Fiqh Tahaarah and Fiqh Solah for the sick

Islamic Input in Medical Practice (IIMP) for year 3 MBBS

16th March 2018 3.00 pm – 5.00 pm

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INTRODUCTION

The ‘fiqh tahaarah (Islamic law on cleanliness) and fiqh solah (Islamic law on formal prayers) for

the sick’ is a seminar for the 3rd year MBBS students under the Islamic Input in Medical Practice

(IIMP) program.

The information provided in this seminar will be useful for both Muslim and non-Muslim

healthcare providers when dealing with Muslim patients. For the Muslim patient, solah (the

formal prayer) is a worship ordain by God and by no means be neglected in any condition,

regardless of health status. In principle, the solah can be performed according to the patient’s

best ability in times of sickness. This is the manifestation of God’s Mercy and Love to

humankind.

The seminar is organized in two sections. The first section discusses the importance of tahaarah

(cleanliness) and solah (formal prayer) among Muslims. In addition to that, the section also

deliberates on the sources of rulings in Islam and the principles of rukhsoh. Emphasis is made

on the issue of tahaarah and solah for the sick.

The second section discusses case examples on rulings related to tahaarah and solah for the

sick, focusing on common medical and surgical problems. Here the application of the principles

of rukhsoh will be demonstrated.

Upon completion of the seminar, participants are expected to understand:

1. What is the importance of solah among Muslim?

2. What are the sources of rulings in Islam?

3. What are the definitions and principles of rukhsoh in Islamic jurisprudence?

4. How the principles of rukhsoh with regards to tahaarah and solah are applied in

common medical conditions?

5. How do we advise patients with common medical conditions with regards to performing

the rituals of tahaarah and solah?

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COURSE PROVIDERS

Lecturer:

Assoc. Prof. Dr. Abdurezak Abdullahi Hashi

Kulliyyah of Science

International Islamic University Malaysia

Facilitators and contributors:

Assoc. Prof. Dr. Mohammad Arif Shahar

Kulliyyah of Medicine

International Islamic University Malaysia

Assist. Prof. Dr. Che Anuar Che Mohamad

Kulliyyah of Pharmacy

International Islamic Univeristy Malaysia

Assist. Prof. Dr. Mohd Faiz Md Tahir

Kulliyyah of Medicine

International Islamic Univeristy Malaysia

Assist. Prof. Dr. Salmi Daraup

Kulliyyah of Medicine

International Islamic Univeristy Malaysia

Assist. Prof. Dr. Nurkhairulnisa Abu Ishak

Kulliyyah of Medicine

International Islamic Univeristy Malaysia

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SECTION 1: LECTURE

1. The Importance of solah among Muslim

2. The sources of rulings in Islam

3. The definition and principle of rukhsoh in Islamic jurisprudence

NOTES

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SECTION 2: CASE DISCUSSIONS AND PRACTICAL SESSIONS

INSTRUCTIONS

Students are required to form 8 groups. Each group is required to complete tasks given for each

case prior to the seminar, as follows:

Group Cases

Group 1 Cases 1 and 8

Group 2 Cases 2 and 7

Group 3 Cases 3 and 6

Group 4 Cases 4 and 5

Group 5 Cases 5 and 4

Group 6 Cases 6 and 3

Group 7 Cases 7 and 2

Group 8 Cases 8 and 1

Representatives from each group will be asked to present their tasks during the seminar. Each

group leader is required to prepared the tools and items (as listed below) to demonstrate on

how the rituals of tahaarah and solah is performed for each case.

TOOLS AND ITEMS

1. Bandages

2. Plaster of Paris (optional)

3. Small water container with/without sprayer

4. Talc powder

5. Bladder catheters with urine bag

6. Stoma bags

7. Others

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THE MEDICAL WARD

CASE 1: THE PATIENT WITH HEMEPERESIS

A 60-year-old man with type 2 diabetes mellitus and hypertension presented with sudden onset

of right-sided body weakness. On examination, he was oriented to time, person and place. He

had slurred speech (spastic dysarthria). His blood pressure was 150/90 mmHg and pulse 80

beats per minute. His right limbs were hypotonic. The power of both the right upper and lower

limbs was 0/5 with depressed reflexes. Plantar was up-going on the right-side.

A Computed Tomography (CT) of the brain without contrast revealed left internal capsule

infarct.

He wanted to pray ‘Asr. None of his relative was around. Only female nurses were on duty at

that time.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’

(ablution) and solah

2. Explain to the patient how to perform the wudo’ and solah

3. Demonstrate how the patient should perform the wudo’ and solah

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CASE 2: LOCK-IN SYNDROME

A 70-year-old woman with hypertension presented with sudden onset of loss of consciousness.

The episode was not associated with abnormal movement. She was initially ventilated in the

intensive care unit (ICU) for cerebral and airway protection. A Computed Tomography (CT) of

the brain done did not reveal any abnormality. Later, a Magnetic Resonance Imaging (MRI) of

the brain was done and showed hypointense area at the ventral pons consistent with an

ischaemic stroke.

