Should Muslim Nurses Expose Their Arms?
Bare Below the Elbows: A British Debate
By Emdad Rahman
IOL Correspondent – UK
Controversy has once again reared its head after British media reported on the reluctance of Muslims to adhere to major hygiene rules. Minutes of a clinical academics conference at Liverpool University publicized the apparent refusal of female Muslim students at Alder Hay hospital to roll up their sleeves.
Further media reports confirmed that parallel fears were also flagged up at Leicester University, along with Birmingham and Sheffield universities.
Reports based on minutes of meetings between the various hospital hierarchies revealed that “A number of Muslim females had difficulty in complying with the procedures to roll up sleeves to the elbow for appropriate hand washing, whilst adding that some students would prefer to resign their courses rather than go against their religious convictions.”
The new guidelines on hospital attire and health etiquette are designed to tackle medical superbugs and infections such as Clostridium difficile and Methicillin-resistant Staphylococcus aureus(MRSA).
Naafis Saliha, one of the medical students of Imperial College London, believes that misunderstanding is fuelling hatred toward Muslims “by providing ammunition to racist media.”
“This story is working to portray Muslims as unhygienic and un-cooperative, and it has worked a treat, judging by the overwhelming response.” Saliha added.
Speaking to the Daily Telegraph, Dr. Mark Enright, professor of microbiology at Imperial College London, said, “To wash your hands properly, and reduce the risks of MRSA and C. difficile, you have to be able to wash the whole area around the wrist.”
“I don’t think it would be right to make an exemption for people on any grounds. The policy of ‘bare below the elbows’ has to be applied universally,” Enright stated.
Dress Code Conflict
Amir Khan, who has just completed TA foundation year What is this for newly qualified doctors, said, “Muslims were pioneers in medicine and science. Those who feel it a burden to raise sleeves to wash up as part of medical procedures are misguided and they are certainly in the wrong profession.”
“Cleanliness is next to godliness, and nobody is asking anyone to perform a teasing strip show for their colleagues or patients. Do it in the privacy of a room or washroom for heaven’s sake, but there’s no need to be difficult. We have enough ill will as it is,” Khan added.
Through a research paper on implementation of dress codes and its conflict with individual religious beliefs, Newham University Hospital (NHS) Trusts multifaith manager Yunus Dudhwala stated many critical facts.
Dudhwala highlighted some cited cases in which many female Muslim — local and national — clinicians, nurses, and students have raised concerns about the introduction of this guidance and how it conflicts with their religious belief. In fact, some members of the Sikh faith have also found difficulty with the implementation of this guidance re the bangle.
“From an Islamic law viewpoint, a woman must cover her arms up to and including the wrist at all times except in front of her close family members. As we are quite aware, not all Muslim female clinicians wear wrist-length uniform and therefore this guideline will not pose a problem for that group that most probably will be the majority from the Muslim female group. It will be a problem for those Muslim females who may ask to cover their arms as they strictly adhere to wrist-length Islamic uniform,” he stated.
Dudhwala insisted that, “Muslim female clinicians along with all medical staff are concerned about the welfare of their patients and would never consider doing anything that may put the patient at risk. This includes following all policies relating to health and safety, infection control, and uniforms.”
“A Wake Up Call”
Miriam Hooper, a hospital receptionist, said, “Anyone flouting these rules should be sacked as a professional measure. There is a very real threat of MRSA in this country. These rules are set to deal with and target bugs, whilst promoting hygiene. These people are not fit to serve in hospitals in a civilized country; they should be sent to medical establishments in Rwanda or Afghanistan or Iraq as a wake up call.”
Neelufar Yasmin and Amaal Ali are unrepentant medical students; “The war on Muslims is still going strong – there is no evidence to support the notion that Muslims are unhygienic and flouting rules” said Yasmin. In fact this mudslinging is so pathetic that even hardcore Islamophobes are beginning to question the motives of the individuals spreading such remarks.” Yasmin wears full sleeves and sees that there is no qualms about this, and her colleagues respect her choices and agree with her totally.
Ali went further; “this is a throwback to the days when black people were viewed as sub humans, supported by the spreading of malicious rumours to sway the public – the only difference is that Muslims are a bit more difficult to enslave, what with the worlds eyes being wide open and the public are less gullible and don’t view the Daily Telegraph as society’s purveyors of truth. I actually wear short sleeves, but if my convictions stretched that far, I would not hesitate to cover up. After all, there is no risk to patients and minimal or equal risk of spreading superbugs as those with exposed arms.”
