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Treating Sikh patients in your practice

There are three key issues ­ religious and linguistic values and naming ­ writes Dr Bhupinder Singh Sacha

The origin of the Sikh nation is from the Punjab state of North India. The majority of Sikhs living in the UK are from the Punjab, but a percentage has come from neighbouring states ­ Kashmir, Harayana, Delhi, Rajasthan ­ and from East Africa, Kenya, Tanzania and Uganda.

To treat a Sikh patient with confidence, and to deliver an efficient service, one must keep in mind religious values, linguistic values and surname.

There are two types of Sikh. Baptised (Amrit-dhari) Sikhs keep their full identity (five Ks):

 · Kesh (keep their hair uncut all over their body)

 · Kangha (comb)

 · Kara (bangle)

 · Kachha (baggy shorts)

 · Kirpan (dagger).

Non-baptised Sikhs are further divided into two categories of those who keep their identity as a symbol ­ they trim their beards, cut their moustache and wear a turban ­ and those who are clean shaven, called Sahajdhari Sikhs.

Amrit-dhari or baptised Sikhs do not drink alcohol and usually do not eat meat. They keep their hair and moustache uncut, and they bathe early every morning and complete the prayer (Path) reading hymn before starting work. Non-baptised Sikhs also take their shower or bath early every morning and complete the prayer reading hymn.

According to Sikh religion, no Sikh should drink alcohol and strictly no tobacco should be used in any way, whether smoking or chewing.

When we treat baptised Sikh patients we should always bear in mind that they do not shave or cut their hair from any part of their body, hence any surgical procedure that involves shaving a part of their body should be explained in such a way as to ensure no offence is taken. When shaving is mandatory, permission should always be sought from both male and female baptised Sikh patients, with a full explanation of why this is essential. After recovery from an operation, they are usually re-baptised.

Linguistic barriers

In the UK, Sikhs are categorised into those who came to this country from India in the 1960s and those who were born and bred in this country.

The first category is further divided: lthose who came from India and with very poor English, mostly the labour class (English language-illiterate)

lthose who came from India who were educated and were well versed in the English language, for example teachers, doctors, engineers and so on.

Problems occur when English language-illiterate Sikhs attend surgery or hospital for treatment. The most common difficulties are linguistic barriers ­ even though they have been living in this country for 30-40 years they are still not literate in the English language. They require a Punjabi- English interpreter during their consultations, especially to explain any investigations or surgical procedures that need to be carried out.

Usually one of their relatives or friends of the new generation who are bilingual (Punjabi/English) are present on such occasions.

Female Sikh patients prefer only to be seen by a female doctor or nurse. In hospital, this class would prefer Indian meals, otherwise they would ask their children and relatives to bring food for them from home.

Educated Sikhs who came to the UK in the 1960s have no problems with medical consultations, but female patients prefer to see female health care professionals.

Sikhs born and bred in this country have no problems.

Surname confusion

Most male Sikhs use their middle name (Singh) but few use it as a surname. In our medical practice Singh is sometimes seen used as a first name, which is incorrect, such as 'Singh Mann'. For example, in this case the patient's first name could be Darrendeep, middle name Singh and surname Mann, but because of a lack of cultural knowledge, the middle name of Singh is displayed as the patient's first name.

Similarly, in female patients, 'Kaur' is a middle name for all Sikh women, but in our practice 'Kaur Mann' is sometimes seen displayed on the computer database and medical case notes, and, again in this case, the patient's first name should read, for example, Sharondeep, with the middle name Kaur and surname Mann. Therefore this patient would be Sharondeep Kaur Mann.

Surname confusion also arises when a few patients do not use their surname but prefer their middle name as a surname, for example 'Surjit Kaur' (female patient) and 'Babu Singh' (male patient). When two patients of similar first names and surnames are admitted in the same ward at a hospital or GP's surgery, problems can easily occur, and clarification is needed so that the patient gets the correct service.

In these cases, medical professionals and administrative staff should always check the date of birth and address of the patient concerned; such confusion could cause great problems in treatment.

It so happens that my mother-in-law is called Surjit Kaur and, while in hospital in the Midlands in the late 1960s, another patient by the same name was in the same ward. A medicine was given to my mother-in-law instead of to the patient with the same name, proving that these mistakes involving surnames can occur.

Pregnancy and postnatal care

When patients become pregnant most of them are usually helped by one of their female relatives such as mother, mother-in-law, sister or sister-in-laws.

At the time of delivery a female relative is usually present in the house and the new mother is helped for 40 days or six weeks after the birth. The family always looks after the newborn baby during the night, and the mother usually sleeps in the same room as the baby.

Some new mothers like to have the baby in the same bed. Because of extra vigilance and caution, cot deaths are very rare in the Sikh community.

There is no ritual ceremony such as circumcision or shaving the head in the Sikh community and Sikh parents are co-operative in immunisation/ vaccination and child health surveillance procedures.

There are no taboos in the Sikh religion. When any Sikh dies, relatives and friends pay a visit to the bereaved family. In the Sikh religion the dead body is always cremated. From the period of death to cremation time, the bereaved family arrange a reading of the hymn from the Holy book (Gurugranth Saheb). This can be completed within 48 hours.

Akhand Path is the continuation reading of the Holy book. It can be completed in seven days, which is called Sahaj Path. After the completion ceremony called Bhog, either at the temple or at home, the bereaved relatives and friends join together and pray for the peace of the departed soul. This is Antim Ardas, the final prayer. Following this, the bereaved family and relatives return to their normal life.

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