A Ramadan like no other

Dr Areej Benafif MBBS, BSc, EADTM&H, MRCP, is an ST6 registrar at Barnet Hospital specialising in Geriatrics and General Internal Medicine. She graduated in 2009 from Kings College, London.

The holy month of Ramadan is one of the highlights of the Islamic calendar. It comprises around 30 days of fasting (no food or water) from sunrise to sunset. It is a month where Muslims concentrate on increasing their religious duties but it is also a very social time where Muslims gather with families and friends to break their fast.

This year will be a Ramadan like no other given the COVID-19 crisis. Many doctors who live with extended families have moved out, concerned they may infect their loved ones. Due to the lockdown and social distancing measures there will be no congregational prayer in mosques or social gatherings at homes or in restaurants. It will be a Ramadan in isolation. 

Recently, work has been particularly difficult. My hours have changed to 12.5 hour a day shifts, working 3 days on and 3 days off. Sadly, this means I lose the continuity of caring for the same patients and working with the same team members I’ve worked with previously. I am working one in two weekends at the moment and seeing my husband and children less often.

At the beginning of the COVID-19 crisis we were hit hard with a sudden increase in the number of patient admissions. Many of them were in a serious condition or critically ill. Very quickly we realised the toll of looking after such patients and the pressure it has placed on the healthcare team and hospital.

The emotional impact it had on me was like no other that I have experienced so far in my career. Having daily difficult discussions with patients around the poor prognosis of COVID-19 in older patients and patients with multiple co-morbidities was a repeated feature of my daily work. Despite repeating similar conversations and phrases, it didn’t become easier to explain to each patient that medical escalation to measures such as ventilation were not appropriate. Once I broke that news to them I then had to inform their families. Many of my older patients were unable to have these conversations due to being too unwell or having dementia or delirium or both. These heart-breaking conversations then took place with their next of kin over the phone, without any of the non-verbal cues and communication skills we would normally use.

Experiencing the escalation of the COVID-19 crisis in the lead up to Ramadan has brought into focus some of the values of Islam and many other faiths, such as gratitude and patience. Speaking to other doctors and healthcare colleagues, we are grateful to return home to our families who are supporting us while we work our longer shifts to tackle this crisis. We are lucky to have the technology to enable us to see and speak to our loved ones even if we’re currently living away from them. Many junior doctors at Foundation and early trainee levels are often living away from their families due to the geographical rotation programmes assigned to them.

Working during Ramadan can be challenging for a number of reasons; lack of sleep and tiredness due to waking up at 3am to have a meal (suhoor/sehri) before the fast starts; hunger and thirst (though your body soon gets used to this); breaking your fast usually whilst still in hospital. With the current crisis, no doubt the challenges listed above will be more apparent. The fact I spend a good few hours of my day wearing full PPE will make fasting a bigger challenge as it can get very hot. There are exemptions to fasting and if it impacts on my health and my ability to care for my patients I am allowed to break my fast and make these days up at a later date.

The days leading up to Ramadan are usually filled with an exciting sense of anticipation for the spiritual focus of the month, as well as the excitement of seeing family and friends and enjoying traditional foods together. We can adapt to this by continuing to decorate our homes as we have done before, even if we won’t be expecting guests and visitors at meal time. We can treat ourselves to a nice meal at home to end the fast by following some family recipes on our days off work. And although our mosques are closed, prayers and worship at home are also an important component of our faith, particularly in Ramadan.

With Ramadan upon us, I am wondering if we are starting to see some light at the end of a long tunnel. The long shifts seem to be less busy and the number of new COVID-19 cases has fallen significantly. Perhaps this is our spiritual lift ahead of the fasting month ahead.