Discrimination in Healthcare
From “Melting Pot” to “Make America Great Again”, modernity in the U.S. has historically been marked by homogenization. Anything, or rather anyone outside of a paradigm of privilege has faced the utmost discrimination, as evidenced by rising counts of Islamophobia across the nation in recent years.
Alongside racism, Islamophobia has become institutionalized in every facet of our society. Our healthcare industry is not immune despite efforts to integrate cultural competence into each level of care. American Muslim female patients bear the brunt of this problem as anti-Muslim racism is gendered through the intersection of marginalized identities. In healthcare settings they are prone to everything from offensive verbal remarks, discrimination based on clothing to physical assault (Hassouneh 2017, 402).
Implicit bias cuts deeper, as even those advocating on behalf of marginalized populations perpetuate harmful stereotypes. In the photo below taken by AP photographer Carlos Osorio, the original caption reads “Although language often is a key barrier for Middle Eastern women, health care providers need to understand the dynamics of the Arab-American family, modesty issues and practices within the Islamic religion”. While the intent of this photo was to promote culturally sensitive practices by healthcare providers, the conflation of different identities “Middle Eastern”, “Arab-American”, and “The Islamic Religion” (an incorrect phrase within itself) is highly problematic.
When Islamophobic stereotypes like these are carried into the creation of broad cultural guides such as this one by the New York Times on hijab, so-called “competence” is lost entirely. Therefore, large-scale cultural competence programs aimed at female Muslim patients in the U.S. perpetuate Islamophobia/racism through the harmful homogenization of their diverse identities.
Complexities of Identity
Despite the multifaceted nature of identity, the racialization of religion is not a new phenomenon. Lumping each of these aspects under one marginalized category is reminiscent of policies in the U.S. such as the one-drop rule that still persist in societal stereotypes today. This is highlighted in an interview with Dr. Jamillah Karim who details the struggles of being Black, Muslim and female in the U.S. today. Not only are African American Muslim women subject to racism from affluent white-washed immigrant Muslims, but also sexism within African American mosque communities as well (Karim, 2016).
This highlights a crucial point in the problem of racializing Muslims, as there is prolific racism within the ummah itself. Coupled with discrimination faced by women especially, putting Muslim patients into a distinct cultural box is inconceivable. This isn’t unique to Muslims, rather it is felt by many minorities around the world. Culture associated with everything from one’s ethnicity to one’s religion is a fluid and evolving phenomenon. A static definition or attempt at generalization simply does not work.
Izumi Sakamoto speaks to this in a personal anecdote when she is shocked to see her Grandfather display emotion at a Buddhist funeral, despite her idea of solemnity within her culture. This demonstrates a transcendence of norms pertaining to religious and cultural identity, making light of individual humanity. She demonstrates the key point that an individual cannot be the public spokesperson for one’s culture, and therefore in order to practice cultural competence best cultural norms should not serve as definitions (Sakamoto, 2007, 105-108). This further stresses the care that must be taken in cultural translation for vulnerable populations.
The Use of Cultural Competence: Harmful or Helpful?
The phrase “Cultural Competence” has become a gold-standard of sorts in the U.S. healthcare and medical education system. But as medical anthropologists such as Dr. Arthur Kleinman have argued, its popularization “suggests culture can be reduced to a technical skill for which clinicians can be trained to develop expertise…This problem stems from how culture is defined in medicine…culture is often made synonymous with ethnicity, nationality, and language” (Kleinman et al 2006, 1673).
This synonymy is what leads to problematic guides such as Maya Hammoud et al.’s “Opening Cultural Doors: Providing Culturally Sensitive Healthcare to Arab American and American Muslim Patients”. The title alone points to serious problems, as Arab-Americans and Muslim Americans are being falsely presented as “similar” enough to warrant the same guidelines. Arab-Americans can be Christians, Jews, Atheists, etc. and American Muslims are largely African American and South Asian. Statements like “some Muslims do not make eye contact with the opposite sex” or “Arab and Muslim women tend to get offended when asked about sexually transmitted diseases because that would imply a deviation from monogamy” being characterized as “cultural norms” only sustain negative stereotypes about female Muslim patients that contribute to health disparities they face (Hammoud et al., 2005, 1309-1310).
American Muslims hold a wide variety of beliefs that speak more to their own individual needs than broad “cultural norms” used for definitional purposes in a medical setting. Dr. Hammoud is pictured below holding a handbook for Middle Eastern female patients written in Arabic. While she clearly holds good intentions, this level of homogenization is still problematic. An Iranian women who speaks Persian and a Turkish woman who speaks Turkish would not find an Arabic healthcare handbook a useful as a Saudi Arabian women perhaps, however they could all be lumped under the category of “Middle Eastern women”.
