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Permissibility of Rotavirus Vaccines

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It looks like the porcine conundrum is making its rounds yet again.

 

http://www.freemalaysiatoday.com/category/nation/2017/07/24/medical-practitioners-affected-by-halal-debate-over-vaccination/

 

Suffice to begin the narrative by quoting a verse each from the Quran and the Hadiths which sums up the compassionate and humane nature of Islam.

 

Allah SWT says in Surah Al-Hajj 22:78: “And strive for Allah with the striving due to Him. He has chosen you and has not placed upon you in the religion any difficulty.”

 

And an authentic tradition narrated by Aisha (RA): “If given an option between 2 actions, the Prophet (SAW) would surely choose the easier one, as long as it is not sinful.” (Bukhari & Muslim)

 

And we firmly believe this spirit and approach pervades the corpus of the jurisprudence of facilitation (Fiqh Taysir). And at no point it time does it blemish the belief nor practise of the faithful because the Muslim scholars have anticipated these challenges of modernity and have reiterated, “Allah will bless the believer who recognises and engages with the new world, yet remains true to his religious values.”

 

History will testify that the Muslim scientists dominated virtually all aspects of knowledge and research from 600 – 1700 AD. Az-Zahrawi (930-1013 AD) the father of modern surgery was pioneering new surgical instrumentations when Europe was restricted by a religious edict in 1163 AD which instructed as follows; “All forms of surgery must be stopped in all medical schools by all surgeons.”

 

Is it any wonder that Martin Kramer, an American Historian wrote; “Had there been Nobel Prizes in 1000, they would have gone almost exclusively to Muslims.”

 

Somehow, the Muslims lost it along the way but the following hadith continues to inspire Muslims to catch up on lost ground and rejuvenate their quest for leadership in the sciences; “A word of wisdom is the lost property of a Muslim. He should seize it wherever he finds it.” (Tirmidhi)

 

It is in this vein that the contemporary Muslim scholar, Syakh Yusuf al-Qaradhawi has said to the effect; “Two areas of human activities (muamalat) which requires cutting edge edicts (fatwa) are economics and medicine.”

 

Hence, it is not surprising that the many Councils of Jurisprudence, all over the world, eg European Council of Fatwa & Research (ECFR) chaired by Syakh al-Qaradhawi,  has deliberated profusely on the many issues related to medicine and biotechnology. These Councils like the ECFR were kept informed of the latest and best practices in medicine by regular meetings with the likes of the Islamic Organisation of Medical Sciences (IOMS) based in Kuwait.

 

The issue of the use of substances of porcine origin in food and medicine is an archaic one. Nonetheless, the ECFR has comprehensively dealt with it, when deliberating the permissibility of the use of Oral Polio Vaccine (OPV) which is manufactured using porcine based trypsin. This was published in their 11th Session of the ECFR held from 1-7 July 2003, in Stockholm.

 

The ECFR argued as follows:

a) what God forbids is the partaking of pork, and trypsin has nothing to do with pork

 

b) even if we admit that trypsin is forbidden, the amount used in preparing the vaccine is negligible, if one applies the rule that “when the amount of water exceed 2 qullah (216 litres)”, impurities no longer affect it”

 

c) supposing that trypsin is unclean, it is thoroughly filtered, that it leaves no traces whatsoever in the final vaccine

 

d) in case the three arguments forwarded are still insufficient, the haram (forbidden) is made permissible in cases of necessity.

 

 

In their concluding remarks they emphasized, “The Council urges Muslim leaders and officials at Islamic Centers not to be too strict in such matters that are open to considered opinion and that bring considerable benefits to Muslim children, as long as these matters involve no conflict with any definite text.”

 

Such is the latitude of rationale and magnanimity of our religious scholars (fuqaha) in addressing the bigger picture of child health, child survival strategies and the advocacy of life saving vaccines.

 

Rotavirus is the leading cause of severe and fatal diarrhea in infants and young children. Virtually every child in the world would have been infected with the rotavirus  (RV) by the age of five years. Globally, rotavirus gastroenteritis kills 527,000 (475,000-580,000) children under five and is responsible for millions of hospitalizations and clinic visits each year. Ninety-five percent of rotavirus deaths occur in developing countries in Africa and Asia. Muslim majority countries, Pakistan and Nigeria are 2 of 5 countries which together contribute up to half of the global RV diarrheal deaths in 2008.

