matter, so the NHS should not provide for it at all. If Sheikh demands the provision of pork-free or alcohol-free drugs, then the NHS should provide totally-animal-free drugs and vaccines for vegans. Regarding any atheistic response, if we all evolved by chance from slime and there is no God, then there is no basis for anyone to disagree with or agree to any position, since without any absolute yardstick, nothing, under any circumstances, can ever be deemed to be Right or Wrong - so NOTHING can ever be deemed immoral or unethical. However, contrary to common superstition, the evidence base does unequivocally show two things: firstly, that humans are not modified apes; and secondly, that God does exist – exactly as recorded by a first century physician: ‘To Him all the prophets bear witness, that everyone who believes in Him receives forgiveness of sins through His name’ (2). References: (1) Should Muslims have faith based health services? Aziz Sheikh BMJ 2007;334:74 (13 January) (2) Acts 10:43 Competing interests: Author of One Small Speck to Man - The Evolution Myth. |
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Naseer Ahmad, Specialist Registrar General Surgery Macclesfield District General Hospital
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Dear Editor, It has been argued that although the NHS was set up for all people in the United Kingdom it only caters for the majority population i.e. white English speaking Christians. It will, therefore, discriminate against minority populations e.g. Urdu speaking Pakistani Muslims. Correcting this should not involve promoting one particular group as this will not solve the innate problem. A new philosophy is required, ‘treating people equally does not mean treating everybody the same’ Although this flies in the face of protocol driven decision making, realising patients are individuals with unique needs will acknowledge all ethnic and racial groups. Whilst halal food is desirable for Muslims, many frail elderly patients on wards are malnourished because no staff help them eat. All health professionals will agree that treating patients involves not only the best medical but also social care. Both need to be tailored for individuals. Research must highlight areas of concern for all patients with clinical audit ensuring improved standards. Competing interests: None declared |
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Deborah A Carr, Paediatric SHO South Birmingham PCT
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As a doctor working within a multicultural society, it is necessary to have an understanding and empathy for members of many social classes, faiths and cultures. The distressing ostrascization of indviduals based on their religion will only be reduced if we take the time to learn about their beliefs.
In reading this article, while I agreed with many of the statements that were made, I could not help but feel that some of the arguments supported the idea of a completely segregated health system for those of a muslim faith. This goes against all of the ideals of a sensitive and culturally aware health system. I agree that there is a need for many facilities specific to the muslim faith, such as improved male circumcision services and increased awareness of the medical impications of Hajj or Ramadan. However, I entirely agree with Prof. Esmail's argument that "In planning our services we should encourage respect and tolerance without having special services for defined groups of people. Going down the path of providing special services for defined groups risks stigmatisation and stereotyping". We should aim to improve our awareness of the requirements of members of different faiths to ensure their medical needs are actively addressed within the health system. It is likely to be more damaging to quarantine muslim patients into their own services by making presumptions of their beliefs instead of listening to the individual needs of our patients and aiming to meet those needs within an integrated system. Competing interests: None declared |
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Abid Hussain, SHO Psychiatry Birmingham and Solihull Mental Health Trust
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I would like to echo some of the sentiments made by Deborah A Carr, in her response, were she mentions the needs to understand a different cultures/religions. This is imperative if we are to deliver good quality effective health care to all those living in the United Kingdom. Male circumcision has been practiced through out the world for hundreds of centuries. The fact that it is still popular means that there must be something good in it. In the USA, which has the greatest medical knowledge and medical expertise in the world, 65-90% of males are circumcised (> 1.2 million newborns per year) 1,2. The moist inner lining of the foreskin represents a thinner epidermal barrier than the more cornified outer surface of the foreskin and the rest of the penis, including the glans of both a circumcised and an uncircumcised penis, which have been found to have the same amount of keratin (i.e., similar skin thickness and protection from invasion of microorganisms) 3. This means that the inner lining is a potential entry point into the body for viruses and bacteria. During sexual intercourse the foreskin is pulled back down the shaft of the penis, meaning that the whole of its inner surface is exposed to vaginal secretions3. An early suggestion that attempted to explain the higher HIV infection in uncircumcised men was that the foreskin could physically trap HIV-infected vaginal secretions and provide a more hospitable environment for the infectious inoculum4. It would like to invite those who may be ignorant of this data to look at some of the evidence presented in well respected medical journals stating the benefits of male circumcision. Professor Aneez Esmail states that there could be moral and ethical problems if the NHS were to meet the demands based on religious identity, such as with female circumcision. I would like to point out that Islam does not allow female circumcision, there is a huge difference between the text of a religion and the practice of people. We should also move away from the stereotype that all Muslims are either black or Asian. I know of many colleagues and co-workers whose parents are native of this country and their offspring have embraced the religion of Islam. We should not be ignorant of the needs of different religious or ethnic groups in the UK. There should be open discussion, with full engagement of people from these backgrounds before sweeping health care plans are made. The evidence strongly shows that circumcision is a positive practice. Thus the Muslim tax payers should be entitled to this treatment on the National Health Service. (1)National Centre for Health Statistics of the Department of Health and Human Services. Trends in Circumcisions Among Newborns. 