Back to Refugees

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Introduction

Refugees bring a variety of religions and faith traditions to their new homes. Like other people, refugees cannot easily be categorized as Muslim or Christian or Buddhist and then be expected to follow a particular set of behaviors based on that religion. Within all religions there are differences of opinion about even some of the most basic tenets of the religion and other doctrinal issues. Among people who define themselves as Christians, for example, there are those who believe that taking medicine reflects a lack of faith and those who are not at all troubled by taking medicine; those who refuse blood transfusions and those who see no problem in transfusions; those who wear makeup and those who see wearing makeup as sinful; and so on. Here we seek only to acquaint readers with some basics about world religions and how they sometimes influence health care beliefs and practices.

Making global characterizations about religions or cultures always puts one on the slippery slope of generalizations and other inaccuracies. To any that may be offended by our discussion of their religion, we apologize. We seek not to make a statement about any religion, but to work toward understanding of how religions influence health care beliefs and practices. Let us know if you feel we have misrepresented your religion, or if we have made mistakes, or neglected something important.

Being a refugee - the suffering in wartime; loss of home, culture, identity; and the challenges (and sometimes failures) of life in the new country - is for many, a spiritual crisis of unparalleled severity. Most or all the basic spiritual needs (hope, meaning, relatedness, forgiveness or acceptance, and transcendence) are threatened and often unmet in the refugee process. Although meeting spiritual needs is not the focus of this work, we do want to state as clearly as possible that unmet spiritual needs are a threat to health and that supporting the refugee's faith is important in improving health.

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Islam

Introduction

Islam is the fastest growing world religion. In the West, Islam was once thought of as an exclusively Middle-Eastern religion. It is now increasingly recognized that Islam flourishes in Europe (e.g., Bosnia); Africa (Sudan, Somalia, Nigeria, Egypt, and other countries); Asia (Indonesia, Malaysia, and to a lesser extent, Thailand, The Philippines, China, India, and other countries); and in the Middle East. On the below map of Muslim distribution, Sunni Muslims are found in light green areas; and Shi`a Muslims in the dark green areas.

There are many Islamic cultures and among them are many differences. There are also significant influences on Muslims other than their faith; and these influences lead to differences among, for example, peasants and intellectuals, women and men, Kurds and Arabs, Palestinians and Saudis, farmers and merchants, and so on. In parts of sub-Saharan Africa, for example, Islam is sometimes accommodating of other faiths and practices not usually associated with Muslims. Individual interpretations of religious and cultural ideals, together with health care realities mean that there are no definitive or universal applications of Islamic health care practices and beliefs. However, there are similarities in health care practices and beliefs, especially among Middle Eastern Muslims. Consistent with universal human nature, there also are ancient and often bitter disagreements among Muslims, both Arab and non-Arab. 

Background

Islam is based on what is considered by Muslims to be the Word of God as revealed to the Prophet Muhammad by (primarily) the Angel Gabriel beginning in the year 610 AD. The word Islam, in Arabic, means surrender, specifically to God; and a Muslim is one who surrenders to God. The foundation and unifying belief or tawhid of all Islam is the belief in One God (Allah). "God! There is no God but Him, the Living, the Ever-existent one." Qur'an, The Imrans 3:1

"God is the only God. There is no God but God. He knoweth what is concealed and what is manifest, and He is Merciful and Compassionate."

The scripture of Islam is the Koran or Qur'an, which is believed to be the revelation of God to The Prophet Muhammad. The Qur'an is divided by chapters or Surahs which are arranged according to revelation. Except for the first Surah, arrangement is from longest to shortest. The Qur'an gives explicit rules or "legislation" for Muslims, with halal describing what is lawful and haram what is unlawful. The Qur'an is available on-line at http://www.islam.org/Mosque/Quran.htm

The Qur'an has received little scholarly inquiry or analysis. Examination of the earliest known copies of the Qur'an show significant differences between early and more recent editions; and between history and dogma. Of course serious scholarship is inhibited by the potential for violence against scholars (Stille, 2002).

