Guest blogger, Elisa Greene, Pharm.D., is an Assistant Professor in the Belmont University College of Pharmacy. Through a collaborative agreement with Belmont, Dr. Greene dedicates half of her time to caring for patients and precepting pharmacy students at Siloam.
Anyone who has spent time at Siloam is aware of the variety of cultures, religions and languages represented in our patient population. We all desire to provide the highest quality of care. However, despite our best efforts at cultural competency and effective use of interpreters, we often overlook an important aspect of cross-cultural care: dietary restrictions.
Common dietary considerations include variations in blood sugar during Ramadan and other times of religious fasting, vitamin D deficiencies due to all over body coverings reducing sun exposure, and vitamin B deficiencies in Vegan diets that many refugees follow. An additional, less well known, restriction involves gelatin. Gelatin (stearic acid) is derived from beef or pork products and is an ingredient in almost all medications that are in capsule form. It is sometimes, although less commonly, present in tablet formulations, as well. For our Muslim patients, ingestion of pork is forbidden by their religious convictions. As you can imagine, this often results in a therapeutic challenge for clinicians!
Consider this case encountered by Dr. Kristin Martel (a staff physician at Siloam)…
“I had a Somali patient with severe hypothyroidism who returned for a follow up visit with continued complaints of the same symptoms. She admitted to not taking the thyroid medication I had prescribed. She revealed her fears that there was, in fact, gelatin, in some of the levothyroxine tablets. The patient was relieved when she heard that I could specify gelatin-free formulations of this medication. Since then, she has been more consistent with taking her medicine.”
This case illustrates the importance of considering whether dietary restrictions, and specifically the fear of products containing gelatin, are functioning as a source of non-adherence with medical therapies. Identifying this concern allows for development of alternative treatment plans. Gelatin-free products are often available, but require extra research into the inactive ingredients. In general, choosing tablet forms of medications instead of capsules for Muslim patients, when possible, can minimize gelatin exposures.
Resources are available to aid in this effort. Here is an excellent website* for identifying inactive ingredients in medications. It can be helpful for those seeking to avoid a substance such as gelatin, lactose, or red dye # 40. Also, a quick Internet search displays many commercially available gelatin-free forms of fish oil, an over the counter medication used to lower cholesterol.
Whole-person health care in general—and care offered by Christian believers in the Incarnation in particular (God among us in the life of Jesus)—should seek to meet the patient where they are. Whether or not we agree with some of the specific convictions of our patients, we nonetheless need to acknowledge and respect them. By creating an open, nonjudgmental atmosphere where potential barriers to care can safely emerge, the setting is optimized for healing. Assuming there is no harm to the patient from the proposed alternative, and that it doesn’t cause the clinician to violate her own integrity, we ought to seek to meet and treat patients on their own terms as much as possible.