A Religious and Cultural Guide for Trust Staff

A Religious and Cultural Guide for Trust Staff Community Development Team 2 gether NHS Foundation Trust Date: 03/08/2011 For review: September 2013

2 Contents Contents 2 Forward 3 Introduction 3 Culture 4 Religion 4 Gloucestershire communities data 4 Basic Principles 5 Key Trust Policies 6 Detailed Religions:- Buddhism 8 Christianity 10 Church of England 11 Roman Catholic 13 Hinduism 15 Islam 17 Judaism 19 Rastafarian 21 Sikhism 23 Other religions:- Baha i 25 Jehovah s Witnesses 26 Mormons 27 Spiritualists 27 Quakers 27 Seventh Day Adventists 28 Pagans 28 Atheists or None 28 Communities 29 Checklist 34 Further Information 35 Acknowledgements 36

3 Forward from Community Development Workers (CDW) There have been many requests from Trust employees to have access to a cultural guide about the main religious groups to extend their understanding on various beliefs and customs. In spring 2010 we began to gather information from nationally recognised sites, including several NHS and local authorities, and subsequently have collated it into one document with their permission. Feedback on the Guide has been given by the Diversity Steering Group members and accuracy checked by various local faith groups. We hope you find this guide useful within your practice and we would welcome your feedback. In order to make it as user friendly as possible, you can view it as one whole PDF document or download each religion as an individual PDF. Introduction Statutory authorities and other agencies must ensure that their equalities plans and arrangements adequately reflect and address the needs of those members of religious and BME groups who receive services in relation to: Beliefs Diet (including fasting) Practices Gender sensitivity (modesty) Physical contact, Medical treatment, inpatient stays Daily acts of faith and/or major annual events They should provide for discussion at an early stage with the appropriate religious and ethnic community leaders to ensure that customs and beliefs are respected, language problems are addressed and requirements for emotional care, medical treatment, hygiene, diet and places for prayer are met. There may be specific needs and requirements, which need to be looked at individually and holistically, if services are to provide for individual needs. This guide is a resource for all staff explaining some of the main religious groups in Gloucestershire, including summaries of their beliefs and customs and good practice guidelines. It is hoped that you enjoy reading this guide and that it will extend your knowledge and understanding. The guide offers a general view but cannot provide all the answers to questions which may arise. If you are in any doubt it is important to ask. A polite and well-intentioned inquiry about how to pronounce a name, how to address a person or about a particular religious belief or a language requirement will not be offensive when promoted by a genuine desire to get it right. It is important to note that not every member of a religious group will adhere to the cultural or religious norm and each person must be treated on an individual basis to understand their personal needs and expectations. Culture

4 We are all born within a culture and we learn it from our earliest days. Our culture helps to shape the way we view the world and others. Culture is defined in many ways but can be basically translated into the ideas, customs, traditions, values, attitudes, influences and conduct of the way we live. Culture can be influenced by history, geography, parents, family, friends, education, religion, and personal beliefs but is not defined by one alone. The most important thing to note is that culture is dynamic and subject to change. As one minority culture comes into contact with another majority culture, the former may adopt some of the host majority culture s attributes. There may be differences between families who have the same cultural background, whereby members of the family may or may not adopt aspects of a culture, depending on whether it fits in with their lifestyle or perhaps for fear of discrimination. Religion Religion in one form or another plays a part in the lives of most of the world s population, sometimes dictating what they eat, where they live, what they wear, whom they marry and influencing their beliefs and values. While some religions will hold out the promise of a future life in the hereafter, most religions, whether they believe in one God, many Gods or no God, will encourage a life of moral rectitude and respect for others. Gloucestershire Communities 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 White: Irish White Other: White Mixed: White and Black Car... Change in BME population, Gloucestershire Mixed: White and Black Afr... Mixed: White and Asian Mixed: Other Mixed Asian or Asian British: Indian Asian or Asian British: Paki... Asian or Asian British: Ban... Asian or Asian British: Othe... Black or Black British: Black... Black or Black British: Black... Black or Black British: Other... Chinese or Other Ethnic Gr... Chinese or Other Ethnic Gr... 2001 2007

5 Basic Principles The experience of discrimination is a reality for some people in Gloucestershire because of race, gender, age, disability or sexual orientation. These issues can deny people life opportunities, find access to services more difficult, and suffer inequalities. This results in injustice that needs to be addressed. What can we do to demonstrate fairness and build confidence? Treat everyone with dignity and respect. Recognise and guard against our own prejudices - we all have them. Make ourselves aware of issues that affect people from minority communities. Don t assume that treating everyone the same is the same thing as treating everyone fairly. For example, holding a meeting at a particular time may cause difficulties for members of some faiths who practise ritual prayer at set times. Be colour conscious, not colour blind. Fair treatment involves taking account of difference. Don t assume that everyone has a religion. Many people seek to live good and responsible lives without religious beliefs. Where you know that someone is a member of a faith community, respect the values of that tradition. Don t project religious or racial stereotypes. This involves categorising a group on knowledge or experience of the actions or behaviour of a few people from that particular group. Racial stereotyping can be seen in views that certain racial groups are good at sport or keep to themselves and should be avoided. Don t perceive minority ethnic groups as the problem. The problem may lie in other people s perception of the culture and traditions of minority groups.

