What SLPs Need to Know when Working with Muslim Clients

You have accessThe ASHA LeaderFeature1 Oct 2012What SLPs Need to Know when Working with Muslim Clients Ovetta Harris, PhD, CCC-SLP Abdul S. Mukati andMA, CCC-SLP Neda Ghandchi Ovetta Harris Google Scholar More articles by this author , PhD, CCC-SLP, Abdul S. Mukati Google Scholar More articles by this author , MA, CCC-SLP and Neda Ghandchi Google Scholar More articles by this author https://doi.org/10.1044/leader.FTR2.17132012.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Suzi, a school-based speech-language pathologist, has a new student on her caseload-a 17-year-old client who is Muslim, speaks Arabic, and uses a speech-generating device (SGD). The client has recently moved to the United States from Saudi Arabia, a Muslim country, and his family is hoping he can adjust while still maintaining his cultural and religious identity (Mukati & Harris, 2011). Immediately following Sept. 11, 2001, the Muslim population received a great deal of attention in the United States. Many Americans during this time did not know much about Islam. In some cases, negative focus was targeted toward Muslim people instead of toward the organization of terrorists responsible for the tragedy, and tensions, stereotypes, and discrimination developed. More individuals of the Muslim faith have come to the United States during recent years for multiple reasons, including jobs, better educational opportunities, or to escape war in their country. For communication professionals, the recent influx of this populations means it is becoming increasingly important to have a basic understanding of the common religious and cultural practices of Muslims. According to the Pew Research Center, the Muslim population of the United States number 6 million to 7 million, and is expected to grow globally at about twice the rate of the non-Muslim population over the next 20 years (Pew Research Center’s Forum on Religion & Public Life, 2011). Increasing your knowledge, cultural awareness, sensitivity, and competency when working with Muslim families in schools and in medical settings can lead to more positive treatment experiences as treatment material and techniques become more culturally acceptable to Muslim individuals. Basics of Islam A first step toward effective work with Muslim clients is understanding the basics of Islam-the fastest-growing and second-most practiced religion in the world, according to the latest U.S. Religion Census (Pew Research Center’s Forum on Religion and Public Life, 2012). Islam is the latest version of the message sent by God through Adam, Noah, Abraham, Moses, and Jesus (Rizvi, 1992). Islam was sent to mankind through Prophet Mohammad. Therefore, in reverence of Mohammad, “Peace and Blessing be upon him” is stated every time the name of the prophet is taken. However, he is not to be worshipped, but rather sent to lead his followers to worship God, or Allah in Arabic (Roseberry-McKibbin, 2002). The Quran is the word of God sent by revelation to Mohammad, and Muslims consider the Quran to be a complete guidance. The Holy Quran for Muslims, word of God, would be similar to the Bible for Christians. Although it is important to note that there are variations in practices and beliefs within the regions and communities, there are core Islam practices and beliefs that are followed by most Muslims. The widely accepted five pillars of Islam are: Pillar 1: Shahadah, or testifying that there is no one worthy of attention, worship, and allegiance other than God (Emerick, 2004). Pillar 2: Salat, or daily prayers, performed five times, are obligatory for every Muslim male and female who has reached puberty. Pillar 3: Zakat, or annual provision for the needy in one’s accumulated wealth. Pillar 4: Saum, or fasting during the month of Ramadan, which requires that a person abstain from eating, drinking, and sexual interactions from sunrise to sunset. Pillar 5: Hajj, or pilgrimage to Mecca, Saudi Arabia, a journey that is obligatory for those who can pay for it and must be performed at least once in one’s lifetime. Cultural Considerations Stemming from the basics of Islam and the five pillars are several areas of cultural considerations. Basic knowledge of these customs can help an SLP or audiologist make decisions about treatment options, communication, and follow through. Greetings: Muslims greet one another with As-salaam alaikum, “May peace be upon you.” The root word of Islam is Salaam, meaning peace. However, physical contact is not permissible between opposite genders unless a blood relationship exists; therefore, Muslims typically do not embrace or shake hands with people of the opposite gender. Clinicians, therefore, may want to avoid physical contact or ask before extending their hands to greet a Muslim client or caregiver of the opposite gender. If a session entails physical contact, the clinician should seek permission or prepare for an individual of the same gender to carry out the physical component. Food: Muslims are required to consume Halal and permissible food: food that does not include pork products, alcohol, or liquor. There is alcohol in some chocolate, some glycerine in toothpaste, enzymes in some candies, and pork by-products in some children’s vitamins. Also, for a Muslim to consume meat, the animal has to be permissible and Zabihah, or slaughtered in the Islamic manner (including, for example, positing the animal toward Mecca and reciting the name of God). Muslims are not permitted to consume pigs and certain other animals (Quran, 3:5). In addition, some Muslims can consume seafood only if the item has scales (Roseberry-McKibbin, 2002). As a result of these food considerations, many Muslims may refuse pain medication in gel capsules or caplets because most of these medications contain gelatin, a non-Halal ingredient. Islam prohibits drinking alcohol (Roseberry-McKibbin, 2002) and thus patients may also refuse medication containing