Upon discharge from ICU care, the patient was able to open her eyes spontaneously. However

both her upper and lower limbs were completely paralyzed. She appeared to be aware of

surrounding. Unfortunately, she was unable to communicate verbally but able to communicate

with vertical eye movements.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’ and

solah

2. Discuss issues with regards to the solah she missed while she was ventilated during her

ICU stay

3. Explain to the patient how to perform the wudo’ and solah

4. Demonstrate how the patient should perform the wudo’ and solah

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THE SURGICAL WARD

CASE 3: THE PATIENT WITH STOMA

A 55-year-old man was diagnosed with rectal cancer. He had undergone an abdominoperineal

(AP) resection and permanent colostomy. He recovered from the operation uneventfully. His

bowel movement via the stoma was three times a day with soft fecal material.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’

2. Discuss issues with regards to the combining the obligatory solah

3. Explain to the patient how to perform the wudo’ and solah

4. Demonstrate how the patient should perform the wudo’ and solah

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CASE 4: THE PATIENT ON CONTINUOUS BLADDER DRAINAGE

A 56-year-old man presented with acute urinary retention. He reported history of frequency,

nocturia, hesitancy and terminal dribbling associated with urination for the past 1 year. At

presentation he was in pain. His blood pressure was 172/96 mmHg with pulse of 110 beats per

minute. His lungs were filled with crepitation up to the mid-zone. His jugular venous pressure

was elevated. Abdominal examination revealed a distended urinary bladder.

Prompt continuous bladder drainage catheter insertion along with administration of diuretics

ameliorates the patient’s symptoms.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’ and

solah

2. Discuss issues with regards to the wudo’ and solah while the patient had the lower

urinary tract symptoms and while the patient was on the continuous bladder drainage

3. Explain to the patient how to perform the wudo’ and solah

4. Demonstrate how the patient should perform the wudo’ and solah

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THE OBSTETRIC AND GYNAECOLOGY WARD

CASE 5: THE PATIENT PROLONGED MENSES

A 45-year-old lady presented with lethargy, reduced effort tolerance and pre-syncopal attacks

for the past 4 months. She also complained of having increase menstrual flow for the past 6

months where by her menses lasted for 16 days with 7 days bleed. The first 3 days was

associated with passing of blood clots. Occasionally she would have spotting in between

menses.

She attained menarche at the age of 12 years old. Her menses was previously regular with 5-

days bleed and 28-days cycle.

Initial blood investigations revealed haemoglobin of 6.8 g/dl with low mean corpuscular

haemoglobin (MCH) and mean corpuscular volume (MCV). Her ferritin and iron to transferrin

saturation ratio were low. Ultrasound of the pelvis revealed a submucosal uterine fibroid.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’ and

ghusl (ritual bath) during her current illness

2. Discuss the issues related to solah for her

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CASE 6: THE PATIENT IN LABOUR

A 32-year-old gravida 1 para 0 presented to the Pregnancy Assessment Centre (PAC) with

contraction pain. She was at 38 weeks period of amenorrhea. Her antenatal follow-up was

uneventful. On physical examination, her vital signs were stable. Abdominal examination

revealed a gravid uterus with a clinical fundal height consistent with 38 weeks gestation,

singleton fetus in normal lie and cephalic position. Her contraction pain was once every half an

hour, mild in intensity.

The patient reported passing of mucus mixed with blood per vagina at home. There was no

leaking liquor or evidence to suggest spontaneous rupture of amniotic membrane.

Per vaginal examination revealed the cervical os 2 cm dilated, vertex presentation, with the

presenting part located at -1 position.

TASKS

1. Her husband was asking about her performing solah in her current situation. What is

your response?

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THE ORTHOPAEDIC WARD

CASE 7: THE PATIENT WITH COLLE’S FRACTURE

An 85-year-old woman presented with right wrist pain after a fall in the bathroom. She claimed

that she was walking to the bathroom and suddenly slipped on spilled water, fell forward

subsequently landed heavily on her right wrist. There was neither giddiness nor pre-syncope

prior to the fall.

On physical examination, her right wrist was swollen, erythematous and tender. An X-ray of the

right wrist revealed a Colle’s fracture. She was treated with an immobilizing cast using plaster of

Paris.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’ and

solah

2. Explain to the patient how to perform the wudo’

3. Demonstrate how the patient should perform the wudo’

4. Should she replace all her solah which was done while she was wearing POP after

removing it?

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CASE 8: THE PATIENT WITH DIABETIC FOOT

A 50-year-old lady with uncontrolled type 2 diabetes mellitus presented with fever for 1 week

duration. She had history of injury to the left foot 10 days ago from a rusted nail. Since then she

had progressive swelling of her left foot associated with erythema and blister formation.

Physical examination at presentation revealed an erythematous, fluctuant area over the left

foot with pus discharge. She was immediately started on broad spectrum antibiotics and

surgical drainage was performed for the foot abscess.

Unfortunately she had to undergo several wound debridement procedures while in the ward

due to persistent infection over the left foot. After several days of wound debridement and

appropriate antibiotics her wound became better. However, there was a wound over the

plantar aspect of the left foot with tendons exposed surrounded with pink granulation tissue.

There was serous discharge but without fresh blood or pus. Daily normal saline dressing was

used.

TASKS

1. In the situation given above, discuss the issues related to performing the wudo’ and

solah

2. Explain to the patient how to perform the wudo’ and solah

3. Demonstrate how the patient should perform the wudo’ and solah

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NOTES