In addition to the Qur'an there is the Tradition or Hadith, "the Sayings and Doings of the Prophet Muhammad." The Hadith is the body of traditions upon which much of the life and traditions of the Muslim community is based. The Hadith is a vast work that evolved from texts appearing from 130-300 years after Muhammad's death and may, in some respects modify or contradict the Qur'an (Rahman, 1987; Stille, 2002). There used to be Hadith on-line, but I cannot find these sites anymore.

As with other religions, there are divisions within Islam, including between fundamentalists and secularists, between Sunni and Shi`a, and the various schools or sects within the larger divisions. Differences between these divisions sometimes result in bloodshed and revolution, such as in Afghanistan, Algeria, Turkey, and Egypt. Islam reaches across different cultures, hence health-related and other behaviors may be influenced more by culture than by religion.

A note on fundamentalism: This author's use of the term "fundamentalist" was deemed "inappropriate" by a Muslim author and physician. Fundamentalist is not meant here as a pejorative term, nor as a means to short-circuit meaningful discussion. On the other hand, radical fundamentalism (e.g., denying health care or education to women, requiring four witnesses for a rape conviction, persecuting people because of their religion (e.g., Jewish or Sufi), terrorism, and other such practices - all of which are associated with and even popular in certain Islamic groups or even nations), whether practiced by Christians, Muslims, or others is extremist and inconsistent with basic human rights and dignity.

After belief in God there is belief in angels, Satan, spirits (jinn), the Day of Reckoning, Heaven and Hell, and in the Prophets and Messengers (including Abraham, Moses, Joseph, and Jesus). Muhammad is considered to be God's (Allah's) final Prophet and Messenger. In Muslim writing one often sees "Allah S.W.T., SWT, or swt." SWT is the acronym for "Subhanahu wa ta'ala" which means "Allah is pure of having partners and He is exalted from having a son." There are also "five pillars of faith." These are:

• Faith in the one God, explicated by daily recitation of the testimony or shahada: There is no God but Allah, and Muhammad is His Prophet
• Daily prayer or salat at least five times daily
• Alms-giving or zahat (or zakat)
• Fasting or sawm (sunrise through sundown), principally during Ramadan
• Pilgrimage or hajj to Mecca, if possible.

Friday is the most important day of worship. Regular worship takes place in mosques and in non-Muslim countries, major holidays or ceremonies may be held at public places to accommodate large crowds.

Islamic Influences on Health Care Beliefs and Practices

While The Qurían seldom speaks directly to issues of sickness or physical health, related issues are addressed. There also are religious obligations and customs associated with Islam that affect health care practices and beliefs. Common health related issues among Muslims include:

