Meeting the needs of different cultures: Austria
Anna Köck, Dipl. Rel-Päd (FH), Catholic Hospital Pastor at Graz University Hospital, Head of the Centre for Graz Hospital Staff and Head of the Christians and Muslims in the Hospital symposium, discusses the legal position of Islam in Austria and examines the question of cooperation or conflict between Christians and Muslims in the hospital.
A young Islamic woman in a surgical ward pulls a blanket up to her nose and watches a nurse approaching to take her blood pressure. The patient understands hardly any German and her environs feel alien. Being an in-patient, and surgery, tend to make any one feel helpless and powerless. For this patient, the addition of an anti-Islamic remark had unnecessarily poisoned the atmosphere. Although the staff try to build her trust, it proves difficult.
She has just given birth. Her large family arrives. After the changeover to the night shift, the staff is puzzled by noises and smells from the common room. The family has spread out food and begun to cook.
These are just two examples of difficulties that can arise.
Austrian law and Islam
Islam in Austria has the same rights and duties as the Christian churches, going back to the Law on Islam, passed in 1912 by Emperor Franz Joseph. For these rights to be followed, the existence of a legal person as a counterpart to the state was required. Since 1979, this has been the Islamic community, which means that Muslims in this country have a legal status unique in Europe. Islam has the freedom of speech, gatherings and press. There is no impediment to practicing Islam. There is Islamic religious education in state schools based on a state-devised curriculum as well as the respective teacher training. Muslim females can wear headscarves at Austrian universities. The complexity of problems surrounding Islamic schools in Germany is unheard of in Austria. In return, the Law on Islam commits Muslims to recognise the Austrian constitution, and the Islamic community abides by this. A Muslim woman who insisted that the law on religious freedom meant she could wear a yashmak (veil) in court was forbidden by law to do so. The Islamic religious community stated that Islam does not call for the wearing of a yashmak and that a headscarf suffices for a woman to ensure adherence to religious duties.
Legal situations can arise that are not compatible with everyone’s perception of Islam. Individual Muslims must accept this because, in return, they are granted religious freedom, but vice versa they do not have the right to impose their views on others.
How Muslims perceive Europeans/Christians
Many Muslims are migrants from traditional, Islamic countries where religion is an important part of everyday public life. Religion is something visible, not just an inward matter. In Austria they join a society where religion is more of a private matter, a personal choice, respected but not playing an essential part in everyday public life and not so publicly displayed.
Europe – and therefore Austria – is considered by Muslims to be Christian in a way that, to them, makes it an essential part of the Austrian identity to be Christian. The largely internalised religiousness of many Christians is often hard for Muslims to recognise and they conclude that religion is not important to Christians. Social deficiencies and circumstances are interpreted as a lack of lived faith, further evidence for Muslims that their religion is not important to Christians. This sometimes leads to the questioning of a presence of Christian symbols in public spaces. The experience of hospital nurses shows that the Christian faith, and its symbols, are well respected and tolerated if someone professes their Christian faith and strongly defends its importance.
How Austrians view Muslims
An ostentatious religious custom or ritual – such as unrolling the prayer rug on the hospital ward or wearing a headscarf – seems strange to Austrians and is considered inappropriate, because, as pointed out, religion is considered a private matter. Muslims realise that, in Austria, Islam is perceived as backward, formalistic and misogynistic. Islam is also increasingly connected with an inclination towards violence and we tend towards a subliminal distrust of Muslims.
I remember, when invited to a celebration of the end of Ramadan, talking to a lady who ran a Turkish grocery store with her husband in a small town. Suddenly she nervously asked: ‘Tell, me, why are these people so afraid of us when all we want to do is live here in peace?’ I was very affected by this.
These views lead to tensions and misgivings that are also evident in hospitals. This is why the Centre for Nursing Staff, an institution run by the parish at the University Hospital Graz, in cooperation with the Styrian Department for Hospital Pastoral Care of the Diocese Graz-Seckau and the Nursing Directorate of the University Hospital Graz, held an inter-religious and interdisciplinary study day on the subjects of Christians and Muslims in the hospital last March.
Dr Markus Ladstätter, Vice Director of the Catholic University College for Education Graz and specialist in Islam, gave the following recommendations and advice for the dialogue between Christians and Muslims. He warned insistently against over-hasty valuations.
• Islam is complex. Islam existed in times of openness and in times of restriction. Therefore it must not be reduced to a certain period in time as progress, modernity and openness cannot be claimed by just any one religion.
• We should try to refrain from overhasty assessments. Someone already with a preconception will perceive anything that confirms these views and will not learn anything new. Learning means opening ourselves up to new facets.
• When comparing religions it is important to compare like for like, i.e. theory with theory, practice with practice. Too often, we tend to compare ‘good’ theories of our own religion with a failed practice of another – a mistake common in Christianity as well as Islam.
• The Second Vatican Council discusses Islam with respect and encourages dialogue. Catholic Teaching demands inter-religious dialogue with Islam.
• Where Muslims are involved, we are too quick to attribute conflicts with others to religion, though may have had problems with that person whether Muslim or not. In reality, an identity is always multilayered; it consists not only of religious but also social and cultural aspects.
