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Paper delivered at a seminar organized jointly by the Islamic University College of Selangor and the Konsortium of Islamic Hospitals at Bangi Kuala Lumpur on 10th April 2009 by Professor Omar Hasan Kasule Sr MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine University of Brunei and Visiting Professor of Epidemiology University of Malaya. EM: omarkasule@yahoo.com and WEB: http://omarkasule.tripod.com
1.0 INTRODUCTION
TAHARAT FOR THE SICK
In urinary incontinence ablution is followed immediately by prayer with no delay. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer.
Patients with urinary catheters wash and pray as usual even if the catheter is discharging urine. The should pray immediately after ablution.
In hematuria, wudhu is followed immediately by salat with no delay. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer. Hematuria causing anemia exempts from saum.
Patients with renal failure not in coma pray as much as they can but are exempt from saum in order to control fluids and electrolytes.
In urolithiasis, salat movements are restricted if they trigger pain and salat is delayed while patients are under sedation to control pain. Stress of hajj movements and change in meals in a hot and dry climate may trigger pain. Patients prone to stone formation have to be careful while fasting to make sure they take plenty of fluid and avoid hot environments that lead to excessive fluid loss.
FISTULAE:
Bladder fistulae may join the vagina (vesico-vaginal fistula) or the colon (vesico-intestinal fistula). They usually follow trauma, infection, or irradiation. Rarely intestinal fistulae may discharge to the outside. Urethral fistulae may open into the vagina (urethro-vaginal), the rectum (urethro-rectal) or the skin (urethro-cutaneous).
For purposes of prayer fistulae are treated like incontinence either of urine or of feces.
19.5.5 SALAT OF THE SICK, salat al maridh
The patient may have the following physical handicaps: inability to face the qiblat, inability to stand, inability to sit, inability to read, inability to bow, and inability to prostrate. The following are solution alternatives: make-up salat, qadha al salat; resting for moments in a sitting position to regain energy for the next movement; praying in a sitting position; praying while sitting down and cross-legged; praying while lying down on one side of the body; resting on a staff in salat; Praying by gesturing with one part of the body e.g. finger; and finally praying in the mind with no motions. The sick stop qiyam al layl and try to fulfill the 5 prescribed prayers. Salat can be interrupted for an urgent need that could be medical or otherwise. Soldiers on the battle field can pray abridged prayers and physical movements are changed. Women are excused from salat during the period of menstruation because of the associated physiological stress.
20.1.4 FASTING IN DIFFICULT CIRCUMSTANCES
The elderly and patients with chronic or terminal illness are permanently excused from saum. They can choose to feed the poor instead or their heirs can make up their missed saum (qadha) if they die. Travelers, partients with curable illnesses, pregnant or breasfeeding women, women in haidh or nifaas are temporarily excused from saum but they have to make up (qadha al saum) before the next Ramadhan. Kaffaarat by feeding the poor is due if the next Ramadhan comes before the qadha. Saum in haidh or nifaas is invalid. More drinks are taken in hot weather to prevent dehydration and more food is eaten in cold environments to generate heat. Polar regions with long days or long nights follow the suhuur anf iftar times of the nearest temperate region.
20.1.5 MEDICAL RULINGS ABOUT FASTING
Hypoglycemia and dehydration are prevented by prohibition of continuous saum and encouragement of early iftaar and late suhuur. Saum is exempted in physiological stress (haidh, nifaas, old age, illness, pregnancy, and breastfeeding). The following should be avoided: over-eating at iftaar and suhuur, and exposure to high temperatures. The following are encouraged: high fiber diets, adequate fluid and mineral intake, and cooling the body. Diabetics should consult trusted physicians before saum. The following do not nullify saum: drugs applied externally on the skin, eye drops, nose drops (if not swallowed), injections (sub-cutaneous, intra-muscular, and intra-venous), and sub lingual tablets. Elective medical procedure should be delayed until after saum. The following nullify saum: inhalants, nourishing i.v. injections, drugs taken orally or rectally. Saum teaches control of the food appetite and prevents diseases of overnutrition. It prevents sexually-related diseases by teaching control of the sex appetite.
20.3.5 PILGRIMAGE OF THE SICK, hajj al mariidh
The physically disabled can circumbulate the ka’aba riding on a vehicle or being carried by another person. The weak can leave Muzdalifat earlier to avoid the crowds. The very old and those with debilitating chronic diseases can ask another person to perform hajj on their behalf. However if the disease is curable it is better to delay hajj until the next year. In case of a fracture, hajj is stopped and is repeated the next year. If disease occurs during hajj, the sick can be carried to Arafat because al hajj Arafat and missing Arafat is missing the whole hajj. They are assisted to complete the other rites as much as is possible.
ACUTE ABDOMEN:
The following are common causes of the clinical syndrome called acute abdomen: acute appendicitis, acute cholecystitis, perforated peptic ulcer, pancreatitis, diverticulitis, and PID. These are serious conditions that require emergency treatment.
The patients are immediately excused from the obligation of fasting until full recovery.
Salat can be performed as much as their physical condition allows.
Acute intestinal obstruction causes vomiting and exempts from fasting because of the need to replace fluids and electrolytes. Hajj is not possible.
Movements in salat will increase the pain of appendicitis. Patient is exempted from saum while being treated.
LOWER GIT BLEEDING
Fresh bleeding from hemorrhoids and anal lesions does not nullify wudhu but must be washed away immediately and before salat commences.
CONSTIPATION
Relief of constipation by enema nullifies wudhu. Enema and suppositories nullify saum.
DISEASES OF THE COLON
The common diseases of the large intestine are: diverticula, volvulus, ulcerative colitis, and chron's disease. They interfere directly with fasting if they are associated with vomiting which voids fasting. Continuous diarrhoea may make the maintenance of wudhu difficult.
CONDITIONS OF THE ANUS
The common conditions of the anus are hemorrhoids and anal fissure that are associated with bleeding and pain. Wudhu will have to be made immediately before the salat and for that salat only. It has to be repeated for every salat. Care must be taken during defecation not to cause undue pain in case of anal fissures. Salat may not be a problem but travel for hajj may be difficult.
In cases of anal incontinence, wudhu is made immediately before each prayer.