• Cleanliness is a requirement for Muslims, with mouth, hands, and feet washed at least five times each day before the required prayers.
• Menstruation is regarded as "an illness" and women are required to remain separate during this time (Qurían, The Cow 2:222).
• Modesty is important, especially among adults who have "carnal knowledge," i.e., sexual awareness (Qurían, Light 24:31). Women and men (but women more than men) are expected to dress and behave conservatively. Many women use a hijab to keep their hair covered in public, and some cover everything but eyes and hands. Health and personal care or assessments from different-gender persons usually are distressing to more conservative or less cosmopolitan Muslims. Complaints or responses to questions may be edited on the basis of health care provider and/or translator gender.
• Dietary restrictions include pork and meat from animals killed outside of Muslim custom, and eating from dishes or with utensils that have had contact with proscribed foods (Qurían, The Table 5:3). Hospitalized patients may restrict their diet to only food brought by the family, a vegetarian diet, or kosher foods.
• During Ramadan, adult Muslims fast from dawn to sun-down. The month of Ramadan is in the ninth month of the Islamic (Julian) calendar - which is ten days shorter than the Gregorian calendar or solar year. This means that Ramadan moves seasonally by ten days each year. In the course of a full life span, a person will be able to fast in all seasons. Fasting for some includes all food, water, and medicine, while others allow water and/or medicine during the day. Patients who need to take medicine or eat to survive may fast at a time other than Ramadan. The Qurían allows people who are ill or traveling to defer fasting (Qurían, The Cow 2: 185). Some patients insist on fasting - to their physical detriment. In devout families, children look forward to fasting as a sign of the faith and maturity.
• Among Muslims from the Middle East, quick pain/symptom relief is expected. The expression of pain, except during labor and delivery, is often private.
• Rituals related to dying include the patient facing Mecca, confession of sins, prayer, and reading or recitation of verses from The Koran (especially the 36th surah, Ya Sin) into the ear of the person who is dying by the eldest man present.
• After death, non-Muslims should not touch the body. The family or a designated person from the community is responsible for washing and preparing the body. Most Muslim scholars have the opinion (fatwa) that autopsies are not allowed (Sheikh, 1998) except when required by civil law and that organ donation may be allowed when necessary (Al-Mousawi, Hamed, & Al-Matouk, 1997). The funeral should take place as quickly as possible and the body buried in a Muslim cemetery when available. Mourning is a family and public community process, with men and women separate.
• Some descriptions of Islam focus on the tendency of Muslims to be fatalistic, citing belief in and surrender to the will of Allah, or inshallah. Illness or tragedy may be explained and accepted through inshallah. On the other hand, Islam is an increasingly activist religion in which change or action are readily accepted or sought when possible.

Social Roles (Family and Community)

While Islam demands acceptance of Allah and thus supersedes allegiance to clan and family (Hiro, 1989), the family remains the major unit of social organization among Muslims. In all health decisions, family concerns take precedence over individual concerns. Health care decisions usually include discussion among family members, with the oldest man having the final say.

Islam is explicit about the honor and respect shown to older people, especially family members.

"But he that rebukes his parents . . . shall justly deserve the fate of bygone nations and jinn: he shall assuredly be lost." Qurr'an The Sand Dunes 46:17-18

Older parents live with their adult children in extended family groups. In some cases, the death of a husband results in the widow marrying her husband's brother, even if he is already married. Thus in this and some other circumstances, a man may have more than one wife.

". . . you may marry other women who seem good to you: two, three, or four of them." Qurían, Women 4:3

Islam gives women the right to inherit property (one-half as much as men), remarry, and not be forced into sex or marriage. Islam also gives specific rules prohibiting incest.

Ritual female genital surgery (RFGS) is practiced in some Muslim cultures in Africa and the Middle East, but is not based on the Qur'an or Islamic tradition. RFGS may include removal of the clitoral foreskin, clitoridectomy (removal of clitoris), and/or infibulation (sewing together the prepuce and/or labia). RFGS is also practiced by Ethiopian Coptic Christians, Bedouins, and others. In many cases, RFGS is conducted without anesthesia, analgesia, or sterile instruments. See sections on specific cultures and on women refugees.

Marriage for women may occur at a young age, shortly after puberty. For men and women, marriage is often arranged. Marriage is generally arranged for the purpose of developing or strengthening ties between families. In some situations, the sister of a man's wife is expected to marry her sister's husband's brother.

Clearly, Muslim men have more freedom and power than women do. It is important to families to have sons, and a lack of at least one son is cause for sorrow (Woods, 1991). Circumcision is required for males.

Islam and Spiritual Needs

Generally accepted or universal spiritual needs from a western perspective include meaning, hope, relatedness (especially to God), forgiveness or acceptance, and transcendence (Kemp, 1999). Among Muslims, these spiritual needs are met or addressed as follows:

• Individualistic meaning, at least in the western sense, is not a major issue among most Muslims. An individual's life has meaning in lived faith, the community of the faithful, and family.
• Hope is available in abundance for believers and there is none for unbelievers.
• Relatedness is not only clear, but also is prescriptive: This God has more power than that of any other religion (Bradley, 1963), and so there is no question about who is God and who is man. There is no humanistic, ecumenical, or syncretic tradition is Islam. There is God above and man below.
• Forgiveness is available for believers, and not for others.
• "He accepts the repentance of His servants, and pardons their sins. He has knowledge of all your actions." Qur'an, Counsel 42:25
• "God will not call you to account for that which is inadvertent in your oaths. But He will take you to task for that which is intended in your hearts." Qur'an, The Cow 2:225
• For believers, transcendence is readily available. Islam provides transcendence, not through miracles, but through straightforward surrender to the Ultimate Reality: God. There is also transcendence for the downtrodden of the earth. Islam, especially fundamentalist Islam, is presented as a religion of "justice and equity" (Hiro, 1989, p. 274). This a powerful and revolutionary religion in an unjust and unequitable world.

"When Allah's succour and the triumph cometh

And thou seest mankind entering the religion of Allah in troops,

Then hymn the praises of thy Lord, and seek forgiveness of Him. Lo! He is ever ready to show mercy." Qur'an, Succour

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Introduction

Buddhism began in the 6th century BC, both as a reform of Hinduism and as a response to the suffering inherent in the human condition, epitomized by illness, aging, and death. The founder of Buddhism was Gautama Siddharta (also spelled Siddhartha), the Buddha (in Sanskrit, "The Awakened," "The Enlightened").

There are two main branches in Buddhism, Theravada Buddhism, or the "lesser vehicle," which is practiced most often by people from Cambodia, Laos, Thailand, Burma, and Sri Lanka; and Mahayana Buddhism, or the "greater vehicle," which is practiced most often by people from Vietnam, China, and Japan. There also are other aspects of Buddhism, such as the Zen Buddhism of Japan and the Lamaism of Tibet. In the Western world, there are differences based on nationality or ethnicity, so that in a particular location, there may be one or more each of a Laotian temple, a Cambodian temple, a Vietnamese temple, a Chinese temple, and so on. Temples and groups of different nationalities may have similar doctrines and practices. In general, each temple/group tends to be insulated, except that there is some cross-attendance and worship. One Buddhist group that seems to be reaching out to other ethnicities, especially in works of charity, is the Taiwanese Buddhist Compassion Relief Tzu Chi Foundation. There are Tzu Chi offices in many Western cities.

In Theravada Buddhism, nirvana is achievable only through complete renunciation (non-attachment) and through living as a monk. The Buddha is "revered, not as a god but as one who has shown the way" (Bradley, 1963, p. 116). In practice, among the laity and many monks, the reverence shown to the Buddha and images of the Buddha is like that shown to a god. In some branches of Mahayana Buddhism, nirvana is possible for non-monks, and among lay persons there appears to be a greater belief in (often multiple) deities, in heaven, and in hell. More sophisticated monks are apt to view these as states of mind.

History of Buddhism

Gautama Siddharta, the son of King Suddhodana was born in southern Nepal. It was predicted at his birth that he would become a great ruler or great teacher. His father attempted to guide him to being a great ruler by protecting him from outside influences and insuring that he lived a life of immense luxury. At age 29 the young prince slipped out of the palace grounds on three subsequent nights and encountered people who were sick, old, dead, and a monk. These encounters were so disturbing to him that he renounced his worldly station in life and became a wandering ascetic.

After years of study, self-denial, and suffering he sat under a bo tree and meditated until he became enlightened. As he became enlightened, he was tempted by Mara (the tempter, evil, death) who offered him the world. Gautama rejected the offer and was mocked by Mara who said that enlightened though he might be, there was nobody to witness his state. Gautama reached down to touch the earth, saying, "the earth is my witness" and at that time, became the Buddha. Thus many images of the Buddha feature the left hand in a meditative position and the right hand with knuckles forward reaching down to touch the earth. This is the most common image and is known as "earth-touching" or "witnessing." There are also different manifestations of the Buddha, and statues of this witnessing posture depict the celestial Buddha, Akshobhya. The picture to the right is of The Buddha meditating and guarded by Naga.