As part of his advisory role, Dudhwala has bought several points to the fore, “Employers must be aware of the risks of discrimination. When devising or reviewing a dress code, employers must ask themselves whether the dress code will require employees to dress in a way that contravenes their religion or belief.”
The Department of Health (DoH) guidance document Uniforms and Workwear, which is the basis of introducing “Bare Below the Elbows” says the following,
“There is no conclusive evidence that uniforms (or other work clothes) pose a significant hazard in terms of spreading infection.”
Based on empirical research conducted by University College London Hospital NHS Trust (UCLH), the DoH document concluded that, “Not all staff need to wear uniforms, and it seems unlikely that uniforms are a significant source of cross-infection.”
“Bare Below the Elbows”
In September 2007, the British Medical Association (BMA) launched its latest statement, in which Dr. Vivienne Nathanson, head of BMA Science and Ethics, said, “The BMA is pleased that the government has taken on board many of the recommendations outlined in our report on reducing hospital-acquired infections, for example the call for doctors to stop wearing ties and white coats in hospitals and how it was preferable for clinicians to wear short-sleeves.” However, Nathanson warned any new guidelines on dress code must be “practical, realistic, and sensitive to different religious groups.”
The guidance from the Central Consultants and Specialists Committee (CCSC) stated that, “However, the policy must be seen as a corporate image and identity issue, for negotiation, rather than an infection control issue which LNCs are asked to agree with without question.”
The guidance clarified that, “The CCSC is particularly concerned that the Secretary of State’s “Bare Below the Elbows” policy is not supported by demonstrable scientific evidence and was issued hastily in response to an intense period of media focus on the issue. The CCSC and the wider BMA support evidence backed policies aimed at fighting infection rates in hospitals but believes that such policies should be introduced on the basis of clear evidence and in partnership with clinicians locally.”
Muslims Clinicians Using Alcohol
Dudhwala’s research concluded that Muslim female clinicians working in the NHS fully support all measures taken to reduce infection risks to patients as long as these measures are based on evidence. “This is why they consistently make use of alcohol gel as a hand rub and encourage its use despite the Islamic view of prohibition toward alcohol. There are currently no better alternatives, and they recognize that fact, and the evidence is clearly available,” the research emphasized.
Dudhwala continued, “However in this case, according to what has been quoted above, the current guidance used for the introduction of ‘Bare Below the Elbows’ does not have the evidence base to be introduced and implemented across-the-board.”
An Opt-Out Option
Dudhwala has advised trusts to look at ways in which they can support their staff who feel they have no other choice except to choose between their religion and profession and look at options that allow compliance with infection-control policies as well as adherence to their religious beliefs.
He has also advised the trust to formulate a policy that incorporates ‘No Sleeves Below the Elbow.’ However, within the policy there should be an option for an individual to opt out due to personal religious or belief reasons. The individual who wishes to opt out will agree in writing (in a pre-prepared Trust form) that they will roll up their sleeves during every clinical episode and wash hands above the wrists after every patient contact according to Infection Control Policies and that this can and will be observed closely.
Pro-life, Pro-family Muslim Campaigner in the UK and in the UN, Dr. Abdul Majid Katme, the spokesman of the Islamic Medical Association has spoken at length regarding issues pertaining to the controversy.
Observing Islamic Modesty
Dr. Katme has also highlighted avoiding exposure of the body, except for the hands and face, is an essential feature of a Muslim woman’s faith.
“Arms that are exposed are likely to pick up germs and there is available evidence that suggest and argue the case for skin being covered as being safer for patients,” he added.
During numerous interviews, Dr. Katme has suggested the use of long-length, sterile, medical gloves that reach up to the elbows; “all these prescribed washing rituals in Islam, which are done many times during the day will make no doubt, any Muslim female medical student or doctor less risky to their patients and will avoid them a lot of infections.
He insisted that exposed arms can pick up germs by the skin and the skin can be more protected and is safer if is covered. An idea, if needed,” it might be useful to consider producing some long sterile disposable non transparent gloves, which can reach the elbows for female Muslim medical student or doctor and to use when they are coming across some patients or in hospitals.”
“Last year one hospital in the Midlands manufactured some new dressing for the female Muslim women surgeons, who wished to keep and observe their Islamic modesty while carrying out operations.” He added.
Finally, he warned that “It will be a great loss to the NHS and to the community, if Muslim medical students are forced to leave their medical studies because of one small important modest decency measure. There is an urgent need now to discuss this important matter for our Muslim medical students with the Dept of Health and the hospital’s trusts in order to sort it out.”
What do you think of the stance of those Muslim female doctors? Do you have any suggestions for overcoming such an obstacle?