Religious leaders can lead the way in promoting healthy behaviours

Religion has always been a sensitive topic in Malaysia.

Despite hosting almost all the major world religions, political leaders constantly remind us to exercise caution when talking about religious matters in order to maintain peace and security.

There is an underlying fear that open discussions about religion may bring a threat to our peace, and cause discord and hatred.

But studies show that such discussions, along with religious beliefs, can affect health behaviour at individual and community levels.

Thus, religious leaders play an important role in influencing their congregants’ attitude toward many health-related matters, such as the Covid-19 vaccines for instance.

However, these leaders are seldom included in the government’s public health programmes to combat diseases.

While religious leaders naturally prioritise the teachings of their respective beliefs, this need not come at the expense of scientific findings.

Against the backdrop of rising Covid-19 cases, it is imperative that people make sound health decisions based on evidence-based medicine.

People hold religious gatherings, citing God as their shield, but limiting the number of participants and practising physical distancing does not make their gathering less effective in invoking religious protection.

“People’s attitudes towards public health messages are shaped by their religious beliefs and how their religious leaders respond to the messages.

“Thus, religious leaders have a strong influence on the health behaviours of their congregants.

“These leaders are in a good position to instil rationality among their congregants, so that there is no conflict between preventive measures for communicable diseases and religious beliefs.

“So why not work together with these religious leaders to promote partnerships between healthcare systems and religious institutions to curb diseases?” suggests Dr Tan Min Min, a research fellow at Monash University Malaysia’s South-East Asia Community Observatory (SEACO).

Faith-based health promotion programmes have been shown to be very successful because some people tend to believe religious leaders more than doctors.

Research also shows that when people have mental health problems, they would rather talk to their religious leader than a psychologist or doctor.

She says: “When people are stressed or ill, they turn to religion for comfort and support.

“They find it easier doing so, because with doctors, we don’t form a very personal relationship, but religious leaders know their congregants well and can reach out to very vulnerable members who may not be reached by routine health services and health promotion programmes.”

Most Malaysians claim a religion and it is definitely an important part of their lives.

Dr Tan notes that: “Search engines have shown that during lockdowns, there was an increase in search for words such as ‘worship’ and ‘sermon’.

“Or some people even flout standard operating procedures and partake in illegal religious gatherings.”

Changing mindsets

More people turned to religious live streaming services to help nourish their faith during the Covid-19 pandemic. — Photos: Filepic

According to Monash University Malaysia’s senior lecturer and former cardiothoracic surgeon Datuk Dr Ahmad Farouk Musa, vaccine hesitancy among religious communities is a widespread, global problem.

“Congregants believe being pious means god will protect them.

“There are many recalcitrant religious leaders who preach things that are contradictory to science and come up with all these conspiracy theories, e.g. non-halal vaccines.

“Independent preachers are difficult to curtail, so the best thing is to call everyone for a dialogue at the state level, especially the anti-vaxxers.

“I’m actually keen to interview these leaders to understand their perspective, because we cannot see it from our perspective as medical practitioners.

“Only then can we dissect their minds and come up with remedies,” he says.

Dr Tan, Dr Farouk and Dr Tin Tin Su recently co-authored a study on “The role of religion in mitigating the Covid-19 pandemic: the Malaysian multi-faith perspectives”, which was published in the Health Promotion International journal.

Dr Tan cited the Ebola outbreak in West Africa in 2014 as an example of how religious leaders and the government could work together.

At the height of its outbreak, there was a ban on traditional burial practices that involved touching and washing the deceased – one of the major transmission routes of the virus.

The ban was ineffective as people resisted practices that went against traditional cultural and religious beliefs.

They wanted to bury the dead themselves.

Authorities later engaged imams and clergy, and worked together to fight the Ebola outbreak in Sierra Leone.

These religious leaders identified passages in the Quran and Bible, and modified the burial practices.

Eventually, people began accepting and participating in the new burial practices, ceasing their resistance and resulting in the number of Ebola cases dropping drastically.

Says Dr Tan: “You cannot force something on people, especially when they cannot accept it.

“When you want to implement any public health measure, you also have to think of the culture and be culturally sensitive.

“In a lot of public health efforts, we tend to exclude the religious community.

“Remember that religious leaders are gatekeepers of their community.

“To engage the community, you must engage these gatekeepers first.

“If you don’t, there will definitely be resistance.”

