The women were seated in a circle in the corner of the Masjid (mosque) As-Salaam. An elderly woman in a draped hijab spoke while her fingers noted every word, a metronome to the Arabic verses of the Qu’ran flowing from her mouth. The women listened and nodded their heads.
Each time we came in for our Islamic Medical Association of North America (IMANA) Medical Clinic, we never knew what to expect. IMANA clinic is a community-based project led by the Albany Medical College Family Medicine Office that connects medical students to the local Muslim population through screening and education clinics at Masjid As-Salaam. This masjid is the central prayer space and community support for many of Albany’s Muslims. The unique quality of this service-learning program is its emphasis on cultural competency and understanding the role of spirituality in medical care. The men and women lead separate clinics, as Islamic masjids have separate prayer spaces for each gender. Before this visit, I had never seen this circle of women, and I stood nervously at the door.
As medical students, we are trained to understand two main concepts. First, the importance of taking a “good history.” Most of the answers to illness, we were told, lies in the stories that patients share with us. The trick is supposedly “good communication skills.” Staring at the diverse women speaking a different language, I felt suddenly that “good communication” was not enough to connect. In fact, outside of the clinic, it seemed almost aggressive to even request their stories in the first place. IMANA serves many Muslim citizens who are survivors of complex stories of immigration. To ask them to translate and share suddenly made me feel uncomfortable.
Secondly, we are taught about the social determinants of health. We are directed to the conclusion that many of the issues refugee families face are due to their difficult living situations. While inadequate resources and access are cited as the most common issues facing people of lower socioeconomic classes, the refugees and immigrants also here shared a different worldview and a spirituality that perhaps did not prioritize or value the same hierarchy valued by Americans. By focusing on American conceptualizations of “need” and the resources we define as vital, we ran the risk of ignoring essential pieces of their stories. What if we were missing resources the Muslim community in particular needed? What role did their worldview play in maintaining the resources they sought and the items they valued? Where was spirituality in defining health and how did it shape their story of resilience?
The women noticed our stark white coats and bare feet, and smiled. One of them stood up and invited us to sit down and listen with them. We had previously spoken of the outcomes we designed for the clinic — understanding x, y and z determinants of health and teaching the patients about diseases — but none of those goals involved listening to the monthly women’s prayer group. I sat down with the two other first-year students, who were unfortunately following my lead. This woman, who spoke in Arabic, paused. All of us gave her a look of confusion, and she said, “Oh, no Arabic? Let’s do this in English.” She invited a group member to sit next to us and translate as she spoke. The story they were discussing was about understanding another human being.
As they spoke, it became clear that these women from all regions of the world had created a spiritual home in sharing the verses of their Holy Book. Everyone had stories to share about their transitions here, each woman giving the others advice. Despite my lack of knowledge of the teachings of the Qu’ran, the shared spirituality created a safe space to discuss personal stories and ask deeper questions. In that space, religion functioned as a mirror, revealing our shared humanity and common stories. When the women were done, they began to eat and invited us to share our information with them. A conversation on diabetes over food was an excellent way to capture their attention and describe why white rice was not as good as brown, ways to reduce sugar in morning coffee, confirm that yes, honey is a form of sugar, how to help family members quit bad habits and methods to get more exercise despite having to run a home or go to work.
Too often in medicine, we are told to follow rules and create boundaries to provide excellent care. Moments like this in IMANA reminded us that erasing the borders, removing the white coats and listening were perhaps the true keys to cross-cultural understanding and overall improvement in health for a community.