Dateline: ANN ARBOR, MichiganFoazia Almadhagi considers herself a modern Muslim woman. She learned to speak English in school in her native Yemen, she doesn't cover her hair, she works for a travel agency.
But when it came to her health, she heeded the cultural and religious tenets of Islam. She located a health center that catered to 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 in obtaining quality health care because of their religious and cultural beliefs. At the same time, many health care providers are making extra 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 3 1/2 years ago and settled in Dearborn, a city of 97,775 with an Arabic community estimated at 20,000. Almadhagi went to ACCESS Community Health and Research Center at the recommendation of others in the Middle Eastern community. 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 in addressing the group's health concerns. The center treated more than 24,000 Middle Eastern women last year alone.
"They've really done a lot to educate providers and also advocate for the population of patients," says Bigby, director of Harvard Medical School's Center of Excellence in Women's Health.
ACCESS is staffed by two female physicians and one male. All of its nurses are women. The entire staff speaks Arabic. The center provides translators and health care pamphlets in Arabic, and medical forms are being translated into Arabic.
Middle Eastern women are reluctant to go to health care providers who do not speak the language or are not of Middle Eastern descent because 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 University of Michigan Health System in Ann Arbor, about 14,000 Middle Eastern patients are treated yearly. Once again, the hospital has a program that provides culturally sensitive care to Middle Eastern women and educates health care providers and medical students about their needs.
Dr. Maya Hammoud, director of the hospital's Middle Eastern Women's Health Program, said a major issue is making sure the patient is seen by a physician of the same sex. Muslim women prefer not to be touched by a man _ not even to shake his hand.
A woman's health comes first, but if she has the option, she would always choose a female doctor.
Western care providers also must understand how the entire Middle Eastern family gets involved in patient care _ including distant relatives, Hammoud said.
"Sometimes if someone is having major surgery, there may be 30 members 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 major decisions. Sometimes, a husband may not tell his wife all the details he has discussed with the physician.
"The wife might not be aware of all the risks and benefits of a procedure before consenting," Hammoud said, noting the contrast with American culture's view that each individual is responsible for making personal health care decisions.
The National Arab American Medical Association is using ACCESS as a model with its members in Chicago, Cleveland and New Jersey, said Dr. Ghaleb Hatem, president of the Birmingham, Michigan-based organization.
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On the Net:
University of Michigan Middle Eastern Women's Health Program: http://www.med.umich.edu/obgyn/mideastclinic.htm
ACCESS Community Health Center: http://www.accesscommunity.org
National Arab American Medical Association: http://www.naama.com
National Centers of Excellence in Women's Health: http://www.4woman.gov/coe/Index.htm