She adds: “Perhaps we can provide our religious leaders with some training e.g. how to help trace congregants with Covid-19.”

Dr Farouk says that in Malaysia, there are laws against certain groups, but not others.

“For example, there are laws against insulting the royalty, but none against anti-vaxxers and those who perform spiritual surgeries (pembedahan batin) – there are many patients who believe in this.

“The government should enact laws and take action against those who perform such surgeries.

“Prior to the pandemic, I published a paper on vaccine hesitancy for diseases like measles, mumps, rubella, hepatitis, etc, and when I did the logistics regression, I found that the most important factor was distrust in the government,” he shares, urging the government to play a more active role in understanding why people are hesitant in getting vaccinated.

Trust issues

It’s quite obvious that much of the general public has a trust issue with our current government; hence, the duo say religious leaders can be roped in to help to heal this rift.

“Maybe the government also does not trust religious organisations.

“When we talk about religion, people feel we want to convert them, but this is not the case,” opines Dr Tan.

“Scientists and religious leaders tend to antagonise each other as their views are poles apart, but for the welfare of the patient, they should be able to find a common ground to work together.”

Most secular countries tend to be more developed and richer than religious ones, but when people are sick, they still turn to religion or spirituality.

She adds: “Even if you are not religious, when you are sick and someone wants to pray for you, you usually won’t say no.

“Because of the escalating Covid-19 cases, the number of prayers has also gone up as people turn to god when they cannot find answers any more.”

Dr Tan also suggests teaching public health in theological seminaries, as well as including a module/course on medicine and spirituality in medical schools.

Past studies show that when doctors do their ward rounds and talk to patients, they seldom ask questions about religion or spirituality, even though patients use it to cope with their illness.

“It would be nice if they (doctors) can talk about it.

“They don’t have to practise the same religion to understand and empathise with the patient; (and) if they have the same religion, then perhaps they can offer a quick prayer.

“A lot of doctors are very sceptical about religious beliefs, and if they keep on saying this, the religious patient will eventually resist evidence-based treatment,” she says.

However, it’s always advisable to ask the patient if he or she is religious before proceeding further, as the majority of us tend to assume an individual practises a certain religion by just looking at them or their name.

Ask the patient

Despite houses of worship being closed during earlier versions of the movement control order, devotees still came and prayed outside the premises, demonstrating a need for spiritual solace.

Dr Farouk shares an experience he had while he was still a practising surgeon.

He was doing a ward round with a devout colleague and they approached a middle-aged patient who was in the terminal stage of colon cancer.

“My colleague was telling the patient that his prognosis was bad and consoled him by asking him to pray.

“Suddenly, the patient burst into anger.

“He said he had been an observant Muslim his whole life, and yet, he was suffering.

“‘This is what I get in the end for being devout!’ he screamed.

“Both of us were shocked at his outburst,” recalls Dr Farouk.

Although medical schools delve more into ethical topics rather than spirituality and religion, he advises doctors to exercise a bit of secularity when dealing with patients.

“In this situation, advising the patient didn’t go well.

“Personally, I would just give the facts and figures, i.e how long more he has to live.

“If he has only six months left, ask him to repent and do what he wants in the remaining time.

“I try my best not to give religious advice because it is very personal and can backfire,” he says.

Dr Tan interjects: “A sickness involves many dimensions, not only the illness part – it includes physical, mental, spiritual, emotional, etc.

“Some people have a negative religious coping behaviour – they blame god for everything.

“This kind of patient tends to be less healthy and has a higher mortality rate.”

Positive religious coping means you try to find meaning in suffering.

She says: “There are different ways to deal with these patients.

“For the negative ones, we need a professional chaplain to talk to them or their family members, but you must first ask them if they want this service.

“Respect the wishes of the patient or the family.

“In life-and-death situations, the comfort is actually more for the family.”

When Kuala Selangor Member of Parliament Datuk Seri Dr Dzulkefly Ahmad was the Health Minister, he had plans to set up chaplaincy services in all major hospitals, but with the change in government, it is not known whether this plan is still in place.

At the end of the day, everyone needs a coping mechanism to wade through this pandemic, and religion can be one of the ways to fulfil this need.

This can be even more so in a healthcare setting where illness and death need to be confronted regularly, whether by the patients themselves, their families and caregivers, or indeed, healthcare professionals themselves.