MCC Program

and Services

 

May 22nd, 2020

An example of Interfaith Human Services

M Basheer Amed M.D.

In the summer of 1995 I received a call from the executive director of Catholic Charities regarding newly arrived Muslim refugees from Bosnia who were looking for a place of worship and the availability of halal food. During the 1990s there were a few mosques in our area and those existing mosques were struggling to build places of worship and heeding the teachings of the Quran and Islam. The Bosnian refugees were assisted by a Christian organization, World Vision, who was helping distressed refugees throughout the world, regardless of their religious affiliations.

 I was aware that the Fort Worth-Dallas area did not have any social service organizations to assist with the issues confronting Muslims refugees and immigrants. I had met some of the refugees and realized that they did need help on multiple issues and were having difficulty in accessing any available services due to religious, cultural and language barriers. I was also aware that other religious entities had established well-functioning social service organizations such as Catholic Charities and Jewish Family Services.

I convened a meeting of Muslim community leaders and approximately 35 individuals from religious establishments, healthcare institutions, corporate entities and nonprofit organizations attended. All affirmed the need to establish an organization to assist Muslim refugees and immigrants who have difficulty transitioning to a new culture. Out of this meeting and discussion, the Muslim Community Center for Human Services (MCC), was established to provide these needed services. Initially, services were only provided to Muslim clients.

In 2003, MCC organized the first Interfaith Health Fair at United Methodist Church in Richland hills, Texas (near the clinic). The Richland Hill Christian Church and St. John Catholic Church co-sponsored the health fair. This was an enormously successful event and became a landmark for the introduction of MCC to the broader community. The cities of Richland hill and north Richland hill proclaimed September 27th, 2003 to be as MCC Health Fair Day.

In addition to the mayors of the cities county commissioner Mr. Whitley and Dr. Hathway Medical Director of the Tarrant County Public Health Department inaugurated the event.

Of the individuals who attend the Interfaith Health Fair, 80% of the participants were non-Muslims and almost 90% of providers were Muslims. It became obvious that our mission needed to be providing services to all indigent residents irrespective of color, creed, religion, and country of origin.

As more individuals of religious identities volunteered, we grew. An ophthalmology group of Fort Worth donated medical equipment, so MCC opened an eye clinic. Upon retirement, Dr. Sam Roach a dentist donated the entire dental equipment from his clinic and our dental clinic was created.

We are pleased to note that Dr. Roach not only donated the equipment but he also volunteered at the dental clinic.

During past 20 years, MCC has added several services in addition to the Medical, Dental and eye Clinic; we added mental health clinic, domestic violence program, child abuse program and breast cancer education and early detection program. The services are provided by individuals of different faiths to the indigent residents of DFW area irrespective of color, race, country of origin and religion.

Humanity is a relationship between one another with compassion, empathy, kindness and treating each other with dignity. All religions teach humanity, however we do not spend enough time in serving the needs of impoverished and needy. We are grateful for the interfaith partnerships that meet the needs of our community at MCC. All of our volunteers and staff feel the essence of responsibility for the care of others in need. Human services to the needy irrespective of their race, religion and country of origin is the real obedience and service to the creator.

  1. Basheer Ahmed, M.D.

Chairman Emeritus, MCC for Human Services.

Member Board of Directors, Multi Cultural Alliance.

May 22nd, 2020

AL-SHIFA CLINIC

A FREE MEDICAL CLINIC

Operated by MCC FOR HUMAN SERVICES

7600 Glenview Dr, Richland Hills, Texas 76180               817-589-9165

M Basheer Ahmed M D

In 1995, there was an influx of refugees into the US from Bosnia, Kosova, Iraq (mostly Kurds), and Somalia. Many agencies like Catholic Charities and World Vision, which were helping to settle these refugees in different locations, faced difficulties in dealing with their physical and emotional problems due to language and cultural barriers.

As a psychiatrist, I have worked with Catholic Charities prior to this, and therefore they contacted me seeking some help. It became very obvious that these refugees definitely need the help, which the public health system is not able to provide.

With the help of a few concerned community leaders, we organized Muslim Community Center for Human Services to offer a variety of services including health and social services to these distressed individuals. As we organized, it became evident that many individuals from Southeast Asia, Africa, and Middle East; especially the recent immigrants were extremely hesitant to seek help at the public hospitals and clinics due to cultural and language barriers. In 1998, MCC for Human Services started a free health clinic to offer services for medical problems such as hypertension, diabetes, minor infections, and arthritis etc. The major goal was to deal with these issues at an early stage of development, so that these people do not neglect their health and wait until the last minute to rush to the emergency room. By that time, a patient may develop some complications requiring more intensive treatment.

The MCC clinic is located in Richland Hills, which is easily accessible to Fort Worth, Midcities, Arlington, and the western part of Dallas. The clinic has now been in operation for about 7 years, and we are seeing many indigent patients irrespective of their race, color, creed, nationality of origin, and religion. Fifteen area physicians give their free time to the clinic, which opens every Saturday between 9 am and 1 pm. We see approximately 20-25 patients per week. Medical students from the area as well as many volunteers, including pre-medical students also help in the clinic. We have negotiated a contract with a local laboratory, which offers almost 60% discount for routine lab work. Many indigent patients cannot afford to purchase medication due to the high cost. We have sent out an appeal to our volunteer physicians, and they bring free samples of medication to the clinic from their office. When no samples are available, physicians prescribe generic medication. Our patients can enroll in an Rx Outreach program, which dispenses a 3-month supply of generic medication for $18.00. We also refer patients to local public and private hospitals if they are in an emergency, or if we cannot handle their medical problem due to lack of resources.

To promote health education and the importance of preventive services among the immigrant population, MCC for Human Services also arranges Annual Health Fairs. The last two Health Fairs were held in United Methodist Church in Richland Hills, and Al Hedayah School in E. Fort Worth. Four to five hundred individuals participated in the Health Fair. Health Fairs offer free blood pressure, blood sugar, and cholesterol screening, BMI assessment, free dental screening, eye screening for sight and glaucoma, and hearing tests. Most of the participants have access to physicians, including ObGyn’s and pediatricians who counsel them during the Fair. The American Cancer Society, Heart Association, Diabetic Association, the Public Health Department, and many other agencies participate, offering educational material on health related issues. The results of the blood test are provided immediately, and individuals with abnormal results are advised to seek help through their private physicians and if they cannot afford it, they are referred to either the MCC clinic or public clinics. The major goal of the Health Fair is to screen patients with abnormal results, and give appropriate consultation. About twenty-four area physicians participate in Health Fair.

During the past few years, we have seen an increase in the number of patients due to high unemployment rates and lack of medical insurance. People used to having a stable income and insurance, experience extreme difficulty in obtaining medical care on losing health insurance from work. For many individuals without health insurance, our clinic is a major resource for healthcare. Individuals who were once hesitant to go to public hospitals and clinics are eager to seek help here not only due to the free services, but also due to feeling at ease with language familiarity and cultural understanding with the staff. Our physicians represent a diverse ethnic and cultural background.

MCC also offers educational programs for breast cancer awareness at the local libraries and Islamic centers. Free mammograms are arranged for indigent patients with the courtesy of the Harris Methodist Program for Breast Cancer.

During the last year, the clinic has served approximately 1000 patients. Due to limited time, we have had to turn some patients away as we cannot see them in the allotted time. We want to increase the clinic timings from one day to two days a week, and we are seriously looking for more physicians to help us in the clinic operation.

___________________________________________________________________________________

Al-Shifa Clinic- Free Medical clinic

7600 Glenview Dr, Richland Hills, Texas 76180

(817) 589-9165                       mcchs1999@hotmail.com

 Sponsoring organization:    Muslim Community Center for Human Services

Medical Director:                  M. Basheer Ahmed, M.D.

Clinic hours:                         Each Saturday– 9:30 am – 1:00 pm

                                                Family physician/internist and psychiatrist available!

Lab work:                               At discounted price

Medication:                           At discounted price through Rx Medic services ($18 for 3 months supply        of generic medicine). Samples provided as available.

Diagnostic &                         Free blood pressure and blood sugar screening to general public

Screening services:              on Saturdays between 9 and 11 am

                                                Mammograms – 3-4 times a year         Pre-registration required!

Educational programs:         Periodic educational programs on common medical and emotional problems such as: diabetes, hypertension, depression, and stress disorders

Needs:                                    Internists, Family Physicians, Psychiatrists, Pediatricians, ObGyn’s, Ophthalmologists, Dentists, and other specialists

 FUTURE PLANS:                   To open a dental and eye clinic once a month for 6 hours

September 18th, 2011

Healthy Marriages

 Strengthening Marriages and Families Through Healthy Relationships

 Basheer Ahmed M.D

 MARRIAGES ARE MADE IN HEAVEN BUT WE HAVE TO MAINTAIN THEM ON EARTH

There is a saying that “All marriages are happy, it is living together that creates all the problems”. There are many problems a couple faces while keeping up with busy careers, home maintenance, parenting responsibilities, and community involvement. It is unfortunate to see just how often a marriage deteriorates after years of pressure produced by day to day living.

            Marital problems among Muslims in America are increasing. Divorce and marital discord are reaching epidemic proportion. Domestic Violence is increasing; Imams and Muslim social workers are concerned as 60% newly married are filing for divorce within a year of marriage. Couples who are in matrimonial relationship for many years are showing signs of marital disharmony are becoming dysfunctional family units.

HEALTHY MARRIAGE:

            Marriage in Islam is not a sacrament but a civil contract between two individuals with equal rights. A healthy marriage is based on couples making decisions and resolving problems according to their faith and commitment. The spouses honor and ensure each other’s rights and privileges and have realistic expectations of each other. A strong willingness to compromise and cooperate is necessary for a healthy marriage. While keeping their individuality and autonomy the couples must develop skills to resolve conflicts in a healthy manner without anger and aggression. It is not marriage that causes a problem, it is the neglect of your relationship with your spouse, which destroys a marriage.

WHY MARIAGES HAVE PROBLEMS:

          There are multiple factors. The most common reasons are personality differences, differences in cultural patterns, differences in religious beliefs, differences in financial matters, parenting and hobbies. The more differences there are, the more experiences the difficulties in building harmonious relationship. And once it has started effecting the communication, it leads to problems, which in turn leads to conflicts.

            Although both partners may have the same basic religion or same basic religious beliefs, there may be differences in depth of one’s belief, the daily practices, and the way it affects the daily life. The husband may be orthodox or the wife may be orthodox and they have intensely different opinions on religious matters. The second major factor is the personality. We all have different personalities and one has to develop a compromising attitude to accept the strengths and weaknesses or the partner’s personality. If the personality is very strong in both partners, they have extreme difficulty. If one partner is more passive than the other, it will be easier. For example a dominant wife may do very well with a passive husband or a passive wife may do very well with a dominant husband. On the other hand, if they both recognize they have a strong personality but they are still willing to work together and accept each other’s views, then those marriages have very few problems.

            Another common problem I find in my practice concerns financial matters. If the husband has a habit of overspending then there are conflicts. When both are spendthrift or both don’t care much about the money the life may be harmonious. On the other hand, if one person is very cautious and prudent with financial matters and the other has a free hand, it will certainly lead to conflicts. Socialization is another issue. If the wife and husband both are socially active and enjoy socialization then the chances of conflict are much less. On the other hand, if the husband wants to socialize and participate in multiple activities when the wife resents, then this pattern becomes the basis of conflicts. What I am trying to explain is the more you have difference of opinion on cultural issues, parenting issues, hobbies or financial matters, there are more problems and a greater likelihood of building long standing conflicts which will result in disharmonial relationship.

            In addition to the long-standing problems of difference in the personality and cultural patterns there are short-term problems which also affect the marriage. The stresses of daily life, illnesses, death in the family, financial crisis, issues related to children and job may also have negative influence on the harmonious relationship. If the child is not doing well in school, instead of exploring the problem and coming with a common understanding sometimes both the spouses blame each other for the child’s academic problem. When one starts blaming, that results in conflict and, instead of resolving the problem of the child, another problem is created I the relationship that will have further negative effect on the children and the harmonious life at home.

SCAPEGOATING:

            Displacing or projecting your anger on your spouse also results in marital disharmony. You may have problem with the boss or any authority figure. You are unable to express anger with the fear of retaliation. You come home and project your anger on safe person, your wife or child. The family members do not understand the reasons for his anger, and your inability to communicate and express your real feelings will further increase conflict and stress.

THE PHASES OF MARITAL RELATIONSHIP:

            THE HONEYMOON PHASE:        This phase lasts anywhere between 3-12 months. This is the period where two young people feel close to each other, they don’t think much about the differences, and attempt to enjoy life and the new experiences.

