Challenges to Jordanian Muslim men with prostate cancer

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Published: 8 May 2019
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Abdulmalik Hasanain - Victoria University of Wellington, Wellington, New Zealand

Abdulmalik Hasanain speaks to ecancer at ONS 2019 about the challenges of providing care to Jordanian Muslim men with prostate cancer.

He explains how treatment for prostate cancer can impact Muslim men with regards to examinations, side effects and effect on gender identity.

Abdulmalik proposes some ways that treatment can be adapted to provide better care for these patients, but notes that this must be individualised for each patient and cannot be generalised.

My presentation was about my study. My study is exploring the challenges facing Jordanian Muslim men with prostate cancer, how they adapt to those challenges and examining the impact of these challenges on their gender identity.

I started with a brief background on prostate cancer. As you know, prostate cancer is the most common cancer among men around the world. Men face challenges during their journey with this cancer, starting from pre-diagnosis symptoms like difficulty urinating. Others may suffer from diagnostic tests like pain and bleeding from the biopsy. Later, at the moment of diagnosis, they may experience uncertainty, fear of death, depression and when they go under treatment they suffer from the complications of that treatment like sexual dysfunction, incontinence problems. The impact of this experience can go beyond that and affect their gender and identity. These experiences are well discussed in the Western world but not in the Middle East where the majority are Muslims; that’s why I did my study on Muslim men with prostate cancer.
Then I discussed three major points about Muslims to give a better picture how their experience with this disease would be. So I started with the first point – Muslims pray five times a day and they need to be ritually pure to be able to perform their prayers. They need to be clean, their clothes need to be clean from urine, stool and semen. Also they need to do an ablution which is a certain way of washing hands, arms and face and feet. But with incontinence it would be difficult for them to maintain that purity and to perform their prayers.

The second point is perception of disease. Muslims, some people look at their diagnosis of cancer as a destiny and we believe in destiny and it’s a kind of acceptance, adaptation techniques. Others, they look at their diagnosis, or not the diagnosis, cancer itself, as a stigma, especially if it’s in a private area like cervical cancer and prostate cancer can be the same.

The other thing is gender beliefs – who can see or touch your body, male or female? For instance female is not appropriate to touch or see the private area of a male and prostate is in a private area. This leads to another thing, that Muslims usually do not talk about their private areas and sexuality, even if they have sexual dysfunction, some studies in the Middle East show that. So for Muslim men with prostate cancer having these kinds of dysfunctions would be difficult for them to talk about this issue or discuss with someone. Also gender roles – Islam does not only [ask for] a great relationship between God and Muslims but also relationships with others, like your role as a son, as a father, as a daughter, as a wife, as a neighbour. So for Muslim men with prostate cancer they may not be able to do their role as a father, as a husband, and this would impact on Islamic masculinity. However, bear in mind that the points I mentioned are also influenced by culture. Muslims are from different cultures, from different ethnicities, so the perception of disease, sexuality, gender belief, gender roles are different from one to another so do not generalise what I have said.

After that I talked about my study. As I mentioned earlier, my study is to explore the challenges facing Jordanian Muslim men and how they adapt to those challenges and examining the impact of these challenges on gender and identity. I did fifteen interviews with Jordanian Muslim men in Jordan who had radiotherapy followed by hormonal therapy. I did a multistage narrative analysis to cover the study objectives. After that I took an overview of findings, the impact – some of the participants mentioned the impact of incontinence on their prayers as I expected. One of the participants said he had to change his underwear before each prayer or to use a tissue to keep him pure otherwise he had to change his underwear. Some of them mentioned the impact on their social life; one of them mentioned that he became imprisoned at home because his is afraid to cause embarrassment to himself or to his family if he couldn’t hold himself. Most of the participants complained about the radiotherapy procedure – the procedure required them to fill and hold their bladders before and during the radiation session. Some of them couldn’t hold themselves and had incidents and wetted themselves. That affected their self-esteem and some of them felt ashamed. That’s most of what they said.

Then some participants mentioned finding a way or strategies for the incontinence to protect themselves from embarrassment like limiting social activities, using a tissue to protect their underwear. Also strategies to avoid incidents like limiting fluid intake or measuring the time needed before going out. Strategies to be able to perform their prayers like doing ablution and managing their ablution time or performing two prayers within a short period.

I finished my presentation by the clinical implications of my study which is the most important thing, the cultural awareness. We, as a healthcare provider, need to be aware of the impact of prostate cancer on cultural practices and roles. There’s a need to recognise the religious practices of Muslim men with prostate cancer when planning care. Also psychosocial support is required for men having incontinence issues. As I mentioned earlier, incontinence has an impact on self-esteem, social life and maybe identity. Some men can be shy to talk about this issue or other issues like sexual dysfunction, especially if the healthcare provider is a female. So be initiative, do your support, be aware of the gender differences.

Also there is a need to investigate and advise on the culturally acceptable incontinence products. I know some products here in maybe the US and New Zealand as well but none of my participants mentioned using a pad. I don’t know if there are products in the Jordanian market. So if we can do something about this it would be great. That’s it about my presentation.