 

The manufacturing process of the two oral vaccines (OPV and RV) are similar, involving the use of minute amounts of trypsin which is later removed by ultra-filtration. Therefore, the pivotal judicial edict of the permissibility of OPV, by the European Council for Research & Fatwa can be similarly applied to the RV vaccine.

 

RVGE  continues to scourge our youngest and most vulnerable, killing more than 1,200 children under five each day. The human tragedy is that RVGE is a vaccine preventable disease (VPD) and many of these deaths can be averted by universal mass vaccination with the RV vaccine. RV vaccination offers the best protection against severe rotavirus diarrhea, and have been shown to save lives in countries which have incorporated RV vaccines in their National Immunization Program (NIP).

 

About 90 countries in the world have introduced RV vaccination in their national immunization program (NIP). Muslim countries which have included RV vaccination in their NIP include Pakistan, Morocco, Iraq, Bahrain, Qatar, Yemen, Saudi Arabia, Sudan, United Arab Emirates and Jordan,

 

The RV vaccine has been in use in Malaysia since 2006. Since it is not part of the Malaysian National Immunization Program (NIP), it is mainly utilized in the private health sector.

 

A study of under-5 mortality in Malaysia in 2006 showed that there were 1,699 deaths. Deaths due to diarrhea was the number 3 cause of deaths, contributing 83 deaths (4.9%), after congenital anomalies (25.1%) and pneumonia deaths (9.2%). This is unacceptably high for a country moving towards a developed nation status. Many of the developed nations in Europe, US, Canada and Australia have included the RV vaccine in their NIP.

 

Discharge records from government hospitals showed that the cumulative risk of RV related disease by 5 years of age was 1 in 61 for hospitalizations and 1 in 37 for out-patient clinic visits. The out of pocket cost associated with RVGE admission was estimated at RM 106-799 in 2009,  which was 26% of the studied household income. The mean parental day work loss associated with RVGE admission was 4.8 days. All of these data suggest that the burden of RV disease is considerable and would be a substantial drain on the nation’s health expenditure.

 

At present there are no other medicines or substances which can act as an alternative to the present two oral RV vaccines. These have been studied in virtually all regions of the world and proved to be effective, safe, cost-effective and are life saving.

 

It behoves Muslim healthcare providers as well as religious leaders to propagate this information especially its similarity with the polio vaccination program and work to increase the utilization of the RV vaccine generally and specifically its inclusion in the NIP of Malaysia.

 

Lessons can be learnt from a precedent, an earlier fatwa issued on the use of OPV which is similarly manufactured using trace amounts of porcine trypsin. The European Council of Fatwa and Research (ECFR) chaired by Dr Yusuf al-Qaradawi and consisting of numerous renowned scholars in the Muslim world, when allowing the use of OPV added that; “the hesitation of some parents to have their children immunized with this vaccine (OPV) poses a risk to Muslim children alone. At the same time, it gives an unfavorable image which portrays Muslims as hindering a process that aims to eradicate, with God’s permission, the existence of this disease on earth once and for all. After all, this eradication cannot be complete while there is even one child on earth carrying the virus.”

We have learnt and read fatwas from religious scholars in Malaysia which unlike the ECFR and IOMS et al are individual-centric, random, ill-researched and anecdotal in nature. Their lack of grasp and understanding of the new science have made them ultra-conservative, restrictive and prohibitive in their religious edicts.

 

The Federation of Islamic Medical Associations (FIMA)  has endeavoured to mainstream evidence based medicine (EBM) of the highest quality and which should henceforth  dictate our best clinical practices. And importantly, it is sanctioned as Shari’ah compliant by the highest authorities of jurisprudential scholarship among Muslim scholars world-wide. This excellent collaboration of the best brains in medicine and jurisprudence has lightened the burden upon the Muslim Ummah (community). It has not only truly embraced the jurisprudence of facilitation (Fiqh Taysir) but also the jurisprudence of realities & priorities (Fiqh Waqi’ah) and the jurisprudence of balance (Fiqh Wasatiyah).