            FANTASIES AMD REALITIES IN A MARRIAGE: When people marry each other, they build a lot of fantasies. The fantasies continue during the honeymoon period. They overlook the shortcomings and develop and expectation that the problem will just disappear. Unfortunately, the reality that appears after some time results in disappointments. There is a misunderstanding that if you have an arranged marriage then you will have more conflicts whereas if the marriage is taken place after a prolonged period of dating the conflicts are less. Unfortunately that is not true. I have seen many couples who have dated for three or four years and they even live together for a year or two and then got divorced just six months after the marriage. During the entire period of dating or living together the couple has not looked into reality and they continue to live in a fantasy. Recently a lady came to see me; she was married for about two and a half years and has known her husband over 5 years. Her major complaints were that her husband was drinking excessively and had been abusive towards her. I questioned that since she knew him for about 3 years prior to marriage, did she recognize these problems. She said that he never drank excessively and he was not abusive. The fact of the matter is that people try to paint the best picture of themselves during the dating period. So, once the honeymoon period is gone, the disappointment start coming to surface which results in conflicts.

DISCOVERY PHASE:

            When they start noticing the differences in each other. This is the phase where the disappointments occur and this is the phase where one has to resolve the issues before it becomes more troublesome. Unfortunately many couples don’t pay attention and they just keep on accumulating the disappointment and instead of dealing with the issues, they attempt to fix the problem in the spouse and the conflicts keep on building.

DISAGREEMENTS IN MARRIAGES:

            When the conflicts start accumulating, naturally this will further increase the disharmony in relationship. Conflicts are not uncommon in any marriage. However, the three possible outcomes of these conflicts are:

  1. The conflicts can be resolved and the couple will end up in happy relationship.
  2. they may compromise and accept some disagreements and still build a fair relationship.
  3. give up resolving any conflicts and go their own way. When one makes this choice, the marriage problems are bound to continue.

LONG TERM EFFECT OF THE DISHARMONIOUS RELATIONSHIP:

Disharmonious relationship leads to constant arguments resulting in not listening and sometimes overt fighting. Fighting may be verbal resulting in emotional trauma and sometimes may even be physical. The constant blame, and fault finding that the other person is responsible for this disharmony is not uncommon. The fights may be covert like nagging, constant criticism and a controlling attitude. Marital disharmony certainly increases the stresses of daily living. It contributes or exacerbates medical illnesses like hypertension or coronary heart disease, diabetes, etc. It may also contribute to exacerbate emotional illnesses like anxiety or depression. Invariably marital disharmony will result in divorce or a dysfunctional family with serious consequences on children.

CONFLICTS, ANGER AND HUMAN RELATIONS:

Conflict is normal in any healthy relationship and it is not a sign of incompatibility. Conflicts are a result of different opinions, values and ways of doing things. Conflicts, if worked out, enhance the relationship and unresolved conflicts result in anger.

Some individuals experience and express anger frequently and even minor situations create anger resulting in loss of self-control. On the other hand, some individuals suppress their anger to the degree that they deny it. Both of these situations lead to unhealthy physical and psychological consequences. Long standing feelings of anger whether expressed or suppressed leads to personality changes, anxiety, depression, mistrust, and paranoid feelings. Anger is also one of the contributory factors for hypertension, heart disease, coronary occlusion and sudden death.

            Some people deal with conflicts by explosive outbursts, constant fighting or passive reactive behavior as silence and not communicating. Others deal with conflict by playing the role of a victim to gain support of the family and friends, or hold past resentments and anger and get revenge.

WHAT IS THE SOLUTION:

Unfortunately no do it yourself guide is available to fix a marriage. Two individuals who seem to have good relations may develop conflicts. Because of changing circumstances new issues will emerge. These issues will not be resolved without communication. Unfortunately many couples show inablitity to communicate and resolve conflicts. They may employ a domineering attitude or even resort to physical violence to force their spouse to comply. They may act as if they have all the knowledge and decision making capability. They may also interpret religious teachings to achieve their goal. Other may turn to constant criticism, nagging, sarcasm, or even ridicule. They know what to say and how to say it so that the other individual involved loses self control.

HEALTHY WAY TO RESOLVE CONFLICTS:

They best way to prevent conflict is to take time to talk when things are going well. This will develop into a habit of communicating without anger. It is important to listen without interruption so that each partner has an opportunity to express feelings and opinions. One must avoid blaming, confrontation, and bringing up his or her past unpleasant experiences. The goal of the communication should be to find solution and ways to resolve the differences. It is necessary to compromise and show willingness to change by communicating about different perceptions and opinions one learns about their own shortcomings. This can be taken as a positive opportunity for growth and development. Learning better ways to deal with anger and conflict will result in improving relationships.

THREE STEPS TO BUILD A HARMONIOUS RELATIONSHIP:

  1. Listen, pay attention and find time to expect to explore each others’ feelings.
  2. Think, feel, act, and sometimes say sorry. Mutual respect is very important in developing a harmonious relationship.
  3. Make a commitment, make adjustments and make compromises.

 COUNSELING:

If the problems are not resolved seek help of a colleague, relative, the elderly or a religious leader whom you trust. IF you do not wish to do that or if that is not helping, counselor may show the techniques to reduce the conflicts and improve the relationship.

WAYS TO KEEP MARRIAGE HEALTHY:

  1. Keep spouse informed:
  1. inform spouse of what is happening in your life
  2. inform spouse of your schedule
  1. Help your spouse, especially when he or she is working hard on a project. It convey sensitivity and devotion.
  2. Communication: regularly taking time to talk and explore feelings, spend 30 minutes each week not focusing on work or controversial issues.
  3. Non sexual affection: Affectionate, nonsexual touching reaffirms the emotional bond.
  4. Elimination of irritating habits. Recognize what is irritable to your spouse and change the habit even if you do not see it as important.
  5. Apologies: no one is perfect, yet many men and women hide behind false pride by never admitting that they have been wrong. It is a sign of strength to personally acknowledge a mistake or when you have hurt your spouse’s feelings to directly and sincerely say, “I am sorry”, it is also a sign of being caring.
  6. Calmly disagreeing: You do not have to agree with each other on all matter but you must have a capability to resolve the differences of opinions.
  7. Loneliness: Loneliness is the most troublesome and uncomfortable feeling a couple has when they have drifted apart. Loneliness is a psychological despair due to a sense of not being understood or accepted by those you care about. Make every effort to prevent this from happening.
  8. Attempt to make sure changes have overcome the fear of change. Change of any kind is uncomfortable and with practice the discomfort will disappear.
  9. Influence of peers: Relatives and friends with whom you share your problems may not support the changes you are bringing in yourself. You must do what is right for your marriage even if you must stand alone.
  10. Fear of consequences: “If I do it once, he/she will expect it all the time”. Remember you are changing to make your relationship better, simply because it is the right thing to do.

Dr. Ahmed is the former Professor of Psychiatry at Southwestern Medical School and Chairman of Muslim Community Center for Human Services. He can be reached at mbahmed03@hotmail.com

September 18th, 2011

DV- ROLE OF VOLUNTEERS

Narika — a domestic violence helpline for abused South Asian women — invites professionals, practitioners and students from the fields of Medicine, Public Health and Social Work in the Bay Area/Northern California to volunteer for its initiative on Engaging Healthcare to End Domestic Violence.

Volunteers for the healthcare initiative will work closely with Narika staff and board members to:

o Forge ties with physicians, nurses, mental health and public health professionals as well as healthcare social workers in the Bay Area/Northern California on the issue of domestic violence in the South Asian community and discuss health impact of violence on South Asian women.

o Encourage healthcare providers to refer abused South Asian women patients to Narika for support.

o Participate in Narika’s Speaker’s Bureau to offer cultural competency/domestic violence in South Asian community trainings/presentations to health care professionals.

o Create a network of care providers (mental health providers and physicians) who can serve the needs of  South Asian survivors through low-cost or free consultations and exams.

o Identify and/or develop culturally/linguistically relevant educational materials and resources for South Asian women (posters, flyers, brochures on health care access and women’s health issues) and care providers (fact-sheets, research on the impact of DV on SA women’s mental, physical, and sexual health).

o Assist Narika staff in creating a support group program for pregnant women and new mothers in the South Asian community by engaging public health nurses and nurse mid-wives.

Training Requirements:
• 8-hour Narika volunteer orientation
• Attend mandatory quarterly volunteer meetings
• Any additional project-specific training

Time commitment:
• A minimum of 8 hours per month
• Attend committee meetings (time varies from month to month depending on projects)
• Attend mandatory quarterly volunteer meetings

  • Attendance at ONE client activity/event per year
  • Staffing of at least TWO community booths per year
  • Work on at least ONE Narika event annually

    Benefits for volunteers:

  • Learn and practice skills such as public speaking, preparing presentations, facilitating workshops and meetings, using different computer and publication programs, awareness raising and community mobilization.
    • Gain program development and strategic planning skills.
    • Apply your language skills and cultural familiarity to work with the healthcare/public health communities to end family violence and violence against women.

To learn more about this initiative, please contact Vibhuti Mehra, Outreach and Education Coordinator, at (510) 540-0754, x2 or email Vibhuti@narika.org.

Narika’s mission is to promote the empowerment of women in our community to confront and overcome the cycles of domestic violence and exploitation.  We work to build a movement to end violence against women and to support women’s rights as human rights.  To learn more about Narika and its work, please visit www.narika.org.

September 18th, 2011

Healthy Marriages

 Strengthening Marriages and Families Through Healthy Relationships

 Basheer Ahmed M.D

 MARRIAGES ARE MADE IN HEAVEN BUT WE HAVE TO MAINTAIN THEM ON EARTH

There is a saying that “All marriages are happy, it is living together that creates all the problems”. There are many problems a couple faces while keeping up with busy careers, home maintenance, parenting responsibilities, and community involvement. It is unfortunate to see just how often a marriage deteriorates after years of pressure produced by day to day living.

            Marital problems among Muslims in America are increasing. Divorce and marital discord are reaching epidemic proportion. Domestic Violence is increasing; Imams and Muslim social workers are concerned as 60% newly married are filing for divorce within a year of marriage. Couples who are in matrimonial relationship for many years are showing signs of marital disharmony are becoming dysfunctional family units.

HEALTHY MARRIAGE:

            Marriage in Islam is not a sacrament but a civil contract between two individuals with equal rights. A healthy marriage is based on couples making decisions and resolving problems according to their faith and commitment. The spouses honor and ensure each other’s rights and privileges and have realistic expectations of each other. A strong willingness to compromise and cooperate is necessary for a healthy marriage. While keeping their individuality and autonomy the couples must develop skills to resolve conflicts in a healthy manner without anger and aggression. It is not marriage that causes a problem, it is the neglect of your relationship with your spouse, which destroys a marriage.

WHY MARIAGES HAVE PROBLEMS:

          There are multiple factors. The most common reasons are personality differences, differences in cultural patterns, differences in religious beliefs, differences in financial matters, parenting and hobbies. The more differences there are, the more experiences the difficulties in building harmonious relationship. And once it has started effecting the communication, it leads to problems, which in turn leads to conflicts.

            Although both partners may have the same basic religion or same basic religious beliefs, there may be differences in depth of one’s belief, the daily practices, and the way it affects the daily life. The husband may be orthodox or the wife may be orthodox and they have intensely different opinions on religious matters. The second major factor is the personality. We all have different personalities and one has to develop a compromising attitude to accept the strengths and weaknesses or the partner’s personality. If the personality is very strong in both partners, they have extreme difficulty. If one partner is more passive than the other, it will be easier. For example a dominant wife may do very well with a passive husband or a passive wife may do very well with a dominant husband. On the other hand, if they both recognize they have a strong personality but they are still willing to work together and accept each other’s views, then those marriages have very few problems.

            Another common problem I find in my practice concerns financial matters. If the husband has a habit of overspending then there are conflicts. When both are spendthrift or both don’t care much about the money the life may be harmonious. On the other hand, if one person is very cautious and prudent with financial matters and the other has a free hand, it will certainly lead to conflicts. Socialization is another issue. If the wife and husband both are socially active and enjoy socialization then the chances of conflict are much less. On the other hand, if the husband wants to socialize and participate in multiple activities when the wife resents, then this pattern becomes the basis of conflicts. What I am trying to explain is the more you have difference of opinion on cultural issues, parenting issues, hobbies or financial matters, there are more problems and a greater likelihood of building long standing conflicts which will result in disharmonial relationship.

            In addition to the long-standing problems of difference in the personality and cultural patterns there are short-term problems which also affect the marriage. The stresses of daily life, illnesses, death in the family, financial crisis, issues related to children and job may also have negative influence on the harmonious relationship. If the child is not doing well in school, instead of exploring the problem and coming with a common understanding sometimes both the spouses blame each other for the child’s academic problem. When one starts blaming, that results in conflict and, instead of resolving the problem of the child, another problem is created I the relationship that will have further negative effect on the children and the harmonious life at home.

