This paper was presented at Institut Kemajuan Islam Malaysia (IKIM) in February 2019

Dr Mohammad Arif Shahar
Dr Mohd Faiz Md Tahir

Last: Updated 17 July 2020

Introduction

Dichotomy in medicine and its consequences

Dichotomy in medical knowledge is defined as separation of medical knowledge and revealed knowledge (i.e. religion). This notion, perhaps started in Europe during the Renaissance, where often religion was seen to contradict science at that time. The gap in dichotomy worsen as medical sciences which originated in the Muslim world decline; while in the Western world continue to flourish. As a result, in the current day and age, the term “contemporary medicine” is seen as a separate entity; if not contradicts the so called “Islamic medicine”.

Among the consequences of this separation is the advent of anti-vaccine groups. They decline vaccine on a pretence that vaccine is un-Islamic. In actual fact, prevention of disease on the self and harm to others is very much Islamic. The concept of prevention of communicable disease has been around since the time of the Prophet. For an example, we learned that that Prophet forbade a person entering a plague endemic area and prevented a person leaving that area to quarantine the infection.1 Unfortunately, due to the anti-vaccine movements, claiming to be Islamic, have caused increase in morbidity and mortality from vaccine preventable communicable diseases. In 2018, there are 19 reported death from diphtheria; while cases of measles have increased by almost 900% since 2013.2

The gap between these dichotomies is made worse by its practitioner denouncing their “rival” (i.e. “contemporary medicine” vs. “Islamic medicine”). The curriculum from which both systems are learned may contribute to such attitude. In our country, “contemporary medicine” is learned in formal medical school (often seen as Western-influenced) while “Islamic medicine” is learned from traditional institutions (seen as more “Islamic”; some times through informal education.

Islamisation as a solution to dichotomy in medicine

In order to combine the two (i.e. “contemporary” and “Islamic” medicine), Islamisation is seen as a feasible strategy. Islamisation is accepting a subject when it is in conformity with the teachings of Islam; rejecting when it is contradictory and modifying it where applicable; in-line with Islamic principles. In medicine, the subject is the medical knowledge, practices and concepts.

The first to set an example of Islamisation in medicine is the Prophet Muhammad (p.b.u.h.) himself. ‘Awf b. Malik said: In the pre-Islamic period we used to apply spells [incantation or ruqa] [a medical practice during that time] and we asked: Messenger of Allah! How do you look upon it? He replied: Submit your spells to me. There is no harm in spells so long as they involve no polytheism (Recorded by Abi Dawud in Sunan Abi Dawud). This is an example of Islamisation based on what we have defined earlier.

Through Islamisation, we are advocating the concept of ‘medicine is medicine’. Adding a pre-fix of ‘Islamic’ or ‘contemporary’ have no benefit to patients and the population health as a whole. Islamisation is putting values in medical practices so that it does not violates the principles of tawheed and shari’ah; implemented in accordance with Islamic ethics.

The Islamisation in medicine model in IIUM

The Kulliyyah of Medicine, International Islamic University Malaysia (IIUM) was established in 1995. Headed by Professor Omar Hasan Kasule, the Kulliyyah pioneered Islamisation in medicine by integrating Islamic values into the medical curriculum.

The Islamic Revealed Knowledge (IRK) programme, as it was known initially was imbedded in the undergraduate curriculum, spreading over five years throughout the medical degree course. The IRK studies are conducted during each medical semesters and clinical blocks. Later, the integration of Islamic values in the medical curriculum came to be known as Islamic Input in Medical Practice (IIMP). The components of Islamic values integrated in the medical curriculum has evolved from ethics, professionalism and fiqh to addressing Islamic rulings in research and contemporary medical technology. The current IIMP programme covers:

  1. Fundamental concepts and paradigms in Islam where student learns the basic tenets of Islam and Islamic world-view;
  2. Medicine, spirituality and revelation where biological miracles of the human body systems in health and illnesses are emphasized;
  3. Medicine and the law where fiqh related to medicine are discussed;
  4. Social issues and medical practice where health related issues are elaborated; and
  5. Professional etiquette and Ethics where the Muslim physician responsibilities and professional conduct are inculcated.

Integrating the Islamic components into the core medical programme have the advantages of allowing students to connect, contemplate and internalize Islamic principles during formal medical teaching sessions. Values are formally inculcated in medical classes. Assessment of the IRK/ IIMP component also imbedded in the main medical examinations. On average 10% of questions in standard examination papers should include Islamic input.  In addition to that, major assessment for the Islamic component are formative. Students are required to keep logbooks of their Islamic activities and keep a record of reflections of what they have learnt. However, the implementation of such models are challenged with difficult documentations and assessment exercises. Not having a course code for itself, the Islamic Revealed Knowledge (IRK) or the Islamic Input in Medical Practice (IIMP) component learnt do not appear on the student’s transcript.