The Buddha returned to the world, where he met five monks with whom he had formerly been associated and they immediately perceived that he was enlightened. He taught them what was to become the precepts of Buddhism and they became his first disciples. These five and others became the Sangha, or order of Buddhist monks. The Buddha continued to teach until his death 45 years later. The death of the Buddha was as his life - conscious - and is depicted in statues showing him reclining.

Tenets of Buddhism

The earliest Buddhist scripture is the Theravada Tipitika or Three Baskets. Originally written in Pali, the liturgical language of Theravada Buddhism, the Tipitika includes the Vinaya Pitika (basket of rules of the rder), Sutta Pitika (basket of discourses), and Abhidhamma Pitika (basket of teachings on metaphysics). The tipitika is very lengthy and along with later scripture comprises an immense body of work. A good external site that includes Buddhist scripture is found at Cambodian Buddhist Telecommunication (click on English).

The essence of Buddhism is found in the Four Noble Truths, the realization of which resulted in Gautama becoming the Buddha. The Four Noble Truths are:

• All sentient beings suffer. Birth, illness, death, and other separations are inescapably part of life.
• The cause of suffering is desire (tanha). Desire is manifested by attachment to life, to security, to others. Most specifically the desire "to be" (Carse, 1980).
• The way to end suffering is to cease to desire.
• The way to cease to desire is to follow the Eightfold Path: (1) right belief, (2) right intent, (3) right speech, (4) right conduct or action, (5) right endeavor or livelihood, (6) right effort, (7) right mindfulness, and (8) right meditation.

Following the Eightfold Path leads to cessation of desire and to nirvana, or emancipation from rebirth. Note that this is not a path of complete renunciation; Buddhism advocates a Middle Way between extreme asceticism and self-indulgence.

Buddhism teaches tolerance and acceptance of life (non-attachment). The moral code of Buddhism is similar to the Ten Commandments of the Bible (Waddell, 1972), and includes abstinence in deed or thought from killing, stealing, lying, sexual immorality, and using intoxicants. The principle of karma (or kamma) is basic to the practice of Buddhism. Karma is popularly interpreted as a moral precept: do right and you will be reborn into a higher state; do wrong and rebirth will be to a lower state. Karma is neither reward nor punishment, but simply cause and effect. In practice, life's misfortunes are often attributed to sins in this or in a previous lifetime.

Although Buddhist scripture has nothing to say about magic, belief in magic is common among some Buddhists, especially people from the Theravada countries of Thailand, Cambodia, and Laos, and also among Tibetans. Magico-religious practices are well-integrated into Buddhism, and include use of amulets, spells, and the presence and power of spirits. It is not uncommon for persons from these countries to return home for the sole purpose of obtaining a talisman or blessing from a particular monk in much the same way as some Christians might journey to Lourdes or other holy place.

Buddhist Influences on Health Care Beliefs and Practices

Buddhist scripture does not speak directly to health and related matters. However, Buddhist philosophy has clear application to health and health practices as follows:

The Middle Way: Buddhism explicitly seeks "the middle way" to enlightenment and in all aspects of life. Thus, following or practicing Buddhism should entail moderation in lifestyle. Our experience working and studying with Buddhists of different backgrounds and traditions shows that among devout Buddhists, the middle way is indeed practiced. Like people of other faiths, many Buddhists are less than devout and less than moderate in lifestyle.

Acceptance of life and suffering: Buddhist philosophy begins with the premise that to live is to suffer (the first Noble Truth). Much has been made by Westerners of the Buddhist (and by extension, Asian) propensity to fatalism. This fatalism or more accurately, acceptance of what cannot be changed is central to Buddhism. One has only to visit a temple in Thailand or Nepal and see the wretched existence of the "temple dogs" to understand something of the one side of this aspect of Buddhism. Yet there is another less obvious face to the acceptance of life and suffering. This other face accepts the existence of suffering in life and persists through that suffering to achieve great things. This is part of the reason for the disproportionate numbers of Buddhist and Asian students achieving in school and science. The direct application to health-related matters of this acceptance of life and suffering is:

• There is a common reluctance to complain or express pain. Suffering or discomfort may thus be accepted to a greater extent by Buddhists than among others.
• Acceptance of suffering as a reality of life leads some to accept other physical, spiritual, or social problems of life. In many cases, questions that seem problematic to Westerners or people of other religions are not viewed as problems by Buddhists. Western thought often forces a choice: Christianity (or Islam) or damnation, health or illness, allopathic medicine or homeopathic medicine, and so on. Buddhists often do not see any value in a forced choice: No conflict is seen between the fundamental precepts of Buddhism and other religions, life is a balance between health and illness, and syncretism in medicine, like other matters, makes perfect sense.
• How one lives/dies may be as important as whether one dies.