SCAPEGOATING:

            Displacing or projecting your anger on your spouse also results in marital disharmony. You may have problem with the boss or any authority figure. You are unable to express anger with the fear of retaliation. You come home and project your anger on safe person, your wife or child. The family members do not understand the reasons for his anger, and your inability to communicate and express your real feelings will further increase conflict and stress.

THE PHASES OF MARITAL RELATIONSHIP:

            THE HONEYMOON PHASE:        This phase lasts anywhere between 3-12 months. This is the period where two young people feel close to each other, they don’t think much about the differences, and attempt to enjoy life and the new experiences.

            FANTASIES AMD REALITIES IN A MARRIAGE: When people marry each other, they build a lot of fantasies. The fantasies continue during the honeymoon period. They overlook the shortcomings and develop and expectation that the problem will just disappear. Unfortunately, the reality that appears after some time results in disappointments. There is a misunderstanding that if you have an arranged marriage then you will have more conflicts whereas if the marriage is taken place after a prolonged period of dating the conflicts are less. Unfortunately that is not true. I have seen many couples who have dated for three or four years and they even live together for a year or two and then got divorced just six months after the marriage. During the entire period of dating or living together the couple has not looked into reality and they continue to live in a fantasy. Recently a lady came to see me; she was married for about two and a half years and has known her husband over 5 years. Her major complaints were that her husband was drinking excessively and had been abusive towards her. I questioned that since she knew him for about 3 years prior to marriage, did she recognize these problems. She said that he never drank excessively and he was not abusive. The fact of the matter is that people try to paint the best picture of themselves during the dating period. So, once the honeymoon period is gone, the disappointment start coming to surface which results in conflicts.

DISCOVERY PHASE:

            When they start noticing the differences in each other. This is the phase where the disappointments occur and this is the phase where one has to resolve the issues before it becomes more troublesome. Unfortunately many couples don’t pay attention and they just keep on accumulating the disappointment and instead of dealing with the issues, they attempt to fix the problem in the spouse and the conflicts keep on building.

DISAGREEMENTS IN MARRIAGES:

            When the conflicts start accumulating, naturally this will further increase the disharmony in relationship. Conflicts are not uncommon in any marriage. However, the three possible outcomes of these conflicts are:

  1. The conflicts can be resolved and the couple will end up in happy relationship.
  2. they may compromise and accept some disagreements and still build a fair relationship.
  3. give up resolving any conflicts and go their own way. When one makes this choice, the marriage problems are bound to continue.

LONG TERM EFFECT OF THE DISHARMONIOUS RELATIONSHIP:

Disharmonious relationship leads to constant arguments resulting in not listening and sometimes overt fighting. Fighting may be verbal resulting in emotional trauma and sometimes may even be physical. The constant blame, and fault finding that the other person is responsible for this disharmony is not uncommon. The fights may be covert like nagging, constant criticism and a controlling attitude. Marital disharmony certainly increases the stresses of daily living. It contributes or exacerbates medical illnesses like hypertension or coronary heart disease, diabetes, etc. It may also contribute to exacerbate emotional illnesses like anxiety or depression. Invariably marital disharmony will result in divorce or a dysfunctional family with serious consequences on children.

CONFLICTS, ANGER AND HUMAN RELATIONS:

Conflict is normal in any healthy relationship and it is not a sign of incompatibility. Conflicts are a result of different opinions, values and ways of doing things. Conflicts, if worked out, enhance the relationship and unresolved conflicts result in anger.

Some individuals experience and express anger frequently and even minor situations create anger resulting in loss of self-control. On the other hand, some individuals suppress their anger to the degree that they deny it. Both of these situations lead to unhealthy physical and psychological consequences. Long standing feelings of anger whether expressed or suppressed leads to personality changes, anxiety, depression, mistrust, and paranoid feelings. Anger is also one of the contributory factors for hypertension, heart disease, coronary occlusion and sudden death.

            Some people deal with conflicts by explosive outbursts, constant fighting or passive reactive behavior as silence and not communicating. Others deal with conflict by playing the role of a victim to gain support of the family and friends, or hold past resentments and anger and get revenge.

WHAT IS THE SOLUTION:

Unfortunately no do it yourself guide is available to fix a marriage. Two individuals who seem to have good relations may develop conflicts. Because of changing circumstances new issues will emerge. These issues will not be resolved without communication. Unfortunately many couples show inablitity to communicate and resolve conflicts. They may employ a domineering attitude or even resort to physical violence to force their spouse to comply. They may act as if they have all the knowledge and decision making capability. They may also interpret religious teachings to achieve their goal. Other may turn to constant criticism, nagging, sarcasm, or even ridicule. They know what to say and how to say it so that the other individual involved loses self control.

HEALTHY WAY TO RESOLVE CONFLICTS:

They best way to prevent conflict is to take time to talk when things are going well. This will develop into a habit of communicating without anger. It is important to listen without interruption so that each partner has an opportunity to express feelings and opinions. One must avoid blaming, confrontation, and bringing up his or her past unpleasant experiences. The goal of the communication should be to find solution and ways to resolve the differences. It is necessary to compromise and show willingness to change by communicating about different perceptions and opinions one learns about their own shortcomings. This can be taken as a positive opportunity for growth and development. Learning better ways to deal with anger and conflict will result in improving relationships.

THREE STEPS TO BUILD A HARMONIOUS RELATIONSHIP:

  1. Listen, pay attention and find time to expect to explore each others’ feelings.
  2. Think, feel, act, and sometimes say sorry. Mutual respect is very important in developing a harmonious relationship.
  3. Make a commitment, make adjustments and make compromises.

 COUNSELING:

If the problems are not resolved seek help of a colleague, relative, the elderly or a religious leader whom you trust. IF you do not wish to do that or if that is not helping, counselor may show the techniques to reduce the conflicts and improve the relationship.

WAYS TO KEEP MARRIAGE HEALTHY:

  1. Keep spouse informed:
  1. inform spouse of what is happening in your life
  2. inform spouse of your schedule
  1. Help your spouse, especially when he or she is working hard on a project. It convey sensitivity and devotion.
  2. Communication: regularly taking time to talk and explore feelings, spend 30 minutes each week not focusing on work or controversial issues.
  3. Non sexual affection: Affectionate, nonsexual touching reaffirms the emotional bond.
  4. Elimination of irritating habits. Recognize what is irritable to your spouse and change the habit even if you do not see it as important.
  5. Apologies: no one is perfect, yet many men and women hide behind false pride by never admitting that they have been wrong. It is a sign of strength to personally acknowledge a mistake or when you have hurt your spouse’s feelings to directly and sincerely say, “I am sorry”, it is also a sign of being caring.
  6. Calmly disagreeing: You do not have to agree with each other on all matter but you must have a capability to resolve the differences of opinions.
  7. Loneliness: Loneliness is the most troublesome and uncomfortable feeling a couple has when they have drifted apart. Loneliness is a psychological despair due to a sense of not being understood or accepted by those you care about. Make every effort to prevent this from happening.
  8. Attempt to make sure changes have overcome the fear of change. Change of any kind is uncomfortable and with practice the discomfort will disappear.
  9. Influence of peers: Relatives and friends with whom you share your problems may not support the changes you are bringing in yourself. You must do what is right for your marriage even if you must stand alone.
  10. Fear of consequences: “If I do it once, he/she will expect it all the time”. Remember you are changing to make your relationship better, simply because it is the right thing to do.

Dr. Ahmed is the former Professor of Psychiatry at Southwestern Medical School and Chairman of Muslim Community Center for Human Services. He can be reached at mbahmed03@hotmail.com

September 16th, 2011

FAMILY DISHARMONY

DOMESTIC VIOLENCE – ISLAMIC PERSPECTIVE

  1. Basheer Ahmed, M.D.

 Our society faces a serious problem of violence, which is symptomatic of a deep psychological and social disorders in society. Home is supposed to be a safe place where one should see an equality and partnership of two spouses and a loving and nurturing environment for children. It is sad to see that millions of individuals face violence at home by the hand of their loved ones. Every few seconds, a wife is battered, a child is abused or an elderly is assaulted, not by a stranger but someone as close as spouse, parents or children. Family violence and domestic violence appear to be civilized terms but they are characterized by the most uncivilized forms of behavior. Family violence includes all violence occurring within the family unit: child abuse, wife abuse and elder abuse. Domestic violence is defined as a pattern of behavior that occurs between two people who are or were in the intimate relationship (wife and ex-wife) with the intent to achieve control and dominance through emotional, psychological, physical and sexual mistreatment. The abusive behavior includes emotional abuse, psychological abuse, sexual and physical assaults. Emotional abuse is characterized by cursing, screaming and degradation by constantly criticizing spouse’s thoughts, feelings and opinions. Psychological abuse consists of threats of badly harm, taking away children and killing spouse or himself. Perpetrator also controls finances, even food and medication and place restriction on socialization even with the family members. Physical abuse occurs when perpetrators actually hit, kick, punch, choke or burn causing laceration and fractures. Forcing unwanted sexual activity is also a form of sexual abuse.

Four million women are assaulted each year in U.S.A. and it is a leading cause of injuries to women ages 15-44. It is more common than accidents and cancer. Unfortunately, despite Islamic teachings of compassion, justice and kindness, many Muslim women in United States experience these tragedies.

Domestic violence is a universal problem. All ethnic, religious, racial and age groups are effected. Economic and educational levels do not alter the incidents. There are known cases of abuser who are prominent and successful members of the society. In some ways, women of high echelon of society are at greater risk as they often maintain silence to avoid embarrassment. It may also be less evident among the affluent because they can find and afford private physicians, counselors, attorneys and living arrangements. Individuals with limited financial resources or supporting relatives turn to more public agencies for health.

            According to Uniceff’s report, quarter to half of women around the world have suffered violence from an intimate partner. In several countries of the world like, Bangladesh, Cambodia, Egypt, Mexico, India, Pakistan and Zimbabwe, many people see wife beating as justified. “A husbands right to correct an erring wife.” Often women share this false notion. In Egypt, up to 81% of women in rural areas, say that wife beating is justified under certain circumstances.

            Domestic violence in Muslim families in Europe and America is prevalent but we do not have the published data on the incidence of domestic violence. According to Muslim women activists in U.S., approximately 10% of women are abused emotionally, psychologically and physically by their husbands. In USA, social service organizations like Muslim Community Center for Human Services of Dallas, Texas and Hamdard Center of Chicago are just beginning to offer services and no data has been published. It needs to be pointed out that in surveys worldwide, 20-70% of abused women said that they have never told about their abuse before being asked in the interview. In communities where there are no services available, people do not even speak about such a problem. Therefore, it will be difficult to get the correct data. However, the actual numbers of abused women are usually much higher than the reported numbers.

Islamic perspective:

            There are many examples in Quran and Ahadith that describes the behavior of Muslims towards husband and wife. The relationship should be one of mutual love, respect and kindness. Allah says in Quran, “O believers treat women with kindness even if you dislike them; it is quite possible that you dislike something which Allah might yet make a source of abundant good (An Nisa 4:19). Arabian society at the beginning of Islam sanctioned appalling violence towards women. Far from giving permission for wife beating Allah Subhanahu watala prohibited or at least severely curtailed excessive violence against women. Allah (swt) repeatedly says in the Quran to show love, kindness and warns that they should not harm their wives even after divorce. Allah (swt) has even forbidden us to call each other by bad names and to humiliate.

            Quran says “And of His signs, another one is that He created for you mates from among yourself and that you may find comfort with them and He planted love and kindness in your hearts. Surely, there are signs in this for those who think about it” (30:21) The abusive behavior does not reflect the kindness and love for their spouses. Still, some men justifies their behavior knowing that they are disobeying Allah’s guidance. How clear does the message have to be regarding the prohibition of ill treatment towards women. Allah (swt) mentions “when you divorce women and they have reached the end of their waiting period (iddat), either allow them to stay with honor or let them go with kindness. You should not retain them to harm them or take undue advantage. If anyone does that, he wrongs his own soul. Do not take Allah’s revelations as joke. Remember the favors of Allah upon you and the fact that He sent down the book and wisdom for your guidance. Fear Allah and know that Allah has knowledge of everything.” (2:231) Abusive men are completely disregarding the Islamic teaching of kindness, mercy and forgiveness.

            Emotional, physical and sexual abuse are not sanctioned by Shariat. It occurs due to individuals lack of respect for Quranic message and Shariat. When Prophet (PBUH) was reported that some men were beating their wives, he said “Certainly those are not the best among you (Abu Dawood). According to Prophet’s (PBUH) sayings, “let no Muslim man consider a Muslim woman as his enemy. If you do not like one of her ways, you will like another.” (Muslim) Aisha (RA) narrated that the messenger of Allah PBUH never hit a woman or a servant with his hand. He only raised his hand in Jihad in Allah’s way. (Muslim) Islam teaches high moral values and family values. Deviation from Islamic teaching is the major cause of domestic violence in Muslim families. Perpetrators do not manifest any tolerance and compassion against women in spite of strong Islamic teachings. They turn to violence to resolve conflicts and gain power and control.

