September 1, 2005 -- Today's Bangkok Post ran a short unsigned item reporting that five nursing schools and a medical school in the south of Thailand, where most of the nation's Muslims live, had banned female students "from wearing the Islamic headscarf, or nijab, and veil during clinical procedures." The piece signals the difficulty in balancing vital infection control measures, the need to avoid deterring nursing students in the midst of a critical shortage, and respect for a small minority's religious practice, especially in the context of the deadly sectarian tension in southern Thailand.
The report, "NRC confirms nurses face headscarf, veil ban," appears to be based entirely on comments by Petdao Tohmeena, a member of the National Reconciliation Commission (NRC), which was evidently created to ease conflict between the nation's majority Buddhist and minority Muslim populations. Though this piece does not mention it, related violence has led to hundreds of deaths since last year, when attacks by militants in the southern provinces reportedly began to increase. The piece does report that "Dr. Petdao" (presumably a physician, though this is not made clear) confirmed that the ban on Islamic garb is in effect, "countering a denial" of the ban by the nation's deputy education minister. Tohmeena reportedly cites complaints from 43 students to the NRC about the ban, and notes that as a result of it, some nursing students have "resigned and gone to study elsewhere." Tohmeena also reportedly said that the students had noted the stated rationale for the ban was the potential for infection from the nijab and veil touching patients, though she added that "certain overseas research studies had found only a very slim chance of long-sleeved Islamic dresses known as abayas and nijabs spreading disease." The piece fails to include any explanation of the ban from the government, or any further context.
Though the body of research is still growing, more hospitals are now paying attention to the role clinical attire is playing in transmitting nosocomial infection. This attire includes headwear, lab coats and long sleeves generally, and even neckties. In fact, the increased risk of infection is generally regarded as a key reason for the demise of the traditional nurses' cap in the United States. In general, many experts who have focused closely on infection control at the bedside--e.g., nurses--would prefer that clinicians wear as few clothes as is practical on the upper parts of their bodies, which have a significant chance of coming into contact with patients. Even with the best laundering practice--and practice in most settings is far from ideal, as the recent rise of "superbugs" suggests--the risk of such infection can be deadly for patients with weakened immune systems. It seems advisable to create a single health-based standard for the attire and grooming of all clinicians regardless of profession, gender or background, and to justify that standard clearly with research and other evidence. This seems especially wise in an environment where a religious minority appears to feel marginalized, and when the standard could deter an important group of potential nurses, in this case Muslim females. Obviously, balancing the tenets of religious practice and public health may not be easy, but there is a clear health care rationale for limiting the wearing of infection-carrying attire, in order to protect patients. Of course, majority cultural attitudes play a role in the standards of attire in all societies; otherwise, why not have clinicians wear no clothing above the waist? Perhaps there are potential measures that could accommodate religious practice without unduly compromising patient health. All of these policy concerns aside, it's difficult to reconcile the symbolism of veils that obscure female nurses' faces with the Center's mission that nurses be recognized and understood in order to improve global health.
The Bangkok Post does not begin to do justice to these issues, but at least its piece raises some of them in a basic way.
See the Bangkok Post article "NRC confirms nurses face headscarf, veil ban" published September 1, 2005.