Her head covered in a purple and pink hijab, Sarah S. Nasir, OMS II, stood out among the 1,000 osteopathic medical students attending DO Day on Capitol Hill in early March. A devout Muslim, she wears the traditional head covering identifying many women of her faith, a sign of modesty and piety.
She was in Washington, D.C., to learn more about how laws are enacted and how health policy is shaped. “When I start practicing, I want to be able to be an advocate for my patients,” says Nasir, a student at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg. “I want to be able to care for my patients not only in my community but also on a larger scale. DO Day on Capitol Hill was a baby step toward being able to give back later.”
Nasir’s Islamic faith stokes her desire to become an osteopathic physician and advocate for patients’ interests. Her experiences on campus and in the community have mostly been positive, she says, and she strives to learn from any difficulties. Understanding how to negotiate and compromise in bridging cultural divides will benefit her when she begins to practice, she believes.
As a soon-to-graduate Muslim man who has been a student leader, Mansoor Ali Jatoi, OMS IV, brings a different perspective to the challenge of practicing one’s faith while preparing to practice osteopathic medicine. His interactions with non-Muslims at school and on rotation have been favorable by and large, as he is someone who welcomes questions from the curious and downplays his religious beliefs in situations governed by other priorities.
Both Nasir and Jatoi appreciate opportunities to tell non-Muslims about Islamic customs and hope to enhance the care of Muslim patients.
Respect is a value Nasir holds dear as a Muslim woman and a physician-in-training. While a girl in Bangladesh, she observed the reverence with which her mother, a physician, was treated by patients and in the community. During a family vacation in India, a man at the airport volunteered to push the family’s luggage cart upon learning that her mother practiced medicine. “My mom told me that this is what being a physician means,” Nasir remembers. “You don’t get that kind of respect or the blessings of people in any other career.”
While her mother did not wear a hijab in Bangladesh, a high-ranking female colleague of her mother’s showed Nasir that the deep religious faith a hijab represents is compatible with a medical career. “This physician was a big motivator for me to turn to my religion,” Nasir says.
After her family settled in California when she was 11, Nasir attempted to wear a hijab but gave up as she struggled to fit in. Her religious convictions deepening as she entered adulthood, she has been wearing a hijab in public since college.
Along with her faith, Nasir’s interest in medicine intensified. “There are narrations by the Prophet Muhammed that say whenever someone saves a life, it is as if he has saved the whole world,” she notes. “I thought that if I became a physician, I would be saving lives. I would definitely be there by the sick, taking care of them within the best of my means. I would be using my hands, my energy, my time, my everything in devotion to that person’s well-being.”
Applying to osteopathic medical school at the suggestion of a mentor, Nasir became seriously interested in WVSOM during her interview. “They looked at what I had to offer as a person,” she says. “There was a very welcoming sense of community in the school.”
In her two years at WVSOM, she has generally felt well-received and at home. “My hijab has had a protective effect on me,” she says. “People become more conscious of what they say around me in that they hesitate to cuss in my presence. Or they think twice about saying anything bad around me to anybody else.”
Out in the community, she has at times sensed people’s stares. “If you see somebody different, you gawk at them. I dismiss this because it’s a natural response,” she says.
Jatoi also has experienced mostly positive comments and questions from people upon learning he is Muslim. The son of a Pakistani father and a South Korean mother who converted to Islam, Jatoi sports a closely trimmed beard and is not immediately identifiable as a Muslim except for the name appearing on his white coat.
“But I have been very forthcoming in letting people know I am a Muslim everywhere I go,” says Jatoi, a student at the Midwestern University/Arizona College of Osteopathic Medicine in Glendale. “During Ramadan, I told people I was fasting for example.
What usually happens is when non-Muslims find out you’re Muslim, it engages them and opens up the avenue for them to ask you a lot of questions. I like being able to answer their questions, to dispel any misconceptions they may have from the media.”
Underdressed in OPP lab
Nasir’s main struggle on campus has been WVSOM’s osteopathic principles and practice lab, where women were expected to wear shorts and a sports bra, while men just wore shorts. Observant Muslim women are supposed to dress modestly, avoiding form-fitting clothes and covering most of their body in public.
Today, because Nasir voiced her concerns, the dress code in OPP lab consists of T-shirts and scrub pants. Nasir wears a loose-fitting, long-sleeved blouse instead of a T-shirt and keeps on her hijab. Working with her lab partner, she is expected to reveal only that part of the body currently under consideration.
“The faculty was kind enough to sit down with me and hear me out,” Nasir says.
She understands the need for students to practice osteopathic manipulative treatment on each other, as well as the instructional value of applying it to both sexes and different body shapes. But she still has some reservations.