6 Key Trust Policies The following is a list of policies for staff to refer to when working with members of religious and BME groups:- Policy on Ordering, Prescribing & Administration of Medicines issue (POPAM) Buddhism re medicines that do not contain alcohol Hinduism and medication that is free from beef products including gelatine Islam as Muslims may be unable to take medication that has a narcotic effect or has the presence of alcohol. Rapid tranquilisation Buddhism re medicines that do not contain alcohol Hinduism and medication that is free from beef products including gelatine Islam as Muslims may be unable to take medication that has a narcotic effect or has the presence of alcohol. CPA policy and inpatient care pathway Buddhism re asking for birth name and ordained Buddhist name when taking medical notes. Discharge policy Seventh day Adventist should not be discharge on the Sabbath (a Saturday) as this is a day of rest. Judaism as travel on the Sabbath (Saturday) is not allowed. Leave policy Seventh day Adventist should not be sent on leave on the Sabbath (a Saturday) as this is a day of rest Judaism as travel on the Sabbath (Saturday) is not allowed. Visiting policy Hinduism due to likely visits by many relatives and the bringing in of prashad food Islam as it is the Muslims duty to visit the sick Sikhism as it is the Sikhs duty to visit the sick where ever possible. Young people visiting adults in psychiatric units Hinduism due to likely visits by many relatives which may include children Islam as it is the Muslims duty to visit the sick Sikhism as it is the Sikhs duty to visit the sick where ever possible. Single sex accommodation Islam as it is a basic tenet of Muslim behaviour that unrelated men and women keep themselves separate and that both genders act with appropriate modesty and reservation at all times Sikhism Sikhs would prefer single gender wards. Translation policy Islam as some Muslim males would prefer to speak to male members of staff and females would prefer to speak to female staff.

7 Medicines Management Some medicines contain alcohol or gelatine, if this is a concern for a particular patient please contact medicines information or your ward pharmacist who can facilitate this information promptly for individual patients. As with all medication prescribed there should be a discussion with the patient where possible, to ensure they are aware of these issues. The telephone number for medicines information is 08454 226108 (direct line) for staff queries or NHS Direct on 08454647 For out of hours please contract the on call pharmacist, however, they may not be able to access the information out of hours as this often requires contacting manufacturers. For acute or chronic poisoning call the National Poisons Information Services on 0844 892 0111. Please refer to page 35 for links to policies.

8 RELIGIONS BUDDHISM Buddhism originated in Asia and has spread worldwide. Buddhism describes a state of life involving no belief in a God. Buddhists believe that life is a process of birth, ageing, illness and death in which people achieve enlightenment by understanding and overcoming suffering. The word Buddha means the enlightened one The life led has a direct bearing on a person s rebirth and the next life with an ultimate goal to be released from the cycle of re-birth and achieving Nirvana (Nibbana). Lay Buddhists seek to live by five precepts. They refrain from Harming any living thing Taking what is not given Sexual misconduct Lying and abusive language Alcohol and other intoxicants which cloud the mind Those who take monastic vows follow another five precepts. To refrain from Eating other than at prescribed times, Dancing, singing, music making and unseemly public displays using anything that will beautify personal appearance Sleeping in a high or large bed Accepting gold or silver (including money) Religious observance If applicable ask a Buddhist for their birth name and ordained Buddhist name when taking medical notes from them. If ordained, ask them whether they would prefer to be called by their birth name or Buddhist name Buddhist worship, whether at home or in a temple, includes meditation, chanting and prayer and listening to the recitation of religious texts. If at home, an area is often set aside as a shrine with an image of Buddha and incense there is no set time for worship; it is undertaken according to individual preferences but may be daily. Buddhists believe in inner peace and calmness through meditation and might need peace and quiet to meditate, so offer them some privacy They may also use incense stick or a candle when meditating in front of a Buddha figure. Buddah images, rosaries and meditation stools must be handled with care and respect. Holy Book: The Pali Scripture and Mahayana literature (Sutras) Holy Day: full and half-moon observance days. No one specific day of the week. Religious Festivals vary depending on tradition but Wesak Festival is the most important and celebrates the Buddah s birthday on the full moon in May, and for some marks his enlightenment and death. The idea of overcoming suffering and unwholesome mental states is a key feature of Buddhism but how this relates for an individual will vary.

9 Diet Some Buddhists are vegetarians and may avoid fish but many Buddhists practicing in the West will often be strict vegetarians, if not vegans. Ideally Buddhists should not be responsible for the death of any other living organism and so it may be wise to offer a vegetarian menu to a Buddhist. Alcohol and Medication One of the 5 precepts of Buddhism states: I undertake to abstain from intoxicants which cloud the mind this includes alcohol and medicine containing alcohol. Some Buddhists interpret this as complete abstention, whereas others allow a small amount of alcohol in their diet because they are ultimately responsible for their own actions. If possible, offer medicines that do not contain alcohol or animal products. Buddhists may choose meditation over medication especially around pain relief. Hygiene/Gender no specific requirements. Death customs The body of the deceased may be handled by non-buddhists. Many Buddhist believe that the soul does not immediately depart the body upon death and therefore it is very important that the corpse should be treated as a person and not an object. Generally there are no objections to a post mortem, should it be necessary. Useful websites:- The Buddhist Society: www.buddsoc.org.uk Buddhist Information Network: www.buddhanet.net Friends of the Western Buddhist Order: www.fwbo.org Community contacts:- Bristol Buddhist Centre, 162 Gloucester Road, Bishopston, Bristol Open Mon-Sat, 9 am 6 pm Tel: 0117 924 9991 www.bristol-buddhist-centre.org Akanishta Kadampa Buddhist Centre (NKT) Tel: 01242 269807 www.meditationincheltenham.org.uk

