ANN ARBOR, Mich. - Foazia Almadhagi considers herself a modernMuslim woman. She learned to speak English in school in her nativeYemen, she doesn't cover her hair, she works for a travel agency.
But when it came to her health, she heeded the cultural andreligious tenets of Islam. She located a health center that cateredto the needs of Middle Eastern women. She asked for - and was granted- a physical examination by a female doctor.
Muslim women in the United States face special challenges inobtaining quality health care because of their religious and culturalbeliefs. At the same time, many health care providers are makingextra efforts to understand the dynamics of the Arab-American family,modesty issues and guidelines within Islam.
Almadhagi, 22, came to the United States from Yemen 31/2 years agoand settled in Dearborn, a city of 97,775 with an Arabic communityestimated at 20,000. Almadhagi went to ACCESS Community Health andResearch Center at the recommendation of others in the Middle Easterncommunity. The doctors treated her even though she had no insurance.
With about 300,000 Middle Easterners living in the Detroit area,Dr. Judy Bigby says southeastern Michigan is at the forefront inaddressing the group's health concerns. The center treated more than24,000 Middle Eastern women last year alone.
'They've really done a lot to educate providers and also advocatefor the population of patients,' says Bigby, director of HarvardMedical School's Center of Excellence in Women's Health.
ACCESS is staffed by two female physicians and one male. All ofits nurses are women. The entire staff speaks Arabic. The centerprovides translators and health care pamphlets in Arabic, and medicalforms are being translated into Arabic.
Middle Eastern women are reluctant to go to health care providerswho do not speak the language or are not of Middle Eastern descentbecause there is a 'lack of sensitivity' to their needs, says Dr.Adnan Hammad, director of ACCESS.
At another medical facility just 30 minutes away, the Universityof Michigan Health System in Ann Arbor, about 14,000 Middle Easternpatients are treated yearly. Once again, the hospital has a programthat provides culturally sensitive care to Middle Eastern women andeducates health care providers and medical students about theirneeds.
Dr. Maya Hammoud, director of the hospital's Middle EasternWomen's Health Program, said a major issue is making sure the patientis seen by a physician of the same sex. Muslim women prefer not to betouched by a man - not even to shake his hand.
A woman's health comes first, but if she has the option, she wouldalways choose a female doctor.
Western care providers also must understand how the entire MiddleEastern family gets involved in patient care - including distantrelatives, Hammoud said.
'Sometimes if someone is having major surgery, there may be 30members of the family in the hospital,' she said.
Middle Eastern women typically seek their husbands' opinions,Hammoud said, and the men generally have the final word in majordecisions. Sometimes, a husband may not tell his wife all the detailshe has discussed with the physician.
'The wife might not be aware of all the risks and benefits of aprocedure before consenting,' Hammoud said, noting the contrast withAmerican culture's view that each individual is responsible formaking personal health-care decisions.
'In the American culture, we are used to obtaining informedconsent directly from the patient,' she said. 'However, it isacceptable informed consent if the patient defers the decision to herhusband or another family member.'
The National Arab American Medical Association is using ACCESS asa model with its members in Chicago, Cleveland and New Jersey, saidDr. Ghaleb Hatem, president of the Birmingham, Mich.-basedorganization.
On the Net:
University of Michigan Middle Eastern Women's Health Program:www.med.umich.edu/obgyn/mideastclinic.htm
ACCESS Community Health Center: www.accesscommuni ty.org
National Arab American Medical Association: www.naama .com
National Centers of Excellence in Women's Health: www. 4woman.gov/coe/Index.htm