 

We urge the religious authorities to take cognisance of the invaluable heritage of medical fatwas that is before us and not attempt to reinvent the wheel. They should instead incorporate these shari’ah compliant best clinical practise into the corpus of our nation’s jurisprudence in medicine.

 

Dato’ Dr Musa Mohd Nordin FRCPCH (UK)

Chairman, Federation of Islamic Medical Associations (FIMA) Advisory Council

 

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Youth Protection from HIV/AIDS and other STDs

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On behalf of FIMA program of Youth Protection from HIV/AIDS and other Sexually Transmitted Diseases (STDs), it is my pleasure to share with you this article prepared by Dr. Abdulhameed Al-Qudah, Director of FIMA Program in the Middle East:

 

PROTECTION OF OUR YOUTH FROM HIV/AIDS AND STDS

 

Hoping it will promote combined FIMA-IMAs efforts in education and prophylaxis from these conditions.

We welcome any comments or suggestions.

 

Click here to download all documents in a compressed zip format (WinZip)

 

Sincerely yours,

Aly Misha’l MD, FACP

FIMA Exec. Director

www.fimaweb.net

Dengue Guidelines for Doctors & Public education

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Prevention and Control of Dengue Fever and Dengue Hemorrhagic Fever

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Substances and actions that nullify the fasting

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http://papisma.org/fekahperubatan/index.php?s=injections#3e

3. Substances and actions that nullify the fasting

According to the Quran and the authentic Sunnah of the prophet (pbuh) three
actions nullify fasting: eating, drinking and sexual intercourse. Therefore,
the passing of any solid or liquid sybstance that can be described as food
or drink, in any quantity through the gullet would nullify fasting. Accord
ingly, the p.articipants agreed unanimously that the following do not
nullIfy fasting.

1. Eye and ear drops, and ear wash.
2. Nitroglycerine tablets placed under the tongue for the treatment of
angina.
3. Insertion into the vagina of pessaries, medical ovules, vaginal washes,
vaginal speculum, and doctor's or midwife's fingers during pelvic
examination.
4. Insertion of the urethroscope into man or woman radio-opaque media for
X-ray diagnosis or bladder irrigation.
5. Tooth drilling, extraction, cleaning or the use of mis-wak and
toothbursh, provided nothing is swallowed into the stomach, do not nullify
fasting.
6. Injections through the skin or muscle or joints or veins, with the
exception ofintravenous feeding.
7 .Blood donation or receiving blood transfusion.
8. Oxygen and anaesthetic gases.
9. All substances absorbed into the body through the skin, such as creams,
ointments, and medicated plaster.
10 .Drawing blood samples for laboratory testing.
11 .Catheter and media for arteriography of heart or other organs.
12 .Endoscopy for diagnostic or intervention purposes.
13. Mouth wash, gargle or oral spray, provided nothing  is swallowed into
the stomach.
14 .Hysteroscopy or insertion of an intrauterine device.
15. Biopsy of the liver or other organs.

A majority ofparticipants added the following:

1. Nose drops, nose sprays, and inhalers.
2.  Anal injections, anoscopes, or digital rectal examination.
3. Surgery involving general anaesthetic, if the patient decided to fast.
4. Machine or intraperitoneal renal dialysis.
5. Use of gastroscope, provided it does not entail the introduction of
liquids or other substances into the stomach.

On the conclusion of its business, the Seminar was pleased to express its
deeply-felt thanks and appreciation to His Majesty, King Hassan II of the
Kingdom of Morocco, for his kind support of the Seminar which was hosted by
the Kingdom of Morocco. The Seminar prays to God to grant His Majesty and
His Heir victory and glory, and the people of the Kingdom of Morocco
prosperity and progress. The Seminar further thanks His Majesty's Government
and officials for their warm welcome and generous hospitality.