2003 (2) Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics. 1998; 101: E51-E56 (3) Szabo R, Short RV. How does male circumcision protect against HIV infection? Brit Med J. 2000; 320: 1592-1594. (4) Cameron BE, Simonsen JN, D'Costa LJ, Ronald AR, Maitha GM, Gakinya MN, Cheang M, Dinya-Achola JO, Piot P, Brunham RC, Plummer FA. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989; ii: 403-407. AbidHussain@doctors.org.uk Competing interests: None declared |
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Achyut Valluri, SHO - Emergency Medicine Stirling Royal Infirmary, FK8 2AU
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Dear Editor, I have recently returned to the UK having spent time working for New Zealand’s health service. Their model of delivering equitable healthcare to ethnically-diverse communities had made quite an impression and I read your article debating faith-based health services (13th January 2007) with interest. In 1999 New Zealand’s Ministry of Health released the white paper, Our Health, Our Future – Hauora Pakari, Koiora Roa. One of the issues it addressed was that for indigenous Mâori (a minority in New Zealand society, comprising ~15 percent of the population) their health status across a range of indicators (e.g. life expectancy, burden of chronic disease) was found to be considerably lower than those of other New Zealanders. Relative socio-economic disadvantage alone could not explain this disparity [1]. It was recognised that there was a general lack of understanding of the health beliefs of minority cultures and a “one size fits all”-approach to healthcare was not proving effective. Culture shapes the individual’s world view, informing concepts such as wellness and illness and influences interactions with others, such as “help-seeking” behaviours and attitudes towards healthcare workers. This definition equally applies to the medical culture and shapes the pattern of interaction between patients and providers. Therefore in order to deliver high quality, effective healthcare to diverse communities “cultural competence” has to be just as important as the clinical competence of the providers. Cultural competence has been defined as “a set of academic, experiential and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among and between groups. This requires a willingness and ability to draw on the values, traditions and customs of other cultural groups, and to work with knowledgeable persons from other cultures in developing targeted interventions, communications and other supports” [2, 3]. In Great Britain and New Zealand the health service has been grounded in the predominantly Western culture. We must therefore recognise that minorities will not have access to the same health opportunities. Aneez Esmail’s argument that special services could enhance stigmatisation is an indicator that greater cultural awareness is required. As Naseer Ahmad commented, this requires a fundamental change in philosophy. In other words we must start providing care not regardless of race, colour and creed, but regardful of all those things that make us unique. [1] Sporle A, Pearce N, Davis P. Social class mortality differences in Mâori and non-Mâori men aged 15 – 64 during the last two decades. NZ Med J 2002; 115: 127-31. [2] Cross T, Bazron B, Dennis K, Isaacs M. 1989 Towards a culturally -competent system of care, Volume I. Washington DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. [3] Isaacs M, Benjamin M. 1991 Towards a culturally-competent system of care, Volume II: programs which utilize culturally-competent principles. Washington DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. Competing interests: None declared |
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Saddichha Sahoo, Resident in Psychiatry Central Institute of Psychiatry, Kanke, Ranchi,India
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I agree with Aziz Sheikh in his article on Muslims having faith-based services.In fact, we could go the whole way and have different services for Hindus, Christians and Sikhs, especially in a multicultural country like India.This would serve to not only sustain the alienation and religious ideologies of various groups which are campaigning to fuel these ideas, but would actually increase the number of doctors from each community since we would require separate doctors for separate religions.We could then extend this to creation of separate wards and probably separate hospitals too. On a serious note, I think that doctors are trained enough in religious and social tolerance although there is a need to enhance it further.It is indeed imperative to understand the needs of different cultures and individualize treatment strategies without sterotyping them and hence stigmatising them further.Let us not carry our dogmatic beliefs to this profession, considered the most holy by many. Competing interests: None declared |
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MUHAMMAD KAMRAN ZAFAR, GP COPENHAGEN1620
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Everybody is clear that health entails not only physical but also mental wellbeing. In my opinion, faiths of patients about their health problems and remedies is an important subject to be taken into account. In multicultural societies doctors come across different peoples of ethnic backround; in fact those physicians who keep a soft edge and respect beliefs are better placed in their profession. Racism in health will further aggravate the deteriorating standards of health care system Competing interests: None declared |
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