These points do not mean that Buddhists should be expected to suffer silently and gracefully, full of acceptance for all aspects of life and death! To the contrary, Buddhists may show as much fear of illness, suffering and death as others. Truly devout Buddhists, like other truly devout people experience less fear of suffering and death. Yet many prayers for longevity and alleviation are sent to the "Medicine Buddha."

More culture-specific discussions of predominantly Buddhist cultures (Cambodian, Laotian, Vietnamese) are found at the Asian Health site: http://www.baylor.edu/~Charles_Kemp/asian_health.html

Buddhism: Dying and Death

The Buddha did not give specific answers to the questions of dying and death - except that they are inevitable. On the question of immortality, the Buddha gave the "fourfold denial":

A saint is after death. A saint is not after death. A saint is and is not after death. A saint neither is nor is not after death. (quoted by Carse, 1980)

Buddhist scholars thus see four possibilities regarding life after death; the less scholarly, i.e., the majority of Buddhists, are likely to believe in rebirth according to deeds, i.e., karma or kamma.

A key issue in dying for many Buddhist patients and families is to maintain consciousness so that patients can go through the process of dying with equanimity and "wholesome thoughts." Wholesome thoughts include awareness of the transient nature of existence, reflection on past "good efforts," and letting go of life "without clinging and grasping" (Ratanakul, 1991, p. 396). A quiet place for dying is preferred to a noisy or busy unit. A monk or lay religious leader may chant or lead chants to help promote a peaceful or insightful state of mind at death. Incense may be burned and amulets, including images of the Buddha, may be placed near the person who is dying.

A Buddhist ceremony after the death of a man from Southeast Asia

A Southeast Asian man died from unknown causes and his body was being held at the Medical Examiner's (ME) facility. Part of his family was in another state and the family members who were living where he died decided to go to the other state as quickly as possible. The most readily available monk was a missionary from Korea. The ME staff laid the body out, covered with a sheet on a gurney on the loading dock of the ME facility and the family was brought to the dock. The monk had the family members light incense and place the sticks in a can filled with rice. He chanted in Pali and sprinkled the body and family members with lustral (holy) water. After more chanting and prayer, the monk laid one end of a string across the body and had the family together hold on to the other end. After more prayer, the monk reached between the body and the family with a pair of scissors and cut the string, thus severing that connection between the living and the dead. More prayers were said and we all left.

Immediate Aftercare, Funeral, and Burial Practices

Organ transplant and autopsy are non-issues for most Buddhists. People other than Buddhists may touch the body, and there is no definitive belief about how the body should be treated (except of course, with respect) and when it should be buried or cremated. The question of burial or cremation is more cultural than religious. Among some Southeast Asians, the family will wash the body and place the hands in a prayerful position. In many cases, if possible, the body should be kept at the home so that ceremonies may be conducted. White is the color of mourning and some close relatives may shave their heads as a sign of mourning. The temple is also the site of ceremonies, both soon after the death, at 100 days, and at other times, e.g., when there is enough money for a proper ceremony.

"Thus shall ye think of all this fleeting world: A star at dawn, a bubble in a stream; A flash of lightening in a summer cloud; A flickering lamp, a phantom, and a dream." The Diamond Sutra (of the Buddha)

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Christianity

It is safe to assume that most people reading this material will be well acquainted with the basic beliefs of Christianity. Except for a brief review of basic tenets and discussion of denominations, this section of the site will focus on the Eastern (or Orthodox) Church.