 Why women do not seek help:

            There are several factors which prevent women from seeking help such as fear of retaliation, shame and humiliation. Some women blame themselves, saying that they deserve the abuse. Some believe the injuries are not serious, and accepted the violence as a normal behavior. Lack of support system, fear or destruction of family unit also prevents many women from reporting and seeking help. Abuser creates a constant fear which prevents the victim from communicating openly. It is to be noted that community regards domestic violence as a private matter between the husband and wife and this also discourages women to seek help.

            Even physicians fail to recognize domestic violence. The major factors are their lack of training and awareness. Even when physician comes across victims of abuse in their offices or emergency room, they pay attention towards physical injury but fail to recognize an obvious abuse. Many physicians do not like to get involved as they feel that it is not their area of expertise. Their lack of knowledge about available sources for referral is also a major hindrance. Another area of concern is the medico-legal aspect. It needs to be pointed out here that in many states, it is required that abuse should be reported however, many physicians are not aware of that and on the other hand they are concerned about legal aspects and are reluctant to testify in the court.

Myths about family violence:

  1. Domestic violence is rare and it does not occur in Muslim families.
  2. Abused spouse can end the violence by divorcing the abuser. However a woman’s dependence and lack of support are major hindering factors for getting divorce.
  3. The victim can learn to stop doing things that provoke the violence. The violence usually occurred with minor provocation and once this unpredictable behavior pattern is developed nothing can stop it.
  4. It is an erroneous belief that being pregnant protects a woman from battering.

Common Anger vs. Power, Control and Abuse:

            Arguments occur at some point in all marital partners. Verbally abuse behavior may occur during arguments about childcare, housework and financial matters. Domestic violence is different from routine arguments and expression of anger. Similarly, in certain cultures women are encouraged to stay home, not allowed to drive car or walk behind husband. These are the examples of inequality and oppressed behavior. This should not be confused or equaled with Domestic violence. In domestic violence the abusers show a complex pattern of behavior that may be verbally or physically aggressive to control the victim. There are numerous tactics used by abuser, for example constant criticism, verbal abuse, threats, throwing objects, kicking, punching and stabbing. This process will continue as long as the man devices the impact of these tactics on the woman and the woman continues to believe that this is normal behavior in marriage, because she has observed it in her family of origin. To further confuse the picture, the abuser often keeps up a good public appearance. He may appear as a gentleman in public, may have stable work record and act as a good provider. Domestic violence is a crime. It is not a private family matter. If religious leaders, health care professionals and community at large are not aware and involved, women will remain in the victims role for many years.

September 16th, 2011

MARITAL PROBLEMS AND PRE-MARITAL COUNSELING:

  1. Basheer Ahmed, M.D.

          In recent years, there has been a significant increase in the Muslim population of USA. We are noticing a rise in personal problems, family issues and crises situations. The most troublesome issue concerns the rapid increase in the number of divorces among Muslims. Unfortunately, the divorces can only ultimately lead to the disruption of the family unity. Imams of Masjids and social workers are concerned as 60% of the newly married are filing for divorce within their first year of marriage.

         There are multiple factors associated with problems involving marital relationships. If there is a great expectation for the amount of emotional satisfaction expected in the marriage, then the potential for great disappointment is also high. The more common reasons for marital discord are personality differences, differences in cultural patterns, differences in religious beliefs, differences in financial matters, differences regarding parenting and different interests in hobbies. The more differences there are, the more difficult it is to build a harmonious realtionship. Once these differences start affecting the communication between the spouses, they lead to problems, which in turn ultimately lead to conflicts. We do not have religious, social, psychological & physical support available due to the lack of an extended family which further contributes to the problem.

IMPORTANCE OF FAMILY STRUCTURE & STABILITY.

         Instability of the family structure can lead to divorce which in turn leads to the further disruption of family unity. Divorce is unquestionably a factor in the family disorganization. How it is affecting the children is evident by the alarming increase in adolescent behavior problems : substance abuse, suicidal behavior & violent behavior. It needs to be clarified that divorce does not have any one single impact on children. Each child will react in a different fashion depending upon parents care & availability of the extended family. It is obvious that the energy required to be a single parent is enormous & is a extremely hard task. Even though this problem is becoming a serious issue, the Muslim Community is not paying attention to this issue with the same energy and interest as we did when building mosques and Islamic schools. We tend to avoid facing reality by having a false sense of perception that Muslim families do not have problems. With the ever increasing number of divorces occuring in the Muslim community, our children are getting lost as a result of this disruption in the family unity. If we lose our children, how can we build a strong community.

 Concerns of immigrant families:

         Most immigrant families are bonded together in their business and social life. They attend religious and social functions together. They hold on to their socially conservative culture – They perceive that the American style of individualism is a form of egoism that has fostered disrespect, premarital sex and other social ills. Although the culture is changing rapidly in the Middle East & the Far East and the children there are catching up with the west, the immigrant families here have held on to the conservative value system they brought with them decades ago. The major problem facing young immigrants is that they are growing up in an environment with different a value system. One they see from T.V., movies, and learn from their peers. These messages create a major conflict between what they are learning outside the home and what they are being taught to do so as Muslims by their families. Children of immigrant families face stress due to the convergence between homeland and newland. They find themselves pushed and pulled between the values and culture of their parents and those being portrayed by a larger American society.   This ambiguity is more pronounced when the decision for marriage is made.

 Parental Responsibility

         We spend lots of time, energy and money on our children in an effort to see them highly educated. However we do not spend enough time and resources towards their Islamic education at home or even in Sunday school. It is sad to see many children growing up with no concept of Islamic religion and no understanding of the consequences of a lack of faith. Many children are not aware of the concept of life after death nor fear of consequences of their behavior in the life after death. Many parents started worrying when their children become teenagers, however, often by this time it is too late to make a change in their behavior at this stage of life. If a strong religious background and a strong Islamic education is lacking, then our children may make a complete turn around and marry a non-Muslim and be convinced that they are doing the best for themselves. The parents will feel helpless in such a situation. Their counsel and advice will have no effect on changing their children’s thoughts and attitudes. In order to prevent and minimize such a problem parents must pay attention to providing an Islamic education, an Islamic environment at home and providing a role model of a successful marriage. It is highly recommended that parents help by organizing marriage preparation courses and premarital counseling. Children must be encouraged to have open communication and speak freely regarding the matter of marriage or selecting a partner.

 Marriage preparation course & Premarital counseling

         Marriage preparation courses and premarital counseling are recommended to reduce the ever increasing number of divorces in Muslim community. In several states of U.S.A., premarital counseling is recommended prior to getting marriage certificate. Sr. Shahina Siddiqui of Manitoba Islamic Association has done an excellent work in offering a marriage preparation workshop. Marriage preparation program consists of courses on several subjects including but not limited to: Purpose and essence of marriage; Basis of marriage; conflict in selecting marriage partner Roles & responsibilities of a husband and a wife; Importance of religion and faith in marriage; Communication, self-awareness and financial matter. 8-10 sessions of courses should be offered to teenagers in preparation for marriage with ample time for open discussion.

 Essence of marriage

         Allah has provided guidance for us in all walks of life. He has created man and women as companions for one another, so that they procreate & live in Peace & Tranquillity. Quran says:

         “And among this signs is this, that He created for you mates from among yourself, that you may dwell in tranquillity with them, and He has put love & mercy between your (Hearts): verily in that are Signs for those who reflect.” 30:21

         It is clearly indicated that the essence of marriage is to live in peace & harmony with each other, to have love & mercy toward each other.

         Marriage in Islam is a social contract between couple before Allah. Allah gives them the opportunity to discuss terms and conditions of the contract prior to entering into their marriage. It also remind couple of the obligations they have before Allah to maintain their contract.

         Since the family is the nucleus of Islamic society & marriage is the only way to bring families into existence the Prophet (PBUH) insisted upon his followers to enter into the marriage. The marriage is a lawful response to the basic biological instinct to have sexual relations & to procreate children. According to Prophet’s (PBUH) Hadith, “Oh you young men! Whoever is able to marry should marry, for that will help him lower his gaze & guard his modesty.” (Al Bukhari) The Sharia has prescribed rules to regulate the functioning of the family so that both spouses can live together in peace, security & tranquillity. The Sharia rules are reinforced by a whole framework of legally enforceable rights & duties for spouses & children.

 Conditions for Marriage

         Marriage is compulsory (Wajib) for a man who has means to easily pay the Mahr & support a wife & children, is healthy & fears that if he does not marry, he may be tempted to commit fornication.

 Consensus in marriage

         The consent of both man and woman is an essential element of marriage & the Quran gives women a substantial role in choosing their own life partners.

Do not prevent them from marrying their husbands when they agree between themselves in a lawful manner.2:22

         It is possible that due to lack of maturity a girl wants to marry a man about whom she has a distorted information or who does not possess a good character or who lacks the proper means of livelihood. In such cases, it is incumbent upon girl’s parents to advise her and if possible, restrain her from marrying such a person and to find a suitable husband for her.

 Selection of marriage partner

         Our Prophet (PBUH) said:

         “A woman is ordinarily sought as a wife for her beauty, for her wealth, for her nobility in her stock or for her religiosity but blessed & fortunate is he who chooses his mate on the bases of her piety and integrity.

         What we are looking for in a spouse is the wealth, education, beauty & family background. We neglect to pay attention towards personality maturity, piety, integrity, temperament, attitude, compromise, toleration and compatibility. A wife with a strong Islamic background can influence her husband and children towards Islamic behavior. As a mother she can play an important role in building character in children. How many families & young men use this criteria for selecting a life partner?

Conflicts in selecting marriage partner

         There is clear conflict between Western or American way of thinking and Eastern way of thinking. The American or Western thinking emphasizes an individual who wants to know the person, wants to like the person, wants to feel comfortable with the person and wants to make the final decision. The Eastern thinking emphasizes that you should know the family background, be concerned about spouse’s education and job, their cultural background and one should trust the judgment of the parents. Our children are also troubled by parent’s process of selecting a spouse. Many parents pay attention towards finding a highly educated spouse, a physician for example, and fail to pay attention towards personality, maturity, compatibility and they are willing to compromise all these factors if they can find a physician to marry their sons or daughters.

 How often one should meet prior to selecting a marital partner

         There is no hard & fast rules or set standards. There is no fool proof method in eliminating the risks involved in choosing a marriage partner. It is a common misperception that if you see a person several times it is easier to make a right decision. In my practice, I have seen several couples who dated for 2-3 years & some even live together for several months prior to getting married. Their marriage was still unsuccessful & they were ready to file for divorce within 2 years of marriage. People tend to make a good impression & present themselves what others want to see or hear. The real person tends to come out after marriage. Traditions of a family involvment in arranging the marriages are important provided the family uses good sense and wisdom about potential spouse’s personality, reliosity, strengths and weaknesses.

 What are the ingredients of a happy, healthy marriage

         According to Khurshid Ahmed, “The relationship between husband & wife is a spiritual relation which sustains and generates love, kindness, mercy, compassion, mutual confidence, self sacrifice and solace.”

         Couples who have a healthy marriage are knowledgeable about their own and each others rights and responsibilities – They both develop realistic expectations of each other and of the marriage. They practice good communication skills, are able to make decision together and resolve conflicts based upon their commitment. They honor mutual rights and each others sexual fulfillment. Good personality traits of honesty, trustworthiness, humility and willingness to cooperate and compromise are essential to make marriage a success. A reliance on Quran and Sunnah for guidance and building a strong relationship with love and respect is a key to healthy marriage.

 Influence of Religion and Faith on Marriages

         As discussed above in order to prepare children to have healthy marriage their fundamental belief in the religion must be sound and strong. It is important to be aware of ones commitment to religion and it’s implications in daily life.

Communication

         This is one of the most important subject to discuss in marriage preparation courses. Communication is the basis of love & hate. It is the source of stress & anger. If we do not pay attention to this subject it leads to conflict & unresolvable conflicts inevitably leads to divorce. One needs to learn the varieties of messages we consciously or unconsciously transmit to our partners for example blaming messages are “You never do anything right”, “You will never change” & “You are stupid.” The controlling messages are “How many times must i tell you”, “Act your age” & “Why don’t you use your head” may lead to psychological trauma of the partner & may result in lasting consequences. Every couple needs to pay attention to preserve the marital relation and prevent it’s deterioration.

 Know yourself

         It is important for each individual to examine themselves. Think about your family of origin, the pleasant and unpleasant experiences and their effects. Understanding the High School experience and it’s effect on personality developement. Explore your own personality: Are you? Dominant, submissive, compulsive, Happy-sad, Trustworthy-suspicious, loving-compassionate, honest, strong willed, easy going, Anger-Tolerant-Rigid or casual in thinking and behavior. Discuss your expectations of your partner in marriage. Do you have the ability to change yourself ? (Adaptability)

 Activities

         What activities are you doing now that you will not be able to do after marriage? What are you expecting to be able to do after marriage that you are not able to do now? Which of your activities can you give up after marriage?      Which of your activities would you hang on at any cost?         What factors may lead to divorce?