10 CHRISTIANITY Christians believe in one God who created the universe. God showed his love for all humanity by becoming a human being, sending His son Jesus to bring humanity back to a personal relationship with God. Jesus life and teaching demonstrated that God is with his people and called upon them to build that relationship with Him. For Christians, His death was not the end, but the beginning. After three days He was raised from the dead (the resurrection). Jesus lived His life as a practising Jew but He was recognised by His followers as the expected Messiah (Hebrew word) or Christ (Greek word). It was after His death that the name Christians was given to His followers and His disciples founded the Christian church. Christians believe in one God who revealed Himself to humankind as three different persons : God the Father, who created the world God the Son - Jesus Christ who redeemed humanity God the Holy Spirit, who strengthens and guides the people of God. Christians believe in the forgiveness of sins through the death of Jesus on the cross. There is a strong sense of service for others based on an understanding of love. From its earliest days, there has been much diversity within Christianity and over the centuries, the differences became divisions and various traditions of Christianity came into being. Practice within the churches also differs, although in recent years these differences have been reduced. The various traditions, (Churches or denominations) include: The eastern or Orthodox tradition The western or Roman Catholic tradition, with the Pope at its head The Protestant tradition arose out of the Reformation period of history. In England, since the sixteenth century, the Church of England has been the established church and is sometimes referred to as the Anglican Church. Delusional belief formations often embrace Christian themes. The reverse is also true, ie Christians (and practitioners of other world faiths) may embrace delusions when mentally ill. For example, strongly committed Christians may exhibit delusions about their faith which may make it very difficult for staff to distinguish between a real faith-need and expressed need which is associated with delusional thinking. Useful websites: Church of England: www.church-of-england.org Catholicism: www.vatican.va Churches together in Britain & Ireland: www.ctbi.org.uk

11 Protestant Tradition Church of England (Anglican) and Free Church, Pentecostals/Assemblies of God The Anglican tradition embraces a wide range of practices where some Anglicans follow almost every belief and practice of the Roman Catholic Church, whilst others are like Free Churches. Free Church is a collective name for a wider number and range of traditions such as Methodist, United Reformed and Baptist Churches. Regular prayer is more common and central in these traditions. Some will not seek Holy Communion as often as in Catholic or Anglican traditions and will not see it as a weekly practice, however, personal knowledge of the bible and regular study will be important. Regular contact with their church, minister or group will be important. Prayer with or without laying on of hands is common practice when seeking healing. Evangelical Churches imply a lively model of worship with particular moral principles drawn from Scripture and the Bible may be seen literally as the word of God. The Charismatic movement believes in the direct action of the Holy Spirit in people s lives and is found in evangelical churches and in main traditions. Worship may involve speaking in tongues, prophetic statements. In all such traditions it is believed that God can and does directly intervene in the life of the world through answering prayer, guiding our actions and acts of healing. There is a belief in the reality of evil, although the frequency with which evil spirits or demonic possession are believed to occur varies widely. Staff can help patients by being aware of their needs, which may be expressed even by patients who are not regular churchgoers. Religious Observance Receiving Holy Communion All confirmed members of the Church of England and free churches are eligible to receive Holy Communion and if in hospital may find particular comfort from this. Chaplains or their helpers can bring Holy Communion to the bedside, gathering patients together where appropriate. Holy Communion services are held in the chapel. Just be aware that alcohol may be used in this celebration. Prayer Church of England and Free Church members are encouraged to develop their own patterns and discipline of prayer, which includes private devotions, and going to church services for public congregational prayer. Prayer can contribute greatly to the healing process. Chaplains can help people with prayers in a wide variety of circumstances, including: Before surgery On Sundays or at major festivals When faced with any major decision When the patient s health deteriorates Preparing for a loved one s death or after death When confronted with bad news In bereavement

12 At the time of a funeral the patient would have attended if well enough. Other sacraments Church of England and Free Church patients or their relatives may have a variety of requirements. The Holy Book is the Bible, a combination of scriptures shared with the Jewish faith (Old Testament) and the collection of gospels and epistles specific to Christian faith (New Testament). The Gideons provide Christian scriptures at every bedside (New Testament and Psalms). Diet and hygiene There are no specific requirements, though some patients may wish to fast before Holy Communion and at the time of Lent. Gender issues The Church of England ordains women and men as priests. Some Church of England patients or their relatives may have conscientious objections to women priests and to the male priests who accept them. They may wish only to be visited by their own parish priest and not by the hospital chaplain. However, the hospital chaplain is available to call if an acceptable priest of the parish priest is unavailable. Visiting Chaplains visit wards regularly but will also visit particular patients and relatives on request. Death customs: Choice of cremation or burial is an individual choice and the wishes of the family should be sought. Community contacts: Gloucestershire Cathedral, 2 College Green, Gloucester Tel: 01452 524167 www.gloucestercathedral.org.uk

