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Bitter Medicine: Islamist Extremism at the Bedside

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This article was originally published in 2010 Summer Issue of the World Policy Journal edited by David Andelman. An original account of this incident first appeared as part of the Center of Islamic Pluralism's Parliamentary Report A guide to Shariah Law and Islamist ideology in Western Europe 2007-2009. edited by Stephen Sulejman Schwartz

LONDON -- Afternoon dissolves into evening. Peering out of the window of my office in the Royal London Hospital, across the street, I spy the window that once framed the "Elephant Man." A century later, a new and equally grotesque spectacle enthralls. In the street below, a well-fed British Pakistani distributes cassettes. Transplanted Wahabi women, black-gloved, clad head-to-toe black abbayas, faces masked by black niqabs, snatch the recordings, nodding brief salaams. Other women, too busy, rush by in damp, rain-streaked chadors. I follow the black figures until they disappear into the dank Whitechapel tube station. Muslim men stuff cassettes into grubby Adidas jackets worn over thobes, the traditional Arab male dress. Only a sprinkling of stolid British police officers remind me: under the lapping October tides of West European Islamofascism, this is London.

He thrusts homemade compilations of Jahiliyyah at passersby. A thobe that ends above his ankles, (standard attire of the Wahabi muttawah) marks his fundamentalism. He mounts the steps to a make-shift podium on a monument donated to Whitechapel by Jews who had thrived here 90 years earlier. What British Jews once dignified, British Muslims now desecrate.

"Death to America! Death to Israel!"
he shouts.

His Geordie is flawless. Leaning into the headwind, he intersperses his sedition with the plea known to every Muslim as the Takbir in laboriously enunciated Saudi Arabic: "Allah-hu-Akbar!" (God is Great).

Anchored to his pulpit of hate by his Nike hi-tops, his fat fists punch a canopy of defiance overhead. Constables eye him, unperturbed. They have heard his shtick before. Uncertain clusters of British Muslims are ensnared in his devious orbit.

Fundamentalism at the bedside.

Abandoning the scene, I hurry. I am needed. Reviewing X-rays, I test the resident, inviting him to read the films. Faisal, a young anesthesiologist, is known to be a caring, gentle physician. He is dressed in operating room greens. To the informed eye, they reveal a cultivated Islamic identity: his scrub pants are a fraction too short, ending above his surgical clogs, and the still-damp hems are a testament to his recent ablutions. Faisal's straggling beard is left untrimmed, and Rimless Cartier glasses frame long-lashed eyes. I squeeze some rub from the dispenser; cleansing my hands en route to the bedside I prompt him to do the same.

"No thank you, Dr. Ahmed. I will wash my hands," he declares, moving to the sink. Puzzled, I explain the recommendations on hand hygiene: alcohol hand rub is preferable to soap for more effective infection control). Perhaps he is not aware of the new guidelines? A vacant stare meets mine.

"Oh no, Dr. Ahmed, you don't follow, I am Muslim." A flicker of superiority flashes across his flat gaze. Suddenly I realize that Faisal has failed to recognize the Muslim in me.

"It is haram for me to touch alcohol," he says. "I can't use alcohol hand rub on my skin." There will be no negotiation. What I've suggested, he is saying, is banned by Shariah, Muslim holy law.

I am agog. His is a radical interpretation of Islam, one which I had never encountered, even among Saudi physicians who were active members of Riyadh's clergy. How had Faisal acquired these beliefs?

I search for explanation in his origins. Like me, he is British by birth, of Pakistani heritage. With an amalgam of nostalgia and pride, he describes an early upbringing in Jeddah. Later, Faisal attended St. Bartholomew's, one of the oldest, most distinguished medical colleges in England. A marriage to a selected Pakistani woman, now secluded in his East London home, quickly followed his graduation.

The Lancet

Some months later I mention the hand washing incident to some Saudi friends at a symposium in Riyadh. They too have encountered similar reports, including at the World Health Organization. Eventually, we publish our findings in The Lancet, Britain's leading medical journal. Faisal, it seems, is far from isolated in his beliefs.

Rejecting alcohol-containing agents on the basis of Islam is increasingly common, and has already triggered research for alternatives. Surprisingly, this refusal seems to be centered in the Western world. At the Liaquat National Hospital in Karachi, a Pakistani graduate of Chicago's Northwestern University had successfully introduced alcohol based hand hygiene without obstacle. In my years practicing medicine and teaching in Riyadh I never met any resistance.

Indeed, alcohol-based hand-hygiene has been throughout Saudi Arabia--site of Islam's two holiest cities, Mecca and Medina for over a decade. In keeping with the Shariah ruling that to preserve life, "necessities override prohibitions" Saudi theocracy ruled alcohol hand-rub permissible. Even porcine- derived therapies pigs--which Muslims must avoid at all cost--have long been available for use in the Kingdom. But among European Muslims, rejection of Western technologies and customs increasingly forms a basis for their Islamic identity, even when is intrudes on advanced medical practice.

Whether growing up in Jeddah, like Faisal, or on grim jaunts to Pakistani madrassas for a better grounding in Islam, many Muslims are acquiring new, badly-skewed Islamic identities. The rejection of alcohol hand-rub is an extreme retreat into Jahiliyyah. Doctors espousing such attitudes consider themselves immutably conservative Muslims first, and physicians second--anathema to the ideals of medicine, which center on apolitical, non-denominational equanimity. In intellectual life physicians have, since medieval times, in all traditions born in the Middle East, (whether Christian, Judaic or Islamic) long been regarded as 'the torchbearers of secular erudition and the professional expounders of philosophy and the sciences, heirs to a universal tradition--a spiritual brotherhood that transcends the barriers of religion, language and countries'. Faisal, and those like him, represents a new departure from centuries of tolerance, abandoning this brotherhood in an era when intellectual dialogue and communication has never been broader, and more vital.