Cultural competence in healthcare becomes beneficial once it steps away from broad definitional guides and narrows in on specific aspects of identity, making note of the ways in which identity does not fit the same mold nationwide. Aasim Padela et al. demonstrates this concept by conducting community based research rather than relying on provider experiences. By asking patients directly, cultural competence becomes more about meeting patient specific needs surrounding “gender-concordant care, halal food, and prayer space”. This way needs pertaining specifically to a patient’s religious identity are met without harmful racialisation of their religion in the process (Padela et al., 2011).
Recognition of the importance of cultural competence in healthcare is on the rise in the U.S., however improper application serves to perpetuate racism and Islamophobia towards female Muslim patients. Initiatives must be careful to avoid conflation of religion and ethnicity, focusing instead on strategies that meet individual needs of the diverse backgrounds of female Muslim patients.
Significant gaps between patient and provider knowledge exist due to the perpetuation of this racism and Islamophobia. A study conducted by Memoona Hasnain revealed significant barriers to healthcare for female Muslim patients due to provider’s ignorance of patient’s cultural and religious needs and patients misconceptions about and distrust of the medical system (Hasnain et al., 2010). This highlights a clear link to further health disparities for this marginalized population. Further research along this line of comparison and elevation of patient perspectives is needed to develop better strategies of cultural competence.
In the current political landscape, we see an uncovering of Islamophobia and racism against Muslims in the U.S. (as well as many other minorities) from the underground channels of the U.S. ‘s so-called “modernity”. Dr. Ilyse Morgenstein-Fuerst’s peice on Tracking Hate after Trump’s Election paints an appropriate picture or the national landscape for American Muslims currently, as “hate crimes reflect both intent and systemic structures of bias. They are not limited to a perpetrator against her victim, but rather extend out to systems of race and racialization, gendered biases, ethnic, and religious-based hatred” (Morgenstein-Fuerst, 2016). President Trump’s election did not merely spark a new wave of racism and Islamophobia, rather it normalised it to explicitly come back into the public sphere from its implicit existence all along.
In a society rife with this level of hate, we must not only recognize the wrongs committed against marginalized groups but also how putting people into said homogenous “groups” has only perpetuated these problems. American Muslims hold diverse set of identities and backgrounds, just as every American does. Therefore when protecting the health of women in our healthcare system through cultural competence, listening to the voice of Muslim patients must be prioritized over reading a provider perspective “cultural guide”.
Hassouneh, Dena. “Anti-Muslim Racism and Women’s Health.” Journal of Women’s Health 26, no. 5 (May 1, 2017): 401-02.
Hammoud, Maya M., Casey B. White, and Michael D. Fetters. “Opening cultural doors: Providing culturally sensitive healthcare to Arab American and American Muslim patients.” American Journal of Obstetrics & Gynecology 193, no. 4 (2005): 1307-1311.
Hasnain, Memoona, Karen J. Connell, Usha Menon, and Patrick A. Tranmer. “Patient-centered care for Muslim women: provider and patient perspectives.” Journal of Women’s Health20, no. 1 (2011): 73-83.
Kleinman, Arthur, and Peter Benson. “Anthropology in the clinic: the problem of cultural competency and how to fix it.” PLoS medicine 3, no. 10 (2006): 1673-1676.
“Mapping Islamophobia.” Visualizing Islamophobia and Its Effects. Accessed March 06, 2018. http://mappingislamophobia.org/maps/.
Morgenstein Fuerst, Ilyse R . “Tracking Hate: Islam and Race After the Presidential Election.” Religion & Politics. May 09, 2017. Accessed March 06, 2018. http://religionandpolitics.org/2016/12/06/tracking-hate-islam-and-race-after-the-presidential-election/.
Osorio, Carlos. “APN Muslim Women.” Photograph. 2002. AP Images, ID02022603995.
Osorio, Carlos. “APN Muslim Women.” Photograph. 2002. AP Images, ID02012503979.
Padela, Aasim, Katie Gunter, and Amal Killawi. “Meeting the healthcare needs of American Muslims: Challenges and strategies for healthcare settings.” Institute for Social Policy and Understanding. June (2011).
Sakamoto, Izumi. “An Anti-Oppressive Approach to Cultural Competence.” Canadian Social Work Review / Revue Canadienne De Service Social 24, no. 1 (2007): 105-14.
“Black, Muslim, American: Interview with Dr. Jamillah Karim.” The Islamic Monthly. November 16, 2016. Accessed March 06, 2018. http://www.theislamicmonthly.com/black-muslim-american-interview-with-dr-jamillah-karim/.