13 Roman Catholic Religious Observance Daily prayer and worship According to a person s needs, various religious and spiritual needs may be expressed, which may include some of the following: Mass All Roman Catholics are obliged to attend mass on Sundays and certain holy days. In reality, though not all keep this practice, it will be very much part of their understanding and outlook. Many patients and their relatives, even if they do not practise their faith on a regular basis, like to attend mass in the hospital chapel on Sundays and holy days. Holy Communion If a patient is not well enough to attend the chapel, Holy Communion can be brought by a chaplain or lay Eucharistic Minister to the patient at their bedside. Just be aware that alcohol may be used at this celebration. A blessing or a visit from a Priest If someone is not well enough to receive Holy Communion or does not practise their faith, a prayer of blessing can be given. On some occasions a visit from the priest, in which they are able to offer counsel and support to patients and relatives, is often a source of great comfort. The Sacrament of Forgiveness (confession) Often Roman Catholic patients may wish to see the priest to celebrate this sacrament in which they confess their sins and worries in total confidence. The priest then offers counsel and support and prays the prayer of God s forgiveness. The Sacrament of the Sick In the case of serious illness, major surgery, or grave concern of a patient s relatives, the priest may perform this sacrament. It involves a short reading from the Bible, the priest laying his hands on the sick person s head, and anointing them on the forehead and palms of the hands with holy oil, and then praying for the person. This is a special prayer for healing, help and strength at a difficult time. Help with Prayer On occasions, priests are asked for items to help with personal prayer, such as a Bible, a prayer book, rosary beads, or prayer cards. Although there is no obligation to set prayer (except for clergy), people are encouraged to adopt some form of personal prayer. Priests are sometimes asked to help people with an appropriate style of prayer for their time in hospital. In general practice, some of these sacraments, blessings and prayers are often performed as one act. For example, the Sacrament of Forgiveness (absolution), Anointing the Sick and Holy

14 Communion are often celebrated together. Baptism and Confirmation can be carried out together. Catholic patients who have married outside the church s discipline often ask for the priests help in putting their marriage right in the eyes of the Church. Diet and hygiene On Ash Wednesday, which marks the beginning of Lent, and on Good Friday, the day of Christ s crucifixion, Catholics are bound to fasting and abstinence. There is an obligation to fast for one hour before receiving Holy Communion. It should be noted that when someone is in hospital they are dispensed from all obligations to fasting or penitential practice. Gender issues - No specific requirements. Death customs As death approaches, the patient (if able to ask) or their relatives may request a priest to pray for the dying, commending the sick person to God, assuring them and their relatives of God s love, care and mercy. If the person has died, the priest will pray the prayers for the dead, as an assurance of God s care for the one who has died, and to give comfort and peace to the relatives. Sometimes Roman Catholics will ask for a priest to perform the Last Rites for a seriously ill relative. There is actually no ceremony of this name, and generally what people are requesting is a rite of passage that could involve the Sacrament of the Sick, the Prayers for the Dying or the Prayers for the Dead. There is a misunderstanding among some Roman Catholics that the priest should be called at the very last moment. Roman Catholic teaching encourages the participation of the church at all stages of illness, and all those who have care of Roman Catholic patients should assure them that the priest is there to offer help and support. Community contacts: St Peter s, London Road, Gloucester Tel. 01452 523603 Catholic Church of St Gregory the Great, 10 St James Square, Cheltenham Tel: 01242 523737

15 HINDUISM Hindus believe in one God, Brahman, who is ultimate reality. All living souls originate from, and seek to be reunited with Brahman. Brahman has been revealed in many forms. In a Hindu temple, there will be shrines to many deities. At home, a Hindu family may have a shrine that includes any of their chosen deities. Popular deities include Shiva, Krishna, Ganesha, Durga, Rama and Sita. The law of Karma is important and provides the soul with further opportunities to achieve its goal of reunion with Brahman. The law of Karma is the law of cause and effect. Free will involves making choices, and the actions of the present life will result in another incarnation or liberation from re-birth. The spiritual journey is therefore different for each individual and religious disciplines will vary from person to person and at different stages in a person s life. Religious Observance There is respect for life in all its forms and for the doctrine of non-violence (Ahimsa). Worship is an individual aspect for the Hindu, whereby some prefer to do this individually in the home, whereas others prefer to worship as part of a larger congregation at a temple. Congregational worship will usually take place in a temple at festival time. Many Hindus pray twice a day - before sunrise with prayer for righteous living and at sunset to end with reflection on the day s work, and this should be respected. People who are followers of a personal God are likely to begin the day with prayer (puja) at a shrine within the home. They may also visit a temple occasionally to make offerings and to pray. Holy Books - The Vedas, Ramayana, Bhagavadgita (Gita) which forms a part of the great epic, the Mahabharata Holy Day - No one specific day of the week. For some, Guruvar (Thursday) is a special day, people in Britain usually gather for worship on Saturday and Sunday. Religious festivals include Diwali and Holi. Married women and children may wear red marking (bindi) on their forehead. Diet & Alcohol Many Hindus are vegetarians, because they are reluctant to consume other creatures and avoid beef, fish, eggs, chicken, animal fat and some will not eat root vegetables. However, it is best to check. Some Hindus are very strict and will not eat food that has come into contact with prohibited food/utensils. It is important to ensure that plates, cutlery and any utensils used for preparing, handling and serving food are not used for meat products as well. In addition, any food is not cooked in oil that has been used to prepare other meat products. Fasting this means eating only pure foods such as fruit or yoghurt rather than complete abstinence. Few would insist on fasting when in hospital. Hot and Cold foods describe the perceived health properties of food and has nothing to do with temperature or spicy qualities. Tobacco and alcohol are not generally accepted. Hygiene Prefer to wash using free flowing water, as in a shower as baths are often considered unhygienic. A jug may be required if using a bath.