Christianity includes the doctrines and religious groups based on the teachings of Jesus Christ. Jesus is the proper name and Christ refers to his position as Messiah, i.e., chosen by God as "the annointed one." As Christianity grew, Jesus was increasingly presented as the risen Lord. The Nicene Creed summarizes the beliefs of Christianity in a manner acceptable (except as noted) to both the Eastern and Western Churches:

"I believe in one God the Father Almighty, Maker of heaven and earth, and of all things visible and invisible;

And in one Lord Jesus Christ, the only-begotten Son of God, begotten of His Father before all worlds; God of God; Light of Light; Very God of Very God; Begotten, not made; Being of one substance with the Father, by whom all things were made; Who for us men, and for our salvation, came down from heaven; And who was incarnate by the Holy Ghost of the Virgin Mary, and was made man; And was crucified also for us under Pontius Pilate. He suffered and was buried; And the third day He rose again according to the Scriptures; And ascended into heaven; And sitteth on the right hand of the Father. And He shall come again with glory to judge both the quick and the dead;

And I believe in the Holy Ghost; the Lord and Giver of Life; Who proceedeth from the Father and the Son;* Who with the Father and the Son together is worshipped and glorified; Who spake by the prophets. And I believe in one Holy Catholic and Apostolic Church. I acknowledge one Baptism for the remission of sins. And I look for the resurrection of the dead; And the Life of the world to come. Amen." From the Presbyterian Hymnbook

* The Eastern Church holds that the Holy Ghost proceeds only from the Father, not from the Father and the Son (the filioque clause).

There are, of course, many branches of Christianity. The divisions best known by laypersons in the Western world are Protestant and Catholic. There are also innumerable divisions according to variations on the basic beliefs and the great division between those who take the Bible as the literal Word of God and those who take the Bible as the inspired word of God. The earliest division was between the Western Church or Church of Rome (Catholic) and the Eastern Church or Greek Church in 1054 when Pope Leo IX condemned the Patriarch of Constantinople. This section will provide readers with information on the Eastern Church - which is the church of many refugees and others from Eastern Europe and parts of East Africa.

The Eastern Church

The Eastern Church includes the Orthodox Church, Greek (Orthodox), the Russian Orthodox Church and others. Although the term Greek Orthodox is often used as a name for the Eastern Church, it is used most accurately for the Patriarch of Constantinople, the Church of Greece and related churches that use the Byzantine rite. The Ethiopian, Coptic, Armenian, Syrian and Indian Churches are considered by some to be heretical.

In the Eastern Church, in general, there is a sacramental view of life with the spiritual and physical worlds perceived as sacred. Thus there is widespread use of icons of Jesus, Mary (Maryam), and apostles; and worship includes a greater degree of ritual that in most Protestant churches. The liturgy is always sung in the Eastern Church.

The clergy of the Eastern Church includes bishops or Patriarchs (whose authority is said to go back to the Apostle Mark) and priests. Parish priests are allowed to marry, but bishops and monks are not. The jurisdiction of the Pope is denied. There are seven Sacraments in the Eastern Church, with the first four expected of every believer and the last three not expected of all:

• Baptism (by triple immersion)
• Penance
• Unction of the sick (as grace for recovery)
• Matrimony
• Confirmation (anointing)
• Holy communion
• Holy orders

The Eastern and Catholic Churches consider one another to be schismatic, but not heretical. Although there have been a number of unsuccessful attempts at reunion between the Catholic and Eastern Churches, there has been increasing progress toward a improved relationship.

Influences of the Eastern Church on Health Care Beliefs and Practices

The many branches of the Eastern Church are based on beliefs and rituals; and also in large part on cultural and regional differences, e.g., Russian Orthodox, Greek Orthodox, and Ethiopian Orthodox. We have not yet identified any health beliefs or practices related to religion as opposed to culture. Readers are encouraged to send additional information they may have to increase the general store of knowledge of these matters.

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http://www.students.uiuc.edu/~moges/orth.html