Some Muslims 'risking their lives' in Ramadan
Ramadan, one of the most important times in a Muslim's annual calendar, started earlier this month.
In this week's Scrubbing Up Nuala Close, lead cancer nurse, at Barts and The London NHS Trust warns that some patients are putting their lives at risk by needlessly neglecting their health and mistakenly refusing or delaying their treatment until after Ramadan.
Ramadan is one of the holiest times of the Islamic calendar, but for some Muslims it is potentially the most deadly.
At risk are the elderly, frail and sick whose devotion to their religion means they will be fasting for up to 18 hours a day.
But some take it further and also risk their health and even survival.
Many stop taking vital medication in order to keep to their fast, while others cancel crucial medical appointments, including cancer treatments, during the holy month as they focus on religious obligations.
This is despite wide agreement among Imams and senior scholars that nobody with a serious medical condition should put their health at risk by fasting.
The challenge we, as health professionals, face is persuading patients to listen to that guidance and to seek medical advice.
Statistics gathered last year by Barts and The London NHS Trust, where we have a large number of Muslim patients, showed a drop of up to 20% in attended hospital appointments during Ramadan.
This has significant cost implications for the NHS at a time when we have to make efficiency savings.
But, more important than the waste of public money, are the serious health consequences for a significant proportion of our patients.
In my own clinics, I have seen cancer patients put off chemotherapy until after Ramadan - a decision that could well impact on their chance of survival.
Others carry on fasting, despite becoming so weak through lack of food, that they are unable to continue chemotherapy.
Some take highly toxic chemotherapy drugs after daylight hours meaning they take one single dose, instead of two spread out through the day.
Screening appointments for cancer are another area where we have seen an increase in missed appointments.
Patients agree to procedures such as a colonoscopy, where the bowel is examined for signs of cancer. After going home to discuss it with their family, they then ring to cancel their appointments, saying they are unwilling to undergo the investigation during Ramadan.
But such delays are dangerous.
As well as cancer, it is clear that in other areas, such as cardiology, psychiatry and respiratory, patients alter their medications without medical advice, believing that taking such medicine during Ramadan is against their religious beliefs.
Faith leaders help
We have been tackling the problems by getting the local Imams on board and their huge influence within their community has proven invaluable.
Working with our local PCT and mosque, we recently organised a health training day for Imams and senior scholars explaining the dangers of not following medical advice during Ramadan.
We covered areas including cancer, diabetes, lung and heart problems and produced a booklet with clear medical and religious guidance, supported by all four Islamic schools.
The Imams have been reminding their followers that they need to attend all investigation appointments considered urgent by their GP, and that cancer patients must go for chemotherapy or radiotherapy as usual.
They have also been urging those who are vulnerable to seek early medical advice before Ramadan starts to check whether it is safe for them to fast.
If fasting is not recommended by their GP or hospital team, the Islamic ruling is that people should not fast and should, instead, make a charitable donation.
But much more still needs to be done. The clear and consistent message we urgently need to get across is that if you suffer from a serious illness, your physical wellbeing takes priority over religious considerations even during Ramadan.
To neglect it, is to risk your health and potentially your life.