16 Most Hindus prefer to wash after they have used the toilet rather than use toilet paper, and water should be made available. They will want to wash their hands before and after a meal and would also want to rinse their mouth after a meal. Gender Issues The gender of the practitioner/clinician should be matched to that of the patient and consideration should be given to their modesty. Generally, women will feel more comfortable in all female ward and likewise for men. For any home visit, it is important to bear the following in mind. Upon entering the home, do not offer to shake hands check with the host. Shoes must be removed on entering the house. When Hindu women are addressed by a man, another family member should be present. Jewellery or clothing can have religious or cultural significance. A married woman s bangles are normally only removed on her husband s death. Some women wear a nuptial thread necklace, whereas some men wear a sacred thread over the right shoulder and around the body. If these have to be removed they should be returned as soon as possible. Death customs A Hindu patient or relative may request the services of a priest during the last stages of life and the patient may wish to lie on the floor as it symbolises their closeness to mother earth. It is preferred that the body is only touched by someone of the same sex. Distress may be felt by some if the body is touched by a non-hindu. Other point to note: It is a Hindu custom for a sick relative or acquaintance to be visited by a number of people - family, friends and other members of the community. Useful websites: Hindu net: www.hindunet.org Community contacts: Cheltenham Hindu Community Centre and Temple 64 Swindon Road, Cheltenham GL50 4AY Tel. 01242 584250

17 ISLAM Islam means submission to the will of God and embraces people from many different countries with its origins in the Middle East. There is a variety of first languages among Muslims, but all worship and religious practice is completed in Arabic. The Holy Qur an was revealed to the Prophet as guidance for mankind. There are five obligations for Muslims, known as the five main pillars of Islam: 1. Shahadah - The declaration of faith that there is only one God (Allah) and Muhammad (PBUH) is his final prophet. (Muslims show their respect for the prophet by saying Peace be upon him after using his name.). 2. Salah - Prayers are said five times a day at fixed times facing towards Mecca (before sunrise, noon, mid/late afternoon, just after sunset, and night). 3. Zakah - The giving of alms or money to the poor. 4. Ramadan - Fasting during the hours of daylight for one month each year. 5. Hajj - there is a requirement to try to make the pilgrimage to Mecca at least once during a Muslim s lifetime. Religious Observance Many observant Muslims will keep the Qur an wrapped up in a cloth cover. Sometimes Qur anic verses are sewn into clothing or worn in a locket around the neck. This is not seen as jewellery, but as a religious artefact and should not be removed. Muslims are obliged to wash their hands, feet and other parts of their body (ablution) before they take the Qur an in their hand. Muslim women cannot pray, fast, or touch the Qur an during menstruation. Islamic dress codes require Muslims to be modest at all times. The extent to which the traditions are observed will vary from culture to culture. Muslim women wear clothes that cover them from head to ankles. Activities on Fridays (Holy day) should not interfere with the need to attend mosque at midday, the need to pray at specific times should be respected and the understanding of modesty should be accommodated. An individual may wish the Imam (religious leader) to visit whilst in hospital. Religious Festivals Two Eid festivals, one which marks the end of Ramadan and the other the end of Pilgrimage (Hajj). The invisible realm includes a race of beings called jinn, capable of both good and bad. When mental disturbance is suspected, it can sometimes be attributed to possession by jinn or evil influences. An individual may not consider themselves to need medical attention but rather spiritual. This should not immediately be presumed to be a delusional belief but advice sought. Diet, Alcohol and Medication Muslims do eat meat but it must come from a reliable and certified Halal or Kosher source. Eating meat that has been slaughtered in a specific way by a trained individual is part of the halal (permissible or lawful)) discipline. Muslims can also eat kosher meat as the animal is slaughtered in much the same manner. As much blood as possible from the slaughtered animal must be removed. Halal excludes pork and pork products, hare, predatory birds, gelatine, animal fat and derivatives. Fish without fins and scales (e.g. shellfish) are haram (unlawful) A menu that excludes these foods could be prepared with help from the Muslim community.

18 Mammals that both chew their cud (ruminate) and have cloven hooves are considered to be halal. Halal forbids the consumption of all alcohol and narcotic substances, therefore Muslims may also be unable to dispense or take medications that have a narcotic effect or have the presence of alcohol or animal based derivatives. During the month of Ramadan a Muslim fasts between sunrise and sunset and food should be made available before sunrise and after sunset. Those who are sick are not required to fast but if an individual wishes to fast consult with a religious leader. Essential drugs or medicines can be administered during Ramadan. Hygiene Prefer to wash using free flowing water, as in a shower as baths are often considered unhygienic. A jug may be required if using a bath. Prefer to wash after they have used the toilet rather than use toilet paper, and water should be made available. They will want to wash their hands before and after a meal. Gender/Family Issues It is a basic tenet of Muslim behaviour that unrelated men and women keep themselves separate, and that both genders act with appropriate modesty and reservation at all times. Whenever possible try to respect gender segregation traditions and also try to match the gender of the practitioner or clinician to that of the patient. The role of the Muslim man as the protector of his wife and children means that it is important to include him in discussions about the individuals illness (unless he is part of the problem). Women from traditional or conservative backgrounds (or the older generation) may refuse treatment unless the head of the family (usually the husband) has been consulted and agrees. A Muslim patient may receive many visitors if they are admitted into inpatient services. Death Customs When a Muslim is near death, those around him or her will give comfort, and reminders of God's mercy and forgiveness. If possible their last words would be the declaration of faith: "I bear witness that there is no god but Allah." Useful websites: Muslim Directory: www.muslimdirectory.co.uk Community contacts: Mufti Abdulla Patel, Tel. 01452 300465