alcohol. Older Muslims tend to be more adamant about following the religious guidelines. They may not compromise on their requirement of Halal and may accept only medical treatments that comply with their religious demands. For example, a Muslim patient may not want to participate in a feeding trial because the patient cannot consume the non-permissible food the SLP wants to introduce. As a result, the patient may refuse trials, lose weight, and need forced feeding. A better approach would be for the SLP to be aware that: Feeding trials should be conducted with Halal foods. Popular types of candy, crackers, pudding, and ice cream may have animal shortening. Gelatin and enzymes in food may be derived from non-Halal sources and should be avoided. Gender Roles: Muslim families have been portrayed as patriarchal, but the reality is that women are now often joint decision-makers and play a vital role in family affairs (Hassouneh-Phillips, 2001). The religion dictates that males are responsible for providing for the family in all ways. However, in many societies, women also work based on necessity. For example, in the American Muslim society, the African American Muslim fathers and mothers often share childcare and work responsibilities (Roseberry-McKibbin, 2002). There are several implications of this arrangement for parental involvement in diagnostic and treatment sessions: The husband is not necessarily the sole decision-maker. Even if women are either the head of the household or joint decision-makers, they may stay behind the scenes. Because Islam bestows respect to elders, grandparents also may be a guiding force in decision-making about children. Dress Code: Modesty is prescribed for Muslims in attire and attitude. The goal of modest dress for males and females is to cover parts of the body and discourage enticing the opposite gender. Modesty is most evident among Muslim women who wear the Hijab, a veil that covers the head and neck and is meant to be worn alongside modest clothing, especially in the presence of men to whom the woman is not married or related (Emerick, 2004). In some cultures, it is necessary for women to cover themselves completely, leaving a small square of netting for visibility called a Burqa. The SLP should be aware that the mother of a Muslim student may come to the school or clinic covered in a variety of ways or not have a head cover at all. It is also important to consider the possibility of a individuals’ discomfort when interacting with opposite genders. If touching, as in positioning the head during swallowing studies, is required of a Muslim client of the opposite gender, it is important to explain to the client why you need to touch, ask permission, and have the person tell you when he or she is ready. Naming conventions: It is important to call the children by their correct names. Clinicians should take the time to learn how to pronounce names correctly, and understand that sometimes an individual’s first name acts only as a prefix. These students have two-part names, and usually prefer to be called by their full names. Name shortening can be offensive to the student and his or her family. The Muslim population is growing in the United States as clinicians are seeing more Muslims on their caseloads at schools and in health care facilities. Clinicians need to be culturally competent as it relates to Muslims’ religious and cultural preferences related to their name, attire, gender, family, and nutritional needs in the delivery of speech-language, hearing, and swallowing diagnostics and treatment. Online Islam Resources Islamic Finder Islami City Discover Islam Sources Emerick Y. (2004). The complete idiot’s guide to understanding Islam (2nd ed.). New York: ALPHA, Penguin Group. Google Scholar Hassouneh-Phillips D. (2001). A qualitative study of Muslim women in America.Journal of Mental Health in Nursing, 22, 735–748. Google Scholar Mosse S. I. (2002). Disability: An Islamic insight. In Islamic Council of Victoria. Retrieved July 8, 2008, from http://www.icv.org.au/disabilityarticle.html. Google Scholar Mukati A. S., & Harris O. (2011, November). How to better serve Muslim patients.Paper presentation at the annual American Speech Language and Hearing Association convention, San Diego, CA. Google Scholar Pew Research Center’s Forum on Religion & Public Life. (2011). The future of the global Muslim population. September 5, 2012. Retrieve from http://www.pewforum.org. Google Scholar Pew Research Center’s Forum on Religion & Public Life. (2012). Press TV: The fastest growing religion in America is Islam. September 5, 2012. Retrieve from http://www.pewforum.org. Google Scholar Rizvi M. (1992). Introduction to Islam. Toronto, ON. Google Scholar Roseberry-McKibbin C. (2002). Multicultural students with special language needs: Practical strategies for assessment and intervention (2nd ed.). Oceanside, CA: Academic Communication Associates. Google Scholar Surah A-A. (n.d). In The Holy Qur’an.(33) :(3:5), (2): (226). Google Scholar Surah A-N.(n.d). In The Holy Qur’an.(4) :(4). Google Scholar Author Notes Ovetta Harris, is an assistant professor in the Department of Communication Sciences and Disorders at Howard University. She is an expert in the areas of cultural diversity and augmentative and alternative communication (AAC). She is an affiliate of Special Interest Group 12, Augmentative and Alternative Communication. Contact her at [email protected]. Abdul S. Mukati, is a doctoral candidate at Howard University. His areas of expertise are in augmentative and alternative communication (AAC), school-age populations, and pediatric swallowing. He is an expert in cultural diversity in speech-language pathology. He is an affiliate of Special Interest Group 12, Augmentative and Alternative Communication. Contact him at [email protected]. Neda Ghandchi, is a student in the master’s program at Howard University. 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