The Islamic Organisation for Medical Sciences wishes to express its sincere
thanks to all the participating organisa- tions, including Hassan II
Institute for Medical and Scientific Research on Rarnadhan, the ISESCO, the
Institute of Islamic Fiqh, Jeddah, and the World Health Orgarusation
Regional Office. The IOMS would also like to extend its thanks to all the
Islamic jurists, doctors and scientists who have contributed to the
successful outcome of this Seminar, praying to God to reward them in a most
generous and compassionate way.     God's peace and mercy be upon you

On Call - The Trials of Being a Muslim Doctor During Ramadhan

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Published on August 1, 2010

by Ahmed Zaafran

With Ramadan rapidly approaching, the time has come to prepare mentally, spiritually, and physically for one of the most important times of the year in Islam. The month of Ramadan comes at the height of summer this year, bringing unique challenges.

The focus of this particular article is geared towards those who are medical professionals: physicians, students, nurses, technicians. However,  as people from all lines of work deal with time management issues, in sha’ Allah (God willing) those who do not work in the healthcare industry  may still benefit from this advice and can work collectively to implement it.

 

Making a Plan

Making a plan is a useful way to get things moving in the right direction.  List out the objectives you aspire to meet for the day. For example, as a resident physician in Anesthesiology at the busiest trauma center in the country, I anticipate being in the operating room for many hours at a time, often without a break.  Knowing that, sometimes I have to use lunchtime or break time to fulfill my obligatory prayers and may even be forced to combine my prayers in unusual situations.

Many hospitals provide prayer areas within chapels for Muslims to pray or even have a masjid (mosque) within the hospital. However, this may not always be the case. Whatever the situation, try to find a spot where you can reflect on your prayer, reconnect with Allah and your intentions for fasting, and reenergize yourself.  In time, you’ll find many unexpected gifts from Allah peppered throughout your day, giving you a firsthand view of the fruits of hard work and good intentions. Remember that Allah knows your circumstances even more than yourself. You may become discouraged that because of your time constraints, you cannot fulfill your desire to be fully engaged with Allah during your Ramadan. Don’t allow yourself to fall into that rut; your two rak`at (units of prayer) are worth more than you think.

 

Establishing the Right Mindset

Establishing the right mindset is half the battle. I can’t tell you how many times throughout medical school my Muslim peers would make excuses as to why they don’t need to fast during Ramadan. The most common excuse I heard was, “How could I possibly concentrate on my studies if I’m fasting?”  Another common cop-out was, “Bro, I’ll just make it up later once finals are done with.”

To many of you, this may sound outlandish or even blasphemous, but it is commonly seen in people who deal with the physical and emotional demands of being a medical student or physician, which brings me to the point of this section. Establishing the right mindset means more than just telling yourself that you will fast during Ramadan. It means training yourself that your “starvation” is in fact the easiest part of Ramadan. The real challenge lies in your remembrance of Allah, making all of your actions a form of worship, and fulfilling your role as a representative of Islam in the midst of a watchful environment.

To be honest, Ramadan is the best time to showcase the beauty of our religion and its focus on self-control. For example, how many times, in any occupational platform, have people come up to you, after finding out that you are fasting from food AND water (for some reason they are always impressed with the water part),  to inquire more about your fast and your faith? This is the perfect time to explain to them what fasting during Ramadan really means, that abstaining from our material desires, including food, sexual relations, backbiting, and slander, are only the physical vehicles that allow the spiritual self a viable platform to elevate itself. People in the healthcare industry understand what it means to make sacrifices. It might sound like clockwork to you, but for many of your colleagues, it is the most profound thing they will ever hear.

 

Time

Amongst medical students and physicians, a quite broad category in and of itself, a high demand on time handcuffs their abilities to have an effective Ramadan. The amount of information required of medical students to learn, memorize, digest, and apply is quite daunting, and they often find themselves missing out on prayers entirely, whether during Ramadan or other times of the year. The key is to prioritize your time around your prayer by redistributing it. The epicenter of your day is your prayer, and you should make everything else the ornamentation to that foundation. As hard as it many seem at the time, you’ll eventually find yourself both excelling in your prayers and concentrating on patient care as well. Keep in mind that the workday has its gaps and moments when you can take quick breaks. For the student, study breaks are a part of the daily routine. Rather than rushing to the TV for a break, take a moment to reconnect with the Qur’an, even if it is just for a few minutes. Ramadan comes only once a year. Don’t let the month leave without cashing in on those precious moments that usually go wasted.