Apart from the formal Islamic education in the medical curriculum, students are required to participate in co-curricular activity known as Halaqah (study circle). Each Halaqah is led by a student leader (Naqib). The students read and study the Quran, common book of Hadith such as the 40 Ahaadith and Riyadh as-Solihin by Imam an-Nawawi. They are taught on tazkiyyah al-nafs by voluntary ibaadah such as itikaaf, qiam al-lail etc. Apart from that, they are also required to discuss current issues in the society and perform community services. The main purpose of these Halaqaats are for personal development and character building.3

The Postgraduate Islamic Input in Medical Practice (PG IIMP) are implemented in a different model. Established in 2008, the programme caters post-graduate students of various specialties. Due to the unique training post-graduate students have to through based on their specialties, the PG IIMP course is conducted annually in a form of a workshop or seminar.4 The PG IIMP covers advance themes on Islam related to medicine, namely:

  1. Principles of Tawheed in clinical medicine which discusses on Islamic world view on health, illness and health seeking behaviour in the context of beliefs;
  2. Fiqh al-Ibaadah for the sick where fiqh of the obligatory worship for Muslim patients are discussed;
  3. Fiqh al-Muamalah in Medicine where health policies including management and financing are deliberated; and finally
  4. Ethics and Professionalism which covers adaab and professional conduct.

The PG IIMP are compulsory for both Muslims and non-Muslims students.

The need for a teachers’ manual

Apart from teaching responsibilities, lecturers are required to perform researches and publish papers. In 2017, we review publications related to Islamisation of medicine in the Kulliyyah. We found that between the year 2000 and 2016, only 3.8% of publications in the official university repository from the Kulliyyah of Medicine was related to Islamisation. The majority of publications (96.2%) were of pure medicine or medical sciences. The Orthopaedic Department led other units in publishing Islamic materials related to their specialty which numbered 10% followed by the department of Internal Medicine, which published 7.9% (Islamic related materials) from their total publications archived.5 Although the analysis is flawed by the assumption that all publication produced by the Kuliyyah are deposited in the official repository, the low number of Islamic related materials over 15 years is indeed worrying.

We postulate that the reason for such observation might be related to the dichotomy of medical training undergone by the lecturer themselves. Most of the lecturers are well trained in their respective medical specialties. However, their experience on Islamisation in medicine are limited by the amount of exposure to the subject during their medical training. Therefore in order to facilitate lecturers to embark on Islamisation, we published a manual on Islamisation in medicine in 2018.6 The manual would not only facilitate teachers in the teaching and learning process, but also in research on Islamisation in their respective medical specialties.

In addition to that, to equip the lecturers with fundamental Islamic knowledge, they are encouraged to enrol in the Postgraduate Diploma in Islamic Studies (PGDIS) on a part-time basis provide in the campus. The course is conducted every semester and lecturers are required to complete eight courses at their own pace throughout the programme without having to leave their teaching and clinical responsibilities. This is one of the strategies to assimilate the medical and the Islamic studies fraternity.

Innovative approach and consideration

The Teachers’ Manual on Islamisation in clinical medicine and medical sciences was written for medical lecturers who are not accustomed to the concept of Islamisation. Therefore a simplified approached was used. We presented the content of the manual in the form of standard clinical practice guidelines (CPG) which medical lecturers are familiar with. In addition to that, we avoided philosophical jargons and uses diagrams to explain conceptual ideas. For instance, instead of, lengthy explanation used to describe the process of integration in comparison with inculcation, the following diagrams are use (Figure 1):

Integrating Islamic principles into body of knowledge, practices and concept without disrupting the overall forms and functions of the subject.

Inculcating Islamic values into body of knowledge, practices and concepts in medicine. Note that inculcation influence the overall subject matter.

Figure 1: Figures are adopted from “Islamisation in Clinical Medicine and Medical Sciences by Shahar & Tahir (2018)”6

The medical disciplines are systematically categorised into basic medical knowledge, medical practices and medical concepts so that approach to Islamisation is comprehensive and inclusive. This approach would also facilitate lecturers to decide on which areas whey would like to focus on.

We also provided explicit instructional keywords that would help lecturers to define what to do next. Instead of providing general solutions we describe for example, integrate, produce or research as the next step of action (i.e. the process of Islamisation itself).