 Parenting Issues

         Good marriage preparation course must offer young people an opportunity to learn about their obligation as parents. They must understand stresses and challenges parents face when raising children from infancy to teenage years. They must discuss how to properly care of the children. They must also discuss methods of discipline and understand the importance of raising children in a loving religious environment.

Financial matters

         We should never neglect to discuss financial matter. A good budget planning with income expenses and saving keeps the marriage healthy and reduces the stresses related to financial problem. Couples must learn to live within their budget. If there is a division of responsibility wife must take the primary responsibility for setting up monthly budget and implementing a savings plan. One must be disciplined not to abusively use a credit card and if it is used, the monthly payment must be made in full to avoid any interest payment.

                            Pre-marital counseling.

         Pre-marital counseling is offered to couples who are planning to get married. The primary purpose of the counseling is to discuss the issues a married couple faces in their day-to-day life. The issues discuss are those which most commonly result in conflicts and often become the sole reason for separation and divorce. Pre-marital counseling also deals with issues related to personality differences and communication style. Pre-marital counseling should be conducted by a professional who has training in family dynamics and who is able to detect the personality patterns, problems in communications, and in certain situations, clinical issues. They should be trained to offer help in alleviating some of the problems and referring to appropriate specialists, if necessary

         The counseling consists of open-ended questions designed to allow the couple to discuss many issues a married couple faces in real life. It also helps in offering some techniques to resolve the conflicts by communication and focusing on developing compromising attitude.

         In the beginning of the session, the couple is given a general information about the purpose of pre-marital counseling and the confidentiality of the discussion. It is generally pointed out that the individuals may have different personalities, different opinions and different feelings regarding various matters that a married couple faces in day-to-day life. However, they may be able to respect each other’s opinions and live with making compromises. On the other hand, there may be areas of conflicts which are so severe that they need to think of resolving them prior to marriage. Unfortunately, many couples do not wish to discuss these issues due to lack of opportunity or over emotional involvement with their future spouse which inhibits them to discuss areas of conflicts. During the sessions, the professional counselor not only points out the areas of conflicts but helps them in resolving the conflicts through compromise and healthy communication.

         It is recommended that the couple should have at least three sessions but in certain circumstances two sessions may be enough. After getting basic data about the couples and their families, the counselor focuses the questions on the following subjects:

1) Role of religion in daily life,

2) Family issues focusing on relationship with in-laws and living with           extended family,

3) Friends, hobbies, and social activities,

4) Children’s upbringing and role of religion,

5) Financial matters,

6) Issues related to relationship and wife’s occupation.

7) Understanding marriage as a contractual agreement.

         Second session – this deals with the expectations of marriage, their major differences, and techniques which may be used to resolve the differences. A Brief discussion about the pre-nuptial agreement is also recommended in this session.

         The third session deals with styles of communication and focusing on issues which have not been resolved.

         Referral to Imams and religious leaders. If a conflict arises based on certain religious convictions, the counselors are trained and encouraged to refer these matters to Imams and religious leaders.

         Research Project: We would like to get the feedback from the couple about the session and their recommendation to improve the questionnaire. We would also like to follow these couples for 5 years after marriage for assessment of various areas which were discussed in pre-marital sessions.

         Conclusion: Divorce rate in the Muslim Community is becoming as high as the Christian Community in U.S. The high divorce rate in U.S. is becoming a source of concern to family courts, religious organizations & government officials.

The concept that in early marriage is a successful marriage does not prove to be correct. The general idea that love prior to marriage is a “key to success” is also becoming a myth. While strong religious teachings are always helpful, they do not focus on issues like personality differences, compromising, attitude & making adjustments in a less than perfect marriage.

         It is my concern that the Muslim Community is not giving enough attention towards marriage & divorce. We must make an effort to ensure the stability of marriage. Islamic schools must offer courses on values & relationships. Islamic Centers must offer marriage preparation courses & Muslim Mental Health Professionals should be trained to offer Pre-Marital Counseling.

         Pre-Marital Counseling does not guaranty the stability of marriage but it makes a couple aware of the realities of marriage & prepare the young couple to become knowledgeable about the potential conflict & way to resolve these conflicts. Further research will hopefully give the answer about its efficacy.

References:

 Holy Quran

  1. Khurshid Ahmed, “Family Life in Islam”, The Islamic Foundation,

     Leicester, United Kingdom, 1974.

  1. Shahina Siddiqui (marriage preparation course) unpublished work.
  2. Aneesah Nadir, “Promoting Positive Marital Outcomes among Muslims in

     America”, presented in ISNA, September 1997.

  1. Mohamed Ismail, “Marriages, what they are and what they should be”, ISNA

     publication.

 Basheer Ahmed, M.D. is the Medical Director

of Islamic Institute of Human Relations

10 Home Place Ct. Arlington, TX 76016

PHONE: (817) 572 – 4981

FAX: (817) 483 – 4699

e-mail: mbahmed@flash.net

July 28, 2009

June 14, 2009

Foundation for Building a Community Medical and Social Service Organization

M. Basheer Ahmed, M.D.

Founder and Chairman of Muslim Community Center for Human Services – North Texas

Introduction

 I have periodically reported on the activities of the Muslim Community Center for Human Services (MCCHS).1-3 This article adds additional details of concern to practitioners who may consider either founding similar organizations or participating in existing charitable medical and social service providers.

Underserved Populations: The Uninsured and Immigrants

            In this country, 47 million Americans do not have health insurance.4 Twenty-five percent of Texas residents are neither covered under any insurance plan nor eligible for public medical services. Ninety-seven thousand illegal immigrants reside in Tarrant County, which includes Fort Worth and Arlington, and do not have insurance coverage.5 Unfortunately, people without health insurance are sicker and die at a relatively younger age. Due to lack of insurance, they delay physician visits and do not receive medical care for common medical problems such as hypertension and diabetes until they develop full blown symptoms or complications. Another sad fact is that hospitals and physicians agree to bill and receive negotiated discounted prices for their services from private and governmental third party payers but bill the full amount to individuals who do not have any insurance coverage. Many uninsured individuals in an emergency situation have to give their entire life’s savings for surgery or treatment in intensive care units. The number of uninsured Americans has been rising inexorably over the past eight years due to a variety of reasons.6 Families who have good insurance may lose it if the bread-winner loses his/her job. Individuals who are earning more than poverty level are not eligible to receive care at public hospitals and clinics. Visitors to the United States and illegal residents andare not eligible for care at the public hospitals or clinics.

Regardless of age, legal status, or insurance coverage, immigrants receive much less health care than native born Americans. Based on data collected from 1996-1998, a high percentage of immigrants are uninsured and they consume 55% less services than non-immigrants. Financial, cultural, and language difficulties make it hard for immigrants to access care. Immigrant children had 74% lower per capita health care expenditures than U.S. born children.7

Immigrants also have difficulty in following directions and often are non compliant. Many immigrants do not understand the significance of elevated blood pressure or high cholesterol as long as they are not experiencing any symptoms. Compared to non-immigrants, immigrants pay little attention towards preventive measures such as diet and exercise. Many elderly immigrants who have not worked in the U.S. are not eligible for Medicare coverage.

Establishing the Center for Providing Medical and Social Services

It was in the late 1990s that Muslims started paying attention towards the social issues. To deal effectively with the social problems was a difficult task. Few acknowledged the existence of these problems. The denial and stigma attached to these problems also created a major hindrance. There was a general fear that social issues would not elicit support from other Muslims.

Development of the Board and Funding

A Board of Directors was selected to provide the organizational leadership. Its members were selected based on their expertise and commitment. All board members were responsible for fund development and financial support as necessary. Fund raising dinners, soiciting local physicians and businessmen by mail for donations, requesting local Muslim organizations to underwrite special projects such as health fairs and seeking grants for specific programs were some of the approaches used to raise funds. MCCHS’s major source of funding is donation from individuals., although it has won some grants.

 Charitable Medical Services – Al-Shifa Clinic

In view of the health care issues discussed above, the Al-Shifa Clinic was opened in October 1998. The clinic is a private not-for-profit agency providing culturally appropriate primary care to medically underserved populations. Indigent patients and visitors from overseas without insurance coverage also come to the clinic. The weekly clinic provides services for general medical problems such as diabetes, hypertension, high cholesterol and minor infections. If these problems are not treated at an early stage, they may lead to more serious problems such as heart disease, stroke, or kidney failure, which can result in more serious consequences for the patients and their families. All surgical and complicated medical cases are referred to public hospitals in this area. Fifteen area physicians come on rotation on Saturdays and donate their time. In addition to free consultation, generic or free medications (donated samples) are also prescribed or dispensed. In 2002, discounted rates were negotiated for lab work, and now laboratory services are also provided. Most of the physicians at the MCCHS clinic are internists and primary care physicians. Some area specialists see patients for free consultation in their own offices when referred by Al-Shifa. Students from local medical school also help at the clinic, getting credit for their work. Foreign medical graduates applying for residency program also attend the clinic as “observers” and work under supervision of the attending physicians.

Initially the clinic was open every Saturday for four hours. Many Muslim women prefer to see female physicians due to religious and cultural modesty. Therefore, beginning in 2007, the clinic opened on Sundays for women and children only. Female physicians and a pediatrician volunteer their time at the women’s clinic.

Eye Clinic and Dental Clinic

In July 2008, an eye clinic opened once a month for minor ophthalmologic problems and glasses for visual correction. MCCHS is also planning to open a dental clinic in the middle of 2009.

Staffing the Clinic

Prior to establishing the clinic several area physicians were contacted to discuss the feasibility of opening the charitable clinic. Fifty physicians expressed interest in volunteering. However, only 15 made the commitment to come to the clinic for three to four hours once in two months. The major question physicians had related to malpractice insurance. It was recommended that physicians who are in private practice must notify their insurance carrier about their work at the clinic and get appropriate malpractice insurance coverage. Physicians working at the United States Veterans Administration or other governmental institutions cannot get the coverage through their insurance company. MCCHS contacted the Texas Medical Association, and it provided extensive information on good Samaritan laws governing charitable medical clinics and the protection they offers to physicians. The Texas medical liability insurance provides coverage to retired physicians providing volunteer services at charitable clinics for the nominal charge of $250 per year. The federal government also offers malpractice coverage with no cost to physicians who are providing free services at charitable clinics.

Recruiting and keeping physicians interested in the charitable clinic is a challenging task. Since the inception of the clinic MCCHS has lost a few physicians to family responsibilities and other commitments. MCCHS constantly recruits new physicians to replace them.

Operations

A part-time officer manager is hired to make appointments, maintain medical records, supervise non-physician volunteers and arrange the lab work. The medical record contains the physician’s initial work up, progress notes, lab work and a list of prescribed medications. A pharmacist comes to the clinic periodically and sets up policies for recording the use of sample medications and disposal of expired medications. A physician dispenses the medication from the pharmacy, which is a locked room where the medications are stored.

The clinic only accepts patients who have no insurance and are unable to pay the physician’s fee in private practice. It is difficult to do a financial assessment on every patient who comes to the clinic due to lack of staff and the high logistical costs. However, MCCHS believes that 90% of the patients meet its criteria for free medical care.

Al-Shifa clinic served 1200 patients in year 2006, 1500 in 2007 and the number of patients has increased to 1800 in the year 2008. Ninety-five percent of the patients at the clinic are adults. The clinic sees a small number of children whenever the pediatrician is able to come to the clinic. Seventy percent of the patients at the clinic are female and 30% are male. The most common problems treated at the clinic are diabetes (30%), heart disease including hypertension and high cholesterol (40%), infections and other minor ailments (15%) and depression, anxiety and other psychiatric problems (15%). Al-Shifa refers patients with acute medical problems such as chest pain, acute infections, surgical problems and chronic medical conditions t o public hospitals.

Most of the patients at the clinic have no other source of receiving treatment. The clinic does reduce the burden of public hospitals and emergency rooms. Patients also feel more comfortable with physicians who understand their culture, language and religious beliefs.

Health Fairs

The major purpose of health fairs is to detect common health problems like hypertension, diabetes, and high cholesterol. These diseases may lead to serious health problems if not detected at an early stage. On an average, 10 to 15 individuals are identified who are in need of medical care. Such patients are referred to physicians in the community, public hospitals, or Al-Shifa Clinic.