19 JUDAISM In Judaism, religion and culture are closely entwined and tradition has an important place in Jewish life. The degree of observance will vary from person to person. Among the Orthodox, a person is considered to be Jewish if born of a Jewish mother. An Orthodox Jew is usually more traditional and strict in observance of religious/dietary laws. Progressive Jews accept the status where either parent is Jewish. However, proselytes are accepted after a rigorous training programme. Non-Orthodox Jews generally make their religious observance fit into modern society in different ways. The Torah is the law revealed to Moses in the Hebrew Scriptures At the heart of the Torah is the belief expressed in the Shema - Hear, O Israel, the Lord our God, the Lord is one. Jewish men remind themselves of this belief by wearing a cappel (or yarmulke, or kippah, or skull cap). Orthodox Jewish women may prefer to have their bodies and limbs covered and they may also prefer to keep their hair covered with a head scarf. Religious Observance Friday evenings and Saturday mornings are times when important services are held. On these occasions, and at other times, the community is gathered before the Ark in which are stored the Torah scrolls. Many rituals happen in the home and a sense of community is strong. The Sabbath (Shabbat) begins at sunset on Friday and lasts for 25 hours. During that time an Orthodox family may rest together, not working but enjoying quality family time. It is a weekly celebration of the creation of the world and involves lighting of candles and blessing of wine and bread to welcome the Sabbath and partaking in a special meal. Kiddush is made when wine and bread are blessed. To ensure that the Sabbath may be observed there should be sensitive planning of activities, such as appointments, discharge. For many Jews, it is a mark of respect to keep the head covered at all times, even indoors, and especially in the presence of the Torah scroll and when praying. Main Festivals - Shabbat, Sukkot, Hanukkah, Pesach (Passover). During Autumn, there are a number of important festivals. The New Year (Rosh Hashanah) is a two day festival beginning the Ten Days of Awe which culminates in Yom Kippur. Many will wish to keep that day to pray and be quiet as it is the holiest day of the year and is considered to set the path for the year to follow. Because the Jewish calendar is based on the lunar cycle, the dates of these festivals vary in relation to the Gregorian calendar from year to year. Diet The requirement to maintain a Kosher way of life is the responsibility of the Jewish family. The Torah establishes which foods shall be eaten and the way that they are prepared. The law identifies the type of meat and fish to be eaten and the way it is to be slaughtered. An individual should be consulted over their dietary requirements. Meat and dairy products are not to be eaten within two hours of each other. For example, an individual would not have milk in a drink or cream with desserts after a meet meal and butter should not be used on meat sandwiches. When kosher meat (from animals that chew the cud and have cloven hooves) or fish (any with scales) are not available vegetarian ( parev ) food is eaten. Always ask for dietary requirements or serve vegetarian food as a general rule. Kosher food prohibits shellfish, pork, rabbit and derivatives. Alcohol is usually acceptable.

20 At Passover in March/April special foods may be required. Fasting if fasting is a danger to health then medical advice will be accepted. Yom Kippur in September/October is a special day of fasting. Medication Orthodox Jews may not be happy to take non-kosher medication and on some occasions may need to be offered alternatives to oral medication when possible, such as injections or suppositories. Hygiene issues - none Gender Issues No specific requirements but would prefer the sexes to be segregated on wards. Ultra-Orthodox Jewish men consider it immodest to touch women other than their wives and care need to be given to what contact is necessary between nurse and patient. Death Customs Death may involve following certain practices but these vary on the tradition and immediate advice from the faith community is important. Some Orthodox groups may wish to appoint someone to stay with the body from the time of death to the burial which is usually within 24 hrs. Other point to note:- It is considered an important religious duty to visit those who are unwell and therefore large numbers of people may visit. However, on the Sabbath (Friday night and Saturday) and on festivals visits may not take place unless patient is within walking distance even if dangerously ill. Care must also be taken when discharging patients on the Sabbath. Useful websites: Community contacts: Cheltenham Synagogue, Synagogue Lane, St James Square, Cheltenham GL50 3PU Tel. 01242 578893 E-mail: info@cheltenham synagogue.org.uk