Western Europe has long borne impotent witness to a growing politicization of Islam. At the same time, Faisal reveals how far and how fast Islamist ideology has encroached upon the Western medical workplace. While Saudi Arabia is often criticized for its extremist brand of Islam, a clear-cut dissonance is present between this religious doctrine and the mature Saudi medical academe, which has successfully navigated many theological dilemmas. As a result, their society embraces state-of-the-art critical care medicine, hand hygiene, organ harvesting and transplantation, end-of-life decision-making, fertility treatments, genetic counseling and many other ethically complex aspects of twenty-first century medicine.

Bridging the Divide

My illiterate Bedouin patients are more accepting of Western medicine than a British-born, British-trained physician such as Faisal, and my peers trained in Saudi medical facilities are more tolerant of Western medical advances than a graduate of Bartholomew's in the heart of London. This is deeply troubling to me.

Physicians, particularly secular Muslim physicians, have a unique role in bridging this divide by challenging rote orthodoxy. Through such engagement, the heterodox, nuanced, pluralistic physician can dismantle misconceptions that are both theologically baseless and scientifically disproven, simultaneously healing both patients and the societies where they live.

Making rounds in East London brings into brutal focus the political cannibalism underway within Islam. While freedom of religious expression is advocated in Britain (as it is here) including allowing the physician's own right to such expression, this must never supersede the needs of the patient. Faisal's extreme beliefs did precisely this, anathema to Hippocratic philosophy. Placing one's religious beliefs above accepted medical standards suggests a proxy behavior for extremism and should be carefully noted as a potential risk factor for radicalization. If Faisal had refused the hand hygiene standard citing a disagreement with scientific data this would represent a separate, valid matter; that he did so citing religious objection is a matter for grave concern to his colleagues.

Exposing such issues within training programs is the beginning of an exploration of how rigid theological flavors of Islam are influencing medicine. Creating a safe space within the medical academe to discuss, broach and ultimately resolve these dilemmas is essential as a first step.

Additionally, recognizing that both in Britain and in the United States, foreign-born physicians comprise up to 25% of all trainees, most of whom will ultimately return to their countries of origin (many of which are Muslim majority nations) indicates a critical need to seeking their engagement in encouraging moderate interpretations of both western science and Islam as it applies to medicine. Accessing and informing these doctors influences healthcare delivery in foreign climes, presenting a much overlooked but valuable opportunity to influence foreign policy, international collaboration and ultimately change US-Muslim relations expressly in keeping with the Obama Administration's articulated foreign policy renaissance which remains nascent in the post Bush era.

Engaging academic medicine in this service is truly an exercise in global health diplomacy, a uniquely powerful armament when deployed in the promotion of a positive experience of America's best export: intellectual capital. Further, such academic spaces lend a dimension to the nexus of medicine and faith, one largely uncomfortable to most physicians and yet central to treating our patients and training our peers. Under the well-meaning guise of permissive tolerance characteristic of Western societies, dangerous pockets of rigidity are propagated and intensified, worsening associations, behaviors and belief systems which quickly fracture our tolerant societies rendering them ironically less tolerant. This cannot be allowed in the hallowed vaults of medicine, one of the last citadels of apolitical exchange.

Speaking to physicians at Harvard about this specific event in conference earlier this year, I detected a surprising reticence: when presented with Faisal's case, physicians cited fear of raising these issues for the risk of offending a fellow colleague; fear of being seen of being intolerant of a fellow physician's belief; lack of awareness of religious belief systems other than one's own, and a general discomfort at venturing beyond the precision and familiarity of scientific medicine. This discomfort must be denatured.

Medicine, one of the few areas where physicians can be non judgmental and influential is a bastion which must be preserved and vigorously protected from proxy symbols of extremism. We can do this only by exposing what is developing within our ranks in an attempt to defuse and dismember evolving fissures in basic belief systems. Best accomplished with the help of physicians who are sophisticated in theology, there may even be a role for formal theological training of certain members of the physician academe to help engage the physician-mind in both enquiry and dialogue of such behaviors.

We may in fact richly benefit from the experience of our academic Saudi peers who have long interpreted Islam at the beside in positive, moderate and sophisticated fashion. Unlike here in the West, a monolithic rigid Islam has not been incubated in a hermetic vacuum, instead in the Muslim world Islam exists in the ether, in all its varieties, maturing ideological interpretations at the beside. Exchange programs must be created to gain from such knowledge. This is not just to advocate better medicine, but also for physicians to become more aware and ultimately more influential in communicating the advanced, tolerant, progressive qualities of American medicine, a precious global export, testament to all that is best in our society. Such dialogue can only happen between brave clinicians who can rise to the challenge and not waiver in uncertainty. We need to be as rigid in our advocacy for tolerance, science, interfaith and intra-faith dialogue as our nihilist peers remain in adhering to their own calcified belief systems and their insistence on imposing these rigidities on the patient body, on their physician peers and the families within their influence.

While we soothe ourselves chasing elusive phantoms in the hurt-lockers of the Hindu Kush, battle lines are being redrawn in the Detol-scented hospital corridors of privileged Western Europe. This is one war that cannot be won with M4s, gunships, even drones. Rather, we are facing an intensifying ideological warfare that demands enormous, multidisciplinary and above all imaginative intellectual retaliation. In this "Greater Jihad", make no mistake: we are all conscripted foot-soldiers, whether firing rounds in bulletproof vests or writing prescriptions in crisp white coats. We may not know it, but we are already knee-deep in pitched battle and, for the moment, losing this war, on every front.