            These health fairs are held in different locations in Dallas/Fort Worth Metropolitan area. Several health fairs have been held mainly in the mosques and community centers. In 2003, MCCHS organized a health fair jointly sponsored by area churches, and 25% of the participants were non-Muslim. It was the first interfaith event of its kind in this area. During the health fairs, MCCHS offers the tests for blood pressure, cholesterol and blood sugar levels, medical consultation, pediatric exam, dental and eye exam, etc. Lectures on different topics including heart disease, diabetes and cancer are given. Many individuals make use of the opportunity to discuss and get professional advice on physical or emotional issues. For the last two years, MCCHS has been holding health fairs twice a year. One is in South Dallas in conjunction with the Humanitarian Day initiative (humanitarianday.com). It primarily serves the indigent African-American residents of the area irrespective of religious affiliation. The other health fair is usually held in one of the Islamic centers, and all the area residents are encouraged to take advantage of the free screening services. More recently MCCHS also participated in the health fair organized by Dallas County Department of Health as a part of the commemoration of Kwanza.

In addition to physicians, medical and nursing students also help in the health fair. Several agencies such as the American Heart Association, American Cancer Society, the Public Health Department, Red Cross and other agencies provide educational material. During the health fairs several participants also donate blood and female participants register for mammogram.

 Breast Cancer Education Program

MCCHS for Human Services received a grant to provide education on the breast self-examination and the importance of mammogram for early detection of cancer in the immigrant community. Many immigrants, especially Muslims from the Middle East, South Asia and Africa, lack knowledge and understanding about the importance of early detection. The small grant from Suzan G Komen foundation enabled the organization to recruit a community outreach worker to arrange educational seminars in Urdu and Arabic. In addition to a physician, a breast cancer survivor is invited to speak at these seminars. Al-Shifa also provides free mammograms to indigent residents by making arrangement with the local mammogram mobile unit. In 2006, thirty free mammograms were provided, and, in 2007, forty-eight mammograms were arranged for indigent residents.

Mental Health and Counseling Services

There are many charitable clinics in the country which offer only medical services. However, from the inception MCCHS made a decision to provide medical, psychiatric and social services under one umbrella. MCCHS offers treatment and counseling services to patients with emotional problems. A volunteer psychiatrist and a staff social worker assess, diagnose, and treat emotional problems. Ten to fifteen patients a month come to the clinic with emotional, marital and other problems. These patients are treated with medication as well as with counseling. MCCHS does not accept patients with serious mental problems such as schizophrenia, severe personality disorders and patients with active suicidal thoughts. These patients are referred to public mental health clinics.

Marital Counseling

All religions promote the concept of healthy marriages. Quran says “and among His signs is that He created for you mates from among your self and that you may dwell in tranquility with them and He has put love and mercy in your hearts.” (30:20). A satisfactory marriage has a positive effect on physical, emotion, and spiritual health. On the other hand, the unsatisfied or unhappy marriage will have a negative effect on health, finances and children. And of course many unhappy marriages end in separation or divorce and this also has negative influence on adults and children. MCCHS offers premarital, marriage and divorce counseling. The major goal of premarital counseling is to prepare young people who are planning to get married to face the realities of married life, giving them an opportunity to openly express their likes and dislikes, preferences and priorities. The major goal of marriage counseling is to reduce the incidence of divorce and the breaking up of the family unit. If divorce becomes inevitable, we recommend mediation to avoid costly legal expenses and counseling with children to reduce the trauma.

Domestic Violence Program – Roshni

The recent news of Muzzammil Hassan, the founder and CEO of first Muslim Television Network, who was charged with murdering his wife by beheading her in February 2009, became a wake up call for the Muslim community, majority of whom do not believe that domestic violence exists in the Muslim community. It is ironic to note that the mission of the Bridge T.V. was to show the Muslims in a positive image. The victim was having marital problems and recently filed for divorce after previous incidents of domestic violence.

In the United States, there are a staggering number of assaults against women by family members and other intimates resulting in death, injury, disability and mental trauma.9,10 Children are also victims within an abusive household.

Some people erroneously assume that because the United States and other industrialized societies report such high numbers of abuse, then domestic violence must be a “Western” problem. In many third world countries, Muslim countries included, there are no services or support for victims of domestic violence and no means to collect such data. Thus, the incident reports will be low. As part of her Ph.D. dissertation, Najma M. Adam, Ph.D. conducted a study on domestic violence against women within South Asian communities in the United States. Nearly 73 percent of the 61 women she interviewed had experienced psychological abuse, 48 per cent physical abuse, 54 per cent sexual abuse and nearly 39 per cent incurred injuries due to the abuse they have experienced. Many of the victims were quite reluctant to share information with her.

It is true that many Muslim women, who are the victims of abusive behavior, do not discuss their issues with families and friend and seldom report to the authorities unless it becomes out of control. There are multiple factors for not reporting the abusive and violent behavior of the spouse: Lack of support system, religious and cultural inhibitions, poor self confidence, and accepting the abuse as a normal behavior. The abusive men attempt to place their partners in a submissive role. The abusive behavior is a learnt behavior which is acquired through life experiences in one’s own family of origin and through the observation of society at large. The abusers believe that they have the right to control others’ behavior.

Physicians must be knowledgeable about the dynamics of domestic violence and must screen all female patients for the science of domestic violence. Physicians need to ask direct questions, specially, to patients who have an unexplained injury or multiple vague symptoms and they must be aware of community resources to which they can refer the patients. 11

Domestic Violence is a crime; it is not a private family matter. If community leaders and health professionals are not aware and involved, women will victims for many years.

MCC’s Domestic Violence Program – Roshni was established five years ago. Initially we developed a helpline and started providing outpatient counseling and referral to the appropriate agencies as needed. We also developed a relationship with other service providers, specially, the shelters in Dallas/Fort Worth area. We have expanded the program during the last two years. MCC offers educational programs in various Islamic centers in Dallas/Fort Worth area at least four to six times a year where they share the information about recognizing the early signs of domestic violence and provide the available resources. The first full-time social worker was hired in 2006 and we trained six volunteers to receive the calls. In 2008, we hired another full-time social worker to provide counseling and support services. Now, we receive 6-8 calls a month from victims of domestic violence and we carry a case load of 23-25 cases. MCC has sent a one page document to all the Muslim physicians about the recognition of symptoms of domestic violence and the available resources in the community. Dr. Ahmed has also published a paper on the Tarrant County Medical Society Journal on this subject on May 28th 2008. 12

Abused Children and Child Protective Agencies

Although there is denial in the community, MCCHS receives a number of calls from families where the children are taken by Child Protective Services for abuse and negligence. We have held seminars for parents informing them about the local laws regarding child abuse and negligence. Many parents don’t realize that beating the children for discipline is not permitted in this country, and quite often, parents blame the Child Protective Agency when they investigate the family after getting a report from teachers or counselors about physical abuse. MCCHS works closely with Child Protective Agencies, and on numerous occasions, children were returned to parents through the involvement of MCCHS and parents’ commitment that they would receive counseling from MCCHS. In serious situations, when the child cannot be returned to the parents, MCCHS  attempts to locate Muslim foster parents for placement of children. Unfortunately, there is a lack of foster parents to take care of the Muslim children.8 MCCHS works very closely with the Child Protective Agency to train Muslim foster parents for emergency placement of children.

Guidelines for Health Care Providers:

Over 150,000 Muslims live in Dallas/Ft. Worth area. Since physicians, nursing staff and chaplains associated with hospitals, home health care agencies, hospices and county departments of health may encounter Muslim patients. MCCHS has prepared a brochure to make them familiar with the religious and cultural sensitivities of Muslim patients, covering the subject of personal hygiene, prayers, diet, interaction with female patients, and Muslim views on illnesses and death. This brochure was circulated to every hospital and many other providers in the Dallas/Ft. Worth Metroplex. MCCHS also conducted educational programs for various hospitals and health care agencies on this subject.

Senior Citizen Program

The Muslim community has a significant number of senior citizens for whom MCCHS is providing services. Special lunch programs for seniors were organized to give them opportunity to socialize and learn about health issues, government assistance programs like Social Security, Medicare and Medicaid, and immigration problems.

 Services for Immigrants

The arrival of a significant number of Muslim refugees from Somalia and Bosnia to the Dallas/Fort Worth region, especially since late 1996, obliged MCCHS to hold workshops on social services and immigration issues. MCCHS assisted in settling the Somali and Bosnian refugees by providing financial assistance for which a separate fundraising program was held. Clothes and household goods were collected and distributed. The MCCHS collaborated with government agencies working very closely with the Somalian Outreach Program. A number of Somali and Bosnian patients also visit the MCCHS medical clinic. More recently, MCCHS is now offering services to newly arriving refugees from Burma and Iraq.

Outreach Program

In 2003, MCCHS started participating in feeding the hungry at a homeless shelter along with local churches. MCCHS serves one breakfast per month at the local homeless shelter where MCCHS volunteers cook and serve hot breakfast for 80 to 100 residents of the Arlington life shelter. MCCHS also serves one dinner during each Ramadan. MCCHS has also collected and distributed clothes and school supplies for children living at the shelter with their parents.

Education and Seminars

MCCHS holds periodic educational seminars including parent/child issues (for example, “Parents just don’t understand”), marital conflicts and disharmonies, challenges women face in America, and a variety of health issues (stroke, diabetes, cancer and heart disease) and mental health issues (depression). Special lectures for senior citizens focus on various health issues, breast cancer, prostate cancer, diabetes and heart disease.

International Health Visitors

At the request of the US State Department through the Cancer Society of Dallas, MCCHS hosted a brief program on November 6, 2007 for seventeen physicians and health care professionals from Bahrain, Egypt, Israel, Jordan, Lebanon, Libya, Morocco, Oman, Saudi Arab, Syria and Palestine. The board members and staff presented the MCCHS’s breast cancer education programs. The major goal of MCCHS is to reach all adult women from the Middle East, Somalia, and South Asia to have early screening of breast cancer by having periodic mammograms. Free mammograms are arranged for individuals who have no insurance coverage or are unable to afford the payment for the mammogram.

Many muslim organizations are involved with religious, educational, and political issues; however, very few organizations are involved in providing medical and social services. We have responsibility towards fellow human beings who are in need of such services but cannot access them. We must make every effort to provide medical and social services to all deserving community members. We must accept that health care accessibility is a human right, and we need to do our best to make this happen by providing direct care to the needy and supporting legislation which makes health care accessible to every body. It is time that Muslims should take a leadership role in offering medical and social services not only to the Muslim community but to the nation at large as well. We are Americans, and we have a responsibility to promote welfare in our nation. We need to train our youth to become the future leaders by carrying out the programs we are in process of developing.

REFERENCES

  1. Ahmed MB. Texan Muslims focus on social services. Islamic Horizons. May/June
  2. pp 30-31.
  3. Ahmed MB. Dallas-Fort Worth Muslim health fair. J Islam Med Assoc. 2000;32:128-30.
  4. Ahmed MB. Southern care. Islamic Horizons. 2008;37(3):26-7.
  5. 4. Eckholm Erik, “Hospitals try free basic care for uninsured”. New York Times, 10/25/06.
  6. Spangler Anthony, “Cost of care for illegal immigrants”. Fort Worth Star Telegram, 01/15/07
  7. 6. Editorial – American Journal of Public Health. August 29th 2007
  8. 7. Mohanty, S. Woolhandler, S. et al. “Health Care Expenditure of Immigrants in the United States – A Nationally Representative Analysis” August 2005, Vol 95, No. 8 | American Journal of Public Health 1431-1438. 2005. American Public Health Association. Washington D.C.
  1. Ahmed, M. B. “Muslim Foster Homes”. Islamic Horizon, May-June 1998. # 31.
  2. Bureau of Justice Statistics Crime Data Brief, Intimate Partner Violence, 1993-2001,
    February 2003
  1. U.S. Department of Justice, Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, March 1998.
  1. Flit, Craft A. H., Hadley, S.M. et al “Diagnostic and Treatment Guidelines on Domestic Violence” American Medical Association. 244, 1992.

 

  1. 12. Ahmed, M. B., “Domestic Violence – Responsibilities of Physicians” Journal of Tarrant County Medical Society. May 28th 2008 Page 9-11

 

March 28, 2006

MUSLIM COMMUNITY CENTER FOR HUMAN SERVICES:

7600 Glenview Dr, Richland Hills, Texas 76180

A brief history of Muslim Community Center’s programs and projects

 The purpose of goals is to focus our attention

The mind will not reach towards achievement until it has clear objectives

The magic begins when we set goals.

It is then that the switch is turned on,

The current begins to flow, and the power to accomplish becomes a reality

(Anonymous)

Goals of the Organization: The goal and the mission of the Muslim Community Center for Human Services is to:

“Strengthen our community to face complex challenges created by duality of culture and lack of appropriate infrastructure. Impacting the domestic, social, medical and economic aspects of life.”