21 Rastafarianism Rastafarianism is a young, Africa-centred religion which developed in Jamaica in the 1930 s and commemorates the coronation of Emperor Haile Selassie I as King of Ethiopia in 1930. They believe the ascension of Ras (Prince) Tafari as the Emperor of Ethiopia and that he is a divine being with direct lineage from the biblical King David and that Haile Selassie is God and that he will return to Africa members of the black community who are living in exile as the result of colonisation and the slave trade. Their greatest concern is the repatriation of blacks to Africa and the reinstatement of blacks in society. Religious Observance Rastafarians follow a number of Old Testament laws but the notion of original sin is rejected. There are no churches, services or clergy. Followers usually meet weekly, either in a believers home or in a community centre and meetings may include large feasts. Religious ceremonies consist of chanting, drumming, and meditating in order to reach a higher level of spirituality and emphasis is placed on mysticism, dignity and the importance of humility and peace. Rastafarians believe reincarnation follows death and that life is eternal. Religious practice includes the use of Marijuana to increase their spiritual awareness Followers are forbidden to cut their hair; instead they grow it and twist it into dreadlocks which represent the lion s mane which is the symbol of Rastafarianism. There are a number of important festivals centred on Emperor Selassie (23 rd July) and Ethiopia New Year (11 th September). The role of women in Rastafari There is a separate code of conduct of religious practice for women and whilst early Rastafarians probably followed these rules strictly, women tend to have more freedom in modern Rastafarian society. In Rastafari there is no formal marriage structure and an unrelated man and women living together are regarded as husband and wife. Women are not called to Rastafari except through their husbands and men are the spiritual head of the family Women are known as Queens The main role of women is to look after their King and are regarded as housekeepers and child bearers. Women are regarded as subordinate to men and cannot be leaders Women must not commit infidelity Women must not cook for their husbands when menstruating Women must not wear make-up, dress in promiscuous clothing, or use chemicals in their hair Women must not use birth control as it is regarded as a European tactic to suppress the development of the African population. This builds on the Old Testament prophesy that The seeds of Israel shall be numberless Women must also abstain from abortion which is regarded as murder Women must cover their hair to pray, in keeping with the Biblical teaching in 1Corinthians 11:5...And any woman who prays or proclaims God s message in public worship with nothing on her head disgraces her husband... 2 Authors: Community Development Team, gether NHS Foundation Trust

22 Diet and Alcohol Food is very important and some believe almost all illness can be cured through eating right. There is no formal dietary code and each may have their own. Healthy food is called I-tal food, which is natural food that is chemical free, free from preservatives and not canned. Many Rastafarians are vegetarians, especially refraining from eating pork and shellfish, and some will avoid milk, herring and sardines. Alcohol is forbidden, and coffee and salt are strongly discouraged. Medicines The Rastafarian patient may not wish to receive any Western medicines or any treatment which will contaminate the body. They may prefer alternative therapies such as herbalism, homeopathy or acupuncture. They may not wish to even answer questions. Hygiene Issues None. Point to note:- Visiting the sick is important and often made in groups. Death Customs:- There are no specific rituals either before or after death. Burial is normal but cremation can also take place. Post mortems would not be acceptable unless ordered by the coroner. Organ donation is very unlikely. Useful websites: www.bbc.co.uk/religion/religions/rastafari www.faithintowerhamlets.com/default/1100.guide/guides/rastafarianisim

23 SIKHISM Sikhism originated in the Punjab in the 15th century. Its followers trace their traditions back to the lives of Ten Gurus (teachers.) The first of these was Guru Nanak, born of Hindu parents in the Punjab. He grew up in an area where Muslims were in power. His teaching was based on a religious experience of being in the presence of God. He said: There is no Hindu; there is no Muslim; we are all children of one God. He established a way of life based on the oneness of God and the equality of all people. The tenth Guru, Guru Gobind Singh founded the Sikh community (khalsa). After his death there was one more living guru. The eleventh and last guru is Guru Granth Sahib, the Sikh scriptures. This is a collection of hymns of Guru Nanak and sayings of the gurus that were treasured and collected over many years. These are the Sikh scriptures and are treated as the living guru. The Guru Granth Sahib should be kept wrapped in a clean silk cloth, in an elevated position and read reverently. Sikhs believe in: One God The Ten Gurus and their teachings The Guru Granth Sahib [Holy Book] The rejection of the hierarchy of the Hindu caste system Equality between men and women The oneness of the human race. There are three rules by which Sikhs live: Remember God Earn one s living by honest means Share with others who are less fortunate than oneself Religious observance The Gurdwara (Temple) is the place of worship, where the Guru Granth Sahib is kept. Any practising Sikh man or woman may perform a ceremony at the gurdwara (Sikh temple). Baptised Sikhs (Amritsari) wear the five Ks which should not be disturbed unless absolutely necessary nor without explanation and permission or before washing one s hands. These are: 1. Kara: steel wrist band/bangle (or ring). It signifies that the wearer is bound both morally and spiritually to the teachings of the Gurus. 2. Kachha: shorts for chastity and self-respect. Worn as an under garment. 3. Kangha: a small comb for keeping a tidy appearance. 4. Kesh: uncut hair. A spiritual element (A turban is practical for the situation and is worn out of respect). A Sikh (male or female) is forbidden to cut hair form any part of the body. 5. Kirpan: a small knife or sword, sign of strength. Only to be used in self-defence or defence of the weak. This may pose a risk in some contexts and an alternative may be sought. Most Sikhs have three names a first name, a religious middle name and a family name. A religious middle name is always Singh (lion) for men and Kaur (princess) for women but some Sikhs just use this religious title as their last name.

