Pulse
Mosques on a Medical Mission
For years, Iqbal Kazi managed the Minnesota Department of Transportation’s $1.5 billion budget. Now semi-retired, Kazi, who holds an M.B.A., manages the budget of the Muslim Community Center, its school, and the tiny Rahma Community Clinic in Bloomington, where on a Saturday morning, he might play receptionist as well. The clinic is a mission of the Community Center’s mosque, Masjid Al Rahman, and one of two free clinics in the Twin Cities supported by Muslim faith communities. The other, the Al-Shifa Clinic in Fridley, is sponsored by the Islamic Center of Minnesota.
Kazi greets patients as they enter the clinic’s small waiting room on a Saturday morning in March, inviting them to sit in one of the dozen chairs that line the walls of the nondescript room. On one wall hangs a gold-framed verse from the Koran—the only overt sign of the clinic’s religious affiliation. It’s that affiliation, however, that inspires Kazi and others to volunteer each Saturday. This week, one of the volunteers is Salman Shafiq, M.D., an internist and hospitalist at United Hospital in St. Paul, who is seeing patients in the clinic’s exam room.
By noon, Shafiq has provided care to nine people with ailments ranging from diabetes to upper respiratory infections. But one is of particular concern to him: a man with leg swelling who has been treated for an infection at another clinic. Shafiq thinks his core issue may be undiagnosed sleep apnea. “He needs a workup, probably a sleep study,” he says. But the patient, who has a job, doesn’t have insurance, and Shafiq wonders where and how to get him the ongoing care he needs.
Although he’s troubled by the man’s predicament, Shafiq is enthusiastic about having the opportunity to help him and others like him. “I cherish this,” he says. “I look forward to coming here. Not only from an Islamic standpoint, but in general, I just feel good about this whole project.”
Honoring Thy Father
The Rahma Clinic is the brainchild of Bibi Swalehah Khoyratty, M.D., a hematologist/oncologist at Minnesota Oncology, who several years ago began noticing that an increasing number of her patients lacked the means to pay for their care. As the economy soured, she became even more concerned about people losing their jobs and their insurance. As an immigrant (she was born and raised in Mauritius), she also was aware that another group of people often lacked health insurance—older adults who come to the United States to visit their immigrant children for extended periods.
Khoyratty thought of her own father, who had passed away a few years earlier and whom she describes as “a great philanthropist.” She approached the leaders of the mosque about starting a free clinic as a legacy to him. With their approval, she began recruiting help, including that of her husband, Ehtesham Khoyratty, a chemical engineer, who serves as the clinic’s operations manager.
A steering committee named the clinic Rahma, meaning “blessing,” and allocated space for it. And the Khoyrattys scrounged used furniture and equipment. They also arranged for low-cost lab services and solicited the services of St. Paul Radiology, which provides free or discounted imaging. In January of 2008, the clinic opened its doors. Its services are promoted in the mosque’s newsletter and on its website, through announcements during services, on fliers posted in a nearby church and apartment buildings, and through word of mouth.
The clinic, which is only open three hours a week, sees 12 to 14 patients during that time. Most, but not all, don’t have health insurance. Most, but not all, are Muslims. Bibi Khoyratty says the patient population includes people born in India, Bangladesh, Pakistan, and other Asian nations; the Middle East; and Africa, as well as the United States. Some patients are here visiting relatives. Others are University of Minnesota students, new immigrants who don’t yet have insurance, long-time U.S. citizens who’ve lost their jobs, people who work part time and don’t have insurance, and people with insurance who can’t afford the co-pays. Some come while their children attend the mosque’s Saturday school, and some come because the doctor-on-call that day might speak their native language. “Whoever walks in the door, we’ll see them,” Khoyratty says.
A combination of factors brings Gulirana Minhas to the clinic. A native of Pakistan, Minhas has lived in Richfield for 22 years. She recently lost her assistant manager job at Macy’s and with it her health insurance. Minhas comes in for a blood pressure check and to have prescriptions written. But she also comes because she knows Khoyratty personally and appreciates the fact that there’s likely to be a doctor on call who speaks her first language, Urdu. It so happens that Urdu is one of the five Khoyratty knows.
Khoyratty admits a number of patients likely come because they feel more comfortable getting their care in a place where they know that the majority of staff are Muslim. “Maybe it’s because we understand their feelings about covering up or the relationships between mother and children or husband and wife,” she speculates, explaining that although the Muslim community in the Twin Cities is multicultural and multiethnic, Muslims from around the world share certain values and faith practices such as daily prayers.
She also thinks that physicians who have immigrated themselves might more readily understand why a patient might not comply with instructions to change their diet or exercise more, or they might understand the isolation a newcomer can feel, particularly during a Minnesota winter.
Although the doctors who volunteer at the clinic might have such cultural knowledge and sensitivities, Khoyratty says that they try to provide high-quality, Western-style medicine. “We practice here the same way we practice in our clinics.”
Common Problems
Khoyratty says high blood pressure, diabetes, and heart disease are the three most common health problems they see at the clinic.
Amin Rahmatullah, M.D., a cardiologist at Mercy Hospital in Coon Rapids and medical director of the Al-Shifa Clinic in Fridley, says Muslims in the Twin Cities are at high risk for these problems. He notes they are more likely to smoke and work in blue-collar jobs than others and may be less aware of the importance of diet and exercise. He points out that immigrants often need to change their habits to stay healthy in their new environment. Somalis probably walked five to 10 times more in Somalia than they do here, he says, yet they continue to eat their same high-carbohydrate diet after immigrating. “It’s not just the Somalis,” he explains. “If you look at any transnational migratory studies, the immigrant population has a much higher incidence of heart disease and diabetes in the United States…. They’re not as active, and they’re not acclimatized to Minnesota’s weather. They don’t let children do things either, so they are much less active in school. They can’t afford gyms. All these factors are extremely powerful.”
Both clinics have sponsored educational sessions on prevention of diabetes and heart disease. And both plan to do more. In addition, Rahmatullah is working with the Anoka County Statewide Health Improvement Program to bring more services to this population.
Both clinics also have plans to grow. The Khoyrattys are in the process of furnishing a second exam room, which they hope will allow them to more regularly bring in specialists to the Rahma Clinic. In addition, they plan to start a monthly eye clinic, and they hope to get a grant so the clinic can be open three half-days a week. The Islamic Center in Fridley is trying to acquire a property next to its community center so it too can expand. Both clinics have a ready and willing pool of physician volunteers.
“We feel that the need is increasing,” says Iqbal Kazi of the Rahma Clinic. “The Koran advises us to do whatever is good for the community,” he explains. “If someone doesn’t have the means for health care, you provide it.”—Carmen Peota