Ramadan begins the evening of Wednesday, March 22, and ends the evening of Thursday, April 21. Celebrated by Muslims across the world and considered one of the Five Pillars of Islam, the annual observance is held in the ninth month of the Islamic calendar and is a time for fasting, reflection, charity and prayer.

Muslims fast every day from sunrise to sundown during the 30 days of Ramadan. All Muslims who have reached puberty are expected to fast. People who are sick, traveling, frail, older, needing multiple medications or injections, and women who are pregnant, menstruating or nursing are exempt from fasting.

As part of the fast, Muslims start the day about 90 minutes before sunrise to eat a breakfast style meal called suhoor. For the rest of the day, they refrain from consuming any food or beverages, including water. At sunset, they break their fast with a meal known as iftar, which traditionally starts with dates and water and is followed by a variable meal to the cultural background of the family.

Muslims may have a heightened commitment to prayer during Ramadan. The daily cadence of observant Muslims is to pray five times daily, facing towards the Kaaba in Mecca. Ramadan includes extra evening prayers, night prayers and reciting from the Holy Quran.

Ramadan is also marked by a focus on community, with Muslims spending more time with their family and community at their place of worship (masjid or mosque). This practice is difficult for hospitalized patients. Family and friends may want to stay with the hospitalized patient until sundown, or request to stay so that they can break the fast with their family member.

Ramadan is also a time for charity, one of the pillars of the religion, with Muslims increasing their charitable giving and community service.

At the end of Ramadan, Muslims celebrate Eid-ul-Fitr, their most celebrated holiday that is comparable in importance to Christmas or Hanukkah. Eid-ul-Fitr generally starts with morning prayers with the rest of the day dedicated to visiting and celebrating with family and friends. As reflected in the religious guidelines provided by the health system Office for Diversity, Equity and Inclusion, Muslims will likely request this day off to observe. Eid is determined based on the sighting of a new moon, so employees may not know when Eid will take place until a day or two before the holiday.

Caring for Muslim patients during Ramadan

Here are some ways to best care for patients observing Ramadan:

• Communicate with the patient about what is needed for them to receive the best medical care possible, listen to their preferences and discuss care options that may align with their observance of Ramadan. Patients who are sick enough to be hospitalized should probably not fast but it’s a good practice to ask. If a patient needs a minor procedure, explore whether the procedure can be performed after Ramadan. Please note that phlebotomy, injections and eye drops break a fast so be mindful in ordering these for your fasting patients.
• Advise food services staff if a hospitalized patient is fasting during Ramadan so food is delivered only before sun up or after sundown. Note, however, that most hospitalized patients may not be fasting.
• Recommend against fasting for Muslims who have uncontrolled diabetes. If the patient decides to fast, suggest a balanced caloric intake at both meals and modification of the timing of medications and injections.
• Remind Muslim patients to hydrate well between sunset and sunrise.
• Explore changing dosing frequency to once or twice daily, changing to long-acting formulations or choosing a different medication administration for patients on medication to allow them to observe Ramadan while maintaining their medication requirements.

Supporting your Muslim colleagues during Ramadan

To show support for your Muslim colleague during Ramadan, consider the following:

• Avoid compulsory meetings, if possible, during Ramadan or be prepared to excuse the employee from these meetings
• Recognize that Muslims may not want to commit to evening events, even virtual ones, since they spend this time with their families to break the day’s fast
• Be as flexible as possible if employees ask to change their work/shift time or modify their lunch break to finish the day early
• Wish Ramadan Mubarak (happy Ramadan) or Ramadan Kareem (blessed Ramadan) to colleagues you know are Muslim and observing Ramadan
• Recognize that your Muslim colleagues may be encumbered with fasting, additional prayer and evening activities while maintaining a regular work schedule so it is best to avoid additional work-related events during Ramadan
• Wish your colleagues and patients Eid Mubarak or happy Eid when the date and time for the EID even has been determined

For more information:

Muslim Patient in Ramadan: A Review for Primary Care Physicians

Diabetes During Ramadan |WellShare International

Safe Ramadan Practices in the Context of COVID19 | World Health Organization, April 15, 2020

What Providers Need to Know About Ramadan | YouTube

Ramadan Fasting and the Medical Patient: An Overview for Clinicians | Mini symposium

Sunrise and sundown times during Ramadan

For more information about diversity and inclusion at the health system, contact the Penn State Health Office for Diversity, Equity and Inclusion, email diversity@pennstatehealth.psu.edu or call 717-531-1012.