 

Spiritual Connection

Finally, put your work into perspective. The type of work you do in medicine exposes you to various situations that challenge your mind and your soul. You are given the task to heal people’s ailments, whether physical or mental, and are able to provide them with a service that nurtures and improves the thing most precious to them: their health. Personally, I can relate to the spiritual challenges faced by physicians on a daily basis at the hospital. Just a few weeks ago, I took care of a young man in his early 30s who seemed to have the world ahead of him. A minor ailment initially brought him to the hospital, but his health deteriorated quite rapidly.

“Who, when disaster strikes them, say, “Indeed we belong to Allah, and indeed to Him we will return.” [Qur'an, 2:156]

The team working to save his life moved quickly and diligently, doing everything humanly possible to resuscitate him. The exact moment Allah subhanahu wa ta`ala (exalted is He) took his soul was quite evident, and the organized chaos in the room instantly transformed into a deafening silence. Despite exhaustive measures on my part and on that of the medical professionals around me, we were not able to save his life. Muslims and non-Muslims alike had to deal with that situation, and the fear can choke the air out of your throat. Moments like these can shake one’s faith if he is not prepared, but it can also strengthen one’s resolve and solidify his love for Allah.

Use Ramadan to strengthen yourself. Seek refuge from Allah from all your insecurities. Use the training that Allah has blessed you with to fulfill His commandments. Take every opportunity to show Allah that more than anything else, you are trying to purify yourself and humble yourself under His Presence. Medicine is a field that carries much responsibility and much prestige. Use your status amongst your peers as a pedestal to serve your Lord and as a mechanism to eradicate arrogance.  The Qur’an gives us pearls every time we read it, and perhaps the verse that can be used by medical practitioners the most to correct their intentions and set the tone for their daily work lies in Surat al-Ma`idah,  entitled  “The Table Spread.”

“Whoever kills a soul unless for a soul or for corruption [done] in the land – it is as if he had slain mankind entirely. And whoever saves one – it is as if he had saved mankind entirely.” [Qur'an, 5:32]

With this verse in mind, we can truly use the month of Ramadan as a springboard not only to serve our fellow human beings in need of medical treatment but also as an opportunity to use our skills  as a means to please our Creator, Allah, exalted is He.

 

The Oath of a Muslim Physician

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Praise be to Allah (God), the Teacher, the Unique, Majesty of the heavens, the Exalted, the Glorious, Glory be to Him, the Eternal Being Who created the Universe and all the creatures within, and the only Being Who contained the infinity and the eternity. We serve no other god besides Thee and regard idolatry as an abominable injustice.

Give us the strength to be truthful, honest, modest, merciful and objective.

Give us the fortitude to admit our mistakes, to amend our ways and to forgive the wrongs of others.

Give us the wisdom to comfort and counsel all towards peace and harmony.

Give us the understanding that ours is a profession sacred that deals with your most precious gifts of life and intellect.

Therefore, make us worthy of this favoured station with honor, dignity and piety so that we may devote our lives in serving mankind, poor or rich, literate or illiterate, Muslim or non-Muslim, black or white with patience and tolerance with virtue and reverence, with knowledge and vigilance, with Thy love in our hearts and compassion for Thy servants, Thy most precious creation.

Hereby we take this oath in Thy name, the Creator of all the Heavens and the earth and follow Thy counsel as Thou has revealed to Prophet Mohammad (pbuh). "Whoever killeth a human being, not in liew of another human being nor because of mischief on earth, it is as if he hath killed all mankind. And if he saveth a human life, he hath saved the life of all mankind." (Qur'an V/35)

This medical oath which is a composite from the historical and contemporary writings of physicians of Islamic World, was officially adopted by I.M.A. in 1977. Islamic Medical Association of North America

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The Federation of Islamic Medical Associations (FIMA) is a registered body of 29 IMAs and 17 associate members worldwide, representing about 50,000 Muslim medical and health professionals. The mission of FIMA is to provide a platform for Muslim Physicians world wide in the areas of Medical education and ethics, Student camps and humanitarian and medical relief. It is a not-for-profit, non-political and non-Governmental organization.

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