24 There is no specific holy day but British Sikhs have adopted Sunday as the holy day. In Britain most Sikhs go to prayer once a week and most Sikhs go on Gurpurbs the festivals of the Gurus. Prayers are read up to five times daily Diet & Alcohol Most practising Sikhs will not eat halal meat Many Sikhs are vegetarian and some may not eat eggs or fish. A few Sikhs who eat meat will not eat beef. The use of tobacco, alcohol and drugs is forbidden. Hygiene For intimate procedures, Sikhs prefer a nurse or a doctor of the same sex. Both sexes should be given privacy if their turban or undergarments are to be removed. At all times the symbols of faith (the five Ks) and turban should be treated with respect. Personal hygiene is extremely important. Before even drinking a cup of tea most patients will want to brush their teeth and, at least, wash their face and hands. Showering is preferred to bathing, and douching with water after using the toilet is normal practice.. Death Customs Sikhs believe in re-incarnation. The dying person might want to have access to the Sikh scriptures. The five Ks should be left on the body. Deliberate expressions of grief are discouraged and the dead person should be cremated. Useful websites: Community contact: www.sikh.net www.sikhs.org www.bbc.co.uk/religion/religions/sikhism The Sikh Resource Centre 114 St Marks Road, Easton, Bristol BS5 6JD Tel. 0117 952 5023

25 Other Religions BAHA I People who follow Bahá u lláh (the Glory of God) the Founder of the Bahá í Faith, are known as Bahá ís. It began in Persia in 1844. The shrines of the Báb and Bahá u lláh now situated in the Holy Land (Israel), are the most holy places of pilgrimage for Bahá ís. The Bahá í Faith has since established itself all over the world. Bahá ís come from virtually every nation, ethnic group, culture, profession and social or economic class. More than 2100 different ethnic and tribal groups are represented. The main theme of Bahá u lláh s message is unity and world peace. He taught that There is only one God, All the world s religions represent aspects of one changeless and eternal Faith of God, All humanity is one race, destined to live in peace and harmony Men and women should have equality of opportunity Bahá ís believe that the future of the world lies in a single world order existing for the benefit of everyone, regardless of race, religion, gender or class. The importance of education is a central theme. There are no priests but a representative of the local Spiritual Assembly or a Baha i teacher may be contacted Some obligations of a Bahá í: Pray daily. Read some of the Bahá í Scriptures daily. Observe the Bahá í Fast if not exempt from it. Engage in some type of work profitable to humankind in a spirit of service. Endeavour to lead a Bahá í life. Endeavour to teach the Faith by example and word. Support the Bahá í administrative system Several special days, some where a Baha i follower should not work Diet Fasting for 19 days, 2 nd 20 th March no feed, drink or smoking from sunrise to sunset. Those who are sick may be considered exempt from this otherwise food is taken outside those hours. Medicine Alcohol and Narcotics are forbidden, except as remedies in case of illness. Community Contact: Bahá í Community of Gloucester 40 Lynton Road, Hucclecote, Gloucester GL3 3HX Tel: 01452 615081

26 JEHOVAH S WITNESSES A worldwide Christian religion, who actively share information with others about God, whose name is Jehovah and about his Son, Jesus Christ. Their beliefs are based on the Holy Bible and they view first-century Christianity as their model. It is their belief that in addition to drawing one closer to God, living by Bible principles gives purpose to life, promotes strong family ties, and develops productive and honest citizens. God s Kingdom is the heavenly Kingdom for which Jesus taught all his followers to pray. Witnesses believe that soon it will become the one government over the entire earth and will solve mankind s pressing problems. Thus, the earth will never be destroyed or depopulated but will become a peaceful paradise. Religious observance Weekly Christian meetings held in Kingdom Halls and private homes and at larger assemblies. Witnesses follow a comprehensive bible educational program to help marriage mates treat each other with respect and parents to develop in their children such desirable qualities as honesty, morality, integrity and dependability. A special meeting is held annually to remember and celebrate the death of Jesus Christ. The situation may arise where only one member of a family is a Jehovah s Witness. Care must be taken to handle this delicate situation with sensitivity when advising the family that the patient s Presiding Overseer has, at the patient s request, been informed. Blood Transfusions They are quite willing to accept medical treatment with the exception of blood transfusions. This stand should be treated with sensitivity. The religious understanding of Jehovah s Witnesses does not absolutely prohibit the use of minor blood fractions such as albumin, immune globulis and haemophiliac preparations. Each Witness must decide individually whether they can accept these. Accepting vaccines from a non-blood source is a medical decision to be made by each one. Life-style choices: Jehovah s Witnesses believe that Bible-based teachings aid in the prevention of many health problems, both for themselves and for others who read their literature, for example, Bible principles discourage the use of tobacco and the abuse of alcohol and other drugs. They closely adhere to the Bible s teaching that sexual relations should be limited to one s marriage mate, and by so doing do not contribute to the spread of sexually transmitted diseases. They shun activities that risk human life, such as driving a car whilst under the influence of alcohol or drugs and promote high standards of cleanliness, which helps prevent the spread of infection, diarrhoea, cholera, dysentery, typhoid, and many other diseases. Death Customs There is no particular preference for cremation or burial. It is entirely a matter of individual choice. Unless there is a compelling reason, such as when a coroner s report is required, Jehovah s Witnesses generally prefer that the body of a beloved relative be not subjected to a port mortem dissection. The appropriate relative(s) can decide if a limited post mortem is advisable to determine cause of death, etc.