My fiancé, a medical student, had just taken me into an operating theater at the Somali hospital where he volunteers when something surprising happened. The surgeon, an American man, started talking. “In Jesus’ name we pray,” he announced.
“We”? The surgeon was the only Christian in the room. Somalia is, in law and in practice, a Muslim country. The operating theater that afternoon was filled with nurses and surgical assistants in modest hijabs who shifted uncomfortably and looked away as the man with the scalpel laid his hands on the unconscious Muslim before him and loudly prayed to “our savior, Jesus Christ.”
Later that afternoon, I asked another employee whether the hospital’s Muslim staff had ever remarked on the surgeon’s tendency to pray aloud. “Of course,” he replied. “It really bothers them when she does that.” She? This habit, it turns out, isn’t limited to one doctor. From what I’ve been told, it’s widespread.
It’s impossible to overstate how vital doctors are in sub-Saharan Africa, especially in conflict regions such as Somalia. It feels ungrateful to criticize the men and women who risk their own safety to serve patients here. Even Doctors Without Borders closed all its medical programs in Somalia in August 2013, leaving a huge gulf of need that only individual physicians, often inspired by religion, can fill.
But doctors aren’t infallible. In some cases, they inadvertently do more harm than good. When Western physicians perform unfamiliar Christian rituals before slicing into their patients’ bodies, word travels fast — and can provoke widespread mistrust that jeopardizes the very lives these doctors intend to save.
Several months ago, after one Christian doctor was asked to leave Somalia for proselytizing, local police reportedly put up Somali-language signs around town warning parents to keep their children away from Americans, including American doctors. Already there’s a rumor going around that Western surgeons are on a secret mission to sterilize Muslims. (Even some local health care practitioners promote this dangerous myth.) This means that women dying in childbirth sometimes reject lifesaving cesarean sections because they’re afraid a doctor will remove their uterus during the operation. It also means that in a country with an ongoing outbreak of polio, patients reject vaccines because — here we go again — they’re afraid that the shot will sterilize them. Worse, this means they reject vaccines and operations for their children.
This is a serious problem. Physicians, like teachers, are in a position of great power and influence compared with their charges. That enormous power imbalance is only heightened in Somalia, where most patients grow up without access to any education or health care and therefore enter the doctor-patient relationship in a position of extreme vulnerability.
This power imbalance reverses the moral status between the two: The patient must come first. If one has to make an uncomfortable concession for the benefit of the other, it should be the doctor. Period. This is why these cases are disturbing: They represent doctors’ using their power and putting their needs above those of their patients.
Christian doctors aren’t the only people with strong faith. What if one of those uncomfortable Muslim surgical assistants someday takes her ill child to a local Islamic hospital with few resources, poorly trained doctors and substandard techniques specifically because she doesn’t want him to be unwillingly drafted into a Christian prayer? And if you think that uncomfortable patients can just seek adequate health care elsewhere, think again. They can’t — not in Somalia and not in many other parts of the world. Is a doctor’s desire to pray aloud over his patients more important than keeping someone alive?
Somalia’s health care landscape is a powerful cautionary tale for nonagnostic medicine. Here religion interferes with medical care in ways that regularly end lives. Doctors, including Western volunteers, are legally required to obtain permission from a male relative before they may operate on a female patient. More than one Somali woman has needlessly died because her husband just wasn’t answering his cellphone that afternoon. That is a human rights violation. Asking religious surgeons and physicians to limit group prayer to culturally respectful situations is not.
This isn’t a call for self-censorship. It is a call for professional responsibility. Even in the United States, there are limits on how doctors may express their faith in a professional setting. Praying aloud over unconsenting patients would never be OK in an American teaching hospital. Christian doctors can and do balance their religious practice with respect for the diversity of faith every day. (The complications of religious medicine are evident in the U.S. as well, though, as when Catholic hospitals refuse to perform lifesaving abortions or other procedures for dying women.) Working abroad does not excuse a lesser standard. And since many of these doctors go to Somalia for short visits, sometimes only for one week, and often never leave the hospital, they just don’t have the time or opportunity to learn how to share their religious views in culturally respectful and professionally appropriate ways.
Personal prayer is great. So is respectful and contextually appropriate public prayer. I even think it is OK for a doctor to comfort a patient by praying with him or her — which, studies show, is what as many as 50 percent of American patients want — as long as it is consensual and the patient, not the doctor, raises the idea. Christian doctors have every right to exercise their faith. But patients, including non-American ones, have a more compelling right to be exempt from practice of a religion they might not share.
So, onward, Christian doctors. Keep saving lives. Keep living your faith in such a wonderful way. But in an Islamic surgery room, keep the prayers in your heads and hearts. God can hear you just fine, and the patients don’t always need to.