Muslim doctors here have successfully nurtured doctor-patient relationships. Despite that bond, fostering a full understanding of their faith is a cure that has eluded them.
Part four of six
For 25 years, Muslims in Hernando County have gone about the quiet business of building their community and becoming pillars in the county’s health care system. But they are worried that their American dreams may be threatened by the fallout from the terrorist attacks of Sept. 11, 2001, and the subsequent war on terror.
Over the past year, the Times has researched the story of Hernando’s Muslim community. The newspaper has interviewed more than 90 people and attended 30 weekly prayer services at the local mosque. This six-part series is the result of that research and shows how, through it all, local Muslims remain united by faith.
SUNDAY: Overview
MONDAY: Religion
TUESDAY: Politics
TODAY: Medicine
FRIDAY: Education
SUNDAY: Family
Neurologist Mohamad Saleh helps people beat back the creeping fog of Alzheimer's disease and plots ways to kill their brain tumors. In the past 12 years, he has treated 50,000 patients.
Gastroenterologist Husam Shuayb probes into the deepest recesses of the human body to seek out hidden cancers in the digestive tract. He has performed 25,000 procedures in the past 24 years.
Obstetrician and gynecologist Samir Shakfeh performs the most intimate medical care women ever receive. Equally important, women trust him to deliver their babies. And in the past 12 years, he has delivered 3,000 Hernando County children, enough to fill three schools.
Although there are only about 200 Muslims in Hernando County - a fraction of 1 percent of the county's population - they account for 15 to 20 percent of the physicians, depending on how one counts. Of the roughly 50 Muslim families here, more than 30 have a doctor in the house.
They hold prominent positions: Ghiath Mahmaljy, one of the spiritual leaders of the Muslim community, is the chief of medicine at Oak Hill Hospital. Ayman Osman is the acting chief of staff at Brooksville Regional and Spring Hill Regional hospitals.
Trained in more than a dozen specialty areas, the county's Muslim doctors treat arthritis and ulcers. They prevent heart attacks and help people breathe easier. They treat allergies and toothaches, even erectile dysfunction.
"From head to toe, they've got you covered," said Shakfeh's wife, Samar, who manages her husband's practice.
And they have endeared themselves to patients such as Cynthia Zimmermann, who moved to Hernando County three years ago. Later this month, she will deliver her second child in less than two years - both ushered into the world at the hands of Dr. Shakfeh.
"I adore him. He's wonderful," Zimmermann, 37, says of Shakfeh. "I trust my body and my children's health completely with him."
Such faith is not uncommon.
Yet even as Hernando County trusts its Muslim doctors to ease its pain, cure its ailments and save the lives of its loved ones, local Muslims find their faith remains misunderstood.
These doctors - who hold lives in their hands - say they must do more to help people get to know their community better.
It is an odd admission: Despite the intimacy of doctor-patient relationships, there is still a distance between local Muslims and everyone else.
The reason for it seems to lie in a couple of areas.
First, the doctors are so busy treating patients, they have little time to get to know people who aren't passing through their exam rooms.
Second, Muslim doctors tend to stick to business with their patients rather than talk about themselves or their community - unless asked a direct question.
Finally, for the past 25 years, there has been some hesitancy among these doctors - who are far from their homes of origin - to open themselves and their community to a society that sometimes thinks of Muslims only in terms of radicals who make the news.
Some patients, such as 80-year-old Mary S. Knights of Brooksville, get the message anyway.
Knights, who had never met a Muslim until she came under Saleh's care, took something away from her neurologist other than relief from her debilitating back pain.
"I have a lot of respect for Muslims," she says now. "He's over here doing a lot of good."
While they are beginning to look for ways to bridge the familiarity gap, doctors in Hernando's Muslim community say the best place to start understanding their devotion to the community is to see their commitment to serving people's health needs.
Building on a bedside manner
Patient loyalty frequently follows a good experience with a doctor. And while Muslims do not have the market cornered on adoring patients, testimonials about their efforts seem to point to something more than merely good medicine.
When a private plane crash in March took the life of Muslim doctor Mohamed-Nagi Hassan Salam-Kadri, more than 300 people turned out for his memorial service. Most of them were devoted patients, including Susan Heal of Spring Hill.
Heal had no medical insurance when she first went to Kadri. But she says he went out of his way to charge her as little as possible for his services. And he gave her bags of free drug samples. Such examples of putting the bill aside are not unique to Kadri.