.The Muslim population in North Texas has been increasing and according to some recent estimates, it might have reached to 200,000. With the growth of population we have seen in influx of various social problems: Marital conflicts, and high rates of divorce, child abuse, women abuse, substance abuse, physical and emotional problems, indigent Muslim population needing medical help, unemployment, immigration and legal problems. During the 1970s-1980s, we built mosques and established organizations and during the 80’s and 90’s, we continue to build mosques and schools. It was in the 1990’s that we started paying attention to the social issues. To deal effectively with these problems, is a difficult task. Few acknowledge the existence of these problems. The denial and stigma attached to these problems also created hindrance. There was a general fear that their problems were not elicit supportive response from fellow Muslims.

The Muslim Community Center for Human Services – the first Muslim social service organization in Texas – was established in 1995 to meet the social and medical needs of a growing Muslim community in the Dallas/ Ft. Worth region. Few concern citizens got together to organize an organization to help the emerging needs of the community. In meeting of the committee leaders was called in August 1995 to explore the feasibility of establishing such an organization. There was a unanimous opinion that Muslim committee needs a strong social service organization in this area. An advisory council of committee leaders was established and the center was registered in the state of Texas.

The first major project organized by the MCC was a Health Fair, which was held in September 1995 in Arlington. More than 500 individuals attended the fair. Over the subsequent years a number of projects and programs were organized successfully in the Metroplex area catering to different needs of the community. The Center organizes periodically a variety of programs targeted towards the needs of children, youth, women and seniors.

The Center has established a 24-hour telephone help-line in 1996. In addition to the annual health fair, the Center ahs established free medical clinic. Special luncheon programs for seniors are organized to give them opportunities to socialize and also to educate them about health issues. Center has assisted the community members on legal, family, immigration, prison, employment, and financial issues. Some of the programs have been reported widely. Horizon, an ISNA publication reported the details of the organization and the Health Fair in 1998 and the Journal of Islamic Medical Association reported in 2000.

The Center worked hard for the tax-exempt status and finally got it in 1996. MCC for Human Services is affiliated with Islamic Social Services Association (ISSA) which is a national organization. The Center has made presentations at different forums about its programs to educate the Muslim communities of other regions in their efforts to provide social services at local level. These presentations were made (twice) at the ISNA Annual Convention in 1998, and at the Islamic Social Services Annual Conference in Toronto in 2000. Several individuals from different parts of North America have contacted the organization to learn from its experiences in serving the Muslim community.

By the Grace of Allah (swt), the Center has acquired a building in 2000 that also serves as the head quarters for the organization. This will go a long way in assisting the organization to pursue its objectives of establishing a center for abused Muslim women and providing services to emotionally disturbed children.

 

Projects and Programs:

Help line: MCC operates a 24-hour telephone counseling and referral service- HELPLINE. This service is primarily for non-emergency calls. A volunteer or a paid employee assists in the caller’s need. Most of the callers who seek medical help are referred to Al-Shifa Clinic if they do not have insurance. The callers also seek help in finding jobs, discussing legal issues and family problems,. The calls are referred to the volunteers who handle specific areas such as: Job opportunities, legal help etc, or volunteers who have interest and expertise in handling domestic violence issues and child abuse..

Senior citizen program: The Muslim community has a significant number of senior citizens whom MCC is providing related services. The first program was held with a Senior Citizen picnic, where female and male physicians addressed participants’ specific health issues. Subsequently, a series of programs were held in Islamic Centers and Community Centers providing educational information about various old-age ailments, social security and Medicaid issues, and immigrant problems. Last program was held in July 04 in the Recreation center in Arlington Tx.

Services for Immigrants: The arrival of a significant number of Muslim refugees from Somalia and Bosnia to the Dallas/Fort Worth region, especially since late 1996, obliged MCC to hold workshops on social services and immigration issues. MCC assisted in settling the Somalians and Bosnian refugees by providing financial assistance for which a fundraising program was held; clothes, and household goods were also collected, and distributed. The MCC collaborated with government agencies working very closely with the Somalian Outreach Program. A member of the Somalian community is on our Advisory Council. A number of Somalian and Bosnian patients also visit MCC medical clinic.

Al-Shifa Clinic- In view of requests for medical help, a clinic was opened in October 1998 where indigent patients come for diagnosis and treatment. Visitors from overseas without insurance coverage also come to the clinic. The weekly clinic provides services only for minor medical problems. For more complicated medical problems, patients are referred to the public hospitals and clinics in the area. The Al-Shifa clinic started initially in the Somalian Outreach Center, and is now housed in MCC’s own building. Eighteen area physicians come on rotation on Saturdays. In addition to free consultation, medications are provided, since many patients cannot afford to pay for the medicines. Most of the physicians bring medication samples from their offices. In 2002, discounted rates were negotiated for Lab work, and now laboratory services are also provided. Most of the physicians at the MCC clinic are internists, and primary care physicians. Some area specialists see patients for free consultation in their own offices when referred by MCC. Local medical school students help at the clinic, getting credit for their work at our Center. We have been serving 1,000 patients each year at the clinic.

Health Fair- The MCC for Human Services organizes Health Fairs on a regular basis. The major purpose of these events is to detect common health problems like hypertension, diabetes, and high cholesterol. These diseases may lead to serious health problems if not detected at an early stage. On an average, 10 to 15 individuals are identified who are in need of serious medical care. Such patients are referred to physicians in the community, public hospitals, or Al-Shifa Clinic.

            The Annual Health Fair was held in different locations in Dallas/Fort Worth Metropolitan area. Several Health Fairs have been held mainly in the mosques and community centers. In 2003, for the first time, MCC is organizing a Health Fair, jointly sponsored by area churches, and hopefully, more than 50% of the participants will be Non-Muslim. This will be the first interfaith event of its kind in this area. In these health fairs, usually more than 500 visitors show up for a checkup. The services provided include a physical examination, tests for cholesterol and blood sugar levels, pediatric exam, dental and eye exam, etc. Lectures on different diseases including Heart Disease, Diabetes and Cancer are given. Many individuals make use of the opportunity to discuss and get professional advice on physical or emotional issues. The last health fair was held in November 2004 at Al-Hidaya Islamic School and next health fair will be held at Martin Luther King Center in South Dallas and this is jointly sponsored by Islamic Charity Day on May-20th 2006.

Guidelines for Health Care Providers- Over 100,000 Muslims live in Dallas/Ft. Worth area. Since physicians, nursing staff and Chaplains associated with hospitals, home health care and hospices may encounter Muslim patients. MCC has prepared a brochure to make them familiar with the religious and cultural sensitivities of Muslim patients, covering the subject of personal hygiene, prayers, diet, interaction with female patients, and Muslim views on illnesses and death. This brochure was circulated to every hospital in Dallas/Ft. Worth Metroplex. Educational Programs are also provided to various hospitals and health care agencies on this subject.

 Breast Cancer Education Program- MCC for Human Services has been receiving a grant from Susan G. Komen foundation for educating the community about the importance of early detection of breast cancer. From 2004, we have held atleast 15 education programs on this subject at various locations including mosques and public libraries. MCC has also arranged free mammograms for indigent women who cannot afford to have mammogram. During past two years, atleast 120 women had screening mammogram at Al-Shifa clinic. This was possible by a support from Harris Methodist Mobile Mammogram Services.

 

 Teaming for Technology- United Way/IBM has donated several computers to MCC for Human Services to develop the program on teaching basic computer technology. The major goal of the program is to offer training to the underprivileged students, women and Senior Citizens, not only for their use of computers routinely at home, but also to have an opportunity to get advanced training. One of the goals of MCC is to train Senior Citizens to use the computer enabling them to explore various websites and send email to their friends and family members.

     OUTREACH PROGRAM: Over the last one year MCC has become a formal partner to Arlington Life Shelter for Homeless. The volunteers of MCC have been providing assistance to the residents of the shelter. MCC provides breakfast to the residents every 2nd and 4th Saturday of the month. Last year the volunteers cooked and served dinner to about 100 residents of the shelter during the Holy month of Ramadan. So far the volunteers of MCC have served more than a 1000 meals

 

Back-to-School Program: MCC has taken up the responsibility of providing school supplies to the children who live in Arlington Life Shelter. In the month of August, the volunteers collected school supplies from Muslim community and donated to the shelter. The school supplies included backpacks, stationary, gift cards for shoes, crayons, pencils, etc. So far 10 sets of supplies have been provided and more are in the process. MCC plans to provide school supplies every quarter as children pass through the shelter throughout the year. MCC has contributed to the society approximately $ 350 worth of goods through this program in the month of August alone.

In September/October 2005, MCC outreach program assisted number of refugees from New Orleans who are displaced due to Hurricane Katrina. In November 2005, MCC has undertaken a major responsibility of assisting newly arrived Somalian immigrants. This program was possible due to cooperation of many Muslim organizations in this area.

 Premarital Counseling- The major goal is to prepare young people planning to get married, to face the realities of married life, giving them an opportunity to openly express their likes and dislikes, preferences and priorities. For example: Wife’s continuing Education and job after marriage, preference as to when to have children, living with extended family, living closer to in-laws, understanding marriage as a contractual agreement, prenuptial agreement, and brief orientation of Islamic family law.

Marriage Counseling- The major goal is to reduce the incidence of divorce and the breaking up of family unit.

Divorce Counseling- If divorce becomes inevitable: mediation to avoid costly legal and court expenses, referral to Islamic Arbitration; avoid child custody battles, counseling with children to reduce the trauma.

Educational Programs:- marital conflicts and how to reduce them before they become a major problem and affecting family integrity; role of culture in family life, positive and negative effects on being from a different culture; child abuse and wife abuse– causes and consequences.

Educational Seminars- The MCC organizes periodic educational seminars on a variety of issues concerning the Muslim community. The past seminars held included the subjects: “Challenges Women face in America,” “Parents Just Don’t Understand,” “Marital Conflicts,” and “Child Abuse and Child Protective Agencies.” Special lectures for senior citizens focus on various health issues, breast cancer, prostate cancer, diabetes and heart disease. We have made several presentations on Parenting- Islamic Perspective. MCC also provides educational services to other organizations such as: Hospices (End of life decisions- Islamic Perspective), County Department of Health and Human Services, and Hospitals, providing information about health care issues relating to Muslim patients.

Abused Children and Child Protective Agencies- Although there is denial in the community, MCC is receiving a number of calls from families where the children are taken by Child Protective Services for abuse and negligence. We have held seminars for parents informing them about the local laws regarding child abuse. Many parents don’t realize that beating the children for discipline is not permitted in this country, and quite often, parents blame the Child Protective Agency when they investigate the family after getting a report from teachers, or counselors about physical abuse. MCC is working closely with Child Protective Agencies, and on numerous occasions, children were returned to parents through the involvement of MCC and parents’ commitment that they would receive counseling from MCC. In serious situations, when the child cannot be returned to the parents, MCC is attempting to locate Muslim foster parents. Unfortunately, there is a lack of enough foster parents to take care of the Muslim children. MCC is working very closely with the Child Protective Agency to train Muslim foster parents, making an effort to help the parents and the children.

 

Domestic Violence and Abused Women. According to Muslim women activists in U.S., the husbands abuse approximately 10% of the Muslim women emotionally, psychologically, and physically. In USA, social service organizations like Muslim Community Center for Human Services of Dallas/Fort Worth, is just beginning to offer services and no data has been published. It needs to be pointed out that in surveys worldwide, 20-70% of abused women said that they have never told about their abuse before being asked in the interview. In communities where there are no services available, people do not even speak about such a problem. Therefore, it will be difficult to get the correct data. However, the actual numbers of abused women are usually much higher than the reported numbers.

The counseling program for domestic violence was launched in Feb. 2001 with a regional conference on ‘Domestic violence- Islamic Perspective.’ Several national speakers including D r. Najma Adam, Ms. Sharifa Al-Khateeb, D. Farzana Hamid, Dr. Juley Fletcher, and the local speakers: Prof. Lehman, Dr. Basheer Ahmed, Mr. Cumings, District Attorney Judge Haraira and Ms. Elliston from Women’s Heaven’s Shelter, participate in the program. Imam Yusuf Kavacki and Imam Moujahed Bakkach made opening remarks about the importance of dealing with the domestic violence, which is most un-Islamic behavior. Ms. Najma Ghouse, and MSW Zeba Salim have been instrumental in launching this program. A training program for volunteers was held in Jan. 2002.

The Muslim Community Center For Human Services receives calls from abused women in distress, and sometimes from shelters where abused women are taking refuge. The Center offers counseling services, and assists them in their. Rehabilitation. The Center prefers to see the families who are having relationship problems before it becomes serious and irreversible. Unfortunately due to some cultural inhibitions, privacy, and denial, very few seek help. Even when the wife starts feeling inability to cope with the persistent abusive behavior and requests help, husbands refuse to come for counseling. Culturally-ingrained attitudes and false beliefs that women have to be totally submissive and under total control of their husbands, are the major factors why many husbands do not seek any help. At present MCC for Human services offer Counseling and referral services to the abused women .We definitely need a Shelter for abused women and must provide all necessary services including protective environment for children,educational facilities for adult and children and job training opportunities for abused women.