Graz University Hospital
An Islamic prayer room was opened many years ago in Graz University Hospital. Common rooms were designed to ensure patients could meet visitors without undue disturbance to other patients. However, the biggest problem in daily hospital life is language – not to do with Islam but with migration, further complicated when different cultural and religious views converge.
Communication is critical in medical care. In the obstetrics department, for example, women from 83 nations, speaking 37 different languages, are treated.
Initiatives of the Islamic organisations
The intercultural Women’s Association Dschanuub runs the ‘Rahma’ project. Organised by migrants and Muslims, members of Rahma want migrants to feel self-confident in public and able to look after their own interests. The service includes providing someone who speaks in a patient’s mother tongue, as well as German, to accompany women for medical appointments or hospital visits – a service that also eases work for the staff. They not only translate, but keep in touch during an in-patient’s stay, and mediate with staff when communication problems arise. If required, they also can provide Quran recitation, help with terminal care or the ritual washing of the corpse.
Another project run by this organisation was called ‘Marhama’. Sponsored by the EU, it resulted in the development of the ‘Female Muslims in our Hospitals’ booklet (download at http://www.dschanuub.at/homepage_marhama/links.htm).
During a study day, the hospital staff was very interested in telephone numbers, to contact people who can mediate in difficult situations with female Muslim patients. It takes a long time and calls for resilience and commitment to spread this knowledge across all wards in such highly complex institutions. The committed Muslims tend to interpret these difficulties as prejudice against their religion. This is definitely not the case. Other, external organisations, and even departments within the hospital, have problems with this.
Complex Islam
As in Christianity, there are many different views and interpretations of religiously motivated actions amongst Muslims. Whilst some Muslim men will shake women’s hands in greeting, others would never do this. Whilst some accept they will be treated by medics of the opposite sex, others cannot conceive of it and would rather go without necessary treatment – despite the Islam commands that followers look after their health and seek treatment. Religiously motivated behaviour is often strongly characterised by culturally dependent interpretations of Islam in different countries of origin. This results in lifestyle differences not specific to Islam.
Visiting hours – progress or regression?
Even after intensive discussion many questions remain unanswered. What appears to be easy and logical in theory is not quite so in practice. Some Austrian hospitals have reverted to the re-introduction and enforcement of strict visiting hours. Not so in Graz. Some consider strict visiting hours as a quality criterion; others view this as a regression to the 1950s.
Recognising steps
I am aware of the enormous dedication and readiness of the staff to meet specific needs not only of Islamic but all patients. At the same time, there is repeated disappointment because these efforts are apparently (or actually, which I’m not in a position to judge for sure) neither appreciated nor recognised by Muslim patients, and this leaves people wondering ‘What else do we have to do to please them? They should be meeting us halfway.’ The big, unresolved issues of migrants’ integration are therefore reflected in the hospital.
Developing common rules
Not all demands and requests justified with reasons of religion are actually based on religion. Rude behaviour should not be tolerated, independent of the individual and his or her religion. Considerate behaviour is expected of everybody, particularly in hospital.
I can sense a certain amount of hesitancy regarding boundary setting, because no one wants to be accused of racism – historically understandable, but actually nothing to do with this issue. Of course, this does not answer the question of where unacceptable behaviour starts. I am convinced that this requires a discussion with the objective to develop common rules, which would be a relief for everyone.
Muslim needs are the needs of everyone
Making provisions for the particular needs of Muslims should be seen in the broader context of more focus on the patient, which applies to all patients. Non-Muslims also have certain preferences or intolerances when it comes to food, they have different inhibitions, some would also prefer examination by a person of the same sex, etc. In this respect, all patients could ultimately benefit from the fact that hospitals are becoming more open to trans-cultural issues.
Ulrike Drexler-Zack, the Public Relations Officer for the Catholic Hospital Pastor at Graz University Hospital, reports on practical steps developed to meet the challenges.
Sprechen Sie Deutsch?’ or ‘Do you speak…?
The proportion of foreign-language patients in the Department for Gynaecology and Obstetrics at the University Hospital has increased continuously since 2005. Data for 2007 show that almost a fifth of out-patients and nearly 25% of in-patients did not speak German. In an extreme case, 22 of a ward’s 26 patients spoke a foreign language.
According to Rita Kober, of the nursing directorate, initially interpreters were supplied with the support of the hospital management. Some planning difficulties arose because some patients did not attend appointments whilst others had long waiting times for unscheduled appointments. Nowadays patients are asked to bring someone to help with translation if necessary.
KOMA (communication materials), a pilot project set up with the help of the departments for organisational development and quality management and helped by Islamic religious community, developed and published the most urgent communication materials – including house rules – in eight languages. Apart from files and folders the project developed word-sentence-lists and pictograms (for the illiterate). It transpired that, although these materials are helpful, in most cases they cannot entirely replace an interpreter.
Apart from language barriers most potential for conflict arises from cultural differences (as described in EH issue 4, and below by Dr Weissen). However, there are one or two additional points: prayers are carried out not only by patients but also their visitors, which can cause of problems, as can rivalries between different groups in the community. These situations are sometimes perceived by the indigenous patients with incomprehension and viewed as a burden.
17.02.2009
