The demands of religious observance in an increasingly diverse Ireland have been placing still further pressure on our healthcare services, writes Religious Affairs Correspondent Patsy McGarry.
The Health Services Executive (HSE) is preparing guidelines for the care of minority religious groupings in the State as it strives to accommodate people whose beliefs about modesty, diet, blood, prayer, birth and death may differ from what has been the norm in Ireland to date.
Last year's census showed that Muslim numbers in Ireland grew by more than 70 per cent in the four years since 2002, making them, at 32,500, the fastest growing of our newer religious communities.
Anecdotally, the figure is believed to be much higher with a population that is spread widely throughout the State and which has unique needs regarding healthcare. These are mainly due to religious rather than medical factors.
As Ali Selim, secretary to the Irish Council of Imams and based at the Islamic Cultural Centre in Dublin's Clonskeagh, says: "A visit to the local doctor, a consultation with a specialist or a short stay in a hospital may cause anxiety to Muslim patients. The impact on a Muslim who is anxious not to violate Islamic injunctions can be quite disturbing."
He says "modesty is an obligation in Islam; consequently a Muslim male or female is extremely shy about being naked and is very reluctant to expose their private parts, though it is permissible in Islam for medical purposes."
So, where Muslim patients are concerned it is desirable that medical examinations be carried out by same sex medical personnel and, as far as possible, only in the presence of members of the same sex. If there is no alternative then opposite sex medical personnel may perform an examination. "By and large touching should be within the limits of necessity," he says.
A further factor is prayer which, like modesty, is an obligation of their religion. It must be carried out five times a day. This involves kneeling and prostration in a clean, quiet area. If a patient is too ill, he/she may pray while sitting or lying in bed, and they should be undisturbed.
Before praying Muslims must wash their hands, mouth, nose, face, head, ears and feet and so will need access to facilities to enable this. It is also possible some Muslims may have difficulty praying in the presence of symbols from other religions.
A Muslim patient can eat only halal food and may not eat any pork, pork products or any food which contains alcohol. This halal food cannot be prepared with non-halal food and any implements or utensils used in preparing non-halal food should be washed carefully before preparing halal food.
As hospitalisation can be a particularly isolating experience for a Muslim in Ireland, due to religious and cultural differences, fellow Muslims tend to visit in numbers. This is encouraged also by the fact that visiting the sick is a Muslim duty.
Muslims mark birth with prayers. During delivery they pray and recite the Qur'an, and when the baby is born the Muslim prayer call is said in the right ear and the Iqamah (prayer) in the left one. Circumcision on Muslim boys are now performed routinely in Ireland.
Until recent years it was not the practice in Irish hospitals to perform circumcisions unless medically necessary, but this changed in order to avoid more inappropriate methods being employed outside a hospital context with the likely dangers involved to the child.
Where the death of a Muslim patient appears imminent, family members should be informed and, if none can be, then an Islamic organisation should be contacted so the dying person can have spiritual support. On death the body should be handled as if he/she were alive. There should not be a post-mortem unless absolutely necessary.
Ali Selim says HSE representatives have attended Islamic awareness courses at the Cultural Centre in Dublin's Clonskeagh.
In general he says that where the healthcare of our growing Muslim population in Ireland is concerned, it is "a process".
An unusual and probably unexpected difficulty in the medical area arose recently at the Royal College of Surgeons in Dublin involving female Muslim medical students. A clash arose between their obligation to wear the hijab and keep their arms covered, and the medical garments they were required to wear in theatre. The matter was resolved in discussion between the college and the Islamic Cultural Centre. Regular meetings now take place. "There is a very good relationship between the centre and the college," Ali Selim says.
Other groups too have beliefs that have to be accommodated by the healthcare system. There are 5,400 Jehovah Witnesses in 114 congregations throughout Ireland but their beliefs about blood means that their healthcare requirements have attracted more public notice than have those of other minority groupings.
Mark O'Malley explains that in their belief blood is sacred. He quotes from Acts chapter 15, verses 20, 28, and 29 in the New Testament to underline the scriptural basis for this "strong religious conviction". He also speaks of advances in medicine which made the shedding of blood during surgery less necessary and quoted the example of an 80-year-old man he had spoken to recently who had had a bloodless quintuple by-pass.
He says that advances in understanding mean that blood transfusions during surgery can be avoided by building up the blood in the body prior to operation through supplements, for instance. Further, less invasive surgery is now possible where it wasn't in the past and methodologies have evolved whereby a patient's blood can be recycled for reuse as an operation takes place.
Generally speaking, O'Malley says the Jehovah Witnesses found the health authorities "very easy to work with. We have a good relationship with the medical community." They also have eight hospital liaison committees around Ireland which ensure that medical cases involving Jehovah Witnesses are handled with sensitivity to all interests involved.
Similarly with our Jewish community, whose population now is about 1,800. Carl Nelkin, vice-chairman of Ireland's Jewish Representative Council, says Irish hospitals "do really try to accommodate" the needs of Jewish patients.
Apart from their dietary needs - they eat kosher foods and also avoid pork and pork products - their medical needs are no different from the rest of the population.
Like Muslims, and for similar reasons of isolation and religious obligation, they tend to visit hospitalised fellow Jews in numbers. "The hospitals really do accommodate that," he says. Traditionally they have "imported" specialists from England to perform circumcisions on newborn Jewish boys here. But this is a rare occurrence, mainly due to the demographic composition of Jews in Ireland, which is mainly in the older age categories.
Not surprisingly this increasingly diverse Ireland has brought challenges for the HSE in caring for patients from among our newer communities, particularly Muslims. But in the main these newer people speak very positively of the sensitivity with which their healthcare needs are being met in Ireland.