Organizational and Board Development

During 2004, we have attended a training program to improve our organization and the Board. We have received a small grant from the Foundation of Community Empowerment (FCE) to develop the organization at a professional level. We sought the help of a consultant who met with all the Board members and the Advisory Council, and this has resulted in our development of a comprehensive strategic plan, board development, outcome strategies, and future funding and planning. With the help of Ms. Candace Gray, the consultant, and the untiring dedicated work of the board members made it possible to transfer this organization into a credible professional organization. The Muslim Community leaders and the Imams of the Islamic centers were the source of inspiration and support for MCC projects and programs.

Conclusion

The success of organization depends on the commitment of volunteers. Two of our volunteers received the presidential recognition award for their volunteer services of over 250 hours during the year of 2005. The MCC projects would not have been possible without the financial support of several individuals in the community.

Our community inflicted with a variety of social issues including marital problems, domestic violence, child abuse, substance abuse, economic problems, and many other challenges. MCC is taking these challenges seriously in making an effort to resolve some of these issues and help individuals and families to live a stable and peaceful lives and make a difference in the community.

 

M.Basheer Ahmed M.D.

Chairman MCC for Human Services

March 11, 2005

by – Asra Syed

A Day in the Life of Al-Shifa Clinic

The stone chimes on Al-Shifa Clinic’s front door jangle loudly, and Tahera Bano rushes in.

The people in the waiting room greet her almost in unison. “As-salaam Alaykum.”

“Salaam Alaykum,” she answers, and hurries past them.

It’s 9 a.m. on Saturday, and Bano, the clinic’s receptionist, is late. The clinic’s only paid employee, Cheryl Almosa, has been covering for her since 8:30.

“Good morning, Cheryl,” Bano says, with apologetic sweetness.

“Good morning.”

“Is the doctor here yet?”

“No, he called and said he’s not coming.”

Bano is annoyed. She checks the schedule. The doctor who volunteered to be at the clinic this morning bailed last time it was his turn, too.

“Is Dr. Basheer here?” Bano asks.

“He’s in his office.”

“That means he knows I’m late.”

Bano pushes past the low swinging door separating the reception area from the hall leading to the examination rooms. She peeps into the office of Dr. Basheer Ahmed, chairman and founder of the Dallas area-based Muslim Community Center for Human Services (MCC), the organization that runs Al-Shifa Clinic. His back is to her and he’s on the phone, earnestly searching for a doctor to fill in this morning.

Bano returns to the reception desk. At 50, the gray is beginning to show in her curly black hair. She wears clothes from her native India to the clinic, saris or shalwar kameez; today it’s the latter, a flowing pantsuit with a red paisley design. She is of average height, and her four children have left their mark on her figure. Her family emigrated from India in 1996, and struggles financially. Still, Bano turned down a $10 an hour job last year because the schedule would have kept her from volunteering at the clinic. Now she works the late shift – 3 p.m. to 2 a.m. – at a cell phone-manufacturing center.

Bano asks Cheryl about the clinic’s other regular volunteers. Dr. Sajid Husain, a retired surgeon and the clinic’s coordinator, is getting the exam rooms in order, and the high school and college girls who help with the paperwork have yet to arrive.

Al-Shifa Clinic is only open Saturdays. It operates out of a refurbished dental office in North Richland Hills, a suburb in the Dallas-Fort Worth Metroplex. The clinic offers general health care, including free diabetes screenings and blood pressure tests. Matters requiring further care are referred to specialists in the clinic’s network. Its volunteer doctors bring in sample prescription drugs, so sometimes patients get free medicine. Lab work is done at reduced prices, often a quarter of the cost at a regular doctor’s office.

MCC volunteers opened the clinic in the mid-1990s to serve refugees from Somalia, Bosnia, and Iraq who had recently settled in the Dallas-Fort Worth area. The volunteers realized that lack of health insurance and language barriers were keeping many refugees from getting medical attention when they needed it. Now anyone in need of low-cost healthcare is welcomed at the clinic, although most of the patients still are Muslim immigrants.

At 9:15 a.m., 10 people sit in donated chairs along the waiting room’s four walls. They all arrived early — the clinic officially begins seeing patients at 9:30 a.m. – and wait for their names to be called. A middle-aged South Asian couple sits in silence, each resting a chin on a fist. A man from Africa stares straight ahead. An Algerian man laughs with his two young daughters as they play and talk in Arabic. His wife, dressed in a floor-length jilbab, face framed by a white hijab, tends to their happy, gurgling baby boy.

Two men chat in Arabic. The one on the left has come for treatment of a cold and blood work to test for diabetes and cholesterol. He’s been waiting to see a doctor for half an hour now.

“Even if you have insurance, you have to wait to find appointment outside clinic, too,” he reasons.

He’s been coming to the clinic for about eight months, and like most of its patients, found out about Al-Shifa through word-of-mouth. “Some brothers at the mosque give me the number of this clinic,” he says.

After 15 minutes on the phone, Ahmed emerges from his office. As the clinic’s champion and primary overseer, Ahmed is seen by many as the engine that keeps Al-Shifa running. The contact sheet taped to the receptionist’s station lists him as “The Boss,” but his avuncular attitude, and plump and pleasant bearing is endearing, not domineering.

Ahmed approaches the receptionist area and tells Almosa and Bano that he’s secured an “emergency doctor” for the morning. His sister-in-law’s houseguest – a recently retired family practitioner – has agreed to fill in, but won’t be able to stay through the afternoon. Ahmed has a meeting with the United Way later, and Husain is too busy managing the clinic to see patients, so anyone arriving after 10:30 a.m. will have to be turned away.

Bano grumbles again in her native language of Urdu about the no-show doctor. Ahmed tactfully ignores her.

More volunteers arrive, and Bano greets them with hugs and relief. Mehreen Khan is a high school senior, and one of the clinic’s two “know-it-alls.” She and Bano’s 17-year-old daughter Fatima Tazeen are at Al-Shifa nearly every Saturday, mostly helping with paperwork and filing. When Almosa asks Ahmed about the clinic’s database program, he admits that only Mehreen and Tazeen know how it works.

Ayesha Kanval has also come to help at Al-Shifa today. Kanval is a first-year student at the Texas College of Osteopathic Medicines. She takes patient histories, and performs blood pressure and blood sugar tests as needed. Today she tells Khan that med school has already “desensitized” her.

“I just stood in while the doctor did a breast exam, and I didn’t even feel weird this time,” Kanval says.

Male doctors at Al-Shifa Clinic will often ask female volunteers to be present during an examination. Many of the clinic’s patients are Muslims from South Asia and the Middle East, where prevailing cultural norms limit contact between the sexes. The clinic’s volunteers try to be sensitive to women who might feel uncomfortable with a male doctor.

A Moroccan doctor who is not yet licensed to practice medicine in the United States pays particular attention to these patients’ comfort.   “She helps those ladies who don’t want to talk about their gynecological problems with the male doctor. So she used to get the information from those ladies, and help the doctor and patient,” Bano says.

By 10:15 a.m., the noise level in the waiting room is significantly higher than an hour earlier. More than half of the 21 chairs in the room are occupied, and patients waiting to be seen by the doctor have struck up conversations with each other. A Nigerian woman has slid off her sandals and curled her feet under her while talking animatedly with a black Muslim man in the seat next to her. Her elementary school-aged daughter wanted a Christmas tree last year, she says, and she had trouble explaining to her daughter why Muslims don’t put up Christmas trees in their homes. The man nods, and shares stories about the difficulty of raising his kids and grandkids Muslim in the United States.

The Nigerian woman’s elderly mother sits by herself in another row of chairs. She’s wearing a long, bright purple skirt and is wrapped up in a thin cotton shawl. A couple of chairs away, a Pakistani man rests in between coughing fits. His wife pays him no attention, and talks instead in Urdu to another Pakistani woman who has come with husband and children in tow.

The door chimes jangle again, and an electronic voice announces “Front Door Open (beep beep).” The people in the waiting room look up and decide not to collectively greet “As-salaam Alaykum.” An overweight white woman with shoulder-length, unwashed, dyed black hair walks in with a skinny man, possibly of Middle Eastern or South Asian descent. He’s wearing an over-sized denim shirt and baggy jeans. She takes a seat apart from the others, and he takes a clipboard of forms. He whispers the form’s questions to her and fills in her answers. After a long moment of silent staring, multi-lingual chatter resumes in the waiting room.

Just before 10:30 a.m., the door opens again. Bano’s mother enters, escorted by Bano’s sister and brother-in-law. Bano’s mother Khaleel is a petite woman in a white sari, bundled in an intricately patterned black shawl. She must have been a stunner in her younger days.

Khaleel Bano has a fungal infection in the third finger of her right hand. Her regular doctor said there wasn’t much to be done about it, so they’ve come for a second opinion. They wait about 20 minutes before her name is called.

Bano escorts her mother, sister, and brother-in-law to one of the two rooms the clinic uses for volunteers to collect patients’ medical history. Kanval asks Bano’s mother in Urdu about her general health and the problem for which she’s come to the clinic, and makes notes in her medical file. Ten minutes later, the doctor is ready to see her.

Dr. Siddiqui is waiting for them in Ahmed’s office. He takes one look at Khaleel Bano’s finger and says, “It’s a fungal infection.”

Bano’s sister, Saleha Elias, asks if there’s any topical ointment that might help, and the doctor says no. He says the best treatment plan for her is to just trim the nail as far as possible, and recommends against any oral medication.

“You can give anti-fungal Lamisil. But first, it’s expensive. Second, you have to eat it for three months. Fourth, it has an effect on the liver. So it’s better to leave it alone,” the doctor says.

“It doesn’t get worse?” Elias asks.

“No. Just keep trimming the nail.”

“This redness … I was getting concerned about that. Is it getting into her skin, like muscles? Can it become a systemic infection?” Elias asks.

The doctor looks closely at Khaleel Bano’s nail. “Did you ever injure this finger?” he asks in Urdu.

“No,” she answers. “It started off very minor, but has been getting worse and worse.”

A volunteer skims the chart, asks if the patient is diabetic. Elias tells them her mother is borderline diabetic.

“How much is blood-sugar?” the doctor asks.

“One ten, one fifteen. She takes one pill a day for it.”

That’s not too bad, he says. The best thing is to just keep trimming the nail.

“If you have a nail clipper, I can do it right now,” he says. “Surgery on the spot.”

Elias pulls a nail clipper out of her purse, and the doctor cuts off as much of the old lady’s nail as he can. Some skin gets clipped. She winces, but doesn’t make a sound.

“Apply vinegar three times a day,” the volunteer says. “Morning, lunchtime, evening. I read it in the newspaper.”

The doctor asks for a bandage to cover the patient’s finger, and Elias grabs one from one of two hall closets stacked with sample prescription drugs.

Not a minute after they leave, the next patient is brought in to the doctor’s makeshift exam room.

By noon, the receptionists have had to tell six people they arrived too late to be seen by a doctor. Not one complained about the reduced schedule, although Bano says not everyone is so well-behaved.

One man came to Al-Shifa last Saturday and was turned away because the volunteer doctor had to leave early.

“It’s my mistake, I came too late. I understand,” he says. “They’re already working very hard, and plus, I can say they’re doing good. I can say, Allah barakat them, I pray for them.”

The man had come to Al-Shifa clinic on the advice of his sister.

“She recommend that it’s a good clinic, plus if you do not have insurance or cannot afford, you can afford over here. That’s the main thing. That’s why everybody comes here. A lot of people don’t have insurance. A lot of people can’t afford,” he says.

Money is a primary concern of the clinic’s organizers as well. The clinic collects very little money from its patients, just a $5 annual membership fee and the partial cost of lab work. It has only one grant, from the Susan G. Komen Breast Cancer Foundation, to help educate women about breast cancer and provide access to free mammograms. Otherwise, it is entirely supported by donations and the fund-raising efforts of the MCC.

The clinic’s main organizers have started researching grants for which they are eligible, but it’s slow going. They want to open up the clinic another day a week, and to have a pediatrician once a month, but Ahmed says they still have trouble getting doctors to volunteer their time.

“Many doctors still hesitate to come because we’re not offering malpractice insurance,” Ahmed says. “We cannot afford it. So they are hesitant to come because doctors concern is always malpractice suits.”

At half past noon, Dr. Husain empties the donation boxes. The final patient for the day leaves the examination room, and as a kind of blessing, places a handful of nuts in each volunteer’s hand.

The volunteers and doctor talk about gathering at a fried chicken restaurant down the street, but the plans slowly fall apart and everyone goes their separate ways. Almosa left almost an hour ago, and Bano is closing up shop. There’s not much to put away. She turns the lights out and puts the alarm on, leaving the spare clinic in peace until next Saturday.

We treat them with goodness and grace!

IN SERVICE TO MCCHS