Maria Burns of Spring Hill was in a tough financial spot after her divorce, but she needed some expensive dental work. When she came to see Muslim dentist Mohammad Shuayb, she remembers crying in his exam chair. Yet, Shuayb fixed her up and gave her the flexibility to pay for it.
"He's a sweetheart," Burns said. "He's been good to me. I'm definitely loyal."
For Karen Slavik, Shakfeh served not only as her OB-GYN, but also as a counselor and a dogged advocate when her baby was diagnosed with spinal muscular atrophy, a disease that typically kills before a child's second birthday.
Slavik had a decision to make almost immediately: end the pregnancy or go forward.
She said Shakfeh explained all the options to her, even though he admitted his religious beliefs could not condone an abortion. It was an agonizing decision, but one made easier by the fact that Slavik said Shakfeh was willing to perform the abortion if she wanted it.
"He called after hours to see how I was doing," Slavik said. "He gave me room to breathe and to think."
In the end, Slavik kept the baby.
In the weeks that followed, Slavik learned of an experimental drug designed to improve the lives of babies like hers. Shakfeh coordinated arrangements with the pediatric neurologist from Utah involved in the program, persuading Spring Hill Regional officials to sign off on the plan, and the doctor's presence during the birth, despite legal concerns.
"Shakfeh went to bat for me," said Slavik, whose baby, Jessica, is now 7 months old.
The child is weak and has difficulty moving, but she eats and drinks on her own. She is in physical therapy. Slavik is hopeful for a cure.
"Without Dr. Shakfeh, I wouldn't be where I am today," she said. "Nor would I have Jessica."
Faith stays in background at offices
While issues of faith come up in conversations between doctors and patients, most Muslim physicians say they do not introduce the subject themselves. Which explains, somewhat, why their faith isn't more widely understood despite their frequent contact with the public.
Even their prayers are done discreetly.
Five times a day - at specified intervals - Muslims stop and pray. Inevitably, some of those prayer windows fall during the workday.
Generally, Muslim doctors say they simply step away for a moment, do their ritual washing in a washroom and repose to their offices for 10 minutes of prayer, often on a special rug they keep handy for such purposes.
Nasser Elmansoury and Allam Reheem, two doctors who share the same office suite, sometimes perform the prayers together. One of the rugs they use has a compass, useful in pointing them to Mecca, where all Muslim prayers are directed.
While these prayers are important, doctors say they won't leave a suffering patient in order to go pray. That would be contrary to the teachings of their faith. Besides, says dentist Mohammad Shuayb, "I can't stand to see people in pain."
The son of Husam Shuayb, Mohammad has lived in Hernando County since he was 2 and is, essentially, a second-generation Muslim physician.
Mohammad says many older Muslim doctors are scared to talk about their faith. Having grown up here, Mohammad says he is accustomed to talking and is less concerned about what others think.
That difference is reflected in the decor of his office, which seemingly invites a dialogue about Islam. A photo of a large mosque decorates his waiting room. So does a picture of a tree that delineates the common lineage of the prophets from Jesus to Mohammed.
"I never start the conversation, but somehow it frequently comes up," Shuayb said. "It's not part of the business. If you ask me, that's fine."
Shuayb says his faith in Islam makes him willing to come in late to work on patients with dental emergencies and to work with patients who have dental needs but little money.
"I think a lot of the people come to me because I am a Muslim," he said.
For Shakfeh, Islam also influences the health care he provides. He says it compels him to be honest, available and compassionate with patients. It means he doesn't perform unnecessary procedures to make an extra buck.
"We have to answer to a lot of agencies. But most of all we have to answer to God," Shakfeh said. "When I go home, I'm happy. I sleep (well) by providing them with care."
Muslim physicians contribute their time and services to Access Hernando, the county's indigent health care program. They volunteer at a free clinic in Tampa.
"You are obligated by your religion to be courteous," said Saleh, the neurologist. "You are obligated to help."
Altruism aside, Muslim doctors have reaped considerable financial rewards for their work.
Several live in homes assessed at more than $200,000 that would likely fetch far more on the real estate market.
Nazir Hamoui, a urologist who was the first Muslim doctor to come to Hernando County, in 1979, now lives in a Lake in the Woods home with an assessed value of more than $900,000, property records show.
Beyond homes, several Muslim physicians own the offices where they practice. Osman's Abbey PrimeCare office at Northcliffe Boulevard and U.S. 19 in Spring Hill, for example, is valued at $400,000.
And the affluence is seen in other areas.