“I feel there is a little bit more middle ground that can be reached in terms of privacy,” she says. “I am willing for my partner to see what needs to been seen, but I’d prefer not to expose my body to whomever is working nearby.” Nasir notes that she has come across non-Muslim women who would also welcome more privacy.
In addition, Nasir would rather have only female partners in OPP lab. “My male colleagues who have worked on me have been very professional and have tried their best to make me feel comfortable,” she says. “I would prefer to have women touch me, although I don’t mind working on men.”
Jatoi, in contrast, did not feel uneasy working on female classmates in OPP lab. “Because I’m married, I may be more confident and comfortable in that situation than most single Muslim men would be,” he says.
On his rotations, Jatoi rarely encountered problems stemming from his religion. At almost every hospital, he saw Muslim physicians—attendings, foreign medical graduates and residents—as well as Muslim female nurses wearing hijabs. So hospital staff members as a rule were accustomed to many aspects of Islamic culture, such as the need to consume halal foods and avoid alcoholic beverages.
“I’ve actually been given some privilege as a Muslim,” Jatoi notes. “A non-Muslim colleague of mine with a similar type of beard was encouraged to shave it off. But I was not asked to shave mine.” In Islam, men are expected to grow beards as a sign of piety and modesty.
Jatoi recalls only one patient who made disparaging remarks to him about Muslims, not knowing his religion. “I had had very good interactions with him up to that point,” Jatoi remembers. “When he asked me outright what my religion is, I didn’t hesitate to let him know that I’m Muslim. I believe I changed his perception of Islam without browbeating him or preaching.”
Room for interpretation
Jatoi notes that Islam allows for mitigating circumstances; actions normally frowned on or not permitted can take place if they’re for the greater good. In medicine and medical education, such situations frequently arise.
For instance, Muslim female patients ideally would be treated by Muslim female physicians or, if unavailable, by non-Muslim female physicians, especially for gynecological problems. But in an emergency, the gender of the physician matters much less than saving a patient’s life, Jatoi says.
As the student representative on the AOA Board of Trustees and in previous leadership positions, Jatoi has had to put his faith in perspective. “If I am representing all osteopathic medical students, I shouldn’t use my position to promote a Muslim point of view,” he explains.
For example, he feels that it is his duty to advance a resolution widely championed by students that would broaden the nondiscrimination statement in the AOA Code of Ethics to include sexual orientation and gender identity. “Probably 99% of Muslim scholars would say that Islam is not accepting of homosexuality,” Jatoi says. “But I know that the students I represent feel a certain way about this topic, and it is my responsibility regardless of anything else to at least portray their views.”
Muslim students on campus and on rotation need to be conduits of information for the culturally sensitive care of Muslim patients, notes Reza Nassiri, DSc, the associate dean for global health and adviser to the Islamic Medical Student Association chapter at the Michigan State University College of Osteopathic Medicine in East Lansing.
Nasir and the small number of other Muslim students at WVSOM do so by sharing Islamic customs with their classmates. “During Ramadan, we had a dinner with the help of the school, at which we did educational activities regarding the health care of Muslim patients, addressing such issues as how to draw blood and how to manage diabetic patients who are fasting,” she says. “Many students and faculty and staff members showed up and asked a lot of questions. It was a very good learning experience for everyone.”
During their clerkships, Muslim students can make sure health care professionals know the difference between what is haram, or forbidden, in Islam, such as eating any form of pork, and what is halal, or permissible because it is prepared according to Muslim law and ritual, Dr. Nassiri says.
When caring for female Muslim patients, hospital staff members need to be sensitive to issues of privacy, perhaps allowing clothing to be worn under a hospital gown, Dr. Nassiri notes. Also, hospitalized men and women of Muslim faith need to be able to wash themselves, with running water if possible, after using the toilet, even if they are using a bedpan. Moreover, a Muslim patient in a coma should be faced toward Mecca. These are just a small sample of the many customs and beliefs that need to be understood to provide Muslim patients optimal care, he says.
Because many Muslims already serve in the health care professions, the task of educating hospital staff about Islamic issues may not be so daunting. “In the internal medicine program where I’ve matched, two of the 12 residents are Muslims, so they are already fairly attuned to Ramadan, halal foods and other aspects of Muslim culture, ” Jatoi says.
Nasir doesn’t know what to expect when she begins her rotations, as West Virginia may have fewer Muslim health professionals than many others parts of the U.S. But she remains optimistic that she will fare well. “There may be challenges,” she says. “But I don’t think I will be given any challenges that I can’t handle.”