Algorithms and decision trees (Figure 2) are presented to help lecturer decide on how to Islamise their syllabus in their specialties. Although the manual do not provide answers, it empowers lecturer to embark on Islamisation in medicine in their respective fields.6

 Figure2: Figure adopted from “Islamisation in Clinical Medicine and Medical Sciences by Shahar & Tahir (2018)”6

Standardized Reporting and Archiving

Apart from the process of Islamisation, we also proposed a system of classification on Islamisation. This is to ensure that Islamisation addresses all areas in medicine as well as the needs of the Ummah. We find that standardized classification is necessary; formulated based from our review of Islamisation in medicine publication from Kulliyyah of Medicine mentioned earlier. We found that among Islamic materials published, majority (36.5%) are on Islamic fundamentals and ethics; 26.8% addresses on the management of specific disease among Muslims such as Diabetes and Ramadan and only 7.9% looked into Tibb an-Nabawi in contemporary medical practice. None of the researcher work on history of medicine among Muslim which is an important aspect to be considered in order to reduce the gap of dichotomy in medical knowledge.5  

Subsequently, we proposed the following classification for standardized areas of Islamisation:6

  1. Fundamentals of Islam and related rulings in medicine;
  2. It deals with topics related to the higher purpose of Islamic Law or Maqasid al-Shari’ah. It also discusses Fiqh (understanding of the Islamic Law), prohibition and allowances (rukhsa) in medicine and medical ethics.
  3. Medical Treatment in Muslim Patients’;
  4. This category addresses the need of Muslims with particular disorders or medical condition. Emphasis is on the management of the disorders itself.
  5. Islamic Input in Medical Practices;
  6. It deals mainly on routine Islamic rituals (Ibaadah) affected by medical practices such as Fiqh Taharah and Solah (i.e rulings on purifications and prayers) for the disabled.
  7. Ruqyah and Tibb An-Nabawi in Contemporary Medical Practice’;
  8. This classification dwells in the subject of Prophetic Medicine either in the form of prayers (Du’a), Ruqyah (an Arabic term for “spell, charm, and incantation“) and food or substances associated with cure as mentioned by the Prophet Muhammad (p.b.u.h.).
  9. History of Medicine among Muslims;
  10. It focuses on the practice of medicine in the early days of Islam and the contribution of Islamic Scholars and Physician to the advancement of medicine.

Having a standardized classification enable self-audit in the institution and efficient communication between institutions. It also a means to measure what has been done and allow planning on what should be the focus in field of Islamisation in medicine at a particular juncture.

Training and Implementation

Lecturers are required to attend training sessions on the use of the manual. This is to ensure that the intended objectives of the manual is achieved. Training sessions in the form of interactive workshop will be conducted in small groups to enhance participation and optimize learning.

The implementation of the guidelines requires co-operation from administrators of the institution and the executives (i.e. the lecturers). Ideally, both parties should understand their strengths and weaknesses. There should also be a dedicated unit overseeing, implementing and archiving Islamisation of Medicine in a particular institution.

Conclusions

Dichotomy in medicine (i.e. “contemporary” vs “Islamic” medicine) is a real problem and pose a significant health consequences. Islamisation in medicine is one of the solutions to this issue.

Islamisation in medicine in the Kulliyyah of Medicine, IIUM is limited by the availabilities of experienced lecturer. Therefore, the Islamisation in Clinical Medicine and Medical Sciences manual was published to address this disadvantage.

Unique in style and approach the manual empower lecturers to embark on Islamisation in their respective specialties using explicit explanations, innovative diagrams, decision trees and instructional keywords.

References

1.           Akhyar LC M, Jasah S. Terjemahan Riyadus Solihin (Taman Orang-Orang Soleh) Imam Nawawi. 1st ed. Kuala Lumpur, Malaysia: Pustaka Al Shafa; 2011.

2.           Imedik. Jadual Immunisasi Kebangsaan. http://www.imedik.org/jadual-immunisasi-kebangsaan/. Published 2019. Accessed February 9, 2019.

3.           Kasule OH. Asurring Basic Islamic Education (Tarbiyah) for Students at Institutions of Higher Learning. youtube.com. https://www.youtube.com/watch?v=hri9CDYbYFo. Published 2016. Accessed February 9, 2019.

4.           Shahar MA, Md Tahir MF, Che Mohamad CA. Fiqh Al-Ibaadah for The Sick, Islamic Input in Medical Practice: A Practical Aid. 1st ed. Kuala Lumpur, Malaysia: Shahar & Tahir Ventures; 2019.

5.           Shahar MA, Idris MF, Anuar C, Mohamad C, Razali ZA. The Formulation of Classification for Islamization in Medicine : Review on 15 Years of Publications from Kulliyyah of Medicine. 2017;16(1).

6.           Shahar MA, Md Tahir MF. Islamisation in Clinical Medicine and Medical Sciences: A Teachers’ Manual. 1st ed. Kuala Lumpur, Malaysia: Shahar & Tahir Ventures; 2018.

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