During the 2002 election, about two dozen local Muslim families donated more than $96,000 to congressional campaigns alone.
Charitable giving, a pillar of Islam, is also performed in earnest. In a five-year period, 15 local Muslim doctors contributed $1.3-million to a pair of charities serving needy Muslims around the world.
The donations came to light as the government began scrutinizing charities for potential links to terrorism. Local Muslims point out that the government's claims were never proven, and that their gifts were made to humanitarian charities, intended for humanitarian purposes.
Contributing medical milestones
Putting into perspective what Muslim doctors have meant to Hernando County's health care is a little difficult. But certain milestones are clear.
Hamoui was one of the county's first urologists. When Husam Shuayb arrived two years later, he became the county's first gastroenterologist. Both filled gaps in care just by showing up.
Working from a converted storage room at what was then Lykes Memorial Hospital in Brooksville, Shuayb discovered upon his arrival that local surgeons were performing colonoscopies with scopes as big around as garden hoses.
Quickly, Shuayb spent his own money to buy two new scopes - at $13,000 apiece - that were half the size. It was an advance in local health care that perhaps only colonoscopy patients might truly appreciate.
More recently, Shakfeh was involved in bringing the licensed practice of midwifery to Hernando County's expectant mothers. And he was among those strongly pushing for the creation of Hernando County's first neonatal intensive care unit - at Spring Hill Regional Hospital.
Those key chapters aside, administrators from Spring Hill Regional and Brooksville Regional hospitals declined to discuss the role of Muslim doctors. And an executive from Oak Hill Hospital danced gingerly around the topic.
Such caution seems grounded in local medical politics.
Muslim doctors make up a significant cluster of the Hernando County medical landscape. But they are not alone. In fact, the largest group of foreign-born physicians in Hernando County may be non-Muslims native to India.
At times, there have been allegations that ethnic groups have engaged in patient-feeding frenzies, drumming up business within their tightly knit communities through their closed referral practices.
Tom Edwards, an associate administrator at Oak Hill Hospital, was reluctant to address the contributions of Muslim physicians, or any ethnic group. Doctors are by nature competitive, he said, and they are business people.
"By touting the achievements of one group," Edwards said, "I can assure you that it will be viewed by the other groups as negative."
His hesitancy also stems from an issue that arose on Sept. 11, 2001.
As a group of Oak Hill doctors gathered around a television to watch coverage of the terrorist attacks on U.S. soil, Dr. Durgarao Parimi - a Hindu physician from India - was reported by another doctor to have said that America was getting what it deserved.
Parimi later said his comment related to America's lack of attention to security. But in the midst of a national crisis, the quote set off a firestorm. His words were perceived as anti-American. And unwanted attention was cast on foreign-born doctors.
"It was not a good thing for cohesiveness," Edwards said. "That was just a bad day. It was a bad thing that happened. I think for the most part people have gotten past it. I'd be throwing myself on the grenade to try to point to the differences that exist between the ethnic groups of physicians."
For the record, Edwards says that there are a significant number of Muslim doctors in Hernando County and, like doctors from the other ethnic groups, they make significant contributions.
Dr. David McGrew, a longtime Hernando County physician who has worked with Hernando-Pasco Hospice, said there are no generalizations to be made about the county's Muslim physicians.
There are some Muslim doctors he routinely refers patients to and others he would never trust with a patient, McGrew said. The same is true of other ethnic and religious groups, he said.
Dr. Jose Berrios, a retired obstetrician-gynecologist, helped bring Hamoui to Hernando. He said most of the Muslim physicians he knows are very good and well trained.
"They have made a very large contribution to the medical community in the county," Berrios said. "They are just like any other regular guys, really."
For three years, Desmond Smoot worked as a paramedic in the emergency room at Oak Hill Hospital. It was a perch that gave him access to a wide array of doctors, including several Muslims.
Samir Shakfeh, he said, had a "wonderful" bedside manner. Ayman Osman displayed a great willingness to answer questions his patients posed about his faith. Cardiologist Adel Eldin, who employed Smoot for a time, is a man who loves his patients like no one else. And Kadri, who died in the plane crash earlier this year, was such a special physician that Smoot's mother would drive from Alabama just to be in his care.
All of it left Smoot with a strong impression of the Muslim doctors in Hernando County: "They make you feel like they are doing it not for the money but for you."
- Times researchers Caryn Baird, Kitty Bennett and Jenny Lichtenwalner contributed to this project. Robert King can be reached at 352 848-1432. Send e-mail to rking@sptimes.com
