Consultation in burqa

The incident

The case takes place in an anaesthetist consultation preceding childbirth. I receive in the consultation a woman dressed in niqab, with a netting covering her face and gloves on her hand. She comes in with her husband who asks that a woman doctor examine his wife. I explain that today there are no female anaesthetists in the consultation and that I cannot change the full organisation of the department. What’s more, the consultation with an anaesthetist is compulsory during the eighth month of pregnancy. I’m getting into a delicate discussion. In the end the patient accepts her examination but the man threatens to lodge a complaint to address his humiliation.

1. Identities of the actors in the situation

Narrator: 59 year old man, anesthetist, working in a public hospital, European, but lived from 4 to 16 years old in Tunis, Tunisia.

Believes in access of medical care for all and in freedom of women to express their choice.

Patient: 24 year old woman, wearing a dark colored Niqab (no visible skin), hands and face also covered. Originally from Maghreb (she has no accent in French)

Patient’s husband: about 30 years old, also Muslim, parents possibly originally from Maghreb but he’s probably born in France (he has no accent in speaking French), has a beard and wearing a djellaba (long loose-fitting unisex outer robe).

Relationship between the two groups – conservative Muslim and French “dominant” society:

France has a colonialist past in several countries of the Maghreb, but in the past decades more than the colonialist past, the first association is about the coexistence of the native French and the descendants of migrants from those countries in current France and in particular those of Islamic religion.  France has traditionally had a universalist – assimilationist strategy toward diversity, implying that it is expected from newcomers and minority groups to accommodate to the values, rules and procedures of dominant society. A rule that is particularly important is that of “laicité” implying a separation of religion from the state (with the exception of Christian religious holidays).

2. Context of the situation

Legal context

A consequence of the value of “laicité” is that officially religious concerns cannot / should not be taken into account in public institutions.

In 2011 France has adopted a Ministerial circular1 forbidding the wearing of the integral veil (niqab or burqa) in public spaces, affecting thousands of women.

1(Circulaire du 2 mars 2011 relative à la mise en œuvre de la loi n° 2010-1192 du 11 octobre 2010 interdisant la dissimulation du visage dans l’espace public)

The space

Consultation room of the anaesthetist, both husband and wife are in the room and seated in front of the doctor. The consultation time is officially the doctor’s, the couple have taken a previous appointment, but the appointments are not for a specific doctor, so the couple could not influence whether it would be a male or female doctor.

The incident takes place before April 2011, the date from which wearing a burqa in public spaces in France is forbidden. The hospital has no official position concerning women wearing burqa

3. Emotional reaction

The shock reaction: feelings of the narrator, and if the shock raised any particular reaction (feelings, behaviour etc).

“Felt rather bad at the beginning, caught between two fires: on the one hand for ensuring the consultation takes place and on the other hand overcoming the resistance of the husband.  It was a bad ambiguous feeling. My reaction was to try to negotiate.

The bad feeling partly comes from the fact that I lived in Tunisia for many years and never met a similar situation, which is culturally so difficult to explain or tolerate. I felt a sense of intolerance towards the situation, almost felt the stimuli for an aggressive reaction.”

Ensuring that the woman accepts the examination is so important that the narrator “tricks” the patient into doing it by talking about possible health risks for her and the baby.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Laicité/ secularism: political secularism is a core component of French constitution and an important value.  However it can be also understood as a taboo to bring considerations related to religion to the public domain, including a public hospital.

Atheism – rational scientific view of the world: scientific training goes hand in hand with a scientific view of the world, and in particular in domains such as health leaves no room for the magical-religious perspectives.

Access of medicine to all: there should be no obstacles for proper access to health care based on culture, religion or gender. In this situation the behavior of the husband threatens the proper access to care of the wife, which is unacceptable.

Communication style: The preferred communication style of the narrator is direct and symmetrical with no differences between men or women. Eye contact is usually part of communication even if sustained direct eye contact is not his preference.

Gender equality: should prevail in communication also, in particular in a situation where the discussion concerns primarily the body and the health of the women, she should be actively involved. The fact that she does not participate actively implies a state of submission, that the husband is entitled to make decisions on her behalf.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

Very negative image at the beginning because of the behavior of the husband, then appreciation of the fact that she manages to negotiate.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Islam – a religion for all domains of life:

In contrast with the idea of “Laicité”, in Islam religion cannot be suspended in certain domains of life, it is always with the believers, and the rules apply in all contexts, also the public domain. It is not an option to choose to behave differently and suspend a certain number of rules according to context.

Mixing between men and women

Although in some interpretations of Islam there is the prohibition of physical contact between unrelated men and women, there does not seem to be any explicit prohibition concerning doctors of the opposite sex, or at least not in the Quran or hadith.  At the same time, there is a hadith (Sunan Ibn Majah Book 31, Hadith 3609) which encourages you to go to the most skilled Doctor, regardless of gender.

A conservative interpretation of Islam

Mainstream Islam does not require a specific dress style for males, nor does it require covering the face and the hands of the women. Accordingly the couple in the incident probably represents a more conservative branch, possibly close to the “salafism” or “wahhabism”. In the French context, these currents often appear motivated not by a particular connection to religion, but by a positioning against the French society, a right from a perceived oppression.

From this perspective, not being able to behave in accordance with the requirements of their interpretation of the religion is a frustration, and the reluctance of the other to comply with his desires is seen as oppression, resistance and bad intentioned.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

Like most religions, Islam is also very heterogeneous, with approaches that can be very different, even opposing on certain issues.  Being unaware of the great differences could lead people to associate Islam and related behaviors, that are not at all characteristic of the religion in general, but rather merely of a minority position.

Similarly, the other party can also be uninformed about the institutional context, and in particular about their rights.  In this situation, the husband would have expected to be able to opt for a female doctor, but in France such a measure is at the hospital’s discretion (a hospital can choose to offer this option or not). Also, while the husband is threating of denouncing the doctor, there is actually no instance where he could make this complaint.

The hospital should issue an official guideline for the treatment of particular cultural practices such as the burqa or niqab so that the health professionals do not bear the burden of deciding alone. Ideally such a position should be part of the charter of the hospital.

The narrator of the incident organised a meeting with colleagues of the department to address together such issues and decide on a common position as long as the hospital does not develop its own official position.